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HomeMy WebLinkAbout19829-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20199 Date SEPTEMBER 9, 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 790 INDIAN NECK LANE PECONIC NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 4 Lot 1.10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 1, 1991 Pursuant to which Building Permit No. 19829-Z dated MAY 1 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 ONE FAMILY DWELLING WITH ATTACHED DECK AS APPLIED FOR. The certificate is issued to' DONALD G. & SAUNDRA J. PERRY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-50-65-APRIL 30, 1991 UNDERWRITERS CERTIFICATE N0. N-073304-5{25/89 & N-141181-7/20/90 PLUMBERS CERTIFICATION DATED SEPT. 14 1990 - K&K PLUMBING & HEATING l~'~~ Building Inspector Rev. 1/81 roans xo. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 19 8 2 9 2 Date ...............~?.:~~....4................., 199.1. Permission is hereby granted to: ....,..~:?.~Q... G:.....~... ~g~...... ...3~..L. gS ~ie~~G u •x.:.....:.1..1.,9 5;~ ~..~..a9..~, ~ , ~-7 . j of premises located at ..7.4.11.... lJ:uq:!:~...lY.R>;.~!"~....Q~~!t.R...........~..gSa?Y:::4S.n I County Tax Map No. 1000 Section ...0.~.~.~....... Block Lot No.....~.:.~......... ,f pursuant to oppiication dated 19.9..x.., and approved by the Building Inspector. Fee S...l..l.~ . ~ Bu ding Inspector ,.9~~, a gate ~ ~~1 a Rev. 6/30/80 ' " ' Form No. G TOWN OP SOUTUOLD ~ ~ j"°°°-: L~ I,a `UJ~ BUILDING DEPARTMENT ~p{~ TOWN UALL Ill I ~~(j ~ ~,~g, 765-1802 Llli IL11 TOI,yBL~ ~St?UTIipLD APPLICATION FOR CERTIFICATE OF OCCUPANCY -a. This application must be filled in by typewriter OR ink and submitted to the building in~ector 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 used in system contains less than 2/10 of 17 lead. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from archi"ect or engineer ~ responsible for the building. a 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. 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 Euildi.ng - $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 _ (ew Construction..., Old Or Pre-existing Building...........h.. .ocation of Property....79~.,,;ZvIL~a'N.~~Clf L4GLQ............ /~f?CD~t,fC,,.,..., House No ~~q Street Hamlet ~nwer or Owners of Property... D~~rrf//~.~...,~",;,,~`^";,,~~!//,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 'ounty Tax Map No 1000, Section...a.b .......Block.... ?...........Lot.... ubdivision.qq.~~~~... F/filed Map......... ~L~ot.. ~ n ermit No..'.(p,~'~,~,,,Date Of Permit..~~./. ~~....Applicant../O.`:h,Q:~~ ~!.'.C'!:~r.... ealth Dept. Approval.~ ......................{{{Underwriters Approval..~,.................... Tanning Board Approval equest for: Temporary Certificate........... Final Certicate...~.... ee Submitted: ~ 0 ~ c7~ (q~ APPLICANT r v rlfz~s~ TEL.,7G5-1802 S~FFOLKC ~p OG TOWN OF SOUTIIOLI~ :i~ y~ OFFICE Or IDUILDiNG INSPECTOR o 'fr` z P.O. BOX 728 U' 1` ~ TOIVN HALL ` ~~0~ ~ ~a~~ SOUTIIOLp, N.Y. 1 1971 May 21, 1991 Donald G. Perry 6 wife P-O. Box 454 Peconic, N.Y. 11958 To Whom This May Coktcern, We are unable to complete your Certificate of Occupancy because of the following reasons. /~.J~ An application for Certificate of Occupancy is not on file. <ENCLOSED) / / No tJnderwriter~ Certificate on file. T}ie check is( /not on file.) $25.00 / / No Health Dept. l~.pproval on file. No final inspccCi.on has been made. Plea~c contact our office on this matter. 