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HomeMy WebLinkAbout22029-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-26864 Date: 01/03/00 THIS CERTIFIES that the building NEW DWELLING Location of Property: 505 PRIVATE ROAD #26 SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 59 Block 9 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 15, 1994 pursuant to which Building Permit No. 22029-Z dated MAY 2, 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 ONE FAMILY DWELLING WITH ATTACHED DECKS AS APPLIED FOR. The certificate is issued to OLYMPIC HOME MORGAGE CO. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 11-SO-81 09/26/86 ELECTRICAL CERTIFICATE NO. N510732 12/27/99 PLUMBERS CERTIFICATION DATED 11/03/99 DUFFYS PLUMBING&HEATING Bu' ding 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) Nn 22029 Z Date 19.. Permission Is hereby granted to: :Tnclel ..+...K~.~i-..... 3(n~l¢ (~G Oa.>.."?........1.~...~r......:sj • to.............9.~/„;ii/~~.C'ia?~f ,.45.......,................... v~~ p ....."'C/,°;.,"f~.-'.`.'!Sr.'~T.• /..1..~~........." "'PGs ...i .h... • I"""...'rte ..............................................................................................Al at premises located at S0`'.~...... i.%..... p.............,...................... County Tax Map No. 1000 Section J Block Lot No. 1.1... pursuant to application dated !i G...... t 19.,/...,e and approved by the Building Inspector. Fee 5...`S •cGwJ uilding Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT '73 % 1 TOWN HALL 2 /,73 765-1802 J 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 buildir 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 au '.'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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25V 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 Location of Property House No. Street Hamlet Onwer or Owners of Property............... County Tax Map No 1000, Section...Y. Block ...1~ ...........Lot...l.:.~............ Subdivision .r.~.......q ...........................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: $....~J......... SC,2tyYJ/?uL~ . $ 7 o? 9.2 APPLICANT Co ~a68~G ~ , THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 11^85077 BUREAU-OF ELECTRICITY - 40 FULTON STREET, NEW YORK, NV 10038 ` Date DS(;FIIBFR 27,1999 Application No. on file 1'9585399/99 N 510732 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of 9I,AW014IR SKLODOPISKl, 7984 SOUNDVIEW AVENUE, SECTION #059.00, SQUTHOLD, NY r~XRryT - in the following lacation- LJ Basement a Is! Fl. ff] L'J 2nd Fl. OUT Section Bock09 0'Zot 004.00 was examined on DF'CET•4HER 1 5 , 1 999 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURE$ RANGES COOKING BECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. ' AMT:: K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL'REC'Pt TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS r SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A. W, G. . AMT. • AMP., AMT.- AMPS.. ;TRANS, AMT. N.P: NO. OF FEET AMT. WATTS'„ SERVICE DISCONNECT NO. OF S' E R f! METER NO. Oi CC COND. A W. O; . W. G q W G AMT. AMP. TYPE EQUIP. 