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Home My WebLink About23504-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCCUPANCY NO Z-25221 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 6500 NEW SUFFOLK AVE. House No. Street County Tax Map No. 1000 Section 115 Block 15 Subdivision Filed Map No. MATTITUCKt N.Y. Hamlet Lot O1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 .pursuant to which Building Permit No. 23504-E dated ~ 14, 1996 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 ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED DONNA L. BREITEN~ACH N/A N/A Rev. 1/81 B ld FO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCN3PANCY NO Z-25220 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 6500 NEW SUFFOLK AVE. House No. Street County Tax Map No. 1000 Section 115 Block 15 Subdivision Filed Map NO. MATTITUCK, N.Y. Hamlet Lot 01 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 pursuant to which Building Permit No. 23504-Z dated JUNE 14, 1996 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 ATTACHED ACCESSORY DE~K TO A~OVE GROUND SWIMMING POOL. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED DONNA L. BREITENBACH N-363091 - SEPTEMBER 8, 1995 N/A ng Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD EUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICAT~ OF OCCUPANCY No Z-25219 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building ACCESSORY Location of Propert~ 6500 N~W SUFFOLK A~FE. House No. Street County Tax Map No. 1000 Section 115 Block 15 Subdivision Filed Map No. MATTITUCK, N.Y. Hamlet Lot O1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17, 1996 ~ursuant to which Building Permit No. 23504-Z dated JUNE 14, 1996 was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY ABOVE GROUND SWIPING POOL AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED DONNA L. HREITEN~ACH N-363091 - SEPTEMBER 8, 1995 N/A ~ilding Inspector Rev. 1/81 lrOTM NO. I TOWN OF SOU3~HOLD I~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 23504 Z Permission is hereby granted.to: . ...~ ....... ...~.~.....~.~....~c~...,.....~....~:.. ...~.' .~... .................. ~...V., ........ ....... ...... ,~...~ ........--~.....~.~.~ ...................................................................................... at premises located o, ....... '/'~.~ ....... ~..~.........~..~.~.....~....~.~...: .................................... County Tax Map No. 1000 Section ....//...~.. ........... Block ..... ~.....O.~... ........ Lot No......~...~.. ............ pumuont ,o epplicotion ~t~ ....... ~ ...... Z~ .................... . 19.~. ~,d approv~ by ~, / Building Insp~tor. /~uilding Inspector Rev. 6/30/80 JUL Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 PPLICATION FOR CERTIFICATE OF OCCUPANCY 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 Compliange from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~ .2~¢, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ..... ........................ .. . New Construction .... .~..~..~.Old Or Pre-existing Building ................. Location of Property..9.~ .......................................... . House No. Street Hamlet County Tax Map No 1000, Section .... ~. ...... Block...J~. .......... Lot.. J ................... Subdivision . Filed Map Lot .............. Permit N- ate Of Permit ......... Applicant. . Health Dept Approval Underwriters Approval ......... Planning Board Approval . .. Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .......................... i ................... BLOG DEPT. , TQWN__~Q F S~QUTHO~I TOWN OF SOUTHOL~ BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: i. 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 sewerageZdisposal(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/I0 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ail 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 Buildinm - $I00.00 3. Copy of Certificate of Occupancy - · .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Bate ........................................ ~ew Construction .... .