Loading...
HomeMy WebLinkAbout20673-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22166 Date FEBRUARY 26, 1993 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 2110 COUNTRY CLUB DRIVE CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 109 Block 3 Lat 2.21 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 30, 1989 pursuant to which Building Permit No. 20673-Z dated JUNE 1 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 DORMER ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING The certificate is issued to EDWARD & SUSAN A. JERMUSYK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-265606 - FEB. 4, 1993 PLUMBERS CERTIFICATION DATED N/A ui1 ing Inspector kev. 1/81 M roam xo. a 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°N° 2067~Z Date 19.,`l.~ Permission is hereby granted to: to ..~.~....la.~~.~`....~,.... ~.....~~~e`~.~.~ ~ J y:~ at premises located ..............P:~l~...... .......~:7~:'.':4•e~-~. ...............................................................~~a' ~.~/~.tit,~.»......................................................... ........................................................................................7........................................................................ County Tax Mop No. 1000 Section ...../i~,~......... Block Lot No...°~`.+z'~ Pursuant to application doted ............f/...~~© 19.~/.., and approved by the Building Inspector. Fee 5... ~Oe. i ~ . ' 'Prr, nl ~j~~ wilding Inspector ~ /O ~i7 Rev. 6/30/80 r I! xosa>< xo. s TOWN OP 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) ~ ~ ~ 8 ~ Z Date .../..~~..y<:~/ . 3°~ Permission is hereby granted to: ~ i3 y`....~' to G^A?~. r.~~'~FkLi~..4:...... .......-Pi.P ..41~'.J....~•/~•••~•`•c~s~~~~'y.... ~....~~~......D ~ , ct premises located at ....~.~.1........~~.,, //ff.. L.~.~~~.r•`.:...~~~ ..~l..~ County Tox Map No. 1000 Section ........1~...~.... Block Lot No.......z.°.Z.~.... pursuant to application dated ........~~~.c3.61 19.~7../~., and approved by the [iuilding Inspector. D0 - Fee ..4r'~~'..G~~.~ . /~ui g Inspector Rev. 6!30/80 ' ~ -~~,~a Form No. 6 ~7.~~5 ~ Jn> fY~' ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ Z 5 I8~ TOWN HALL C__ w _~u~~~~"~ 765-1802 c BI_d~3. UCf??".~ 'M'OV+hd t:~S' "CIaJ?„618 S') r .o.mm..... mco' . . µ.tt u.= 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 Pire 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 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 $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 - $5.00 over 5 years - $10.00 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..ca.. ...1 ,C,,,,,,,,,,,,,,,,. f. House No. Street Hamlet Onwer or Owners of Property... ~:':'t^:C~.. 