102W 103W 303W 304W ,,,PER OF CC 'CONDi 'NO OF'HbLFG Op NbLEG NO OF NEUTRALS OF NEUTRAL i' OTHER APPARATUS: ELECTRICAL SURVEY AS PER 12/15/99-1 *NO VISUAI, DEFECTS: "An electrical survey nas peen made of the exposed electrical equipment in the premises indicated." "No'obvious gnsatisfactorv condition was found. „r f=pl hl ~I m I li° i Ik. 1 H?L MICHAEL J. HURLEY I~ #4221 I 9995 NASSAU PT,. RC?F1D, i GHN~RAL MANAGER CUTC.HOGUE,, NY, 119$5 9. •Thls Fis"Iflcate must not be Oltered in anb mob er„ etLYr IQ thgr O Ide pt.t6 FdT ~0"ra te'1„1 - is b nt hair rec enti Is' IF I s DEC 3 0 "1'i51:Ji_L7 1'C1VL~iu :;r sou s4f FOL e Fax (516) 765-1823 Town Hall, 53095 Main Road COD Telephone (516) 765-1802 p. 0. Box 1179 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T 1 0 N DATE: Building Permit No. owner: (please print) Plumber: 14CATi-19 (please print)L,1,pnce certify that the solder used in the water supply system contains less than 2/10 of 1% lead. -4ignatiA (Plu ersSignatu e) sworn to before me this 13 v-d day of ~\JG~)eyhL.)ey-__ 1999 Notary Public, County LYWA M. 11" NDVWPUSUG, State of Now" No. 01906020932 Quall1led in Suffolk Cow, UM 90M Alamh S, 20 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 7, 777 DATE INSPECTOR 765-1802 j BUILDING DEPT.' ECTIOA ~6UNDATION 1ST [ ] ROUGH PLBG.. [ ] FOUNDATION 2ND [ ] INSULATION ~1 e r [ ]FRAMING ~ [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: Olt., C DATE INSPECTOR _ ^ FIELD INSPEC,T"IOON DATE COMMENTS ti - •a H FOUNDATION (1st) C~ FOUNDATION (2nd) m 2. o ROUGH FRAME & efi PLUMBING INSULATION PER N. Y. H STATE ENERGY CSODE x a 3 r S 4 ip . y C , G FINAL LW o " x z ADDITIONAL COMMENTS: i C.t;:K 4917 'Ha 0 C41 x Ch" H 01 N Age e~ H 17 $13FF0j, O a ~ Gym Town Hall, 53095 Main Road O 1 Fax (516) 765-1823 P.O. Box 1179 Telephone (516) 765-1802 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD NOVEMBER 26, 1999 SLAWOMIR SKLODOWSKI P.O. BOX 1637 MATTITUCK, N.Y. 119521 To Whom This May Concern: We are unable to complete your Certificate of occupancy because of the following reasons: An application for Certificate of occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. The check is (not on file.)$25.00 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 # 22029-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. I M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ J ROUGH PLBG. ,NgULATION [ ] FOUNDATION 2ND [ ]I [ ] FRAMING [ ] FINAL [ ] FIREPLACE &/C~HIMNEY REMARKS. DATE t !J INSPECTOR Z N d s w 3 ~5 3W W ..i ~ ~ <u0 (S) pl'y' 4 K a O a N z 0 O ~j.. N 5 r 0) b s z 2 a Y/~!~ ti p Q Ro W iii .O U 3 ~y ~ W 'W z y V (=q E ~NZ W Z 3 gyp} r ~koy ° < J a ~ UO N J 4 48 7 t W E O1 p ep~ w~ ou a - n O 01 •p m yti+ x rc I Z V y m „q U 3 ~ o fm9 a H o h p u z O a y IIJ>}uMi m 00a W v 00 z U X U 4 60 f EE++ p 3J m O 'LA. -fC m O o m LL. CA 4 to p w d G N< W O U O LL I.: M, Q O W C; a 6 N Oa F-{ m » CC ° ~ ~ S o 3 p6 a C lu Lo Z t m` O O q' o O z e o I m J C C z ~ 6 Y, aSti Stg a O s? LL s q c~M(n o y o a ~ E v y c T 0) Ch i O UA m _ 0 Z vi®O W Q O 0.- 2 ON m W p. F w .Y» D" ~ U z~ ~ r7t~ m W d o U LL Z Z U 0 01 C~ E u. ea o o p y ON N y ~ U ~ m f r 'g' a C 3< 4 c ':•46io? m W' N W w m y ~ I U r FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date 21 April.. 