79zanlc you for your cooperation. Building Permit it 1 9 $ 2 9 2 Bui.ldi.nq Dcpt> No Plumber Solder Certificate on file. ~ . ( all permits involving plumbing being .i:,sucd after April 1,1984 ) S~FFOLk~ ~ TEL; 7G5-1802 q~p ~ Opy TOWN OF SOUTIIOLO „ . ':a~ 6i;:a~.- ~ ~ OFFICE OF BUILDING INSPECTOR o 'r'" (v~'I:~'~}:rF rn P.O. BOX 728 i' ~ ~ TONN fIALL " "oy ~ ~ 0~- SOUTHOLI), N.Y. 11971 col ya May 21, 1991 Donald G. Perry S wife P.O. Box 454 Peconic, N.Y. 11958 To Whom This May Concern, We are unable to complete your Certificate oL- Occupancy because of the following reasons. An application for Certificate of Occupancy is not on file. (ENCLOSED) / / No Underwriter:, Certificate on file. Ttie check is( /not on file.) $25.00 No ]lcalth Dept. P,pproval on file. No final ins.pccCion has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit It 1 9 8 2 9 2 BULldl.ncJ Dept. No Plumber Solder Certificate on file. ( all permits involving plumbing being .issued after npril 1,1984 ) a INSPECTORS ~~gOFFO(,~co (516) 765-1802 h~0 Gy SCOTT L.HARRIS,Supervisor VICTOR LESSARD, Principal ~ ~ CURTIS HORTON, Senior r°n Southold Town Hall VINCENT R. WIECZOREK, Ordinance p ^x+ P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire ~ o~~ Southold, New York 11971 Building Inspectors ~ ~a Telephonel(5 6)5765 1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD April 17, 1991 Donald G. & Sandra J. Perry P.O. Box 454 Peconic, N.Y. 11958 Re: Building Permit #17183-Z (New Dwelling) Premises: 790 Indian Neck Peconic, N.Y. Suff.Co. Tax Map #1000-86-4-1.10 Dear Mr. & Mrs. Perry: During a review of our files, it was noted that the above building permit has expired and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold Article XXVIII 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures, alterations or new dwellings, and it is unlawful to occupy or use said structure until the Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Vincent R. Wieczarek, Ordinance Inspector VRW:gar ( 1 M N :JUG I l-1(,~i ~ ~ P A.IV~iI G~ BQ~AR,D j , TQ~N O~SOU :H'6ZD Sti~~EO,LI~"UOUNTY Southold, N.Y. 11971 (516) 765-1938 November 25, 1987 Samuel Kopper 310 Plymouth Street Pembroke, MA 02359 Re: Access road in minor subdivision for Samuel and Eliza Kopper Dear Mr. Kopper: The following action was taken by the Southold Town Planning Board, Monday, November 9, 1987. RESOLVED that the Southold Town Planning Board authorize the Chairman to endorse the minor subdivision map for Samuel K.C. and Eliza Kopper subject to receipt of the covenants and restrictions signed and filed with the Suffolk County Clerk's Office. RESOLVED that the Southold Town Planning Board accept the engineers report to the final inspection on the access road within the minor subdivision for Samuel K.C. Kopper and Eliza Kopper located at Peconic. SCTM# 1000-86-4-1.2. If you have any questions, please don't hesitate to contact our office. Very truly yours, C39~x-Q Bti~~k-~_, ~ ~ r7~ BENNETT ORLOWSKI, JR. CHAIRMAN SOUTHOLD TOWN PLANNING BOARD Boljd A ~ SIDNEY B. BOWNE & SON ; Sidney B. BOWOe, P.E., LS l0 ~ ~ Rolantl gntlers (1922-1958) andt~ir$ iz~iizeerd RogerL Cocchi Chester C Kelsey, P E., L.S. 45 rfl8110Y ROOd Francis J' Lynch Alexandre W. Mercil, P E. Pndip Scniotznauer RobeA A. stamon, P.E. Smithtown, N.Y. 11787 Joseph F Steg man Robert W. Brown, L S 516 724-0611 Paul F Stevens Zabdiel A. Blackman, P.E., L.S. ( ~ wdbam t Sryne Rwhard 8 Weber George A. Slyte, P.E Jerry D. Almont, P.E. George L. Fagan, Jr., Ph.D., P.E. Frank Capobianco, C.E. Thomas R. Pynchon, L.S. November 5, 1987 Mr. Bennett Orlowski, Jr „ Chairman TOb1N OF SOUTHOLD Planning Board 53095 P4ain Road Southold, New York 11971 Re: Site Inspection, Samuel K.C. Kopper, Peconic, Town of Southold, New York (SBB N0. 87154) Gentlemen: A site inspection was conducted on 11/4/87 by Mr. C.S. Heffernan of this office. We find that construction has been completed, as per requirements, and recommend acceptance, Very truly yours, SIDNEY B. BOWNE & SON CONSULTING ENGINEERS CORNELIUS HF~ F RN CSH:cIg ~ xc: Ray Jacobs, Supt./Hwys. Ray Dean (SBB) , _.,.,~~»l~,a~u~Afw DATA MINEOLA • SMITHTOWN • NEW YORK CITY • CLEARWATER An Equel OppoAunay Employef M/F/H d ^ ~S~F~OCk~o TEL. ~~s-laoz TOWN OI' SOYJTHOb,D ,`z; ~ i 't ~ OFFICE OF IIUILDI2QC INSPECTOR sx' ~ r° < e: a c°n ~ ~ ~ • ~ P.O. BOX 728 , ~ ` ~ cs •'r "r TOWN HALL y~o! SOUTHULD, N.Y. 11971 ~ • jti, ~j,,: C E R T I F I C A T I O N ~ ~ ' Date ~1~ Building Permit No. Owner ~ ' (please pri t) Plumber ~ ~ ~w,M~l,~~ ~ (please print) ~ . 2~~51 _ `P ' ~x I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. . , ;rs,;; ' (plumber's signature) Swor ~to befor^ a this " day of ~.1~.%J/J'/~` 199 ~ " otary Public potary Publi County ERICt~l. KOCM Notary SMte of NawYak No. 62.2182100 QualHlad in &uffoNc County TermExpireatian.31, 14R~,' THE NEW YORK BOARD OF FIRE UNDERWRITERS 1'rfh~, ! 1i7f1fl!~Qif> BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 _ Date •.IliC,,Y y. "SUS APPlication No. on file 4h ~gd7j$'t ~ THIS CERTIFIES THAT only the etectrico) equipment as described below and introduced 6y the applicant named on the above application number in the premises of MR_& t4R~, 71. FrFRRY, 7915 l.Nt},CAN 1~17rf:Y3 trz`;~~;r fl~f;if(8't.(.`.r E~d.Y, in lhefollouing loco orpl ggse eat ~ lac Fl. ~ 2nd FT. L~~{r Section Bloek Lot ~ltirY 0~3,'f u~frtn! uns examined on and found W 6e in cornplianee with the requirements of this /3aord. FIXTURE ECEPTACLE$ $WItCHES FIXTURES RANGES COOKING DECR$ OVENS DISH WASHERS EXHAUST FANS EOyUTLETS IN/CANDESCENT FLUORESCENT OTHEfl PMi K W. AMT. K W yPMi N{W,~. A9Mi K.W. AMT. ~H H P !J ( E" ~ f>!~ W ~ .K e 1 ~ ~ ~ 1 ~ C DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME ClOCRS BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS AMT. K. W Oll H. P. GAS H. P. AMT. NO A. W G AMi. AMP. AMi AMPS TRANS. AMi H P NO. OF FEET AMi. WAitS h 1: I .'2?3 7 SERVICE DISCONNECT NO.OF 5 E R V I C E AMi. AMP. TypE METER ~ 1W ~ ~ DW 9 S, JW 5B AW NO. OF CC COND A. W. G. NO OF HbLEG A W' G NO OF NEUTRALS A W G. EQUIP. PER ¢ OF CG. COND OF HbIEG OF NEUTRAL 1'rf) t. i x 1 ~ ~ 1. OTHER APPARATUS: ft~;QUF;a'C};L1 RF7CAti~'1' Fl-P.B1'IrTA~ €N"~~'t'ki.-'9, tr.F~.C.I; 4 ~2~ t".7S P,I~rTCC'1"If.tC; [rl4e. ~1,~i~S°~°~ i'.i5l3 Hf3i'KY }'S7I?S`t' fi(tjySi k'1ii7LiLk, ISLAND, 4~''F, 1}c1 ri3 GENERAL MANAGER 3.7. 