HomeMy WebLinkAbout19363-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20109 Date JULY 25, 1991
THIS CERTIFIES that the building NEW DWELLING
Location of Property 625 TUTHILL ROAD EXTENSION SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.18
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 27, 1990 pursuant to which
Building Permit No. 19363-Z dated SEPTEMBER 4 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 WITH ATTACHED GARAGE DECK AND BALCONY
AS APPLIED FOR.
The certificate is issued to GAIL RAST
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-105 - JUNE 17 1991
UNDERWRITERS CERTIFICATE NO. N-187048 - MAY 14, 1991
PLUMBERS CERTIFICATION DATED JUNE 3 1991 - HARDY PLUMBING & HEATING
Building Inspector
Rev. 1/81
"Rx NO. f
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° 936 Z 9
®ate .....� ..f�..'.......................................... 19...P..
Permission is hereby granted to: tt�,�
�T... ..............................................
to . .. .. . . �.....Q�"Xj �......... ! .. . .Grp. ..... d !t.
atpremises located at .... ..�`�. ...T ...� �............................
................................................ ..5 .........................................................................
................................................................................................................................................................
County Tax Map No. 1000 Section .....��.. ....... Block .........4�1.........
Lot No. ....fS
pursuant to application dated .......t/tP.7...................................,19.,/..10, and approved by the
Building Inspector.
Fee $...145.`Pa
r
.......... ... .�f�. .................
/ Buil g nspecto
Rev. 6/30/80
I
F Our
COGy�
JAMES C. McMAHON ►� SCOTT L. HARRIS
Administrator v rn Supervisor
tl� Ze
Telephone (516) 765-1892 y0,y,l!�� ��� Town Hall, 53095 Main Road
P.O. Box 1179
T Southold, New York 11971
r r_ Fax (516) 765-1823
TOWN OF SOUTHOLD
JU� z MMUNITY DEVELOPMENT AGENCY
11
BLDG`p r-> �bf
TOWN OF. *Pr U
TO: VI LESSARD, PRINCIPAL BUILDING INSPECTOR
FROM: JIM MCMAHON, DIRECTOR, COMMUNITY DEVELOPMENT
SUBJECT: CERTIFICATE OF OCCUPANCY - AFFORDABLE HOUSING PROGRAM
DATE: July 29 , 1991
I hereby certify that Gail Rast has been
issued a valid Certificate of Eligibility for the Town of
Southold' s Affordable Housing Program and the issuance of a
Certificate of Occupancy to Gail Rast will not
permit a use, occupancy, sale or lease of a dwelling unit or
unimproved lot in violation of the provisions of the Southold
Town Affordable Housing Code.
C�'\ Lx�
JaNes C. McMahon
Director, Community Development
i\Vy
i
JUL 2 91991
TOWN OF 9C7il7P7f.,57
� FFD(�-��-�
o
tr T
O ® �
Town. of Southold Affordable Housing Program
C CERTIFICATE OF ELIGIBILITY
GA1L RAST has been found eligible to participate
in the Town of Southold's Affordable Housing Program. This Certificate
of Eligibility shall expire on December 31, 199o.
Date Issued MAY 9, 1990
Cr
James C. McMahon, Director
Community Development
* This Certificate of Eligibility does not guarantee the ability of the
holder to obtain a mortage.
i' e
JAMES C. MCMAHONiF SCOTT L. HARRIS
Administrator ' "',� ('< z�i?yx;. �'q'+ , Supervisor
Telephone (516) 765-18921. {xs {{ Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
II TOWN OF.SOUT14OLD
JUL 2 g ,99COMMUNITY DEVELOPMENT AGENCY
w._:9LDtI,6,t P'T- 1
TOWN OF SOUTM)i"1)
TO: VICTOR LESSARD, PRINCIPAL BUILDING INSPECTOR
FROM: JIM MCMAHON, DIRECTOR, COMMUNITY DEVELOPMENT
SUBJECT: CERTIFICATE OF OCCUPANCY - AFFORDABLE HOUSING PROGRAM
DATE: July 29, 1991
I hereby certify that Gail Rast has been
issued a valid Certificate of Eligibility for the Town of
Southold' s Affordable Housing Program and the issuance of a
Certificate of Occupancy to Gail Rast will not
permit a use, occupancy, sale or lease of a dwelling unit or
unimproved lot in violation of the provisions of the Southold
Town Affordable Housing Code.
