HomeMy WebLinkAbout19899-z i
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Nc Z-20419 Date DECEMBER 19, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 4670 PECONIC BAY BLVD. LAUREL N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 128 Block 4 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 6, 1991 pursuant to which
Building Permit No. 19899-Z dated MAY 28, 1991
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 ONE FAMILY DWELLING AS APPLIED FOR
AND TO CONDITIONS OF THE ZONING BOARD OF APPEALS #4006.
The certificate is issued to ERIC & MARY ANN ALEXANDER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-210130 - OCT. 19 1991
PLUMBERS CERTIFICATION DATED DEC. 16, 1991 - EAST END PLUMBING
Yd
B ilding Inspector
Rev. 1/81
FORM 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)
N° 19899 Z Date .. ? ........................................ 19.1
Permission is hereby granted to:
��.?�... .. e ..... ..... �
... ,1 �........................... .........
tam - f '... `
G .: ..... ....... ..... ? ' . ` .` ..aft
e z.�L1....at premises located at .... ......? G ... �... . . .. ---3.�• <—/00 a
...........................................� .................................................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section .....A 9..... Block ......... ...... Lot No. ........................
pursuant to application dated ...... /l5? ./....................... 19......... and approved by the
Building Inspector.
FeeS•••
....... ..........
Build Inspecto
Rev. 6130180
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Form No. 6
TOWN OF SOUT[IOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802 ;, ` atd y
APPLICATION FOR CERTIFICATE OF OCCUPANCY �.`-rw' , � y*
'�. This application must be filled in by typewriter OR ink and submitted '.kh.e-,buld$n
inspector with the following: for new building or new use: p
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 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 . 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 . . . . C Q/ f . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . .
Old Or Pre-ex sting Bu��i77lding. .
Location of Property. . . . . . . . . . . . . . . . .f . . .
House No. Street p Hamlet
Onwer or Owners of Property. Lt'7 //�yy,
(:ounty Tax Map No 1000, Section. . . ./? �1 . . . . . .Block. . . . . . . . . . . . . .Lot. . V_-Lo. . . . . . . . . . . . . . .
:;ubdivision. . . .A. . .Q. �.rFFiiled Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . l.9[f�. F.L.�. . . .Date Of Permit. . . :�!`�.�4 I, , ,Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
:'fanning Board Approval. . . . . . . . ... . . . . . . . . . . . . . .
'Zequest for: Temporary Ceertificate. . . . . . . .'. . . Final Certicate. . .
�'ee Submitted: $. . . . .a �.^. 1 . . . . . . . . . . . . . . e0. nn
. . . . . . . . . . . . . . . . .
APPLICANT
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THE NEW YORK BOARD OF FIRE UNDERWRITERS "R`'
' BUREAU OF ELECTRICITY
88 JOHN STREET. NEW YORK, NEW YORK 10038 `.
OCTODKii 29, 1991 i4945591 %91 N >.i i1 a :4 lsa
Date Application No.on file Z
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premiaas of
P
EfiTC Ai:F;XANT?F;R, FF;(.'ONTC RAY f36VD. , 54-'i TO °,9_fiH, MZ'�"(' 'P(k:K, FLY.
in thefollou•inR locotinutl @q/epy�p IAt FI. ❑ 2nd Fl. .Section Block Lot
was examined on - and found to 6e in compliancy with the requirements q(this Board.
PI%TURF FIXTURES I RANGES ICOOKING DKKS OVENS dSN WASHERS EXHAUST PANS
OUTLETS EC5PTACIRf SWITCHES Nf:NIDESCEMI FLUORESCENT OTHER I WT. I K.W. AMT. K.W. WT. I K.W. ANT. K.W. AMT. H.P.
