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Home My WebLink About14180-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z14941 Date October 2, 86 .................... , 19 THIS CERTIFIES that the buildhig Two story addition with deck 2025 North Sea Drive Southold Location of Property .................................................... · House No. Street Hamlet 04 1 County Tax Map No. I000 Section. ..........054 .Block ............... Lot ................. Subdivision ............................... FiJed Map No ......... Lot No .............. conforms substantta~y to the Application for Btdlding Permit heretofore f'ded in this office dated July 19, 85 ..................... ,19...pursuant to which B~Id~§ Permit No. 14180 Z dated August 1, 1985 , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... T.w.o story addition with deck to existing one family dwelling. The certificate is issued to Louis. Mas tro .................... ................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO .............. ?.7.6. 7..7.6.4 ............................ Rev. 1/81 1~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT {THIS PERJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14180 Z / Date .... .~.....~. ........................................ , 19..~...~.- Permission is hereby granted to: ~ ........... ./...~'~.~,.....-J,?~,~ .P... ........................... .......... /.-~..~....~./..~ ......................................... ..... ~.~..~,~.g.~.o.~., ~...: ~_ '" ' ,o .......... ~.:.,~..~..~ ....... .~..~......~....~.,..,..'/~i~ ....... z~. .................. ........ ~.~..(.~.....~.~.~......~......~ /~.~...~.......//~.~ o, premises located at ....:~.~....~......~...'~.......Z~.~,(~' .~..~/.....J~........~, .............................................. .......................... ~ ............... '~ . .............. ~~.....~:..~ .... County Tax Mop No. 1000 Section ...,~..,~.,...~... ..... Block ..~...,~.., ......... Lot No.~....~.,../. ............. puts,ant ,o application da,~ ...t,~.....~.~. ....................... , 19.~and approv~ by the Building Inspector. ~., ,...~..~ Building I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF Instructions This application must be filled in typewriter OR ink, and submitted =. =..---.=== to the Building Inspec- tor with the following; for new buildings or new use: 1. FinaJ survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sifinilar buildings and installa- tions, a certificate of Code comp[iance from the Architect or Engineer responsible for the building. 5, Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. ,,?; · :,, C. Fees: ~,~ ,.. ~ 1. Certificate of occupancy $5.00 r 2. Certificate of bccupancy on pre-existing dwelling $15.00 /: 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New Building ............. Old or Pre-existing Building Date .~)~.~J. Vacant Land House No. . Street Ham/et Owner or Owners of Property ............. $. fY County Tax Map No. 1000 Section .~.~..~. ......... Block .. ~J..~. ........ Lot....(~..~..~ ..... Subdivision ................................. Filed Map No ........... Lot No ..... ~ .-.~ ..... Permit No./..~/~.~...~. Date of Pormit -yy~..~..Applicant ~y'. Health Dept, Approval ........................ Labor Dept. Approval ....................... Underwriters Approval . ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .. ~ ................ Fee Submitted $. ,~,-: ,~).~)., . .~, ,~,,~.(0 ,~.,~, ....... Construction on above described building and perm!t~meets all applicable co~l~es and regulations. lOOO418 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~'kl 65 JOHN E~TRF..ET, NEW YORK, NEW YORK 10038 Bate September 5.1986 ~p,,c. ao.~o.o, flo 380217186 N 7677G4 THIS CERTIFIES THAT only the electrical equipment az described below and introduced by the applicant named on the above application nur~ber in the premises of Louis Mastro, North Sea Dr., ~ of Hile East of Kenne¥ Rd.., Southold, N.Yo in the followl.g location; ~ Ba,sement ~ Ist FI. ~ 2nd FL Section Block Lot ~s examined onJ~U gu S t ?, 8 ~, 1 9 8 ~ and found to be in compl an¢,e u'ith the requ re.~ents of this Board. FIXTURE OUTLETS 8 DRYERS FIXTURES 16 ]4 8 SERVICE DISCONNEC1~ APPARATUS: Motors-1 .-1H, P. G.F.C.I.