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HomeMy WebLinkAbout24116-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25542 Date: 02/17/98 THIS CERTIFIES that the building NEW DWELLING Location of Property: 175 BURTIS AVE SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 67 Block 4 Lot 15.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 14, 1997 pursuant to which Building Permit No. 24116-Z dated JUNE 24, 1997 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & FRONT PORCH AS APPLIED FOR The certificate is issued to BARBARA KUNEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-96-0077 02/17/98 ELECTRICAL CERTIFICATE NO. 17384 10/11/97 PLUMBERS CERTIFICATION DATED 10/29/97 PECONIC PLUMB.&HEATING c � Building Ins-p-WOEtor Rev. 1/81 FORM NO. f 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° 24116 Z Date .......................... 9.l z Permission is hereby granted to: ............... ..............:...........! � 9nv ........ . ............................................................... ......0 u............•............o e.u u u.........a u........... .................... .............a. ,(.......... �^ .. . ...u. .uuuuo ..... ...... .. ....... ofpremises located at./.75...... � ...../... ................v.............. County Tax Map No. 1000 Section �F ......... Block &/ Lot No. .` / pursuant to application dated ........°°�/1.. .......................... 19.,/ , and approved by the Building (Inspector. Fee 5...f.7-....... /Si /b6rS AS /. . . . . uildl g I for Rev. 6/30/80 Eorm No. 6 baa--V$ S1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 IMICATION 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - 1 .25v� 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 lA n Y, Date . . . a .o lq.d. . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . Z. . . Old Or Pre-existing Building. . . . . . . . . �7. . . . . Location of Property. . . . /.!,57 1. . . . . . a 4717 5 House No. 7�Street Hamlet � ttA Onwer or Owners of Property. . . ,4Y4. /4.14. . . !?. PH r.N„ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . .4�.7 . . . . . .Block. . . Y. . . . .,./. . . . .Lot. . . . . . . . . . . . . . . . el Subdivision. ''.//.F#kG?!!!L. SYI411 <4 . , , • • , , , , ,Filed Map. .' �.`T. . . . .Lot. . . .�. . . . . . . . . . . . . Permit No.<26///(,.'.Z . . . .Date Of��DDPermit.✓ �?�1. ?. . .Applicant ACAWiF%441.1.14FA.);07 �„ • ep- Health Dept. Approval. . 1.7 �7A. . . . . . . . . . . .Underwriters Approval�©!///f,7 . . . . . . . . . . . . . Planning Board Approval. .'. . Request for: Temporary CCCe+rti,>ficate. . . . . . . . . . . Final Certicate. .✓. . . . . . . Fee Submitted: . . . . . . . . . . . . . . . . / S d G d M S I G z1A P. 6 .tl_,S`��olu APPLICANT f1 co as sva_ Town Fall, 53095 Main Road `i v Fax (516) 765.1823 P. O. Box 1179 -� , Telephone (516) 765-1802 Soul hold, New York 11971 ' OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE : 9-9 Building Permit No . \ Owner: (please print) / i Plumber: p/ "/6, // /J �I° N � ( please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead . Pli rs Sig tune) Sworn to before me this day olJ( 19 L Notary Public , County y� "a BARBARA STEPNOWSKI Notary Public,Stato of New York No.OIST4E414;i? oualiffed in Sufic":�aunly Commission Expires�c;d:30,I9—7 ELECTRICAL INSPECTION SERVICE INC. . 