2.4 16 '19 23
DRYERS FURNACE MOTORS PUTURE APPLIANCE MOM ISPECIAL UVIFT1 TIME t].00NS EHL TT HEATEK MULTI.OUTIRT DIMMERS
AMi. K.W. OIL M.P. GAS M.P. HAT. NO. A.W.G. "T. NAP. HAT. AANa. TRANS. AMT. H.P. SYSTEMS
aFFEET AMT. WATTS
SERVICE DISCONNlCT NO.OF S E R V I C E
AMI. ALAI. TYPE MITIM
1 X TN 1 X]N' S X SW 7 X AW �'GpER 4COND. Of CC COND. NO.OF M4LEG Oi W LEGNO, NEUTRALS or A W.G.
OTNER APPARATUS:
c..e .c.T:-3
A(,EXANDRR G. 111184ARD
BOX 2.22
AtwiJkNOGIIk i„ (. , t(Y, 3 1ti;4 i. OL41M MANAGER
1 G �
Per Y
This certificate nwst not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by'their credentials.
COPY FOR=LDW DEPARTMENT. THIS COPY OF CERTIFICATE MAST NOT BE ALTERED IN ANY MANNER.
TEL. 765-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
.. ; � //79
P.O. BOX
TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date L l(o c1 f
Building Permit No. / g
Owner �
(please pr .it)
r� �l' �r
Plumber deems ri2P7
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
X
(plumber ' s signature)
Sworn to before me this
Jday of Lece hel' ,
19�. ?/Jt
terry Public
Notary Public ,S ��� County MgpyE
Stalee 1 Nw York
No.d9M13
INSPECTORS
Victor Lessard Principal Building Inspector O�%$UFPO(k
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Curtis Horton =� y� SCOTT L.HARRIS,Supervisor
Senior Building Inspector y x Southold Town Hall
Thomas Fisher v- ^+ P.O.Box 1179,53095 Main Road
Building Inspector
Fish �j �O� Southold,New York 11971
Garg Building Inspector Ol Fax (516) 765-1823
Telephone (516) 765-1800
Vincent R.Wieezorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
October 10, 1991
Eric Alexander
4670 Peconic Bay Blvd.
Laurel, N.Y. 11948
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
`� XX An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is (not on file. )$25.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
--- issued after April 1, 1984) .
BUILDING PERMIT # 19899-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
.- l-LD Ii;SPSC:iU;i IUn?E OtKMENT
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ADDITIONAL COMMENTS :
--� INFORMATION FOR BUILDING DEPARTMENT
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE rq
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION ro •\
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AS COVERED IN AN APPLICATION FILED WITH OUR y .�
DISTRICT OFFICE. yi
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THE W YORK BOARD OF FIRE UNDERWRITERS z N
APPLICATION NO _.—�J�-�+•� / ---7
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DATE INSPECTOR Cf
FORM IBD(REV 1/86) m
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16619 AVW
APPEALS BOARD MEMBERS � � "t
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Gerard P.Goeluinger,Chairman ,, :
Charles Grigonis,Jr. Town Hall,53095 Main Road
Serge Doyen,Jr. P.O.Box 1179
James Dinizio, Jr. Southold,New York 11971
Robert A. Villa BOARD OF APPEALS Fax(516)765-1823
Telephone(516)765-1809 TOWN OF SOUTHOLD Telephone(516)765-1800
May 6, 1991
Mr. and Mrs. Eric Alexander
4580 Peconic Bay Boulevard
Laurel, NY 11948
Re: Appl. No. 4006 - Variance for Westerly Addition
Dear Mr. and Mrs. Alexander:
This letter will confirm that the plan, as submitted today
(drawn by LE dated 5-91) is acceptable under the above variance,
provided that the structure not protrude more than six inches
( 611) from the variance restriction, which will allow a set-back
not closer than 616" inclusive of all above ground construction.
The construction plan submitted has been made a permanent
part of our permanent file.
A copy of this decision has simultaneously been transmitted
to the Building Department for their files and update.