19.89... TO Keith Gilbride (owner or authorized agent of owner) 570 North Sea Drive Southold; NY 11971 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CN: 100 Other Applicable Laws, Ordinances•or Regulations at premises hereinafter described in that an addition has been constructed without (state character of violation) a Building Permit and occupying a dwelling without a Certificate of Occupancy. in violation of .....Article XXVIII-100-281 and 100-284 (State sec..........p...a.r.a..g.......raph.. ....of.. .....appliccaobb...,l..e.....low..,.. o.. .rd inaa ncnc'e...or......reguu I at ion.)......... ti on or YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers .are situated at 505 Pvt: Rd. 1126, Southold County of Suffolk, New York. d SUFFOLK COUNTY TAX MAP #1000-59-09-4.1 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. S.P. i~~-,tx..:.c ` J Ordinance Insp for utw Vincent R. Wieczorek FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date DECEMBER... '..1989 19........ KEITH GILBRIDE (owner or authorized agent of owner) 505 PVT ROAD 1126, SOUTHOLD, NY 11971 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CHAP. " 100 Other Applicable Laws, Ordinances-or Regulations at premises hereinafter described in that AN.ADDITION HAS. .BEEN CONSTRUCTED WITHOUT..A (state character of violation) BUILDING PERMIT AND OCCUPYING A DWELLING WITHOUT A CERTIFICATE OF OCCUPANCY. . 100 . -284 in violation of ARTICT,E . XXVIII . . - . ]00 . . -28 . . 1 and . . . . (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 50.5 PVT ROAD......1126. SOUTHOLD County of Suffolk, New York. SUFFOLK COUNTY TAX MAP 0 1000- 59- 09- 4.1 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. ..........L . E3uilding Ins ctor FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date DECEMBER 11, 1989 KEITH GILBRIDE TO .............wner or auth ........o... rizeedd agent of owne r..) (o 505 PVT ROAD k26, SOUTHOLD, NY 11971 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CHAP. 100 Other Applicable Laws, Ordinances-or Regulations at premises hereinafter described in that AN.ADDITIOH HAS BEEN CONSTRUCTED WITHOUT A (state character of violation) BUILDING PERMIT AND OCCUPYING A DWELLING WITHOUT A CERTIFICATE OF OCCUPANCY. in violation of ARTICT,E XXVIII-10'0-281 and 100-284 (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at 50.5 PVT.. ROAD.. . 11.26. .,....SOUTHOLD County of Suffolk, New York. SUFFOLK COUNTY TAX MAP # 1000- 59- 09- 4.1 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. Building Ins ctor i FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date .............J lp...6>..........................., 19.89... TO Keith Gilbricle (owner or authorized agent of owner) 570 North Sea Drive .............Southold NY 11971.............................. (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CH. 100 Other Applicable Laws, Ordinances•or Regulations at premises hereinafter described in that an addition has been constructed without . . (state character of violation) a Building Permit and occupying a dwelling without a Certificate of Occupancy. . II. - 1 . 00 . in violation of .....Article XXVI . . - . 28 . . 1 . 00 . . - .284. . 