Loading...
HomeMy WebLinkAbout19653-z 1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY' No Z-20274 Date OCTOBER 11, 1991 THIS CERTIFIES that the building BUSINESS Location of Property 55 COUNTY ROAD #48 MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section I21 Block 2 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 30, 1991 pursuant to which Building Permit No. 19653-Z dated FEBRUARY 5, 1991 was issued, and conforms to all of the requirements of the applicable provisions o£ the law. The occupancy for which this certificate is issued is ALTERATIONS FOR A VIDEO STORE AS APPLIED FOR. STORE #6&7 The certificate is issued to MIDDLE ROAD SHOPPING CENTER ZNC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-17389 - FEBRUARY 12 1991 PLUMBERS CERTIFICATION DATED FEB. 7 1991 - HENRY G. LANGE JR. A~? wilding Inspector Rev. 1/81 >r08lR NU / TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 19653 Z Dare 19,//.... Permission is hereby granted to:~~,/~ .~..9..,~.... to .L~~...~....lT~.~k~~rliC~•G ...l~.~a ............:~C'~.....~k:....~/F~.~r~......~.~?-lc...-........ ~~ier~ of premises locoted ot ......U~.._.....~..~.......~~ ...................Wl~:~...5?....~.7....... y............................................................................. . County Tox Map No. 1000 Section,....../...2~..... Block ~ Lot No........1 pursuant to application dated ....:1.,~..„~t~'7 ~~qq / IY,r~., and approved by the Building Inspector. a Fee S...fQ.P......~`,!'~J g .~:t..~ dln 1 for Rev. 6/30/80 ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. TEMPORARY CERTIFICATE OF OCCUPANCY No Z-19733 DATE: February 15, 1991 THIS CERTIFIES that the building BUSINESS Location of Property 55 COUNTY ROAD #48 MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 121 Block 2 Lot I Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 30 1991 pursuant to which Building Permit No. 19653-Z dated FEBRUARY 5, 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 ALTERATIONS FOR A VIDEO STORE AS APPLIED FOR. STORE #6 & 7 The certificate is issued to MIDDLE ROAD SHOPPING CENTER, INC. (owner) of the aforesaid building. SUFFOLR COUNTY DEPARTMENT OF HEALTH APPROVAL NjA UNDERWRITERS CERTIFICATE NO. N-173849 - FEBRUARY 12, 1991 PLUMBERS CERTIFICATION DATED FEB. 7, 1991- HENRY G. LANCE, JR. uildin9 Inspector Rev. 1/81 y Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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-4 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 znd installations, a certi.`:icate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 y 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date Feb: 15: 1991 ;ew Construction........... Old Or Pre-existing Building „ .ocation of Property... 55 Ct~ Rd.•~/48.6. 