Yours very truly,
GERARD P. GOEHRINGER
lk CHAIRMAN
Copy to:
Building Department
Suffolk County Department of Planning
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APPEAL BOty GD SCOTT L.HARRIS
1°
Supervisor
Gerard P. Goehringer,Chairman
_ '�' '-
Charles Gri onis Jr.
g 1 e � Town Hall,53095 Main Road
Serge Doyen,Jr. P.O.P.O.Box 1179
James Dinizio, Jr. Southold,New York 11971
Robert A. Villa BOARD OF APPEALS Fax(516)765-1823
Telephone(516)765-1809 TOWN OF SOUTHOLD Telephone(516)765-1800
ACTION OF THE BOARD OF APPEALS
Appeal No. 4006:
Application of ERIC AND MARY ANN ALEXANDER for a variance
to the Zoning Ordinance, Article XXIV, Section 100-244B, for
permission to construct addition to dwelling with an
insufficient side yard setback from the westerly property line.
Premises is nonconforming as to lot area in this R-40 Zone
District, and the existing dwelling structure is nonconforming
as to the westerly side yard and southerly (rear) yard
setbacks. Location of Property: South Side of Peconic Bay
Boulevard, Laurel, NY; County Tax Map Designation:
1000-128-04-020 .
WHEREAS, a public hearing was held on February 22, 1991 and
on March 22, 1991 in the Matter of the Application of ERIC AND
MARY ANN ALEXANDER under Appeal No. 4006; and
WHEREAS, at said hearings all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerninq_ this application; and
WHEREAS, the Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. The premises in question is located along the southerly
side of Peconic Bay Boulevard in the Hamlet of Laurel, Town of
Southold, containing a total lot area of approximately 28,750
sq. ft. , and is identified on the Suffolk County Tax Maps as
District 1000, Section 128, Block 4, Lot 20.
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Page 2
April la, 1991 Special Meeting
Southold Town Board of Appeals
(ALEXANDER Decision, continued: )
2. The subject premises:
(a) is improved with a one story single-family
dwelling structure set back at its closest points 11. 8 and 14. 8
feet from the westerly (rear) property line; 35+- feet from the
southerly (side) property line; 90+- feet from the northerly
( front) property line, and 13+- feet from the right-of-way
easement line and 28. 5 feet to the easterly (front) property
easterly right-of-way easement boundary, all in the ownership of
the applicants;
(b) is located in the R-40 Zone District which
requires a minimum side yard at 15 feet (Section 100-244B) for
substandard parcel of this size.
3 . Appellants are requesting permission to construct a 10'
wide x 53 ' long one-story addition with a proposed setback of
4. 8 feet from the westerly property line.
4. The amount of relief requested by this application is
68 percent of the requirement ( 10. 2 feet) , which is
substantial.
5. It is the opinion of the Board that although the
variance as requested is not the minimum necessary to afford to
afford relief, that an alternative setback at not less than
seven (71 ) feet from the westerly property line is more
appropriate under the circumstances.
6. In considering this application, the Board also finds
and determines:
( a) that the grant of alternative relief will not be
adverse to the essential character of the neighborhood;
(b) the alternative relief will not in turn be
adverse to the safety, health, welfare, comfort, convenience or
order of the town, or be adverse to neighboring properties;
page '3
April 10, 1991 Special Meeting
Southold Town Board of Appeals
(ALEXANDER decision, continued: )
(c) the grant of the alternative relief will not
increase dwelling unit density or cause a substantial effect on
available governmental facilities;
(d) the relief, as alternatively granted, is the
minimum necessary to afford relief ;
(e) the practical difficulties claimed are uniquely
related to the land and are not personal in nature;
(f) the difficulties cannot be obviated by some other
method feasible to appellant to pursue, other than a variance;
(g) in considering all of the above factors, the
interests of justice will be served by denying the variance
requested and granting alternative relief, as conditionally
noted below.
Accordingly, on motion by Mr. Goehringer, seconded by
Mr. Villa, it was
RESOLVED, to DEN the variance as applied for a proposed
setback from the we ly property line at 4. 8 feet, and to
ALTERNATIVELY GRANT a reduced setback from the westerly property
line at not less than seven ( 71 ) feet.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
Dinizio and Villa. (Member Doyen of Fishers Island was -
absent. ) This resolution was duly adopted.
lk
GERARD P. GOEHRINGER, CHAIRMAN
FORM NO,3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
/ Date . ./././'e//. . . . . . . . . . . . . . . . . .. 19
To 499lit.~ $
. . . . . . . . . . . . . . .
