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HomeMy WebLinkAbout19409-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219654 Date JANUARY 14, 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1235 ISLAND VIEW LANE GREENPORT House No. Street Hamlet County Tax Map No. 1000 Section 057 Block 02 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 20, 1990 pursuant to which Building Permit No. I9409Z dated SEPT. 24, 1990 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 IN PLACE OF DWELLING THAT EXISTED. The certificate is issued to MR. & MRS. CHARLES KREPP (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-108 - 12j5/90 UNDERWRITERS CERTIFICATE N0. N167526-JAN. 3, 1991 PLUMBERS CERTIFICATION DATED MIKE JACOBI-NOV. 26, 1990 uil ing Inspector Rev. 1/81 roast xo. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) i N i 9 4 Z Date .....9 .~~.~-n a..`f i 9.~ 4 i Permission is hereby granted to:~ ~ ~j,, ~ ~ Q~,,~ ~ Q ~4,~ • _ ~p-- of premises located of ...~.a~.~.,5..... !.^..'~,-1............)241?-nrrC~O~..`1..... U ' County Tox Map No. 1000 Section ...~.5.~....... Biock .....4.~-....... Lot No..0..8 r { Pursuant to application dated ..AY~7..:RX~!cr.~~:-.... ~.7 19.9.v, and approved by the Building Inspector. U i Fee 5...7.4P..:.~.d.... .....1.~.~?~..... Building 'Inspector s Rev.6/30/80 / Form No. 6 ~~~L~~ C/~G~~`7~~ d.I~, 7 TOWN OF SOUTHOLD ~ ~ t~~~~ BUILDING DEPARTMENT D ° ~ TOWN HALL ~ {j 765-1802 11' ~~C ~ 2. APPLICATION FOR CERTII'ICATE OF OC UPA~Y BLDG•DEP~ ypWN OF SOUTHOtO A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1~ 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. 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 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15/.00, Commercial $15.00 / Date ..I ?IIL[.1~ New Construction........... Old Or Pre-existing Building q Location of Property.. /a ~SLi~L~b ~//C'2z1 G/9~uC-, _ ...G~EZ-~ U 0~ 1....... . House No~~//.Y~~ ~1 Street Hamlet Onwer or Owners of Property..I:<nr,~1~~.f....C/~,A~CS„1~~~~~,,,,,,,,,,,,,,,,,,,,,,,,,, County Tax Map No 1000, Section..v .v. ~......Block..~ 2:.........Lot...~.~Y Subdivision ....................................Filed Map............Lot...................... I ? ~/off' z ~7on~~~f~~ s: --wc I'~ Permit No... ....Date Of Permit.. .Applicant. t~. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval ~ _ Request for: Temporary Certificate........... Final Certicate........... .Fee Submitted: ~'S.... ~~..~1.a.y.. / C o z/ 9~ s"S~ . ~ APPLICANT 7`12,. he.i,n L-~~~o ~D~~' 'r1~LC+ I;;~~~CT1U;J (IUAiE ( CO(~tMLNi~ 1 . ~ C3 H .9 FOUNDATION (1st) G N FOUNDATIOT (2nd) - - ~ 0 PI 2. r 2 „y o ~ ROUGH FRAME & © 3 PLUMBING ` v~ . ~ ® H 3. ~ r~ IIJSULATIOPI PER N. Y. ~ y STATE ENERGY CODE ~ r m ~ H 4. } FIi4AL ~l 7 ~ ~ ~ ~ o~ AD TIONAL COMMENTS: x . ) O ..2 F ra • x ^o M 31 W . H O z O x~~ d~ -o v H r b~® 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ~ INSULATION [ ]FRAMING [ ]FINAL REMARKS: - ~ ~ DATE O INSPECTOR ~C~~o ~ 765-1$02 BUILDING DEPT. INSPE~Tit~N 1' F'ouN~ATION iST ROUGH PLBG. C] 1 N ND IN _ "c!'- REMARKS. ~ a 7 DATE ~ ~ INSPECTOR a. ey~a~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~MING [ ]FINAL REMARKS: ~ic.-f.~~~~.. DATE l ~ ( / C:~ INSPECTORS s~ a ~ ~ ~ . . I CI ~D ~ 765-1802 I BUILDING DEPT. INSPECTION [ FOUNDATION iST [ ] ROUGH PLBG. [ c}~UNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~,9~~,9~ - DATE ~ IN5PECTOR C 765-1862 ~ BUILDING DEPT. - I NSPECTIOt~O (FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL ' REMARKS: ~ ~~~,~-c~~ ~ ~ /~'~'W DATE ~ INSPECTOR FORM N0. ll TOWN OI' SOU'rHOLD BUILDIN4 DEFARTMLT3T TOWN HALT, SOUTHOLD, NY ~(I~ D~vrl.o~rtT:~~' z>k:Rrtrr Yex~niaeion Se hor©by grantod to; "y~'~` -~--~`~-~--L!