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. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'.rt~~,': Lt1t)t;9br7 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 t~IAY :?h,i;7$jd F{i#301.EL'fi/t~fi hT f?'L~3V•1 Data gpp(ication No. un file THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant named on the above application number in the premises of 3~ER. t"e i'(175. 71. P1~;PYpY, `I`.1Q %fl{?1 itl~? d'lx;t;l; f~~%.. ~'i+"(:Cri~'P,o ~1.Y. in the foliouinq lncotipng ° semen[ © lst F(. ~ 2nd F'l. Section Block Lot ~Ir.4 7:F3~~,`f was examined on andfound W 6e in emreplianro with the raquirentents of this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS ~ OUTLETS INCANDESCENT RUORESCENT OTHEH AMi K W. AMT. K W. AMT KW, qMi K W AMT, H P b2 (i5 b!i !iL ~ f,. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gELI UN17 HEATERS MULTI.OUTLET DIMMERS AMT. K. W. OIL H P. GAS H P. AMi NO. A. W. G AMT. AMP. AMi AMFS TRANS. AMi M. P SYSTEMS AMT WATTS NO.OF FEET SERVICE DISCONNECT NO.OF 5 E R V 1 C E METER AMi. AMP. TYPE EQUIP I q 4W I,e 3W 3g ~W 3q <W NO OpERCaCOND. Of CC. COND NO OF HbLEG OF~H LEG NO OF NEUTNAlS OF ~ EUTRAI "1. 1511 C;1f ! h 2 Ili? I %!(3 OTNER APPARATUS: G.ti'. C<la~~$ ~IG~~2~a7~ aGT~LfRk~'M', IdY, 2A'1 GENER1~l MY1NA0@R Per -s This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified~y tt eidentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED BN ANY MANRIER. - r-~~~ 1 ~ 765-1802 BUILDING DEPT. INSPECTIt~N [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL ~ REMARKS: DATE ~ INSPECTOR 17~g~ ~ 7GS-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. (J FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [i-~''~NAL REMARKS: r - ~ ~ rl~ a / T h 3 * ` d ~ c, t DATE `INSPECTOR 765-1802 BUILDING DEPT, INSPECTION (]FOUNDATION 1ST [ ] ROUGH PLBG. ()FOUNDATION 2ND [ ] INSU TION FRAMING [ FINAL REMARKS: ~ CU'SS' ~4 t DATE ~ ~ ~ INSPECTOR t 765.1802 BUILDING DEPT. 1 NSPECTI®N [ ]FOUNDATION i5T [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [~ULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~~~~~y~G~ / DATE 4 INSPE R I , 765-1802 BUIlDING DEPT. 11~15PECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND ~~LATION [ ] FRAMIN(T [ ] FINA! REMARKS: r DATE ~ INSPECTOR r1ELD II:SPECiIUU ~~llATF, ~ COMMENTS Ulm -`ti.~ H - H Pv FOUNDATION (1st) ~ c FOUNDATION) ( 2nd ) ~ _ - ~ rNrU a 2. ° ,J w ROUGH FRAME & p a PLUMBING c cn H 3. ~ ~6 ~ ~ IIJSULATIOPI PER N. Y. ~ _ • • y STATE ENERGY ~ d CODE `v x A ~ m 4 . C FIiJAL ~ ~fT .d~ipl9~.. z e/ DITIONAL COMMENTS: x f ~ / f~ m~ G(,,p o9'" l H H H o ~ z S yr 0 • di ra ~ b H V'~ s i I. i4.• `~i""'~' " !Z ~ ~5 _fi ~]`I 1' . ~ i b~ y \ R 4 ~ U ~ - _ - - i r R ` 1 ~I It~ia N.r~>C~ C,C? L~, irs { to ~ 1 R ~ ,bra 1 jA r i _ ; n t ~ I_._. Jry . r., m i I ai5 ( 1 SJ ~ ;'t 5~ ' ~N~I ~ S' \ ;~1 ` \ j4~ ./'~f l .J ~ ~ ~ll ~'~1-.^ 7 v - i ~7 ~ ~ i L- :Ii.~F~.,a,<... f lF6E~YNE EJ$! NBIYlV ~ ~ ~ g3 r~-isoz BUILDING DEPT. INSPECTION ~ . [ ] FO DATION i5T [ ]ROUGH PLBG. [ FOUNDATION 2ND INSU [ ] CATION [ I FRAMING [L ]FINAL REMARKS: _ .~~-~.~.~u ~ _ J DATE ( INSPE~C'TOR ' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [)FINAL DATE S / / INSPECTOR ~1~~ 765-1802 BUILDING DEPT. INSPECTION [FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~~~~i-.