PLEASE TAKE NOTICE that your application dated . . . . . . . . . . . . . . . . . . . .. 19 Y,/.
e
for permit to /�.e �6r�. GL. .��i /- - - - - - - at
�✓r� �` (/
Location of Property . . . . . . . . . . . . . . . i, c(/ . . . . , . . . . . . .��Z�G�Q�
House No. eet Hamlet
County Tax Map No. 1000 Section . . . . . . . Block . . . ./�-/. . . . . . . Lot
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . .
is returned herewith and disapproved on the followina grounds . /✓�12 ��iL , . . /GYM , )(�,
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
unl nS ector
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RV 1/80
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ROU H PLBG.
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FOUNDATION 2ND je INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
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DATE INSPECTOR
70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
] FO NDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
REMARKS:
DATE 1 INSPECTOR
i
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO PLBG.
[ ] FOUNDATION 2ND INSULATION
[ 7 FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR
i
M-1802 �
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ 1 FRAMING [ ] FINAL
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Standard NN B T.U. Fbnn 8002-20M —Bargain and Sale Decd,nah Covenants against Grantor's Acts—Individual or COIlOOMum. (single sheet)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THIS INDENTURE, made the loth day of June , nineteen hundred andseventy-f ive
XY BETWEEN ELAINE A. KENDALL, residing at 4580 Peconic Bay Boulevard,
fi •1� Mat tituck, New York
party of the first part,and ERIC H. ALEXANDER and MARY ANN ALEXANDER, his wif e,
both residing at 406 East Main Street, Riverhead, New York
a•�1!
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party of the second part,
1
tf� WITNESSETH, that the party of the first part, in consideration of ten dollars and other valuable consideration
paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs
or successors and assigns of the party of the second part forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon er ted, situate,
lying andbeingjtt;s at Laurel, Town of Southold, County of Suffo�rk, New
V York, more particularly bounded and described as follows :
BEGINNING at a monument set in the southerly side of Peconic Bay
Boulevard at the northwesterly corner of land now or formerly of
Joseph M. Connelly; running thence South 18 degrees 29 minutes
30 seconds East along land now or formerly of Connelly, McGowan,
Belz, Marnie and Brush 300.0 feet to a monument ; thence South
71 degrees 30 minutes 30 seconds West along land now or formerly
of Henry Steffens 73 .61 feet to a concrete monument ; thence
North 18 degrees 35 minutes 10 seconds West along land now or
formerly of Leonard Plechavicius 232 .48 feet to a monument set in
the southerly side of Peconic Bay Boulevard ; thence along the
southerly side of Peconic Bay Boulevard North 29 degrees 07 minutes
20 seconds East 100. 16 feet to the point of BEGINNING.
IV REAL ESTATE -F;-rr STATE OF �
TRANSFER iAYYf ; �,'�'`�`:Nr YORK ,*
Dept of
Inzatlon JUN1275 Y y G 9, 8 5
S hnnnue Pe Insas
TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and
roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances
and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO
HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of
the party of the second part forever.
AND the party of the first part covenants that the party of the first part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of
the first part will receive the consideration for this conveyance and will hold the right to receive such consid-
eration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply
the same first to the payment of the cost of the improvement before using any part of the total of the same for
any other purpose.
The word "party" shall be construed as if it read "parties" whenever the sense of this indentl re so requires.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above
written.
IN PRESENCE OF:
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tc'('-�2' -��(
ELAINE A. KENDALL
LIQER7855 fALL508
STATE OF NEW YORK, COUNTY OF SUFFOLK SS: STATE OF NEW YORK, COUNTY OF SS:
On the loth day of June 19 75, before me Oil the day of 19 before me
personally came personally came
ELAINE A. KENDALL
to me known to be the individual described in and who to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged that executed the foregoing instrument, and acknowledged that
She executed the same. I executed the same.