-2 Smoke Detector-] RANGES ;PRCIAL REC'PT R 1 COOKING DECKS OVENS DISH WASHERS jAMT K, W AMT K W, ~MT K W 'IMECLOCKS BELL UNIT HEATERS MUL -OUT V I C E A.W G iO. OF ~UTRAL$ NO OF HI-LEG OF HI-LEG EXHAUST FANS DIMMERS AW, G, OF NEUTRAL Alexander g. Hubbard Box 222 Aquohogue, N.Y., 11951 GENERAL MANAGER ii certificate must not ,be altered in any manner; return to the office of the Boa(d if incorrect. Inspectors may be identified by their credentials. COPY FOR BUjLDING DEPARTMENT. THIS COPY OF CERTIFICATE ~UST NOT BE AL~ERED IN ANY MANNER. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO.] ~/~0 Owner].Q (A ~tkO (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this t~~ day of~~ , Notary Public,~County UNDA J. COOFER Notary Pu~. ~t~te ~f NeW YO¢~-~-/ Term Expires ~m~r 31, 19~ (plumber' s signature) Notary/ Publi6 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May C ncern, We are unable~to complete your Certificate of Occupancy because .of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /_--~/ No Underwriters Certificate on file. /5/ The check is(outdated/not on file.) /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # ~_ ~ I ~ O Z ** _~o Plumber · C 'f' ate on file. ( all permits involving plumbing being issued after April 1,1984 ) ~,~ ¥O~K STATE BEPAR'P:E~ OF E;:!~IRO~!E~TAL C~!SERVATIO~ Regulator?Affairs Unit Building40, SUNY Stony B~ook, NY 11794 UO PER'~IT ~.!ECESS^RY - TIDAL k:ETLA;!DS ACT Henry G. l'ft111a~s Caemtsstoner A revte~ has been mde of .your DroDosal to: ~., ~ p~'l~,~ 1.,~,..~,._ ~_i,T)~,~.L~ ~)C~' '(~. '.~ Location: It has been de~mtned thath~mtt ts necessary under Arttcle (TJda] 'Jetlands). Hoover, any a~ttto~1 ~rk or mdtftcattons'to t~ p~Ject my requtre a ~e~tt. It ts y~ ~s~nsJbtlJty to ~ttfy this offtce tn ~ttng tf such additional ~rk or ~dtf~catJons a~ cont~la~d. Assumtn~ you. have obtatned any other a~pltcmble permits, you may aroceed ~ith 3,our project. Very truly yours, ~1~, Re~lnal Pe~Jt ~JL:R[!T:11 TO37N OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX TOWN HALL SOUTHOLD, N.Y. 11971 July 14~ 1986 TEL. 765-1802 To Whom This May Concern, Please complete the enclosed application for Certificate of Occupancy and enclose a check for $5.00 (the fee for the C.O.)'and I will be able to complete the Certificate of Occupancy. Thank you so much for your cooperation in this matter. i FIELD INSfECT~ON FOUNDATION FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY C~ODE FINAL COMMENTS ADDITIONAL COMMEN~TS: 7ss.18o2 BUILDING DEPT, ~ INSPECTION, FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION 2ND [ ~] ~:ATION FRAMING [//]"FINAL REMARKS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DE?ARTME'NT TOWN CLERK'S OFFICE SOUT][IOLD, N.Y. NOTICE OF DISAPPROVAL rot ~e~mit to ~.,~. .~. /i~.O >.~. . . .T. .~, . . .,~. /.~, ?: z. :~. '9" .~ ~-I..~.~ ..... ~t Hou~ No. Strut Hamlet County Tax Map No. lO00 Section .... G?.oL~... Block ..~ ........ ~t · ~2~ ....... Subdivision ................. Filed Map No ................. Lot No .................. herewith and~tiisapproved on tile following grounds:/~..4~5-- .~:~..., ./,,~, .~.C~',~.. is returned z~... ~ ~o. .... ~ ...... ~ ......... ~o~..~.. ~.~/~.~... ~.. Building /.nspector RV 1/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ... ,,~..o..,. ~.o..7~.~. ~/:?..: < PLEASE TAKE NOTICE that your application dated ... ~.~.~.~...., [. ? ..... Location of Property/~.~u.,~o ~.~ .~.~. .... Z~.~'{...~. -~rr~3:''-~' ~" t County Tax Map No. 1000 Section .... .(~..~.--..~.... Block ..~..~. ........ Lot . .(~.~. ....... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and.disapproved../on the following/~gr°unds~' ~.(~. 4'J '~'~"'' '/5 '~ ~'~' /.~... ~..~ .... ~&...w .... ~z~..~.~.~/,.~.. .::~. .~. .: c.7. .... ~. . c.~.~.c ~D. :.ag. (~$. :~c .................... .~ ~ . .~o ~ ~ /~ . :...