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HomeMy WebLinkAbout22902-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24742 Date NOVEMBER 15, 1996 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 405 EDS ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 79 Block 6 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 3, 1995 pursuant to which Building Permit No. 22902-2 dated JULY 20, 1995 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 ALTERATION IN CELLAR (REC ROOM) & SUNROOM ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CHARLES & DONNA GRAY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL INSPECTION CERT. #13590 - OCTOBER 7, 1996 PLUMBERS CERTIFICATION DATED NOV. 4, 1996-CHARLES GRAY (1'~ X Building Inapec r 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 N2 22902 z Permission Is hereby gra~ to: ......y~ . ...Ael, - to .............1.4-U ~~.1~i 4 x'11 1 ~411-111 -1 1-. 1 _ at premises located at........../... s.....:~ I County Tax Map No. 1000 Section 7~1 Block (s~ 0. pursuant to application dated 19./............, and approved by the Building Inspector. Fee$..~~............ . Building Inspector Rev. 6/30/80 Form No. 6 y~~_/. 1 f J~ TOWN OF SOUTHOLD!/ G/~~" 01 BUILDING DEPARTMENT TOWN HALL t l' 1~~1Q l~g~l 765-1502 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, Industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer w responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. R B. For existing buildings (prior to April. 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - .25i 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $.]0, Commercial $15.00 v Date New Construction........... Old Or Pre-existing Building Location of Property.... d-~ 4G1.. ~ _ House No. Street . . Hamlet ',Onwer or Owners of Proper.ty.. ~....A.`^!. ;County Tax Map No 1000, Section....... Block ........(;~;......Lot . Subdivision ~Filed Map............ Lot........................ Permit No...I.. ateee,, Of Permit. _.~~....Applicant. 8 Health Dept. Approval.......'! 0 ...............Underwriters Approval... Planning Board Approval..... q/00 Request for: Temporary Certificate........... Final Certicate.....r..... Fee Submitted: ..v7.~. C0'L„(77Y~ ..r S Town Hall, 53095 Main Road co Fax (516) 765.1823 P. O. Box 1179 0 Telephone (516) 765-1802 Southold, 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 Building Permit No. Y y ® y Owner: b4/11-f,(d'1)JA1A1X (please print) Plumber: elllS rZoIV/1~ 07r?-// (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. P umbers S' atur ) Sworn to before me this day of 19 9f6 c i - Notary Public, rI~L °7 in , County HELENE 0.HORNE Notary Public, State of New York No.A951364 Qualified in Suffolk Counttyy aj Commission Expires Play 22, 19 p-pol :11 -:1-1 ~yy &LECTRTCL INSPECCTI©NSETSV7CE:INC 375 DUNTONAVENUA E4STPATCHO VXNEW YORK 11772, f a s. i (516), -M-6642 13590 DATE- . 