120 Cox Neck Rd. Mattituck, N.Y. House No... .....Street Hamlet nwer or Owners of Property......... MTppJJ3~'. ]SAP. $aOPPING• CENTER: INC. _ ounty Tax Map No 1000, Section.....1z1.......Block...? I ............Lot....... ~bdivision... .................................Filed Map............Lu[...... _ ~rmit No. 9653-Z••• ,,-Date Of Permit., • ••••••........Applicant•Middle•Rd: Shopping Center, Inc. ~alth Dept. Approval •••••••••••.Underwriters Approval...,........ anning Board Approval ~ quest for: Temporary Certificate......, 7°~••.. Final Cert icate..... , e Submitted: • 15 00 ~CO'i; I9`I33 ~ APPLICANT _ ~ t. ~,.;-,.~P~~ Form No. 6 TOtJN OF SOUTEIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION POR CERTIFICATE 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: I. 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 caater 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 19 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. :S. 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. Fces 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 October ]0: 1991 '~ew Construction........... Old Or Pre-existing Building Location of Property...,,55 COUNTY.RD. 848 & 120 CO% NECR MATTITUCR, N.Y. RD House No. Street Hamlet Jnwcr or Owners of Pro ert MIDDLE ROAD SROPPING CENTHR, INC. P y ~:uunty Tax Map No 1000, Section.... ? .......Block.. 2 I ..............Lot...................... :subdivision ....................................Filed Nap............Lot................ 'crmLt No „ 196532 ,,pp FEB. 5, 1991 ~(VIDEO~§TO1~')ate Of Permit AUGUSTO MALANDRUCCOLO .Applicant.. :Iealtlt Dept. Approval ..........................Underwriters Approval......................... Tanning Board Approval ~equust for: Temporary Certificate........... Final Certicate........... ~~~e Submitted: 50.00 CO ~.?b~~~f ~ 4.. ..;;.:.:m eoo, TEL. 765-1802 '~FFO~-~~' TO'4Y!N OF SO~JTIIO,LD IF BUILDIIQG INSPECTOR P.O. BOX 728 ~j, S TOWN HALL -1' I JTHOLD, N.Y. l 1971 T I F I C A T I O N , Date Z Building Permit No.~~ Owner (please print) Plumber ; r~J/,? / lV~r}~JGO~ J~'., (ple se print)T- TA~6~ p~UM61NG & HEATING CORP. 21408 POND ROAD ROl!' KONKOMA, N.Y. 11779 I certify that the solder used in the water supply system contains less than 2/10 of to lead. f (plum 's signature - Sworn~to bef r_ me this ~9 /day of 19~, N tart' Public fJotary Public~~lSSG~C'~~_County . ry~. 60RIS 'k031NSOp7 aw'+rARY PUBLIC SfaPO oP Maw Yong. "`~1p. 46312'76, Nassau Count j T6fm Expires May .31, 19 y r -TEED it:SPEC.iU;J ~~llkTE ~ SUMMENT'° ~ ~ ~ m f,. 1 • . M z~~ ' _ _ FOUNDATION (1st) FOUNDATIOIJ (2nd) _ - 2. G( ROUGH FRAME & PLUMBING ti H 3. H IIJSULATIOM PER N. Y. STATE ENERGY CODE x FIIJAL Q ADDITIONAL COMMENTS: x • ' x •n H\`~ ~ W\ H o N z s x cn a • r H _ m v cn ro H TEMPORARY CERTIFICATE ~ . The New York Board of Fire Underwriters BUREAU OF ELECTRICITY ~ ~~I99D NEW YORKNN.IY~ 10038 N1107763 NO. NE,H CNANGE UNDEF- ` / OVEN- METENS 6EflV~~ SEflVICE ONWMD x NE.EO ' This Ccrti(ies, that the electrical service equipment installed has been duly reported to this Bureau - ' and the use of s e is hereb ~ r9lit~d for no more thin 90 da s from above