375 DUNTONAVENUE EASTPATCH0G(IE,NEJVP072K-11772 " (5I0)286-6649; 17384 DATE: 10/77197 APPLICATIONNo:ONFILE, VILL4GE - Peconic - \ TOW': - Southold, ADDRESS: n s o Place ISSUEDTO: - USACons"ciion F.":f INTRODUCED BY.' WEB Electric - - LICNq:, '45,65E- d' 545E - _ - - Wasa{amined an 10/11/97 and found tq be m compdjattee with HJe Nahanal.];7eetncaZCade., f- 77777-7-7 LOCATION.' .. - Base.. xx 1st xx 2nd - - 3rd ,- - - Attic - - - Det Garage HotTtib - `Pool - - �.SWITCHES .RECEPTACLES FIX1'URESHEATERS; .FAMS ,- GE-L AIR,COND. - - - 29-" 36 3I" 2=bdthfcua " ' '4 s40Atnp. DISHWASHER DRYER CLOTHES WASH. .GAR DISP. RANGE OVEN �WOKEDETECTOR - 2#12 30A'mp. 20AMR 40Amp. 5 FURNACE, , .06-- GAS :;- CAt MOTORS}'. BELL TRAM" SERVICE{J/SCONNECT -IWTart' -A,�s rxnss� OTHER - ' =i 30 ekt.panel 1-20Amp. well pump oil hot air-oil water heater - HdGO S:�SCIR_Dl. ; ` -PRESIDENT - - BUILDINGPEAWITNPI rn m�Iaolne�ar�am y a Ins,�dm -Ybeide .dbYlheum1*fi1b BLUE ORIGINAL' -YELLOW COPY PINK COPY OFFICE o�OgUFFO(�-C O Town Hall, 53095 Main Road y x Fax (516)765-1823 P. O. Box 1179 Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD November 7, 1997 Liso Construction P.O. Box 439 Jamesport, N.Y. 11947 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984 ) . BUILDING PERMIT # 24116-Z (Kunen,B. ) Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. . u;1;11 III;II It 1, 11ofI it l;I.oll 1. I161l WHIAH ii ull nun f l0(Im. �`c:.r�G�r�✓ /tel o I!,IiI.A"1'11111 I'1'.Il if . NIAIR F.IIr.II I:y (:IIIA! P� _^/.�`._-�� -4L- I') I')IIA 1. •_.--_--«,.._«.. r,�« AYII11'r I1AlA1, from T r V JACK P. CHKYCT 2700 Raeford Gourt MAR 19198 Orlando, Florida 32806 7 March 13, 1997 Town Of Southold Board of Assessors P.O. Box 11779 Southold, New York 11971 Re: SCTM No: 1000-67-4-14 1000-67-4-15 Dear Sir/Madam: Please be advised that the two lots described by the above-referenced tax map numbers have merged and I intend to sell them as one buildable lot. If you need any further information regarding the merger of these lots and/or the sale of this property, please direct any inquiries to my attorney, Christopher E. Kent at (516) 727-3417. Thank you Jack P. Chryst cc: Christopher E. Kent, Esq. M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN N [ ] FRAMING [ FINAL [ ] FIREPLACES CHIMNEY R ARKS:je r �I� DATE a—`�%1=�—INSPECTOR �//(t!:50 M-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION IST [ A;] 84AUGH PLBG. [ ] FOUNDATION 2ND [ �] INSULATION ] FINAL [�] FIREPLACE S CHIMNEY REMAR • _� (� DATE �� INSPECT R M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R UGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FF�AMING [ ] FINAL [ pFIREPLAC A CHIMNEY REMARKS: Cwt... s DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUN ATION 2ND [ ] INSULATION IN OZ [ ] FINAL [ FIREPLACE & CHIMNEY REMARKS: 6APOL P-� DATE INSPECT M-1802 BUILDING1 I INDATION 1ST ROUGH 1 DATION 1 I INSULATION FRAMING I FINAL Old","I A INSPECT i lr,73�1 1 1 � j M-1802 BUILDING DEPT. CTION [ tJIGUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ( ] FRAMING [ ] FINAL ( ] FIREPLACE & CHIMNEY REMARKS: r DATE -- I��INSPECTOR i 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] j .SULATION [ ] FRAMING [ ] FINAL`& [ ] FIREPLACE & CHIMNEY REMARKS: AL, r-- � _- DATE INSPECTO ALIAa W:E . TEL No .516-734-5176 Feb . 