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HomeMy WebLinkAbout20084-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Insgector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20788 Date JUNE 12, 1992 THIS CERTIFIES that the building ADDITION Location of Property 1725 SMITH DR. NORTH SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 76 Block 3 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 9 1991 pursuant to which Building Permit No. 20084-Z dated AUGUST 9 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 ADDITIONS TO EXISTING ONE FAMILY IIWELLING AS APPLIED FOR. The certificate is issued to PHYLLIS MICHAELS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 8 1992 PLUMBERS CERTIFICATION DATED JUNE 2, 1992-MATTITUCK PLUMBING & HEAT. B 1 ing Insg ctor Rev. 1/81 108M NO. 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 ° ~ 0 0 ~ ~ Z Date ~(r!~q'..1...w 19.7.. Permission is hereby granted~+to:~ ti:.y.:.....i.~. to ...~%U~`:9~?:41:Y1r .....pr'4~'~:!r~,4!:.°:Y1:41....~/..~.....~^.f1....i~~t!elrAr.~...~:.'.1:L..~. at premises located at a.k:^.^.::^:!'.... QY..4t1....................4i~!::tlt.!`1~~~...... ....~.....,~.~.;~.a~f..~~.~:~.~ County Tax Map No. 1000 Sectio ..o-?..~P........ Blockq.....S~aa....... Lot No...~..` pursuant to application dated .....4M.~......./ 19.~.~., and approved by the Building Inspector. Fee 5...~~.J~.:..~...... .t C!.~• . . ing Inspector Rev. 6/30/80 . Form No. 6 TOWN OF SOUTIIOLD ' 4" ~ ~ ~ BUILDING DGPARThfGNT < TOWN unLL M,AY 2 6 765-1802 ~~~4:~ APPLICATION POR CGRTIPICATE 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 to caCion 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 thaC 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. :j. 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 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building 525.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on I're-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 $/15.00, Commercial 515.00 Date ...~,(.~"~1.:.~' ':ew Construction.........9.. Old~+Or Pre-existing Build`i~ng.. Location of Property....1~.~.~:V ...............~~;h,1.?Cl.,~~,?1.-..#:'d....... ~Or~,~.v)O! ~J EIouse No. Street 'J II ~/y~ Hamlet Onwcr or Owners of Property.. ~~,°6• ` , . , , , m. !~l~i..~'.~~ County Tax Map No 1000, Section....~1. `~.,,,B1ock....V ~ .Lot... :,ubdivision.~ Yij? 0~". ~~s:E'..~:L,... j ...Pji~led MnP...(.~~0.~..Lot.,,...~. . Pcrmtt No..~t/.©.~ Date Of Permit..(J.~l~/T~,,,,APPlicanC.G.~.~~~'~~d??~~~'~`~~j..7~~- l!cal[h Dept. Approval......'~~.~ ...............Underwriters A PProval ~'}arming Board Approval...... ::e quest for: Temporary Certificate........... Pinal Cert„ycate.,. `ee Submitted: . C~ ~~~1~$O APPLICAti INSPECTORS t~, Victor Lessard ; ;~':)Ei'f7(,~1~~_~ Principal Building Inspector ~?yti1 ~ Curtis Horton ~ SCOTT L. HARRIS, Supervisrn Senior Building Inspector cn ra' , Southold Town Hall Thomas Fisher v- ~ ' ;='"1,'u ~ P.O. Box 1179, 53095 Main Road Building Inspector '~^A~. ~ Southold, New York 11971 Gary Fish aJ, y l~ Fax (516) 765-1823 Building Inspector -z~~~~`~ Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD MAY 29, 1992 ENVIRONMENT EAST, INC. INDIAN NECK LANE PECONIC, NY 11958 RE: PHYLLIS MICHAELS To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) ffi No Underwriters Certificate on file. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. %%x No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 20084-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. THE NEW YORK BOARD OF FIRE UNDERWRITERS PA~e~ .1 1aeg1zl BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10036 Date J9f 11 9h t1'!ly~ APPlication No. on file 756U'~~1911~1 ~ ~~r)~®~ THIS CERTIFIES THAT only the electrical equipment as described 6ebw and introduced 6y the applicant Homed on the oboes application number in the premises of PtfYI,~Ia Mrc~Aert~, ~.f~a5 ~I+r.T~ uRtvr I7aRTII, sau~xor~~, t~,Y- in the following location; ®Baaement © )xt Fl. ®2nd Fl. f}II~ 3ertion Block Lot t 1 ~ g 2 and found to be in contplianer with the requirements of thix Roard. uns examined on FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FWOFESCENi OTHER AMT. K W AMT. K W AMi. K.W PMi. K W AMT. H.P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLFT DIMMERS AMi. K. W. Oll H. P, GAS H. P AMT. NO. A. W. G. AMT AMP. AMT AMPS. TRANS. AMi H. P. SYSTEMS pMT. WATTS NO.Of FEET 2 SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF Cc COND A. W. G. A w. G A. w G AMi, qq AMP TYPE EQULP 1 q 2W 1 % tW 3 % aw 3 4W PER % OF /CSC. COND. !b ~ NIdEG OF HIdEG NryO OE NEUTRAIS q Of NEUTRAL 7. S. ~t'1 CD ~ ~ i4 1~0 4 A OTHER APPARATUS: 6LCC. R<)t);t UEAS'IIRS:3•I,5 R,bl,rt°7,f~ R.F~= I{p9'URU t 3-t+ Il. P. PAtdFI~9f}A.RI)9:1-1.9 t:?R. 1N0 R G.I'.C.Ia-~ SidQK'A DETECI'I:)Rt-2 TRACK I,T{i1fT7.I7C: _q ,c.tz~ PAUT, R. It99ftNS li7C.~2f32 ~ 275 Tt741t7 NARB~JR LANE SOOIIffChQt NYr 11)79. OENERAI MANAGER 1.1 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. ~~S~EFOL,~'`O'r TEL. 765-1802 _ TOWN OF SOYTTIIOd.D _ ~ ~ OFFICE OF IIUILDIi~IG INSPECTOR o P.O. BOX 728 -c TOWN HALL ~ ~ ~ ~ SOUTHULD, N.Y. ] 1971 "t~,~" ?~jN C E R T I F I C A T I O N r0"I'~%` ~ ~ " h v ` i9.c Date (p ,z ~ Building Permmit No. ('a ©0" Owner ~ ~ 1 1 \ ~ 1 S (p ease print) Plumber v,`= (p?~ d- {a.~;~~r~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber's si e) Sworn to before me this S'~'CO/U 1~ day o f ~Cf .U ~ , ~ <~~=~~lv ~h 19~~ Notary Pub c c~otary Public,L~j~ fIJ~G~ County 111!lNf.~lON ~wr~~ r«k ~'~'a:~ =1::LD it:S:'EC:iU:J ~~UA:a I OOMMENT° ~Q tYhre• _aD H FOUNDATION (1st) - FOUNDATIOtJ (2nd) ~ m o.~ 2. z ~ o~ P,OUGH FRAME & ~ ~1 PLUMBING ~ 1~ d~ x 3 . _ k ' ~ m ~ IIJSULATIOPI PER N. Y. y STATE ENERGY ~ ~ ~e~~ _ ~ ~ CODE . x 4 . ~ ~ D' m H G!i CI7' ~ FIiJAL a o E ADDITIOIJAL COMMENTS: . ~ J x _ . r H S+ " H W H O Z ~ m r ~ ~ o~ ~ . -v H ~C~~`~. §5-?0~6 (ial§01-25c NEW YORK STATF. DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER ~ EFFECTIVE UATE 1-4738-00368/00001-0 _ October 11, 1991 _ j r FACILITYIPROCRA U s ~wY ~ C, ! ~ i ~I EXPIRATION DATE ~~C.j ~~~•>~S_.. PERMIT ~s•-^^- "tinder; the Environmental Conservation Law (ECL) ~ I October 31, 1993 ~i~t a rt TYPE', OF PERMIT ~(~h~ezk"All jlpplicabl9 Boues) «t {b=,,a ®New}, + . , ?Renewal ?Modrficahon ? Permit to Construct ?Permit to Operate Article 15, Title 5: ~ Article 17, Titles 7, 8: ~ Article 27, Title 9; 6NYCRR 373: Protection of Water SPDES Hazardous Waste Management WatelrSu5ppjyle 15: ~ AirlPollution Control ~ Coastal3Er~osion Management Watelr Transpolet 15. ~ Mitneld Land IRec amation ~ F oodplain~ Management Long Island IWellsS~ ~ Freishwaier Wetlands ~ 6NYCRRI3 0: Rada9ion Control W Id1eScen eland Recreational a Tidal Wetlands Other: Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: ~ Solid Waste Management Water Quality Certification PERMIT ISSUED TO ~ TELEPHONE NUMBER Ph 11is Michaels ( ADDRESS OF PERMITTEE Smith Drive North, Southold, NY 11971 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Environment East Inc. 3075 ~'nd~~ar1 ~{ecK ~q. Pecon~~ fJY X19 $`6 (51 l7 4- NAME AND ADDRESS Of PROJECTIFACILITY ~Slnith DriNe.Narth, Southold, NY 11971 LOCATION OF PRO)ECTIFACILITY Smith Drive North, Southold, NY 11971 COUNTY TOW Nx:7r117fDQKAriVG1C WATERCOURSEIWETLAND NO. NYTM COORDINATES ' Suffolk Southold West Goose Cre E. ~ N:4 _ DESCRIPTION OF AUTHORIZED ACTIVITY Construct 8' x 28' addition to existin 1 1 2 s c S By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (See Reverse Side) and any Special Conditio s igcludled as part of this permit._ _ _ e ut ~e Iona n~-~....s.