5 a::~:: tZZ...,~:.....~~ v County Tax Map No 1000, Section.. ~..~.......Block.. .~1..........Lot.. Subdivision ....................................Filed Map............Lot...................... Permit No. ~~~~~:~.~.~...Date Of Permit. 1.~....Applicant Health Dept. Approval ..........................Underwriters Approval...................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $ ' Co ,~K~) r r APPLICANT. -1 ~ ~x 7 ~t N o'~'~' °c~ 2 ° ~ ~ "xm p o ~ r G ~ ~ ~ c~ r.~~ L:s v~ ~ f a a ~ ~•it x'~' d ~ a'° ~m ~L1 ~t"x lam 1 ~ ~ O ~ m `T~.3.e ~ N.{ y i~ r m ~ 2 GL t" .F =.yy n iM1 h3 3 m 1y W .Lp ~ (x oil %2~ ILL ~.O ~ ~ Z ~.Q¢ ~ y nt v16.w O~yy e° i ~:..N L'n q ~W W ~ a r. ~ 0 Y ~ ~t ;r ~ rd 4f ~M b1 ~r L ~ ~h 6~ f m ~~r5 m r '£~N ~ ~ MC Q o w ~ ~ Q ~ ~ ~ c o a G - £ M dd ' a z o A~ ~tti 2 ~L ,11 O N Y ~ O w ~ ~ ~ 3 i m ~ rt *T? n ...»~G ~ ~ 4 Q a ~ ...amp N ~ ~ or P ~ @~i. MS d 9 ~ c:. N ~ D$ ~ N o z~~1' U~ ~ G ~ R b " " ~ ~ o K' ? x N A a N O 3 4 a a ~~n ~ o_ y c N 7+ m oc ~ Z a; R ~ z f N "u 'z' +-.z k oM~ f ~ , 9 -pt 'C ~ m 0.3 ~ Z P ? c, of T'"g v ~q ~ ~ m ~ ~ b Y ~ q ~ Z m ~ ~ i ~y ~ Z T ~ ';i ~ gc ~ 4 N ,,,,~r~lpf4 ZZZi1 IuH 1®'a` ~ fitNH ]o INSPECTORS Victor Lessard '"yv,.. ~,1Ff0(,1,'-~ Principal Building Inspector O~.j...;• Curtis Horton SCOTT L. HARRIS, Supervisor Senior Buik{ing Inspector o 1 ~a ; ;,;r'. F''~-~:.x'+s`. s Southold Town Hall Thomas Fisher is„ ~:=•>~.4 z ' P.O. Box 1179, 53095 Main Road Buildin Ins ector ~ r~ ~ ~ " 8 p A1~~a^,~-~,., Southold, New York 11971 Gary Fish ~ .~~~,r Fax (516) 765-1823 Building Inspector Vincent R. Wieczorek ~z', u~F Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD NOVEMBER 6, 1992 EDWARD S SUSAN JERMUSYIC 2110 COUNTRY CLUB DRIVE CUTCAOGUE, NY 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: x~Y An application for Certificate of Occupancy is not on file. (Enclosed) Rxx No Underwriters Certificate on file. ffi 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 # 20673-Z Please contact our office on this matter. Thank you for cooperation. SOUTIIOLD TOWN BUILDING DEPT. , i::L~ i:: ~I~.in... I~ ii: 1!'I F:NT~ 1~ II ~ 1 . ~ - ~ • a OUiJDATI0;1 (1st) ' ti ~OUtJDATIO;J (2nd ) _.s - o 4,y 'OUGH FRAtfE & ~ PLUMBIidG O / y 6 H C 3. ~ m m IIJSULATIOM PER N. Y. ~ ~ y STAT° EPIERGX CODE II 4. FI;IAL p~ ADDITIOP]AL COMMEIITS: x f„ .~y \ [*1 X ' H i `n O • / N C7 m .