HomeMy WebLinkAbout26781-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27617 Date: 04/11/01
THIS CERTIFIES that the building ADDITION
Location of Property: 4075 STILLWATER AVE CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 137 Block 1 Lot 8.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 19, 2000 pursuant to which
Building Permit No. 26781-Z dated SEPTEMBER 19, 2000
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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GEORGE J SAILER JR
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-844048 11/19/87
PLUMBERS CERTIFICATION DATED N/A
�'�a� A 2�2�4
ZXth/ized Signature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27618 Date: 04/11/01
THIS CERTIFIES that the building ADDITION
Location of Property: 4075 STILLWATER AVE CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 137 Block 1 Lot 8.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 19, 2000 pursuant to which
Building Permit No. 26782-Z dated SEPTEMBER 19, 2000
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 COVERED PORCH ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to GEORGE J SAILER JR
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
A` horized Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 26781 Z Date SEPTEMBER 19, 2000
Permission is hereby granted to:
GEORGE J SAILER JR
4075 STILLWATER AVE
CUTCHOGUE,NY 11935
for
CONSTRUCT AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR. THIS PERMIT REPLACES BP#18487 .
at premises located at 4075 STILLWATER AVE CUTCHOGUE
County Tax Map No. 473889 Section 137 Block 0001 Lot No. 008.001
pursuant to application dated SEPTEMBER 19, 2000 and approved by the
Building Inspector.
Fee $ 75.00
,JaA-4
roreed S'gnature
ORIGINAL
Rev. 2/19/98
7n,, � y o s4t4Ak,#6..ave.
--_ Form No. 6
TOWN OF SOUTHOLD
` BUILDING DEPARTMENT
' i TOWN HALL
j 765-1802
_- - - ` =-PLICATION FOR.CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of .property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) .
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% .lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for .the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
_ Additions to accessory building ,$25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildinrz - $100.00
3. Copy of Certificate of Ocupancy - : gip
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . .O '. . 0/. . . . . . . . . . .. . ... . . . . . . . . . . .
New Construction. . . .... . . . . Old Or Pre-existing Buildi g. . . . . . . . . .
Location of Property. Qlf��. �7 . . . . . . . : �e. . . . . . . . \...G%.� �0 . . . . . , .
House No. l Street Hamlet
Onwer or Owners of Property.. 4. � � . . .V . . . ��C� . . ... . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . ./ 1. . . . . . .Block. . . Q.00/. . . . . .Lot. .(2 a1?_-'. 4V . . . . . . . .
Subdivision
.�. . . . . ....`. . . . . . . . . . ... . . . .. . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . .
Permit No. .�.7. `: .Z..Date Of Permit-. .. . .��. s2�A licant -
PP . . . . . .`, 1. .
Health Dept. Approval. .. . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . .
cam. s9a9�1 . . . . I. . . . . . . . . . . . . . . . . . . . . . . . .
CD z? a7f,J8" APPLIC •T
Form No. 6
r
; i TOWN OF SOUTHOLD
BUILDING DEPARTMENT
I TOWN HALL
765-1802
APPLICATION FOR,CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of .property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) .
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for .the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'-'pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building ,$25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building: - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Clommercial $15.00
Date . .V ✓.'. � . 0!. . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . ... . . . Old Or Pre-existing Building. . . . . . . . . .
Location of Property. . ��. �f��. :����. . . . . . . . . . .� . . . . . . . . . .�.���.�. .9.� . . . . . . .
House No.
l Street , Hamlet
Onwer or Owners of Property.. 4.� � . . .�/ . . . :-'g1CG� . . OJ• . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . . . . . . .Block. . . 0.0. 6).1 . . . . .Lot. .Y. J-cV/. . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
/�,� rr ��11 l� ��
Permit No. `:./ . /. J4
.Z.Date Of Permit�!.�:./.!. .��.vApplicant. . :./. .� F./. .J . 1� /�
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .. . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*'ex .Sga°f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
L' 0z- 7�0 / APPLIC T
t
THE NEW YORK BOARD OF FIRE UNDERWRITERS
kh BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date November 19, 1987 Application No.on file 4979"/87 N 844048
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
George Sailer, 4075 Stillwater Ave. , Cutchogue, N.Y.
in thefollowinq location; Ek Basement E]Klst Fl. Ej 2nd Fl. Section Block Lot
was examined on November 6, 1987 and found to be in compliance with the requirements of this Board.