-~' ' PERMIT ADMINISTRATOR ADDR.($~;;;Ct] ff ~ rw]= ''t Dal~id DeRidd~r _ _::~~ia•:~ss~s AUTHORIZED SIGNATURE DATE Oc b 11 1991 Page 1 of 4 ~I GENERAL CONDITIONS Inspections 1. The permitted site or facility, Including relevant records, is subject to Inspection at reasonable hours and Intervals by an aujhorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of this permit, including call referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the protect site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Renewals 2. The bepartment reserves the right to modify, suspend or revoke this permit when: a) the scope of the' permitted activity is exceeded or a violation of any condition of.the permit or, provisions of 4he ECL and pertinent regulations is found; b) the permit was dbtalned by misrepresentation or failure to disclose relevant facts; c) new material infgrmation is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was Issued: „ 3. The permittee must su'~bmit a separate written application to the Department for renewal, modifica- tion or transfer of this permit. Such application must Include any forms, fees or supplemental infor• mation the Departmeht requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a) 180 days before e}cpiratlon of permits for State Pollutant Discharge Elimination System (SPDESj, ' Hazardous Wast$ Management Facilities (HWMF), mayor Alr Pollution Control (APC) and Solid - Waste Management Facilities (SWMF); and b) 30 days before ekPiration of all other permit types. ' 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede~`± or rescind any order orii determination previously Issued by the Department or any of the terms, con- ditions or requirements contained in such order or determination. Other Legal Obligations of'iPermiitee 6. •'•The permittee has acc$pted expressly, by the execution of the application, the full legal responsiblll•;, ` ty for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of;„, 1 the project described.ih this permit and has agreed to Indemnify and save harmless.the State from,, suits, actions, damages and costs of every name and description resulting from this project. " 7. This permit does not convey to the permittee any right to trespass upon the lands'or Interfere'with it the riparian rights of o}hers In order to perform the permitted work nor does It authorize.the,,impalr- ment ofany rights, t(tle, or Interest In real or personal property held or vested in a person not a party ' to the permit. i 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rlghts• of-way that may be required for this project. „ , I Page 2 of ~ t A~, J a ..i'y ~ j. i 952Uba (10/90)-25c - ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( I 9. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the. structure or work herein authorized, or project. ".'if;initKe -opinion of the Department of Environmental ConservaUOn 13. Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway. remove or alter [he structural work, obstructions, or hazards caused 14. There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fell, excavation, or other 15 If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be com- pleted, the owners, shall, without expense to the State, and to such authorized has not been completed, the applicant shall, without expense extent and in such time and manner as the Department of Environmental to the State, and to such extent and in such time and manner as the Conservation may require, remove all or any portion of the uncompleted Department of Environmental Conservation may require, remove all or structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse. No claim shall be made against to its former condition. No claim shall be made against the State of the State of New York on account of any such removal or alteration. New York on account of any such removal or alteration. 10. That the State of New Vork shall in no case be liable for any damage 16 If granted under Article 36, this permit does not signify in any way or injury to the structure or work herein authorized which maybe caused that the project will be free from flooding. by or result from future operations undertaken by the State for the 17 If granted under 6 NYCRR Part 608, the NYS Department of Environ- conservation or improvement of navigation, or for other purposes, and mental Conservation hereby certifies that the sublect project will not no claim or right to compensation shall accrue from any such damage. contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 11 . Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met. bility of obtaining any other permission, consent or approval from 18. All activities authorized by this permit must be in strict confotmance the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part Office of General Services or local government which may be required. of the permit application. 12. Ail necessary precautions shall be taken to preclude contamination ~ dS er SUrVe of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans i(')C9GXIxlW@R9~xb69f p y solvents, lubricants, epoxy coatings, paints, concrete, leachateor any by Roderi ek Van Tu 1 onAUq. 20 ~ 197,9 SPECIAL CONDITIONS ,During construction, no wet or fresh concrete or leachate shall be allowed to escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices be allowed to enter tidal wetlands. .Any debris or excess material from construction of this project shall be completely rremoved from the adjacent area (upland) and removed to an approved upland area for disposa1'. No debris is permitted in tidal wetlands. ,The storage of construction equipment and materials shall be confined to within the "project work site and/or upland areas greater than 50`linear feet distant from the tidal wetland boundary. ,Roof runoff shall be directed to drywells landward of addition: for immediate on-site recharge. No decks, accessory structures, or additions will be permitted without further approval of the Department. . .There shall be no disturbance to vegetated tidal wetlands as a result of the per- mitted activity. Supplementary Special Conditions (A) thru (J) attached. • .pEC PERMIT NUMBER 1-4738-00368/00001-0 PROGRAM/FACILITY NUMBER Page of s `'Mr` r , 5 ~ rw 1 t r 1 ? ~ ~ , ~ ~ ~ ~ 1 ~k~,,,°< _ _AS sho~nYon file mA~l'~.. ~ €xtstlnQ.. hiA water r:~"~.t & -n I cork ~..f'' ue4 rev" U ~A'iLy.,. 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OF• AID, Q~..~`~ ~~s~ or, 1.. r 7Q'. ~ 1 ~t~~iF111 h Vq ,t ~ ~ Y s ~ ix~t~~e#s ~ . I (1 M1 tt`~ R ~~~jjj''' y E~y i S,~§ ypgy . ~ ~ , ~ r w • . Y ~r ~ ~ 1 ~ ~ ~ Y 1 t~ +~B e+ ~ 6J ~I~ ~ i5 t irOn ~7f~G' e!n~~.. ' ~~2 oM1 t ICi . I' - • t~:at;.ltiohWtABht ~ ^ ~7a, . , i ,!ifl. e ~ d ' 1+,~#.~ ,kiq:7~C76•~2951. 'v;'t._rli~ s!`,; ~ ' ~ ; ' r ~ ~ Y ` ~..n~~f.