ALIEN M. SMITH
NOTARY P(IUIIC, Slot, of Now York
No. 52-3714225
Qualified in Suffolk County
Commission Expiras March 30, 19117
STATE OF NEW YORK, COUNTY OF SS: STATE OF NEW YORK, COUNTY OF SS:
On the day of 19 before me On the day of 19 before me
personally came personally came
to me known, who, being by me duly sworn, (lid depose and the subscribing witness to the foregoing instrument, with
say that he resides at No. whom I am personally acquainted, who, being by me duly
sworn, did depose and say that he resides at No.
that he, is the
of that he knows
the corporation described
in and which executed the foregoing instrument; that he to be the individual
knows the seal of said corporation; that the seal affixed described in and who executed the foregoing instrument;
to said instrument is such corporate seal; that it was so that he, said subscribing witness, was present and saw
affixed by order of the board of directors of said corpora- execute the same; and that he, said witness,
tion, and that he signed h name thereto by like order. at the same time subscribed h name as witness thereto.
Bargain ttnd #ale Web
WITH COVENANT AGAINST GRANTOR'S ACTS SECTION
TITLE NO. '� _ ,/' Z ,�y� BLOCK
LOT
ELAINE A. KENDALL
COUNTY OR TOWN
TO
ERIC H. ALEXANDER, and Recorded at Request of
MARY ANN ALEXANDER, his wife CHICAGO TITLE INSURANCE COMPANY
STANDARD FORM OF NEW YORK NUN OF TITLE ONOEAWRITERS Return by Mail to
Distributed by t {
01
ATTORNEYS AND COUNSELORS AT LAw
CHICAGO TITLE 456 GRIPPING AVENUE
P. O, BOX 389
INSUIIANCE COMPANY RIVERHEAD, NEW YORK 11901
Zip No.
Att : Allen M. Smith
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LS FORM 3 SETS OF PL1:7S
TOWN OFSOUTHOLD SURVEY .
�,01991 BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
BLOO. E TEL.: 765-1802 NOTIFY
TOWN O S0 'OLD"`'' �y/ CALL .a��:.�. 3.1
Examined .� . . . ., 19,91 MAIL T0 : 7- '
Approved��i �. . . . . 19� Permit No.
Disapproved a/c ��/.y.,l9i • • .�s=( �� . . . . a`J 11\J I
. . . MAY 2199i
( ilding s ctor) rOtrvr; t�P� <^ntr�'i;Ot �
APPLICA ION F R BUILDING PERMIT
Date . . . . . .� 1. /D . . . . . ., 19 91.
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 alter , r for rem val or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordina d' g co e, using code, and regulations, and to
admit authorized inspectors on premises and in building for ne ssary inspe i n
t�
(Signature of applicant, or name, if a corp ration)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . .(50 n.e—.(7� . . . . . .... . `. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises rlL �Q! �• .J7T1•�( , , , Ole X,, O �. . ..' --
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title f orporatefficer) ''// � rl
r E,c� & Zss F�caMS
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . ))IS d
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .>ly, . . . . . . . . . . . /.a�.� . . . . . . . . . . . . . . . . . . ..
House Number Street Hamlet
County Tax Map No. 1000 Section . . .J .?: � . . . . . . . . Block . . . . . . . . . . . . . . . . Lot . . . .z O . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intenlled use/and occupancy of proposed construction:
a. Existing use and occupancy . . . . A,,K9�. . .�f kl,,� I'/, /. &, )4 :. . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . . . . . . _. . .l vl "z . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work (check which applicable): New Buildin
g . . . . . . . . . . Addition . . ..(:`.1 .• ',Alteration .. . . . . . . . . .
Repair . . . . . . . Removal . . . . . . . . . . . . . . Demolition `Other Work .
4. Estimated Cost . �c� 1 Dc7c� . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . �( cription)
11 ��. .