-3 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: CSC/ c DATE ~I S INSPECTOR ~ t, s' so:~:w4~" ti ~ ~.m ! w,~' Y I i'f ~i` ~ m p" H Y+' ~"R . ~c ^rr.. .ww, r, fig i 4~q'" ,a _-r- h .s41 r. i~~'ifa: i l ~ ~ ~ T65-1802 BUILDING DEPT. ,,:d INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION 'i ri [ ]FRAMING [ ]FINAL REMARKS: G~~~~l ~z, ~ 4 1 +5 V I ~ DA INSPECTOR / ~ p, r. .R. ~ ~ a cud". ra,.§iSGx.a<,~.;~ i,. ~?„c~h°..',~.~d esFti. l',,...~. S x nw..~~.,.?..3`„ 765-1802 BUILDING DEPT. tNSPECTtON [ ]FOUNDATION i5T [ ]ROUGH PLBG. [ J FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: . ~ "G . G~ t DATE INSPECTOR rte' 7ss-isoz BUILDING DEPT. ~NS~?E~~eoN [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ FRAMING [ ]FINAL REMARKS: _i~ ~ v r~ DATE 2- ~ INSPECTOR N_(DQ;::~G~~~:~~8 ~s~aa:1~B_ j~. ~:~zUY1t314~{R1"JllX~'X ;.;arl ~r l '54;~. V i~~'~ilf;}14'..'. Y;-l;ll! ` w'~`Y 4Yi'ew~~~i'JIF,Nllled3dltrka4~;k.IJ p' wr r .~NI 1 ~l r r I i I." R(,r y~y f~y""~ k~~~~9~~. >n ~~~~1''ti~.~l"{t'i ~°"r7i~'I ll ~~lr ~~~~~~r 1~i ~1 ~~11~i ~ i!~'~~~{8~~~~77 ~~~~~~1~~ )~f~r~ u 1 t I K\; r rl i d r ip 1 F xr /t II ! I i i y ~f}~~ ~~j e~l~:~,~'~~a ~1 .~i~yl IRkI Y it 4'~~Y',i ~d~ar4r ~4-i:~~, ~~~ri~U. 1.~ IW]{, e~~f tii5 1 b{' rl ~e ~ I o Y ; 11 ni ~ e.i l,r r r 1 rR'"grI ~~~'h~if3!`~k1000NTR NI it r~.,l1/!R 1~nn.e ~.1 h ~ ef~ ~ i, . r r ~~ejri~a 11 ~~n v r P"rf + ~lII1~eA i~ i [ 11~ ~Ci Yf rc (~~l I~1~~~~4 t r l~ r~l * ti Sd ~ I ~ ~~~~'t~is Stl 51I1t at .r ~~111e :~,ed v ;..t lr e .1 1)r r 1{~~,r~,~ ,a '.t e FIf ,I ! f.~,i ,~sne ,r//n~~, I ~9 /~,"c ~r ~ ~~4i V.i~~~a1~~~r L: Lfl. 1.. v r 111"`;, "+r ~ -p j'-'.9` .~I p r ~6 ~ 1e:1 1 fl; I:~h Y ~Il r~ ~''ue I~F ~jl ~ .1 I,I ~ jll I l.~ ~~V{r ~r~~e lil ]III ~~e"r pp I I r,.. ~ .1 y~ r'.{.. y lrll T, {fr IY {~1" Yr f.~~ir ~11 11 ~ I Y rii~, Iii 1~ ~ k ~if ~.(litlla~4y~~1.4 i^I~~b,~ ~kF'r~ r(4 .,.i i n mn , ~J t.. r~ y r~ !n ~ 1 ~ I ~ i I I i Y , I,~ ~"~~.r~'Ir ~~7'i I e,' ~ i-1A~ V r~~ ir~%:~SI1 I ~~i iF ei, ip r 11 jt l~-~ qd' t! f t rr ~ ei 1 r,, ~ r,~ ii ~ 1 jLa Iil~i u r~ 1 ry '.~~.d e r~ r „1 e ~ 'zl , A~Irf r~ i., e ~ .r 1-,.. .e_ f{~,,,~~ ~y, 1 i Y rrv' ~~'~W ~ Iii 1 { I N ~ 41 ii ~ S y{ S'r+, [ r r n I ~I~ W it i 1 ~f t_ 11 c nl ~ l f Y Y t l II 1~ (1 1Q 1 N dad ~y,t a~1~1r~~la~y~ r f~ h~ li~ 1 ~rl' rA,.. lyrt rnl Ylii 1~~ le ~r~ ~Mf I1 r 1 Il l Y ~ 1 1. 1 Z r ~~}titlhGe~p,n,~g;,l~~~~-~---,' `~l7-a~~f I~: r r~(I~'~Ylie~r,~,h~ls,i f }rJ l µ 1 ~ ~ ` 1 ! IY + 1 ~ ~ ~ ° I' ~ it Fll: "1 'C'. ~1 v i i,.~ i 'bl Y ~ 'f I' R 3 h~ I I F r i e ' e i i.. ~ i 1 n; rr . t 3rI t~ti 3<~~ L / 1 I'~li~f i Irl I r ~1'~~ ! ~~I~r,. 