James C. McMahon
Director, Community Development
Form No. 6
TOWN OF SOUTHOLD �}
BUILDING DEPARTMENT 7
TOWN !{ALL Si
765-1802 J�?# 1991
APPLICATION FOR CERTIFICATE OF 'OCCUGINCY TOWN D SOUTHOLCi E
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 C,,mpliance from archi_ect or engineer
responsible for the building,
6, Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses , or buildings and
'lpre-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 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 . . .?. . ,+/ ! / . . .
ew Construction. 0<tcTOr nrn_ov;_,.,., 'Id " • ' ' • • ' • •
�+«g B ing.
ocation of Property. �, 21
House No. St ee
�/ Hamlet
ewer or Owners of Property. i- ti g
runty Tax Map No 1000, Section.4,5„01L- J,Alock. . . . . , .
. . . . . . .Lot. . . . :?. .
bdivision. . . . . .
• • • " " " • •
g Filed Map„ .Lot
emit No. . l. ✓. •' �-rZ. .Datc . . . . . . . . . .�. .y,- �� . . . . . . . . . j(j��� . . . . . . . . . . . . . . . . . .
Q Of Permit. . . Applicant, ,�,J� /V ✓I/
filth Dept. Approval. . / SG ,-� d 'J— ���JJJJJJ
. . . . . . . . . . . .. . . . . . .Underwriters Approval. . 4''! „
Inning Board Approval. . . . . . . . . . . . . . . . . . . . . . . /
uese for: Temporary Certificate. . . . . . . . . . . Final Curticate, v a . . . . . . . .
Submitted: $.
yaa;' . . . . . . . . . . . . . . . .
a��o APPLICANT
SUFFOLK CC JATY,. ARTMENT OF HEALTH SERVICES
S f IlY DWELLING ONLY
DATIM 1� .S.REF. NO.
The sewage isposa6 and water supply facilities for this
location havi been inspected by this Department and/or
„ . ; . . otherA
and f nd 1p �satis{ 3ory. ,
r Bureau of Wastewater Management
f
LEt�.,��� JUN
NEA 0�
Of L7N
a _ y SERVICES
i
,yt mod, /V X,
'. t'r972°%✓uv� Z7'�9�. i1r °d�r,a �9se+
�cYlts►�mfla .�..uri.A+�ct:,r�«/yyi
r
TEL 763-1,802.
TOWN Or, SO�JTB[®r LD1
y'; /'• _� ��`c OFFICE OF BUILDING INSPECTOR
f: — P.O. BO' ,28
TOWN I-::,LL
SOUTHOLD.N.Y. 11971
C E R T I F I C A T I O: U
r�
Buildin Permit No. J
Owne
(p ease print)
Plumber c _
(pleast pri t)
I certify that the solder used in the water supply system
contains less than 2!10 of 1% lead.
(plumber 's signature)
Sworn to before me this_
3 day of
19-31 1 Rotary Pu is
Nota: Yvh_ic,� rJ ` County
4t3EiiNE A.MAGi.R7i
wry%. vx.'tune of Ptaw Yost
No.IM6588
cualried is Sul O%cou*
Ccmroh•si�n ExFiros htay t4,t8,�
a
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1000174
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
Date Application 14, 1 991 gpplicotion No.on file 71327690/90 N 187048
_I_
THIS CERTIFIES THAT
only the electrical equipment as deacribed below and introduced by the sWicent named on the above application number in the premism of
GAIL RAST, TUTHILL RD.EXT_ , SOUTHOI,D, N.Y.
in the following loco 'f� 001 ntent Ist Ft. Ynd F1. GAR/OIIT Section Block Lot 1.5
4
was examined on and found to be in compliance with the requirements of this Board.
