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HomeMy WebLinkAbout18594-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 220115 Date JULY 25. 1991 THIS CERTIFIES that the building ACCESSORY GARAGE Location of Property 8145 ALVAHS LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. ]000 Section 095 Block 03 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 18, 1989 pursuant to which Building Permit No. 185442 dated OCT. 25 1989 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 ACCESSORY GARAGE. The certificate is issued to ROBERT & DARICE CLARK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL__ N/A UNDERWRITERS CERTIFICATE N0. N195949 JULY 12, 1991 PLUMBERS CERTIFICATION DATED N/A t B lding Inspector Rev. 1/81 voaa: xo. s 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°- x.8594 Z Date ....s~.s~:.....ay 1~,~9. Permission is hereby granted t(o~~: ry~ n . to ...~~.~P..i1rs.c:~.......S1,.x.~.....G~e~:CRea~A.R-~..,.~0.~r.~.R..... Qr.?.....~t~?.IC.l.~tlt.....A.L... ct premises located at ..~.~.`.~.,L~ ...~`.a:#44.... ~.!:~5..........,~, ,~„s~.~~..................... Cvunty Tox Map No. 1000 Section .......Q~~...... Block ......Sa..3....... Lot No....~..C? pursuant to vpplication dated ~.4:X. (!.~`!ct......~..~ 19.8.., and approved by the Building Inspector. Fee $..l.~f?.:.~...... ......tS. ..'a.:.i'.:.:. Building Ir~spectvr Rev. 6/30/80 . . ln', Form No. a/~-' ~t~~~3 ~ G TOWN OP SOUTIIOLD ~ 7 jJ~~„ ~ ~ 91 ¦M ~ Q ~gg~ ' ' ~t~ BUILDING DEPARTMENT JV~. • ~ ~ TO[JN ItALL LDO UF.I~I, 765-1802 TOWN OF 50 IltiiLt7 ,,,,I APPLICATION FOR CERTIFICATE OF 'OCCUPANCY This application must be filled in by typewriter OF, inlc 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, propert streets, and unusual natural or topographic features, Z• Final Approval Y lines, 3• Approval of elefrom Health Dept, of water supply and sewerage-disposal (S-9 form , ctrical installation from Board of Fire Underwriters. ) 4• Sworn statement from plumber certifying that the solder used in s stem less than 2/10 of 17, lead, 5• Commercial buildin Y contains and installations,ga industrial building, multiple residences and similar buildings certificate of Code G;mpliance from archi':ect or enh' responsible for the building. 6• Submit Plannin oineer g Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) Eton-conforming "pre-existing" land uses: d uses, or buildings and 1• Accurate survey of property showin;, all property lines, streets, building and unusual natural or topographic features. . 2• A Properly completed application and a consent [o inspect signed by the a If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons the fo PPlicant. re r 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 buildin Additions to accessory building $25,p0• Businesses $50.00, 2• Certificate of Occu anc on Pre- g $25.00, P Y existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4• Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ^^_w Construction.., Date ,,,.