date or until recalled. - ~ ~ Location ~ir Issued to Installed by EED resident Pe ` INFORMATION FOR ELECTRIC COMPANY Size and type of service SERVICE EQUIPMENT WILL BE READY ~ SERVICE CONNECTION C' FOR ELECTRIC COMPANY INSPECTION ~ REQUIRED BY o ~,,~~~i (D cl (DalEl ---~jgned tElmuwiun) tTekp~one NmnEep TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 199 (D NEWBYORKNN.IY.f 10038 N 110 `l7 6 4 ' NO. NEW(((( CHANGE UNDEfl~ OVEfl~ ~ ~ ' METEflS 6EgVICE SEgVICE GROUND HEAD This Certifies, that the electrical service equipment installed has been duly reported to this Bureau ' and the use of s e is hereby pitted for no more than 90 days from above date or until recalled. Location ~ C Issued to ?~~/•~-.L~,~-~L~ /~aC / ~-a~ o Installed by Y'-G~~~f: - ~"g:QLG~ I )ce e _ Per ' INFORMATION FOR ELECTRIC COMPANY . Size and type of service SERVICE GQUIPMENT WILL BE READY y 4 SL'RVICE CONNEC FOR ELECTRIC COMPANY 1NSPL'CT10N ~ REQUIRED BY f~ ate) (oak) Signed ~GP" c°~ifr~~rr~-. C~~g 7lL°~ ~ (Glemnclenl ~-~f-- ' (Telephone Nombcrl TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 85 JOHN STRGL'T N 110 7 7 6 ~ ' / / 199rG NEW YORK, N. Y. 10038 NO. NEW CHANGE UNOEq. OVEq~ METEflS SEgVICE SEgVICE GRGUNO HEAD This Certifies, that the electrical service equipment installed has been duly reported to this Bureau and the use of sa s hereby per[,Ititt r no more than 90 days f/rpm~abgve date oar un-ti-l r-ecalled. Location ~L-t%t-~'~L. ~ ~ /'~+~-~.-~'~iLI.L'~ . Issued to ~77(~,~lwt.~' Installed by ~ '-9yc. EED Y sident P INFORMATION FOR ELECTRIC COMPANY " Size and type of service SERVICIi EQUIPMENT WILL BE READY SERVICE CONNECTIO , FOR ELECT IC COMPANY INSPECTION G ~ REQUIRED BY (o Dak) Si ned ~ ~~E X99-~~i Zo~~ ' g (Glectnman) (T ep" 11 hone Nulober) TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 99~ 85 JOHN STRGET N 110 7 7 6 5 NEW YORK, N. Y. 10038 " NO. NEW CHANGE UNOEg~ OVEfl~ METENS SEgVICE SEflVICF 6gOUND HEAD This Certifies, that the electrical s~fvice equipment installed has been duly reported to this Bureau )v and the use of sa Is hereby per Y~ ed for n ore than 9 ys from above date or until recalled. ,~;t.tt~, ~ Location Issued to ~ Installed by `r~- A. ED 0 'f~-C~ ~ Pe \ -INFORMATION FOR ELECTRIC COMPANY Size and type of service SERVICE EQUIPMENT WILL BE READY SERVICE CONNECTION~'' F'OR ELECTRIC COMPANY INSPECTION ~b REQUIRED BYE elo) <<Uate) Signed_~_r_ ~I~~~ai~%a~ `~9~-?~Zt~~~ (Electrlcinn) (1elepbone NumbcO i TEMPORARY CERTIFICATE , The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 1y9 ~ NEW YORKNNTY.EL1003& N1113618 ' NO. NEW CHANGE UNOEfl~ OVEq~ ' METEflS &ENVICE SEflVICE OflOUNO HEAD ' This Certifies, that the electrical service equipment installed has been duly reported to this Bureau ' and the use of same is hereby permitled~fntno mo e t • n 90 days from above date or until recalled. Location Issued to Installed by A. J. EED ~~~jl/'~j ru-~-~71~'O r tdent Y /~-~'l_,C~.(.t:.~t.