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HomeMy WebLinkAbout22445-z ! b FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24538 Date JULY 31, 1996 THIS CERTIFIES that the building ADDITION Location of Property 205 WILLOW STREET ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 26 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 27, 1994 pursuant to which Building Permit No. 22445-Z dated NOVEMBER 3, 1994 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 DORMER ADDITION & FOUNDATION UNDER EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ELLEN MCNEILLY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-375048- JANUARY 10, 1996 PLUMBERS CERTIFICATION DATED MARCH , 1996-VAN ETTEN PLUMBING & HEAT. Building Ins ctor 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) QQ. Date 19..1 N® 22445 Z i Permission Is hereby granted to: ......J I........ . ~ ~...Al ...:....4"./......... to..: V 7z6e ~ ~ A;Ft .....is7r i at premises located at ...............J- l ~ ....................1 j County Tax Map No. 1000 Section Block li Lot No. r !I pursuant to application dated 1~-~?.. i 191 E and approved by the i Building Inspector. Fee / A / Building Inspector Rev. 6/30/80 Corm No. o * j r e TOCN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 chat the solder used in system contains ' less than 2/10 of 1% lead. ' S. Commercial building, industrial building, multiple resiaences 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 525.00, Additions to dwelling $25.00, Alterations to dwelling 525.00 Swimming pool $25.00, Accessory building $25.00, dditions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildind - $100.00 3. Copy of Certificate of Occupancy - .251 , 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date -/7"i./ f New Construction........... Old Or Pre-existing Building t!........ Location of Srmr*.!f 10440F!cdr House No, Street Hamlet Onwer or Owners of Property... ~c RAJ ..t'/. ~rfrlj......................................... County Tax Map No 1000, Section... Block t......... Lot.... Subdivision Filed Map............ Lott~.."..................... Permi` No ...Applicanc.. ? JJ!5lC 7•, • ~f*+ • • Date Of Periit.... Health Dept. Approval ..........................Underwriters Approval. yy~;?.37--fo ~ •l. +qAr, Planning Board Approval Request for: Temporarv Certtificate..............SFi~nfa-1 Certicate.... Fee Submitted: $2-zr.y.~4--ir3r fV 1z. .V..YY`:!~'~/ APPLICANT C o i~j `11-5 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000121 BUREAU OF ELECTRICITY F 85 JOHN STREET. NEW YORK. NEW YORK 10038 JANUARY 10,1996 Application No, onfile 88763395/95 N 375048 Dace 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 ELLEN MCNIELLY, FLETCHER STREET, ORIENT, N.Y. in thefollowing location; ? Basement 1Z Ist FL © 2nd Fl. GAR/OUT Section Block Lot was examined on JANUARY 04,1996 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FWCRESCENT OTHER NAT. K.W. AMT. K W. AMT. K.W. AMT. K. W. AMT H. P. 26 32 18 25 1 1 1.2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS M SULTI YSTEMS -OUTUET DIMMERS NO. OF FEET AMT. WAITS AMT. K. W. OIL H. P. GAS H. P. PMT. NO. A. W. G. Mr. P. ANS. AMPS. TRANS. AMT. H. P. 2 F 1 30 1 13 600 SERVICE DISCONNE NO. OF S E R V I C E CT METER NO.OF CC. COND. A. W.O. A. G NO. OF NEUTRALS A W. G PER 8 OF CC. COND NO. OF MbLEG OF NEUTRAL AMT. AMP TYPE [QUIP. I A' 1W I R ]W ],e ]W ],9 AW OF HFIEG 1 2/0 1 2/0 1 200 CB 1 X OTHER APPARATUS: WELL PUMP-1 MOTORS:1-F H.P. G.F.C.I:-5 SMOKE DETECTOR:-2 PAUL R. BURNS LIC.#3097-E P . O. BOX 1061 -GENiEgAE AGRJI SOUTHOLD, NY, 11971-0932 11 Per 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. r 71 Fax (516) 765-1823 Town Hall, 53095 Main Road P. O. Box 1179 Telephone (516) 765-1802 Southold, New York 11971 t ti~, J 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. 4 G S Z Owner: G /e.l 2 (please print) k Y1 , r =t`-~`iC~+g j_. Plumber: j¢/V `><~11) &bey'l 1?00 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this / l°9 day o 19~ Notary Public, ounty JOYCE M ILKINS Notary Public, State of New York No. 4952246, Suffolk Court Term ExpiresA 12, 19 / s ~O~~SOFFOC~-C O o Gyp .S. ca Town Hall, 53095 Main Road p • Fax (516) 765-1823 P. 0. Box 91971 Telephone (516) 765-1802 Southold, Now York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 1, 1996 Ms. Ellen J. McNeilly 1 0 adw 4D P04V 3iCt N or , Y 10 1 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) tr/ xx No Underwriters Certificate on file. 615yo~ xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. & (All permits involving plumbing being ~/p issued after April 1, 1984). BUILDING PERMIT # 22445-Z * Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. - NEED AN ADDITIONAL $35.00 FOR A STONE WALL 6 FENCE BEFORE CO CAN BE ISSUED. l..J ll.S r'a.. :11.1 IIIIn ~,-~•'~I .......,_-+.:r_: - 0 IDATI.0:1 ~(1st) _ - y DAT011 I ) y I (2nd rI3 .H FRAME & - I o ••PLUMRINGY . ~ R 4'- y / o m n L;,TI01I PER N. Y. STATE EIIERGY fill (/t?