~ _ DATE 1 ~ INSPECTOR FOt3M NO. E ' 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) Nfl 017183 Z Date ...........:~........1 19.Q~ Permission is hereby granted to: r, -p ~ tgo.y~..~4-~j I.1:u:GA....~.....~?:SR,~.~.....1.]..5,.,..4aru~. ~.....d..IY..GF>r..r....Q.~4.~...... D '7 p n ~J ct premises located at .../...1.........~alfdYr4:?rrt....~~.~K.... .t:'!:4R.........~..C.~:!~:.tr ...........................................................................................................t.I................................................... County Tox Map No. 1000 Section ......~.~.~R....... Block ......O.l.......c.~. plot No....~.:. pursuont to application doted ........~.~<(!r4:5......°~7 19.d.R.., and approved by the Building Ignspector. Fee ~aR, . Building Inspector oZ $D ~ Rev. 6/30/80 l " (5 6j 7690 802 o~OgUFfO(,~-co VICTOR LESSARD, Principal G'y~ SCOTTL.HARRIS,Supervisot CURTIS HORTON, Senior w x Southold Town Hall VINCENT R. WIECZOREK, Ordinance 0 P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire y ~ Southold, New York 11971 Building Inspectors 'h0,( ,yL ~`a Fax (516) 765-1823 THOMAS FISHER T Telephone (516) 765-1800 GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD April 17, 1991 Donald G. & Sandra J. Perry P.O. Box 454 Peconic, N.Y. 11958 Re: Building Permit #17183-Z (New Dwelling) Premises: 790 Indian Neck Peconic, N.Y. Suff.Co. Tax Map #1000-86-4-1.10 Dear Mr. & Mrs. Perry: During a review of our files, it was noted that the above building permit has expired and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold Article XXVIIT 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures, alterations or new dwellings, and it is unlawful to occupy or use said structure until the Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Vincent R. Wieczorek, Ordinance Inspector VRW:gar G l Y . , ~i,_.~ii. . , 1,_ , ;~r ; ~ , ~_~st' ~-io~~: _ _ ~ _ _ ~OF" Y.rAY i _ _ _ sY , yra a ~ ~ ~ ~ . t 'J~-i t i ~ ~i ' 120 ± ~ 1, ~ PRQP. `,v 1. i.L. 1 ~ ' ~ _q ~ .7 i ~ r ~(AY }~K7_ i i ~7 ail _._____i ~L f pG.~iP ~ LPZtC ~ ~ . f is t_' .~.,..e~~,.__ _ y g~ f~ pp'' i-~k i aver #e ~r~~e. ;~-`,:v'~;=~, v=8~~"'"°"~"""""°'~~ BOARD OF HEALTH Yj~ ~ J~rrf"-. I.7\Y'!~-., 3 SETS OF PLANS FORM N0.1 SURVEY ~I~ TOWN OFSOUTHOLD CHECK ' BUILDING DEPARTMENT SEPTIC PORbf TOWN HALL BLDG. DES'T. ~~r J.91 SOUTHOLD, N.Y. 11971 NOTIFY TOWN OFSOUTHOLD n TEL.:765-1802 CALL p~ .F?t1 MAIL TO Examined .r~:~ 19 4.. 119sa ~ Approved . „ 19~~. Permit No.T'~:" Disapptoveda/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~~Z: 7........, 15 INSTRUCTIONS a. Tlris application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises ar 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 shalt be occupied or used in wfrole 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building, code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. J {Signature ot" applicant, or name; if a~ orau n) ...........,.....Y ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. t~c~,J ~2 Name of owner of premises ~/JALJ C ,~£K-rZ~ Ge'`^cQ ~'gt7N,~r21Q P~rc~~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No, ,,,,,,,,,,,,,,,,,,,!;,,®~/J~I"L Plumber's License No. . Electrician's License No . . q Other Trade's License No . . 