101719h.. APPLICA7'lONNo. t7N'FILE: T7t[ GE SOUTHOLD zbwrF~ - SOUTHOLD ADi3(tESSr 405 R'XS.C ko-41) 1SSUEt]iO~ CHARLES&DONNA GR,4Y 1NTRODUC&Dl?Y_ LADEiMANNELECTRICINC. LCCNa: 4141E - was exarAixed on J017,96 : 'andfoundto be in compliance wifk tlieAr'ati6nalElecti7aaLCade- L©CA1'10N; Base...' 1st . end Trd Atlic, Det Garage, Hot 7Yab~ - - - - - - - - . , FIXTURE'S HEATERS ~ FANS GF.L - " AIR COND. 'SiPI7C'H¢S RECEPTACLE'S DjSIIWASHER- : DRYER CLOTHES WA.W. GAR. Dlfft:. RA,yGE - OVRN "S'Ar OKEDETECTOR - - . . ''FUWRACE O9 :..0AS Cm, ~ MOTORS' : B= 7R", ~ WRYTCEDJXOAWECT " niezen agars Vaasa 0 um, 109, M. 3 D11v1M1ERS HuGOS SSJROd RES/IJENT . . BUILDING pp"I'Wo, vay~n,.~m y~,ewmaseaora~e~v~e~s : ":.`BLUWQRIGINAL YELIOW COPY' PINKCOPY_OMbE pppM-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU=ATI G. [ ] FOUNDATION 2ND [ ] 1 [ ] FR AMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ~2 c? INSPECTO ~11•il.h III~iPI;I;t IUII IU: 1.1111 I/f~ll U Ll/l 11 llallti 1(IIII(IIA 1((111 (I;i I') - ~I f•VUl lop, l'l oil - - - 211u) IIUIICII 1'1111 IIIIIIfI I11'i IIIA 1'IUII 1'Id 11 11. Y. IMY - 1 _ I F I PA I. - AIMI'I IIIIIAI, CUlll ll!Ill$: T - r' I~ - .i •I _ s,, e G o S F I ' k PA NC~ l fYuY,^aa - - S ~,rS S ~ :rxtv Jr 9 0, GUT ATE T / UJ ~ 5, c;,.- j ' LP 5 rv S., l4' ak UNDERVYRIfEliSCERnftCIIT£ s°- 's REQUIRED If copper tubing is used pLUMBiNG for water distributing ALL PLUMBING WAVE, system; piping shall be & WATER LINES NE It of types K or L only TESTING BEFORE COV ING e~ . A K /J 6.. c `>t1 PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT o EXCEED 2110 of 1% LEAD. ry x a va °I 4 oll l .1CLZe4l7 ela feel 1 ./~~~-//D1~t1.~ ,,-a G `L C?,+~~/~L-~~4 i~~'G~ZGloLr~6,,/ Gt fb I~ it i. !I !i . LEO D. RUSSELL MASON CONTRACTOR Page No 1 _of-L_Poges BERGEN AVENUE • MATTITUCK, NEW YORK 11952 « PHONE 298-4982 1 PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB: Job Tom Saladino 405 Ed's Road (Gray Residence) Address 1450 Marlene Dr. City state Mattituck,_NY 11952 Southold, NY Phone Date 298-1055 11-7-94 I 31Ir ~rrebg i~tthitttt specifications and estimates for 0) 12 lineal feet of concrete footing 36" below grade. Includes excavation but no removal of material from premises. (2) Install 8x8x16 concrete blocks to same height as existing I foundation. (3) Pour 411 concrete floor 91x12' and 21x121 concrete apron to Meet existing asphalt driveway, (4) One coat stucco over exterior block. I I i l We Nerelty Propose to furnish labor and materials complete "t accordance with the above specifications, for the I sum of$1960.00 (one thousand- ni.ne_hundred sixty dollars) I With payment to be made as follows 1960.00 on starting of job and delivery of block. 