~~?L~ _ aY i l y~~ Old Or Pre-existing Building.. ucation of Property,,,~l~ (j-' " " liousc No, Street ~ iwcr or ® Hamlet Owners of Property...j.;Q~•~~°T.,,~;,~D,9,IP~-~ aunty Tax Pfap No 1000, Section. ~ " " ~.......Block...~s~... bdivision....... .......Lot.... q cc~~ ..........................Filed it:~I~.. .Lot.. 4~ .Date Of Permi.t.~a,~~}~~~ Appliuant.~,~?~7'.~~y~ filth Dept. Approval..,, / " " " '••••••••••.....Underwriters Approval „ (O Inning Board Approval ucst for: Temporary Certificate...... / Final Curticatc,• Submitted: ~ • " " C~ z. ~Q pis- - ~~u~ APPLICANT - , ~ TFIE NEW YORK BOARD OF FIRE UNDERWRITERS Pr.G~ L 1.000378 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ Date JULY 12,:.991 APPlirotion Nu. on file 7;i?, Ii.90/90 ;U t95«t.~ THIS CERTIFIES THAT only the electrical equipment os described below and introduced by the applicant named on the above application number in the premises of i I kICHARD CLARK, 8115 ALVAH'S LANE, POIIE #67, <!?TCHOGCK„ N.Y. in the following locution; ? Basement ? Ist Fl. ? 2nd F1, 6Rk ~OIi':" .Sertion R/ark Lot was exantinetf on JULY 01,1.991 and found to be in wmplianre with [he regaireneen LS q~ this Itonrd. ~ FIXTURE ECEPTAGLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS i OUTWTS INCANDESCENT FIUORESCENi OTHEfl AM} K W AM} K W PMi K W AM,} K. W M1i. H P ~ 11 .7 5 3 t? DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. Oll H P. GAS H. P. AML NO. A W. G AMT. AMP AML AMPS TRANS. AMT H P SYSTEMS NO. OF FEET Ar^} WA}is 3G SERVICE DISCONNECT NO.OF S R V I C E F METER No. OF CG COND, q W G, i AMT. AMP. TYPE EQUIP. I BYW I ~ RW 3 9 ]W 3,e" 4W pER 9 OF CC CON4 NO OF NbIFG A W G NO Of NfULRAIS A' G Of HbLEG Of NFU}RAL J. 200 CB 1 X 7 G/G 2/0 OTHER APPARATUS: WIRING FOR NlETAL COIi1?.GARAGF~-"I. ~ C i i ~ STEVE'S ELN;C/S.ALIAER?'SORI ~,iC.#393? ?.0. HOX 17.68 SOi1TH0?Il), bjy, 11971 GENERAL MANAGER Per G- 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. 1ELD I;:S:c~:i~; ~~'Ji,:L I :;vMMENT,^. _ , t . ~ - ~ ~ - iL µ oO m ~ _ N OUtJDATI0f1 (1st) "3 ?OUNDATIOW (2nd) N~ 2 z o ROUGH FRAME „L v~ .PLUMBING 3 , H m IIJSULATIOf7 PER N. Y, ~ °~~O y FF STATE EIJERGY CODE i q lZC r m yS ~Ce i H FINAL ADDITIOffAL COMMENTS: ~ • _ x f/ ° " . . r C'7 X '9 H 9 ~ 1? H H ~-'--1Y O .A m Z ~ ti ~ ~ • ~ H b H . - _ _ _ moo~eza~saooY..__...___.._.._..---.........-.._..-.~_~___.. 'I'~rm~>Irrr®-ti?I..I,, r..~. Pnc© Page: MB-2 nufn~ rhd« r~~d~ei„~~i rkwr, ~So-or~µe v~ue, <n,a~ aacu; Effective: April 1 , 1989 ~t Yr l ~ v ~ JOHN ROUSER ~JIBrYICr MeneyB~ (71]) 7a3~ 1843 s;-~ ;1` ~ 4;: ( i~ `3" Innovators in Metal F3uilding Insulation HEAOGfUARTERS IIdID1ANAPOLI$ ~ t 7000 Foltz Industrial Parkway 5845 West 82nd 6tre~t, Suite 110 Strongsville, Ohiq 44138 Iq ianapGQ~, irA l•~~u~ 23b 9a0U t-t'b`Pi6y8~R'~A~~fsn e-6~c•~Ai°'1~~! (317 ~~9222 ;11226 - 1 (800) 362-1054 _ .