~q~q ~(4 . ~ ~ ~ ~ ~. . ~ ~ ....... ................................. ......................................... Bu~ld~n~ Inspector RV 1/80 § 46-18 FLOODPLAIN MANAGEMENT § 46,.19 (3) Be certified by a registered professional engineer or architect that the standards of this subsection are satisfied. Such certifications shall be provided to the official as set forth in § 46-14G. C. Mobile homes. (1) Mobile horace shall be anchored in accordance with § 46..17A(2). (2) For new mobile home parks and mobile home sub- divisions; for expansions to existing mobile home parks and mobile home subdivisions; for existing mobile home parks and mobile home subdivisions where the repair, x'eeonstruction or improvement of the streets, utilities and pads equals or exceeds fifty percent (50%) of the value of the streets, utilities and pads before the repair, reconstruction or improvement has commenced; and for mobile homes not placed in a mobile home park or mobile home subdivision, it shall be required that: (a) Stands er lots are elevated on corqpacted fill or on pilings so that the lowest floor of the mobile home will be at or above the base flood level. (b) Adequate surface drainage and access for a hauler are provided. {c) In the instance of elevation on pilings, lots are large enough to per,nit steps, piling foundations are placed in stable soft no nmre than ten { 10) feet apart and reinforcement is provided for pilings more thtm six (6) feet above the ground level. (8) No mobile home shall be placed in a coastal high. hazard area except in an existing mobile home park or an existing mobile home subdivision. Coastal high-he~,ard areas (V Zones) are located within the areas of special flood hazard established in § 46-7. These areas (Cont'd on page 4617) § 46-19 FLOODPLAIN MANAGEMENT § 46-19 have special flood hazards associated with high-velocity waters from tidal surges and hurricane wash; therefore, the following provisions shall apply in coastal high-hazard areas: All buildings or structures shall be located landward of the reach of the mean high tide. {2} The placement of mobile homes shall be prohibited except in an existing mobile home park or mobile home subdivision. (1) Elevation. AIl buildings or structures shall be elevated so that the lowest portion of the structural members of the lowest floor is located no lower than the base flood elevation, with all space below the lowest floor's supporting member open so as not to impede the flow of water, except for breakaway walls as provided for in § 46-19B(4). fa) All buildings or structures shall be securely anchored on pilings or columns. (b) Pilings or columns used as structural support shall be designed and anchored so as to withstand all applied loads of the base flood flow. (c) There shall be no fill used for structural support. ' (,~^JI~,~I~P~ ce w,th the provm,ons of Subsection B(1) and (2)hbove shall be certified to by a registered professional engineer or architect. (4) Space below the lowest floor. (al Any alteration, repair, reconstruction or provement to a structure or building started after the enactment of this chapter shall not enclose the space below the lowest floor unless breakaway walls are used as provided herein. 4617 ~.~.s0 § 46-19 SOUTHOLD CODE § ,t6-20 (bi Breakaway walis shall be allowed below the base flood elevation, provided that they are not a part of the structural support of the building and are daslgned so as to break away under abnormallv high tides or wave action without damage to thee structural integrity of the building on which they are to be used. ' (c} If breakaway walls are utilized, such enclased space shall not be used for human habitation. (dl Prior to construction, plans for any structure that will have breakaway walls must be submitted to and approved by the Building Inspector. C. Sand dunes. There shall be no alteration of sand dunes which would increase potential flood damage. § 46.20. Notice of violation; revocatlon of permit, A. Whenever the Building Inspect, or has reasonable grounds to believe that operations regulated hereby are being conducted in violation of the provisions of this chapter or are not in compliance with a development permit issued pursuant to this chapter, he may notify the owner of the property or the owner's agent or the person performing such operations to suspend all opeations, and any such person shall forthwith cease operations until such notice of violation has been rescinded. B. Such notice shall be in writing, shall speci.fy the violation and shall state the conditions which must be Complied with and the time within which compliance must be completed before operations may be resumed. C. Such notice shall be sen, ed upon the person to whom it is directed by delivering it to him personally or by posting the same in a conspicuous place on the premises where operations are being conducted and mailing a copy thereof to such person by certified mail to his last known address. 