NXTURE AORS SWITCNK RXTURK RANGES COOKINGM RS OVENS DISH WASNNS WCHAUST FANS
OUTIITS NCANDESCENr FLUONSCENT I OTHER I AMT. I K.W. I "T. I K.W. I WT. I K.W. I AMT. I K.W. I HAT. N.P. —
31 49 1 27 1 28 1 1 1 1 .2 1 F _
mr
DRYIRS RMNACE MOTORS jo IsmAI RECK TINE CIOC S I . I UNIT NIATIRS I MUtTI.OUTLST I DItA MS
AMT. K.W. OIL H.P. GAS N.P. AMT. NO. A.W.a. AMT. AMP. HAT, AMPS. TRANS. "T. H.p. NO.OF�T AMT. WATTS _s
1 F 1 600
SERVICE DIECONNICT 1140.OF S E E V 1 C E
"T. M.V. TTPE 1 A 7W 1/3W 3I 3W 3/AW NO.FW*COND. Oi't NO.OF NI4EG oA HIS NO,w NFUTKAl3 Oi'r N1.
1 200 CB ] X 1. 4/0
OTHER ANARATUS:
4TON A/C UNIT-1
G.F.C.I:-4
SMOKE. DETECTOR:-2 �
E.E.C.O.EIIECTRIC CORP. LIC.#2816E -
35650 COUNTRY RD.48 —
PECONIC, NY, 11958 GENERAE MANAGRR `—
Per
This certificate mutt not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR WILDMNC DEPARTMENT. TINS COPY OF CERTIPIG1TE AdAff NOT BE ALTERED IN ANY MUSM.
0
Officers
�� I
MAYOR illaye of green�oort
GEORGE W. HUBBARU UTILITY OFFICE
INCORPORATED 1898 NEW INCORPORATION APflIL).1460 (516)477.1748
WILLIAM D.
T D S RE-0NCORPORAT1ON UNDER GENERAL LAW MAY 28.1884
ALLEN � POWER PLANT
.Tr�4t-1 -_cM—"Ka ir'�N 15161 4774172
UAVIU S.CORWIN FAX(516,477-1877
GAIL F. HORTON
p N G L A r4 SUPT, OF UTILITIES
SUWP.OF WA1'RWWABTF:WATER .�_ -• — IAMES I. MONSBLL
GF:RALU W. IiIC'KSON
/,A/./.a /Y.A
236 THIRD STREET • P.O.BOX AH
GREENPORT,NEW YORK 11944
December 5, 1990 r0li, oylglhllli
Mr. Robert Petritsch " �M �[II
Suffolk County Health Department 2
Suffolk County Center k
Riverhead, N.Y. 11901 BLDG. DEPT.
TOWN OF SOUTHOLD
Dear Mr. Petritsch,
The following water service line was recently connected to the
public water supply by the Village of Greenport. The installation
was done according to our Rules and Regulations, and to the best of
our knowledge, meets with the Suffolk County Health Department
Standards. The location of the work and the date that the job was
completed is shown below:
D.B.M. Co. Lot No. 18
Tuthill Road Ext. Reference No. 90-SO-118
Highpoint Meadows Job No. F91-99
Southold, N.Y. 11971 Water District: Outside
Contractor: Latham Sand & Gravel & Applicant
If I can be of further assistance, please contact me.'
Very truly yours,
Gerald W. Hickson
By order of the Superintendent
of Public Utilities
GWH:cr
100 Years of Community Service
� 730
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [I,,-KFINAL
REMARKS:
i
DATE INSPECTOR
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
DAT NSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ROUGH PLBG.
[ j FOUNDATION 2ND [ ] INSULATION
[j-"FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR
63 03 765-1802
BUILDING DEPT.
INSPECTION
[ 7] F NDATION 1ST [ I ROUGH PLBG.
FOUNDATION 2ND [ I INSULATION
[ ] FRAMING [ I FINAL
REMARKS:
DATE ?ZS_h INSPECTOR
r5�3 70-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ROUGH PLBG.
[ } FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE �D INSPECTOR
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ el-ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ( ] FINAL
REMARKS:
622
DATE r' � 0 INSPECTOR
A
F Slf#TIt'COUNTY t OF F#AtTN' ICEB:
fOR�APPROVAL ONSTRUCTalpf "
Sinjoe Fyniyt esidence Only' r,
' " r1fITE w
'APPROVED—
SE pSE0 L�,�
z UNRES TWO YELT voc tr o �o
30a?95�
V�� �� � �CW YOP**
,�►�r. +�' � ' pia✓ � : ;
F
1 am familiar withl,the standards for A to J a
Qonstre•otion ^,F."SC�cS �t; -3*s:rasai a9>s�iz�ee '� * . ` ' • '
conditions sr�i.for+h therrrU nna on tYie remit to
signature
I
y � M
41990 E
i9nYea9eo�4 BLDG. DEPT.Uecw, TOWN OF SOUTHOLD
/OZ•OD'
SED LAryDSG ' ...
