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Home My WebLink About48476-Z Cot Town of Southold 1/27/2023 P.O.Box 1179 oco • 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43795 Date: 1/27/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 860 Bayberry Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 118.-1-15.1 Subdivision: Filed Map No. Lot No. i conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/29/1986 pursuant to which Building Permit No. 48476 dated 11/10/2022 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: alterations and additions, including screened porch,to existing single family dwelling as applied for. The certificate is issued to Mayne,Frederick&Lorraine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48476 12/2/2022 PLUMBERS CERTIFICATION DATED 1/19/2023 F e rick Ma4je u ori a Signature suFFoe TOWN OF SOUTHOLD BUILDING DEPARTMENT y z TOWN CLERK'S OFFICE oy • � Q� SOUTHOLD, NY dol � ,�•�� BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48476 Date: 11/10/2022 Permission is hereby granted to: Mayne, Frederick 860 Bayberry Rd Cutchogue, NY 11935 To: ADDITION & RENOVATION replaces 15065 t At premises located at: 860 Bayberry Rd, Cutchogue SCTM # 473889 Sec/Block/Lot# 118.-1-15.1 Pursuant to application dated 1/1/1900 and approved by the Building Inspector. To expire on 5/11/2024. Fees: - PERMIT RENEWAL $87.50 Total: $87.50 Building Inspector FORK NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 15065 Z ....:......1.......................... 19 !t�4 Permission is hereby granted to: �6O .. tom............. ..... — ..................�iL6A1CZI.A :...... .c...zc.-1.� . -..�..cr..`�:.. .l.�. to ...G®hST.l .V ....... ...1.0 aul?.�..l.ht�z... ccs......,.1 .r .,................................................... at premises located at .......FJk-f�.I:�:1.cK... ..l��.l`1 .... � til.:t ........ ............................................ .. .4?........ fa ...Rol ..�....................... .............................................. (,-4 -- ..................................................... County Tax Map No. 1000 Section ....... ...15....... Block .......Q.(....... Lot No. ..��..�..�.�.�.. l� pursuant to application dated ..... .N.l,:.....Z.p.:{...................., 19 ? and approved by the Building Inspector. Fee $...�.. ..o d V . i. ... . ............... Building Inspector Rev. 6/30/80 pF SO!/T�OI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 aQ sean.deviina-town.southold.ny.us Southold,NY 11971-0959 CpUIVT`1,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Frederick Mayne Address: 860 Bayberry Rd city:Cutchogue st: NY zip: 11935 Building Permit#: 48476 Section: 118 Block: 1 Lot: 15.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Doroski Electrical License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser 2 Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower 2 Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency StrobeHeat Detectors Disconnect 2 Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Notes: " AS BUILT NO VISUAL DEFECTS " Two AC's Inspector Signature: Date: December 2, 2022 S.Devlin-Cert Electrical Compliance Form Town Hall AnnexTelephone(631)765-1802 ' 54375 Main Road Fax(63 i)765-9502 P.O.Box 1179 �•. _ Southold,NY 11971-0959 � _. BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATIAN Date: q.I Building Permit No. L V b-7 Owner: Mme print) Plumber:--- (Please lumber:._ (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day of ZMR04 20 f3 S JK DIANE DISALVO Notary. Public, Pounly NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qualified in Suffolk County ,/ My Commission Expires April 30, 20!fa 12r /✓cid T- � nr ) 161(-IV THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1785077 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 Date JULY 26,1996 Application No.on file 11414996/96 N 392354 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of KAITERIM MAYM, 860 BAYBERRY ROM, CUTCHOGM, PLY. in thefollowing location;_ ElBasement ® Ist Fl. }' 2nd Fl. Section Block Lot was examined on `UX 22 r 1996 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENTI.FLUORESCENT I OTHER AMT. K.W. I AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 5 12 7 5 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTI TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. I AMPS. TRANS. AMT. I H.P. NOSYSTEMS.