4618 5,25 - 80 ~flpplication Received Disapproval Issued' .v. Per.mitff i9__ i~_ FORM NO. 10 :~ ~/d ~ APPLICATIONIn thoFORTownDli:'qE['Ot>MENTo~'% oc utliold ~'' PEt~MIT Addition and/or AltoPation~FYood. P~oof Below }3as~e Flood l:;levation~ Other (specify) Elevation Data in relation to abo~o me, an sea level ~.~. (a) Lowest floor elevation, including basement foot (b) In a V Zone, bottom of lowest structural ~em-'[76~ inches feet inches 3 i, qHM--Flood Insurance Rate Map, Zone dos[gnation~,: [/~ ,~f ~ / ~ / 5. Location of Property: ......... County Tax Map No., District, 1000 Section Subdivision ........ Filed Map ~/ -- Approval From other(s) before Po~ig Block ~ Lot( Lot( is issued: DEC ....... WETLANDS (Town Board) STATE OF NEt,/ ~(0RK o~L_~ .... _ss COUNTY SWORN TO THIS IIEALTH SERVICE ZBA BUILDING PERMIT PLANNING BOARD ~~wnor[Tji , , tho applicant, am tt,o Ownei-.[~, Oo- tractor~ and agree to comply with al]. applicable ~cci'iorl~. of the Code of tho Town of Southo]d; Courity, and State and to admib authorized ~n- .~o,~ctozs to premises authorized to porfoinn or have performed the said work and to make and file this application, that all statomon~,s contain- ed J.n this application are true to the best of my knowledge mid bellef !~nd that the work will be porfo~ed in the mannerset Forth in the .pplication filed therewith. Notary P ub~i'i'~ Applicant,s mail!ll£~ address and phone ';f not gi. von ii/a0 P.O. BOX 728 SOTYFHOLD, NY 11971 FORM NO. ,%0 TOWN 0F SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 APPLICATION FOR DEVELOPMENT TOWN HALL MAIN ROAD SOUTHOLD, NY Instructions: The app!lcatlon to 'the Building In t'~--d~) 1. Fon~ No. l0 filIed out in ink vey of premises with elevations above mean sea 1 posed work. The appli!cation must give complete the p~oposed can comply to the Local Law No. 1-1 Cede of the Town o.£ o0uthold known as "Flood D~ Town of Southold. The applic~t must submit app agency requires. General Standards as ~equired in Section ~age: i A. Anchoring of ~tmuctures, including tank and mobile homes B. Uso of constr~ction material and methods C. Desi~ and lo~ation of utilities D~ Subdivision p~oposal with drainage, publ base flood elevations ~ciftc Standards as ~equired in Section 46-18r - A~" ~~l construction Non-re sldentl~l construction C. Mobile homes The applic~t must subml$ plans and specificatio infoz~ation requested ~by the Building Inspector that the structure ha5 or wtl.1 have the lowest cellar, elevated abov9 the base flood elevation Federal Regulation, $1~at: 1. such stPucSu~e ma~or that below the ~base flood level the struc walls' substantially arid ~mp ~eablc to tho passa structural components_ . :ape caoable_ _ ~o resisting h leads and effects of buo~anc . ' Y Y, 3 applicant mu~ a rogiste?od professiQnal engineer oP architect ro~th in Section 46-18B (1) (2) (3) or the Soutk Cp~tal ttir~h Hnzzard ~mea (V Zone) 46-19. Appl~ specmimc~tlons including the required certificai fo~ation as th? Building Inspector may require 46-19 ape complmod wmth. Mobile homes are pmohi of the structural memberc of the lowest floo~ cannot be lower than the base flood elevation ~ith all. space below open except breskaway walls. Sand d~en. If sand ~unes exist on the premises ~nd the applicant pro- p~es to ~]teP same, plans and specification taus be shown in detailed nature or any alteration submitted. ~ildi~r~it. A BWlldin~ Pe~zt ts also ~eq red for any stPucbure. ~;th ~ Development and a Bumlding Pe~it must be issued before any wom~, can sSa~3t in a spoc[a~ ~].ood hazza~.d zone. A writte~ disapproval or a pe~i$ mus~ he'issued within ton (10) working ds rs. Duping construct;fen, ;ho inspector shall be noti ~iod ~n $i~e so he may make tho required in~]],octions. Upon 0ompletion,~ thc ~oquzrod certification fo the final elevations and wo~k must b'~~ submJtto, before the appI. oval $o lis oP occupy can be approv~ed. (F].ll out thc £or~ on the back of 4/8o specter includes (each or typewritten, 2. Sur- evel, 3. Drawings of pro- information to show that 980, Chapter 46 of'the age Prevoution Law" of the rgvals that any.other the ].aw to minimize flood ic utilities design and ~s as well as any other bo substantiate the facts leer, including basement/ )r; if permitted by thc flood proofed in such ~ure is water tight with ge of water, 2. that 'drostatic and hydrodynamic sub~it certification