2--$1000.00 on completion of_job__ All matenal is guaranteed to be as specified All work to be oomplct ,l in a work manbke manner arcording to standard practices Any ulternlion or dovlanon from above Authorize( Signature speclhcatons Involving extra costs will be executed only upon written orders, and will - hecome an extra charge over and above the estimate All agreements contingent upon strikes, accidents or delays beyond our control Owner to carry fire, tornado and other Note' This proposal slay be with- necessary insurance Our workers are fully covered by workmen's compensation drawn by us if not accepted within- 1 0 days msuiance Araptaurr of t1rtipastd--The above prices, specs- flcatlons and conditions are satisfactory and are hereby accepted. You are authorized to do the wort( as specified Signature-____ Signature- Payment will be made as outlined above Date Accepted -1~_t~--~-1-f------------ Slgnatr-~a.~z~'11 ~L~vF I* W401-14 l d/ PA y6 3.. d.. •:3. <Atkt.•; l.t. P,6A 5(J, I'N'~~k;'~i:'1'l;;d.. •Pt d~;, ;I If .V,1111.UC!S.I.[',~Y('Rk'. 1.'''i;'~fF'I~nli.:~1: 4q1;. ~~M~~f?'~4~ PROPOSAL SUBMITTED TO DESCRIPTION OF= J06- Joh~~_ _ Tom Sa.ladino Gray Residence--_,_ meter r•;ti 1450 Marlene Drive Ed's __Road_________, Mal;tituck, NY 11952 Southold I'hnrlo Ihrln - - 295-1055 31)=9(i-_ Or i~rrrhq , ltlutdt epecancnnons mid e!;lin,nlu; for ( 1 ) OUtuide entry way. Block walls extending 4 feel; out from house. Steps to basement level to be 12" deep and approximately 71-1" high. Dry well at bottom with drain. Excavation by mason contractor. DirL to be lerl: on premisrs. All. footings to he 36" below (trade. Entry into basement by other. Railing by other. i i ' ~Mt / i i / 1lrQ lirrehil 11411VII11$ to fuu,c;h Inhor and nr•IIOrL J', con q>I<vo m occoldilnce Willi tho, ahove Spr(.I fecal toll,;, for thr •;Ilr„ (IF S 3980. QQ__(__7`hree- thousand nine hl.lndred- eighty. dol.l.ars)__.__ With payment to be rnnoeos follows 'Start_ of job _11 980. 00 $20 00.00 on corripleti or of job. A" •..ea.. ,II gn.ndnrl •rd In III, a? tin.. dird All wai 1. r. nl h,.. nnldotrd . vn.k ? oihUI`I/t4 ..bnq ro •u..nJ.".lpl.n l.u nny nm..u.a.I. d, rn. o..... ib• 11 Sily-c lIr . • ab. n I'll r I•x n..I "IN wtll Ins a1rd. nIY uP. r . r. n. ul .vtl 1"4 .1`.I.. 1`~rr •I <:Il.re 1)~` tlvl.f .Intl .I lNlvr I.......II lll.l ll. All .•.f,,... ,a-1 .j t..l . •kOh .lrl'rtlopliu. Ja11, b rd om oonuo Ow nm m oay o. r, ls. vnn nr o l o,fho. Note This proposal may be wllll- 0 ,.y ..~.o~„~ Our w1)1o,1,ko.. .nl nllly rov~~od I,v a. k.alo . ~~p. a...l.o^ drown by us iC nUt accepiod wrt hill ___~-Q_-d I ACCPQtFU1CP elf ?PYUpliliflt "rhn shove pncos, •:pocl - hcnnons and conditions nre 5olrsfoctory nod ow hereby occopled You .ne nulhori/ed to do III(! work nv •;IWOh d `I(pinluro_.__ P.rynnv,t will he 1110(10 ;IS UtIll oMl ahovq Unl"AcceplOd-_-... SICJnnIUni FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) II If__ 111 ~ FOUNDATION (2ND)-- -n ' `peg II ~~I ~ W L®17 C.Gyee-E' II ROUGH FRAME E1 /-V XI I NG ~ PLUMBING I _ r INSULATION PER N. Y. STATE ENERGY CODE u- iiCG?