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HomeMy WebLinkAbout20390-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office o£ the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20486 Date JANUARY 16, 1992 THIS CERTIFIES that the building ADDITION Location of Property 6920 MAIN ROAD LAUREL, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 1 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 15, 1992 pursuant to which Building Permit No. 20390-Z dated JANUARY 16 1992 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 ADDITION TO EXISTING NON-CONFORMING REAL ESTATE OFFICE AS APPLIED FOR. The certificate is issued to BURT G. LEWIS JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-031144 - SEPT. 1, 1988 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 ros~t xo. s 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) N°- 20390 Z Date .......~.~?::~::r.:,,......1.Sc:........., i9.g Permission is hereby granted to: , .......(~(~!N 4~0.~'..YU c-SY:.~!:qtr,~,:,e~...~l~r,~?....~~..~s~,,...~~~sh.~...~.....~ ..~.,ere,1 at premises located at ...(<tgss'~.,fl........~.4h~kta.....~d:cl:c~.......... ~4~:~, : County Tox Map No. 1000 Section ~.~l~a....... Block ......5:~..~......... Lot No......~:..~............ ` pursuant to application doted ....1.~ 19..3-:, and approved by the Building Inspector, ' Fee 5..~.~ ~ Building Inspector \ Rev. 6130180 I , Form No. 6 TO[JN OF SOUTIIOLD BUILDING DGPARTNCNT TO[JN IIALL 765-1802 APPLICATION POR CGRTIFICATC OF OCCUPANCY This application must be filled in by typewriter OP, 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-° form), 3. Approval of electrical installation from Board of Fire Undercariters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. .lc curate 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 ~ r C 4M H, `Y ~ ~ 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 I're-existing Buildins - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10,00 4, Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . ~4~; y V ,+a K.t~ ....~.~n....~ R.el.; ':cw Construction.. J(,,,,,,, Old Or Pre-existing Building.. Location of Property..~o,gS~O,,.,,,mF1fN.,~,......, ~ .,,~AUI~~~ House No. Street......... Hamlet Unwer or Owners of Property... ,!.V.u?y~,/,..~~:...•L.l:"W1,8.. ~12 ':uunty Tax Map No 1000, Section.. ~.el.-,y~, , , , , ,Block.. d ~ . .........Lot subdivision...... ..........................II....Filed hi:~P............Lot................ 'crmLt aoc~~.J7.Q(7.,`}~,....Date Of Permit.. ~/.~4J,`T,;Y,,, PP ~ !ealtli Dept. Approval........ ~;,,,,,,,,,,,,,Undcrwriters A PProval... IY. ,Q . 'l:uu:ing Board Approval equest for: Temporary Certificate........... Final Certicate~.,,,,,, ee Submitted: . C a ~.ao y~~ ~ _z . APPLIG.