LEk gryO Tf�/GL �.�Gt91J EXTE.I/' /
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�E ;�ae.C�ai� �SCssT .9.aryav�*'h/.«'iYA.f/G�sr�.Ci•.
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OW
V$ BLDG• DEPT. -
0,� wmw }3m - TOWN OF'SOUTHOL
777
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AWWAW WOW
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Form 8002e —nergnin and Sate Deed.wit],Covenant against Grantor's Am—Individual or Corporation. (slugle elwet)9/Z 9O
1 CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENTaTHIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
THIS INDENTURE,made the day of , nineteen hundred and
BETWEEN 2 f S August
ninety
Herbert R. Mandel and Richard Israel, d/b/a DBM Co. , a New York
partnership with principal offices at 443 Main Street, Greenport,
New York
party of the first part, and
S.
Gail Rast
New Suffolk Avenue
New Suffolk, NY 11956
party of the second part,
WITNESSETH,that the party of the first part,in consideration of Ten Dollars and other valuable consideration
paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs
or successors and assigns of the party of the second part forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon orected, situate,
lying and being in the
Town Of Southold, County Of Suffolk and State of New York, known
and designated as Lot # 15 on a certain map entitled, "Map of
Highpoint Meadows, Section Two" which map was filed in the Suffolk
County Clerk's Office on 3/19/1990 as Map No. 8911.
Subject to the following covenant- and restriction which shall run
With the land to be binding upon the land, the heirs, successors,
and assigns of both the party of the first part and the party of
the second part: the party of the first part or assigns shall be
reimbursed the sum of $2,570.00 by the party of the second part,
or their successors and assigns at the time the Town Of Southold
issues a building permit for the construction of a single family
residence on the property conveyed herein. This sum of money
constitutes reimbursement for that portion of the "consumer hook-
up deposit per dwelling unit" which has been advanced on behalf of
the party of the second part by DBM Co. , the party of the first
part, to the Village of Greenport.
Being and intended to be a portion of the premises conveyed by deed
dated 4/24/90 and recorded in the Office of the Clerk of Suffolk
County 5/9/90 in Liber 11064 page 193.
TAX MAP
DESIGNATION
]st. /000 TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and
roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances
�• 05$. and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO
HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of
k. 06, the party of the second part forever.
OlS.0
01 AND the party of the first part covenants that the party of the first part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever, except as aforesaid..
AND the party of the first art in compliance with Section 13'of the'rLien Law,,covenants that the party of
6. •'the%first part will receive the consideration for this conveyance'add will hold the.right to'receive such consid-
eratioti as'a trust fund to be applied first for the purpose of paying the'cost of*the improvement and will apply
, the'same first to the payment of the cost of the improvemett before using art
any 'other"purpose. g. y,part'ofah'e total of the same for
The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires.
'IN WITNESS WHEREOF,the party of the first part has duly executed this deed a day and year first above
written. .
IN PRESENCE OF: D CO.
BY
erbe R. Ma el
DBM CO.
BY:
ichard Israel
STATE OF NEW YORK, COUNTY OF SUFFOLK ssr STATE Of NEW YORK, COUNTY OF SUFFOLK _ r
On the v?' day of 19 9"� r before me On the 0/� day of 19 9, before the
personally came personally came J
Herbert R. Mandel Richard Israel
to me known to be the individual described in and who to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged that executed the foregoing instrument, and acknowledged that
he executed the same, he executed the same,,
� -kL= J
No a y Pu lic Notary Public
VIAUJAM M MOORE W UJAM D.MOORE
Nota►y Public,State of New York (jgxy pub8c Stets'of New Yak
No.4832728 No.4832�28
Qualified In Suffolk County QuelNied in Suffolk County
CoRlmlasion Expires January 31,1998�
9a- co Eltpkes Jtinuary 31,1 9a—
STATE OF NEW YORK, COUNTY OF sin STATE OF NEW YORK, COUNTY OF $51
On the day of 19 , before me On the day of i 19 before me
personally came personally came
to me known, who, being by me duly sworn, did depose and the subscribing witness t the foregoing instrument, with
say that he resides at No. whom I am personally acquainted, who, being by me duly
sworn, did depose and say,that he resides at No.