1 and . . . (State section or paragraph of applicable low, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at 505 Pvt. Rd. /126, Southold County of Suffolk, New York. v t d SUFFOLK COUNTY TAX MAP #1000-59-09-4.1 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. LI.GC' tK :.l Sl..~ Or 'ic as, e- Ins tar Vincent R. Wieczorek FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N© 11353 Z Date .......9-7 19.p/ Permission is hereby granted to: 7 ..&f70...... r.Y..a...... ......4 pS?T.f~G to at premises located at ...~3 f/......... r 1.. 7" .....JQfrrCr/JG'l. LEJ. ~G . ........................,a..~ir-,h!uL+..^...1 County Tax Map No. 1000 Section ....0.4..?...... Block Q...?........ Lot No..~.Q..4~.~.C1L7f pursuant to application dated ...,j' Gf /.id. 194and approved by the Building Inspector. Fee .r....... r i v B [ding Inspector .Rev. 6/30/80 . L V V-1 ~C i~ 5 z Ala ft E ~Z=~ #~t2EV ~Tt mio q,t g, M-1802 BUILDING DEPT. INSPECTION [ ] YNoFDAITION ION 1ST [ UGH PLBG. [ ] 2ND NSULATION [ ] FIN L REMARKS: R U L 1 C t2 Ci-~ 1~L1 (i S if k( b a-e-, N t ~ri- a ~ , 3 i H (L Co r,7- I t © w q el l DATE C INSPECTOR u uv A ~ tN s~trts~7, a_9, 4.r sWPaxc~troermreRrr~n~senru _ ` s~ o n+~ar ar+eainc ~t f mod.' WON %M 6i mnclt' br PPS&COOWRIC VWW !MIT 'r Ctrl Leee ~f • y~am(. ' f « . !AMfL r 3~$82'TC Sh1140 q?r.J WYE-, ti•d ~ w y 56 "ftr OF WAY ' LAND OF A. SGLWWAY ~'nww ac Claw P1Y~ MAP F PUPS-Q i Y iR'v cL Tort Gt L21 v L A' . T7-vN OF 5:)LjrA .u,ALY C t noeo ~f t i li I~ T I A SUFFOLK CO. HCAI.TH SFATEMEN'7. OF tlf7N17 ^ f1/At~ N • 6~11i THE WATER 911q_Y AND 9 i 1 P I SYSTEia vas TMK ALSMANIMM •,Q . y; \ I J CONFORM TO THE SrANOAP M. OF + 1 ~•i - ' , gFFmx CO. OE77. OF FEALrH a 3Y SUFFOLK COUNTY Omm. Or ,y/' / ~•c i SERVICES -FOR APMOrAi:~ i L $ I CONSTRUCTION ONLY I . C DItTC: l AF7ROVED: 1 1J 1 ~'17Q C.~ SUFFOLK CO. ritA MAP vwcA x- 0097. 9DLr. Nuom. ;^c' D wry", fdoo 40" ~ a 1 ! c~LBeloe ~ y :+a. sew SRI. ~ _ %t Z + OEM L. "Z'7 P: TSi t TCAT HOLE 1 _j 1 A' e 1 f pMCdJ'J `iE;NT r.. •b: 'ply _L ~~M~ Y• ..x rrv..ra.ws~• ~•iiJ a.._ r . ,tM£NOSO AN14.17,08! _ =~..,..~:...~;.i'.i... W t!MK Rib _ Y _M.iEtuO®4R-qtr-pc-tT1 i4risi.r.F~ I tor,.11EfY . s• Lmev AS JL" 17F Lo - _974a RI t YAM j'LLYU P, i _ 'C : I. - . GAl.E1R'CIrP RaYORK r' I T 3. Nature of work (check which applicable): New Building Addition Alteration . Repair . Removal Demolition Other Work 4. Estimated Cost .l (Description) ~.QC7~4 . Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units ONC....... Number of dwelling units on each floor If garage, number of cars N0.04Z . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use N/A 7, Dimensions of existin structures, if any: Front Rear Depth Height Number of Stories ...4. . . Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories ,y~. . . 8. Dimensions of entire new construction: Front,3.Q .4- , , , , Rear .%i~+A `/0.4y'':°/'.~'vepth. . Height L.KSS, + Av). 3X:~ Number of Stories A•.......... . 9. Size of lot: Front v1 i1 .S Rear ;18.(~ Depth ( 10. Date of Purchase . y Name of Former Owner ...(a +L 'i~ Ita~ j , 1; l 11. Zone or use district in which premises are situated E}. , 12. Does proposed construction violate any zoning law, ordinance or regulation: X.; . 