~-- . to - cam.. o~it,;., c.~ _ U-~ ~~~.,c.~ ~~e~eQ~-~.._. pt premix®a located nt /a35~~_~~,,,{~~~-? rv~ Cowit'y Tax rs~n zzo. 1000 Sootion ~5~7-,~ Bloctc `~O 2- I,ob / 8 _ pureuc~nt to a~plioc~tion dated ~,9~1_.~~, ~ r , 19~,, snd approved by the Building Inspector. I~ iiuildinLr Permit No. • AuildinR Inspoctor 4/ao P~ COUNTY OF SUFFOLK ~a,~ a p, 'v PATRICK G. HALPIN SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.D., M.P.H. COMMISSIONER FACT SHEET LEAD IN DRINKING WATER SUPPLIES Sources of Lead Concentrations in Drinking Water Systems Use of lead solder in new plumbing or in plumbing modifications to existing water supply piping. Lead is not a naturally occurring element in Long Island groundwater. Occurrences Lead is present in drinking water as a product of corrosion. The natural corrosiveness of Long Island groundwaters contributes to this process. Most public water supplies in Suffolk provide chemical treatment to increase the water's natural pH, and minimize corrosion products, but no amount of treatment can produce a totally non-corrosive water, Studies indicate that after prolonged periods of water non-use, lead concentrations can be found in excess of Drinking Water Standards. This problem appears to be limited to newly installed internal water piping systems, or recently modified systems, in which lead-based solder is used. Lead is rarely detected in routine water supply surveillance. This fact is seen as indicating that, at a particular location plumbed with lead solder, this problem will diminish with time. The New York State Health Department concurs with this evaluation. Health Considerations Lead is a compound which is accumulated,in the body. Human intake can be expected to occurthrough many environmental sources, including water. Recommended Aclion In order to minimize lead occurences, the following steps are recommended: Particularly in new or recently modified plumbing systems, users should be encouraged to flush the water line for a period of at least two minutes prior to consumptive water use. This is particularly necessary after prolonged water non-use, such as the overnight period. WWM-050 June 1985 Page 1 of 2 Rev. January 1989 COUNTY CENTER SEE REVERSE SIDE FOR INSTRUCTIONS FOR FINAL APPROVAL RIVERHEAD. N.Y. 71901 78-1118a..2/89pa r ~ ` INSTRUCTIONS FOR FINAL APPROVAL OF CONSTRUCTED SYSTEMS It is the applicant's responsibility to call the Departmentto arrange inspections of the septic system and water supply facilities prior to backfilling. This', includes inspections of the soil excavation for the septic system and inspections of the water supply well, well lateral, public water supply line, septic system and piping. Following satisfactory construction and inspections: 1. The applicant must submif 4 prints of a survey (up to and including 11 "x17"), by a licensed surveyor, of the subject property showing the following: a. the lot location and dimensions; b. the lot number(s) and the name of the subdivision, if applicable; , c. the final elevations of the lot; d. the exact location of the private well, if applicable (give at least 2 dimensions measured from the corners of the building); e. the exact location of the public water service line, if applicable; f. the exact location of the septic tank and leaching pool(s), if applicable. Give 2 dimensions from the building corners to the centers df the septic tank and each leaching pool; g. the exact location of the sewer line from the dwelling to the street, if applicable; and h. have a clear area at least 3"x5" for the Department's approval stamp. 