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER .sw t,ep 3W 3 0 3W 3,0'4W NO.OF CC.COND. A.W.G. NO.OF HI-lEG A•W�' NO • .OF NEUTRALS A.W.G. EQUIP. PER BOF CC.COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: SMOKE DETECR�-1 ROSIM ELECTRIC LIC.4036577 k ' L L P.O.BOX 164 CUTCI-IC GUE, NY, 11935 GENERAL MANAGER _ SS Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. �ZIFOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATEINSPECTOR M-102 . . - BUILDING DE". INSPECTION C ] FOUNDATION 1ST [ , ROUGH FLI3G. C ] FOUNDATION 2ND [ ] INSULATION [4-j--FRAMING [ ] FINAL, ' fel i ®A'T'E � � '�""� INSPECTOR 'ss-iso2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 18T [ ] ROUGH PLB6. [ ] FOUNDATION .2ND [ N8ULATION [ ] FRAMING [ ] FINAL c REMARKS: vie DATE t —INSPECTOR Or� r1p'LL!_ -Lila LL:juI LVIV _- �a FOUNDATION ( 1s ), TM • -� FOUNDATIO ( 2nd ) 2 . zo 74y ROUGH FRAME & l PLUMBING L w �I H 3 . y INSULATION PER N . Y . ' L STATE ENERGY CODE x r 4 . .� FINAL ti - ADDITIONAL COMMENTS : /0/u, d 7 Alp r o a3 is arvm �sa3 l� r - �J;� ,2�—s � CPQ?_� ` • ' L�- `tom tij 1 y x _ d C=] H �i FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . V. L-�". Q9. . ., 19eL Received . . . . . . . . . . . , 19 . . . Approved Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Datef'c 1!��.Z9. . . . . ., 19 � INSTRUCTIONS a. This 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 shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whgle or-in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to theBuil ing Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, uffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary�insctions, . . .. . . . . . . . .. . . . . . . . . . . . . . . . . (Signatureof pplicant, or name, if a corporation)' . . . . . . . . . . . . . . . . . . .YF . . . .. . . . . . . . . . (Mailin address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . .F" , , er .r. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . � `� Name of owner of premises . . . .�� . R . . . . . . . . . >-r (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. '�!Z CL�FTOy/v o7o 2 (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . 99 � Plumber's License No. p�. h i fi. . ./�J n.� .� �� Electrician's License No. �. � .,. . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CLT House Number Stet Hamlet County Tax Map No. 1000 Section . . . .�. Block . . . . . . . . Lot . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . .� . h.. . . . . �/�/�' F�VI�I�C-,Y . . . . . . ... . . . . . . . . . . . . . . . b. Intended use and occupancy . . : . . •�•/ �� • • • • Lvf�..,/a/��l �3�V.S • • • . . . . . . . . . . . . • . 3. Nature of work (check which applicable): New'Building . . . . . . . . . -Addition'. Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal : . . . . . . . ... . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . (Description) 44. Estimated Cost . . . . . . . . . . . . . . . . . . . . Fee �.7�? (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . .T,. . .. . . . ... Number of dwelling units on each floor . . . . . . . . . .. . . . . . . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify n ture7 and extent of each ty�e of use . . . . . . . . :. . . . �. 7. Dimensions of existing structures,if any: Front . . ... . . . Rear . ., . . . . Depth . . .�. .J .. • . . Height . . . . . . : . . . Number of Stories . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . .�v.lf Rear ��. . Depth . . . . . . . . .. 1.� .J�� . . Height.. . . . . ... . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . 8. Dimensions of entire new construction: Front �. . . . . . . De th',. �.y ' . . . . . . . . Rear . . . p . . . . . . . . . . . . Height . . . . . .. Number of Stories . . . .'PZ.. . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . Rear . . . ,.a' d. . . . . . . . . . . . epth ... . . 10. Date of Purchase . . �.��. . . . . . . . . . . . . . . . . . me of Former Owner R,% . !vr��7 CJ J). . . . . . . . . . . . 11'. Zone or use district in which premises are situated . . . . ��.r.�.e��QL.. . . . . . . . . . . • .. . . . , . . . . . . . . . , . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded 6 r . . . . Will excess fill removed from premises*1� Yes 14.: Name of Owner of premises 11 ca't7�. . Cr. 9d.W . . . Address . �.� ��5��. .Phone No. 73./. Name of Architect . . . . . . . . . . . Address Phone No. Name of Contractor��'�.nZS ).e . . �.Y.►.j. .h �.... A . Address .GG .'A � & . Phone No. ��. � . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and-indicate whether interior or corner lot. � r W l 1 (�6 N, 0"v e- go - STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . • • . . • • • • • • . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners,,&r(i is duly authorized to perform or have performed the said work and to make and file this application; that.all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . day of. . . . , 19 � !lotary Public, . . . . . 114. � . . P��!. . . . . . . . County � r `: . . . . . . . . . . . . . . . . ... . . . . . HELEN K DE NOTARY P BLIC State f New York (Signature of applicant) No.4707878,Suffolk County Y70 :. Terra Expires March 30,19 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11.971 TEL.: 765-1802 ExaminedReceived . . . . . . . . . , 19 . . . Ap roved . ��L : ., 19K Permit No. p . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . ! . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT ,... Date y� 9. . . . . .. 19 INSTRUCTIONS a. ,This 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. Q. The work covered by this application may not be commenced before issuance of Building Permit. a: Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whgle or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buil ing Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,' ,uffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp ctions. • ?v•`: . . . . . . . . . . . . . . (S.ja ,natur o�icant, or name, if a corporation) (Mailih address of applicant) State whether applicant is owner, lessee, agent, architect, .engineer, general contractor, electrician, plumber or(builder. . . . . . . . . . . . . . . . . . . J' �,�. .-. . . . . . . . . . . . . . . . . . . . Name of owner of premises °�J JL X Q.v�. . . K.?an .... . . . . . . . .��L✓ ?N!�4 AW. 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,License No. vP . Y�i.t. .�� .1}�.� . ��r'� S Electrician's License No. �. � . .. . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��. . . ��. �e.r. .r. � ��.� i �Te�:4 Gam. . . .. House Number Stet Hamlet 1 County Tax Map No. 1000 Section . . . ; . �. .. . . . . . .�. Block . . . . . . . . . Lot . . . . . . . . . . . . Subdivision-. . ... . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . '. . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .. ��!�(P—A-rct. '. . . . .F•A . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occup, : . .geS, . T�`4-. ajZT/- X1,2121 1 -ON� . • . . . • • • . . . . n� .,. Nature of work (check which applicable): New Building . . . . ... . . . . .Additiori . .�..f: .'. I: ... .. Alteration . . . . . . . .�. . Repair . . . . . . . . . . . . Removal :. . . . . . . . . . . . . Demolition . . . . . . . . . . . . : . Other Work . . . . . . . . . . . . . _ (Description) . '.Q j.�.� /. .� . . ... . . . . ... . . . . . . . . . . . . 4. Estimated Cost:. . . . . . �. .� Fee. (to be paid on filing this application) S. If dwelling,number of dwelling units . . . . . . . . . . . . Number of dwelling units on each floor • • •. If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify n tures and extent of each ty�e of`use . . . . . . : . . . . ... �. 7. Dimensions of existing structures,if any: Front . . y` . Rear �`. . . . . . ,J�. . ,3�: Depth Height . . : ..: . 'A • . . • Number of Stories . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or ad VP Front . . .6.Zf. . . . . . . . Rear Depth . . . . . 