FIXTURE E►TACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT[FLUORESCENT y AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
17 32 18 17
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'►T TIME CLOCKS ALL UNIT HEATERS MULT40UTLET DIMMERS
AMT. K.W. OIL N.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AML H.R SYSTEFEET I MS AMT. WATTS
NO.OF AS
i 30 2 600
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP TYPEMETER I X 2W 1 JV3W 3 A 3W 3 X 4W NO.OF CC COND. A.W.G. NO.OF HIAEG A'W.G• NO.OF NEUTRALS
EQUIP. PER& OF CC.GOND. OF HIAEG OF NEUTRAL
OTHER APPARATUS:
2-G.F.C.I.
;- 140KE DETECITLR 8-2
.
Georege Sailer
4075 Stillwater Ave.
Cutehogue, N.Y. 11935 GROW WANAM
11
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 A4Y�MAW9.
FORK NO. I
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)
00
N° 18487 Z Date .... ',�� ....................................... 19 �
Permission is hereby granted to:
v_.?94T ....... .........
...� ., ..,�..���. t...../..�.9�,5
to ?...... ......... . ...1. ..I.... ........
9-17 ..... .....� oG..... .��..................................
ofpremises located at ............................................................................................................................
................................................................................ ................................................................................
.........................................................................................................,.��..r�....ff...................................................
County Tax Map No. 1000 Section ......./.3.7..... Block f,�/....... Lot No. ��
....... . .......... ... . ......
pursuant to application dated ......( ...r�. ,1.. .7..................... 19........, and approved by the
Building Inspector.
od
Fee �4X- 3
...... . .Q . ,,�.................
B t
Rev. 6/30/80
FORM 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)
W 16376 Z Date ..... ....... 19.x,7
Permission is hereby granted to:
.. . .. ...
.... .. . . ....... ......... ........
...Co-. . . ......... a4
. ..........,
.. . ........
.... .... .... ......... ...... A�;........ . ...
� ,
at premises located at .....1. k...........
........ . .
tk....
.................................................................................................................................................................
................................................................................................................................................................
County Tax Map No. 1000 Secti .... ....... Block ........�l...... Lot No. .(:AtA..........
pursuant to application dated ................ 19.2.1., and approved by the
Building Inspector.
Fee $.zz..f.....
.... . . ............... ......
Build ng 4
Rev. 6/30/80
a
� C
�1-� y f� � s
s1,R(i. DkPT.
TOWN OF SQUTHOLD
FORK N06 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)
N2 14153 Z Date ..... ........... 2 ............. 191.
Permission is hereby granted to:
..........
....... ...... . ........
..... ... :. , ... .1....
.......A7 C&..C! .. ...5.......
-7—/ V
to .........
.............
z c:
..
at premises located at ... r�e-/.. ........ ..................
.....................o...........................
...
............................ ...... ................
............0......0-0................ ...... ............ .................. ..................... ......................
County Tax Map No. 1000 Section ...131........ Block .......(2)/....... Lot No. ...C)OFel...
pursuant to application dated ...... ..................1 19x?.., and approved by the
Building Inspector.
P-7-- CIV
Fee .....
... .....................Building
.................. .... ..
Inspector
................ ..........
Rev. 6/30/80
TEL. 765-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
' P.O. BOX 728
TOWN HALL
O Off. SOUTHOLD, N.Y. 11971
February 24 , 1987
Dear Mr . Sailer :
I am writing to you to inform you that
we have extended your Building Permit # 14153Z
for six months . With the extension your permit
will 'expire July .23 , 1987 .
