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Home My WebLink About20422-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23927 Date OCTOBER 4, 1995 THIS CERTIFIES that the building REPAIRS Location of Property 45400 MAIN RD. SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 6 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 5, 1992 pursuant to which Building Permit No. 20422-Z dated FEBRUARY 6, 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 REPAIR FIRE DAMAGE TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NFB DEVELOPMENT CORP. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - SEPT. 15, 1995 PLUMBERS CERTIFICATION DATED NOV. 5, 1992-JOHN E. WALTERS PLUMB.&HEAT. J ding Inspector Rev. 1/81 !OXX NO. 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) No 20422 n N _ Z Date ~,,.~1......... 6 19..,6.•• Permission is hereby granted to: r. . ~G.. to ......ax ;3 ,1....... ~ . . zl.lle . . . of premises Iota ed a9~ / .,1~~Gf.....`...... J > ..a .Jt.. ..by( . County Tax Map No. 1000 Section .....Zwi. Block -A Lot No...112............ pursuant to application doted ? 19.j.A pnd approved by the Building Inspector. F Fee 5... ~.l,~i.....10 Building Inspector Rev. 6/30/80 Form Nu. 6 row OF SOUTHOLD U ~l BUILDING DEPARTMENT II~ TORN HALL SEP 2 7 1995 763-1802 BLS PFTL TOWN OF OF APPLICATION FOR CERTIFICATE OF OCCUPANCY (1J'rHOLr` 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: L. 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-4 form). 3. Approval of electrical installation From Board of Fire Underwriters. 6. Sworn statement From plumber certifying that the solder used in system contains less than 2/10 of Q 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. K Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 4, 1457) 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 CertiEicate 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 525.00, Alterations to dwelling 05.00, 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 7. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $1/5/.00, Commercial 515.00 Da te... New Construction............ Old Or pre-existing Building.................. . ....s Location of Property.. `.Y4~(W. House No. ppSDDt/r~eet Hamlet Omae_r or Owners of Property.. .~V.~...\--T ? T...f~ 2ounCy Tax Map No 1000, Section ..~.5........ Bt,;ck....(0 Lot..(0. Subdivision ......................................Filed Hop... ..........Lot...... 'ermit No. 2.~ ZDate OC permit.. deallh Depl. Approval. UnderwriLcrc Approval... v . Tanning Board Approval..... . 'equcst for Tcmpornry Certificate....... Final CcrticnLe. ee Suhmitted' 5 Z Or 6~~- 5A010 ens-a39a7 _ _ THE NEW YORK BOARD OF FIRE UNDERWRITERS WE ARE IN THE PROCESS OF ISSUING A CERTIFITE OF ELECTRIICCAL NSTALLLATION AS COVERED Lt IN AN APPLICATION NOT I) BELOW. APPLICATION NO. LOCATION k-% INSPECTOGATE 7 ) 181) (REV 9190) THE NEW YORK BOARD OF FIRE UNDERWRITERS CE ARE IN THE PROCESS OF ISSUING A RTIFICATE OF COMPLIANCE FOR THE E CELECTRICAL INSTALLATION AS IN AN APPLICATION NOT D BEIOW COVERED Q APPLICATION NO, ~i- LOCATION INSPECTOR IBD(REV9/90) ATE c~~FF~(~•C, TEL. 765-(802 0~0 TOWN OF SOUTHOLD ? OFFICE OF BUILDING INSPECTOR ~ [..rye: 31• ~,_r rn o ' ' P.O. BOX 1179 v~ 'c' TOWN HALL O~Ol SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date - hla.Ie beg 5~)0(4z. Buildinpg' Permit No. Owner I}~ MANDO C (please print) Plumber ]SaW C• W4Lft (`66 x f ~~t3 cialf; (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1, lead. (plumber's signature) Sworn to before me this .4~ day of ~t_ 19 9d--. eu _ /I Ces e Nota -y Public Notary Public, County LINDA J. COOPER Notary Pubii~, State of New York~ Term ExPirOs5December 31,, tey I^~ . At FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. TEMPORARY CERTIFICATE OF OCCUPANCY No Z-21129 Date November 4, 1992 THIS CERTIFIES that the building REPAIRS Location of Property 45400 MAIN ROAD (RTE 25) SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 6 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 5 1992 pursuant to which Building Permit No. 20422-Z dated FEBRUARY 6, 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 REPAIR FIRE DAMAGE TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ARMANDO CAPPA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING PLUMBERS CERTIFICATION DATED PENDING p ,t cal il.s. B ilding Inspector Rev. 1/81 Form No. 6 t 5 J ~'I =,.A~ I TOWN OF SOUTHOLD~ ` BUILDING DEPARTMENT NOV.41M TOWN HALL 765-1802, BLDG DEPT TOWN OP SOUTHOLD 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 ysed in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences ant similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. i 6. Submit Planning Board Approval of completed site plan requirements. I• 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. 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 w Construction.., 1.... Old Or Pre e stin ~~LL px' g ui di ication of Property:./. House No., ~o2s^~d~.......... n Street Hamlet war or Owners of Property. ~7 unty Tax Map No 1000, Section ........~.....Block 10 Lot........... division ................................r1.....jFiled Map.. .Lot., 'mit No. ...Date Of Permit. ~t;/~° /.y. -Applica t.` ~j - 11th Dept. Approval l Underwriters Approval...... . nning Board Approval ucst for: Temporary Certificate..' Final Certicate........ Submitted: Ll> co aJC , C V JA a S' c< b~5 11 q~ r~ Q/71~(Sj L Icy 8 APPLZCAN / ~OMMEN7° =1ELD i;:SPEC:iUtJ IIDATE 11 HD` _ y Jv FOUNDATION (1st) FOUNDATION (2nd) m 2. ROUGH FRAME & < PLUMBING 3 .3 3. x m m H~ I14SULATION PER N. Y. STATE ENERGY CODE xC_ H 4. m FINAL f/vx/ q5- c~ ADDITIONAL COMMENTS: /Se / r_°h %Z / ~ Pi~/~• i9~~ ~i i~i'reJ ~v//tr/>7ri,? 612 ~j wV y x m A ' • r H • - x O m •v H THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1155023 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK. NEW YORK 10038 Date SEPTEMBER 20, 1995 Application No. on file 10177195/95 N 364012 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 NORTH FORK HANK & TRUST, 45400 MAIN RD., SOUTHOLD, N.Y. ry in thefollowinp location; Basement tat Fl. LI 2nd F1. OUT Section Block Lot was examined on SEPTEMBER 15 , 1995 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 FLUORESCENT OTHER WT. K W. AMi K. W. AML KW, WT K.W AMT. H P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W. Oll H. P GAS N. P. AMT. NO A. W. G. WT AMP WT. AMPS TRANS. AMT H P SYSTEMS WT. WATTS NO. OF FEET SERVICE DISCONNECT NO. OF S E R V I C E AMT. AMP. TYPE METER 1020 1Z3W 393W 3,e AW NO. OF CC. CORD A W.G. NO OF HIAEG A W G NO. OF NEUTRALS A_W G EQUIP. PER d Of CG COND OF H1 LEG OF NEUTRAL OTHER APPARATUS: SMOKE DETECTOR:--3 *NO VISUAI, DEFECTS: "An electrical survey has been made of the exposed electrical equipment in the premises indicated." "No obvious unsatisfactory condition