1. Location of land oqn which proposed work will be done . . . . House Number Strcet~ Hamlet ~ County Tax Map No. 1000 SeCIiOn ..Q. 8.6.°.Q~ Block ~ ~ ;,D,~,J, , , , , Lot . od Subdivision Filed Map No. Lot . (Name) t State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy VF1C+~II~T L~~~ • . b. Intended use and occupancy FHvnrLy i2Fs~~C~ ~"_i • ....:~'-:Y:... ~i...y: _ e~ ~ r'i , .f.. Ya 3. Nature of work check which pplicable): New Building • Addition Alteration , , , . ern Repair oval . Demolition , Ot111 i . 00 description) 4. Estimated Cost ~ ~.~.r©f~~J . . Fee , (to be paid on filing thisrappji~atiod) . g 5 If darage number of carsvellmg units , , , , , , Number of dwellin units on each floor . . g oft 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , , . s... , es, if any: Front , . sUc:")£........ Rear Depth . • mberofStorics D mthtsions of same'struct reuvvith alterations or additions: Front Rear . p 8. Dimensions of entire new const ~ ' Ileight , , , , , , , , , , , , , , , , , , , , , , Nuntbcr of Stories . ruction: Front 31.,g1,4~„ Rear . (el ;3~ c2H . ,Depth .5.O,.D • . Height ......?`f. Ff'. , Number of Stories F7:.. , ~ ~ ~ ~ ~ • • 9. Size of lot: Front ?•So7;l, 8~ Rear ..•3,ro„&6, , , , . , , Depth `.~!!o'6S- £ , ZhT 6 • f 10. Date of Purchase , ,7. R~? . nl ~J ,/,°(Q8; , , , , , , , , , ,Name of Former Owner s'A!yJ£~, f~, , EL!?rf Kop~e2 11. Zane or use district inw}ticltpicmisesaresituated,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,•...,. 12. Does proposed construction viglate any zoning law, ordinance or re ulation: g :I 13. Will lot be regraded . . ..Will ~Xcesslfill be removed from premises: ~es Ne 14. Name of Owner of premises ~vJheD, vucn Y , , , , , , ,Address PO.$r?'!`(sl`, Pff4a;r,~:{ .Phone No..~~7 ; .BS,roo, , Name of Architect . £ `O~ Gr^]b• ~ ~ ~ ~ p0 -I a~ brc cC~ P~~ 2g . Y , .Address pO27,.t~r~.sra; iJ' .Phone No. y'...'.5~:.... Nam ~ f Contractor , CI , , , , , , , , , , , , , , , , , ,Address y ~ Phone No..... . 15.Is this property located with in~00 feet of a tidal wetland? *YL+S'...~ *If es Southold Tow~r Trustees Permit may be required. PLOT DIAGRAM _ r. Locate clearly and distinctly alj buildings, whether existing or proposed, and, indicate all set-back dimensions from. property lines. Give street and bloc) number or description according to deed, and show street names and indicate whether interior or corner lot. Drs. 1QDO S£c7rokl ~g6.00, ~LUCLf Oc(~oO' G©T ~l•OlO - 1_.........__. TN i)rNrJ ' nJ~Gk G+4 A7E. - ' 2-iJ rEKr~A ' WT p,~~ ~ 2'S'w~oE r ~ n-~6w r + w~ti ~ O 0 M ~ WEtL O ~ /LOaPO JD ~ a©~' H ~ ~ 5'ar~~ OtF ~ r` A rJ Drt~ W S ,'I ~ M cd SrQ~C- 8 ~ I ~ ~ I STATE OF NEW YORK Y36-r/ COUNTY OF Sc? r(-O(.K 'iS.S e ~ f • • • • • • • • • • • • • • being duly sworn, deposes and says that Ite is the applicant (Name of individual si~n~ng contract) above named. qq (Contractor, agent, corporate officer, etc.) o and is dul~ authorized to perform or have performed the said work and to make and Gle this application; that all statements cont~tned in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manned set forth in the application filed therewith. Swom to befo~~r//e me this ~i ' ~ /.......day ofl~... 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