(, Per c. y INFORMATION FO ELECTRICJ~.OMPANY Size and type of service ~ SIiRVICE EQUIPMENT W[LL BE READY SL'RVICE CONNECTION/~~ FOR ELECTRIC COMPANY INSPECTION REQUIRED BY-1L s ( ate) (Dale) Signed ./~~~~~C~ ,~~'2 Z (ClecUimen) (telephone Nmnber) TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 199 ~ 85 JOhIN STREET N 110 7 7 6 7 NEW YORK, N. Y. 10038 NO, NEW CHANGE UNDEft~ OE SERVICE OF GNWND ~AD ' METEflS SEflVICF This Certifies, that the electrical service equipment installed has been duly reported to this Bureau and the use of sa is hereby permi ed for no mo an 90 day~from • ove date or until recalled. Location 1l`/', a~ / Issued to 1 ~ a Installed by ~ .REED ~ _ e resident Pe(~• INFORMATION FOR ELECTRIC COMPANY Size and type of service SERVICE EQUIPMENT WILL BE READY SERVICE CONNECTIO r FOR L'LECTR COMPANY INSPECTION REQUIRLD BY lol (Date) ' Signed ~ l~~i-~/ lElectriclen) (Telephone Nmnbet) TEMPORARY CERTIFICATE W The New York Board of Fire Underwriters BUREAU OF ELECTRICITY ~ ~ 199t~ NEW YORKNN. Y ~ 10038 N 110 717 6 6 NO. NEW CHANGE UNDEfl. OVEfl. ' METEfl6 6ENVICE &EflVICE GgOUNO NEAO ' This Certifies, that the electrical service equipment installed has been duly reported to this Bureau and the use of sa ishereby eer~ d fur no ire than 90 d(~y,~ from above date or until recalled. Location ( ~ L/t-°°"~.-~ Issued to x. ~ ~ Installed by ' REED ~ ~ e r sident !J Per INFORMATION FOR ELECTRIC CQMPANY Size and type of service SL'RVICE EQUIPMENT WILL B4 READY SERVICE CONNECTIO ~ FOR ELECT C COMPANY INSPECTION REQUIRED BY el ( ate) Signed 3~^7~?~7 (aledrmlan) (T6lephone Numheq , TEMPORARY CERTIFICATE ' The New York Board of Fire Underwriters BUREAU OF ELECTRICITY ' / 199 HS JOHN STR[:ET N 1113 ~-G-L/-`J-- ~ NEW YORK, N. Y. 10038 NO. NEW CHANGE UNDEfl~ OVEq METEP6 6EPVICE 6EPVICE OPOUND MEAD ' This Certifies, that the electrical service equipment installed has been duly reported to this Bureau and the use of a is hereby permitted for n m re than 90~from above date or until recalled. Location ~~i (((JJJ Issued to Installed by A. J E '~/1 ~ V' e ent 4 / Per INFORMDA~ION FOR~E~ T C4 CEO,MPANY Size and type of service f> SERVICE' EQUIPMENT WILL DE RL'ADY SERVICE CONNECTION ~ FOR ELECTRIC COMIANY INSPECCIO REQUIRL'D BY (Daul (Deu) Signed ~Z7 Z ZO/ (IilecUiclan) (Telephone Nmnbe+) TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY ~ 199 ~ NEW YORKNN. Y ~ 10038 N 111 15 ND. NEW CNANDE UNDEP. `}E~ OVEP. METEP6 6EPVICE SEPVICE GNOUND / \ HEAD . This Certifies, that the electrical service equipment installed has been duly reported to this Bureau ' and the use of same i ereby permittedv~er no more than 90 days fro ove date or until recalled. Location ~ 6~ l~ Issued to I Installed by A.J.R ~ V' Pr nt Per INFOR ATION F~ E E TRIC COMPANY f~i i Size and type of service SERVICE EQUIPMENT WILL BE READY ~ - SERVICE CONNEC " FOR ELECTRI COMPANY INSPECTION REQUIRL'D BY ~ (Date) (Date) Signed, . ~ G+j-Z 2 0 / ~ (aleclncien) (Telephone