~sT . , _ ~ ~ _CPJ - TWE NEW YORK BOARD OF FIRE UNDERWRITERS PAGB 1 teeteit r EtUREAU OF RLEtCTRICITY ff JOHN STREET, NEW YORK, NEW YORK 1003f Div SBPTBNBBR 30,1993 ApplicottonNo.onfiM 81468493193 N 291089 TNif CERTIFNIf THAT owb tM eioetrled egsTipment w dwcrt6ed hdotx oad lwtriodaced by tM ayNliwnt TYlned on tM gIN01YP~t~ number In eMPMnttelx of GBNB NIBBA, 725 NARATOOBA LANB, NAPTITUCK, N.Y. IstMJeMotelnllksn~/ g~~ssr4e IetFl. ? End F1. ATTIC/OUT Serttan Block Lot uw sxoosiTSed on T B ~B' R 1 vJ , 19 9 ~ ~~ynd ro be in eotwpltanee with tM NaNoeaJ Electricd Code. ~T{f{ ltWTglli TNg15 pEM WASMlES EXHAUST fANf 011ittTt orNtN AMT. t. w. AMr. c. w. AMT. t.w. AMT. t. w. AMT. N. r. 19 19 25 1T 2 1 8.6 1 1.4 1 F OEYEES RNMA<f MOTORS tUTUY ARUANCf RRIONt At MC'H fIM!'QOCKS tyll {IIRf IfAIEEt MUttM1UT1lT DUAMERS AMT. t. W. pl N. r. 6AS N. r. NAT. NO. A W. G. AMT. AMr. AMT. AMrs. TEANf. AMT. N. r. a~IRT AMT. WATTS t F 2 1 2 600 f~VlEi EROOIIINCT NO.Oi S i R V 1 C p E w~p~ NAT. AAV. Twe ttRIRR T X sw T / xw t R xw s,e Aw No. a . coNO. . w. No. oT NFltO 01~MILf'. No. a NFUT11A15 of 'NtultAl 1 100 CB 1 B i 4 1 4 onw A}?MA1Yk IfATBR PUMP-1 NOTORST8-F H.P. O.P.C.I:-6 SNOBS DBTBCYORo-1 .Po~ G & S CONTRACTOR LLC.0578-B BOB Z15 80UTHOLD, NY, 11911 OMIltAI MANAGER 11 Per Thb not 6o Mond in a Toium M offin of Nw Eoard N ineorreei. Inspoefws may M iTATMNiod by HTeir eroitntio . OP CERTifICATE IrK18T IYOT ~ ALTERED W AMY MAPM~44'R. J APPEALS BOARD MEMBERS ~ r ;;ut~~C~{~„~, SCOTT L. HARRIS ~ 5u ervisor Gerard P. Goehringer, Chairman ~ ~4 P Charles Grigonis, Jr, z -flr Town Hall, 53095 Main Road Serge Doyen, Jr. v' ~~s ~ P.O. Box 1179 James Dinizio, Jr. *,''3 .:r, r ' Southold, New York 11971 Robert A. Villa ` v~ . ~ Fax (516) 765-1823 Telephone (516) 765-1809 Telephone (516) 765-1800 BOARD OF APPEALS TOWN OF SOUTHOLD I ~ 4 ~ OGl' ! 61991 ~.1,~ Oc*_doer 15, 1991 r+~s~~. [tE~°~. Mr. Ronald B. Lewis Burt Lewis Real Estate P.O. Bex 983 Cutchogue, NY 11935 Re: Variance Application - Burt Lewis at Mattituck Dear Dlr. Lewis: This letter will confirm that we are in receipt of the proposed landscaping and blacktop walkway at the front (north) side of the subject building for its entire length. The plan as propcsed is acceptable. Please be sure to contact my office when the improvements have been completed for final inspection and acceptance. Thank you for your attention and efforts to bring the site into compliance. Very truly yours, GERARD P. GOEHRINGER CHAIRMAN lk cc: B~zilding Department P.S. Please be sure to place a "no parking" sign at the front area, which should direct parking to the southwest side area. ~~~©~~~FO~~~~ 3s ~ ~t l .K 1 PLANNING BOARD MEMBERS "~Y~ SCOTT L. HARRIS ~r ~'y...': h9 Y Bennett Orlowski, Jr., Chairman ~,'e,,+na~, ~'~,h Supervisor ~ ~ ~ George Ritchie Latham, Jr. _,yy~~~' Richard G. Ward ~ r Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards pLANNING BOARD OFFICE Southold, New York 11971 TOWN OF SOUTHOLD ,..F,ax~ 16 Telephone (516) 765-1938 ~ ~ ~(r5j4~23 October 11 199. ~ f i' QL'~(( ~ ~g~~ ~ Burt G. Lewis, Jr. P.O. Box 983 Main Road Tct~~1~vC~~ Yclt~ipy~~'-~ Cutchogue, NY 11935 RE: Requirement for site plan for Burt Lewis