was found. L~x~E:ecc~ crr~ OCEAN ELECTRIC CORP. P. 0. BOX 428 (QUOGUE, NY, 11959 GENERAL MANAGER 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. ~aj COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST.NOT BE ALTERED IN ANY MANNER. o~Kk~e 7"-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY rr xS~~~1~ REMARKS: DATE ~J INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION KI FRAMING [ ) FINAL REMARKS: O~Er `INSPECTOR ` 765-1802 BUILDING DEPT. f INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND ] INSULATION [ 7 FRAMING [ ] FINAL REMARKS: i DATE INSPECTOR 7- / M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST k ROUGH PLBG. [ ] FOUNDATION 2ND [ ) INSULATION [ ] FRAMING FINAL REMARKS: 1 DATEINSPECTOR -'L ter-- " FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 216154.... Date ......Sep,t,emhe,r 11987. THIS CERTIFIES that the building ..Qne. f.a a i } y..d~ P l,t, i n g, , , , . , Location of Property „45400 Main Road Peconic House No. Street il.)ir uai County Tax Map No. 1000 Section 7 S........ Block 6..........Lot 0....... . Subdivision ...............................Filed Map No. ........Lot No. Re u rements for a rivateone family dwell'" hail! prior i„ conforms substanciial}y to the A7p~1M Hp914icII>utlcjilS~tB'HdhtiKXt2fdi1k7fadtaPilS i tfii~V14,,`J i:y<d Certificate of Occupancy April 23; 1957 161pursuanttowhich3BHXig~l'&)It No. dated September, .14,R, 1987 was issued, and conforms to all of the rcquiremni ; of the applicable provisions of the law. The occupancy for which this certificate is issued is . One family dwelling, 2 accessory wood garages The certificate is issued to ARMANDO CAPPA . (ownar,1R,26i C&:t3i~ Y0~ of the aforesaid building. N A Suffolk County Department of Health Approval . N/A UNDERWRITERS CERTIFICATE NO . PLUMBERS CERTIFICATION DATED: N/A SEE INSPECTION REPORT ATTACHED Building Inspector Rev. III YL cr o S e.0 , C1i 1~ Y nn 106 r' cO z-~~y. doge a A Ac k. 7B I 3f r ,1 I 3~ " Oa ~ ~1 0 / prr 6~^~ p 0Oa ` v1 0 1, ~ U, p p c o ~ v 167544 a aa 4r, ~r CASELLA CONSTRUCTION CORPORATION BUILDERS - APPRAISERS - CONSULTANTS 10 MINEOLA AVENUE * ROSLYN HEIGHTS, NEW YORK 11577 i OFFICE 516-621-1500 FAX # 516 621-5271 Fire 12-26-91 ESTIMATE JD295B Armando and Marie Cappa FANCY O v Old Main Road _ Southhold, NY IS 1AY l!" 1st Floor ~Y/tl.h! R00£ Over Den CEO 2x4 Rafters 8/10 r OOOUPVi Tongue and groove sheathing Den 16x82x82 + C1 Sheetrock ceiling on furring 7 J" Sheetrock wall liner Plywood wall panel Oak strip floor Base & ceiling molding ? ' Large trimmed opening to Dining Room Picture window unit Partition door ~'a r1 i1 ( / & "fl . r Closet fittings 1 Hot and cold water risers Pipe boxing Radiator and enclosure 4 outlets, 1 fixture Paint ceiling & trim Dining Room 16x16 Sheetrock ceiling Yc- Sheetrock walls Oak parquet floor Ceiling molding Base Plywood panel wainscot Chair rail Large radiator and enclosure 2 Double hung windows 2 Aluminum storm windows Raised panel double action door Raised panel entry door with vision Aluminum storm door lite 6 outlets,,1 fixture Paint & decorate FEB A ~OCVs Living Room 132x31 + 8x3 Sheetrock ceiling CASELLA CONSTRUCTION CORIyORATION 2 Sheetrock walls Oak strip floor Base & ceiling molding Pair casement doors 8 Double hung windows 8 Aluminum storm windows Fixed picture window with insulated glass Trimmed opening to Dining Room Fireplace mantel, facing and Fireplace