by that the standards set old Code are satisfied. cant shall submit plans, ions and such other, in- in that ]~he provisions of bited. The lowest portion his sheet) FORM NO. HO TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. BOX 728 TOWN HALL SOUTHOLD, NY MAIN ROAD 11971 SOUTHOLD~ NY APPLICAT~0N F 0R__DEVEL 0 PMENT__PER] ~ iT Instructions: The application to the Building Inspector includes (each ~----6~) 1. Fora No. l0 filled out in ink or typewritten, 2. Sur~ vey of premises with elevations above mean sea level, 3. Drawings of pro- posed work. The application must givo complete information to show that the proposed can comply to the Local Law No. 1-1980, Chapter 46 of'the Code of the Town of Southold known as "Flood Damage Prevention Law" of the Town of Southold. The applicant must submit approvals that any.other agency requires. General S%andard_~s as required in Section 46-17 of the law to minimize flood A. Anchoring of structures, including tanks and mobile homes B. Use of construction material and methods C. Design and location of utilities D. Subdivision proposal with drainage, public utilities design and base flood elevations S_joeci~fc Standards as required in Section 46-18r A. Residential construction B. Non-residential construction C. Mobile homes ~ The applicant must submit plans and specifications as well as any other information requested by the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the base flood level the structure is water tight with walls substantially and impermeable to the passage of water, 2. that structural components are capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3o applicant must sub~it certification by a registered professional engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal Hi_~ Hazzard area (V Zone) 46-19. Applicant shall submit plans~ specifications including the required certifications ~d such other in~ formation as the Building Inspector may require in that ~he provisions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation with all space mbelow open except breakaway walls~ Sand dun.__e_~s. If saud dunes exist on the premises and the applicant pro- poses to alter seme, plans and specification must be shown in detailed nature of any alteration submitted. ~uildin~it. A Building Pe~uit is also required for any structure. Both ~-' e]~gg-e~ent and a Building Permit must'be issued before any work can start in a special flood hazzard zone. A, writte~disapproval or a permit must be issued within ten (10) working days. During construction, the inspector ~hall be notified in time so he may make the required inspections. required c rtificatzon fo the final elevations and wor~-m~t~4itted before the approval to use or occupy can be 4/80 (Fill out the fo~m on the back of this sheet) iApplication Received ~ Disapproval Issued Pez~it - /~ ~ /~ AP~PLICATION FOR DEVELOPMENT PERMIT own ' ~. Typ~ +f Develop, en~o~Ne~ur (including stet,ge tanksn ~ddztzon and/or ~lteratzon~ood P~oof elow Base Flood Elevation~ ® Other (specify) i ....... Elevation Data in relation to above mean se (a) Lowest floor ielevation, including basem (b) In a V Zone, !bottom of lowest strucbura FIRM--Flood Insurance Rate Map, Zone design h.. o~er of Premises ,,/__ ~ ~ ~:~ /~.~p" .. Location of P~op0rty: Co~ty Tax Map No., Dtstpict, lO00~ Section Subdivt sioni 6. Pe~lssion to bo ~g~ted: _ net aB above I IUnder Contrac~I [ Lessee ~Contractor 7. Approval from other(s) before Permit is iss DEC WA~LAND~ HEALTH SERVICE i ZBA BUILDING PERMIT : PLANNIN( I, ~ i - ~, the appl~ 0where, New Owne~__, Unde~ Contractl_--~, tractor[~ and agree to comply with al~ a~ of the Town of S0uthold; Co~ty, and State specters to premises authorized to perform work and.to mak~land fzle thzs applmcat~on~ ed in th~s applzcation are true to the bes~ and that the work will be performed in the application file~ therewith. STATE OF NEW ~0RK ~ ~OUNT~ OF .... ~~_~S '. SWORN TO TItIS I /~ DAY OF ~-/.~-__.]~ Applzcant s mailing address and phone ~/ if not given above: 4/80 level of: ~nt feet ~inches me~'~fe-'e-~-" inches ,ttons__ /3 Block . Lot(s) ~,, ~i].ed Map ~ __ Lot(s)~ ~]New O~er --- ~ed: (Town Board) BOARD ~ant, am the 0wner~--~, Co- Lessee~-~, Agentl~, Con- plicable s~ctions o£ the Code and to admzt authorized in- or have performed the said that all statements contain- of my knowledge and belief mannerset forth in the 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 \ TEL.: 765-1803 Examined..d~... f....,19..