6 ,97 12 :38 P .03 .j1�ke5 fP e�kc sl'�c. Hwt6 o•a Sow�pUlE� �rir�llJEo Lc�fst w,uoo�� CEDnR SnAKES ' I Chi GAAW I t-� 611t6v6ar (/RAISES otW krclile?J JAA/I.A.. )4/fzitSJ 1�j GKS SnVC. FK /D66� Dlw l t.� ,D 01+t3,nx=rS C�,r>>Ccf WdH&-/DAY4: t /N '6AfSHGn�r 1 uy s1I„a iLtS SEpi+Rq� wEcc� bEl'JKob-1S LR -CAiwjAAL C4!�1,1)0;j Arr�c ��G gRs .. Pt�t.��o�,•J, s RI1ik5 �,.a Itrtc.�. ObTS (pr= SAW4k c'R- O H PA b g N 47 • v iP, y+ ' / Y IJ, V ,s Wow 13' ty 4 Ba,sc jrboa aa.fr (a,4o LR twirls' t>m Y'r 9' K AA YJ BRA 11'rR5'(1ir�5'� , 5 AA 2 II'rRa'(H'K�z' SMLr) 7 I4M = /D' / 1, FP' V LONG, r�n� E se to'rzs' --------------- DthENSrot N O CAMt tN Q E RLeR PeerC I` Ql110 511r= pY� I Fit,O � i S o GIBE ti tatrarur.raw BI P.W i '9 re LIYING ROOH p o Yrr r (1 Li ui z t('eo reD 6JL YtYYl�• a...i� (.oVfRm PORcu w•Dr+ rr' W Q ah ccJ Q Pollryl NO. 1 7 SETS or I'l..1Ns ;-r. . . . . . . . TOWN Or= SOUTHOLD SURVEY . . . • • • • • • . BUILDING DEPAR-I'MMI, CIIEc1, fqo . . . . . . . . . . . . . . . t j TOWN IIALL SEPTIC Mill . ✓ . . . . . . . . , SOUTHOLD, N.Y. 11971 1 EL.: 765 1802 tio71 PY ; Examined . . 19?� NA 11, To Appioved . . . .// . , I9�/. Pelmil No. . /��� . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (1) ng It .peclor) APPLICATION 1-0 \ BUILDING PERMIT Dale . . .... . . /,® . . . . . . .. 19 !. INSTRUCTIONS A. '1'Ids application mist be completely filled III by typewriter or In Ink and submitted to lila I)ulltling Inspector, with 3 sets of plans, accurate plot plan to scale. Pee according to schedule. b. Plot plan showlug location of lot still of buildings oil premises, iela(lonship Io a(Ijoining premises or public streets m areas, and giving a detailed desclipllon of layout of ptope+ly must be drnwn on the dlagraut which Is pall of this appli- callUn. T c. hwork ork coveted by tills application may not be commenced before issuance of Building Pernill. d. Upon npproval of (ills applicnllon, the Building Inspector will Issued a Building Peunll to the applicant. Such peuull shall be kept on the premises available for iospectiou Iluoughoul the work. e. No building shall be occupied or Used lU witole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspeclo+. APPLICATION IS 1111REBY MADE to the Building Depa+ltttetit for (he issuance of a Building Penult pursuant to the Building Zone Ordinance of (he 'I'owa of Southold, Suffolk County, New York, slid other applicable Laws, Ordinances or Regulations, for the conshuction of buildings, additions or alterations, or for removal or demolition, as herein desctfbed. ;The applicant agrees to comply with all applicnbie laws, ortlimutces, bullding code, housing ode, and regulations, mud to adunit authorized Inspectors on pieutlses and In building for necessmy cusp 41 �1 �-4 . � . (Signalute of np dicast or na . .me, if a corpora onr O S-3 .X/Y . . . . . . . . . . . . . . (Malting add Less of appllenul) Slate whether applicant Is owner, lessee, ageul, auchllecl, engineer, general contractor, eleclrieinn, plumber or butidei. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Naote of owner of premises . . . . . . .V./. ! tall . . . . / �� •S� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ss on til lox toll or tales( deed) If applicant Is it corporation, signature of d oly aulhotized officer. . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . (Name and (tile of corpolaate officer) Builder's License No. . . . . .J //n. . . . . . . . . . . . . . . ('lumber's License No. . . .T/..b. . . . . . . . . . . . . . . . Elecirdchm's License No. . . . I.UD. . . . . . . . . . . . . . Other Trade's lAceose No. . . I . . . . . . . . . . . I . Location of land on which proposed work will be done. . . . .� �)N9�✓,4j2' F--e. , , • , • . . . . . . . . . . . . . . . . . . . ►as. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . >.e . . . . . . . . . . . . . . . . . . . . 1 Dasa Number / Street Ilamlel Coun(y Tax Mail No. 1000 Section Gam . . . . . .-7. . . . . . . . Block . . . . . . . . . . . . . . . . Lot . ( .L . H—/7.. .... . . . . Subdivision . . .ac..O.I �� . . . `S/./.V�S. . . . . . . . . . Piled Map No. . . 1 .411 . . . . Lot . . (� .� /•/ . . . Omic) g rpancy of premises and lo(euded use and occupancy of proposed construction: 1/� C�nor. s >D nIT L. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . 2. Slal!xisll ngirrisetarendlocc rponcy . . . . . . . . . . . . . . . . .�. . \ b, intended Ilse nud occupancy . . !! [V�. . r.11!l��l. .l"�'�l. fYllrl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r} 3. Nulurc of workcheck which a r i ( I 1 liceble): New Ih111dh1g . , �. . . . Addition . . . . . . . . . . Allernliml . . . . . . . . . . Repalr . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . , , . . . . . Other Work . . . . . . . . . • , . , . . 7� (1)0acripl lot 4. i?slimntedCost �, /. .✓,�,a� .�. . . . . . . . . . . . . . . . . . . . . . . ilea . , . . . . . . . . , . . . • . . . . . , . . , , . . . . , . . . . 5. if flwullin number of dwallin u� nnyy (to be pall on Ming tills application) e. g Ills . . . • . . .'1�1, Number of dwelling mills oil each floor • . . . . l. . , . . . . . . . If garage, number of cars . , , , . . , 6, If business, commercial or mixed h ccupftney, specify n fill and extent of each type of rise , . m. . . . . . . . . . . . . 1. Dlmenslons ol'uxisling elnlcluras,llf nuy: Irront . . ./IP,�f�. • • • • • Rear . . . . . . . . . . . . . . Depth , . . . . . . . . . . . . . . Height or of Stories , . , . . . . . . • . . . . . . . . . . g . . . . . . . . . . . . . . . Numb Dimensions of slime structure wtlb nllernlions or additlons: l7ront Ilei hl , , , o , ,� � Ilelghl . . . . , . . . . . . . umba oplolles. . . . . �. . . . . , . Depth ; . , . . . . . . Icon: Profit . . , . Q.� . . . . . Itear . , . :/•u , , . . , . . , Depth . .a . . g G um G of Stories . . . . . . . . 9. Size of lot: Front e, Runr . . . ,7/J�, Depth r i , . . • , menslous of til re conslru 10. Dila of I urchns0 0 Name of ' Lb 111 0 11e�sTlrmi led . . . . . . . . . . . . . . . . . . . . . . l�� q' ;�r /�(r� ?•'t:( ySq ' �' ,i„ I I. Lona or use district In dch � am' ,, rr 12. Does proposed constrict oLvtolnlu ally zoning law, or(Itnanee or reIr lnllon; . .liTt%�. . . . . . . . . . . . . . . . . . . • . . . . . . . 