Real Estate, Main Road, Mattituck Zoning: Agricultural-Conservation SCTM #1000-126-1-4.1 Dear Mr. Lewis: The Planning Board has received a copy of the Zoning Board of Appeals' variance that was granted on September 12, 1991. Please submit eight (8) revised site plans that incorporate the conditions of the variance, as well as the items contained in the Board's letter to you of September 20, 1988, (copy enclosed). An approved site plan for the addition and a recommendation to the Principal Building Inspector for a Certificate of Occupancy cannot be provided until the site plan is modified as requested in the September 20, 1988 letter. Further, you must obtain a curb cut permit from The New York State Department of Transportation. .~ee,~,„~~__ Page 2 Burt Lewis If you have any questions, or require further assistance, please contact staff member Bob Kassner at this office. Very truly yours, Bennett Orlowski Jr. "'~-S Chairman Encl. cc: vVictor Lessard, Principal Building Inspector Vincent Wieczorek, Ordinance Inspector Matthew Kiernan, Assistant Town Attorney Gerard F. Goehringer, Chairman, Board of Appeals N - ; r,~~9`~t~;i' , , . _ _ - - ~ OL"1. 1 ~i 1994 ~tr~~. t~~w>r~. 'rl~ttv~d G~ ~~s€z~.~~.~~K~, ~ i ~ t\ n-'• M r ~ sn' ~ A9~a~`~`,~~sa~l~~t~133 1 Town Hall, 53095 Main Road P.O. Box 1 179 Pi ~ ~ I :ww,._ . i+ 9• ^ q , ii Southold, New York 1 1971 • ~ r ; r (516)'165.~j 938 ~ ~ ~~%~1 1 ~lrl ~ ~ ~~,7~ J )S 4J PLANNINGBOARDOFFICE ? ~<,;~n,~"~~';j;°=.~,_;';'~;-~.~ °a,, _ _ TOtiVN OF SOUTI{OLD ~ ' ~ September 20, 1988 Burt G. Lewis,Jr. Main Road _ P.O. Box 983 Cutchogue, NY 11935 RE: Burt Lewis Real Estate SCTPQ #1000-126-1-4.1 Dear Mr. Lewis; The revised site plan dated July 28, 1988 has been reviewed by the Planning Board at a work session. The following changes are requested in order to complete your application: 1. There should be one clearly defined curb-cut of 30 feet in width to control access to the rear parking area. There should not be parking spaces within the access/exit area to State Route-25. Indicate on plan where pavement ends on State Route 25 relative to the property line. 2. The land in-between the building and the street should be landscaped including street trees as per Section A108-41 of the Town Code (Highway Specifications). 3. Parking area drainage, and proposed grades should be . shown. All roof runoff shall be routed to dry wells. 4. Indicate square footage of building and parking required. (One space for every 150 feet of floor area.) 5. Indicate location of dumpster, if any. 6. Indicate outside lighting fixture type and height. The enclosed marked site plan will be of help in your review of these comments. ~ ~ ` If there should be any further questions, do not hesitate to contact this office. Upon receipt of revised plans, the Planning Board will proceed with its review. ,~~.d _ fl ~ Sincerel,y .