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Home My WebLink About23225-z P FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-24140 Date JANUARY 29, 1996 THIS CERTIFIES that the building ALTERATION Location of Property 200 DENKEL LANE CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 1 Lot 23.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 22, 1989 pursuant to which Building Permit No. 23225-5 dated JANUARY 23, 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 ie ALTERATION TO BASEMENT (NON-HABITABLE) IN EXISTING ONE FAMILY DWELLING. The certificate is issued to WAI LING Ca= (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-100062-10/30/89 & PENDING 1/24/96 H2M LABS, INC. DATED OCTOBER 23, 1995 Bu lding Inspector 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) Date.......4-nR! TX.P?................................. 19.96..... NG 23225 Z Permission Is hereby granted to: WAI LING CHENG E ..Eog..1'1'03...............................I........................... 200 Denkel Lane ..........................................I............................................... Cutchogue, N.Y. 11935 ......................................................................I................... to alteration to basement (non-habitable) in eaistin one family...,, ..... ... . . . . . .... . . . ....... ................... dwelling . .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ................................................................................................................................................................. at premises located at........200 DEN&EL LANE ......CDTCHOGUE.r..N.Y................................... ........... . REPLACES BP 1117940-Z ................................................................................................................................................................ County Tax Map No. 1000 Section ........9............... Block.........1................ Lot No. .....23...6............... pursuant to application dated ........1t v.Ox...2Z....19.$.9119 19..............., and approved by the (Jan. 23, 1996) Building Inspector. Fee $........ ....... .. ..:.. ......................................... Building Inspector Rev. 6/30/80 ?OEM NO. • 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 017940 Z Date ....1Z .................................. 19.5.E Permission;s hpreby granted to: a.pa... lie................... .. .. .......... ,.: . ...................... to . ....... .........�a.`........ ,......... ... ..... . ' .... ...... .. .............�: ........�........ . .... J............... at premises located at ....12 �......... ............................................. ..............................................�� .. . .......5,�...r�..........................................I................. ................................................................................................................................................................ County Tax Map No. 1000 Section ........9....7...... Block .........../......... Lot No. ..... 3t pursuant to application dated ........ ..................................1 19..� and approved by the Building Inspector. dd, Fee $. ... .. .... ... .......... ��uildl... ..Inspecfor Rev. 6/30/80 �' - Form No. 6 TOWN OF SOUTHOID V A 2 � I BUILDING DEP PM%=i i G G TOWN !':_AI L 765-iSC BLDG.DEFT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCOP ANCY A. This application must be filled in by typewriter OR ink and submitted to the buil "*ag inspector with the 'following: for new building or new use: 1. Final survey of property with accurate location of a'_1 buildings, property lines, streets, and unusual natural or topographic features- 2- Final Approval from Health Dept. of water supply and sewerage-disposal{c_g fo m) 3. &.DnrOval of electrical installation from Board of :_re Under-write=s. 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. 3. For existing buildings (prior to April °, 1057) aon-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 Occupancv is denied, the Building Inspector s'ra_1 state tae reasons therefor in writing to the applicant. C. Fees 1 . Certificate of Occupancy - New dwelling 525.00, Additions to dwelling 525.00, Alterations to dwelling 525.00, Swimming pool 525.00, Accessory buildin_= 525.00, Additions to accessory building 525.00- Businesses $50-00. 