13. Will lot be regraded , V., , J , , • , , , , , Will excess ill o r•1 o I n premises- Yes o ISI. Name of Owner of premises . T. G , t� ,C , it o�� kv • r¢ranrAc/ III to N?'y0�,��p6 Nuntu of Architect . . . . . . . . . . . : . . . . . . . . . . . . . . . Address . . , , . . . . . . . . , . , . . . . Phone No, property Address . . . . . . . . . . . . . . . . . . Phone No. . . . , • . . . . . . . • . . 15. In till.* withln 3Ub feet of a tldat wetland? *Yes. . . . . . . . No. .�Q . . . . enc of Lonlrnclor if yes, Southold Toon Trustees Permit may be required. PLOT DIAGRAIJ Locate fierily and dlsllnclly all bi111dings, whether uxislilng or proposed, nnd.lmilenle ail sat-back dlmensiolls from properly Ifnes. Give street and block nut liber or descripllon according to (teed, nod allow street names and indicate whether interior or corner lot. S'I'A'I'll OI', NI 1W YOI C COLIN'I'Y Ole . S.d. �. K s.s' • •c✓ /l/`6. . •�• I • •� •�.�. . . . . , . . . being duly sworn, deposes and says Ihnl hs Is lila npptiunnl (Nome of Individual signing ;bontrncl) nbovenmued. O Ile is Ilse . . . . . . . . . . . �I) , raci( ger , corporate officer, etc.) Of sold owner or owners, still Is duly authorized to perform or have performed the sold work aril to make and file this +npplicalfoil; that all slolemenls conlahlel in this npplicalion are 11-110 to the best of his knowledge and belief; find 111111 the work will be performed In the manner se forlh in the npplicalion filed lberewilh. Sworn to before mu tills / d - I/j� , , .fifty Of J,`G. . . .. .. . . . . . . . . .1 19 . Notary Public, / "` Counly N0.4ii0 PUBLIC, •SUFFOLKNOAH6RK " " " ' IESSICA TOMLINSON NOTARY PUBLIC,STATE L NEWTY 9 I COMMISSION EXPIRES MARCH 30, 19/7 (Signnlnre of nppllaull) J: -((J�•»,.._._-_. . ... BOARD OF HEALTH . . . . . • . . . . . . . . . _.f-`__Si... ,. �! '� FORM NO. 1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . JUN 31997 % BUILDING DEPARTMENT CHECK . . . . . . . . . .. . .. . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . .. . .. . . . . . . . . . n_........ r. 8 SOUTHOLD, N.Y. 11971 f3Lry+„,:2{:i'[ TEL: 765-1802 NOTIFY: TC)WPI OFSOu,-r?OI Fxanined..... //� ..., 191.� .. MAMAIL TO: . . . . . . . . . . . . . . . . . . . . Approved....... a ... 19 ,1. Permit No � .AIO°Wll�� .................................... Disapproveda/c/.................................. .................................... ................................................... (ISol ld nsCOr) ?m4 / APPLICATION FOR BUILDING PERMIT lit, �ggqr Date. juNG. .3 . . . . . , 1917 L� ,INS'1'EOC'1'IONS 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 application. c. The work covered by this application may not be con enced before issuance of Building Permit. d. Upon approval of this application, the )building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection througluout 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 HEBEW WEC to the Building Department for the issuance of a Building Permit pursuant to the Building Woe 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 canply 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) 4 M..Aet-?n 9:5R-47"..N.Y.r09A/7 (Mailing address of. applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Co rvw�Rrsl ...................................................C- v . "'�y'°�`' odd.. . ........... ......................................................... Nage of owner of premises $Gibb r�ca a !