~l ' i` ~ ~ 1 ~y t BENNETT ORLOWSKI, ,JR? cxalRriarr cc: Building Department jt C @" Yv~ X,n ~ j,~~ f~ J 't/~ t-~9~1 ~ ~ , flt,~ a, '6C31~dl~t i FIELD INSPECTION DATE COMMENTS y,la FOUNDATION (1st) ~ d _ T - ~ IW a nn ~ ~ FOUNDATION ( 2nd ) tT~G ~o ~-0. ~ ~ 2. z 0 ROUGH FRAME & PLUMBING ~ ~ P ~'o ~ H _ ~ C+7 3. - ~ H ' INSULATION PER N. Y. STATE ENERGY CtODE x G io o-~c r r' 4 . y: FINAL - L b ~ 14 .o. ,'z~ x, ADDITIONAL COMMENTS: =n N ~[a.o` c C.4 . ~ ~ ~ ~ x ro~ H ~1""~ a~ HC F-T~. O.A z,~,~ :t x aZa r..~ ya x d r~ ro H FOAM NO. 3 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIIOLD, N.Y. NOTICE OF DISAPPROVAL , ~s~s+~..~'.~'"~ Date ~ 8 19 `l.l.. . To PLEASE TAKE NOTICE that yopur a(p~plication dated ~ , . , , 19`~ 1. . for permit to 4,~QQ.~.o.. (r-RwY...~:~~t~ tst at Location of Property ..6 /~v j'Y14..... ~v-r~.~C House No. " " " " ' Street Hamlet County Tax Map No. 1000 Section , ...Block ~ ~ ......Lot r ' ~ Subdivision Filed Map No. L,~ot nNo. ~ ) is returned herewith and disapproved on the follow(in\g gr~o{,unds . kS~,.. , .~1R,c,~, w,•h /d7~ " '~Z-- ~13~Q;~...Q.~.+4"}' . M..A . ~•.c ..l~c.D,~w.....p1,A r~MA~...-• ~A• .'~Z,p~ P-?1,.~..~ .o~.~g.~S..,~... rt;.\!i'.~:'u-4~. :GtA+o.A:. (~IIJJ... l.tl~. o ¢J ~ ~ . . Bui ding Inspector RV 1/80 p c~Pl THE NEW YORK BOARD OF FIRE UNDERWRITERS ~1~r.,1': ) maze 7J. BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK 10038 Data SEp't'EMNrR :3l~, 199;? AppHDOtionNo.onfile t3t~68993193 N 291x89 THIS CERTIFIES THAT only the electrtcol equipment as deaeri6ed 6abu+ond introduced by the applicant named on the above application number in the premises of t;t;NE 4tT9KA, '12.5 PSAftATp(?RA 'I,AtIE, MAS`PLTtlCK, N.Y. in [hefollominq locatioq~ n Basemegt ~ /xt Fl. ? 2nd Fl. ~1 ~'JJ .Section Block Lot S F P T.C6 (~P R 9 ~r r 1. 9 ~ 3 and ound to be in cam hence with the National Electrical Code. uos examined on P FIXTURE ECEPTACLES SWItCHE$ FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS WCANDESCENi FWORESCENi OTHEn AMi K.W. AMT N.W AMT K.W qMT. K.W AMT. N P 19 .19 25 l.'7 ? t iJ.6 l 1,d L DRYERS FURNACE MOTORS PUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME'CLOCKS ggLL UNIT HEATERS MULTI.OUTLET DIMMERS AMi K. W. Oll H. P. GAS H. P PMT. NO. A W. G. AMT. AMP. AMT. AMPS. TRANS. AMT M P SYSTEMS AMi. WATTS NO.OF RET SERVICE DISCONNECT NO.OF S E R V 1 C E AMi. AMP TYPE METER I ]W I ,a ~W 3,a aW 3,a dW NO. OF CC COND A. W. G. NO. OF HI-LEG A. W. G. NO. OF NEUTRALS A. W. G. EQUIP. PER % OF CC. COND. OF H4lEG Of NEUTRAL 1. 1.0e CI) 1 % I. 4 1 OTHER APPARATUS: 41t~~~IR B1JMP'1 Cd0'PORSs&-C' H. SMOKE llE'PEC'J'ORr -1 i _ G & S CON1'R~CTOft GiC.ik578°E C/~~~ J30? 21!i SOU1'HQtII), NY, 11971 OENERAI MANAGER t i. ~ 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST. NOT BE ALTERED IN ANY MANNER. ~ _ .w.~_ 1~ C./v9 ,per ~ 4 ' 765-1802 BUI4DING DEPT. INSPEC"TI N [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU4ATION [FRAMING [ ]FINAL REMARKS: °Tc.~~ ' ~ - 2 ~ L DATE __~f Z_~ I NSPECTOit , Iln r11211 I)I' III?A 1,'1'11 D ~4._~~,Ll i'J l,~~~~ ~I SI?'I'S OIL Pt ~Nf7 ~7..