~~....,.~..m.....,,..~„~~.. I A-.-..... d....„..~.___.~ } i ~ Mt3 ~!OQ1 vapor barrier for insulation ~ 8uHeos 8uminp Chsroctsrl®tlctt ' M reW1 M WlrnnXrr teknedn M NTM t41 Irxr euetl ConmumioR t:ompoNt~ Fllm. 0016", WhKe, Mete11~e0 ThIe MOInBhq oMelnede compwhe lire hexmd KrNt 12 Ibs Neturel claeel11ce110n of 26 llama eRreed/60 smoke de- AdI1Hiw , , Flame gelardent ~elopsd m lace wlth the following wmgonenle RelnlorclnB . TrFdirectlonel FlberylMe Vern. I M04/Inch FlberBleee Olenket• All MenuMMUrere XU4/Inch Adheelw4: ' N. B. Ful4r G-34ppX Milllgen 10.160L8 Oenerd Latex s-8-710A MIIIIBan 8880 Nellonal 40-0067 MIIIIBan BBBOLS I Mllllgen 10.020 MIIIIBan 31607 MllllBAn 10.160 MiBlBen 7 i 608 COMPAC CORPORA'f10N ~ Netconp, NBw JeneY ~ 201/347.3800 p; 800/831•®347 ~ 800/631-8360 ~ Telex No. 138323 I t' . llMMIk f. f (Standard Duty) Polypropylene Reinforced Kraft 170W Faltz Induatrixl Fkw . / Htrnn uvilk UI( 441,8 . 21F1) 23n.4Afp • CONSTRUCTION ENGLISH _ METRIC Fdm ..00015' Whitt+,. Metallized 38 micron, ~/hute Mninlbird Kraft 12 Ibs/3000 N.'. Natural 20 y/rn' Natural Adhesive , . Flame retardant Flame retardant in dlrectu>nal Oberylass yam reinfor<;mg Machine Dirnetion(MD) 4/Inch MD t6/100 mm Cross Direction (XD) 4/Inch XU 1 F$/ 100 mm TYPICAL PHYSICAL PROPERTIES ENGLISH M_ ETRIC 1'ennflence IMVT R) 1v51 M I. Oh, Ueaa ,,eni Method, PCnns, grplns/hr, !t m Ily, Max (g/7A hr m tern Hr,t Mm ~ ~ n~ nl ~ Pundwe ReslSlanco ASTM p-761 Reath l'Un~.IIJfP Unds. !`vy (Melnc., wy) IS Fi., Tenmle Stronglh ASTM d~8261be/In. WIUIh,~~y lNy/15 mrn, Avy) MD AO xn?4 Mh 11 ul'; Mullon Rural 6tranglh ASTM D-71A R 91 ,Avg. (kg~cm , Avy 1 1r5 , t1 Mold 8 Mddnw Floslstanco A9 tM 0-2020 Method A MOId Growth Su9b•n.u'r rr N~>r,~• None Humldlly Roslelance UO Uays 96eh RH/120'F (48' C) Corroslnn or Delanunau°n Nr+nr Nnne • Urmensronal Ato5lilty 15 rear Gn 20U f" (99 C) Peroent Length Cbengx. Max n r~ pq Cold Weather Flexibility ~,S rM L)-1790, F- (0) qfr Ar, kliyN Temperature Roslstanr;a, P Max (G Max 770 104 Liyhl Slabtllly ASTM G 2.1, Method J, Discoloration After 150 hrn Nonr• nlnnr• 1. fight RelleCilvigf ASTM C~5231i11 0-6G) "V 7,7 rq Warghl per MSF, Ibs ~ Sa6 (kg/i p00 nY 1 G'bl ~ 70 9A SURFACE BURNING CHARACTERISTICS Ae 1a31eJ by UnAenvrllars L'abU•9lonFln Par A3TM E ll4 iPllr gA~S'r COMPOSITE This facing has obtained a composite fire hazard elasaRicatlon of 26 flame spread/GO smoke developed or lass with the following components Fiberglass Blanket: All Manufacturers ~dhesivea. H.B. Fuller C'3492X Milligan 10-150L5 General Latex A-9'716A Milligan 6A90 Nat10na140'OA57 Milligan 6A90LS MAliyan 10-020 Milligan 71.507 Milligan 10-750 Milligan 7150A r - _ - - W/•flflAHiY. NI GUMi•AG proCucu a•e