1. . . . . . . Height.. . . . . . . . . . . . . . . . . . . . . . Number of Stories . ; .. . . . . . ... . . . S. Dimensions of entire new construction: Front '. . . . . . . . . . . . Rear . . De th ,1.. . . . . . . .i. . . . Height . . . Z '? Number of Stories . . . . sem.-. . . . . . . . . . . p . . . . . . . . . . . . . 9. Size of lot:Front . . Qyp: . . . . . . . . . . Rear . . . a�.4 epth' '. :� . . . . . . . . . ... . . . 0. Date of Purchase �.��:�f me of Former Owner RA . . . . . . . . . ... . . 1. Zone or use district in which premises are situated . . . ,e l_. . . . . . . . . . . . . . . . . • . . . • . , 2. Does proposed construction violate any zoning law, ordinance oir T7'egulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . . . . Will excess fill e removed from premises: Yes 1. Name of Owner of premises f"�cti hP,vi. . !r.'F4)!? . . .Address . .�-t . . ��t eF� .Phone No. 7 �. ..�;. . Name of Architect .. P. . Address . Phone No. Name of Contractor l'.�.d V,e . �,k). l.h A . Address �ts 6� .. .Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and-indicate whether terior or corner lot. - 'P— Y 1 s ,ITE OF NEW YORK, UNTY OF . . . . . . . . . . . . ... . S.S • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) •ve named. isthe . . . . . . . . . . . . . . . . ...... ._.. _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . (Contractor, agent,corporate officer, etc.) said owner or owners,,affd is duly authorized to perform or have performed the said work and to make and file this lication; that,all,statements contained in this application are true to the best of his knowledge and belief;and that the :k will be performed in the'manner set forth in the application filed therewith. )m to before'me this. . . . . . . . . . . . . .day of. . .ary Public, . . . . . . .!l,•�. . Qi�!.'�2 Count j . . . . . .� . . . . . . . . . . • . . . . . . . . . . . . HELEN K OE VOE (Signature of applicant) NOTARY PVPLiC State of New York f htb,47P A! 'Suffolk County ;; ► 1eFFn Exrires a►eh 31 U,n jf ?. „ `, r --- Memorandum from . . . . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765_-1802 Jut AuLev;r7l OF Uol, /A/ 101011-eC10110Aj I �� /�o FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL:: 765-1802 119. . . . . . . . . 19 . . . Received . . . . . . . . . . . , 19 . . . Approved . . . . . : . . . . . .'. . . ., 19 . Permit No. . . . . . . . . . . . , Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . ?. . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) ;�. APPLICATION FOR BUILDING PERMIT 19 Date INSTRUCTIONS a. This 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 shall 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 a Certificate of Occupancy shall have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Buil ing Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of theTown of Southold, ,uffolk County, New York, and .other applicable Laws, Ordinances or Regulations; for. the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply,with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp ctions. ,.•� L 1'. 9�:• d? . . . . . . . . . . . . . . . . . . . . . (Signator off di or name, if a corporation) . . . ® x (Mailin address of applicant) State whether applicant is owner, lessee, agent, architect; engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .l. . . . . . . . . . . . . � . :. . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises �'.`°� �x �Ld '�" . :e off- .47(u (as o e tax roll oi�latested) If applicant is a corporation, signature a officer.t L . . . . . . . . . . . . . . . . . . . . . . . . . . . IZN-4 (Name"and title of corporate officer) 0,ecWVx0v Builder's License No. . . . . . . . ..: . . . . . . . . . . . . . . . T �p .� /� 1 f . �r Plumbe'r's License No. �. h i.�. L h. Electrician's License No. . �'�. �� .,. . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . ... .. fid. . . . . . . ��r. r� . . . House Number e Hamlet County Tax Map No, 1000 on . . . . . . . . . . . . Block . . .