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Home My WebLink About18604-z • , • FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19518 Date NOVEMBER 19, 1990 THIS CERTIFIES that the building NEW DWELLING f 1 Location of Property 2710 D_IGNANS ROAD CUTCHOGUE NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 83 Block 2 Lot 6.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 11, 1989 pursuant to which Building Permit No. 18604-Z dated OCTOBER 26, 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 ONE FAMILY DWELLING WITH ATTACHED DECKS AS APPLIED FOR. The certificate is issued to JOHN P. CONNOLLY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 9/20/90 - 9-SO-64 UNDERWRITERS CERTIFICATE N0. H-012790-11/9/89 & N-121691-4/3/90 PLUMBERS CERTIFICATION DATED 10/1/1990 - JOHN CONNOLLY GL _ B ldin Inspector Rev. 1/81 Fosat xo. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUS7 BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o 8 6 n 4 Z Date ....ca.~:-...... 19.$..1. Permission is hereby granted to: ~ c~~s I ...............~~I v at premises located at ..tr.~..?.(.4?.....~. ~'}.4-!~<~?~....~ :.............4~;,c.~-t_,........,.. County Tax Map No. 1000 Section ......5?.~.a~,...... Block .....4?.~r........oLot No....la....(o......... pursuant to application doted ..,Q.,S.~.,~?:t.,......~.~ 19.~~..1.., and approved by the Building Inspector. Fee 5..797:..'... ..a-s:~........... Buil ing Inspector Rev. 6/30/80 FOHM NO. 8 ' . TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N: Y. BUILDING P~ERfv1IT ;r' 1 (THIS PERMIT;:.MUST BE KEPT ON TH.E PREMISES UNTIL FULL"' COMPL&,']"ION OF THE WORK`AUTHORIZED3' N~ 1184c5 Z Date 19.~1t~G"f C~ Permission is hereby grouted to: . , -Y at premises located at ..A?..~...~~...~....::~4s:::.f„1~./7.~i!?''~.`.~.:.. ,~1 ~ ~r County Tax Map No. 1000 Section ~F'"i.~~.......... ;Block Lot No/~~ pursuant to application dated ....V.G~~.t~......t~.C~ 19(/. yj'~., and approved by the Building Inspector. ~JG Fee 1 ,~GC.(G~.z~. Building Inspector Rev. 6/30/80 r Form No. 6 ~ ---..M"""' ' TOWN OF SOUTHOLD BUILDING DEPARTMENT { 1 ~:i~ t TOWN HALL } 1 765-1802 BLCG.OLP'1'. ~YJ, TOV'JN Op%gntf~t-~Ol_S'l_~„ APPLICATION FOR. GERTIFZCATE OF OCCUPANCY " .1. 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 17. 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. ' j 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 aad , 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. Cectificate 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 accessary 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 Upuated Certificate oY Occupancy - $50.00 . 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ;~SQ :.cw Construction...., 01d Or Pre-existing Building Location of Property... 2 , House No. Street Hamlet Onwer or Owners of Property......,~Oht~„ ~CYitl/VO~fi~ County Tax Map No 1000, Section...Q .....BLock...... Z .......LoC.....~P.: . Subdivision ....................................FileJd Map...........-.7-Lot.............':........ - ?ermit No..~ Y.6o , ,Date OE Permit.'.. ~~~?rO./ .Applicant..sd41'f~U, , ,L90KJN0l~t~ _ {ealth Dept. Approval.,~..50...!