~C..... FORM NO.1 SURVEY Pd: s R ( ~ „OWN OF SOUTHOLD cnecK - Y- - - - - BIJILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTTFY ,h,_,..., . I- t's. i~ri ; ~ ~OUTHOLD, N.Y. 11971 CALL ~6 5 .~-w..__,..._,.- TEL: 765.1802 MAIL T0: Examined .................19... Approved 19 Permit No........... . Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date y~~~ p~...., 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inrsp~ectionps\. _(t,_~ ~ (Signa'_ture of a~(pplicant, or name, if a corporaCtion~),, y (Mailing address of applicant) 11`~,Z I ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........~J~.(~....4^:E=wd5.... h~~... ~5~!e . (as on the tax roll or latest deed) If appli ~~nt ipQs a corporation, siggature of duly a orized officer. (Name and title of corporate officer) - ' ALL CONTRACTOR'S MUS~ BE~SUFFOLK COUNTY LICENSED Builder's License No. . • k, • .._-_--~--v Plumber's License No . . Electrician's License No. ..C.g•~~~~• • ' Other Trade's License No . . 1. Location of land on which proposed work will be done....~e...~~ ...\rf 4''~~sS,C~x°~ Z., . ' {1 House Nwnber Street ~ Hamlet County Tax Map No. 1000 Section w......... Block I Lot < . 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 ..~.5.~~~....~ • . b. Intended use and occupancy Cvc.;N~Ae ~{al 'OE '1~!"$ sa~ldx3 uolsslwwo~ ~ • l4uno~ Flo;;nS u! Pa:flle"d (luea?Iddz;o am;zu9[S) I osasvev'~N ~ r;ioA H,eN }o otoES 'onena xablow ~i~~ ~ r--~~---~~ ~ 7?i3>I 'A 13NVf , ? ? ~ ~ilunoQ . ~clgn~,(xeloN ~I~ 'Q~61 ~ ~11i.~, ~ 30 lep . i ~`'V ~1-1-~~ s?ql aw axo;aq of cuomS •yl?,aaxagl pa?g uo?lea?Idde aql u? q;xo} las xauuew at{l u? pawxo3xad aq ?pm xxom ax{l legl pue :3a?taq pue aSpalrnoux $?u;o lsaq aql of anal axe uo?lea?Idde s?ql u? pau?eluoa sluawalz;s ??e lecll `.uo?leo??ddr. s?i?l a?r3 pue a>?ew of pue xxom p?e's ac{l pauuo3xad aneq xo uuo3xad of pazuot{lne !?np s? puz `sxaumo xo xaumo p?es 30 (•ala `xaa?33o alzxodxoa `lua~z `xolaexluo ll ~ • . pau!eu anogt: (loexluoo ~uru~?s ?enp?n?pu? •?o awzN) luea??ddz aql s? ai? lei?l s~Ces pue sas Pdap `uxoms ~C?np ~u?aq a.;r~(... S S . C, o , n~~ O~C'MHN 30 3.I.V,LS •loI xauxoa.zo xoualur xaglagm aleo?pu? puz sauieu laax;s ,~oqs pue `paap of 2u?pxoaae uo?lduasap xo xagwnu xaotq puz laax;s an?~ •sau?? .ilxadoxd wox3 suo?suave?p xaeq-las ItE alea?pu? pue `pasodoxd xo ~u?;s?xa xatjlagM `s9u?p??nq I?e ~Stlau?;s?p pue llxeata alzao7 pa.z~t• nbazdaQq 7.~u7id~tmza saa snz umo o ono ~ sa! ' d ~ S Z PT q S 32x. • o sa~~ ~pueT~aM TepFl u ~o xaa3 00£ uTgl-IM pa~aaoT 6~zadozd sFq~ sI 'SI • ~•1•Z•1s~~S.%Z. •o~N oqd`~"~ •~••n. .....>;Z ssaxPPd •v~n rs xolazxluo o awz .oN auot?d . ssaxPPV . ~ laalcuaxy 3o awzN S:~ L: N Id ssaxPPd S.'.,r,•a..>` •.z~nc+c~' sas?ward;o saump;o awzN 'ti I oN sad aas[waxd wox} panowax a4 II?3 ssaaxa II?M • • • • • • • • • • • • • ' • ' 'Q'(~/{' ' • • • • • papexeax aq lot IRM '£I ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' :uo[ a n~ax xo aaueu? xo `me 2u?uoz hue a z otn uo? anx;suoa asodoxd sao ~ ........