~ ` Lfc I llsyy~ ~~C H ryI - -fi II FINAL _ ADDITIONAL ADDI° TIONAL COMMENTS: 7- H w~ R 6 OCCUPANT S UIAi rg USE IS t UN~A 'FUL o 9 KATE up , 6,10~ F OCR IY o cY r~ ~~scf:~t %~Q 1 t 5' pLUMBER CERTIFICATION - r E ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUppLY SYSTEM CANNOT sm Il e~- EXCEED 211o of I% LEAD. ~ ° If copper tubing is used fs` !c for water distributing ` G system; piping shall be N of types st or L onty PLUMBING ALL PLUMBING WASTE o & WATER LINES NEED TESTING BEFORE COVERING ro k E E cl} o t -%o lry~ a, O Lv'h Cx"~ 1, - 11 Page No l ; of 1 Pages I, f LEO 0. RUSSELL MASON CONTRACTOR BERGEN AVENUE • MATTITUCKr NEW YORK 11952 • PHONE 298.49811rtrt[~} jl liF?Ra PROPOSAL SUBMITTED TO: DESCRIPTION, OF JOB: Job Tom Saladino 405 Ed's Road (Gray Residence) Address ` 1450 Marlene Dr. City - - State Mattituck, NY 11952 Southold, NY Phone - Date ' 29.8-1,055 11-7-94 19t'gtrrhV `J11111mt specifications and estimates for l L) 12 lineal feet of concrete footing t L. 3611 .below grade. Includes escavation.but no removal of material from ' remises 2 Install 8x8x16_concrete blocks to same height as existing ,ation...;, (3)_ jr Poconcrete floor 91x12' and 2T1x12' concrete apron, to found Meet exi.stin,g asphalt .driveway .-_(4 Ore coat stucco over exterior block. - We 31erchp PoPLISt to furnish labor and materials complete in ;accorda n'ce-with the;aboup specifications, for the sumof$ 1960 00 (one thousand nine hundred sixty"dollars) With payment to be made as follows; $960.00 on starting' of job and del'idery of block.,".,; -2--$1000 00 on completion of job. All material is goarant4ed to be as specified Alt works is to be completed in ~e work- Authorized madlikemsoneraccording to standard practices Any alteration or deviation fromabove 'Signature specifications involving:extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate All agreements conunge t c stakes, accidents or tleldYS beyond our control Owner to carry fire, to natlo anb .,he r - Note T1hi5 prOObSaI maybe with- necessary insurance Our workers are fully covered by workmen s compensaten drawn by us if not accepted within 10 days - insurance f' Arrtptana of Fropood-The above prices, spec fl s cations aril conditions are satisfactory and are hereby accepted, You are authorized to do the work as specified. Signature - Payment will, be made as outlined above. _ - ` Date Accepted Sign • 1 F £ Fo m 4G'Zn, --®TM1 b NH BDae 50 1 # ; Was-I44oi y~ Page No I of Pages ~,10 3. RUSSELL MASON, CIONTRACT01111, ~3t PGLN AVENUE. ^ MATTITUCK. "4CW YORK I .954' ^ PP(1^t9: 29P,1,98' 2 641 r1l PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB: Job Tom Saladino r Residence Address 1450 Marlene Drive Ed's_ Road _ City _ - Slat" Mattituck,_ NY _1_1-952__ SouthQl~______-_]Y..__-_ Phone Date 298-1055 - TUp i~prrhls 0011111it specifications and estimates for ( 1 ) Outside entry way. Block walls extending n feet out from house. Steps to basement level to be 12" deep and approximately V'11 high. Pry well at bottom with drain. Excavation by mason contractor. Dirt to be left on premises. All footings to be 36" below grade. Entry into basement by other. Railing by other. i Ric litubp Vr1 ponp to furnish Tabor and materials complete in accordance with the ahove specifications, for the sum of - 39 $ Q . 42.(-ThX'?ot_h411_u l.Xl.~-TL7.I]_S'..