13. Will lot be regraded IJ©.................... Will excess fill be remgyed from premises: Yes o 14. Name of Owner of premises v~1e1~,$Jf+'j?{4f't..Address fu`):3f.F('TSt~6iccµijls •PhoneNo.7tlE1 .793:G.~~ Name of Architect ...........................Address s. Phone No............... . Name of Contractor . Address Phone No. 1 Is this property within 300 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW. CRK,W~ r~ S.S COUNTY OF Ll Rob! e , M , ,i`7, t5 Arley being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the.......... A r (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 performed in the manner set forth in the application filed therewith. Sworn to before me th's n.da f. ..1.(./...., 19 NotaryPubY~ic; County CtAI E L LEW Notary Public, State of New York er-----_ No.4879506 Qualified in Suffolk County Commission Expires December 8,10 (Signature o applicant) BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT ClIECK _ _ . TOWN HALL SEPTIC FORM _ . SOUTHOLD, N.Y. 11971 TEL.: 765.1502 t:OT I FY ; CALL Examined.... ....,19/ MAIL TO: q/ ~`Zo Approved ~ , 19 ermit No. OZ(~ I . Disapproved a/c . I (Btg I. Spector) APPLICATION FOR BUILDING PERMIT Date / 19gq 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 availablel,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'I all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary iqsp"ns. .Nc!Y1 . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) J 17 Z- i I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 1i.' ...............I. Name of owner of premises .....p, A ' R~.l. 1!\O ~1 . (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. . . 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 pa Hamlet Count f Y Tax Map No. 1000 section ....W .l Black b..l.......... Lot. . a D ®Q . Subdivision Filed Map No. Lot (Dame) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy IfNoml~ A,.4P:wtePkfi>. b. Intended use and occupancy t- r~ •41 3. Nature of work (check which applicable): New Building Y......... Addition Alteration.. . Repair Removal , Demolition Other Work . li~ I- (Description) Estimated Cost lOCJ;Q . . . . Fee , . . , (to be paid on filing this application) If dwelling, number of dwelling units .p.N Number of dwelling units on each floor . If gara e, number of cars ..`l.. h i. If business, commercial or mixed occupancy, specify nature and extent of each type of use . Dimensions of existing structures, if any: Front Rear Depth , . . height Number of Stories , . Dimensions of same structure with alterations or additions: Front Rear , , . Depth Height Number of Stories 3. Dimensions of entire new construction: Front 3.0......... Rear ....3.0 Depth .0l. f 2 . Height L.pss. A-, . }.S.... Number of Stories r a £ . Size of lot: Front . g.3 Rear D th . . . . 9. Date of Purchase .7 ~ Name of F/ormer caner . J~ L u 1. Zone or use district in which premises are situated . / , , , , , , , , , , , , 2. Does proposed construc~t}ion violate any zoning law, ordinance or regulation: V. Q . 3. Will lot be regraded , l0 Will excess fill be removed from premises: Yes 1. Name of Owner of prem}'aes ? ll Address . S 70, /V 5~~ 1-2A . Phone No. Name of Architect Address Vll, Phone No.7~' ? . Name of Contractor ..Address ...................Phone No......... , . 