11~: f q ~,}Yr 1>Y, yii! " r -r<I ~ L ~ IP~i,f r d rl . ~ . ~c 1 J {~4e 1}i I 11 r 1!~~fr II I lYl tr~ r I 1~ ra Ii1/ ~I i~~I 11 1~ r .il~;~/~,o~l~N r1li e~ebiY,f.. 7 JI rl (~fl lli +~'r ~ ~ ,;II ( 31~~i1~~ ~ri~ `~l~Ll. !.,I ~gI~F`raa ~ u Ir ° e I ~ I~ iii I ,t~, f~~ r~~l4~~~~H`r orn 1(i1~/ Ir1Nlu7.~~i Fl~fl My i-~~ 'I'7~ f Ili'1 •I III IR >•jlj~h4x f~16 ~:',4 ~TrM~~ F p ~ r 4:, r )I r1 i~, f a.. t .Y Cfpr1{ 1~. vii It 1;1 k, , , r; ll'1: 8~ 4,> 1~ ~'Srl 1 ~~a> CIE ~r (I~I~ ~Yfl i ,ei,.w,./IH I~ lilrl~/ ~I , a ..I"i ~ ~"i f ~ 1_. 1 e~1rYPrNt , I N~ ~;r j ~ I~"`.' r ~~~~~~~~I~i Y a~ iy r~~ll ~ Y~ YI ~1 ~~I f~ ~.E~j r 11YI ~ P l'. 1 I / ~ r I ~ 1. •r ~i Iv; l ~y ~e 4q ~FN kl~n~4k r~Y'{at,~rlY l~,~,~rMi -~~~t NA lift ~y f.~i ~Y{1. ' `>f ~ 'Yr~`t~ S ~r , ~ I r 0 Flo b~ 1 r~ ~7 r~WP 'qOr N I7j I r4Y( ~ ~i I., ~ o O.I~,y hle` #°j` pF of +r~r;;: r l~ ~ II 1 hlifl c o ~ ll r f { d e„r, i X11. fr~ w uo,"r ~ 4~~~1~~k r`~~Il i 4l~r~' .l ~k Y . , r~1ah r3 <,~Q,,r, 1,~4 t I' ' !/;FORK~CCxINTle l r 1 ua, {!Nr I , _ ~p~-~ r~ y~ 1~ ! ~~i~~ herl it r:l~l 11 ~ r{i ~ I i r f v ~1~~1 ~YS ~11,(~F ^ ~1 ~ 1 'r I ( i~. M1 ti ~r~C ~1 1 !lu °R~ r;'11If.'t iii"@1 ° ,',li ~ Yc ~`I~a r~e~ ~e, I I{ ~ t " i e 1 oy~ al oyie 1" 41 ~~1ii I:.~ IMAP OF ..1 ~ I~r I~uno5 y'. t t i~f 44 j~l 8 e!S ;I~~Tr'?, n} Z ~ e r if I f ~ ~ I it u{ li 11 ~~li~ptlu u1M ..fin ll. Nr.~ 1 oC, ~ i MA('~.OE y, I$' f. arr. I•i' rCENrITlf0,,T0 rrt !Yl 1 ,~.~r I , CO ]'RYG'~-U{a~ Fuj 1'<~~f- 4 Ilk T/][. (-•~UA AANT_F~COAI~~NY p i {1 ` t~N S'~ J ~ ~ 11 TlI[EN~ITl2B~e+ .3UJ F ~ I I NOl1 N O KB/INK B~TRUST CG ~(L EP O~'T/7 /978 FlGENA{6T7 ~S f: 1 i T f R i, _ F 1 I ~ ~ CUT H06UF If li s I ~ I RoBlvPllvlgKNaW ~I ,~rl, :rr y ~~~{ruY C 1 r ~ I 'i~hah E$~~I~CEi1 ,p 11 r~~1~+. IIf m. { DTI TQ1Y(V vrN~,Nv,~/nv~~/'.' 1.t~ ' li l.i{a~c ~ .Itll 1~}.~: ' .r S UFFOL if CO, /y Y ~ 1 ~'3 I ~ S8Q~Q11r~ sur q;la~ e I . , ~ ; i '~eji9lneering'pc~~`~ r I I nrie est?mm~'str~eet,:~r` r ~i nvcrliead,:new yorkli~01 `s i _ , . k. t f /~,1h,<~N'41 _v$7 I~I 11 liyI~I~~ I~I lll; I)~Z~~I~ ('U I CI IUGI11_ , NI U! YURI< , i'~ ICI,1 t•l I\~ ~ {(I`If 11 IJ I 11.1 1,11 ~I~l 11f1 1.1 .l~ l I ~~ivl II I. i : ~1~~,'t1 ;~rsr»^~Iws;~a?~a~sia:~sr~ :.,~lr~,~ar~.::...~z. _,4. ` aoJ(Maur, pnailJi'a~ci~ l ; io~lL~ ,a~?'~`s laa~~s,,uluw'js,aM w t;, . ,y ~ .t }.~~dj,6,ui~aaul6~aia l' ,,y ;x~,l~lr ,3i";~ 1't~ r r"~+ 'f . ~el~fi~ll~an"iris ~puo~uas ' I uP • , i T ~ { r ~ ~II~ r' 1 i. li ~l l ' a t ! ; ~ 1 t ~ !'I ' . ,11,. i`rir,•Ynli / in it cr''./n ~?M~~' IJI II'+~ e{ 11 r , I~1 ,1 fl r rr, •-I~~l}r+ ,17` ,illy„ h` fiR {.I~ t~tlt~l~. 