2. The applicant must submit a certificate from the sewage disposal system installer attesting thatthe system has been installed according to the criteria of the Suffolk County Department of Health, when applicable. 3. The applicant must submit a well water analysis and well driller's certificate, when applicable. Ifthe well or water quality does not conform to standards, proof of corrective measures will be required. 4. In those cases where public sewers are utilized for the dwelling, the applicant is also to submit one (1) copy of the r sewer line inspection approval forthe public sewer district. In districts operated by Suffolk County, two (2) copies for Form S-9, duly executed by the Suffolk County Department of Public Works, are required. 5.. 7r?#hose,cases in which theinstallation and connection of the public water service Ijne have not been inspected by the,' Department of Health, a tap letter from the appropriate water company is required. t,; r PLEASEINOTE: HEALTH DEPARTMENT REFERENCE NUMBER MUST BE O~1 ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. i PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. PLEASE SUBMIT ALL NECESSARY FINAL PAPERS AT THE SAME TIME. SUFFQ~LK COUNTY DEPARTMENT OF HEALTH SERVICES BUREAU OF WASTEWATER MANAGEMENT SUFFOLK COUNTY CENTER RIVERHEAD, NEW YORK 11901 WWM-050 June 1985 ' Page 2 of 2 Rev. January 1989 ' ie-mw..aeePe w. FOkT1 N0. 11 TOWN QF 50tPPHOLD BUILDING DEPARTMk.TIT TOWN HALL SOUTHOLD, NY' /I DE'VELOPMF.3JT I'ERMI'P No ~ 7~F Dato ~ 1`)a,~v Pex7niaaion is herabq``''grantod to: _Y~~~~ _ _ _ a.~ premia®Q~~ ed :?t / a35 Y,~ CJ~Q-,~.R ~ P - - w~~~ Couzitq Taac Map No. 1000 Beotion oS7 Bloclt APO Z_ I,ot / _ ~W~~ pursuant to applioation dated ~9~T 19,~u,, and approved bq th® Building Inspector. I~uildinq Poxmzit No. ? 9`#09 _z IIuildinR Tnspoctor !}/t30 y A ~Pr a z ? THE NEW YORK BOARD OF FIRE UNDERWRITERS t>~t:=,~, 1 OOf)t~£~~. BUREAU OF ELEGTRICITV 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date '7ANU~. k'y (1'I,t991 Application No. on file '~f ~$~)kt ri ~7 C1)9ti 1} ~ti7Fl;?t, THIS CERTIFIES THAT only [he electrico! equipment r[s described below and introduced 6y the applicant Homed an the above opplicotion number in the premises of C'f{Af2lrF;5 K~TiK}'t~5, :f d~~5 .I:SIIANII VIf;W I1Nr fv~?flil!lI`7fsr1~{I'. ~j.~+~ in the fallowing Iocotion> ©Ba.cement ~ 7xt FL ? 2nd FL. A°P.E ~~("Jfl[1'i` Sectioned ~ BlockG Lot ~ Tt~;CN;Y4t3'f~R ~ , ~ A'3fJ was examined on andfoand to be in compliance with the requireneenLr o/this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER bNi K W AMi K.W PMi NW AMi K.W AMT. N P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEU UNIT HEATERS MUL11.OUTLET DIMMERS AMi. K. W. Oll H. P GAS H P AMT NO. A. W. G AMi AMP qMT. AMPS TRANS. AMT H P SYSTEMS AMT. WATTS NO.OF FEET f 2, t PL?7(1 SERVICE DISCONNECT NO.OF 5 E R V I C E PMt. AMP TYPE METER ~ R. 4W t g 3W 3.e' 3W 3 ff 4W NO OF CC. COND. A W G NO.Of MI-LEG A' W' G NO. OF NEUTRAiS A. W. G II EQUIP. PER .B' ggOF CC COND OF HI-LEG Of NEUTRAL .d (~li l iS ~ tC 3 6~ OTHER APPARATUS: xrr:~l~~>zn x[r>ti:rnra~~;~,n~r~ zlTt;e~~~k~-~: l I A CARh'PUt>7 lStIF; C/~~~ GENERAL MANAGER 7;+LTF `1'1tiYtft,,, T~tY. (!'7i~ !'i 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. z { COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _ ~ i '~f, ~ ~ ~'"1. ~ 'A r / .mss"_/S, ""~'4'/ \ lid ~C . .'a ~ ~ ~ 4 r \ R ~ , ` a ~ ~r~ ~ >°p Qom" jT~`` ~ ~ th ~ ~ ~ x, ~ a a ~n ,fir- Aar :-t T~~ w'~'~. VC7 ,1 /1 - *a' C f' P Cq~ .t"<ri ~;b ~a~ ~ ~~rn'' '~~?m n'rn~~ mm~~ 4iz ~ Cl W ~ ~ .'jj ' y~ ~ x ~ r r r ~ d ~ o ~ f 4-' kk~ w .p' \s, ~b 7_ ~ r Ci._._Z-.