Yours truly ,
;V� A/ /9 UIQ
Secretary
r �c 71-
' S
le�X" N — - - - -- -
-
J
r7ZV &-�- J
wlr �zs
Af73
TEL. 765-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
• TOWN HALL
O Off. SOUTHOLD, N.Y. 11971
February 24 , 1987
Dear Mr . Sailer :
I am writing to you to inform you that
we have extended your Building Permit # 14153Z
for six months . With the extension your permit
will 'expire July .23 , 1987 .
Yours truly ,
Secretary
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: o ' ,ev/ �
sly (l<All -
S
.�. 7F2-Z o
DAT c� _ INSPECTO
I::LD l'= TIU;1 JJDATE jI COMMENTS
1lrS ....V 11
3 Zj
H f°�1s
_ _ y
FOUNDATION ( 1st)
c
FOUNDATION ( 2nd )
m
2 .
ROUGH FRAME
PLUMBING
rn
3 .
INSULATION PER N .
STATE ENERGY
CODE
x
rna
r
4 .
cle
gt
FINAL
0
_ r Z
ADDITIONAL COMMEN S : a
% x
a
. - x
b
H
ALSAnr,Hila luW. I[1JJ _• ..... . ,„ . . .... . .. ...... . .. _.�..._—__
API'LICATION NO
A
1M ON t1ACR Rt;
Mat[ COEt[ COEQQ NG T1tI9 APPLICATION. PLEASE TYPE OR IT CLEARLY IN INK. ME SEPARATE .
'I t0 N[ I T FXPIANATTONS FOR W'IICII S. i. ON T'IE FARM IS 14ADEQI'ATE.
Yy Aetlllli 1119 Tit4i;3 (CO1TI'a0L 01 AQUATIC t"39 8, HEEDS, OR UNDESIRABLE n511)
�VFiolo 13, Title 3 (MTTCTIOM OP WATM) :
pygetrygtlpa#,>yeoastruetioo,,or repair of a DAM or other Impoundment structure.
13199 Lho opaeteustiooe reeoastruction, of repair of any•psaMnent DOCK■ •pier, or wharf; and any deck, glare or
VWAguilt 04 opMMPth supporta. wtlich Ma a top surraci area of more than 200 square feet.
r ayey CIM aistvrbV*s of a MEAN B® or excavation in or fill of navigable voters.
C]Actisle 15, Title 13 t3VAT'ER 5V??LV 13LONG 13LMM WELL
011ti1Aj0 K (twSWATIJI V9 ) PPer:sit QLsctsr of Permiastoa
,�I�ARtsR1� ii (Titt�ir 1tR;IAMPs) '
of �Pt►t.tc.Wtl �' 70C
AMICAIM 15410 0Ia4lei4U$1 OPsrtaerahip ❑Aaaociscioa OCorporscion ❑liunicipallcy ClCovernmental Ataacy
,4 ,1W$ ` Tl= OP
�mGc i�cc jxa Nniasl J ' � wa"q _Cly Pttoctl: �i�731'C 70 7(
��.IlAwwwwrwr.� .w■w,,q .�pw ....
P ��, N �• .
STAT VM •� ���1�• 'f�, I?...i�r�r4r . .
as 1900 batt PMT OMCZ ,_ AC�CQ/J/G STATE N ZIP CODE�3/
X0'4 i 40DRL84 Of t>W. >� l 11' �f p/
(II; npe OFteit<wae) „f eO , ..,ac:_, fir. PHONE I_ �67 _ 2 °w..
,. ,4111LZT �ODitt�ti '
OR t.O; Btl>< V'e POST OFFICE e 141 STATE zIP CODE„LJIIP
JAWFT I.OLATIOIII. •c;• a 6. WILL PROJECT UTILIZE
Vary 4 ,f� „■� ; MM OF STTIYAN OA OTHER 11TEA BODY: STA-Z OV`F:+ TO`.-D?
• (19appropriate;
- SeeItemSb)
if °a-named, show on. YES
,
4 �1•J 14`:1 Ar.w� �t S�III„j � • �.
