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FORK NO. a 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° 23786 Z Date .................(.� dv......................, 19..Zfe Permission is hereby granted to: / . a..r 46.x' .. ✓<`.........✓1 ...... ' / to/�Llr�Y.l'�! ... ..vi•:u.�.;7".ae.......1�!rV....... e'�... .:e Aw ���� ... ��.!:... ' ��.�a2 ..T s /� r ¢`fya�a....i3 c:...�K✓eaY at premises located at ... .... efr!1 �.,.�. Fie,............ ! ..APpCS..S�f/. ... 1.� ...1..1..�.............................................................. ..................................................................................................................................................�....pp...;.......... County Tax Map No. 1000 Section .. ............. Block .....4( ...... Lot No. .......GN. ........... pursuant to application dated .......... /✓......l,,l...................... 19�.�, and approved by the Building Inspector. Fee $...i1/lff.'.../.R67 ...... .... ....................... /�� .. /n;;;Z;�o Rev. 6/30/80 i _. COMPLAINT REPORT NAME zf A10 Al YM 0 644 DATE Ila7 ADDRESS PHONE# --- HOW RECEIVED, TEL MAIL IN PERSON LOCATION OF sas COMPLAINT NATURE OF p COMPLAINT - 4*1&11 75- PIZ or ASSIGNED TO INSP. DATE 12_r/l REMARKS ACTION TAKEN FILE # (IF APPLICABLE) RE-INSP DATE I I OFI RVA'Olt I- DA'I'P. COCIMI°N'1'i -- PUIIrINn'I'1 ON ( ISI') I .. . POUNIIAILON (ZNU) N ulnn:n r•unnr. F 111.1114111 NO ...... - ._ I' Illi OI ATION MCA N. Y . I (1 E'I STATE Ii NIiNRY . ............_ CODE - I t P I IIA I. IJJII ----------_ .. AUNI'YIONAI. GfttIC11;N'I';i: R r 4 (] b + BOARD OF ORAL'I'1I FORM N0. 1 3 810.3 OF LANS . . . . , . . . . . TOWN OF SOUTHOLD SURVEY p BUILDING DEPARTMENT JUL Ims TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . f 5011'1'IWLD, N.X. 11971 j 'ry TEL: 765- 1002 N0TIFY: C22-4tL=7 I-A, fag-`^ BLDG.DE y OWN OF SOUTHOLD .� S (;At.[. . . . . . . 19?6 MA 11. TO-�iP-p,to /!�, /�)Z;Y✓1. , . . . Approved..!. ...... 197., 11enni1, No. Z". 90 I...7.......... Disapproved n/c ..... v .. .../..� ..e ...........tic.. ..r.. Y.1 Iq 7 .,.r,,.._w_,.�«...(( 6 z (Ikuld nL Inslneclor) it APPLICA'T'ION FOR BUILDING 1'Eimur INSTRUCTIONS a. 'Reis applicatiannarst be colpfelely filled in Iry typecirit.er or in ink aril suimitted to the Wilding Inspector wide 3 sets of plans, accurate plot: plait to scale. Fee acconlineg to schedule. ,b. Plot: plan showing location of lot and of buildings on premises, relationship to adjoining premises or lxdnlic streets or areas, aril giving a detailed description of lay(xrl: of property ttrest lee drarem on the diagram wllich is part of This applicad n. c. 'Nee work coveted by tens algnlicaticxn orry rat be carrneuced be = 'enmr" of Miildirig Permit. d. Illxxi ap[uwal of this cipplicition, the Building Inspector tail, a Wilding Permit to the vof)licant. Swcle Twnnil shall Ila kept cat the premises available for bmpectior lhrueglxxwl ,/j irk. e. No Ixtilding sleall be occupied or used in winole or in part for aery purpose whatever wntil a Certificate of (kxulcaxy edeall have been granted by the Wilding faspector. Aft MA'I'ION IS l ITUlY ME to the lkeildiog UeparWwnt for the issuarxr. of a Ikeilding Permit peersuant to the Ikeilding 7xxee Onlireatice of lite Tam of SociUwld, 9ci folk (kxenty, New York, mil other ipplicable laws, Orditmnces or Regulatitm s, for Ute crxestructiae of Imildings, wiclitiors or alterations, or for removal or donAltion, as herein described. 