~•1...........p... I 1[ 1 P Q 'Z[ ' palenl?s axe sas?waxd qa?qm u? la?x;s?p asn xo auoZ ' I I xaump xauuo3 }o awzN aseuamd 3o aleQ 'OI LRdaQ ...............xza ............................~i......:., ~ luox3 ;lot3o az?S •6 sauolS 3o xagwnN 1 , lug?aH da sauo ~ 4 Z' • • • ~ l 3 ' 1 lsuoa mau as?lua 3o suo?suave?Q •g . 1$ xea uox uo?anx .....,'3o xagwnN .................9.~... l~taH c5'•z uldaQ ' ' ' ' ' ' ' ' ' • • 6 ~j • • • • xeag • • • • • •~h • • • luox3 :suo?l?p?~e xo suo?lexal?e >Il?m axnlanx;s awns 3o.suo?suaunQ dip sauolS 3o xagwnN ;t?S?ag / , g1daQ .......I• ~2 • • xea~ • . • •bZ• • • luox3 :,iue 3? `saxnlanx;s Bu?;s?xa 3o suo?suaux?Q • ~ ' • • ' ' ' ' ' ° • • • • • • • • • • • •asn 3o a4t~l goea ,?o lualxa pue ax!~leu 63?Dads `,iauednaao pax?w xo te?axawwoa `ssauisnq 3I '9 sxea;oxagwnu`aSexe53I ' ' ' ' ' '-~,y' ' ' ' ' • xoo~ uoza uo sI?un 2urliamp 3o xagwnN • • • ~ • • • • • sl?un Su?[Iamp 3o xagwnu `~utt[amp 3I ' S (uo?lea??ddz s?ql 8u?IIl uo p?ecj aq ol) aa3 O~ Z~ • • ;sod paletu?lsg (uo?~duosaQ) ~xon1 xau30 . , uo?l??owaQ , tenowag xteda~? uo?lexalit~ • • , . • , uo?3?PPH 2u?ptmg maN :(a?qza??ddz i?on?m xaaga) xxom3o axnlzN ' BOARD OF HEALTH FORMN0.1 3 SETS OF PL.1N5 TOWN OF SOUTHOLD SURVEY . BUILDING DEPARTMENT C11ECt; . TOWN HALL SEPTIC r• Dart . . SOUTHOLD, N.Y, 11971 TEL.: 765-1802 ttDT i FY CALL Examined 19q~- PSAIL T0: Approved ~°Ln~~a~-!~,. j~a, 199?-: Permit No. a~ . Disapproved a/c . (Building 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 ;ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~ation. 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 ;hall 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 & Certificate of Occupancy ;hall 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 3uilding 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. fYre 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 ins ctions, (ignature of applicant, or name, iF a corporation) (Mailing address of applicant) State whether applicant is owner, lessee agent, architect, engineer, general contractor, electrician, plumber or builder. name of owner of remises ~!~;l.. C.a CS J~ . 1 (as on the tax roll o ~e~.&d) !f applicant is a corporation, signature of duly authorized officer. ~ °~F (Name and title of corporate officer) Builder's License No . . Plumber's License No . . . Electrician's License No . . Other Trade's License No . . I`. Location of land on which proposed work will be done. . ,f4, 9e10 , , , , , , . , • . • , . , , ~0 Ark (-~3 d?Grv~ house Number Street Hamlet County Tax Map No. ] 000 Section ~ Z:: Block ~ Lot ..T' Subdivision . Filed Map No. Lot . (Name) State existing use and occupancy of premi~sles and intended use and occupancy of proposed construction: a. Existing use and occupancy n~~ :/.L. ~r~r~.~/~'.. U~!~IG f; . b. Intended use and occupancy lh~.