that he is the
of that he knows
the corporation described
in and which executed the foregoing instrument; that he to be the individual
knows the seal of said corporation; that the seal affixed described in and who executed the foregoing instrument;
to said instrument is such corporate seal; that it was so that he, said subscribing witness, was present and saw
affixed by order of the board of directors of said corpora- execute the same; and that he, said witness,
tion, and that he signed h name thereto by like order. at the same time subscribed h name as witness thereto.
bargain anb �balE �eeb SECTION
WITH COVENANT AGAINST GRANTOR'S Ams
TITLE NO. BLOCK
LOT
COUNTY OR TOWN
DBM CO. TAX BILLING AnbRESS
TO
Gail Rast Recorded At�Request of Tlcor Title Guarantee Company
RBTURN BY NAIL TO:
William H''. Price Jr. , Esq.
Oiuribuud by P.O. BOX
Greenport', NY 11944
go
TICOR TITLE GUARANTEE Zip No.
O
Z
a
o
of
s
1J i
Q
N I
N �
iE
No
K
Q �I � BOARD OF HEALTH �/�
!TOWN
� FORMNO. 1 3 SETS OF PL.I�Y$,Q�fSURVEY XV. .j' TOWN OFSOUTHOLD CHECKBUILDING DEPARTMENT SEPTIC FORM . . CS tC .. . , ,BLDG.DEPT. TOWN HALL
OFSOtlTHOL SOUTHOLD, N.Y. 11971 NOTIFY
/ TEL.: 765-1802 CALL . . . . . . . . . . . . . . . . . .
Examine d .96. . . . . . . . . . .1 19 � MAIL TO :
\pproved . . . !i l� . . . . . . ., 10 Permit No. i-�.✓�
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Bu' ding Ins ctor)
APPLICATION FOR BUILDING PERMIT
Dat . . . . -
INSTRUCTIONS
a. This application must be completely filled in by typewriter Orin ink and submitted to the Building Inspector,with 3
t, Of plans,accurate plot plan t&scale. Fee according to schedule.
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 part of this appli-
luon.
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
:.A be kept on the premises available for inspection throughout the work.
c. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
! !lave been granted by the Building Inspector.
',PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
• :•.:�; Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
!;Ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
:;:,I;cant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
: authorized inspectors on premises and in building for necessary inspections-
(Signature of applicant, or name, if a corporation)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Mailing address of applicant)
-nether a licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. �- - , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
of owner of premises . . . . �a 1. k. . . . �a$T7
(as on the tax roll or latest deed)
;ant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) -{
ildcr's License No. .1 i A16 3, , H. -7'
i'!:unbcr's License No. . . . . . . . . . . . . . . . . . . . . . . .
: !:ctrician's License No. . . . . . . . . . . . . . . . . . . . . .
(Mier Trade's License No. . . . . . . . . . . . . . . . . . . . . .
cation of land on which proposed work will be done:
house Number Street Hamlet . .
��++ J / q
Ccunty Tax 11ap No. 1000 Section . .55 ! Block ,l�, ,
Lot .
au bdivision .. . . ea" dO LtJS . . . . . . . . . . .l. . . . .�.
Filed Nlap NO`5S c � ;$`i I 1 Lot . I • {�
(Name) Q. .
'121c existing use and occupancy of premises and intended use and occuppaancy of proposed construction:
A. Existing use and occupancy. . . f'. m 1 1
L ,;v . . (
B. Intended use and occupancy. . Co,t?sY. +� cYIoN „ vlrllG -fiGt ►v1�.kt1It/P��)NG
> . . Addition . . . . . . . . . . Alicia + l
Naturebf work (check which applicable): New Building . /
Repair . � , , , , • R�moval'li . . . .^. . . . . . . . Demolition " Swi, o
Tennis Court . . . . . Accessory Building . • . . . . . . . . Fence • , .0Vt 00 1
Estimated Cost . . . J Q.Qj. A U.Q. . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . ... . : . . . . . .