~~l~°G ti~gulat~rr~y'R{{~~aers ~ f 'r r + ~ ~ Gudre,nl'ded {~o +he ChieAl~o"`Ti~WIm~ #~uk ~•?Jq.;it ' Cpu~nany'rdtld fb~'1t8 QW11Ar'. ,zW.., r•i As serve ed. ` ~4~!nllt~i~dNs cho~ari rc¢cr t~a "1t1a it/~rfil,.,;.1:t~1~'•t:,/iy>~'"~, ;h~r~bli9d'~ Neck;" fled in +he' Su¢}rolle. ~ ~ ~ ;~Run~y;;.'~CIEk`k.'s: ~.}~flGC";~A9 7nap ho'. 165 ~ ate,-.,•' 1, r~ ''~'~,'`.~A)S1Y?141?.i7651GNATlp?,J. l~cen .sand Survei~ors ~~-~'~,r_~?'r~ ;3't'r~..~, .Greenrart; 1~e~v.yark ~ , i ' ~ r,l• 765-1802 BUILDING DEPT. f NSPECTION [ ]FOUNDATION 1ST #~RVUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMAR S: „~u-e-~-~ - M G I I _ ` DATE ~ ~ INSPECTO~ r 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ~RAMING [ ]FINAL REMARKS: ~ _.w ~ ~ DATE ~`s INSPECTOR _ 765-1802 BUILDING DEPT. 1 NSPECTION [ ~ UNDATION 1ST [ ] ROUGH PLBG. [FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. (]FOUNDATION 2ND [~I~NSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ A ~ ~ti~ w I ~ 1/ DATE ~ INSPECTOR 1SUAI:U UP HLSAL"1't1 ~.~,C. fORMN0.1 ~ S' OF PLANS( Y~;~~;'J{,J. TOWN OF SOUTHOLD CHGCK . Y ,1,7 ~Q ~J/, J , , J { J J i ~ ;KY~°~ BUILDING DEPARTMENT SEPTTC ['ORM , ,~i , {~,,,,i z,t 1„iq~ J. r. TOWN HALL ' `t 1, EOUTfiOlO, N•Y. t1~J71 NOTIFY TEL.: TUG-1802: CALL ' J . ~lr3;f, ,~IiTi'~i~/(~~' r y , t`J ;u;o 1 ' c3ntin• .S+?, 19q.~ MAIL To: ~ ~'•,i~i~~.:~,E,,~,'.# apro 19~ ~ Pcnnit.IVo• d,OC~~. 1,'~. ~ a sapproved a/c . { I ! n ' z s. a•i . .............,.,i..... , nt~ „ fI V ~ ~ . >..4 AUG .9t9~1: a~~~ • DEPT. aA (BuiWing [nspecto~) ~SDUTHt) utE~ ,r " ~ APPLICATION FOR BUILDING PERMIT ~ ~ ~ ~ ~ ~ ~ ~ ;;i~ ~ - w~y ,.y • ~ , ~ „ , ~ ~ Date .'7JJ.aJ9~J i~ ;ilk "I I I i 1 J 1 1,,1 ~ ~ INSTRUCTIONS ~ ~ .~:3s. „~~~~.~1' ` ~ ~ ~ ~ ~ ~ ~ is nr ~u° ; r.' e,''i'~•`;: a.~ ,Ties application must be completely filled ]n by typewriter or in,ink and submitted to the Building Inspector, with 3 s of plans; accurate plot plan to scale. rce according to schedule. ~ ~ r b. 'Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this nppli~ .ion. - ~e: YThe work covered by this application may not be commenced b~fnre issuance of Building Permit. a i,.~ ~ . 'd;it Upon'npproval of this application, the Building Inspector will issued a building Permit to the applicant) Such permit dl,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 dl have been granted by the Building Inspector. APPLICATION IS HERE$Y MADE to the Building Department for thesuance of a Building Permit pursuant to the" ' ilding Zone Ordinance of the Town of Southold, Suffolk County, New Y' k, and other applicable Laws, Ordinances or gulations, for. the construction of buildings, additions or alterations, or fd~ removal or demolition, as herein described. e dppilcant agrees to comply with nil applicable laws, ordinances, buUdin' codo, housintt code, and regulations, and to .nit nuthorizec~inspectors on premises and in building for necessary inspect,~,~is. .~laU1~o1~1Ml~N.~ `~•~~f~ ~ Y J . i i { (Signature of plicat t, or name, if a car oration) 4~c. • L~3~.a0p~~/~~~' = tJ~`,ia/rj` rItrCK f,wnJpp . . ~ ~ . J .Yi144 ~.~cV .1N. ..I, 4~V (1. f 1 . { J i J { 1 , , J . J J . ~y (Mailing aJdress of applicant) i 'rte whether applicant is owner, lessee, agent, architect, engineer ~ • o ,general contractor, electrician, plumber or builder, ' ii•iii..•...... ii ii•.... J.,.{IYi ii{i JiJ, ' .meot•ownerpfpremises .~41y,~~la..i.~.l~?.R?r.~•}......i J. Y,I,JJJ.J.i, " (as on the tax roll or latest deed) rp leant ' o , s' ature of duly authorized officer, (Name and title of c rporate officer) " Builder's License No. . , • J~ $,$,fo. i •T, • , • i • Plumber's Liconse No . i i , ~ ; ~ ~ iu;y''i~ , ~.4~~~:1'.' Electrician's License No . ~ ` '~`bther~Trade`s License No . . - - --'~`"~'+`a - + ~ Location of land on which proposed work will be done. , J i , , • ~ ~ • • . J . J . . i , . 