~~i CODE FINAL ADDITI011AL C014NE11TS: ell m~\ arse ~ x -3 O r m r • v• M o~~S~FFO~,~~0 Gym 0 N ,Z. Town Hall, 53095 Main Road p • Fax (516) 765-1823 P. 0. ox 11 Southold, New York 911971 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 1, 1996 Ms. Ellen J. McNeilly 1200 Broadway 4D New York, NY 10001 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 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 # 22445-Z * Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. - NEED AN ADDITIONAL $35.00 FOR A STONE WALL & FENCE BEFORE CO CAN BE ISSUED. JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK pay rn, P.O. Box 1179 sr x Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE Telephone (516) 765-1801 RECORDS S MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Specia Flood Hazard Area"[- Xf9377 - TOWN OF SO-UP LD 50 5 Judith T. Terry Southold Town Cler August 25, 1 12 D R U APPLICATION PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. '5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable . inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) DATE SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) .:.:,eat. APPLICATION # _ PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ? New Structure ? Residential (1-4 Family) ? Addition ? Residential (More than 4 Family) ? Alteration 17 Non-residential (Floodproofmg? D Yes) ? Relocation ? Combined Use (Residential & Commercial) ? Demolition ? Manufactured (Mobile) Home (In Manu- ? Replacement factured Home Park? ? Yes) ESTIMATED COST OF PROJECT $ B. OTHER DEVELOPMENT ACTIVITIES: ? Fill ? Mining ? Drilling ? Grading ? Excavation (Except for Structural Development Checked Above) ? Watercourse Alteration (Including Dredging and Channel Modifications) ? Drainage Improvements (Including Culvert Work) ? Road, Street or Bridge Construction ? Subdivision (New or Expansion) ? Individual Water or Sewer System ? Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: ? Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ? Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) . ? Unavailable ? The proposed development is located in a floodway. FBFM Panel No. Dated ? See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ? A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ? Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first floor, details of floodproofng of utilities located below the first floor and details of enclosures below the first floor. Also, ? Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ? Plans showing the extent of watercourse relocation and/or landform alterations. ? Top of new fill elevation Ft. NGVD (MSL). ? Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ? Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ? Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ? Is B. ? Is not in conformance with provisions of Local Law #19 The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ? Yes ? No Hearing date: Appeals Board Decision Approved? ? Yes ? No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofng protection is FP. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community s local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ? YES ? NO DATE BY DEFICIENCIES? ? YES ? NO DATE BY DEFICIENCIES? ? YES ? NO SECTION 8: CERTIFICATE OF OMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area Y TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ? NEW BUILDING ? EXISTING BUILDING ? VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW 19_ SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19,_, AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUG PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS:, ~ 42 C6,G lie A 40~; a e2d DATE INSPECTOR 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ CO. DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION ( ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL ( ] FIREPLACE & CHIMNEY REMARKS: a Ae& INSPECTO DATE M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUL ION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY - 6 REMARKS: Sri c~__I d , 7 IV- (;a o DATE ~INSPECTO I M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] R GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRA [ ] FINAL [ FIREPLACE HIMNEY REMARKS: e c DATE ~INSPECTO 7W-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [)01 INSULATION [ ] FRAMING [ ] FINAL [ ] FIB REPLACE 8 CHIMNEY, REMARKS:-'a7~ca~~JC=mod d /1e fl&m?, or DATES INSPECT 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ OUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION ( ] FRAMING [ ] FINAL [ ] FIREPLACE IMNEY REMARKS: DATE /f ~~INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATI:72ND T f ] ROUGH" PLBG. ] OU D [ ] INSULATION [ ] FRAMING FINAL f REMARKS: , ev t t, t E i t DATE/2 Z INSPECT i p... ,BOARD OF HEALTH FORMNO.1 3 SETS OF PLANS ' TOWN OF SOUTHOLD ?SURVEY UCT 271994 BUILDING DEPARTMENT ?CIIECK TOWN HALL SEPTIC FORM SOUTHOLD N.Y.11971 TEL.: 765.1802 t:OT I FY ; y) t~ CALL 2tr . Opts) / y/~ Examined. 