-- sa cv~ } ` x r pro ~ y _ o~_ -o, U' . r'~ _ m J/ f ,1i T !n ` ,tom ~p _ rt, nJ~~Y Nic}f t J." ki ~i~~ 9{ ~m lp ~r~2 ~ m .r 'A~ r. Mq~Ky `0~~~t'Ul ~.R ~ Ti11 ~~.)~(jl'~ri x ~M t ,'-ri ~ , ~z, I 0 ~1 'p ~ 1 ~ u~ ~ ~ ~ X11 rp C~ 4 L~ N J ~ t~.,..~ . ~ Ca ~ ! t y ~ ~l ~~c7 ~ ~ ~ ~ ~ p'~~ ~ ~ ~7 t~3 f~ ir'~ ~ ~ ~ Z Q i o c ~ ~ 1•...,~ ~ ~ , r Application Re,/ceived Disapproval Issued Permit # a~2,G, y,,,~q~719~U 19_ o~Rd?~~yuta._3_+1_199U FORM N0. 10 0 APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD Ga.« ~ ~ 19 go ' 1. 'type of Uevelopmeht Proposea: New Structure (including storage tanks Addition and/or Alteration n F Below Base Flood Elevation_ Other (specify) ~}y,~,~µQ ~}-Qey t~ ~SLk) 2. Elevation Data in relation to above mean sea level of: (a) Lowest floor elevation, including basement ~ feet D inches (b) In a V Zone, bottom of lowest structural member feet inches 3. FIRM--Flood Insurance Rate Map, Zone designations 4. Owner of Premises L/~Z1- ~ ~J~~ 5. Location of Property: House # Street Haml t ' County Tax Map No., Dist. 1000, Section O S 7 Block p Z Lot(s) 1 ~ Subdivision Filed Map# Lot(s) ' 6. Permission to be granted: ,X Owner as above _ New Owner Under Contract - Lessee _ Contractor _ Phone # Name if not given above Mailing address 7. Approval from other(s) before Permit is issued: DEC Wetlands (Town Board) Health Services ZBA Building Permit ~ q 9 ~i. Planning Board g. I, the applicant, am the Owner Co-Owner New Owner Under Contract Lessee Agent Contractor and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises 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 my knowledge and belief and that the work will be performed in the manner set forth in the application filed therewith. STATE OF NE YORK ~f „ COUNTY OF _~~tLBI..QJ~t_ SS -t"~y~ ' gnatur p~ SWORN TO THI51,~/ go7 ~ DAY OF 19 [ Q sic . ' >\Jfi (/0"C? tEEtFN K. QE VOE Notary Public NOTARYVU$LiC,StateofNe~nYork Na. 4767$7$, SuSfuiA Cou Applicant's mailing T®emEzpiresMarcb30,19_.1L. address and phone # if not given above 11/85 i FORM NO. 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT j (516) 765-1802 P.O. Sox 728 I! Town Hall Southold, N.Y. 119'71 Main Road Southold,N.Y. A~PT~TC.AT-_r,nt~ FOR nFVELOPMFnTT PFpMrm Instructions: The application to the Building. Inspector includes (each in duplicate) 1. Form No'. 10 filled out in ink or typewritten, 2. Sur- vey of premises withi,elevations above mean sea level, 3. Drawings of pro- posed work. The application must give complete information to show that the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the Code of the Town of Southold known as "Flood barrage Prevention Law" of the Town of Southold. TY}e applicant must submit approvals that any other agency requires. General Standards as required in Section 46-17 of the law to minimize flood damage: A. Anchoring of ',structures, includinq.tanks and mobile homes B. Use of construction material and methods C. Design and location of utilities D. Subdivision proposal with drainage, public utilities design and base fhood.e~evations Specific Standards as required in Section 46-18: A. Residential construction B. Non-residential construction C. Mobile homes) The applicant must s~ibmit plans and specifications as well as any other information requested by the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the base flood level the structure is water tight with walls substantially and impermeable to the passage of water, 2. that structural component$ are