1 ,.1J , . J Y 1,. J.i.,-Y ~ , rh'. I i`iYY'y` . J ~ J Y I • r 'i~ J . . . i , . . . . J J ~ ' TAI { V t T .Yyf . Y Y •Y SY, • .I , . ~ • • • • `J Elj nSe N~mber ,$treett. S-•-'+ ~`t~l-(aini@i '•ftii{ ~ rPe ~~fF'>if~, rl l~~I~i i, i , w ~ I Y•i , ~ i ' County`Tax hlap No: 1000 5actiott Q?, 4a , , , , . , , BI ck ~ ~ { ~t < 'i• • - ~ ~ ~ P Lott•JfJ,Jii J, J.i i,, i.~.r ,,,i~' ivisi QF Z,C.(~. Y sled hlap No. ~~3 Lot . { { t.3, .(Name) ~ i.YiJJ JI,i„J{J State existing use and occupancy of premises and intended use and occupancy of proposed construction: ii ,~,i K; r a. Existing use and occupancy . ~ S'. ~a .~i~i . ~.4~.~.e~t.~.l•A9.~t , • • , i i • . , ~J ?i•{? •..i i•i„ YJ,,JiY iYil.ii,\ b,Vintendeduseandoccupancy ..~.~\.)'J!hr.1,r.~~.~P.e.),Q~~i.!~q•i•j~~(.n{;~ir~~r`h~kf I y r ..JJJ,J J:.J: J i 9: 'Nature ul` work (check whfch' • lieable): New Wlilding Repair Rl~val • . • . ~ition , Alteration , . , , . , , . ' • . • • • • . • • . . • , • Demolition , Other IVork , +.11.1, {1 11111 4, Estimate ©WQ1', , (Description) d Cast , , . ;~)}1 , ,.1.. , i., ~ A Fee ..1„ ...:..........1,1.,.'11.,11111 •:1~, ~ ~ ~ ~ (to ba paid on filing this 4 S,. If dwelling, number of dwcili~tg units , , , , , , , , pPlicatlon) Number of dwelling units on each Moor , 1 1 1 1 1 I,1., r,~,,1 t, ~ , If garage,numbcrofcars .1.i...1...f...,1..1.. ....1.1..,...,,,..(11.1+11111,1111,11,1,11 6. If business, commercial or mired occupancy, specify nature and extent of each typo of use , , , 1 , , , , , 1':'1 1.1;1.1.1 , 7. Dimensions of existing If any:.Front , , 12' , ,1 tI t~ ..1.1.; ROaC'1,i11t71111,11111)epthla,P~, 111/11/1 Huipitt 1 , , 1 . , 1 , . , , : 1 , i ~Irl Cr of Stories Dimensions of sa~mo structure with alterations or add ttonst Front , r~~ ; , (p ,111 ~ ' 1 1 , , , ,'f,*;y~y,•I;il,'' Dlutll I V 1 1 1 1 '1.1.1.1 , ttt~l~lc . / 1 1 1 1 aoa~/' 1 1 1 l91 11'1 1 1 1 1 1 ~ Dimensions a aa~~'_ r " + + + 1 1 1 . 1 . Number nC Stories . ~?.ZL,., , 1 „ g ~~~+sJe"nC,~:bo struction: Front Rear _g1'0u .Depth y1 1 / , ; / 1 l'icl ht . 1 . . 1 . N t tber of S • 1 • " " " 1 + / 1 1 / 1 1 1 1 / ~ ta17CS'1. 9,~ Size of lot:-Fro t 11 ,1.::1.,.......1..,1..11... 9,1..,,,1,1111/1.. IOr n l,-`"~~ •r.,,..`,Rcar,..$'$ Depth ,?1~`111;,,/,1,1,,, 111, Date,of Pucghdsa=:~~,"~~ + { , , ~ . Nome of Former Owner . , , , , 1 1 1..111111 1 , 1 1 1,1 ~ 1 n /'1 ` I Zone lii• u'se dlsfrict in which ~rcmises are situated , . ,e, ~eW1.T V11•. `iV(:..~:~'....,,..11,.1..,111,1{111,111.1 2: Does proposed construction violate any zoning law, ordinance or regulation: + . , 1 , , , , , , , , , , , , , 111 / ~ 1 3;, Will lot be regraded ; , , , , , , 1,1111 + 1 1 1 1 1 • 1 . r ,,VIII eRCQS~S~fi~ 1 be ren oved from premises. Y@$ ~ ' N~ ~1 `Name of Owner of prcmisesf?~tt (ts, Jtl,Ir,.Qttt,~l,~ , , , , ' Name of Architect , , ~ AddresgSr7atY~1•VKtJ:C, , , , , , ,phone No7,6,~; ; , , 1 , Addrei:ssol.c.V-t,o IQ.,N~ 'Name of Contructor~l~~lRplJ,g1~;A~T}~ r Boi~''.~fJ~71w rdBckb,~,d~hone No. 1, , / 1,111 ~ 11.11 HP.~. r~l~C-, . ~ Addross~ ~e•iE~!t1+IC~ IhJ>,j11>I',•1 , 1`Fl~ane Ntl~~i~1'~l°~''7,~/;~y~11;; r'1 ~ (SaI1s;,Chis,ptopeYtq 1,o~ated'within~00;;Eeet„ofF„~a~.ltidal well,sod?:*,YR!*itlliylGNtl`i'1±if!;' *If 'qes, Southold Town Trustees Permit may bg, rrequinedl; ~€r.rtll rl ahltlw+'rptfa.it+tl+y 1ui~( ~aYJ, . I ~,i,re•1•~rq,if PLOT~DIAGRAM'` 1 < It' '.'t 1 ~.Ct `c,. h ( gr1 ~ c .r?1,{ r ~r~y )'r~tl J9 ~ti,tyi~. ItIT~ Itltt"~~r4~, ~,+'Locate 'bleatly and' distinctly !,all buildmgs, whether existing or proposed, and Indicate alt set•b4gk dimensl;4~lst(tdh ' roperty lutes. Give street and blot;k number or description according to deed; and show`Stteet nwritls and°1~dlcate heth4 ItenOr Or COrrier lat., ~ :~y. ~ ~}~«4 ~ .