1.~.~....... 19< NAIL TO: 9 ! k0 r~nA?" Approved l~~? 19l•.ermit No...~~ . Disapproved a/c '7~6!J -571 76 - dirfg Inspector) APPLICATION FOR 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 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 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 or demolition, as herein described. The applicant agrees to comply with all, applicable laws, ordinances, building code, housint code, and regulations, and to admit authorized inspectors on- premises and in building for necessary ' io s. Signature of applicant, or nam , if a corporation) A&i (Mailing address of applic t) State whether applicant (ED lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................~A.......,...+.........,.......... Name of owner of premises (as on the t roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name arid title of corporate officer) Builder's License No . Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done . • • • • • • • • • • • • • , • • • • • • ' ' House Number Street Hamlet .G., Block Lot.... f............ County Tax Map No. 1000 Section 0.?- Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /A (,lam b. Intended use and occupancy I ...5iQ3r?~ . ' I t 3. Nature of work (check which applicable): New Building Addition D*Oe/.--Alteration Repair Removal Demolition , Other Wor ~ovG?(/ (Description) 4. Estimated Cost ..5°.>_.-o Fee.............................,........ (to be paid on filing this application) 5. If dwelling, number of dwelling tjnits Number of dwelling units on each floor , , . , , . If garage, number of cars 6. If business, commercial or mixed, occupancy, specify nature and extent of each type of use . . ....r . 7. Dimensions c; Wing structures,, if any: Front ..Z. / , . , Rear ~.r , Depth3.9. f .7~. Height ,~Q.. Number of Stories , , . 4 . , , . , , . Dimensions of same structure with alterations or additions: Frorjt ~7. Rear 1873'!okl%, , . . Depth ...`S!d'n4lr . Height ..SAMPMtM2.21 . , . , sco fto& . 8. Dimensions of entire new construction: Front . . Rear Depth , . Height . Number of Stories . , , . 9. Size of lot: Front , , , . , , . , Rear . . . Depth 10. Date of Purchase . . . Name of Former Owner Ai?/~. ?~rru ~./v!Sr iola iare situated 1211. . Does o oes es pr or use district di strict in construction which violalte'any zoning law, ordinance or regulation: AI . . . . 13. Will lot be regraded , ,1 . Will excess fill b remove from p ~ees: Yes No 14. Name of Owner of premises ~41111~. Address 240, ~ Phb'ti~'N0. 7`~I'e Name of Architect . ' .,Address . . Name of Contractor .lrf~'"-If . ? AX/Address . Pffi"-P . 15. Is this property within 300 feet tidal wetland?, *Yes.. No./VO *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing-or proposed, and. indicate all setback dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. • I I . I' i 1 STATE OF NEW YQRK, S.S CO Y F.......'....... • . . .....'I . . being duly sworn, deposes and says that he is the applicant Name of indivi 'al signing contract) above named. / $Heisthe Q4tl.r (Contractor, agent.... officer, etc.) of said owner or owners, and is duly, authorize o perform or have performed the said work and to make and file this application; that aWstatements contained in this application are truetto the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before m this . ~.~.'........day of f%. f ~4 -.........19 Notary Public/_' 9 , unty HELENE 0. HOPNE C/mss/ ~ Notery Public, Stote of Newyork No.496t36a Ruetified in Suffolk 22 (Signature of applicant) Commission Expiros N1aV i Z-090) 7 - ~-1 ~C;C~UI:'d..drt~~dWXb.h(J~'i~(15 i Vic`; (x7_3--1 <'_IWfI (3217Dt7 9LI "O) I f r ks ! {y 1 i A„Vh3 ®yl Uloym/gj UOB16tl BtM oy Apo %"*@=Om v eq of Po+oPl~ 1gWugeyo ry0a a Pull wo jo mm bulmaq NU1"Mloolto tos 'Q6 i Aau gy6p su,dop •me7 uopeonpg VMS v o). mom ey1 Jo ou"'I uoii-::3 10I;C; t C;A u E1 hww upi'l0{ i I l.:l?J.l~ /^lt`l iP1 Ib I I J - c-. 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I~4~ I~"xto° F Y4 2500151 WNC. 41n\ ` II i I -Tv Miw- A Piftc-etr or- 'f PICAL W/tLL, APPROVED AS NOTED OCC OCCUPANCY OR N~ r E ~,°rY. - PLUMBING DATE; II 3 4 sP,q Y7~~ USE ALL PWMBINra _ ER LINES N E . FEE aY;' USE IS UNLAWFUL M ETZ DE SIGT `l TESTINGSEPORECOVERING NOTIFY BUILDING DEPARTMENT AT WIT ENT AT WITHOUT CERTIFICATE 1200 5ROADWA'{ 765-1802 B AM TO 4 PM FOR THE OF NY, N.`( 10001 THE OF OCCUPANCY 21z, 532. s;y~ FOLLOWING INSPECTIONS: , PLUMBER CERT/F/CAT10N 1' FOUNDATION - TWO REQUIRED If copper tubing is used FOR POURED CONCRETE QUIRED I fOr water distributing ON LEAD CONTENT BEFORE . NSULATION AMING & PLUMBING JMBING LL hI M°N! ILL( 205 L?ILLUWS~ system;' piping shall be CERT/F/CAFE OF OCCUP 3 "Of types K Or L pn~y 4. FINAL . ~ CONSTRUCRON MUST" ANCY MUST" PRaPE~i"Y o141 t T N.Y. 11°! O c.SH UNDERWRITERS CERTIFICATE BE COMPLETE IFOR _ SOLDER USED IN WATER ALL CONSTRUCTION SHALL MEET REQUIRED , SUPPLY,SYSTEMCANNOT - ~ETREQUIREMENTS F&THE'N.Y MEET HE N.Y. 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