~.. .... Old Or Pre-existing Bu±lding ................. Location of Property..~.~.q~ House No. Street Hamlet of Property Onwer or Owners .. .. County Tax Map No 1000, Section .............. Block ................ Lot ...................... Subdivision .................................... Filed Map ............ Lot ...................... Permit No ......... Date Of Permit ...... Applicant.. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .... ? .~.~.: . .~. .............. ~ ~..~~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 sewerageidisposal(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 iastallations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B4 For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 Buildin~ - $100,00 3. Copy of Certificate of Occupancy ~ · .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ....................................... New Construction .... .~/..~Old Or Pre-existing Building ................. Locatio of property k .qo .... House No. Street Hamlet Onwer or Owners of Property..,~.(}~%.L:..~. [f-~i.~...~.. .............................. County Tax Map No tO00, Section .............. Block ................ Lot ...................... Subdivision .................................... Filed Map ............ Lot ...................... ~ermit ~o ............ Date Of ~ermit ................ Applicant ........................... tlealth Dept. Approval .......................... Underwriters Approval Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .... THE NEW YORK BOARD OF FIRE UNDERWRITERS 2 ~.~1S67 BUREAU Or:: ELECTRICITY ~--- 85 JOHN STREET, NEW YORK, NEW YORK 10038 Da*~ SEPTEMBF..R 08, ~99fi ~ppllcatio. No. on/ire 1~27795/95 N 363~9~ THIS CE~IFIES THAT o~y the e[~t~cal equipmen~ ~ ~scrlb~ be~w a~ int~uc~ by t~ applica~ ~m~ o. t~ o~ve application .umber in ~he prem~es of DONNE L. BRMITERBACH, 6500 NEW SUFFOLK AVENI~, MA?TITUCK, N.Y. in the following location; ~ Bas.ment [] I~t FI. [] 2nd f'l. O~ ,Section Block ~s examined on SE~TE~R 05 , i 995 and found to be i. ¢ompfiante ~ith the National Electdcal Code. Lot FIXTURE [ I I t FIXTURES ' RANGES IcOOKING DECKS --bVENS I DISH WASHERS EXHAUST FANS OU1t~S ECEt~TI~CLE$ SW TCHEE ~NCANDESCENT FtUm~SC~Nl OTH~t~ ~i K W. ~T , ' ' MULti T~T DRYERS ' ~ ~ACE ~°T~5~ { ~Tu~ A~LIANCE ~E~R$ ~PECIAL REC PT TIME C~tt ' (U~ HEATERS ~ DIMMERS OTHER APPARATUS: THOMAS MADOI~IA LIC. #1905~E RR1 40 T~*NAGER LANM W/%T~R MILL, ~, 11976 11 Per ~is ce~ificate must not be altered in any manner; return to the off)ce of the Board if incorrect. Inspectors may be identified by their crede~iob, COPY FOR BUI[~DING DEPARTMENT. THIS COPY OF CERTIFICATE MUsT N~T BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS [ 85 JOHN STREET, NEW YORK, NEW YORK 10038 S~P~ER eS, 1995 ~ppticetJon No. on file 1~27795/95 N 36~91 the eJ~trtc~ ~ip~e~t ~ ~scrJb~ be~w a~ i~t~uc~ by t~ applicant ~ o~ the a~e appllcatio~ ~mber in t~ p~m~es o~ DONN~ L. BREITERBACH, 6500 NEW SUFFOI~{ AVeNUe, ~TTI~CK, tn th~ follow~,g toc,tlon; ~ 8,sement ~ I st FL ~ 2nd Ft. O~ .%etlon Bilk t~s exatnt~d on ~E~R O~ ~ 1995 and found to be in compl~nce with the N~onal Electdcal Lot FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST PANS 1 I 1 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FESDSRS TtMS CLOCKS , MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE Or,CONNECT S E R ~HER APPARATUS: SWIHMINGPOOL-1 ~($WIMMING POOL} This certificate covers compliance at the date of inspection only, Because of unusual environme~ts it is advisable to Rave freqttent test/and or repairs made by a qualified person. .o. %.%co.o] <<< Continued on Page 2 >~> C 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. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD June 12, 1997 Donna Breitenbach 6500 New Suffolk Ave. Mattituck, N.Y. 11952 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.)