•t ~~n.r1+ qn~ ~11~ i, I~tti95t ~ ~ ; ~r n t ' tl+t YIi} 1~1,i 1 It~.191., ~p~n ~ + i,fl~ tx1~+4td3+111 ~It"t. ~ r1 . ~ , r.tefaxyt ~ ~;f ~~,xlgl~,. ~''x 'i ~ y , ~ 9 :'U 'W''Aht lir;x'~L y+JVSh~~~?t~ "i~ 1'ly„k i.r nr ? --i ~'i1 ''.T ''r 4f ti IV f~"~ll~~t~ iW ~ ~ ~i i ~ ~,i ire IE, rat ^~d,`pS'tk'1~r i~ , ~ '.1 ..`r~ ~ ' ~ ~ ~ n , 3; f:r , - ~ . i ~ / i ~~'1°~:{i: iY7! ! ~ . ~ ~ ~ - - ..i 41,n; •~l ti9'~jQri;~Har'.l'4:ifil br+; JM1Y- . ' _ ,r i a x4,`za ~ - 1c: . , , ~ r,' i ~ : ~ ( 7 ~i p tw•, ~ .,~5 1'f(t"1 ~ (f ~d('1^I ~ ~ i' ~ 1' y ~ ~ ~ ' I 1: ~ - . ~ i, 'te ~~i l4iji$14i(~r9i,Lii: ;r: sr~Rtty'~C4{"~~~Y- i ~ e ~ H, Ilttrp,,Idl7flhr'tA~Y ' ~ 1 • of NEIV Yoax, I . ~ ",'~,I,:,~r~:; ~~fit,i~~lo.lr~i UNpT_~/p~F,~.,. I SS . 6..~'J'1`P'tl1 ..~.51~...~ ~ ~ , , - ^''':'sP Y ill ~iiutlrltl'~la~~~i~~,~_ .'1 being c~hly sworn, deposes and says that he 15 the,4p qtt- (Noma of individual signing contract) ,.,rat~xr$i~,. 01,.,,1,. y~~~~H,,, 1ve named, i y _ - - - > - l 41a'~al.~f 1, r inlSrP'4"1,7u~ 1 is~lhPr ,..,~1 ~ 1 . , 1'1 1 1 1 1 1 1 1 , 1 . 1 1 1 , : 1~, 1 , 1 1 . , . ~ ~ - ~ •••1 cf 1+11+••11 .111.11..1 i1,111111t111111 t11~.! i ~ ` ! ~ ~ ~ ~ (COntrACtOC, , g0nt, COrpar~tC ofllccr, ~etC1) ~ 'v ~ H +r++11~:+. ;aid owner'or owners, and is duly,authorizc p5rform or have pctftmned the said work and to malit:Yand flg~ttt , licafion; that all statements contained in this application arc true' to the best of his knowlodge 4nd,b1"•Iiq~'1 a11d'th4tdlt- ( ~ k will tic performed~in tite,manner set forth~in~thc application filed therowtthl ~ ~ d'"'"` ' - rn to before' me thi3 " ' - ~i~"~ ' i,.r ti~~I ~~I"l7~llii~j~t9~tl2a °7r ~ t ~.t .1 1 . 1 , 1 ...:..day'~of . 1 , . 1 1 11 19~~, i7 d, ~ i, ~ ~ r1,;'~~i.,.l~vkr;y~~uldst,r r,9~~ Iry Public, d~:~ ~ ~ ountY _ . ~ i r r1~ 11 . Fi t+.rlSr~a`,~I~Jtld'~,'.t.+~ , ~ ; HELENEO.~HpRNfi t t~:. ~ •i . 1 1 1', !.1.,?~',}41,rll~zl~'1~ Norarypaapl~,g~eofN+n?rygk ~ ~ ~ (5ignututeofapp~ic4n~ Dualt NO' 4981384 Commlaslon~ le Surfolk Countyry E14tlres'iM+W221 t8.~ . ' ~i' ~ 4 f $:i ~ f Y ,~i s ~ ~l T " ' SUPPLEMENTARY SPLCTAL CONbITIONS ~ ,sir :~LE f S tl ,The; following conditions apply to all permits: ' .`YI y Y A;'' If'any of the .permit conditions are unclear, the permittee shall;`oon i th ; ..tact the Division of Regulatory Affairs at the address and telephone f:' t`~ ` r 'noted below. ~ ~ - ~ ,r~ ~ xM ~ x xw ~ ~ B '."A"copy of this permit with supplementary conditions and approved,~r`* xa t~sy %f S 1 4(1}C A~Y l plans shal'1 be available at the project site. whenever authorized, r~ ~x~ ;~t~, WOYk 1S In r0 teas. ~ x Sr1~r ~K 3~,~~ r. _ 1 P C ,'The permit sign enclosed with the permit or a.copy of letteY o~~~~»F~; ~~n~~ .~~r~'`F; approval shall 'be protected from the weather and posted in, a aon~-~'"~' w~~" spicuous~trlocation at the, work -site until completion;of ~uthoPS~ei~`W~~ ~ ,,D.~t`At,least;48 hours prior to commencement of,'th~e, proO~Ct„<$the~p~Yt~~S~nt> ee ~ bz~~shall"complete` and return~~the-'top portionxof,`,the:.enclose~d ~'Yece~p~ r~d~~~"~ ;,certifying that he is, fully,"aware of and understands ally p,ro~i~s~.~% ' j"~ conditions :of' this permit. Within one week of completrin 'of ,t~h`"d~ a~~ ° permitted-~wdrk, the bottom portion ~of that form shall a so~ be'CO~~~~g~k,~r''~~ ~"i,~t~sr,l~ I ~ pleted'~and returned. ~ ~ ~ , ~s,r ~'~;~~~.