�) ipeelilla pro4sct /lto of eros is marked on U.S.G.S. or equivalent map, attached as Exhibit No.—
PROPOSLD IIsi: of frivatM q, MIOMED SURTING MTI: 9, APPROXIMATE CWLETION DATE 10. PEE OF $,,_j4CI.OSEO
r4aaCT DEBCRlmoill (Pest of rip-cap aaw chsanel; cubic yards of malarial to bo removed; drainir►g, dredging,
tilling, &” location of disposal sites; type of structure to be installed; height of dam; &Lao of impoundment;
"P04008 94 P49gwe4 90901 pounces; Outset of distribution system; etc'.)
wds�l��rvcf' /"s dory �ut�e.�sio vn exsf..��
Zr'Q d coI 7�1't�G?�iv in 7� /yin chi, /VS, Gv r� /✓a �i
This project will require the following additional parmits. applications for whLch are the responsibility of others:
04kh 00MI OWA
STX DISTUSAUM CSPI)FAINPDBS OWATER SUPPLY El L.L WELLS OFRESMATER WETLANDS ❑TIDAL WETLA;Ds
tiA# A A ttu} Ol *"ZCIAL I+MPAM OF LOCALITY WHERE PROPOSED WORKS ARE LOCATED:
li "y PORTION Or T119 ACIIVITV PO4 WiICII A PERMIT 18 SOUGHT NOW BEGUN Ox compLETE? OYES KNO
1f "YES", srlptaln in ettdeada, givin$ reasons and dates, 804 show existing work on drawings or map.
W.44y AIM Un* penalty Of pidury that information provided on this form and all attachments submitted here.
aritA'.F p4P jp t h�sl of my Itrlo�vledso and belief. False statements made herein are punishable as a Class A
miWaraMr four;uant 11oSection210.45 of the Penal law. As a condition to the issu,;nce of a permit, the applicant
accepts full 10941 respogsibllity for all damage, direct or indirect■ of whatever nature, and by whumever suffered,
alisblg crus Of ft proieCl described herein and agrees to indemnify and save harmless the Slate from suits,actions,
damtae�l li1)fl tF.psli,91411fly t1l1mC and descript r0sulting from the said project, s
., I ,� f
_ I DATE SIGNAIURC
• �•SEE REV[ASIE' SIDE— -
AIdAhI,htw VU" 1124J _ a.... . .. . .... ........ . ____..
�' -. r—'��AVI'UCATI(1N NO.
I t Ng am �R ggrM COI? �NC THIS APPLICATION. PLEASE TYPE OA IT CLEARLY IN INK, USE SEPARATE
�ptTO:1 ,'i l T !� i. 0"t VF FOR U'IICII S. E FARM IS INADEQI'ATE,�^'.,��
"Stato 134 T19l@;3 (COl1Ti & 00 AQUATIC INSECTS, WEEDS, OR UNDESIRABLE FISH)
FtalM 13. pgle 3 (PROTiC 00 Of WATERS)
'? ;O►qr gM $0049rugttons,.reeoaatructIOUs•os repair of a DANor other Impoundment structure.
9114 ""grugtione rewootr4ctlon. of repair of any-petmsnent DOCK,-pier$ or wharf; and any dock# oterr, or
cJfY� ,*ASS, pullg oq opaeWr11 supporta. which has a top surface area of more than 200 square feet.
oaf gb# d9atlrsb4O0 of a STREAM 50 or excavation in or till of navigable vat•rv.
ClArttele 35. Title 1S 13VATgR SUPPLY 13TA4G ISLAM) WELL
Alf 34 (MSOFATW Vg ) prarmit QLetter of Permission
latita�iN IT144 WATIAM)
tyl, OI AftR.if�Rt me
APKIt:AtR IS 41wM C3104t4duel COPartoership QAasociatloa OCorporation Qtrunlcipallty QGovernmentsi tgsacy
�+ 4 TITtIC Of �/yl�lrJ
1?t nm� IIQ414 APPLIGTT0i[ PHONE: �/_„�]��L ?�C�(L
�..�u.. .�.. ....iw.�.�+....�..�r.. wan.