prMuceO anent cunaunad geanly elenriartle a~tl ere wane tied to Ue aea nn~m rlomrt In elelelBl Bnd wor Nm9n0Ulp Aay mxrOP81 e~pwn Ia our e9tlErnu110r'to UP dol¢~M ^ M1M1In JO tleye of 6al!vary will Mp ,pple: ¢d ••-I,gpul 1 cRarOa GOMPFC CORaOM n VN elll not be reelpnelple for glpr,na Uey ~ r apRr , vn! orlbo n~ale•rxl hold An pnyu;re a~ n yr m vna f Ira upwee unJerglandinplpnlroe p~•rchunr wlli rndopentlenl7 Jnom^•rrl^s ser'r~'rrry •dmemnla~~nl ro~rn+n rpnee by vn4 nrM1rp i Pte Parc40ed necamnlantlerlom Uy COMPAC CORnpgATl( I• mn • ' .r, b0 •~~~'p ~^-r ac wpfra~0ao W r ry Nml Nr nelunn~nq j rePra~enlalm&or gpanl olCOMPAG COgPOgAT1ANle arena,. ,ry~g•: ~•q.,prenF,~, ur lr,•,er~^e~~r ~ev'exn^txrk,~~ ![I a001tion Iq or canbpry IG Ihp fore9nlnp ••/~rrnnnrrl CrlNrn ATr/lM q o(1 Clnv f]o n nLI f. L, ,...r ,,,I q Nrnlrn.. r, nl..u, h~nnV nvpcl P~rYr Ian IINn 18 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS f>~r~; a BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 70038 Dace RI•;h"!'IsAiN~;k2 :L6.1~3#39 gppltcationNo.ony/'tle 6Qti44f~$~/~~ H fJ1I'-li~~? THIS CERTIFIES THAT f~`%~~~LfP NO,. 1 t~~fSl only the elactl~rical equipment as deacrihed 6elofo and introduced 6y the applicant Homed on the a(rove application number in the premieea of you ~'r~st`K~~"Krll~.~, Ar:i7ntr';; rlArzr;: zyG;ll~~ cG~'I'cxr~r;~rr,. rr.Y. in thefollouing location; ? Basement ? /at F'(. ? 2nd F'(. .~f~~GJ'{f(SIJ",{' `~(`}:I, (j'I, 2t}, Ski}+1'FtfIJF'H "C`~ 'I 9$u Sertioa' Bock Lot nwa examined on and found to 6e in cmrtplianee with the requirernenta q/this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT fIUORESCENT OTHER PMT K W. AMi. K. W. AMT. K. W, qMT. K W AMi N. P 5 ~ Q, ~ st DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS $PECIAt REC'PT TIME CtOCK$ UNIT HEATERS MULTI.OUTLET PMi. K. W. Oll H. P. GAS H. P. AMT. NO. A. W. G. AMi AMP. AMT AMPS. TRANS. AMi. H. P SYSTEMS DIMMERS NO.OF FEET AMT wnii5 T SERVICE DISCONNECT NO.OF METER S E R V I C E AMi. AMP. TYPE EQUIP. 1,6' ]W 1 $ 3W 8,a' 3W 3,P' 4W NO OF CC. COND. A W. G. NO. OF MbLEG A. W G. PER .e OF CC. COND Of H6LEG NO OF NEUTRALS A. W G OF NEUTRAL OTHER APPARATUS: WT.RTIIG F'UR ;tla;F;;;;iO1tY ~?aR~f f;tl',tJG.-1 FikNT~,)',,(iUP,Rbg¢1-~ CT3i. 1.t),) R.~EJIIYtT CilAR1C HH~,~, $145 A1;Vt~?i"E; f,Ailt'P; CUT'CNDGCJI';,. IVE, 7'!'335 6ENERAI MANAGER it This certificate must not 6e altered in any manner; return to the office of the Board if incorrect. Ins ectors maPbe i entifie'~ ..f r P Y " by hEii credentials. COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. - L I L j ~ ~ ~ ~ ~ ~ ~ ~ 1 , - ` ; - ~ ; J ; ~ _ , ~ ~ ~ I ~ , I ~ ~ r 1 ~ ~ ~r ~ -r- f ~ ~ ~ i ~ ~ ~ I ~ ~ t i ~ - _ ~ E I~' ~ ' 1 i ~ ~ 1 M { ~.l1-III ~ J~ ~ F ~ - f ~ ~-1- I Li i ~ I ~ i~ ~ ~ { - _ , ~ 1- ~ - i ~ ~ r ~ , I ~ f ~ ~ ~ ~ - - - - ~ _r _ , ~ - I - ~ - _ ~ ~ i ~ l ~ -I ~ t i ~ ' I ~ I - ; 1-~-- F- ~ ~ I I ' ~ i I~ t I ~ r ~ - i i 1. I I I ~ ~ _ L~ ~ ~ ~ _ ~ I ~ I ~ f I_ 4~ ~-I 1-, _ ~r ~ ~ ~ , ~ I ~r t , j ~ ~ ~ i - ~ ~ ~ ~ ~ 1 ~ ~ ~t _ ~ ; ~ a _ _ ~ ~ ~ - ~ - ~ ~ - ~ ~ - ~ - i-- - ~ - ~ ~ _ I-, I ~ ~ _ f i ~ - I ~ - ~ - r I~ ~ ~ - -1-. . __~I ~ - ' ~ ' ~j ~ E ~ !...i i~~~ I ~I" j ` ! .i ~r~) ~ ~ i ~ ~ ~ , , ~ ~ f ; ~ I ~ --,;,gib' ,=~-"~y_L a ~ ~ -1 I I } _ i. f ~ I ~ j I F I-----~ i ~__I_j ;_i__~ f~ F~ ~ ~f - i -i I ~ 1 ~ ~ ~ ~ ~ - - 1 ~ 1_ ~ - - - C E ' ~ ~ I"' 1. -~-I-~ ~ ~ ~ - - ~ _ _ I _ ~ ( i ~ - ~ ~ , 1~-;--- ~ ~ ; ~ - ~ - r~ - - ~ I ~ - - t ~ j ~ i I ~ I ~ ~ _ .I. I` . _a -i--fi ~ ~ ~ ~ , { ' ' - ~ ~ ~ ~ - , _ ~ ~ I -1~~i' ~t~, ,~_~~1 ~-~~-rte±~~ t_! fiI. _ - r ~ y _ 3 ~ ~ ~ o ~ ~ j r{ , - - _ ~_.i ~ ~ - ~ ~ F ~ ~ ~ ~ ~ - ~ ~ ~ i i ~ ~ - ~ ~ ~ ' i I ~ ~h _ ~ iid X,~~ ~ ~ ~ I ~ - -i" ~ -I -amp ~ ~ - ~ ( r - _ { ' i L I _ . - ~ O ~ ~ ~ ~_r ~ ~ ~ ' Esc ~ ~~~-'--~~Ya~: ~ ~ ~ -I_ ~ ~ ~ - ~ r~° ~ ~I~ i ~ - - _L._._;_I-_F , ~I~- ~ . t~~~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. (]FOUNDATION 2ND [ ]INSULATION C ]FRAMING [ INAL REMARKS: Z--- DATE D INSPECTOR r ' 765-1802 BUILDING DEPT. INSPECTI®N [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ J FRAMING [ ]FINAL REMARKS: ~~L DATE `I ~ > INSPECTO ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ) ROUGH PLBG. [ ] FO ATION 2ND [ ]INSULATION [ FRAMING r ]FINAL REMARKS: ~j~~~ DATE U INSPECTOR 765-1862 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL r-'"° REMARKS:~/jam\7+~~.~.,~5.-„~ DATE L~f INSPECTOR q ' ut• en",: •,.i;.xT;.t ?yry.y..p^++r. J' _ " .•i' i•l'a' e: p'aY ~Zn..a`.:~+f^w .i:tlj!#4.~i"Y 6.`•rtrY6',.. Y.'2 . t.. ~C'rSYX •if~'fy`R•~,~ 4 ~ i... M.3Rin n>I.~~~~,,t~a L~1'v. f,l~ W, r k OWNLRi~ ;y,..iw r ~4y~•'•i 'r.;~.~^_µ , SUFP.CO. HEALTH DEP'r.XAPROVAL.:^ H.B NO O•~• P ~ 4 f~/^~(~f) fM~~~~//~~//r AMY .,A Y. h A's . d 1 ~Y.Y \ ial.Y ~ r~~~/J ~ y~T{i ~'r•r •J,..E 'Y ~5.'e'T•~~~. ^7~.'.r `y (ry) T,^!! 1'F{1 -f I /~~~'~'~[~+_~(~~J! .O`f~.l~a. >Y i f` ~ V / •IIV K 4:^ ~d.fkn + •-4 •~•Srv #Y,v.'. ..i. 'ul. .3s - t'. .,y~ ~~r 11 .Z:r' ''.i?' s.?k:~:,. ~iti.,~ c;" I 4y.~/A~~~'.S~A+',~a'L::fVy K;: -._y`•4'.'': ...;zN.°sa.::•:r'?t`v:^r 4.k:~i`s:~~5"' _ t..- _ir. ZV ' . ?T~V ! i'7~.+f...4./''1 i ~~r. ) ~;v ~i'a r., t~.i, y. F. ;.f~ C~a~fn :....VC...-. ,p.:.. FV, ~!'r '=r., ~~4~:'+.:'•i.~~r; a. 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EDUCATION IAY/. .'G,4..: " . r < a+~;y,;,t~~:ti'?y,a_-rv r•, ,Y U ~r~.k~ COCIFS Of THIS SUKVET MAf NOT LAMA . r x ' ' THE LAk6 SUFVEYOC'S RC:.D sal Ol • ` '`Y - :f'~ ~ EMBOSSED SCAE SHALL I::T tE CONSIDEEED Elev. r'lfa.50.O fOtfVSW' - I -.-o ~y~ TO BE A VAIID T: UE CCVT. -fo'kBnfronr~Ca.GZP,NftCN~'ictC~<.;':Y~~/'~ ~ •~x.':'_..~;`.~=x-,r..'~°,.~•~ •;'7{;T1a`,~~~.•`.1 'c~:uANTteflNOlcwn~3ir::Yr!;sirAUBUN dYTd orE± CJ X. -:;..':.yt ~~~`?^r`:'^'{::±<?.,. '.r "2.