�C a rl E N,_,.,..„..................................................... (as on the tax toll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ��`} ` 1✓. 6 ` Builders License No. ....�.� d.y•-c^........ Pluniuers License No. ..4!;1. 9:. .......... Electricians License No. .. (� P.' ...... Other Trades License No, t ,1 wl or pu �� s Qiwa� _ I,la� 1✓ eFrAsfo�N+ R I. Location of land ou which proposed work will be done... .��....�........Q:.......................s...�...........�h.� .........x.7.5 .................. u� 1:.S...t?�!►� ............/�<.c� ,y :c House Number Street Ha det County Tax Map No. 1000 Section ....(v.7 ....... Block ...4.4......... Lot Subdivision4...5. .kt P.-r,.—e......... Filed Map No. .li S-#....... Lot .g:t X3,`9,..... (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 .................. 3. Ndwe of work (check whicb apiIAicable): New Building ,Y.,,,.... Addition .......... Alteration .......... ' eclair ............ Removal .......... Demolition ............ Olber Work .........:.........t.............. (Description) 4. Est:inmated Cost .... � nd 1......... Fee .............................................. (to be paid on filing this application) 5, if dwelling, unifier of chaellh units ....40...... timber of dwelling unit's on eadn floorf.!�'Q .......... Ifgarage, nnber of cars ... ......................... 6. Ifbusiness, commercial or mi occupancy,occupancy, specify nature and extent of each type of use...................... 7. Dinensions of existing structures, if any: Front.,::: ....... Rear .. --.-........ Depth ................ ?eight Mnber of Stories ......'................. Dimensions of same structure with alterations or additions: Front ............... hear ............... Depth .......--.....:... leipJit .... `............ Naber of Stories .^ .......... 3118rt R. Dimensionq, of entire new construct inn: Front ... � Rear .,.5$........ Depth .............. yy�p4� Ileil;lnt .....f.l.......p.....`./. �. Nriber of Stories —Z.r DAY ' 9. Size of lot: Front ...0/',T ........ Rear .,9Q:�{ ......... Depth „�!Gr L......... IO. Mate of Purchase ......x6,971,....... Mame of Ponrer Owner Aa�e.,f� e=4{ RAS 1„••„.•••,•. II. Zone or use district in which premises are situated .............................................................. 12, lees proposed construction violate any zoning law, ordinance or regulation: .NQ.................. 13. Will lot be regraded ..... AJ.......... Will excess fill be removed from premises: YES 14. Dimes of Owner of premises ).+f� ({�!4.�9„�i!vk!�(`�.. Kklressl�P.R? .�1Q.�rY/4!{°.4w�..NYPVxxne 110.3'. S �V. C N.me of ArebitecC ....... Address ...... Ibone No. ............. _ /7v Ltol�zl39 / — o.fBS/ tine of Contractor L,1.SP.�:�:ih•15.�•.S slip......... Address ................>1.4!?Bfi�ah!..I9xmne No.�.r�u�:...... 