Ott P.Q. us POST Omcz—_ / C''c' /9'0 BTATe /V. V 2IP CODE�j/
tit roc eppltasnt) -�,o• w' ' 00 ace�„�G.gC/ PHoxe o I� -`f� Z,� 2_._/.5�
OR 1.0, BQx �:,Qg ,vt„ FOST OYFICZ a'F- STATE �2IP CODEoil
P
jllWf W"11003. , , �. �';''�L 6. WILL PROJECT InILIZE
Flgy 11t.1r}lileN, 0 *�i f—.la + •. ,...; MOM$ OF STREAM OR OTHER EATER BODY. STATE OV4.7^ a •:p?
(It appropriate; if un-named, show oo.
Tom 0 nap 0 See item Sb) p YES p r0
,.
+) �yeatlts aroleat Otto 41F area to marked on U.S.G,S. or equivalent map. attached as Exhibit No.���
PROPOSED too (IPrlvay 0. PA0MED STARTING VATtis 9. APP"XIN&TE COlOUTION DATE 10. FEE OF S_I_j:ICLOSED
C)P0144 pCol�teesoiel .
�o c�a is 1
t'ty=CT Duu1niaxt (feat of rip-rap now channel; cubic yards of malarial to bo removed; draining, dredging,
MILDS# end location of disposal sites; type of structure to be installed; height of dam; size of Impoundment;
"PO"tt*e 14 pkaf"e4 Wtar pourcos; extent of dtotributiun system; etc'.)
t• P!1��,�'!/Gf• A �'-51�ory �Yf��Sio�I . I�r on a"Lris1. r3f ewe//ir��
/A /tea�c,�i. /✓ 0144,
This proJacg will require the following additional permits. applications for which are the responsibility of others;
04kh QGOGS QSTR►INi DISTURpANCB Q'SPDEBJaiPDFs ❑WATEA SUPPLY ElL.L WELLS [)FRESH1ATER NETLANMS ❑TIDAL WETIA.' S
W% ANO � tj OF MICEA1. 11IMPAP94 Of LOCALITY WHERE PROPOSED WORKS ARE LOCATED;
v�
lx "Y PORTION Of TIM ACTIVITY FOIL WHICH A PERMIT 18 SOUGHT Now BEGUN OR CohP1ETE? []YES 'KNO
1f "YES", aiPlato in 44404a, giving reasons and dates, and show existing work on drawings or map.
1 heal Y af(itm under pedally Of pitiury that information provided on this form and all attachments submitted here-
withlputt IQ Itf fust of my knowledge and belief. False statements made herein are punishable as a Class A
09104rAA09 p IWI 10S00011210.45 of the Penal law. As a condition to the iscawnce of a permit, the applicant
4ccelts full legal fesppQSib(lity for all damage, direct or indirect. of whatever nature, and by whumever suffered,
414419 941 of the prpieGf desuibed herein and agrees to indemnify and save harailess the State from suits,actlons,
d fnaaell d CAs,1ii.G�Qltfly noom and desCript resulting from the said project, �
PAC
D I sIGNAIURl
} ' a SEE REVERSE SIDE— -
ALOANY,nlw %U" 121JJ _. ..... , .... . _�..
APPLICATION NO.
,�_ t�rut{tpN ON LCR ti♦►Otiti fQ ANG TRIS APPLICATION. PLEASE TYPE OA IT CLEARLY IN INK. VS2 SEPARATE .
'° ''�'+ •�" .1Jill 12 CUMPA ! T !� FXPIANATiO`:S Fon U'ItcN S, e 0 T•YE FARM tS INA LATE,
ANtlatlo 13Tltl♦,3 (COMM 01 AQUATIC INfRCTS, frEEOS, OA lR1DF..RIAABLE FISH)
flat♦ ls: Title S (PAOTS6T M Of WATERS)
'Q Pgr ib♦ �Oq*ttYpttlpp+,iNoastructtoa.•or repair of a DAx or oq er impouadmcnt structure.
nttotr til♦ amtruotione recoaatroction. or repair of any-permanent DOCK, •pier, or wharf; and any dock, pier, Of
� #Itnstrf *jig 0% op"Wrk supporta. which has a top eurfaci area of more than 200 square feet.
lor �l,P i�W the dlstprbeago of a STREAM NO or excavation In of till of navigable maters.