~AliriS1 S 15J11 .y_~SLlls1Yu W th Payment to he made as follows:-LI) 'Start o~o~19t10.00 32000_00" on completio of-job. - - All mauv gar r., aramond rn bo a. tiP('cIL('d NI work , to hi' complnln•1 In .I worla- Authorized rnUoIII, %I'rord inylatilandardpracbcvY NI"I11Clab1"I'll Vllllnll Lum ahoy(' Signature x/t0 np•tvh<prl uvt.. n,vulvlmr extra coyly wdl b0 r .culaA only orOn wntten o-ders, (Ind will W b.a;omc an exva cha o ovormd "boy(' the estimate All ocdreemonts e nt a'ob cl vnkey.aroACnisor el" beyond o urco ntrol Ownert r ry fire, tornrn erid do o end other her Note. This drawn oroposal accepted with- css.vy Ir..r,r.,nc I. Our workers ago nary coyared by by workoI roelry e:on," e n ya I. draw on dran by u uss if not accepted within _ 1 0 days `111 rt\S.1(,1f\C.e Arreptatirr of Vr11;t011tt1 The above: prices, speci- fications and conditions are satisfactory and are hereby accepted You are authorized to do the work as specified Signature- _ _ Payment will be made as outlined above Date Accepted - signature - rm~ e11 r u ma r no uo,wrrzr u•,.,n. „o • o•.. nm . oml.,., o.,. r t I i I V .t f t k i 0000000000000000000000000000000000000000000000000oooo~O p (516) 286-6642 ELECTRICAL INSPECTION SERVICE, INC. 0 375 OUNTON AVENUE ° EAST PATCHOGUE, NEW YORK 11772 9510 0 O Date 1-12-96 _APPLICATION No. ON PILE OO 0 O O ° 0 ADDRESS:__405 Ed's Road ___-VILLAGE_ Southold TOWN: Southold O ° O 0 ISSUED TO: Charles GYdy_ O O INTRODUCED BY, JadBIOan EleotY1G Inc. - L,I C. NO:` - 4141'E-0-- - O O 0 was examined on 1-12-96 and found to be in compliance with the National Electrical Code. O 0 LOCATION BASE. XX 1st. 2nd 3rd -Attic Pool 00 O DET. GARAGE _ HOT TUB UO 0 4 FIXTURE RECEPTACLES SWITCHES G. F. C. 1. DIMMERS FANS AIR. COND. O ° 0 2 4 1 1 1 0 0 DISHWASHER DRYER CLOTHES WASH. GAR. DISP. RANGE OVEN SMK, DET. Q 0 O O ° O FURNACE OIL GAS Cl R. MOTORS BELL TRAIN. SERVICE DISCONNECT O 1 O - e ers m s. ase ° 0 1 200 off o o ° O SERVICE CHANGE D 0 0 o President o ° 0 This certificate must not be altered in any manner. O O Inspectors may be identified by their credentials. O O O ooooeoeoeooeeoeoeceoeoeoeoooeoeoeoeoeaeoeoeoeoeoeoeo M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] F DATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: lg ,47 DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] RO PLBG- [ ] FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLAC~Ei& CHIMNEY REMARKS: !f'~~ L DATE r INSPECTO 175~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ATION [ ] FRAMING [ FINAL [ ] FIREPLACE CHIMNEY REMA KS: eJa DATEc INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE /&nCHIMNEY REMARKS: 1'~-t~-t- G~ - DATED / INSPECTOR r M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ~INSPECTO 4 ~a S.l{!~ Y' ~KMrB c~, m~ S'7 rxLT~p}~+ q.(A.lf+~ S t ' r i ~ r I + \SS~ _4 1A1G 6lrr 1 I x ~'w.f}^ C d~ x i ) flh t ~~~~r~ ~..~r~ ~Y~ ~f ~l ~•l 4 3 r 5 ~f~}',~. fff i,? hlx .P I .r x 1,. xis r ~ I t~ 'lld t ~ t ~ ~ r " ~ yl ~ t 4 ~ (tl rA r' }f F>' hh}~ ~ wJr f} ~1 rf't 4- W lr 9 n . rr r,; 41 l y . r T., Cw .7r t, &Fxr ,ter ~ 7t } Et 2 i;r ltP r f f t' 11. .J , ` , r i I S r V Vr4 It ~U (A~ ,.