~?' Disapproved a/c ........................... (~ ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~all be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until 0 Certificate of Occupancy ,hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmit authorized inspectors on premises and in building for necessary inspect, jo~. ~o;~-..>.(. 7...<~.X,.~.. ~,~-~ · ./~-..~ ................ ~ (Mailing' address of applicant) $tate whether applicant is owner, lessee, agent, architect, engineer, general contracto~r, electrician, plumber or builder. Name of owner of premises ....~U~-. ..... ~.~...~.'T..~.~. ·~. .......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... >...?..~..~... ~ ........ Plumber s ~icense No.~ ..//~.. ~? Electrician s License No....~..~.~-4-~'. ~ Other Trade s License No ...................... Location of land on which proposed work will be done .... ~...~.~...(~.~.. (..~. ............................. ...................... /..~?. ~ .t.4.., ~..~...~. ?. ~:..~. ........... .d..o/. ~/..~. ................... House Number Street Hamlet County Tax Map No. 1000 Section ...~.~.~.~..~. ....... Block .... ~..¢ ........ Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~A~...~.~..~f".~ .,.~./~... .~ ................................ b. Intended use and occupancy ~ .~.~..'T2¢~. ,~~/~}~a~,;~?j~ .... /' ..... ~ .... ,~ ~:r~ "3~,m~ ~ ~,~ ................ 10. ll. 12. 13. 14. Nature of work (check which applicable): New Building ..... '; .... · Repair .............. Removal ............. Demolition .. Estimated Cost~.L~.. 'g~f~'' 'q .~..'~. ................ Fee~/ If dwelling, number of dwellin~ units ............... Number of d ,ddition ......... Alteration .......... .......... Other Work ............... (Description) .......... .... ...... (to be paid n ling t is apl cation) yelling units on each floor ................ If garage, number of cars ... ~ .................................................................. If business, commercial or mi~ed occupancy, specify nature and extent Dimensions of existing structures, if any: Front... ,~. ....... Res Height . .fl..6>. ...... ~ ' .. Number of Stones ...... ¢ ........... Dimensions of same structure with alterations or additions: Front ... Depth ....... ~. ~. ....... ;... Height ...... ..fl...~. .......... of each type of use ~ .~ ~ Depth 3..&/ · cA.. . er ..... qumber of Stories .... ¥ ............... Dimensions of entire new construction: Front ............... Rear .............. Depth ............. N~mbSr of Storie~ ::. '.'~'. { lr'l~gh t ' Size 6flor: Front ..... ' r' Rear .... /. ~. .............. Depth ...'~>-.. ~...~ ............. Dat~ of Purchase ......... ~ ................... Name of Forrrlf r Owner ............................. Zone or use district in which premises are situated ................................................ Does proposed construction viblate any zoning law, ordinance or regula :ion: i .............................. Will lot be regraded ....... i .................... Will excess fill Name of Owner of premises . ~,~..o..~ff~--.. f~..~.r .~..~.-f. Address ...... Name of Architect ... >o. · · ~ Name of Contractor .~./~ .~i :.~ :~.'~ '~"5 .......... ....... AddressAddress ~.~¢: ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propos property lines. Give street and bloc ~ number or description according to dee interior or corner lot. be removed from premises: Yes No ............ Phone No ................ ............ Phone No ................ ~.~/9~.. ....... Phone No..~. ~...,~ ,.:..~.~.o./. ,~d, and, indicate all set-back dimensions from and show street names and indicate whether STA'rE OF NEW YORK, : COUNTY OF ..... : S.S ' ' being duly s (Name of individual si~ning contract) above named. ~orn, deposes and says that he is the applicant He is the .................... (Contractor, agent, corporate o 'fleer, etc.) of said owner or owners, and is daly authorized to perform or have perfo application; that all statements contained in this application are true to th~ work will be performed in the manner set forth in the application fil6d there' Sworn to before me this ~ned the said work and to make and file this best of his knowledge and belief; and that the vith. ? Lou/~