14a ~.~od~y.~~•~llvdN'f li !t I: ' r~7,~c~f~1~}i~~n90N~ln~','~;:l~~~p t, ~I~I>1 a f~~ IYC'N)lJ/Mld N/AOd,. j I i' 1: rl I], 7 , N + 4 r I' 'J~,7 1Snd1 8~N1''9JJ~+D~N1bA7N, i ~ `rlP;` 9L'.C9~rN.r7r7/.~,,816/Ll.1~d~d9ty/ ~ l``i} ` M'a~11}~N_~7[/1 ' , I I , , I l r ~ f ''I I,?S ~L 1~:.~5.~~~~77.7.(~l~lVl~n,? p ~i .(N dIV07 ~d1ND' D'/]J•?7~/l all ~ ~ c-, , p1 03/~/1r!l3.7 I t ~ ~Ir`yt ?~A l";'1 '~,~0 ~NN' ` I ,t r ~g1,.„gy+yjH •{,},t ~ rp'I I+ ~ j~ Y ~ "d~r ` is R r vJ ~ rlt ,}r~..-la F{ rti2 I IR tl!'(.tl~'I~IJ,~l~ i ~ I11~111~~~~~~d,k41j~v'~-..1~,0"'/~I~ tr'~ 1~•; n4(INVI'~~ ~l{ I.,,.~.~ i i 1,.'I' ,~fl+~( ~(7.d~W I I ,~Ik 1~~ 1~~ Fb b cti , + } ~ r rl. ' t$h ~ I ` ~.+a~~S t a1, I. I~ rl yr •II, 7 I ' ~~qL I.M'IJ ,.)I•,,f 1111 1~ v ~I 1'( iJ ' ~1, ) i N~!'!' ,l I i 4i' V S~~ rl ! n I r i ' ~ 1~ if 1 .n 1' g (1 ~ `I ~ , ~ '.1F I dl r I 1 s 1`'ji (lf r' iI y 1~ ~4, f. ~1 ~ ~ ' ~~I ~ I ~ 7 III t VI ~f~ U ~ -t' I v~' f .<~'d~rt,+ si~~l (v ~ I ~ +?.1 ~ ~ j r ~ ~ r i', h','+~":i ,k! t ~ 1 ~'i4f4;~tr FN. ~10~11.~/N~ r r, o ~ C' rn N } tr,ATM,f r 111`K 1 'll>~a +;rt : i. ' f4 ~o{ w` ` ~ 4 l I , I r R f'I i~ ~1 4 f ~ F' ( 5 ~ r~ ~ 1(i , p ~l rrr ti~l t(:, , ~ i ,~r171?t~1~}} j l~~e~gSo~~rr~~ ~t~~ I ~~7~J, MAN dCIA l ~yl I Ah 'I I j~ ~ rll~i 1.,( 1 ~y,~r;~ i. IL'I I~b'I yp Mil' ~ t N , r 11'd 1f111V~c Od 71• ~ 1 ~ ~ 77r .'I i~ ~I~~t' i111')~ ~ k ~'r' !"1 >.1 ~41 J r 1't ,I 1 h~0 I, ' ,.r it1, S { lid ~..ir, - ~I ~ trJ~ ,~ZT`J)I i'~}F.l'18l ~ ~ J 1~ irl~+t ,ra;~4~y ~ j.~ yr •4~ 1y~jy 111 L ; n I. ~ f i t vl~t rvnM n+l a 1,~1 s 1 ~ f lr `.1'~'. ~4'~ L~ ~i i f vr, ~',~.,tT •rrrl ~i'11~~ 'Ill I~~,~` )~IIkINti,cN>t,4~~P~, ~ h' l 1 ,J I'liv~r ( 1. r A ~f, { }I .,,~1Uf f ~ I.I ~j f~~ ~ 4~r~ 1 11 ~ riy,~ r Jr k~ ~'w• { r'.~ I I i I ~.i F' ( }~III~Y~~.,Ae.~fl~lt!:: ~ `~l~'I- ~a~~F~i2..1~ ~ 't 1 11 l,,.1 ~S t'I 1 h ,I I, ~ 14' 1r 1,~w ' 7tY .,rrt , ~ ~ 5 r~l ( 1 ( i { ..1 I's .p ti}' l Y' ''~fV , ~IE~' i }tege,~` (11I,, I, tir ~l~'~4{ ~~'~Q~ y~~ r yt } t'r f+d~lil l I . ,..~~5~! J~ a~~~1;~f,n~s~~l~~ra l~"~jli'f Eli~!~`Y!'~~dsi ~ r~'i~;l)i~r~,~'}~f~l.~~~;~ ~.~~t'~7'I.,.rK~ficr~+ 3'~'~~~~~ ~ ~ , ~ v I U ~ 1 ~ t i rt )I II r i I }1. f~ ~'t+k 1{!: i~ 1.yy~~I I i , r , I ..F~ L l I ~ I1 r s.. ~'~~'k~•?II~~~a.314}I n~flti,~ ,;r1(,lil~°~~ ~"~.~',I1,"r.,l~Y~~i~r"111'rL~`'"It~'-}~r~tl~}~~r~r~~~~~~t~~'ri r.,.. 1~~~ 1. 1 ~ I~~ „i }r l Il 7, I I if I(r, i r"~ r I r r , ~~r1 ~I}{ (t jl 1 !a Mf f ~ rl:~,t' • a~l}~1 G6 1 ~n I7 r r ~ ll, ~ I r ~ i I 1 f e. ri; ~ 1 r a 1 I, ,y t l r~ b ~ I 'yD! f ) ~ ! 