OArttl♦ts Is, Title is pYATEA SVPPLY ALONG ISLAND WELL
AM v)w) preg it QLetter of Permission
t�lAMli 0I APPLiGIR: Mc
1rPPI.IOAtR ii'�/aM
01e4WAuel Dfartaership QAssoeiacioa OCorporation E3Munietpslity QGoverrmental Agency
4 TITh of J' '���•� �'
�,�; PHONZ ,I"i� 73f� ,die 7�
as P.C. gaol Pose OMC1k _ � STATE N —ZIP CODE 3/
t � +►e3asRf) — e„ „`;, `r-=ee1;- - .' raoN1:02 l a -��'7• ?/
{
gm
OR
N;
x
OR ).p, - tragi oFi:ICR e'1- STATE _zIP CODE D
WCATIONi: 6. WILL PROJECT U71LIZZ
017 �Ir•Y�� w�►`04,.. ,,... tNMR OF iT RAM OA OTHER MTER BODY: STATEoto:+ *,A�;)±
�slltl ♦ (mapappropriate;eee tteoSb) 0 YES un-named, show on. ,
V "iia pwa4est Otte or swop is marked on U.S.G.S. or equivalent map. attached as Exhibit No.�Y
Jaamn UJJf OFrivst♦ 4. 114I00 SLATING QATIs 9, APPROXItikTE COKFUTION DATE 10, PEE OF $,.,,,_J.rCLOSED
. .G>Rt+#�►♦ " QCAIwMsaisl . � l'D G'Ztd ��
fspuT M SCAYPI'lt1lir (feet of sip-cap sev chaanal; cubic yards of matorlal to bo reswved; draining, dredging,
Sitting, wA location of disposal sit"; type of structure to be installed; height of data; &Lao of impoundment;
",PWtlp# Of PWOM,04 11019411r ponnta♦p; extsat of distribution system; etc:)
>y aCYfe.�sio.� . on Q't!is1'�ir3 j dw�//�.ri�
•
xr,hn� cQas�rv� v'r�
Vg A~
y/. �.�
ibis proJect will reouire the following additional permits. applications for which are the responsibility of others:
t7. n:+1M CIIiOCi[ �iTRWt DISTURLMCS CSPMJ1ipDBS OWITER SUPPLY EJL.L YELLS ❑FRESMATER WET"-MS ❑TIDAL WETtA;.DS
t A1♦1 AI► 9"IM& M6 OPAP94 Of LOCALITY WHERE PROPOSED WORKS ARE LOCATED:
i4!t.� J
trORTIOM Of TO ACTIVITY POti wutcH A PERMIT It SOUGHT Now BEGUN OB cmwLETE4 (]YES ,�'jNO
1i'"Wits", aiglaio to attdeada, giviaj reasons and dates. and show existing work on drawings or map.
S�Ii�it��tiAT�tMt a
.ra-, 1�a• ti
hetepv;itirm under PVnalty Of perjury that information provided on this form and all attachments submitted here-
Wilk*044 I.0 tt pest Of may knowledge and belief. False statements made herein are punishable as a Class A
p404vanw pur;Want 1O$QC1ion 210.4S of the Penal Law. As a condition to the issuance of a permit, the applicant
4CCQPcs lull legal resl)Q*400 for all damage, direct or indirect, of whatever nature, and by whomever suffered,
,atjsi Q l o� lite prp�ec� described herein and agrees to indemnify and save harmless the State from suits,actions,
��pwoesi xqd t:Akli,li! Il ��f Mime and descript' resulting from the said project.
yj).
DAT '
SICNA1 URE
tEv[R5I SIDE- -
AtdAhr,htw %U" It1JJ _' `'••• • „ •• ' ._._. _ �_..