15. Is this property within 300 feet of a tidal wetland? * YES .......... ND .N�.... *IF YIDS, SOWI1101D IMN 'ITA Smug PI'smrr MAY RE Ill'sOil ill. PI.O'f DIAGRAM Inc:ate clearly and distinctly 411 buildings, whether existing or proposed, and indicate all set-back dimensions from property linea. Give street and block nnber or description according to deed, and show street names and inlicate ubether interior or corner lot. �I s 41 L/ 45 < SI'A'lls 017 ICW YMK, S5� O II1N1'Y OF .. .. ... dSa , R • "'.••• •• ••"'being duly sworn, deposes amxl says that he is tlx: applicant of individual signing contract) above nnxvl Ile if,, the ...........Gvwl/tro - .. .................................................................................... (CcnntracLor, agent, corporate officer, etc.) of said owner or owners, and in duly fnrihorizel to perform or have performed the said work and to make and file this apps ication; Llnl: all statements contained in this app]icaLion are true to Lbe best of his knowledge and lxelief; and that the work will be performed in Lh� nnnner set: forth in the application filed therewith. .,horn Lo before nr_.day9of .. 11� ..... 19..G..7. , ` 3 M)L a ry Public ..C.. .... ...... LIWAd.CooPER (Signature of AD>[nlicant) Notary Publio,State of Newyork No.4822563,Suffolk CouotY Term Expires December 31,19 SCDHS. Ref. # RIO' 96-0077 IV -. 0 A L Q 3A vie\\ t c:) c,r• J v n ea F�'oe W E S v i M). b � �� c § ( +�.w � `Yi"r43 NW.� A-+�i��e••;2a.+..��✓iYi ,�pgRKs@oM7uL0AM 'e . rqj, � _. _ '880104 40AMV''9AMD RALE ATOWN A160RM1 . SA/iDY CLAY -YANDY C"y h 0 P R 9? . K COUMDEPAR'l1o�NTOPMaT8SERVtCES AREA s 10 137 s f t. APPROVALOFCONSTRUCTEDWORI ,strrol Q �( muk1 7 IGLEFAMILYR mart+ (� f Rate M&RSP.W CERTIFIED T0t ►"� The sewage disposal and wMer sappiy t'apllities at Lhta locwon nave Open BARBARA KUNEN inspected and/or eatifial by this DepRtr ther=W,,,tes nnp f=jd W be satisfactory POR Xi MOOMS. _ S en A.Costa P E Chief CURVE OFo�cfWatcrandW Ma , LOTS 98 & 99 MAP ; NO. 2 The locations of web and cesspools shown her'e'on-are from field � 'PECONIC, SHORES observationsand or from dsts obtaned from:others. PILED $EPTEMem ''l5, 1930 FILE NO. 834 ` P 'TheONIC ,water supply and sewage disposal 1 T PEC . systsnta'for this reaidenoe wt'd conform 'to the sia"Weds of fie Suffak County TOWN OF SOUTHOLD _ Depsrt> ►nt of emth services. SUFFOLK COUNTY, N Y. 1000 - 67 -- 04 - 14 & Stile 1" 20' ELEVAMMS ARE REFEREaNCD TO A sUWD i7A No v1, 1990 Xlv i 24, 1997 ( FOUNDA'.T ION ) Sept. 30, 1897( final ) ` P�� of NEW ANY ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLA,7110N S� o�ta 7 MEr�o 'pf OF SECTION 7209 OF THE NEW YORK STATE &'fV(/CATION LNwF4 , EXCEPT AS PIEP? MON'7209-SUBDIV1SION.2..ALL CERTIF 77�1NS a HEREON ARE VA FOR THIS�►/fAP AND COPIES THEFEOF ONL Y SAID MAP OR C S BEAR TtIE pNPRESSED'SEAC. OF" t SURVEYOR," _ t *' WN05E'St( jATY.�th.,API�'EARS HEREON. Y. i ADUIT"ACLY.TO COMW vY,WITH SAND LAW THE TERM "AL,,t0 D #Y':- N 92 i GP t 6• 3j v - cov° o 0• . e y C4 �V . ry' � W E' vjea 3 o � ~ X32 S 6� z E pr A. in 7 � o w , / ON // V DWEL1/NQS I DARK BROWN LOAM 61• 9'1 'BROWN LOAMY SAND Z,5• / �O� lY I VALE BROWN MEDIUM 0NA_// •`' 'O COARSE SAND 12• / SANDY CLAY \ LO PP $ANDY CUY IN ` i WA'rE2 C O`R\ RO 92 GR AREA = 10, 137 sq. ft CERTIFIED TO: F P5� BARBARA KUNEN SURVEY OF LOTS 98 & 99 MAP NO, 2 The locations of wells and cesspools shown hereon are from field 1 1PECONIC SHORES 11 observations