Number) TEMPORARY CERTIFICATE The New York Board of Fire Underwriters BUREAU OF ELECTRICITY 199 NEW YO1iKNN.IY L 10038 N 1113 617 ND. NEW CHANGE UNOEq~ OVEfl. OF 6EPVICE 6EgVICE OPOUND R MEAD METEPS ~ This Certifies, that the electrical service equipment installed has been duly reported to this Bureau and the use of sa 's hereby permitted for no re hen 90 days f~on~,ayovc-date or until recalled. location J Issued to Installed by . J. EE ice esi nt ' - Per INFORMATION FOR E CTRIC COMPANY Size and type of service -3 SERVICE EQUIPMENT WILL BE READY /l' / SERVICE CONNEC'~~bQ POR Y:LEC1'RIC CO~MP~A~/N/J/Y I/N~/'SJPECCION 7~ REQUIRL'D BY lr~/'; Signed a3~g'ZZO / (Electru:ien) (Telephone NmnbeU i ~ ~ ~o~~~ BOe1RD OF HEALTH _ FORM NO.1 3 SETS OF PLAr1S • JAN $ 11991 SURVEY • • • • • • TOWN OF SOUTHOLD CIIECt::#~ .a,~y ; g~,pG py~ BUILDING DEPARTMENT SEPTIC r•oarl . `v`TQWNOF60UTNOLQ" TOWN HALL ' ' ' ' ' • • • - • • . . SDUTHoLD~ C~LY_ 11271 p;aT I FY I 9 ~tqy ~~aa / TEL.: 765-1B02 CALL .11p.J.°.a l$,to• Exatttincd . //~~.4~......... l9GG/j~.~ p/ MAIL T O : • • . Approved .f~b......... 9!f o..~9fe 5 ~3 . I Permit N Disapproved a/c ' . tttld• Inspector) APPLICATION FOR BUILDING PERMIT Bate ..:,Iaruary, 30.•.... Iy91 INSTRUCTIONS sets of plans, accurate plot plan to s ~peeLl=~ ~llccv~inY typewriter or in ink and submitted to the Building Ins b. Plot plan showing location of lot and of buildino schedule. pector, tuitl or areas, and giving a detailed description of layout of property mustsbeedra~ n on the dia=gram which is pare oCt hissaPF cation. , c. The work covered by this application may not be commenced before issuance of Building Permit. ' -d. Upon approval of tltis application, the Building Inspector will issued a Building Permit to the applicant. Such pear 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 Occupant s4ta11 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describes The applicant agrees to comply with All applicable laws, ordinances, building admit authorized inspectors on premises and in building for necessa =node, housing code, and regu tions, and t ty pectin s., • (S~ ature of"applicant, or name, if a corporation) . ,298 Ha1f,Ho•llow Road_ Cix Hfills NewYor_k 1174E (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer,=e_neral co_-__ ntr_~tor, electrician, plumber or builder .................OWNER~~~R;&~~~••.~DDLE ROAD SHOPPING CENTER: INC. Name of owner of premises ~ ~ " 5~i~~~~?I}lj~ . i`77-\I~A CpN$7.'RUGTI4~1., . INC _ (as on the tax roll or latest deed) • • • • • ~ ~ • • • ' ' !C applicant is a corporation, signature of duly authorized officer. ,A,UGUSTO i,~lALANDgU000ZOt Pres. • (Name and title of corporate officer) Builder's Liccnsc No. ,.,1b A~00. _ • _ _ • , . • , • . . Plurnber's Liccnsc No. .4,9,1; p, , , , , , , . Electrician's Liccnsc No. 1,4,4,1,-,E, , , , , , , , , , • ' Outer Trade's Liccnsc No . I. Location of land on which proposed work will be done. 55. C: R, 48 MATTITUCK NEW YORK 55 County Road,48 IiouscNumbcr ~ ••••..,,,MdttltUCk ' Street Hamlet County Tax ,c\fap No. 1000 Section ,1, ;1„ • Block , ? Subdivision . ~ • ' ' ' • • • • • • • • • Lot ..1.......... . F.ilcd Alap No. (N:rtrtc) .Lot . State casting use and occupancy of premises and intended use and occupancy of proposed construction; • • A. Existing use and accupaRCy...