'Ihe applicant agrees to cnneply with all applicable laws, ordinaex:es, Ixtilding cock, hansing code, mxl refnilatio ns, aril to axliolt authorized lnspecl.ors ane premises atxl 3n Wilding for necessary inspections. ........ - _................ (Signature of applicant, or tmer_, if a corltorntion) 1 ...Bc?. ....'(o7yS ..... !-?:t'...... Willing arklress of applicant) State wleedwr applicant is owner, lessee, agent, architect-, engirieer, gereerat contractor, electrician, phxiier or Wilder. r0% 0 Tr, . ....��J=S1Ca> ....................................... ............... ................ Nair of (tourer of preaises ......VI�Jff—,C 1. 1 ....... .... C��/� IL1Gt=.............................. ...... ......... (is on the lax nett or latest deed) If applicant is it corporation, sigrtaUere of citify audwrized officer. ......................................................... (Nave atxl title of corporate officer) fknilders License Nit. .rp.i?................... Plueieers License No. .731?.................. Electricians License No.TB1)................ (Illicit: 'Itak's License No. ............ ........ I. 1<wal lon of larxl on t dch profosed nark will be doete.................................................. ............ ......................... .... Hatese Nioher Street Ikmlet (minty Tax Kip a). 1000 Section ...;?-2 3.-...... (Nock ....G ......... Int .......... Stilxlivisian ......................... . ............ Filed Wap No. ............... lot ............... (Nave) 2. Slate existing use Poll occupancy of premises aexl inteoleel use anal occupincy of proposed construction: a. Existing use anti ocarlkerecy ......C-���-.I:( .XTAL-..... ...... ...................... ................. b. hdewled tine Poll occ7npmiy rr '( N '1. Nluna of Imelc (clw:ck rahich all'ilicabte); 1164 Ik,lldinll ........ . . /ukllllon , .X. ..:. AtIeratlon .... .. kelulir . . .......... Itelr,val ,....... ... IIeIK)litlnll .... ....... . 011 let tdnk ... . � ((yy �i Akncrl pt ion) ' hII4 . Its( I1t I'll ( )sI. .. . . YO �.•.'�.1. .. ... . fee .... ... ... . .. ... .. . . . .. .. ......... ....... ..... . (lo be paid on filing this applicalloo) 'i. If thiol Iinli, oxolIer tilt cka(:IIinq ollits . . . ,.. ... ... ItY11N:1' of dwelliait unlls oil each floor .. .. .'7... ... .. . 11` garage, nKYdor of caro . . . .. . .fJ.�P:... .... ... . . . ...... . G. If Ixahwun, canlerclal or udxyd oc:cutoecy, filx'.clfy nnlule alul extent: of efirh tylIe of use..... ..... .... ..... . .. /. IlixK:aatrnH+ of exiHCtng filnN)tul�on, if ally: R)oxrt.-51. . . .. ... . Rear ..51. .... . . .. . Dopilk ..L'..7... . . ..... li:iltfll: ... ................. ... :. lluiw.r of Stories 5 .... . .. . . ..1 .. ... .. . . .. • .. . I Ihi with nllerel.hos or FNI(Iltlal lH: FI'OIII. .. ..�L . . . . . .. . hear �,/, ...... Ik n.11H rot of o K. Hlnuaurli wl, 1l ... ... .. . . . . ... ... .. Maher oI' filar lea .. . .I .. . .. . ..., Ikl U ..... .. 'cNa Ilxl: Flow- . ..fit.(... .. . .. .. Ikfnr S/. . . .. ... ... ' hl 2. ...............,. Mnlx±r of SlorieH . . .. . . �.. . .. ... .. .... ll. IllaK�n:a uxls of entlu• Ix�ta rcoal)� 9. Sive til` 101 : Rrcxa. ...�.