: . . . :: : .
(to be paid on filing this application)
g
If dwelling, number of dwcllin unit ."'
• � fs • • • • • • �. . . . . . . . Number of dwelling units on each floor , , , , , , , , , , , , , , ,
If garage, number of cars t
if business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . • ,
Dimensions of existing structures, if any: Front . . . . . . . . . . . . . Rear . ... . . . . . . . . . . . Depth .
lieielit . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . : . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . Rear ,
Depth . . . . . . . . . . . . . . . . . . . . . . ilcight . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . .
:. Dimensions of entire new constnict�'on: Front . . ..4 3 . , , Rear . . .6 . . . . Depth
lici;ht . . . . . . . . . . . . . . . Number of Stories . 2-,
Size of lot: Front . . r. D. R . + 1. Rear . . . ./ .,4. . . . . . . . . Depth
Date of Purchase . . • , , , • • . . • , , , Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
proposed o n ,any zoning law, ordinance or regulation:
Will lot be reoraded _ Will excess fill be removed from premises: Yes . .. . No!^,
Doesconstruction violate'
Name of Owner of premi s �!( , ,l�R61"'. . . Address . . . . . . . . . . . . . . . . . . .Phone No. .
`:ame of Architect A/� y � • . .
y• !'� . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .
Name of Contractor Qf✓J.�� , ;[l�+ �?!!yG , • .Address . . . . . . . PhoneNo. . .y77; q�/,7/, •
Is this property loc1ted within 300 feet of a tidal wetland? *YES. . . .NO. . . .
< If yes , Southold Town Trustees Permit may be required.
PLOT DIAGRAM
I.ccate clearly and distinctly.all buildings, whether existing or proposed, and,indicate all set-back dimensions from
:crty lines. Give street and block number or description according to deed, and show street names and indicate whether
=r:e r or comer lot.
i' OF NEW YORK, S.S�!
111, OF . . . . . . . . . . . . . . . . .
. 11.0
' ' • • • • • • • • � • • • • • • • • • • • • . . , , being duly sworn, deposes and says that he is the applicant
(Name of individual signingntract)
the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(Contractor, agent, corporate officer. etc.) . . !
:ul owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
,ccuon: that all statements contained in this application are true to the best of his knowledge and belief;and that the
adl be perforated in the manner set forth in the application filed therewith.
om to before me this \
/. . day of. 19gQ
!!!. !/ .
nary Public, . . . F`;, . � �. . . County
NELEN K DE .
NMRYPliONSbteofl wWA (Signature of applicant)
Na 4107873 SiAfolk
Term Eutpires Mach 3%
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I F,R .-rr
DONOTPROCEED 0/7-fj/
FOU UNTIL NURVEY OF
CATION
HAS BEEN APPROVED
IL
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�NGE M�,
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sfESFIDNi'
FLUMB
AP ED AS NOTED
ALL PLIRB1EIp u8}B H copper Rubinp Is used DATE: y QO B.P.M 3 3
A W10ER LINES NEED for Vgtsr distributing FEE:,19- -s BY:TESTING BEFORE COVERINQ onlenu plpinp shell be NOTIFY BUILDING DE AT
of types K or L only 765-1802 9 AM TO 4 PM OR THE --- — -- - — —
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED I gg
FOR POURED CONCRETE _' _� aY '
2. HOUGH - FRAMING A PLUMBING
3, INSULATION t�j }la
PLUMBERCERT/F/CAT/ON OCCUPANCY OR 4. FINAL - CONSTRUCTION MUST
ONLEAD CONTENT BEFORE BE COMPLETE FOR C.O.
CERTIFICATE OF OCCUPANCY USE IS UNLAWFUL ALL CONSTRUCTION SHALL MEET lr jZ}'.J" Pt ik 1 , Y I t 9 '4
+ THE REQUIREMENTS OF THE N.Y
SOLDER USED /N WATER WITHOUT CERTIFICATE STATE CONSTRUCTION B ENERGY D i nI N J G.`
CODES, NOT RESPONSIBLE FORS----__-.....:�. —_T__._,__�_...,�..- —,..
SUPPLY SYSTEM CANNOT DESIGN OR CONSTRUCTION ERRORS
EXCEED 2110of1%LEAD. OF OCCUPANCY
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