If garage, number of cars grunts . . . ./. . . . . . . . . . . Number of dwelling nits on-each floor. .a . . . . . ..( P "i PP
5. If dwelling,number of dwellin I
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . .
7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
Height Number of Stories . . . . . . . . . . . . . . . . . . . ._ . . ✓ . . . . . . . . . . . . . . . . .c r cf,N. . . . .
DepthB , , . �� � th alterations or additions: Front . . .�. . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
8. D .o,'r... tl ire new construction:' Height . . . . . . . . . . . . . .h . . . Number of Stories . . . . . . /. . . . . . . . . . . . . . .
Dimensions of same stru ture w
Front . . . . . . . . . . Rear . . .4f0.'.9 ... . . . Depth . . . .`�.?. .�`
Height . . . . . . . . . . . . . . . Nurdbe f Stories . . . . . . . . . .f. .
9. Size of lot: Front . . �14 o f.0..0.1..9 . . . . . Rear . . . . . .7. 3. 0. . . . . . . . . . .Depth. . . �O� .1. . . . . . . . . . . .
10. Date of Purchase . . . '/!7-.:r , , , , , , , , , , , , , , NanA of FoTmer Owner „Ke cra�Q
11. Zone
Does oro use
di coca i u this premises are situated . . . . . .
P P (at any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded Will excess filI be removed from premises: Yes A70
Name of Architect . . . . . . . . . .2�FUaN�rn� Atidress !�r? vw� day AY/Phone No. . � :�?.3.
11. . . . . . . . . ' ' ' ' ' ' • • Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . .
Name of Contractor . . . . . . . ,
14. Name of Owner of remises
� ,I . Address . . . . . . . . . . . . . . . . . . . Phone . . . . . . . . . . . . . . .
15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . . . . No. .% .
*If yes, Southold Town Trustees Permit may be required. +
PLOT DIAGRAMI
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 yQLtK S S
COUNTY OF . . . . . . . 4%K. . . . .
(Name of individual signing
,I,G . . . ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
contract)
above named.
Heis the . . . . . . . . . . . . . . . . . . . . .
(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 this
. . . . . . . . . . .dayof.... . .. . . . . 19T .
Notary Public, . . . . . .`! . F�.�K County
1013MT C. DICK LI
Notary public, State of Now York . . . . . . , .
ile' SaLollk ( ignature of applicant)
Qualified in Suffolk County
Commissiion Expires June 80, 199 L• i_
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-_ c) I . �-.A - AP RO DASNOTED
DATE:`.���e.cf-B.RN
FEE: 1
. UNDERWRIIER$CER11DGjE NOTIFY B LNG DEPA �YR AT ,
REQUIRED 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED ',
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING'•
- -
- 3. INSULATION
4. FINAL - CONSTRUCTION MUST
--- - --- -- -- - - - BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
.- __:_ ' - - � . „- —_ ,v . _- THE REQUIREMENTS OF THE N.V.
STATE CONSTRUCTION 6 ENERGY
CODES. NOT RESPONSIBLE FOR
- SIGN OR CONSTRUCTION ERRORS
T
MIJIMING
ALL PLLMBIND WASTE �-
2ya. lG'oo &VW7ER UNES NEED -
2 e-i'4'oc 1ESTWO BEPM COVERING If copper tubing Is used
i110"I(r'ao 19 for water distributing
shall
M1c¢r,-I �ns to UEU S NAY OR ONTLEAD CONTENT
OCCUPANCY
system piping�e ki
— \'' 'q �1 a+ i r--
_j eA PLUMBER CERTIFICATION of types K or L on
f'' KA T S.w� J15 U LAWFUL CER ICAT O O
E I---
2 Cp f6a� SCALE: 1 bPFROV °SY:
WITHOUT CERTIFICATECANNOT °AYE: t RSYE,ER
SOLDER USED IN WATER
OF OCCUPANCY E CEEDSYSTEM % LEAD.
EXCEED 2/10 of T% LEAD. fE5510N 1
7� r .DRAWING NUM
71
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