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 tenor or corner lot. TATE OF NEW YORK, OUNTY OF 4't6tT,6.L/G, , , S'S ~ 6_ .6_mAe 22. E being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) )ove named. eisthe (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed tnerewith. worn to before me this ..........dav of. ...~fttfj CtS 1........., 19 ~ Otary Public da-) .j:(1~GQJ/>tjt , , , , , , , LItQbAltffttOWALSKI S w 7 NOTARY PU No. 52-45241 No. /Qualified in SuTfblk CnbdH ' ' ' "Mmission Expires March 33; 19CPi (Signature of appliq r FORM NO. 1 TOWN OF SOUTHOLD 1\ BUILDING DEPARTMENT ~IC9T (w Y~ TOWN HALL 0 4~ SOUTHOLD, N.Y. 11971 TEL.: 765.1302 Examined /~..Z. Application No. • . Approvecj/'Y.. Z 7 11311.. Permit No. Disapproved a/c ...........................il....... (Building Inspector) APPLICATION FOR BUILDING PERMIT 7 Date cC Z....., 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accFate 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 stre( or areas, and giving a detailed dcs9ription of layout of property must be drawn on the diagram which is part of this app cation, a The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcral of this application, the Building Inspector will issue a Building Permit to the applicant. Such porn shall be kept on die premises available for inspection 0:1`013g110ut the work. e. No building shall be occupiFd or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. f~ / 1c! rC7 (Signature of applicant,, for name, if a corporation) .6.~ .1:~.~?~ .r/~..... (Mailing address of applicant) State whether applicant is owner; lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Name of owner of premises !(.1~2/~, p~," ~ ~/.afC~? . ~ ,~/G~~ , . . . . . , , , . 4 ~?u. r~~~._ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . .(Name. and . . .title of core, orate 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 County Tax Map No. 1000 Section ~ Block . , . , Lot . .r~.~• . Subdivision Filed Map No. Lot .77'~ . (Name) 2 State use and occupancy! o cupcy of premises and intended use and occupancy of proposed construction: Existing existing use and n . X16........ b. Intended use and occupancy ~IxS, . , / ~ . . . x. ~L~• e s f O ' 3'1.7 A z 7 LT ; Y ] b a~ I{ 7 j -40 7a X0 VA im. 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O bFTNROaH .o I+_ 0 I, ,p n _ - I ~ -Q QI r i vN\ i T '(3ED pou N~ W Lrvi Nlc L z--tL----- a n - ~xro- 1~y N AU1RM ~ I ~I y S~onc/8 - I Iljl f 2Kros lt,'m , I y NF? .Q j pDlQC/d o~oF .ly i ~ , C o NCACT]f ti /Y{xJ PatiTS' ~85L,' - 1 i 3b o. o CCU APll X-I)PANCY OR USE IS Ul F IS UNLAWFUL ~ IMI f CUT CERTIFICATE OF OCCUP OUPANCY - - ---t - -ze,7 t ! 7arz_ sznns~ - ur- I 'I' I F,\1I 4xq ccW -nP iv"¢IL"x8"6or-+` APOd A OVIS AS N010 _-'7 Z~ 4 "'_a '7 ~;c1 4` I DF'4TFf NOTIFY BUILD NOTIFY BUILDING DEPARTMENT AT T ~ 7657802 9 Ar - 1 -I I-- II v , E ~ FOLLOWING If 7651802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I , p L FOUNDATIC L FOUNDATION - TWO REQUIRED FOR POURr FOR POURED CONCRETE 2 ROUGH - FF ROUGH - FRAMING & PLUMBING 3. INSULATIOP L INSULATION 4. FINAL - C( 1. FINAL - CONSTRUCTION MUST .y-----'I /-;RE COMPLE °Lcf' Po[A(2CD CoNC __,.