1 i { r .LLl +t v t ~'Ju, f)aJ r y ,t y j}. V ' ! J : t ~ 1{~ l"'I~{I .I•.~, { I ~ ;i~ i ~ I.+f ~ / i f ~ ~f~ ~ f 13 , .4. i, k r h J i- I I 1 ! l l.j. t`tf r,~ {f e~r?~ n v ` ~ , ' i r J~ .r ~ I,fl ( vl~l.r: ~ - e-~lj~ 7~ I.r' J Vr{,?'SI ,Is i,~.f tV I' ~ ` 1..~~. 4~= t, t r 1hi ,Ill ~tlr 1 1t1v' ( „ ~ , I , , ,.t'f;~~~ } ? 1 ~ " f ~(tA,,~ ~ ~(T rl i~ ~,h''t r71 T I r ~ ,•I ti I ~ yy~ ~ r ' 1 ~ I r~i (j,(.t\ ~ ~i 'i,. J, a I," , r, ! 10 I I 'p. .r ~ 1'~{n~ VI l ~ IVt 1 '4j r~t'(yG 7~ II µ..~l ~4 1, L ~ .M1..I'~yparr hTl~"~I ,11 ]7 ` ~If~ il~~J MM' . 1 , ( a ! a ~n I'.I t~'yhr fJNI y rri~vl , iJ ~t• i fir. }t~• I ~ , `ii Y~•h ~>t~' Pr' ~ I+ la} II tl H ..I; . ~ ! ~ if ~ ~f i.1~ 1 I],'l. ~ li-~ II "}I r :.I 4i'Ll: t -h'M)/dMf/~1.~1 s~~r ~ f{iyA. 77~r. f t,! V ~~I rI I I { r {'fi'r' 2 ~.~'J'~, Ip ~rx'.~,'~'1 rl. ~ ~IM IGt F ~ i~l r ~ - %~,tl, ; v r:lit,~~i f~l Ij, Ipp I. I,~:.I ' ~~;,y,,t GI ~,'r. 4~" rr, '~i_r~'r1,? r~ i IIIfI( ?G I i ` I ~ ' ,1,~ .ri I~ ' 11.,11 1i.~ j rr 'i-~ ~YI~I ' ,v- ~1+ i~lY 1111 , rfu It , , ~ '~(yi~ ir) 1 ~ 'I rt ~ 11 ,I'I~ 11 1 h j~=~l . y it i # i' yc ~i rf{ I };s~ I,,1 r~. J,7 ~!1~1 ~ ~K of C~.i ~~1~ ~1 i. 7 'Ir l.~ ( ~t ~Iv tl r, ( I 1 L ~ (f i4 I I I ~ ~I~' r r ,b I ~ l ` ` I ~,1. ~ wt's. ~I 1.~~ ~~,i 11 'f:~? rf;i ~ , et l I, ~ ~ ~+,;1 ~ 11~. "i„ ,s if~~ ~.,,r 'I r. 1 , F ~;,II;, .;~g~ ~}rl `11~ I++ I'r I w x v.. t +r ~ t I I ~ ~i -ir~r I~'~ Ih'C1 L r1 II` .1~1' I''r''kII~ •N`:i I fil]r I sYl .f!( ~1 r i i ~'1~~~ sa•~ `P~tii~ y~~xi~ ~~'~I ~ ~ ~ I~ },ll ~ i ~ . ~I I , ,:y'? 1 I ~ r ` I ~ ` , 1 C ) I I 1:,"~I + , ( ~ _ ~ ~ 1 1 r r~ 1'J I ~ s'• ' w" , , I~'' it}~ 'rl~Vl~'d,l 1 ill fJ X11 -fffi,.: I .,r, ~1 :I'f ~ t ~ ~i~ 1 ~ '`t , Je 1 ti(`'i "+1 ~ +1j`i\~ 'ICI ' ~ ,t ? ~ ~ (1 rl , ~r. ~4(., 1,5~ k`' iM1"I y~',~ It~,~~ ~,I~~~Ij~,'ill(.I.!~.a~t~ II} ~ f:.~~lt ~ II.} j,,f~~'•~1,1~'i iT7'A}'ak...y%IFI,l~~l rl ~i s.:,l~ o~ r:~nl~, ,~artr,e.,F9,~si'/ I SitY.1v] .,0//N 8 ap. ~ >r ; +yl f ~ y I, LQ L.#! , ! 1 5 ~ { 8S1asrrrr.~t~ 1 { i i I 11, r , + r w 7 rt,i l5 ] iir rf , l o) +II1 11`'-L ` -.l. jl ~ 1St i ~,i M~'„ i { + { r 1 I' .•t, t, ~i' ~ 11 I« ~ 1 ! 1~ s r ~r~ t `t r r ~ I~ r,.i I r r~ 4 ~ ; I r la~t t !„It r ~ t j ' + r# r'rt+t r s 1, {I r I 1 't f(il r: ~I I f .i1 tt~'[ it ~ I,3 6 1t ~ I Imo{ a I Ir r X 1 1 Y, 1 i lti ~!1 '1 C v i ~ V ~ I lr f ytr f n~ I 1~ I h) 311i~~ fr}~~'I~,y.-.rry r7' I{ -j 1/ I l s r+ e, itl' '~f~ ~r ! Ilx:, ~ ' ' 1111 q. , 1 '.~/flU'~7 ? riPd/I JJA tfi 4 ` , ( i.c ,t, I, f i I, ~ , I,c~rlNnoo~~~ c~~ /'w11Y19,e.'~1_, Y1~.((([[ ~^.J{,z~l~~..~ ' rl'~ }r l~h?~!}I~~~~; ti I r N~1!