�. APPUCATIUN No ._
IgST}UC�IOM OM YCR RIORx CO!? '1110 THIS APPLICATION. PLEASE TYPE OR IT CLEArtLY IN INK. USB SEPARATE
i00 JIM-A%�ll TEggirfRlI T !� FXPLANATIONS FOR w'IICII S. c. 0.4 T'IE FORM IS INADEQUATE, ��:•�i
�A 114111 1119 T191g;7 (CO=& 00 AQUATIC INSECTS& WEEDS, OR ONDESIRABE.6 FISH)
S t o ill 13. Title S (pROT1iC'tI011 Of ifATBA9)
17 yqe itlq OpOSRSYitloAo.i"onstruetion..or repair of a DAN or other impoundment structure.
pygr Ely epoatruotion, rewwtr4ot1946 or repair of any•permanenc DOCK. pier, or wharf; and any dock, pier, of
IrhvirR.
(p►llt oq opanWrk supports. which has a top surfac: area of more than 200 square feet.
dlaWth vi o of a STREAM DIED or excavation in or fill of us able vacera.
OArtiols 130 Title iS OWATER SUPPLY OLONG ISLAND WELL
.:(]APi4A18 ;4' (f=UMTU WlTls'M) Pi faratlt [Loner of Permission
,P61;10.10
14 (1144 Wt )
tL OF 6Py1.ICAtrtt �'
'' API'I.IGA/iT Ia A/AtM CII04;v44wl QPartae:ehip ❑Assoeiacioa oCorporarl,on []Nuntcipallty C]Governmental Agsecy
tilAi$ 6 TITLE OF
Ormw 11gan w"I 1. PHOtiZ ;? ?e
Olt p.Q, "+� P00? OPlIt3L_ frU/J/G STATE /V- Z IP CODE 1191-41
r I{ANdr �ApRt;SS OlT GtII 'tCp Q Ce PHONE-
(I( poi #PPI1,6400
r1Tt1LLT,#maps
Ita ,
OR .O, IIQR ��,�Q$ vL�I" U JUST OFPICS e 't STATE—` ZIP CODEILJP
AW I.00ATIQQI• 6. WILL PROJECT UtILEzr
Vitt' ".1f iilW�o�..� � ..t�.,...,... RANK OF STREAM OR OTHER EATER BODY: STAT.:
(It appropriate; if un-nomad. show via.
4. • slap - See Item Sb) []vE8 O`:0
!) jPeClfla project; plto pr aroa to marked on U.S.G.S. or equivalent maps attached as Exhibit No.
IROP069D U0$1 orrivat0 rte MMED 5TARM9 OA•1'l;0 9, APPROXinkT9 coKn8TI0d DATE 10. FEE OF $ �YCI.OSED
OF0114a pcwmi"141 . 1*e 60 aPa Er _
fW ACT DCSCRInicMs (Peet of sip-rap aaw channel; cubic yards of matortal to bo removed; draining, dredgind,
tillieg, avid location of disposal sites; type of structure to be installed; height of dam; sirs of impoundment,
qtpos4ttoo pj p;op"04 falter pourcoa; "tout of distribution system; etc.)
t4Pti�14,cwc rc a /—s/o ry f�Y fe v:r1v 7 . A on �trial�lr3� dol e/%3�
11 a
Awe~ eQ/�S Iry /U- 71 /&,g 10 rah. /va ce"1f /✓o /Ci T1.
This project will require the following additional permits, applications for which are the responsibility of others;
Dull'/ LIDWIC (36TRIIAM DISTMIAANCd CSPDEB/NPDeS OWATER SUPPLY El L.L WELLS OFRFShNATER NETLA-MS ❑TIDAL WETLA',"DS
tiAt� A I O OF QfFICE4 trlplrSPAP91 Of LOCALITY WHERE PROPOSED WORKS ARE LOCATED:
vXg Id.
14 4M PORTION Of TIM ACTIVITY FOA WHICH A PERMIT IS SOUGHT Now BEGUN OR compLEIE? OYES ,Kxo
It "YBS", alrplato la 044048, giving reasons and data&, and &how existing work on drawings or mmp.