~~:'• '~•7',^'",',a•.w x'.. ONLY IO aR:iu30:i,fut Yi:.CM THE WFYE f x.;J~}.a y"-> . '~y i 1f P?EI'ARLD. A.D U.: H.S :,:aAIG f0 i[£ TITLE ~ - .TIRE COLtFAP"/.:6:V'_~i2UK.At AGfNG] ' °'•'..~'4 i CERTIF. ` ;}.a.~~ - lFND04G ISSRTLTIO~ t3Ti^ H.L"UN, ANC ~~~e , i.~ e±.,`ir;r~ °„v- ...4` ~ . , • ,,,,~(//.I~~~~, :.'i;:-a.F,, oTQ THE ASSr.C;•1:3 G 4~ tL.DWG MfTM - • ~ ~~T4,TT'TRY ~ .-R1TiON. lh1AEAMEES Aa RxG7 iRAMff MAP' pr- P~'CX~C(r?~"Y`.., ~ ' fd ~fte C1irt~.tLd~~,~~~'" >'.ro ,~TwNAB - - f> ~y~!i'=it ~N!/LK. STAMP " . ~ ~ ~~SY' i,3, ~ K~tlfNf{5~'?~~ttlyj.,~.,~ elf-~r~ SEAL U'~°GNO//~w~~ Il/I Consf{i;/nc.,eriKa!-,FO:S~cui-' - >'„.'',•.C. C ~Y~i' T r fem. i.• ~ y~ ~~Ri ,.~t :J ' , ' - ~ r. %Yr btt G~ti. cl'O., a - :+ad t,~t~. ^ TG9W/J Sour>~y,.p ~ ~ DER4CK'VAN` YL' ~ ~ ` .%i ~VLIC. LANG SURVEY(9R8r~RE PO ,N. Y. `"V~:r`~': , ..Sci~l,G'`z_'d`.''~Ciz'7Gfer ':~ocat"trcil~iani'lJi3f./~G,.^s~:CUI TEST HOLC 8UFF. CO• DEPTr OF HEALTH 86RVICE6"' ~ ~ % x" • ' BTATEMENT OF INTENT, . Or - 1V ( - + r 4 Y. ~ j •i y; .rE~" 1-,~.•iJ't,.,4 _ 3~ ~A - FOR APPROVAL OF CONSTRUCTION ONLY x < ~ _ [Odirf a, ~ . 4,, • n_c..~E' ,:THIZ~IYATER` SUPPLY AND.'EEWADE bAT6: "e.'.. _DISPOSAL'11Y8`CEMS~P'OR THIS RE61. _ ' ' : . ~ bENCE W(({.~ CONFORM ~T1p THE sd~Kd H. B. REK NOa 8 S O ~ ' , . ,.c• , gIR7VGl w • BTANDARDS~ t1F BUFPOLIC CO.~~ DER ..a,..~+e ~•ri.~•:t.i v.:w OF'':IiOGALTH:.'.BERYI ' APPROVED: . •M1. t,.: ',';P • ' ` - ? . r -A - • y' - :~.Y :~4 V~Y.. y.tt r°w r~-~:•..:F+~:~. tT'a'°~~~ r_ r.: BOARD OF HEALTH . 3 SETS OF pL~,7$ . y/, , , ,~FORMN0.1 SURVEY TOWV OF SOUTHOLD CHECK • • BUICD.ING DEPARTMENT SEPTIC FORDI .r TOWN HALL SOUTHOLD, N. Y. 11971 NOT . J~,-/~~-~ ' TEL.: 765.1802 CALL . _ . Examined .O.e-~`/.Q.l;~, dS 19 'f IL T0: ry~ ApprovedO,e~O'J'r^!4... rZy 19'9. Permit No. 1. $ Y~./7: Rz. M ~ N1 Disapproved a/c Y D dCT t 8 ~ ................................~Cil 1~:4.. • • TOWN OF SOUTHOLO Oy.~ BLOB. OEPL (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~ ~ 194 .l.... INSTRUCTIONS a. Tlus 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 or 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. e. 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 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 h1ADE 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 bui]ding for necessary in ' .....j.........~.. (Si nature of applicant, or name, if a corporation) (bfailing address ofapplicant) /,eP~-" State/w~~t~her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ou•n~r of premises ;qR-.. ~/4,~r{.~.~. ~Z,Jj~~=........... . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. • • (Name and title of corporate officer) ALL C011'fRACTOR' S J~YjIST B • SUPPOI,Jg COUpITY LTCEN$ED Buildei s License No. 4?w!r!~, ;~5 o'r Plumber's License No . Electrician's License No . . Otltcr Trade's License No . . 