~ttN ~~.A "~r1 tiTi'~'!.'~~ ~~-rn~~E~yi~~ Ii.1~~~'~ 1 ! ~ Irl{. 1; t 7 I I - 1 I I', f ) 1 rY!' , ~'1' . 1~. ~ I ~r rl ~ 'It I.t } 11 ~ T )If r r y, r 'If r•{ ~ l},;~~ t 1 ,j u i z r' r `ti, )rtla ~ +y~ r c i 71 x~' f ~ ~I 1~~' J " , 1, !yl el7 I'1'~l 'H ~I I, a , R~1 ~ r , , ~ r14, I r I i I cPl " n S' lil' A I i1 v I'4 ' i ' ~ ~t~~~ ~ ~~,~~}~~T}~` ~l.~T`~I~~I"'t~~~rll~l~'!~I r Iir~ ~i~ >'~'N!~~j{~~~fltr+t~i~r~1~~~1~.~'~I~'~~~ ~~~11~~ A~ ~~,a - . ,f;ill~1 i ,If ~Ff~: rrY i' i t ~isl '~I I+-16r~ lal~ ~~.i ! Ir ..I,wn. r ~ Iti:, _ , ' [I"1~'2'~~`~~f~`~I~iir.4?i.~:'~r'~~1`~ ~~'~!i i (11,x;`1 'i`~'~-C`~t11Fk ,~ta+44~t:',3r"~1':`r'~t,~[r>~^!rxt'r.~UG;~!IF~fit!'i!}' ~I.'7~ . aQ'Al~iwn+~:l7a;ri8N7:%.S~L:AN,A~Lir..;- ..S...dJa. +.fJ.hieHf!".~rs I N 1 i x BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 Sl1RV EY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC r•oarl ' TOWN HALL SOUTHOLO. N.Y. 11971 NOTIFY -7 _ TEL.: 765-1802 CALL . ~ 19~ ~ MAIL T0: . Examined ~ ~ ~ ,lpproved 1 Permit No../. (!~>.Q,a`. ~ D ~ Disapproved a/c / ~ . . F3LDG. DEP?. ( dding Inspector) APPLICATION FOR BUILDING PERMIT ' Date . ~l'.. 15~g. INSTRUCTIONS a. Tlris 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. t' d. Upon appnovai 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 Ce~ficate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildin; 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 demol' ion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c e, and regulations, and to admit authorized inspectors on premises and in building for necessary ir~spe io - (Sigtyature of applicant, or name, if a corporation) r aC'c~t~ (Mailing address of applicant) ~J' e7f State whether applicant is owner, lessee, agent, architect, engineer,rgeneral contractor electrician, plumber or builder. S U~FF3N. . Name of owner of premises •,~/I°4•'62;'L•(.OL•••••••••••••••••••••••••••••,... ( n the tax roll o atest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .~30 q.~~. . Plumber's License No . Electrician's License No . ' Other Trade's License No . . 1. Location of land on which proposed work will be do~~ ...~~,rr*'r• .....,.2~^.'' house Number V` •Strcet~ Hamlet G~ ~ County Tax Map No. 1000 Section [ Block ~ Subdivision ~ . (.-J.L.r+(.p.. F,ilcd ttlap No. Lot . (Name) i, State existing use and occupancy of premises and intended use nd occupancy of proposed construction: a. Existing use and occupancy . • . b. Intended use and occupancy i 3. Nature of work (check which applicable): New Building Addition ~Uteration . . Repair Rempval , , Demolition Other 1Vork . ~,y (Description) 4. Estimated Cost `.