°y...........Underwriters Approval... ~~.~z.~9d..... ' , Tanning Board Approval ` equese for: .Temporary Certificate........... Final Certicate..~ , ee Submitted; z ~ ~ O ~ ' (J`g3C,.y O`~~p',~j APPLIC. .~t-'5 t; • 1~•~ zk~a~a ~dr+ ~ ~ ~ 4x . ga., - . a Co 2.195 I A' _ ,„`.a,. , ...,w,~ . r~5. _ ~ y THE NSW YORK BAARD OF FIRE UN~1"?~RWRITERS ' ~IItUI:f 711 - . - lUREAU OF ELECTRICITY B6 JOHN STREET. NEW YORK, NEW YORK 10088 AYNTI O:i,199C1 APPlicationNo.onfile 1, F./~.L:S?Y9/£t9 N iTf,9:1 n THIS CERTIFIES THAT only the elertrlcsd equipnaM v descrlhed heloto end introduced by the oppBcent nomad on the ehoue eppNcetion numher in theprsmises of _ dUfiN C11NNt'_1.LY, 27111 I)IGNTAN RD., GU(f;lOGlt)t', N. Y. _ in the folbwinR lacotionq A f 1 1 C/ (11I 1 v ? Bsuement ? Ist Fl. ~ Ynd Fl. Section Black Lot Fces exomined on NANCN 05,19'!1) andfoundto he in complienre with the requirements of this Berard. R%TU9 RXTURRS RANOlf tbORINO WCKS G 015!1 WABIMRS R1(MAUST FANS twTIRT1 ACIRS SWITCMB INCANpESCENT FIUOtFSCFNT OTNen AMT, K. W. AMT. K. W. AMT: K.W. AMT. K. W. AMT. N. P. 1 14 l i; ~ i{. DRY9S 11JRNACE MOTORS IUTIIRf AeeOANt:R RR095 fltClAl itRC?T TIIAR CIOCKf eNl YI/IT IIRATRRS ~f S1R DIIFIIARRS r AMT. K. W. ql N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS.. AMT. N. P. ~.1» 11~T AMT. WATTS ~ 6(111 S9VK7 DISCONIIRCT NO.Oi S ! R V 1 C E AMT. AW. TTPE 1,I xW 1/xW J!J`N )X nv NO.O~CeCOND. OF CC L ~ D. NO. OF M4a'G OF~MII C NO. q'NEUTIUIb a NWEuTGMI 07119 ARPARATUf: 2~•fON NF.AC t'UMN-1. I I?ACI.HN AIR IIANULI 3 1'ANt'.L.130ANpS;1 -11 fftt. IOU it i~.f. WA'11'.k IiI:. AiCI?3::3-h.b Y.. W. I,.t~f,.I:-2 %MOhF UhTEC'IUH:-I 11 p f,.Ifi53NIK1: IH. 1'tl. ~.1C. ttv15 s..~;' t U. lU)% 'tStiA ~ 9:t$O 5;4UNI) AVF:. OryIRµ~AANAO~ P1AI11II1CK, NY, 1't9`~s I;t r?j/ d- Ptf d~ r This cartificaro must not be olrored in Gny monnsr; return ro the,offin of ehs Board if incorrsd. 1 n moy,be identified by Meir`crodentioM. - COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGT! ANNTs,. A~~ IN ANY MAMIER. +P TEL. 765-1802 S~FF~L~i C TOWN OF SO~JTB[0~~ O ~l_•, " s'~` '`c OFFICE OF BUILDING INSPECTOR - o - P.O. BOX 728 y~'~ ~ ~ TOWN HALL O~Ol ~ ~b~~ SOUTHULD, N.Y. 11971 , C E R T I F I C A T I O N Date /U Building Permit No. ~ Z Owner .poi-~rJ ~tUnSp~~L/ (please print) Plumber UW/J~2 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. , - (plumber's si ture? Sworn to before me this day of ~ / / p 19 ~ ° otary Public Notary Public, County ' .IDN~t e1.INIl~I1y4At ~IIy,~Mlr1 1 1 ~1_LJ I::~:'w^:,~"_u:_ ~ I~~~:.. 1~ ~G:`dME.NTC ~ 00 {I M c i. a _ N ,T{~ -i 'OUtJDATI0IJ (lstl ~ ~ ~ BIZ m , ?OUIJDP,TI01J (2nd) U ~ _ ~ I ~ J 30UGH FRAME b I o .PLUMBING 3 ~ , H to ~ Q+ 3. m m =IJSULAT201J PER N. Y. ( y STATE EtJERGY CODE I rn • vf7 FI;JAL ~ " ~e 3 o m ADDITIOIJAL COMMEIITS: x o- C Q a • X H ~ S •-3 H O m ~ H . v • m .ti -j {qk lr'~~~W~W~~ INSULATED ENTRY DOOR SYSTEM AVANTI - ~ Peachiree's Avanfi is the most complete and efficient entry door system available anywhere. The Avanfi system consists of frames, weatherstripping, Thresholds, glass door tires, side tiles and