~ f. 5'19 ~%Z Q c~~ !a o,~\ ~rg 3. Nature of work (check which applicable): New Building Addition . Alteration . Repair Removal • Demolition , ...........Other Work . (Description) 4. Estimated Cost 2,a ,0 U,a.r . Fee ~~'.OJ........................... . g (to be paid on filing this application) 5. f dwelling, number of dwellin u g g pits . . . Number of dwelling units on each floor . If era a number of cazs 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimgensions of existing stru Numb ~f any: Front . .Rear Depth , . Hei ht er of Stories , , imensions of same structure wit~t alterations or additions: Front . . . Rear , Depth .Height . . . . . . . . • , , , , , Number of Stories . 8. Dimensions of entire new construction: Front . Rear . .Depth Height Number of Stories . 9. Size of lot: Front Rear...'....................Depth....................... 10. Date of Purchase , . L , , , , , , , , , , , , , , , ,Name of Former Owner . 1 1. Zone or use district in which premises are situated , , , , , , , , , , , , 12, Does proposed construction violate any zoning law, ordinance or regulation : . . 13. Will lot be re,raded , , , , , , , , , , , , , , , , , , , , ,Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . .Address ...................Phone No............... . Name of Architect . . . . .Address , , . , , , , ,phone No. Name of Contractor . .Address . .Phone No. . 15. Is this property within 300 feet of a tidal wetland? ~yes,.,.......No *If yes, Southold Tqwn 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. Y ~~~~~`P,~~~Y 9~ ~~~~~~'~llL @~~"~~~~~` ~~~Y~FICA~'~ ap~uave~ a~ ~aflr~n Q~' OCCU PAiVCY i7ATEr ! ~.F~ ~1a/. a.-_-.0_.3.`3_0 ~ fiEE: R3Y:.f~.~.7t . ~.:t... NO'CIFY r3c,6lL[}1NC dJEPARTfV1ENi' rai' '7fi6-1f402 ~ ANl Tq cw, 3'M fiO4? 3''ME fi'ol.r..nuvl~~~~ lnrrs~~cTre)N . t, r-cruN~aATlt)N TWta FicntnFi~;r~ fi~l; PtJllllE CS cc)Nrl~er x. rrulc;N ~ ~~~araruvc; c~ i~t.unnt:;NC; 3. INSUYnrlt)ra 4~. RfNP.L C:C)Nf>Tf?UCTtpN 1VlIJ'a'T i3fi tJ(7Mfii.t"T'F fiC)h K;.Ll ALL t:()NfiTRtlt;Tlt)N SHAI..I. MEET ~fFIE RE(3UIRkttRFNTR (ip THE N.Y. eu"7;4TE CC)NSTRtIC:TIQN ge ENERCa`Y (:C)t7E5. NpT RESPONSlBt.E 1=0R t)i:SIC,N ClR C0N5'fRUCTII)N ERRQRS STATE OF NEW YORK, S. . 'OUNTY O (Name of indi idual si nin' ' ' ' ' ' • • • • • • • • • • • • • ~ • being duly sworn, deposes and says that he is the applicant g g contract) hove named. feisthe . ' (Contracto , agen 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 pplication; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set fort in the application filed therewith. worn to before meythis , of.: .........,19~~ otary Public; ~ , , , , County ' GARY ~ NNE LSEN ~ ,2/ Nonu+rlpietl pn auff IkCo ryr ork r 6~ ComrrdssionEniresMsrch30,iSL..`~f (Signature of applicant) r - 4 ~ ' ' i i ~ MAP QF PI2G PERTY t - ~U~~V1~YEU Pb2. ~ . ~U 2~ t.~. L I , ~ f ~ - ~.u~~. ~ l ? l ~4 ' ~ y~ ~ ' „yam ` ~ ~ ~~1 t 1 ~ + ~ f ~ ` 1 _ f -f ~ ~ ! ' ~ i `t ' f ~ ~ ~ /I i t ! y - t { _ ± _ / - ~ ~ I ~ { ~ ~ ~ LJ ' / 1 1! ~ ! ~ , 4 e~ . ,g . 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