screen Mica radiator enclosure Remove & reset radiator Radiator enclosure' Wood stairs to 2nd Floor complete, including hand and well railing and platforms Wall mirror 15 outlets, 4 High hats Paint complete Porch Room 192x10x8 Ceiling insulation Tile block ceiling Sheetrock wall liner Wall paneling Plywood underlayment Vinyl composition tile floor covering Base & ceiling molding 2 Fixed picture windows with insulated glass 5'x4' 1 Fixed picture window with insulated glass 8'x5' Remove & reset radiator 8 Outlets, 2 surface mounted 4/48" fluorescent fixtures Thermostat Paint trim Pantry 82x6x82 +5x6 Sheetrock complete Plywood floor Linoleum floor cover and underlay Base & ceiling molding Double hung window Aluminum storm window Raised panel door Trimmed opening Standing dish cabinets 581Ix98" Standing dish cabinets 561lx98" Connecting wall shelf Remove & reset radiator Pantry shelving 3 outlets, 2 fixtures Paint & decorate Kitchen 18x14 + 92x6 CASE' - 3 - Sheetrock complete Linoleum floor cover Underlayment Repair,ease & fit woodwork Base and wall cabinets including mica to Recessed shelving and soffet trim Repair and recondition 12 Anderson window units Decorative brick at 1 wall Remove, repair and reset sink, dishwasher, bar sink Tappan gas range Remove, repair and reset Jen Air set-in unit Exhaust hood (self-contained) Built-in can opener, toaster, towel despenser Remove & reset radiator ceiling molding 20 Outlets, 1 4/48" fluorescent fixture Thermostat and wiring 1 Ceiling fixture, soffet fixture Paint & decorate /f(1! Laundry Room 6x6-- Occlt' p, I Repair sheetrock ceiling & walls ~"E Underlayment Linoleum YY'16' ceiling molding OF ~ Repair, glaze, ease and fit side entry door 4 outlets, 1 fixture Paint & decorate Toilet Room 5x32 + 3x3-- Clean and grout ceramic tile floor Recondition water compartment and basin Toilet seat Glaze window 4 outlets, 1 fixture Paint & decorate 2nd Floor - - ,JET /-o- Front and Rear Stairhalls 13x5 + 2x3 + 6x3 + 6X3 + 6x12 + 8-2X3 + 3 Sheetrock complete Oak strip floor Base & ceiling molding 4 Raised panel doors Repair 2 riased panel doors mtj Remove & reset radiator Repair stairs to 1st floor Reset closet shelving East and fit window cASELLA CO' 4 - 8 Outlets, 2 fixture, Paint & decorate Front Hall Bedroom 10x122 + 52x3 + 3x3 + C1 Repair sheetrock ceiling & walls Repair,scrape,finish wood floor Repair,ease & fit woodwork Remove & reset radiator 5 Outlets Paint & decorate Rear Right Room 132x11 + 10x4 Repair sheetrock ceiling & walls Repair,scrape,finish wood floor Remove & reset radiator Repair,ease & fit woodwork 6 outlets, 1 fixture Wash down & paint Center Rear Room 112x12 + 4x8 Repair sheetrock ceiling & walls Repair,scrape,finish wood floor Repair,ease & fit woodwork Remove & reset radiator 5 Outlets Paint & decorate Hall Bath 6x8 Ceramic tile walls Sheetrock ceiling Repair sheetrock wall liner Linoleum floor covering Repair and glaze double hung window Aluminum storm window Water compartment, tub, cultured sink top mica vanity Medicine cabinet with 3 doors Shower rod, seat Shower head Remove & reset radiator 5 Outlets, 2 fixtures Paint & decorate Master Bedroom 132x18 Repair sheetrock ceiling & walls Repair,scrape,finish wood floor Ceiling molding Remove & reset radiator pup Plate glass wall mirrors including 2 sliding closet doors Repair,ease & fit woodwork 7 Outlets, thermostat Wash down & paint CASELLA CONSTRUCT 5 Attic