�14�;111'AT;ARAE �' .,.: .�„�;1•t. , ,,.�
J he( Oy 4ffirm unlet penalty of perjury that information provided on this form and all attachments submitted here-
witb'4 pile 19 the bast of my knowledge and belief. False statements made herein are punishable as a Class A
WAWA Wr p1 IWI to SOCtiOn 210.45 of the Penal Law. As a condition to the issi, nce of a permit, the applicant
MFIS full lebal reSP-M Q 10 for all damage, direct or indirect, of whatever nature, and by whumever suffered.
Gala 941 Of th0 910JOCI 0SCribed herein and agrees to indemnify and save harn►less the State from suits,actlons,
woes and fus'ISA4lland deseript'ion
rosulling from the said project, �
Lae
�AI SIGNA1l1R_E _
”' -• SEE REVERSE SIDE —
loeoll /,Y� 1q"
4 7 IZ-7sT XICI
ov Z?Z06 flflvll- 79�- 1C1 �M
-e�1-�Ylf
n �
e
B�np p�PT. !D
TOWN OF 8th TH9
7�
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: `L C-C/
,DATE O7 INSPECTOR .�vf
c
r 70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] UGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: rte . «2
DATE O INSPECTORS
suauINc DE".
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] GAMING [ ] FINAI.
REMARKS: .
DATE �/ INSPECTO �
� 76 70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS•
DATE // � / u � INSPECTOR
FORM NO. 1
TOWN OF SOUTHOLD .W 1 T M
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
/ TEL.: 765-1802 i --
Examined . .A, . �Z� ., 19 f� Received . . . . . . . . . . . , 1 9 . . .
Approved .<A:!/ . .2 S. . . ., 107Permit No. `? .
Disapproved a/c . . . . . . . . . . . . . . . . .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT //
9 YJq Date .� 7. . . . . . . . . . .. IA5
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 Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk 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 inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.(?- 4. . .Po PLP ALTQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises me - . �A I l.ff iZ_
(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. . . . 3. . . . . . . . . . . . . . . . . .
Plumber's License No. �. . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 G�
�Tt(.�w AT. (i.,... . ,FA �. . . . . . . . . . . . . . . . . .C �zl raG c . . . . . . . . . . . . . . .
House Number Street Hamlet
County Tax Map No. 1000 Section . J 3 7 . . . . . . . . . . . Block . . . _ I. . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . '.l-� � !. . .�� . 4�/�l�1.� . . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work(check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . Alteration
Repai*Rp,. ti. f . . . . . . Removal . . . . . a . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Description)
4. Estimated Cost . . . .43,.( ao'o-6. . . . . . . . . . . . . . . . . . . . . . Fee ��—o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
# (to be paid on filing this application)
5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . .
Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy,specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . .
7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front . .3. . . . . . . . . . . Rear . 2 a.'. . . . . . . . . . Depth .1.30 •,
Height . . . !�. . . . . . . . . . Number of Stor. '-s . . . .I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . .
10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: MA . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . . . . . . . . . . . . . . . Will ex ess ll be re ove from premises: Yes No
14. Name of Owner of premises �eaf��. Sit,le . . . . Addres� `�.11W . I'ue.Phone No. . . . . . . . . . . . . . . .
Name of Architect . Address
Name of Contractor . V S �"t 'e. .+? . y/`� ��: p� '� ' Phone No.
t� . . . Address Q��IT". . .Phone No.� &.b .
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 whethgr
interior or corner lot.
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.
Heis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and 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 Qf 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 p
. . . . . . . . . .� ./. . `4th . . . . .day of. . . . . . . . . . . . . .1 19
Notary Public, . . . . . . I(./lt. V.4 . . . Count
HELEN K.DE VO£
NOTARY PUBLIC,Mate of New York . . . . . . . . . . . . . . . .
No.4707878.Su -,!!:Count •ignature of applicant)
Tecm Expires March 30, 19 7
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