2. Certificate of Occupancy on Pre-exisriag Buildin¢ - 5100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - 550.00 5. Temporary Certificate of Occupancy - Residential 515.00, Commercial $15.00 . . . . . . . . Date � ,`.� ? 4 Ib . . . . . . . . . . . . . . . . . . . . . . . . Vew Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . :,ocation of Property. . . ?OO. . . .X" �. . .LJOLV1e... . . . . . .G" e. . . . . . . . . . . . . . . . House No. Street Hamlet Jawer or Owners of Property. G`:1 . - . - W. . . . . .`.r'.�'. . .4►'1e-P.I. . :ounry Tax -Map No 1000, Section. . . . 51.1 .. . . . .Block. . . . .Q . . . . . . . . .Lot. . . . . Subdivision. . . .n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _Filed SaD. . . . . . . . . . . .Lot_ . . . - . . . . . . . . . . . . . . . Permit No. . l�--11"k' t� . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . M anning Board AD Drove!. . . . . . . . . . . . . . . . . . . . . . . . Bequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . -_ Submitted: 5 . .��."� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (20 z '2VI !uO APPLICANT ��-\ INC 575 Broad 040fA Pn5d, 420-8 le, N.Y, W11747 I e., (515),D" H 0 FAX:(516)120-81.'i6 NYso01 iur laN9 LAB NO: 9529530 HARRY GOLDMAN 'WATER ANALYSIS TYPE. . . . . . POTABLE WATER MAIN RD ROUTINE MATTITUCK, NY 11952 ORIGIN. . . . DISTRIBUTION DATE COLLECTED. 10/19/95 POINT NO: TIME COLLECTED. 0731 HRS. LOCATION: CHRISTINA KUHLLMAN DATE RECEIVED..• 10/19/95 200 DEN KEL LA. ,CUTCHOGUE COLLECTED BY... D99 REMARKS: SOURCE:KS/FLOW:2.6GPM PROSECT NO. . . . . 2 PARAMETER (S) - RESULTS UNITS LIMIT TOTAL COLIFORM SACT. negative ----- negative E. COLI. absent ----- absent CHLORIDE 20 mg/l 250 SPECIFIC CONDUCTIVITY 297 umhos COPPER 0.35 mg/l [1.3] IRON 0.09 mg/1 0.30 DETERGENTS (MBAS) <0.04 mg/1 MANGANESE 0.01 mg/l 0.30 AMMONIA (AS N) <0.02 mg/l NITRATE (AS N) 8.6 mg/l 10.0 LEAD <1.0 ug/l [15.0] PH 5.8 units ZINC 0.32 mg/1 5.0 - Result(s) Reported meet(s) NEW YORK STATE/USEPA limits for potable water. - Result(s) Reported meet(s) [USEPA action level] for potable water. COPIES TO: DATE ISSUED 10/23/95 - RATORY DIRECTOR ORIGINAL UUU THE NEW YORK BOARD OF FIRE UNDERWRITERS WE ARE IN THE PROCESS OrC ISSUING A ECERTIFICATELECTRICAL OF COMPLIANCE FOR THE IN AN A ELECTRICAL APPLICATION LAiION BE COVEPFO IN AN APPLIC/9'ION tNQ�f.E.�D� )BELOIh! APPlIO4NON NO.�C , ( LOCATION?o 7C-Z( ` Lr INSPECTOR R" • � DAM / ISD(REN9I9S) p),4fcm, wlr- n 1::LD 11:S:'E�TrUN, + UA:E OOMMENTS -o 1 . m 5 .. 3 H FOUNDATION ( 13t ) FOUNDATION ( 2nd ) mr _ r 2 . 3 z 0 ROUGH FRAME & / \ PLUMBING 0 O Jr �� c 3 . m INSULATION PER N . Y. j STATE ENERGY CODE r x a � 4 . r �y FINAL �� dF 7 0 � ADDITIONAL COM ENTS : 1 l , . r m b H � 77 � H .1 O C m • r x�c7 m ^o H FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT "DOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION p Date .........4/.1..4..................................... 191Z.. TO ..W..AI......U.N...6t......5 CR-4;L..................... (owner or authorized agent of owner) (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ...... -,eIOU ....................... Other Applicable Laws, Ordinances•or Regulations ............................................ at premises hereinafter described in that .. titLtZ Kfi oft: !7` : ] °{O x E/., 5 (state character of violation) ......acc,u,t?Nuc "(......6? 45....kaT r1.......1...`�.S 41 .e.........................................................................................._..........I........ in violation ofQ1tiGLCc....KkV, tf. ....... . (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the low and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at 200 .... ,H k�L L►4uk C u J"GNeCtYf County of Suffolk, New York. SUFFOLK COUNTY TAX MAP 6 D 0 0 — Q?- 01- 2 3. 6 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of low may constitute an offense punishable by fine or imprisonment or both. ................................................................................ &w44+mi-trispector '9 INSPECTORS Victor Lessard �gpFfO(,f C Principal Building Inspector �� pG Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector ca i Southold Town Hall Thomas FisherP.O.Box 1179,53095 Main Road Building InspectorGar0 • `g 9 Fishp! Southold, New York 11971 Building Inspector �Ol �� Fax (516) 765-1823 Vincent R.Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: SEPTEMBER 19, 1991 TO: MAI LING CHENG 350 COLUMBIA ROAD SOUTHOLD, N.Y. 11971 PLEASE TARE NOTICE there exists a violation of: Zoning Ordinance - CHAP. 100 Other Applicable Laws, Ordinances or Regulations at premises hereinafter described in that: BUILDING PERMIT #17940-Z HAS EXPIRED AND A CERTIFICATE OF OCCUPANCY HAS NOT BEEN ISSUED. In violation of ARTICLE XXVIII CHAP. 100-281 & 100-284 YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 200 DENKEL LANE, CUTCHOGUE, COUNTY OF SUFFOLK, NEW YORK SUFFOLK COUNTY TAX MAP #1000-97-01-23 .6 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. _( ) U.�Q�;- LNJ �..,. INCENT R. WIECZOREK ORDINANCE INSPECTOR INSPECTORS Vicor Ussard Principal Building Building I pector O�pSVFFOL,� COG Curtis Horton =� 'd'j� SCOTT L. HARRIS,Supervisor Senior Building Inspector o Thomas Fisher y = Southold Town Hall Building Inspector O g P.O.Box 1179,53095 Main Road Gary Fish �'�Oj �0W Fax Southold,New 765-1823 11 71 Building Inspector Telephone (516) 765-1800 Vincent R.Wieczorelc Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone(516) 765-1802 TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: SEPTEMBER 19, 1991 tvAZ TO: 'MAI LING CHENG 350 COLUMBIA ROAD SOUTHOLD, N.Y. 11971 PLEASE TARE NOTICE there exists a violation of: Zoning Ordinance - CHAP. 100 Other Applicable Laws, Ordinances or Regulations at premises hereinafter described in that: BUILDING PERMIT #17940-Z HAS EXPIRED AND A CERTIFICATE OF OCCUPANCY HAS NOT BEEN ISSUED. In violation of ARTICLE XXVIII CHAP. 100-281 & 100-284 YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 200 DENKEL LANE, CUTCHOGUE, COUNTY OF SUFFOLK, NEW YORK SUFFOLK COUNTY TAX MAP #1000-97-01-23 .6 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. VINCENT R. WIECZOREKI) ORDINANCE INSPECTOR INSPECTORS r Lessard Principal Building Inspector O�pSVFFO(�COG � Curtis Horton =� � SCOTT L. HARRIS, Supervisor Senior Building Inspector o Thomas Fisher CA x Southold Town Hall Building Inspector O t P.O.Box 1179,53095 Main Road Fishp! Southold, New York 11971 Building Inspector �O� �� Fax(516) 765-1823 Vincent R. Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD October 9, 1991 Wai Ling Cheng 200 Denkel Lane Cutchogue, N.Y. 11935 Re: Building Permit #17940-Z (Expired) Dear Mr. Cheng: It has been determined that you must apply for a Certificate of Occupancy for the alteration work that is completed in your cellar. The Building Department will allow you until October 31, 1991 to obtain the C.O. You will need a final inspection, Plumbers Certificate and an Underwriters Certificate. I am enclosing an application for the C.O. The fee is $25.00. Please contact the Building Department to arrange for a final inspection. Thank you for your cooperation in resolving this matter. Sincerely, S�OyUMOLLDD TOWN U-)a" DEPT. VL.Lt.bu�(} VimU-)fes" . Vincent R. Wieczore , Ordinance Inspector VRW:gar 4 M A aDU DAtH 3s' asks 6 r`6 ASEnp_Nt � I LAN DIN ��i��/f '� � /per!/ . /,f� �yy�� ,L�Q•yL- l,�i eoftER KM li copPet tubing R M , for water distributing �� u system. piping shall be Of I BM T" Tr B A+H 4= 3 � n i . \ f-INCY 0 c-, R tuNLAINFUL x AS a Wcre4 t :40Lj—j C' FITIFICATE "D LANDIN9 UPANCY o'p # DATE:-7f) Ole 9 FEE "I"- NOTIFY T AT 76;, IW* 9AMVV04 FOR THE I FOLUI'/INQ INSPECTKM; 1. FOUNDATION . TIKIREGUIRED FOR POUROCONCNM 2. ROUGH - FMMWQ a PLUMBING 3. INSULATION I 11A 4, FINAL CONSTIRUCTM M BE COMPLETE KO CO. K m ALL CONSTRUCTIONSHP_"' WET-" '-r"tj vl L �t�tTIF CATE C JPA� IND "o gj bEIZVO 14 wy, D D THE REQUIREMENTS OF THE STATE CONSTRUCTM & ENERGY ' ;r*-Aao..a too CODES,.. NOT RESPONSIBLE FOR DESIGN OR CONSTOI)CWH EPJIM ----- ---- A /7 / MA5� e- BDA i OA+H RM i - LANDIN9 ' ,CL S S;Li f Sg .919 C13 s � r� OILER - - -- 6 ' 1�0�, ec1��►1, -I'o (3 c R o e k e�. '/� Gy/� '411 C jc° N5 5e 5 �(--)'� � e c Rvw\ 5e-- s 5 l l d � `. � )Volw�i�v ,Elc�lrl�c9� PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2110 of 1% LEAD. t ? gl(o ct+604 t W141 �•t►tCh M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [4,r'FINAL REMARKS: UJ 164boLo s - Gi2aS5 , 2 y. ,5SWo(-e 70 e— - Y, A-Tw , 4LL- tmc)ttsc-ttr� t> N t�nT� r7 Nri��r�ot�rz� �9.a�lc ,�oa>2 Ta K11i co DATE /D�f�� INSPECTORu�, l 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE �'� �� INSPECTOR '^�'1 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE t "� �� INSPECTOR ,,� 179�� M-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION 1ST [ I ROUGH PLBG. [ ] FOUNDATION 2ND [INSULATION [ 7 FRAMING [ ] FINAL REMARK44 �" .ti DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING 1 FINA �7'o- � ��/� G� REMARKS: DATE / r v / INSPECTOR ' TSS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ RO�PLBG. [ FOUNDATION 2ND [ ] INSULATION [ 1 FRAMING [ ] FINAL REMARKS--. T _ DATE 3 m INSPECTOR c ✓ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE'; 1 1.001'433 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date ()C P08NR 30,:l984 Application No.on file 62035859/89 N 100062 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 WY1 CHEKBNT LEE, 200 ilFSKEL I,V , CU`PCHOGUE, N.Y. in the following location; ® Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot was examined on OCTOBER 16,1 98 k) and found to be in compliance with the requirements of this Board. FIXTUS RE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DIyH WASHERS EXHAUST FAN OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 5 9 12 5 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMG NO.OF FEET AMT. WK.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS ATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP. TYPE METER 1 p 2W 1 0 3W 3 0 3W 3,d 4W NO.OF CC.COND. A.W.G. NO.OF HIAEG A•W.G• NO.OF NEa Ap . W.G. EQUIP. PER.B OF CC.COND. OF HI-LEG f3F'NEUTRAL OTHER APPARATUS: uiw G.F.C.1:..I SMOKE DETECTOR:--1 THOMAS J. BALL UIC.12 520-1 P.O. BOX 1708 SOUTHOLD, MY, 11971 11 y Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ide 4' b ev credentials. CQFY FOR BUILDING DE E"AlRED I ANX MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1175003 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Onto FEBRUARY 22,1996 Application No.on file 11051.996/96 N 378421 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 MRS. WAS LING CHENG, 200 DEN-KEL LANE, CUTCHOGUE, N.Y. in the following location; IN Basement ❑ w Fl. ❑ Ynd Fl. Sertion Block Lot was examined on JANUARY 26,1996 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DICKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1.FLUORESCENT OTHER AMT. K.W. AMT. K.W. ART. K.W. AMT. K.W. AMT. M.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE MOORS SPECIAL REC'PT TIME CLOCKS .EELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K.W. OIL M.P. OAS M.P. AMT. NO. A.W.G. AMT. AMP. AML AMPS. TRANS. . AMT. H.►. SYSTEMS AMT. WATTS NO.OF FIST SERVICE DISCONNECT NO.OF 5 E R V I C E AMT. AMI. TrP! 1,I 2W 1,9 3VN 30 7RN 3 X 4W NO'OF Cc.PER A,COND. OFC COND. NO.OF MIAEG OF A.MI•EO NO.OF NEtRRALS OF NEUTRAL OTHER ARMRATUSe G.F.C.It-6 SMOKE DETECTORt-1 Q.C. ELECTRIC INC. LIC.#3823 P.O.BOX 518 LAUREL, NY, 11948 9110 LAI. MANAGER 11 per This atrtifkate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified liy their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. -- BOARD OF HEAL . . . 3 SETS OF PLANS . . . . . . . S FORM NO. 1 SURVEY . . . /•oLR .44 �!' TOWN OFSOUTHOLD CHECK . . . . . . (!. . . . ..r Y : : : �t BUILDING DEPARTMENT SEPTIC FORM TOWN HALL 811Da.DEPT SOl1THOLD, N.Y. 11971 NOTIFY FS TEL.: 7G5-1802 CALL . . . . . . . . . . . . . . . . . . . . / 19 . MAIL TO_: Approved ..�t/y 191 A Permit No. . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Buildin Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 15 . . INSTRUCTIONS f a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with Pts 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 streei or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl 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 permi 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 Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describes The applicant agrees to comply with all applicabie laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . (Signatureof applicant, or name, facorporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde . . . . . . . . C--.rrjCr.Qs��. . . . . . . . . . . .