capable to resisting hydrostatic and hydrodynamic loads and effects of!buoyancy, 3. applicant must submit certification by a registered profess}}tonal engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard"I area (V Zone) 46-19. Applicant shall submit plans, specifications including the required certifications and such other in- formation as the Building Inspector may require in that the provisions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural meihbers of the lowest floor cannot be lower than the base flood elevationjwith all space below open except breakaway walls. Sand Dunes. If sandildunes exist on the premises and the applicant pro- poses to alter same,,plans and specification must be shown in detailed nature of any alteration sub~itted. Building Permit. A Building'Permit is also required for any structure. Both a Development aid a Building Permit must be issued before any work can start in a special flood hazard zone. A written disapproval or a permit must be issued within ten (10) working days. During construction,',the inspector shall be notified in time so he may make the required inspections. Upon completion, the required certification of the final elevations and work must be submitted before the approval to use or occupy can be approved. (Fill Iput the form on the back of this sheet) 11/85 . i i / c 3. Nature of work (check which applicable): New Building Addition Alteration , • Repair Rf!moval Demolition ..............Swi:nnin~~ , , , , , . , • ~ ~ ,,,....Other Work:........... Tennis Court Accessory Building..........1'ence 4. Estimated Cost ~ P 6 ~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage,numbcrofcars 6. If business, commercial or mixed occupancy, specify n lure and extent of each~e of use , , 7. Dimensions of existing structures, iC any: Front Rear , , Depth . L•Z,~ , , , , , , , , , , Hcigirt . vim.-. Number of Stories • • • • ~i Dimensions of same structure with alterations or additions: Front ReaF ..~4 . Depth ........`p~.~'........... IIcight ....I. e~ .........Number of Stories . • , • , , • , , 8. Dimensions Q~ entire new constntction: Front a , Rear ..a Depth .r"~.~ . :Icigttt ,N1 umber of Stories j . 9. Size of lot: Front P.ear .....4, .C~.............. Depth ..1CQ i0. Date of Purchase . Name of Fo~cr Owner , . 1 1. Zone or use district in which premises are situated . J~tL~~~~~1 ~ ~ • • • • • • • • • • • • • • • • • • • • ' ' ' ' ' ' ' ' ' ' • • ' • • 12. Does proposed construction violate any zoning law, ordinance or regulation : 13. Ni11 lot be regraded ~(j..'.~j Nill excess till be removed from premises: ^7 Yes . No: . 14. Name of Owner of prises . C:/T~ ..lf Address ~~~..~~~t':?-~. ~!4~Phone No. ~ /.Z • ~l 7f. • : . Name of Architect . ~ f~fGlf. LLI.. ...Address Y~t?h!~.5 . d~~ Phone No.~ a~•~r~, Name of Contractor . "TI.l~C+~~L„SG'''t?, ,d~'C,/~r~ 5.:,. • Address . nQ: (Y?,~. ~~~~~ione No..`7..'~ • ~ G~• ]S.Is this property located within 300 feet of a tidal wetland? *YES_...NO::-- *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM ~ Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from I property fines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. I ~R. STATE OF NEN G~~ S.S COUNTYOF. . ,~~.(?y,~ ..~~.K..~~`f~ v being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. }3c istJtc (Contractor, a • nt, 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 oChis knowledge and belief; and that the work tvill be performed in the manner set forth in the application Glcd therewith. Swom to before me this Notary Public,\_...-X".~:~/v'~• • u• • • • • • • • • • • • County / CLAIRE 4 OLEW /~~P ig~~/~ " ' - ' . 