and or from data obtained from others. FILED SE/P1 TEMBER 15, 1930 FILE NO. 654 A C P The water supply and sewage disposal T PECONIC systems for this residence will conform to the standards of The Suffalk County TOWN OF SOUTHOLD Department of Health Services. SUFFOLK COUNTY, N. Y. 1000 - 67 - 04 - 14 & 15 Scale 1" = 20' ELEVATIONS ARE REFERENCED TO ASSUMED DATUM. NOV. 1, 1990 �Ju(n�e 1997 / FOUNDATION ) ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, b Q O EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS w. 111��newmrff S� ,�N Y' McTdo HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF _IF JUy E �o �� „ SAID MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SURVEYOR S. LIC. NO. 496/8 WHOSE SIGNATURE APPEARS HEREON. � ,�,,• i�c�,-`,t 3 j - I e6 V7 �e1� � X'l 0" F'l7UAf.D�"6t�N WPIC / Otis I(9� >< FOVTI a4 c— L{}. ` �; `t I I I� "�I i Tvvlrn' 3=s SY I. coL I I 1 F- -7 -- r 3- XIoFIr<.bC�_ ��I ' ,N! 1 51e'_ .;F A r" >• • I 0^i 6YER 4 3FT $EYO N9 TNt ! SILL S� i � r OCCUPANCY ORUSE iS UNLAWFUL -- WITHOUT CERTIFICATE OF OCCUPANCY 5 0 DATE'. DEPPPROVED AS ARTMENT AT OAR THE 7G6 1P02 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS: 7 FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ------ 2. ROUGH - FRAMING & PLUMBING —'— �+'�"--"-'-- --" ---'- - - -` 1 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. Q�• gRQ��fJ r�U lf' ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. r STATE CONSTRUCTION & ENERGY [3J R11S PLACI CODES. NOT RESPONSIBLE FORa E�C'a�11C SFkNLES" DESIGN OR CONSTRUCTION ERRORS P .rr -�— S, c. 1006 - 6T GARgG�E /oN 0PPDS wl¢ c an > �LRN � �55� Ea mod—�£Fr YxcEP_7' '-- LDCRT9Uo luetz + cess; ��s P&ft SURvE4 CC &1�7/94 lv d- awralKCD. DEPT, 0s f/F474 41PPPOJA-L Rtir et 210. 96"017] ?,fACkEN-DVt-t_T" 1- _- -t _.: . - o _ E _ , -- — — — ri 7T I — fiaI oll , I-I ti 2' e ar . ;; go z � I DO NOT PROCEED WITH FRAMING UNTIL SURVEY OF FOUNDATION LOCATION Ali HAS BEEN APPROVED. — OCCUPANCY 0�. �� . El USE IS UNLAW L � ' OF OCCUPANCY WITHOIff IFICATE� �LV«i(Ci �rrrI� <$ 1 'o 11 NOTE11 maill B.P.Kum� # tTSE-t�eoz e-A `� - FEE� By: �9� nu�y rMme PLUMBETLEANG DEPARTMENT AT AnTO a PM FOR THE � ` - Ilk VAUM UM NMON LEAD CONTEMBEfORE * FOLLOWING INSPECTIONS: �� • TEBTWOBEFORE 00VENN0 CERT/F/CATEOFOCCUPANCY Ni1�NQ 1. FOUNDATION - TWO REQUIRED meq_ SOLDER USEDAV WATER - FOR POURED CONCRETE / - SUPpaSMEMCANNOT - Z: ROUGH - FRAMING k PLUMBING' EXCEED 2-110 OF1%LEAD. S:' INSULATION k `� 4' FINAL - CONSTRUCTION MUS'P dFo _ _ BE COMPLETE FOR C.O. ��- . - FAOVIOE OPENINGS FOA am ALL CONSTRUCTION SHALL MEEF , /� ENE . E� THE REQUIREMENTS OF THE N.Y. - REQUTAEOAYPAALi140F . Noonnr VAIN Is d � � SATE CONSTRUCTION B ENERGW r/ ✓ �p( - - - N.Y.VAR GNNDING CGOE. Tr 1MIUf dIBYBNMBIO - GOOES: NOT RESPONSIBLE' FOIF' /� ,T.e«ro vro wrM'w an anugrrEu+� orr>� - LqmownmcsmwAE *sun a , - - ' X V WALL '(IRh 2)(1Z KAM err 2Bf3 � v >y �N \ P - Iz �f0*Rt z,g° 4dnR gRA��e m 9 �� t V{'s' _,� —Q"� s_ _—... _ ._�-.'(�_ _� GlR bCA J- _-�-•.��'f� — � .— � —..�r...�-I. T- _ -- - I '`++� __ .__ _ p .`s+ 2OY20Xt0' Il� � FOOTING- -- 00'- y � I ilff DWPI _ - .. u 4iw f sTefs -� -7 �v� 5b" � o 2.2 58 ` (0" IF CO 1u 1 17D r? 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