� �ue� ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . "Ir' L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�hnq J (as on the tax roll or latest deed) IC applicant i a rporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. (Name and title of corporate officer) Builder's License No. .1k 4. 1 5 q -. .4;. . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . a4.7a te� . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . I. Location of land on which proposed work will be done. . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DENtCE1- . . . . . . . . . . . . ... . . . . . . . . . :�. . .t:-ate. . . . . House Number /Streeet. / �l Hamlet County Tax Map No. 1000 Section �-f' !.G Block . . . . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . . . VA.a Z Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . .r..1. . . . . . . . . . . (Name) State existing use and occupancy of-preemQise`s and untended use and 1occlttpancy of proposed construction: a. Existing use and occupancy . . . . . 1 x�dN• • • .Rba •¢�(Q11. . .[ iQi1` . , , , • • , • . . . . . . . . . . . . . . . • . . b. Intended use and occupancy . • /�+l6lr^� • • . . . �/1 t. . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Al �#". . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . Other Work !tel ZQS�,Y. Q M . - • . escription) 4. Estimated Cost . . . . .O��C%Q. . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . .. . . . . . . . (to be pais!on filing this appikcation) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . Number of dwellis n uritts on each floor. .t . , 4 , , . Ifgarage,number of cars . . . . . . .051• . . • . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 17t a lV.4C!! 1G l. . . . 7. Dimensions of xisting structures, if any: Front . . . .,7 0.��; . . Rear . ...fib PE . . . . Depth . .9L1TFk , , , P Height . A- �� . . . . . . . Number of Stories . . .C?. .�: Y�. , , . , , , , , , Dimensions of same structure with alterations or add'{tions: Front . . Ute. . . . . . . . . . Rear . . .J'<) . . . . . . . . . Depth . . . . 4NO-A; . . . . . . . . . IIeight . . GP. . S ! . . . . . . . . . Number of Stories . .,Q.. . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . .JrT�. . . . . . . . Rear . .X17?. . . . . . . . . Depth .as . . . . . . Height . . ;. t:. . . . . .Number of Stories . . .4?... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . I0. 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: . .N4. . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . Will excess fill be removed from premises: Yes 14. Name of Owner of premises LOy I. ,L,t. C{,P'?� . . Add resso244 D4I}GI. .(AA4. . . . Phone No. . - - . . o. . . . . . . Name of Architect ,-fc KACI. . �4GAcia . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . Name of Contractor .Hkck)4t:A. . .6ar.ylen. . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . 15 .Is this property located within300 feet of a tidal wetland? *YES. . . .NO . *If yes , Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or comer lot. STATE OF NEW YORK, S.S COUNTY OF . . . _ M!,.C-. .h 4. �, slgly�l�rJ . . , being duly sworn, deposes and says that he is the applica: (Name of individual signing contract) above named. Ile is the . . . . . . . . . . . . . . . . . . . . . . . . . . S.UiY.r/2.N. .1 Gd2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 tl application; that all statements contained in this application are true to the best of his knowledge and belief;and that tl work will be performed in the manner set forth in the application filed therewith. Swom to before me this \\^ . . . . . . . . . . . . . . . . . .day of. . ,1�_c!L . . . . . . . . ., 19 : c Notary Public. . . . . . . . . . . . . . . ..k� i : . . . County . .c.. . . . . . . . . . . . . . . . . . . . . . . . . . . LINDA J.COOPER (Signature of applican Notary Public,State of New YOT " No.4822563,Suffolk County i Term Expires December 31,19� -