� . . . . . . . . . Lot . .,/ . . t: Subdivision . . ... . . . . . . .. . . .... . Lot (Name) � ` . . . . . . . . . . 2. State existing use and occupancy of premises and int-etn'ded use and occupancy of proposed construction: a. Existing use and occupancy . . . .'. .��. . . .Cly.. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . b. Intended use and occupa:. . . . . . . C?.�.� � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , 3. .Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . .!/. . Alteration . . . . . . . .N Repair . . . . . . . :. . . . . . Removal ": . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . .��.OAO.� . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . ., g units . . . ... Number of dwelling units on each floor . . . . . . . . . . . . ..... . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy,specify n ture7 and extent of eac ty�e ofIuse . . . . . . . . . . . . `. 7. Dimensions of existing structures, if any: Front . . . . . ... . . . . Rear . .J. ,> . . . . . Depth . . . . . Height . . . . . . . . . . Number of Stories . .A. . . . . . . . . . . . . . . �j . . . . . . . . . . : �. . .�, Dimensions of same structure w,th alterations or a it�ns: Front . . .4.� . . . . . . Rear . l�. . . . . . . . . . . . Depth . . . . . . . . .)q. f. . . . . . Height . . . . -. . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . .y. 8. - Dimensions of entire new construction: Front . . . . . . . . , . . . Rear . . . ..:�3 C?/. . . . . . Depth .. . . . . . . . . . . . . Height . . . . . . ,,� Number of Stories . . . . Z • . . , . , . , . , , • �. Size of lot: Front . . Ci Rear . . : �,)-,. -.(?. . . . . . . . . . . . . epth -.2SS_CJ. . . . . . . . . . . . . J. Date of Purchase . . �.��d' . . . . . . . . . . . . . . . . . . me of Former Owner .�: . �W 41) . . . . . . . . . . . . 1. Zone or use district in which premises are situated . . . • �j r c zc�4." . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . Will lot be regraded . . . X1`.6' . . . . Will excess fill. removed,from premises-'� Yes Name of Owner of premises I"�e<` �iz . . Cr.'n)!? . . . Address ti �Y!�' 4e�. . Phone No:/..1�� Name of Architect . . . . . Address Phone No. _ Name of Contractor��'.�. . ..)R . . �.Y►.j.�.h A . Address .�.'�� G� C;1 E'_ . . Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether tenor or corner lot.' a, �e -y- 0 WIWI '=- — rte e-y 4<- (T a kTE OF NEW YORK, S S UNTY OF . . . . . . . . . . . . . . . . . • • • • • • • • . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) we named. is .ie . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) said u`iner or owners, and is duly authorized to perform or have performed the said work and to make mid file this ,lication; that all statements contained in this application are true to the best of his knowledge and belief;and that the k will be performed in the manner set forth in the application .fled therewith. )rn to before me this . . . . . . . . . ,gid , . .day of. . . . . At.-41-A .. . . . . . . .. 19 f�° ary Public, . . . . . , . . . . . .. County' ount Y , G " HELEN K.DE VaE (Signature of applicant), Nt)1lY Puff IC,State of Na+�York No.4797878,Suffolk county � Teruo Expires Marek 30,19._ �� I 5 fN 4 J7 GcJ � CANADA ONLY Rebate Certificate Number: �r��o,` I 1210 847051 DWNER, NOT INSTALLING DEALER. ted in its entirety.Commercial applications/commercial properties/rental properties do not apply.Residential l ion. son � � O Phone(6 31 ) 76 7 7 L Total Postage&Fees $ $5.21n:'�`' ��47 Salesperson, &A- o 5,v S de/Prov. N Phone(� ) 3 S ��7 S. � No.f No.