-4.- I ALL CONSTRU BE COMPLETE FOR C. 0. ILL CONSTRUCTION SHALL MEET r THE REQUIRP, -HE REQUIREMENTS OF THE N. Y. 1- - _ - - - - _ - I ' C Ae Pmam, TAr InK,D1 it n^n, - CODES. NOT O CIVCKU! :ODES. NOT RESPONSIBLE FOR DESIGN OR COI )ESIGN OR CONSTRUCTION ERRORS. i w I,,,, . I I I I I P'1R.-'l'IR'? (Zr'!~Fr vArc-o eEMIMEO er. oeewe er J. FI ,IC q'etas ~~4 - ~ . e.ER LJ A~~ J MIME. ORAWNG MVwEER ~ YR9~6 II I I I I 4 ~x E R~rofY E` - - ~~!bNN6nTGD ~ ~.y ISt~ F'CLf23 S}y-- - _ _ ~~~1541'.~!'! HnIG _ n VCD Roo-', RST'h5A1,Z.'SN, uc Le.~- _ _ ell _.l7-I' , ~ 2xl,os 1L LT,11 ~CP^..YwE 11 TFIt`A~ Wrfl.l. oC IF1Su to kr•r lr .W FT -11 T-1 ~I I I I ~ II I'--'~ T I R. T 1-Al ~y C.DK-5 pIIFA-mR 2 7 ~L SHOE ;ni7FUl~.rti; 'a' tJ .l.n- • .~1 - _ .'2' - pA~CB ti ~x 2EL_Si_C1 ilC ~ K`Il,'- 1 1 t CONG ~-dNC ALL --FQJICftJ% 1 ~S-"Pa¢7tea'- 1Aii ~ 1:t1MiY ~ t ~ _ R_ >!C nJ4 t tSiOCi< ,.ill-,. PG•a yF_ _ 1 .q2.. FS r,Ln~l 6Kd6, CY.n~~ 64tlrsr , SCCt1oN.1- 'Iu~Y f o T ~P•~e CLC ~N`i"r,>u ~ , 1:i1t k i4 i' 7.JL7AC[ CC COLtI1r=- K °t '(cart, {:cF r=r .w. ;4. .1saa+ F_. 'Z It 'i'~,- (nr~ :twri- N/Ihlc h/IN6ra6S ALL ALL-Wt7aA~-, OR)A, oR~AH•~ jYbKr4 4+.'nd AouS I wl~~c W IN pe ers SH1.I« (3C WOpV rwL•lro ~oox< poe,L - PftP5Ii9 k°- AL4M, Sncr.t D~btc AND AND IJ ,.rty'H •-G55Kn' Dnbr{ EkT ERT.- fNVrt_,w_.. art ,gou eS@o A ~1-uts ~LUt45_:!-]ooc NPP RaK .21o ! ATio 1'f°;o. - i ~ i 11 CiTk1 0c_3F;ls~ -~1f"s Ki APPROVED BY S, P~ CH t~t ECLL6 'J M.W. IY c~ OATE ^O Au4 C~ J~ REVMEO DIIAW14G NUMIEO 0 I 4 ~T I i i - ~ ,~0~~' ! i'llj j ail I i I, ~ I~~ Q ' ~ I I I ~ ~"z= { ~ ' ~ - ~ ~ l i i I f I j~ ' I i I I ~ ~ ~ ; i 'i I I i ' ~ ~ - 4 ~te~x. e~~~r i i i - - - __--~-r ~-fTaE Li fTaE L~EV. i~4~~_ Q„ } x I k s2.~__, rvemso rv' G11rr-A:[14 uC b'f----. - eau5o s WIIIM1N~ MIIM~LII „ u~ i i I F I f li -J a a H~ ~ i t>~II A F B L~ lA LEFT Sip ta" OF DGOR +'ii Gl'RCLB I _ I x ag OR G VENT ( E 'T -.--p[tpmy' put ¢ - _.._..T-_."..-..T_ f CiRCULw1~en,t -j Fi Y C IF u R+y cmArhAhL ~ f t xt i t~ t f ILI -11 I 4r_Y SuLF~ 1+, I az + V "f _ III lFA6.% 4 m _ J F<tin tw r,a [ash p{,U9~S~yluCl~I!?VtR ` / i ~ t F / ^s s+ b pex dtEL 2*4-Wo4-" > I L' 4 ! ong 1'R _ iwG _ AP _Phoi_ r 7.0400 "r A1;;r,l ~?nad r _ Ex:( S71 W,K& 16 01, r~~~M1 z E- L~F I I i ham-- EX 571 G- 'I _ A D L7 Fla ~ C x I5 r _ I cg35 ' g~ RA« Aec less DeoR I j y'h r> t J! 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CEVA{r, - C I , I i f ; G 235 i i i ' II I I ' ~ f QJ ate, ~ ~ I - 2v ~ V, x s`i. ~ I I I f~ I ' f I n'D'p.ci C;UT SliE - FEK 6RND k" .~:---~ceu n-2 spa rte. i I YA j 3f.-CP?S-2a _ I . a. 79` tf~ ~1 5'R CJEG9 ~3~t8 Q~R4VlTR ;yip f1"I~J'I1-'~I`--_ I 1 I VV Paw y n' Main Road Phone 477-0400 ° i84C GREENPORT,N.X,11944 - Gti-BFt hE KEITH Ali nitrRrer v, gig f owG. FIT Sr FLOCK -),'"N Ii PLANNO SCALE 4 t =1 Cr4 i-13-e' AE 1 J / Sn 1 I! i -1- cw 1 77 II \ vl I Ii1 !;'III f ~ _ i1 ~1 ~IEwI 1 I I I~ - ua ' ~ ex, sT t ~ - uH j }IA~~^~ 3G r-~ 4 C. n. S1 ~I sin=¢ F~f;T ro~iiwf+ ~ I >1 `,'er kxlst ~ ~opF ivy ' ~ ~5 ~ T I _ ~II:~`1 4-1 N T1[ _ tf{ K rAw ' I ' ~ ~ ~ 3 Sk UGNr~. MR5TE9 BED C) tl\ 5 p„` CATO EZRki- I i t _tA '1 ~ i I I NII { I 1 ~ I r f N 1 { - TOa I N . 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