~~~~.4~.~ Q Fee . g ~ (to be paid on filing this application) 5. If dwelling, number of dwellin units Number of dwelling units on each t}oor . If garage, number of cars . , . . if business, commercial or mixed occupancy, spectl'y nature and extent of each type of use . . 7 Dimensions of cxistirig stntctures, if any: Front . , , Rear .Depth . Height ~ Number of Stories r^ . , . Dimen f sa tructu're with alterations or additions: Front . t~4`r.~~ Rear . r~:~~-r...... , Depth IIcight .~::^r:'~--. ..........Nun bcr of Stories , , . 8. Dimensions of entire new construction: Front ..~ts.~.h...... Rear . ~-.S`,'.1....... Depth . ~.19. Height , ~ , . D.. Nuntlber of Stories . ~y , . 9. Size of let: Front . /0. /z !tip , , , , , , Rcar S.-~ . Depth' f ~ 7t ! A.. . 10. Date of Purchase `J.Cf'..~. , . , .Name of Former Owner ~Q~~a . Gtj/~!4 /(!R!'~: `??i9~!.~NAO6 . . 1 1. Zone or use district in which premises are situated . 13. Hilt lot be regraded , , , . ~te any zoning law, ordinance or regulation: /7id . . p p p \Vill excess fill be removed from premises: .Yes No 14. Name of Owner of premises v~Qi;-)~, ,Address u- N~. Phone No . . Name of Architect ~ Address ~y04~•G!+~-~G .Phone No. Name of Contractor l~.ll/c',~.~'!~`,'!;~... ......Address/.~7~..4 ~~.r?/aT~GPS~~Phone No 7ur~.~.`f ~ . 15.Is this property located within ~p0 feet of a t>ldal wetland? *YES....NO *If yes, Southold Town'Trustees Permit may be required. PLOT DIAGRAM Locate c]early and distinctly all (buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block dumber or description according to deed, and show street names and indicate whether interior or corner lot. I ~rr - U ~ ~ .a ~ aL i i ~~vJ D ~ l - i ~ - ~ I ~ ~ Y E i r - ~~.r~_"_ _ _ - STATE OP NE1V YORK, S :OUNTY OF . ~ • - • • . • . • • , . . . . being duly sworn, deposes and says that lie is the applicant (Name olindividual signing contracU hove named. ~ lc isthc ~ (Contractor, agent, corporate officer, etcJ y :authorized to perform or have performed the said work and to make and file this f said owner or owners, and is del >plication; that all statements contain ~d in this application arc true to the best of his knowledge and belief; and that the irk wilt be performed in ti+e manner sit forth in the application tiled therewith. vorn to before me this . , ~ ~ .day of ..li,... ~.¢F-:.........., 19 ''~f f~i Mary Public, K/.~ County M4TARYPllBIIC S~t~eo~EN~wYork (Si^natura of applicant) ~.aTOTaTas~nmAC~ti ~ Term Expires March 90,1