~lt~~.t,~~yy,:,~.ft`'~:, { ~A i S ~ _ J 4i 4{~y { kkR ~"d3 d. T~!n 4 5AF s~E FoX' 'projects involving activities to be accomplished over 'a pe~LOd~'of~E~,,u~ g~~ ~ f,'~if,'~;_more",than;one~year; the.permittee s,hallpotify,the~Regional~Perm~~t°;` ~'°rt~~~`a{;`~~'~r"„ ~ ~,y Administrator yin w~rting'' at least 48 hours prior to, the commericem~e~7t r ',ie°~ ' ~ ~ s n ,~'~,~~~,Of reSUI[)ptl-O? Hof work each year. _ ~ 1 i i~ ji ~dt~' ~¢Pa~ r~ai~,~~ftp~?y`~~~wt5~ rr t ~ t ! ~ P ~ r i° l F s~~~'t ,v ~ ~ ro-C )Ig S{y~k rty F,;:` lf` pco7ect design modif,i~pati,ons: take place,';after ,,permits issuance`s§~r~4~11e~~~~~s~ permi ttee~, shall submit the appropriate plan;chang;es. for t:'apprbvaj.~~b}~ ~jrr~~rF~~y ~z~ , ` ~;~the~:Regional ~~Pecmit Admi~nis~;rator prior', to :uhdett',ak"rng an.y sugh,modi ;~4~ ~~t , ;'fications. The permiittee ~is~ advised that 'substan'tial modification j,~ r «,rr,~' ~ may'require, submissign~iof~ a, new application 'for permit ;x ~ ~rr~, t' r; G"t~.Al1,'~nece~sary:'precautions shall be~~taken to `precl'ude contamination `of'x,~'~x~r any,~wetlands or waterway 'by suspended ~sol.ids,:' sediment, ',;fuels, r "-~s~ s , solvents;, lubricants, epoxy ,coatings, pairsts~,.'concrete, sl.eachate or ~M 4~~~,`, ~ ~ x'`~ ''~c~-.any;~~othec,, engironmental,ly deleterious materials associated With the r ,~Fi'f i u ~ r Yprolect, w rk.. ~ ~ ~ ,x a, s. Ii: Any°:failune,'to,.comply precisely.with all of °~the `terms and conditions ~lfiq;~s~*" ~ ~ '~3`'of,this_permit,, unless authorized in writing, shall be treated'~s,a',~~~~r~y".~ ' ru a l+ y~.` 'tviolation;j of the Environmental Conservation ;Law ~ t ~ -~s tc~~~ ~ r P ~'~',The'perm~tteeis advised :to ~obtain.~any:~permi~s or, approvals tthazt~~may`~~~`c 'f= ~be',~r~qui~ed_£rom the U.5~°Departmen.t o5 Aemy;~Carps'of Dirgl~ieers~Y,.NY °,y$ r 7 ~ ~ t~ ~ z,~ X40 a .~.~,D~.strict;'26,Federal PTaza,,;~New~York,~~NY 10278, .(At.tention~ 4Regulatory.~, S - ,s~~~Functions~~Branch), prior`to commencement of ,'work. authoYized~xherein. ~ ,~~„~C~ ~ .u.~~rt r ~ . ~ ~ ~ r,~ z. s~ J~~;The:granting'of this permit'~does not~rglieve'the pe,rmittee`of the t~~~`~i~' P '~'~`tesponaibility of obtaining~,a grant, ~easement~; 'oc other?;neGessary d''~ k~~~ ~ ~ s ~arapproval~,€rom;the Division of Lanc1 Utilizatign,`.Offipe o£jCeneraJ+~~ ~ `~~3~~' M~pn F ,~~Seryioes`Tower Building; Empire Stake.Plaza~~;-'Albany, NY:'~12242,r~which;~~,~~s~~`~~~n x ~~t~pay,, be 'required for any,;encroachment upon State-owned lands und,~e"r~WateY p~„,#~yejy, "1: Y}kp~~~,y.}j$ rfZY+l ~ , ~ . ~ ~ .Y ~ 'Ejl P '~i ~~5; ~ ~ ~5# o) 1`,'[` p v Y ~ Yr= 1 t i b °a r - 'ReglOna~ Permlt'Admi ?1StratOY ~ ke" ~,~tv i~!F~,, rn: ~ ~ NYS Dept of, Environmental_ConseYVatioh ~,~'~~,t ` ~.X<p~ i~~i( n Bldg.. QO,. $UNY°ROOm~ 219 i i~'n ~ ' a~°'vt° y' ~~'i'`,# 'Stony Brook,- NY 11790-2356 ~ zr`fl ~'~,at~',~ v~ ~yfi~tz" ~t"a~ ~ •T~ ~ ~ (516) 7 51 7 9 Q 0'I , , , x , " n ~ ate?"`; a ~~5~~ ~ ~a5 'l" Wes"` e 5 y~,+h ~ ~ ~ _ 1 e3, r~. 2~zY"z~' es rt ~ rti,. yy //J~ X~j /~r~ X'~ C ti ~ t , 2~ x,~~i~ ~r~. ~r b~r<L" . / V'^VD~~~a~/ ~G i i4 ~ ~~~~c~d~i S~n~Q ~y'~~x`~ y ~ ~ G (nl F1 Ek , xr d 7 ~e ~M # }}~~~r~ { i 3 ~ 1 ~ tr x s3ix~.~ "k t§ "~~a3 1 _ i ~ ~~~5er,~of ~ ~ ` 'rt'~,~~~' i ~~i. e FY A a )¢~t+ f x ~ ~ ~~~a A i ~ a n ' ~,~y5~.'~"lxiz rc k~ ' ,J~ ~~~$~1~ r , - ~ r v z~, 7 i ~ f 9~~ 'p 6 k w~` p % ~ysT~ ~ Fr< ~Jt a 5 ~ ~ ~,~~'~xl~"Y~~~~l ' ~ ~Ej~ ~*~a- _ ~ { s ' x?5}~pY'•~~`~' ~:rah;.!~~'1 ~ ` r~ ~'rt ~i L ~ ex A~~y2 F~ ¢ ks~"y{~n{ E i~ 1~ R ~ x S~ °99NS 1 A~ f"7.#36 d S ,1~ t.. tr " ~ ~ ~ . :,,r=i ~ n4 ~ ~ ~ - x ~ ~ , ;z;:, ~ r n x~~r { n~:~ ~ yS r r a ~ y~ x r n~ N Xb+R~ue~¢"°txm"F~n >