4vG~~~ M041y t?ubllq, State of Nsw,Ya16 Y No.4879608 (Signature of ap QuatlHed M Suffdk ~r~ OommMWon Expka Dax N rmba 8,18 7~-u. [t ~ (0 ~ Q ~ ~i, Y" BOARD OF HEALTH ~:K:........ U II FORMNO.1 3 SETS OF PLANS D SURVEY .Q.... ~P Off) TOWN OF SOUTHOLD CHECK 7 , , , ' BUILDING DEPARTMENT SEPTIC roam .o:K:........... BLDG. DEPT. TOWN HALL 70WNOFSOUTHOLD ~I $pUTHOLD,N.Y.11971 NOTIFY; /6 TEL.: 7G5-1802 , C p CALL Examinod .~~?`f~, 19p/l0 p q MAIL T0.... , , . , , . Approvad~?~.~'~^!~: 'Z 7., 19 11~~ ~ Permit No.. ! Q.~. / ~ . Disapproved a/c i . (Building Inspector) I'I APPLICATION FOR BUILDING PERMIT / n Dale ..~1./~.......... ISI.~ INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or In ink and submitted to the Building Inspector, with ~ sets of plans, accurate plot plan to sci;le. Fee according to schedule. b. Plot plan showing location of`lot and of buildings on premises, relationship to ad}wining premises or public streets or areas, and giving a detailed description of ]ayout 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 an the premises avallable, 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 MA~& 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 Yotk, and other applicable Laws, Ordinances or Regulations, for the construction of puildings, additions or alterations, or for removal or demolition, as hBrelit described. i The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premiss and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~ J Cr 7r Stat~e^whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.1~?IC~? , , , , C ~t ~~~G'~`S, , , , , , , , , , , , , , , , , (as on the tax roll or latest deed) - If ap is co~~a r n ture pf d~ul,~yaauth ized officer. ame and title o/f~ c~ officer) Builder s License No. /..1~ J Plumber's License No. ~ ` s Electrician's License No. Other Trade's License No. . 1. Location of land on which proposed work will be done; Itouse Number ' Street, Hamlet ~ County Tax Map No. 1000 Section ! BI'ock , , , , , . , _ , Lot . . subdivision . Filed t<lap No. Lot . ~ ~ ~(N;u~te) ' ~x~i~sting useg nd occupancy of I~rcmises anffd~~~~in~tended use a(n~d occupancy of pprr/o~p}~osed~c/onstruction: Lstin use and occup~ncy...~Y`tC...~7d0.:'~..~Vy.~~t/Vb`"f,'el~'~R%R~'S.•..•.....•..•••. 4~ tr 7tW'~(eNekltpnflt7P.3ti:fttgYlNatA mtended use and occupancy ,°:r?~'': rats . G~ni+a...•!' rt.~.. vai p~i'Rfasi~~' . ,.w..8e.t~ se:,+~ ,.a,~r+,Ct+E~ti4t-3:ttra~lfnrr~il Db9 ~ ~ r I' ~ ~ ~._w _ ~ _ . I~ ~ I ~ ~ ~ _ ~ t r 4 ~ ~ ~ CJ~. ~ .~,e~ s1 a ~t { ~ M `f~i4•;S ~ \ ~ ~ ~ ] i flib V" fir, x?, ' N} ii - ~ I ~.r ? I u• v C1 , ~ ' ~ i C ~S N~ ! rl 41 QM. ~ ( c~ ~ I„~\pr ~ ~~4~ ~ ~ il.! x ~ t~~u ~,y r 'W4'`~>~ rr~ 7, 4 a t r~ I ~ I ~ Si flf.~ N j ~ f ASS ~ ~ ~ rQ~ v ~10U..~ ~~c' } r ~l lu ~ ~_HI--~~ i l_F ~ I C d ' ~ S,.( ! 999 k ~u; ~ a. 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ROUGH - FRAMING & PLUMBING �ilF New \ -e - — �fl0o ' \ W�'^— 3. INSULATION 1� m - 4. FINAL - CONSTRUCTION MUST ,y��tMce wA, BE COMPLETE FOR C.O 2 ALL CONSTRUCTION SHALL MEET µ' %j,b sc•tE a� T. n THE REQUIREMENTS OF THE N.Y. ocew SHB,I[kr iQ /�IwwtYl�y�/ 'OCC )PANCY OR STATE' CONSTRUCTION S ENERGY m oTZ 7L2[ Ssr fii417 FOR CODES. NOT RESPONSIBLE IS UNLAWFUIDESIGN OR CONSTRUCTION ERRORS fir"' -' �dSs1Cd}�' - , .4 � ROUT CERTIFICATE WIT FCUPANCY 5''r � w . ., � e t x p 4 �;r'P"'!r� x � <r„a �l+•�S'� .,,�W, f dµ- a f 4E -� .9 ..Y1�,_. ..,.. ,"�'.�...�'�-_._..._. —_ - _ _ .:•._ — __-,__��. ,�� ._ -___ .______.._ _ _ , ...._- .. � _ _ ?v*, .. `cy y �7<a Y F ' a r, i. 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