`�. . . . .. .... IL:nr ... .7 ... ...... . . . Ilapll) .. .1$$.. ... ... .. .. . III. Dale of ILrr.Ilase ......... .... .. . .. .. N nK of foulx:r Qaor ..... ..,.. .... .. .. . . .......... .... ... ... H. Ylxo ar uac dtnl rice in rAlirh t�ranl Hen are filtoated ..... .. .... ..... . .. .. ...... . . . .. .... .. ... ........ . .... . . . . . . .. 12. Ikoll prol)osed consi.rucitoo viol�ale ally uoinit law, ordteuxwL or ' 0... .... .... Will excess fill Ix: relrrveel Fran p all!Mae: YRS M) 4177-/QOO Il. tMines of: Qaneri'of preHlfies v1A.K-k")`l;r. f.,JpK`yl!-V;6�....... /vklreHH3'y }'t"SFR�¢ :Q..O.;C Pt:. llwx>< No. Mie of Architect: ... ... ... .... /vkh ass I5b.QR ,I(?�.$..:°>•c?-?TI;L:a-t'�... 11,coe . . .. . . .. . .. . N;nr: of Gxll.raccor ... . .. .............. ... Address .. . ... . . ...... .. . ... .. .. .......I'lolx: tb. . . .... . .. .. . . 15. Is (ilia proix;rly withic)*,W) f"i of it tidal w tlaxl'1 * YIS.S ...X, Pio . . . . ...... *IP YRS, %Afllkxl) 'Inim 'illl5:MWS 19iINITHAY Ix: ILII)lII1fIiD. PIAT DIAGRAM I[x:ale: clearly aid distinctly Ijll Ixftldllyts, 'whether existing or protosed, slxl hxlicate 4111 set-lalcic flinuosiolla (lull propelly lines. Give streat sIN( block IKuber or descripHoo ncetoxiing to (teed{ and al)aa sheet nm,es Hlxl ilwilcale lAwtlor iolerior or corner lot. I MAW (x? "M Y(xo(, (.t)(lIJ1Y (A' .... . t i 'Ivid 11 01,111111, runU I�.. .. ... . .. . .. . . .. . Ax!ing duly a(x)n1, doloaea alNl says ilial. he is 111C applicant above owed, Ilais Ihe ... . ... . . ... .. ..... . .. ... .. ... ... .. .. .. 11 ..... .. . ............ .... (Canllnr.U)r, nitenC, �:orioruLe of fleet, etc:.) of Said IxJIKa` (11' (l4HNU:1, mxl Is duly folhorized to ixn rolln or have torfowed the Said Mille old to nwlile al KI filo this app( icaLion; lhl'L al l alslaneots cont'fetlod in thin spill lcnl too rlre lllx: to Ilia Wal, of Ilia li ouledge HINI list ic:f; ISMI Ihnl. the ")It( will he perfonwil In the II4IIIIw:r Het: Iorth to file application I'Itell lhercnaflh. !(x)111 to l,elore lira this . . .. ..l. . . . ... .( ' of ... .i. . ...�./1�19�.4�� . . Ma.ary ILblic ... ..... :. I�� .!.({'/L�r.-�. 1 VCE M.WLKINS Oignraure of Applicant) Notary Public,State of NOW Ya't Te m9ExpiresJune 5 " 1 _ , x , 06, -- __..— ..._ .. o o , , _ r i a lF ar a•. :�! - - ., - : , -. - ' _.'t:7!t,. ..x...;:, r' ate. - .. r,.. - O R OCCUPANCY -- t USE IS U N LAWFUI. ; , WITHOUT CERTIFICATE, I OF OCCUPANCY PROVIDE OPENINGS FOR APPR'0 ED AS NOT ED EMERGENCY ESCAPE AS oATE: ' M REQUIRED BY PART.714 OF ., FEE: r � B1�: ` N.Y. STATE BUILDING CODE. NOTIFY BUI DING DEPARTMENT AT 765-1802 9 AM TO ,4 PM FOR THE FOLLOWING iNBPECTiONS: Y 1 , PLUMBING 1. FOUNDATION - TWO REQUIRED ALL PLUMBING WASTE FOR POURED CONCRETE &WATER LINES NEED 2. ROUGH - FRAIVIING & PLUMBING 3. INSULATION TEST[ilG ar`vORE�COVrFilldu 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET , PLUMBER CERT�r-ICAT�*1IV THE REOiIIREMENTS OF THE N Y V STATECONSTRUCTION & ENERGY ON LEAD CONTENT BEFORE CODES. NOT RESPONSIBLE FOR, CERTIFICATE OF OCCUPANCY DESIGN OR CONSTRUCTION ERRORS SOLDER USED IN WATER a, , . SUPPLY SYSTEM CANNOT � o EXCEED 2/I0 of 1% LEAD k. ,6, 14P- If copper tubing is used for water distributing, system; piping shall be of types K or L gft _ UNDERWRITERS CERTIFICATE , t REQUIRED44 ;�. 31 +I :i4''' -"�"►,+r, fir i ►� d5►- �e+'-b3 r : r Y ^ �"�."1"' � � �-��i.. '��a.�...► �t rye,:. '' .r " • +t. 3�` 4 Y' - 0 E 11 1MM''l�Y c l J n r' g. -. 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