{.,3 ~ ~y>t rr.- 1, l w' r . t t V o''I r~ d{it ~ l~S Y t.~, ~4+ r 'I tA, f } 11~ I r ~.'vQG ( f J ~1 k4/.Y i ~QT~tt+e~'yz Zt ~5 v 1~ *t' ; d S ~~\IM ~ i1 ~ A IN ~T ~ r}: t~ it ~rtb A 1"i. 4(•) YN ail t t 4i. ~ ~ x ~ 4 t 1~; ~ t• ~ pt y a) Y ry. 1 t! ~ 1 1. 1 1 L Ik;~ ~l 1 L ~ ~ 1.1,, i pr QoJO~r e d. l ky t ~f it f..r'v' u' if tR 3 r~ '"17 to " ~ ~ i ~ r ' ` ) P - t ' 2 ~ • , v ~ '?,,';w k71N1 M8~1121~fTtdC?1iP9ylc!`~~az t+ vi r ~t; Y ; I?r ' r )F • ~ ~ . , s ~ 7 ~ h b...... x L „sy~t b " Sf4'!" t >~s «s a i ~ Wit iQ~,4~ 1 ~~yxyq,,~ si t r 4 s r r-I J! t^} y+yi• A'f+. l t; w?~ ~A i, ,x;'rr v4m ? ; , t ~ r i ~ ii < p Y t{~ r IiMmr.1,T1 {n i t~' ~ , . w 8 rj f t .IN yWE~b'M~ - 5 t r. ~ P ~i f I 1' ~t~ c t, ~ i t~ x, A t~ Je r r r V 1 ' ~ , rz rl tri pP, t1; x, t' } f ~,t ~Fil ~'a ~Wffi ~')h~M r`y zCfi*dd _ a k fie' , f / hSa ~.r4a iv' r spy" (j/e, / f A f a r t A h 1 ' f i f ~ t ' ` r i x t ~ P 1 p Si uu e 4 ^4 r ux •rq. r,~„ pr, .r 4,., ..t. M+-ww,MdrS ~1'IP, L y~ f cN iuj C2 (I,{:i,~:",j ~ Chi ojf ~1 -tv V0 uj i j SJT g r ..1 u. , dS i2 , 04 r ' t7l I ~ti~r.t?~ ; • ;,,5. u, 111 a ,+r spa 41 N' m I tY 1,~ o 11 _ O LU 1 1y/r• F y ?Ja19r7 V71 1 5,, nsu. 713~t~3 ~~ly _Jiro 4 ! t ~ - ,ti ~+f a •'ts"v .a.. .r~e~' ryas if '-ce {1 -;e j r Al al w wk fi~ i BOARD OF BEALTII 4 FORM NO.1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY . . . 31995 BUILDING DEPARTMENT ClIrcr TOWN HALL SEPTIC FORM 6 SOUTHOLD, N.Y. 11971 TOV1 ;a TEL.: 765-1802 ttoFIFY OL f' CALL ~I 0~ Examined 19 J HAIL To : Approved ....1/,j 19 a.. 1 errnit No. f!'~"...... Disapproved a/c (Building Inspector) ICATION F.OR BUILDING PERMIT Date 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing I9cation of lot and of buildings on premises, relationship to adjoining premises or public stieets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal of demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) X-10 sr (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 77A4T Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done . . 5/0 ....11, cb~1~®I~ ...ley....., House Number Street Ilamle4 County "fax Map No. 1000 Section Block Lot . J-/.............. Subdivision Filed Map.No. Lot (Name) , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: it. Existing use and occupancy . , 29'C(??1 P ' r~'' 'I'.Bt..,_.g;r??.,•;,q:,;•.:~.,t.. ,,.;1€.............. b. Intended use and occupancy .~i25iOf~ ff ~ emiNew building Addition Alteration Repair oval . . Demolition . . . . . . . . . Other Work . t 00 (Description) 4. Estimated Cost.. d0©... Fee (to be paid on tiling this application) 5. If dwelling, number of dwelling, units Nuniber of dwelling units on each floor If garage, number of cars OkiC . . . . . . . . . G, If business, commercial or mixed occupancy, specify tj&ire and extent of.each type of use . . 7. Dimensions of existing structures, if any: Front Rear ....el.2........ Depth . X$. ~ . ~ . Ileight . /F............ Nunnber of Stories ..O.hkr.... W. 4 P~^ . arwSt ~hd e~ (4J0~±1, 51 I e , , , Dimensions of shine s(nwtuie with alterations or 1dditions; Front 40.......... Rear . Depth .26.' Height i . Number of Stories C..4?.4&..4'0.e e,. m4-e--' • • . / : Front Z , ; . :Rear /.L Depth g 8. Dimensions of entire new construction: of Stories . ~^e ...t . 9q r , er, , , , , Height 1 . . . . . . . . .'q~. . u~. 9, Size of lot. Front . 5. Nun Rear ...70. r Repth . /.6.Q.... • • . • • , . 10, Date of Purchase PAO-r ?h .4. I , J91) • • , , , , , , Name of Former Owner KQ YOW , • . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded it . t Will excess fill be rennoved from premises: Yes No 14. Name of Owner of pr nises~lkA tti5.Clw 5 k /A'Iress Phone No. ,~6s -/x!7 0l~lV a , , uwn4er ` ...y, Name of Architect Address , Phone No. Name of Contractor .~4tr..S,' . ,cXIGac~,in?C~. ,Address y.Jt?.. I\f,lfr;,e , , Phon~g No. A 9 a'ldbS~ 15. Is this property within 500 feet of a tidal wetland? *Yes........ No......... *If yes, Southold 'own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly 911! buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street nannes and indicate whether. interior or corner lot. I i i 16 I , II i I STATE OF NEW O COUN-I'Y 1, \ S.S , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 11 lie is the ....C~+t tySa!^Qc®. ( • , • . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfonned in the ilia per; set forth in the application filed therewith. Sworn to before nne this i?~ VCQ day f'i... 19 Notary Public, r County R08EST I. SCOT Ti JR. NOTARY PUBLIC. St t' Y. (Signature of applicant) No. 4725089, Su11ol oun}Y Term Expires MaY ,.18 1 4fi~faa7~S' y I I !0' ,II I _ tx I i 11, LI ~tc? _ kvcy d i :~117L Ll.! VLy'Tl dri , i OCCUPANCY OR P- USE IS UNLAWFUL gas WITHOUT CERTIFICATE r" OF OCCUPANCY i r'4 e j APPRD ED AS NOTED NEW so4 ROOM = DATE: - B.P.R a~ fJ.2 rt i. FEE: n, NOTIFY BUILDING D M TO O766-1802 R A R THE FOLLOWING INSPECTIONS: Ev5T RNi V 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH. FRAMING n PLUMBING 3. INSULATION ib EG_O.R 1 1-„I--~{~•~ 4. FINAL COh6'1RiICPIONMUST- , BE COMPLETE FOR C.O. I ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE - N.Y. STATE CONSTRUCTION St ENERGY _ - CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRO46 - - - _.__INIP~N MIND UT f^n'* h'•~r ~au~rT p~'Inn( Poolz L _ li-Toot LV9M, 10 N~~7{are ~~~i"tf R 15 f" SUA) ROM ~ TILk ~,tGNT CPDtcI~E'P - ~ i ~ Ctu pBER MENBfAh~t' ~BfA!^It 7 . PUTT MhiCN pF. .FAN FLO, AIRY w~rs.= _ Rv'~Ir I f N i rtrl.e t:N r,[.. FrnNr sun ~!s sun ~ ' . ~ Vi nu n41 LL d' 6 i' ~Y, Fig .A 1 F1idCN l.o6.crmf: U- FIwuH ,..r 1oiR¢ i Dkn, ~r 1 - ° pXlo phone 477.0400 fy;, Main R F4 DR- zo-m j ° CR££Npo RT, N.Y. 11944., ?fP - f . ~Z><8 i ~I KIonK c'r66-12, ~8L--.----- SOMAS SA,I!}DIhIO'co~rwY,a I.I~~L$(8GfP5VX ~1 WIN ~'1 fU L. ` 1. ...~'-~rl l4 { 1'IEtL ?r' µTYPk xY / SJpµtY?¢Xv - - bR NI /+bCITfIXN mac""' ti I ` n QYPSu NA bE IIIL ,-11I 6 QYtSU rr "~1 1iMi,N Jz cef~~uG pouNa.+7iaH t-J scA~E YY= 10' ~ 6P _ jo - - - - - I -E~ ML AT ~7