~OP(~ B. Intended use and occupancy.: , V1DE,0, SJO,RJ=, • • ~ ~ ~ • • • • • • 3. Nature of work (check which applicable): New puilJing • • • • • • • AJJiticn ,U,teration ~r}teriox•, , Repair RFmoval , , , , Demolition .Swiatnin~ Pool`:', Tennis Court iAccessory.Buildin , , , , X • • • " S•• ....Fence .......Other Work: 4. Estimated Cost ...$1,,.Q0.Q..OD. it . Fee 'll: 4tn be pail on filing this avplication~ S, If dweilin^ number of Jwclting'i , . • • • units ~r!Z1........ Number of Dwelling units on each floor . If ~aracc, number of cars i N/A, • 6, If business, commercial or mixcil occupancy, specify nature and extent of each type of use YIDEQ. S10fiE• ~ • ~ ~ • ~ ~ • 7, Dimensions oC existing structurCs, if any: Front ~P; , , , , , , , , , , Rcar . , 3(!', , , , , , , , , Depth . , (Q; , _ • Hcicht „~(l;,dRRCoX•.•,Nun46croCStorics...,1.. Dimensions of same structure with alterations or additions• Front 3~ Rcar •30 • • • • ~ • Depth .......6Q . J IIcight ? Q' ~ . Number of Stories ....1... • . 8• Dimensions of entire new constnution• Front , ,NIA, •Rcar Depth • • • ~ • Hcigltt „ ,Nurt16erofStorics. , 9. Sizcoflot:Fiont. 1'76.+- P.car.•,~~261~+•-••.•.~•,,~•,•y•~Dcpth ...:~4~.t.-~•~~~••~•• 10. Date of Purchase ~larch• 2P, •19$'5' ~ Name of Former 01V2iCYl~`Road A~~ociates ! I. Zone or use district in wlticlt pr miles arc situated B, Light• Business . • • . • • • . • • • • • , , , , , , , , , , • , . • • • . 12, Does proposed construction vio~ate any zoning law, ordinance or regulation:. 1V,0 . . . l3, 1Vill lot be regra~lr.t t~Tq writ cxccss~(il~l be r1cmovpd from prprrtiscs: • • • • Yc. X , 1VP 14, Name of Owner of premises ~?die ?~:~t?te~a~~98s; NY'P174~ ~ru... Phohc No.51,Cr563_ $986 Name of Architect ? _ _ ~ • • • • . Ad Tess ........:Phone No. . Name of Contractor .,vki7fiz,Q~~tn~Qifx•1 Its. ~ • • • ~ Sim ~ ~ • ~ ~ • • • • • i• ,.......Address.. .............PhoneNo...S~•••••••. 15_Ls this groperty located within 300 feet of a tidal wetland? ^YES....210.%.. *If yes, Southold Town Trustees Permit may be required. I PLOT DIAGRAM Locate cleazly and distinctly a1G, buildings, whether existing or proposed, and. indicate all set-back dimensior.