- - ` ��cnl �� , PRi�K�7�Z1P+4 lfi 5 I a I ` P Y �J nium Heat Pum S stem* •• ••• Heat Recovery Ventilator 00 Total_System Rebates Energy Recovery Ventilator +CZE 15/18 SEER Affinity AC R410A YZE 15/18 SEER Affinity R410A10 Ultraviolet Air Treatment System 5300 Cash Rebate PC9,PV9,PV8,PV8-L,AVY,MV' Electronic Air Cleaner PC9 95%M V/S Enhanced Premium Air Conditioning System* •• ••• ❑Media Air Cleaner DNX/BHX 15 SEER Respac n $1,500 Total System Rebate El Media House Humidifiers D 5250 Cash Rebate CZE 15/18 Affinity R41,0A AC u NY 14 SEER Respac PC9 200 Cash Rebate Premium Air Conditioning System* « •" +CMB/CZB 13 SEER Affinity AC R22/R410A n $1,000 Total System Rebate +YMB/YZB 13 SEER Affinity HP R22/1341 OA CZE 15/18 Affinity R41 OA AC +ERE 14 SEER Latitude HP R-22 PV9,PV8,PV8-L,AVY,MV +HRE 14 SEER Latitude AC R-22 Premium Package System* •••• •Consumer may choose their choice of FREE color PV9 Affinity 92%V/S or college logo panel when purchasing a PM9 Affinity 95%Modulating PSC IJ DNX/BHX 15 SEER Package Units qualified Affinity Heat Pump or Air Conditioner. DNZ/BHZ 13 SEER Residential Respac F— $150 Cash Rebate DNP/BHP 13 SEER Residential Respac REQUIRED $100 Cash Rebate odember . l , ppa+o ., o,16 , - L-F PT9 Affinity 92%Two-Stage , ,,. ,. PV8/PV8-L Affinity 80%V/S(including LoNox) AVY/MV Variable Speed A/Ht�ek 7 3Or� `( l PTS/PT8-L Affinity 80%Two-Stage(including LoNox) + ARI Matched Coil or A/H Premium System requires a: Matching York Thermostat •' UPG Matched Coil or A/H _ '•• Two York IAQ products _ •••• One York IAQ product To Be Completed By Homeowner (Please Print Clearly) Name JM.A YM 1-' Phone( 7Z " 707- - Installation Address --Mailing Ad Ss C _ City I(?rX State/Prov. _A\ 'z� ZIP/Postal Code Homeowner Rebate Instructions 1) Mail original,completed certificate to York Redemption Headquarters. Photocopies of the Rebate Certificate will not be accepted. York Redemption Headquarters 2) Include legible copy of your sales receipt with model number, Advertising Checking Bureau serial number, purchase price,and installation address and date. Dealer proposal will not be accepted. 1610 Century Center Parkway,Suite 104 3) Return completed warranty registration card(s)to York UPG, Memphis,TN 3813 $ or register online at www.yorkupg.com. 4) Mail-in envelope must be postmarked by July 31,2007. RETURN RECEIPT MAIL STRONGLY RECOMMENDED IMMWHomeowner:Retain A Copy Of This Certificate For Your Records Offer limited to one York Spring Consumer Promotion incentive for each qualifying model purchased between April 15 and June 30,2007,and aj installed by July 15, 2007. MAIL-IN ENVELOPE MUST BE POSTMARKED BY July 31, 2007. LATE OR INCOMPLETE SUBMISSION WILL NOT BE �� ACCEPTED.Omission of sales receipt or any other information will delay processing.Allow 8-10 weeks from receipt of certificate for delivery of HIE incentive.To check the status of your claim,please go to www.acbrebate.com/yorkconsumer,call 888-296-9675,or write to the York Redemption Headquarters. U•S. & CANADA ONLY It's time to get comfortable" 292466-YFM-A-0207 Nei} ac Cz' r s ASP, � f$ capper iUbing is used for w(3tcr distributing f < piping shall be '�'�'S!('ri'1 of types K or L only T[ricl,nam Lr ON ","ID CONTENT 11EXORE, SED TAT 147A TE SOLDEP - �fj��I' (� /�tj 7I CA A T'�T X96!/- ��1�T iJ�,�1lJ1Y� lJl'�l�l'V _... . LEA of 1�i - ,'; Js , \ F t ; _ _ • LL=Lil I ! t , ' :r { 1 i I -°D AS NOTED ! !M /�,�.��-c; ✓ - i";r Cir -1A ATEE::r� B.P. BY NOTIFY BUILDING DEPARTM N AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: J. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION - 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. 0- ALL CONSTRUCTION SHALL MEET THE REQIJ!P.-,'0,ENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY .CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ' � �---- _r.-- - , 1. '.0�- _l.::c "_..!.?.__ ...��_,��' ; .�✓.� � � �..w �...?i,�.i�lit:_.,;:�- -_ .. y IN ' 1 ..��'•. APPROVED BY: - - SCALE: DRAWN BY DATE t ,��» +._sa. 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DRAWN BV Q• 4' SCALE:/. ,% REVISED DATE: �/ .r/�' "3 ' DRAWING NUMBER T fJt 1 ' a r t' 1ti r�'\ •? r � �1 o r 1 1 i !�\ r`� '` � , V r ��SI;\r�\ / + i •-�O.uFi��s rp /t✓��Et..D ./i T.-�irE CID +�( fir✓0v r v 1 /IAsr�� .�.'�.��, 5 W"!Lts a .� r . �+'C.�.-a.-z.-y� .rr ten- ✓m...r..�.7�.r!.•t.'l�w.�„+t.t'-` U�1�`G.G-s TQ . .s , „� �) 7 f z ! I '�1• jam°I' k?X';frr�'J?':.`� a yt t Nrv�1G?� 133 44V%/ G? v1 .Syt' APPROVED BY: r; SCALE:'- DRAWN BYf—>' Tl- /nd!/ ✓ . DA1E: �P�'�/ `� • REVISED� i DRAWfNC.M;<e;<...q , _ k i \ �\ ------ --- - i i I 4 � b f �. APPROVED BY: it `. . SCALE: u�J- l -� DRAWN BY �\ REVtSFD DRAWING NUMSFR