transoms ~ available from a single manufacturer. Every Avanfi panel features a foamed-in-place polyurethane core and an integral moulded rubber i I boTTOm door seal. Each panel is factory prepared for hardware. ' Beautifully embossed panel designs and exclusive matching flush ~ 4 I factory glazed door tires provide a wide variety of architectural styles f and possible combinations. I ~ i a Specifications r I ~ I ! Exterior entry doors shall be Avanfi system as manufactured by ~ Peachtree Door. Sizes and styles shall be detailed on plans. Panels to ~ be full 13/<" thickness, 24 gauge galvanized steel faces, precision moulded wood stiles and top rail, insert-moulded neoprene bottom rail and seal; all bonded by foamed-in-place polyurethane core. Frames to be Ponderosa pine; ioam type compression weatherstrip I..-: factory installed; self draining aluminum sill with adjustable oak threshold; factory mortised for hinges and hardware. All wood and steel components To be prime painted. '.a:1 Avanfi Enfry System fabricated in accordance with ISDSI standards Characteristics except where more stringent requirements are specified. • Door Panels: 24 gauge galvanized steel faces; weepsystem; oak threshold full adjustable for proper ACCESSORIES: precision moulded Ponderosa Pine stiles and lop contact to door panel bottom seal. Standard Glass Options: Two tiles of clear tem- rail; insert-moulded steel and neoprene bottom rail Weathersirlpping: Polyethylene covered foam pared, exterior Ilte bronze tint tempered with interior and seal; all bonded toala/4"thickness in precision compression type; coped for overlap at corners, rein- clear tempered,exteriorliteclearremperedwithinte- lixtures by a foamed-in-place polyurethane core of a forced to resist shrinkage. rior life Low E coated clear tempered. sulficlent density to provide R-value = 14.9 mini- • Astragals: Extruded cellular PVC; flush mounted , gyllles: Removable wood grilles, fully frametl; mum. activators; concealed heatl antl foot bolts. push-pin retaining hardware to factory-installed re- Door Lltes: factory glazetl; wrap-around life Hinges: (Standard inswing) three 4" template, celvera. Irame, integrally bonded to panel at time of panel butt type steel hinges per operating panel; remov- , Frame Extenders: Prime painted Ponderosa pine fabrication; trim Ilush with panel faces; glass t1/1s" able pins; fully mortisetl tojamb and door edge; finish extenders make frame and sill depth 51/4" or 6ahe:' clear tempered l'winsul insulating.(Optional Glazing UG N4 dull brass. (Optional: 1) self-closing spring SIII Extenders: Extruded aluminum extenders avatlable.) loaded, 2) swedge bull type for outswin@@, remov- make sill depth 51/4" or 6shs:' • Hardware Preparation: Provide moulded cross- able or norvremovable pin, 3) ball-bearing.) .Compliance: A. All-units to meet or exceed ISDSI bore insert with 2116" crossbore 23/4" backset (tale" Side Liles: 24 gauge I3alvanized steel faces; ex- perfdrmahee ~stenderd6C 701 through 107..6. Avanfi available on order), and t" edge bore. Deatlbo t the truded PVC stiles and rat s; bontletl by a foamed-in- ppa0al