$75.00* No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 23504-Z Please contact our office on this matter. cooperation. *THREE CO'S REQUIRED - & 1 FOR ACCY SHED Thank you for SOUTHOLD TOWN BUILDING DEPT. 1 FOR A/G POOL - 1 FOR ATTACHED ACCY DECK ECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]FRAMING [ ] INSULATION [ ~FINAL [ ] FIREPLACE & CHIMNEY I'IjlJIIIIA I I()11 (Il;f) 4o~... 'dC~'d 0 ,o 765-1802 BUILDING DEPT. IN PECTION [ ~*~'FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: b Town Hall, 53095 Main Road P. O, Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 29, 1996 Ms. Donna Breitenbach 6500 New Suffolk Ave. Mattituck, N.Y. Re: Building Permit Applications for Accessory Shed, Above Ground Swimming Pool & Deck around pool Suff. Co. Tax Map #1000-115-15-1 Dear Ms. Breitenbach: As per our telephone conservation today, I am returning your original building permit application and checks so that you can include the construction of a deck around the pool. Please resubmit the application with 3 sets of construction plans for the shed & for the deck. We will need new checks - $50.00 for the pool, $35.00 for accessory shed, and the fee for the deck is $35.00 for up to 500 square feet, and $.20 for each additional sq. foot. (See attached copy of fee schedule) If you have any questions, please do not hesitate to call me. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Georgia Rudder, Secretary encls. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOIl CERTIFICATE OF OCCUPANCY 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. .. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) nou-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and uuusuai natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupaucy is denied, the Building Inspector shall state the reasons therefor in writiug to the applicant. 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 Occupaacy on Pre-existin~ Buildiu~ - $100.00 3. Copy of Certificate of Occupancy - $20.OO 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,, Commercial $15.00 Date ....... ............................ ;Jew Construction. i ......... Old Or Pre-exisking'Buii~i~g...'~;~.[.~.[.~.. 6ocation of Property . ~.. House No. Street Hamlet 0 of Property ':ou. y o00, .... .... ............... ..................... , 3ubdivision .................................... F.iled Mup ....... ..... Lot ................... . .. :'armit No ................ Date Of Permit ................ ;lealth Dept. Approval .......................... Uuderwriters Approval ......................... 'lanning Board Approw~l ........................ ~ ' / // [~ ;/ ., ~equest for: Temporary Certificate ........... Final Certicate ........... ~ '7 "ee Submitted: $ ...... ~.~. ................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM ENT~ TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved. a/c ' · (Buj~dingdnspect6r) APPLICATION FOR BUILDING PEaMIT BO(RD'OF HEALTIt SURVEY .............. CI1ECK ................. SEPTIC FORH .......... CALL ............ INSTRUCTIONS a. This apt}lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,jsets 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 sti'eets * or areas, and giving a detailed description of layout of property muJt be drawn on the diagram which is part of this applP cation. c. The work covered by thls.application may not be commenced before issuance of Building Permit. ' ~ d. Upon approval of this application, the Building Inspector will i~sued 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 be~n grahted bY the Building Inspector. APP'LICATIDN IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ZoheI Ordinance~of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulati6ns 'fbi~.the/~6nstruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant .agrees to comply w~th all applicable laws ordinances building code, housing code, and regulations, and to admft aut,hg~iz~¢ ~p~dthf~ ~n premises and in building for necessary inst~tions. . . ..... (S~gnature of apphoffnt, or name, ff a corporanon) ,,,, . ........ ..... ......... ~.,~:-/;~;,:~:.) ~/,; ,. ~'~.~? (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises 0 t~ o- . f' ........ (~--~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 Dcense No ............... .......... Electrician's License No ....................... BLDG. DEPT, ....... TOWN OFSOUTHOLD Other Trade s L~cense No ...................... Location of land on which proposed work will be done .................................................. b o' . ' ' ltouse Number Street Hamlet County Tax Map No. 1000 Section ...'.,(./..x~.. ....... Block..~ ....... :... Lot./. ................ Subdivision ........ , ..................................... ' Filed Map No ............... Lot (Name) , State existing use m~d occupancy of premises and intended use and occupancy of proposed constructiou: a. Existing use and occupancy ~,~,~[t. C~. ~ .~i~lc~./.~ b. Intended use and occupancy S~¢ ~ [~0.~A. L0t~(~' gl30~-0(r)0~ p.~bl ~ %.~.. 3. Nature of w?rk (check which applicable): New Building .... ; ..... Addition ~. ~ah ~.. Alteration .... ;.. i,. Repair ........ Removal .............. Demolition .... : ....... [.. Other Work .............. ~t ,0~)~ ' (D ipti ) 4 Estim d C ' ' i escr on . ate cst . , ·; ........................ Fee .......... ~ ............... (t b p id fil' gtl' ppli ti ) 0 e a on lB lis a ca on Ifd fd Iii 5. welling, number o we ng units ............... Number of dwell ng units on each floor ................ Ifg b ' · arage, nunl el' of cars ............... 6. If business, commercial or mixed occupancy, specify nature and extent of.each typ~ of use .......... · Di i ........... 7 mens ons of existing structures, if any: Front ............... Rear ........... De ~ ......... H igl b fsi ' . . · pti e it ............... Num er o cries .......... ' ...... Di f itt It liti ........................... mensions o shine structure w 1 aerations or adc ons: Front ............ Rear ............... ,D,.epth ..... ~ ight ' ' ' ' b f~t ' 8 o~" 'ii ............. He ...... . ......... ... Num er o cries ........... 2 .......... . ~lmenmons en re new constrnction: Front ........... : Rear ............... Depth .... ight b f St He ............... Num er o cries ................ . ........... 9 Si '" · ...., ..... i ................ : ......... · ze of lot: Front .................... Rear ............ Depth . O. Date of Purchase ............................... Naine of Former Owner ' I Zone or use district in which premises are situated ' 'i ................ D.o. es ~roposed construction violate any zonim, law ordinad 3. Will lot be regraded ....... ". · ~ ............ i . . Will excess fill b'&.re~QYed~from ~premises' Yes 4' Name °f Owner °f premises i~°.~ ]~lF~.d~... Ad dress I~ ~Ot, a iq-,fE t~a., t~m,e oi ~rcnlleCl .... Address ' . ~F~?~'''~ ',~i~ ~ ~' ~.'~,- -, ' .... Nmne of Contractor ' ...... . i .... -~' 'i ,:~;' ~' '~"~ 'i~' ~ .~x-one l~o ............. . . ' ................... ~tauress -.,.~,~ .A~ · .,'Plio-~ ~'~ ' . *If yes, Soutbold Town rrustees Permit may be required. .i ............ .. PLOT DIAGRAM . Locate clearly and distinctly all buildings, whether existing or proposed, and. indiCate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether t,!erior or corner lot. APPROVED AS NOTED · D^'m NOTI~ BUILDING DEPAflTMEN 76~1802 9 AM TO 4 PM FOR F~LOWING INSPE~IONS: 1, FOUNDATION - TWO REOU FOR ~URED CONCRETE ~ 2. *RO~H -~FRAMING & PLUMI 3. INSerTION 4. FINAL - CONSTRUCTION ~ BE COMPLETE FOR C.O. ALL C~NSTRUCTION SHALL M THE REQUIREMENTS OF THE ~ STATE CONSTRUCTION & ENER CODES. NOT RESPONSIBLE F DESIGN OR CONSTRUCTION ERR~ AT RED ~ING )ST ET SY RS '~TE OF NEW YORK.. S S UNTY OF .... · '... i. ~.~'q .............. being duly sworn, deposes:and says that he is the applicant (Name of individual signing contract) we nanled. is the .................................. ~ .............................. (Contractor, agent, cor'porate officer, etc.) ;aid owner or owners, ~d is duly authorized to perfom or have perfo~ed the said ~ork and to m~e 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 w~l be perfonned in the m ~ner set forth in the application filed therewith. ': )m to before me this a~'Public' ~ '~'~~' '~ ~'(~ County ~ ' ' Nolo~ PuB[ici Sloto o[ New York ................. No, 5~ - 4617