General 32x15x7 + 20x30 Repair and scrape floor to include cedar closet lr;~ » Repair and reglaze 2 windows q') 2 Aluminum storm windows Repair matched and beaded ceiling Repair & test electric wiring Recondition air conditioning unit Blow out, clean, spray and deodorize All ductwork, repair ductwork and Registers and returns as necessary Cellar General " 4 bre panel Rewire Repair,2checkcand testkbasement air sfoQM° rerc& 91sUsegy ing handler, registerscasanecessaryk, new ®ftYPes,~Pp9shallb. Clean and paint UNpfRwRIPfRS L or7P 2Y.mPG FJ ! ayP;~ L~ cUC Cfpf/fi Stairs to 1st Floor 3x6x8? ~fQUIRfD CATf Pair sash Paint complete Exterior Right Elevation /'4at/r Repair composition shingle siding Match and bead ceiling at porch Pine porch decking Girder and column boxing f»- Plywood soffet and fascia Aluminum gutters and leaders 2 Fiberglass shutters Aluminum siding at porch roof` 1 outlet, 1 fixture Paint complete Front Elevation Paint complete Left Elevation Aluminum siding at extension roof Repair composition siding Repair fascia soffet and cornice Repair porch rail and trim Paint complete Rear Elevation. Rear Mud Room 7zx6x8 Mica cabinets CASELLA CONS! 1 outlet, 1 fixture - 5 Wash down & paint General Paint Rear Elevation MISCELLANEOUS Permits and Fees.. General Conditions incl. Supervision.. Removing and Carting away Debris Total ®OPPSr ttataing IS Maater i inri USed sof°prng 811 4 TffICAY RCpU1REQ E CY OR I LAWFUL ,UT CERTIFICATE OCLUPANCY w CASELLA CONSTRE 7 R E C A P I ..T U L A T I O N Sheetrock Finish carpentry Rough carpentry Windows & doors Kitchen cabinets Acoustical ceilings Tile,marble,terrazzo..... Floor/floor covering....... Roofing & sheetmetal Plumbing & heating.. Electrical wiring & fixtures Painting & decorating Glass and mirrors..... Air conditioning & ventilation Stairs & Railings Insulation Permits and Fees.. General Conditions incl. Supervision Removing and carting away Debris . Total r BUILDIi'IG DEPARTi•ENT TOl•!N OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location 45400 MAIN ROAD _ SOUT1101.D, N.Y. t,nwnoer• u street) i'iunlci.paiir,y) Subdivision Alan No, Lot(s) Name of Owner(s) ARMANDO CAPPA Occupancy R-1 owner (type) owner-tenant ) Admitted by:MS..K14ASZZIK Accompanied by: SAME Key available Suffolk Co. Tax Ho. 75-6-10 Source of request ARMANDO CAPPA Date Sept .8, 1957 M (LING: Typo of construction wood _____Irstories`3 Foundation brick Cellar Fu II Cra%,J_ space 'T'otal room-, lst. Fl 5 2nd. Fl 4 3rd. Fl I Bathroom(s) I Toilet room(s) I Porch, type WDDD Deck, -type Patio, -type____ Breezeway Garage Utility room xx Type Heaton, FIRED Warm Air Hot,.Iater xx Fireplace(s) I No. Exits Airconditi.oning xx Domestic hottlater Yes Type heater GAS Other PANTRY _ ACCESSORY STRUCTURES: GARAGE: Garage, type coast,2 CAR WOOD XKX~Y$i~ type conat. 2 r: r Wf'od Swimming pool Guest, type conat. Other _ VIOLATIONS: Housing Code, Chapter 45 N.Y. State, Uniform Pirx_ Prevention _[3yI).1cTiI1c `ode Location Descrioii.ton ~Art.~ S"'• IIAS A SMOKE DETECTOR 2ND FLOOR OUTSrDIi both 2 CAR WOOD CARACRS NU..tZIZ PAIIlTN MainlrnancL~ Rerlarks: Inopected by:~~ Date of. In,"p. 9/l0/R7 r o. l CURTTS td. U9R'reN Time `tartQ0 end 10:30 BOARD OF HEALTH _ FORM NO.1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT C1ICC1 FEB Cp TOWN HALL SEPTIC FORA . . it 5 10 SOUTHOLD, N. Y. 11971 TEL.: 765-1802 t:OT I F'f ; CALL Examined , 19 . [~j rtnlL To: Approved , In~/j,f-YermitNo.eG/..