~ tr property lines. Give street and blockl,number or description according to deed, and show street names and indicate vv::c:. interior or comer lot. T • ~I II ~ . I • II it I STATC OF NE\V YORE, I'IS.S COUNTY OF Su>tik'4irk~....... AtIGVS7'0 ,N}ALANI)RU~CO];0 • • • • (Aamc of,individual sign' ' ' • • • being duly sworn, deposes and says that he is the applica: ' , mgcon[rac[) above named. ' IIc is fire P~1;~?n:' ' (Contractor, agent, corporate officer, etc.) ~ • ~ ~ ~ • ~ ~ • • ~ ~ ~ ~ • • • of said owner or owners, and is dull authorized to perform or have performed the said work and to make and file tl: application; that all statements cont~nrcd in this application arc true to the best of his knowledge and belie(; and that u: work will be pcrfomtcd in the mannc{ set forth in the application filed therewith. Swom to bciorc me this 'i .....:3.~.... .......day oflL ...1lanuary , 19.91 Notary Public, (,i,C,~-~ ..~G, ( ~C". County ' ELAINE SI~SCHINO ~~C. NMary PNot6YS4778~64Nt~valt' J QualltledinSpNolkCoumy ~ (Signature oC applican' • CammiwiatEWlrarJuty3t,1 I q~~~e ~~ii~,, ~,~gp~ - 3.~0„ - ~ - - 3_~~,~ ~ re r E r ©-1d ~ i ! ._.mw_._._._._...._ar.~.~ . ~i ~ I sl r ! ~ ~ ~ ' ` - ~ i ~ ! 1 ~ ~ / 4 'i r ~ ~ , ~ ~ ~ ~ I 1. ~ t / y pg v\T r t.« 1{f i ~ ~ s ti 3 ° ; ~ ~ ~ 9 D xs gl ~r ~ ~ i ~ ~ m ~ i ~ ~ I ~ s, - ~ . o ~ r k s s i ~ e~~~ _ 1 ~ ~ ~J~-~i ~~'y/~ _ _ _ _ . ~ ~u ~ , ~!~Rw~ir~-~s p j QUrq~'t3 GAVE i ~A ~vn . a4i~4~ pS ~ p i e~ _ ' /9~"~ D Cd4~SRe1 F~iJfLl~!NG DEP R ME AT 7G~-2 f 5t g r1f4t9 TO ~ M FOR THE ~+~T~ FOtl.t JilUti INSf'FCTIO E j b. FO[ IDATION - EQUIRED ~ { ~ FOI POUREDCONC ET ~ 51~e,~ ~ 2. RO H -FRAMING LUMBING L ;~/~/r~~ ~ i ~ 3. INS CATION _ ~ I FIN L CONSTR 4 ON MUST ~ ~ ~ ~ i ~ ~ ~ j BE OMPLETE FOR .O. j _ _ _ _ _ I ~ ALL ONSTRUCTION W LL MEET ~ ; ~ THE EQUIREMENT5 F THE N.Y. STATE CONSTRUCTIO ENERGY ` CODES. NOT' RESP $ BLE FOR ~ DESIGN OR CONSTRU ~l ERRORS ~ N ~ ~ i ~J I .-1.-.,- t t I ~w. ..._w~~ 1 i PLUIi~I~'ER CE T/F/CqT/®N UN LEgD CUNT ~T BEF®RE fe cERrlFicgTE of ,~~~e~ ~ CcuPANCY ~ SULDER USED 1N WgTER SUPPLYSYSTE ;CANNOT ~ EXCEED 2/1O v qo ~ 6-~ /o LEgD ' I ~ i ~ \ I _ , ~~~5 r~ fau~C~ tx~ ~ ~ 3~ in f jf € Ii ! r i ~ ~ I; t; ' I ~ t i ; j F ~ l jij ~ II [ Ii ' ~ I - ~i ~i ~ o i j j ~ ~ N 1~. I ~ ~ 11 R ~f 7 ^,t.. f j' ~ISPr4y T9Ff~ I I• ~ ~ i 7 I I~ ~ ~ ~ E I.~ I~ ~ 'i j ~~f~~i ~i~- 1 ~f ~I 1 ~ I ~ i UNDERWRRERS CERTIFIC TE . a e. n r~ ~~i ~^'s ~'g j j REQWRED , w,>,,~`y~~ryryp~~~,.y~~~YSg~ I 3 ~ RPt ~FD,~SMpTED ~ ' ~LFf/_ " ~ R.F?N ~oJU~ s 9~'~'9.~ry°~~P_ j~,',~A"~°Bi~~~h,~gl~° ~ ~I ILL, II Ip~ ~DH~ / ~ ~6Jf: d~,a`~3..d~~ d',~~~B LU ~k u~ j i ~ FGF ~~-RV: o p ~g f pf4}0'IeM CiU D EO OEPART N7 A7 I (~l~j~~~'9 ~~;j~f~,~~"e _ ~ ;~~dII112..- AI1TO 4 PM FOR THE l~~~li,^~,n i~,~y d~~1 A F0, LilVJiN I~i tPECTIQNS: 3 F(;Un!P~A 10 ~ f1N0 REQUIRED I ~ ~ ~ F'vR: POI E CONCRETE r z RfYUGH F .AMINO & PLUMBING Cl,"''''~~~ ~ i; I 1 ! 3 OIVSt)tl'~P O?3 i n 6'Ihl.",L d:ON$TROCTIDN MUST ~ o - ~ ~ BE COhtl I_E E FOR C.O. j ~ ! U ALI. CONS R CTION SHALL MEET i ' ~ THE REQU~E ENTS OF THE N.V. ' SLATE CO S7 UCTION & ENERGV CODES. N $ RESPONSIBLE FOR N DE51GN OR CO STRUCTION ERRORS ~ ~ I ~ y`~ ! I PLUMBER CERTI NATION ON LEAU CONTE~'BEFORE ~ ° ' ~ CERTIFICATE OF 0 CUPANCY L ~ ~'6~ _ SOLDER USED ! WATER I ~ ~ r ; SUPPLY SYSTEM ANNOT I ~ j ' EXCEED 2/10 of % LEAD. j~ ~ -II- _ _ EGRESS 1 I, ~ ii J'O 3 ~ .w.