1. Location of land on which proposed work will be done . . HouseNumbcr ~}.~-•S-treet Hamlet County Tax tvlap No. 1000 Section l.Y. , Block •3 , , , , , , , , , , , Lot • ~,Q, , • • Subdivision .Filed \lap No. Lot . ..(Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing u o ' se and ccu anc .G9/.r~.:~ ~ /!'~~,~L b. Intended use and occupancy !T.!/.~4? ./.'~,~,6?rrC~, , , . 3. Nature of work (check which appl,icable): Tr'ety Building Addition Alteration . Repair Remov$1 Demolition Other 1Vark , ~bC7 (Description) . .4. Estimated Cost..... Fee...................................... (to be paid on filing this application) S. If dwelling, number of dwelling urjits Number of dwelling units on each floor . If garage, number of cars 6. If business, commercial or mired Qccupancy, sp cify na ur nd a tent o each t fuse . 7. Dim_ensi ns rres,',rfany: Fron S7S~.~a~~~Rea ~t!7~°.~¢~~~?~d$?~Depth~~t~y+E?~~.~KgR'~4~ _ Htr~li~M~o~4t umber of Stories.vo.~r~. r%Isg~4~ ~ . ~,h,~n o :1 with alterations or additions: Front Rear I~ep ._.3 Height y............ Number Qf Stories . 8. Dimens~ ~ttt"d;ite~y st eti n: Front ...~Q . Rear ~4.......... Depth ..3C?..` Height .Erfr/6,5.,,.., r t o Stories _ 9. Size of lot: Front } , . , . Rear . . /.~y." Degth . o7i,~~° 0. Date of Purchase _ , l:.C'~.. ..............Name of Former Owner . +~at',CN:6.7.':. 6:~(°x/,~i°~~ . . 1. Zorte or use district in which premises are situated . . 2. Does proposed construction violate any zoning law, ordinance or regulation: 3. Will lot be regraded ~r~.. j , . , , , , , , _ ~ • • • Will excess fill be removed from premises: Yes No 4. A`ame of Owner of.pre ices ..............Address ...................Phone No.............. Name of Architect ..............Address ...................Phone No.._ Name of Contractor . ~ .Address .......Phone No. 5. Is this property located w}thin 300 feet of a tidal wetland? *Yes No .f:..`` *If yes, Southold Town Trustees Permit may be reqyu~ired. ~ PLOT DIAG1tAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block nt;mber or description according to deed, and show street names and indicate whether aterior or corner lot. op ~r~,Y~~-- , ~ ~ ~ ~ ~k ` ~ O - - _ ~ 1, ~ ~ t r ~ ~ a,=-~~ 9a 4/ 40' ~ ~ I ~ ~ ~ ~ i r ~ r;, i~ ~ 3; i" I i'ATL- Of-" NE~V YORK, Ala: f ~,F ~ du~ .i, being duly sworh, deposes and says that he is the applicant Hof mdi~i signora contract) -ovc named. _isthe (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to pcrfotm or have performed tile'"said work and to make and file this plication: that all statements contained in this application are true to the best of his knowledge and belief; and that the irk will be performed in the manner sFt forth in the application filed therewith. turn to before me this i ...day~o/f./~.QG/~/ 19~~ :tart' Public, ; ~ .V County HELEN K. 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