(.R'~d~ Z' _ . 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- 3tion. 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 tall 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 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 Suilding 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. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing ode, and regu ations, and to dmit authorized inspectors on premises and in building for nece7ip`aiu`r*eoj ' ctions. applicant, or na e, Ka corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. T=A . Jame of owner of premises A..R~~.~., n. Ci7/7 /p/./ (as on the tax roll or latest deed) f 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. /Y::...! Other Trade's License No . Location of land on which proposed work will be done. . House Number Street Hamlet County Tax Map No. 1000 Section 6. Block Lot ....1 e , Subdivision Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy A6?/1-X/= , , , , , , , , , , , , , , , , , , b. Intended use and occupancy . . . . . 3. Nature of work (c k Repair/ plicable): New Building Addition Alteration mo val Demolition Other Work 4. Estimated Cost {BOG R (Description) / . . Fee ..l?.U~ .L f t t (to be- artt on filing this application) 5. If dwelling, number of dwelling nits , , . , . • , • , Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixedtoccupancy, specify nature and extent of each t 7. Dimensions of existing structures', if any: Front , , , type of use , , , , , , , , , • , , , , Height.... Rear Depth............... . Numl?er of Stories . Dimensions of same structure with 8. Dimensions . of entire new . j alterations or additions: Front , Rear . Depth .Height . . Number of Stories ~ ~ ~ • ~ • construction: Front Rear Depth . Height Num ber of Stories . . 9. Size of lot: Front Rear . ' .....................Depth . 0. Date of Purchase . , • • , • , . , , • • Name of Former Owner . 11. Zone or use district in which pre uses are situated 12. Does proposed . . . . . . . . . . . 13. Will lot oposed co regraded truction violate any zoning law, ordinance or regulation : . , • 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 . I' 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 n~ interior or corner lot. TATE OF NE~W7/K O NTY OF ./YQ,~ I-FpL(I S.S ',O~• • • • • • • , being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) )ove named. 5 e is the O , (Contractor, agent, corporate officer, etc.) 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 irk will be performed in the manner set forth in the application filed therewith. torn to before me this i yof. Fcfo!''°?t~... ,19~(Z ,tary Public, ` . Cou t l~ ROBERT 1. S ~t NCTAItYUBUC, of! No. 472 Sufto Term Expim May egnature l icant) 31,19 EL-- I I yo__ ITLIE x r-;- L 'it F \ L ,s Lf Ili % y` k i •1~ z~ x 1 f.?. - Phone 477-0400 Meiji Road CUFNVO:Z 1- d v ' - - Nor;"' `?EI'l~r-r Hr. z- fj ~~~ie~~„c.l~j 'owc i PLAN NO SCALF i~ O LE r i ~ LE Vfl i l:~'~ a i 5 i i IL--s i El Phone 47 7 11;7or~ _ 'vl r,n Read DIV PL Ara 61 C; SCALE yy" 2 -L ee- ii y„ 5TELL. I F N N E_A t ' 14 sa `l 4', z ~ i~ : (;~I lii i 3 I I ~L~L5M4 C' ` ^h I I .,s' k 3 M 7 -f - ~ 1 C 1 I it O_ ~ f _ - - - _ - J ~ ~ ~ ~ ~i~ j / ~ , 3 - 2- ~ I Mull{' I ~ _ - Ul l 1 0 3 0 1 0 So'~ Y~ t" f.. ~ -Y' zo5 2- 3 0 i G a ~ R i Phnme: 4-17-0400 ,.~Main Road f (-y~I fNPORT. 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