dire Seated and ratetl~to~{lame endurance and same, 111/4" center to center. Mortise for 21/4 x 1" place polyurethane core; full to/a" thickness to ho3s stream in accortlance wnh ASTM Et52,with a square corner face plate. Finish Iloor to single bore: match standard door panels. Life frame, integrally a/4 hbur (45 minute) rating. C. Frame lire tested (and 35" bonded attimeof panel fabrication, removable Inside labeled when specified) fo flame endurance and Frames: Ponderosq pine, toxic treated; fully rab- stop to allow alternate glazing of optional inserts. hose stream tests in accordance with ASTM E-152 betted and reversible; mortised for hinges and lock Panels factory-installed in frames to match doors. (1976), UBC~43.2 (1976), UL 10(6)(1974), California strikes; strike mortise reinforced with steel security Transom Assembly: Ponderosa pine, toxic $tet~ Title 19 Section 48-7 for a t!a hour (20 minute) plate. treated and prime painted components nailed to se- • Sills: Combination aluminum and prefinished oak cure 11ha" clear tempered Twinsul insulating; or ~ tested nnacoordance with ASTMPE84 75h75 flame assembled to a sub-sill incorporating concealed leaded tempered Insulating glass. spread;'450 smokerating. Technical Dpta shedmgce.nl4lem Test data in accordance with AAMA and NWMA standard industr Alr lnilllrellon Y Glees Clear Bmnze testing specifications. Data calculated using standard published .o3 cFM reeled Twlaevl e9 ]3 formulas of 1981 ASHRAE Handbook of Fundamentals. .so cFM Indust Sid. LowE Twlnaul .)9 64 Clear Opening Heet loss getlleted Neet O•In Glass Venllleling Opening U Value Per Sq. FI. Total Geln BTU/Hr. Daylight Unll Alr Unlt LowE Bronze Opening Toler Inlllirallon Slze Without er Bronze Clear Bronze LowE LowE Unit Syuere S4uere Total Sauere Glees LowE Twinsul Twinsul 1Winaul Twinsul Size Foot Wldlh Haight Foot CFM Foot Twineut 2668 2019" ]mhe" 15.]3 54 1].65 .OB .2888 30],6" ]el/is", 18:82 55 ~ to ]8 ~~".0e rx JOBa - 3]19" ]8]/1e" 19.00 5) 2104 .OB - - 3868 - 4219" ]B1Ae" 23.35 .81 2555 .09 - - - - _ E' 6088 592592" )elh s" 3258 1.09 3508 OB 8188 83&4" ]B1he" 34.]3 1 10 3].32 OB 8089 ]1x592^ ]87/ie" 39.10 115 41.48 .OB 2888 380 3019" 781he" 1882 55 1e ]8 .13 11 6]0 SSa 5W 4]5 JO88 360 3419" ]87/te" 1900 .5] 2104 .12 11 870 558 Sa] 0]5 ~ 5188 ].ZO 8394' ]elite" 34.]3 1 10 37.32 .13 .11 1339 1118 1174 950 i BO6S ].20 ]12592" ]Ellie" 39.10 115 4184 .12 11 1338 1116 11]4 950 2868 490 2e19" ]91/m" 15 ]3 .54 1].85 21 .16 911 ]60 ]99 847 w 2888 4.90 3019" ]Ellie" 18 a2 55 to ]8 21 18 811 760 799 847 ~ 3088 4.90 3419" ]8]he" 19.00 .5] 21.04 .19 .15 911 ]60 ]99 84] # 8069 981 59xs9x" ]87/ie" 3256 1.09 35.08 21 16 1025 1521 1599 1295 6488 9.81 63Y4" ]e7h6" 34.]3 110 3732 20 .15 1825 1521 1599 1295 8088 981 712592" 7e1/i s" 39.10 1.15 41.Bd ,19 15 1825 1521 1599 1295 'Special glazing check for availablllly and pricing 4,Z Note: See Chadeau for C79 Panel Specs 1Vi'emorand.um from . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN IIALL, SOUTHOLD, N. Y. 11971 765-1802 ~llU/ad~g/~-.. Cy ~s~~-~-c~-~.~,~,~~ lyr~~~ ~ ~ r ~ / r; ~L~tN Nc 1G N'I ! ! ~F ~_~a~ I ~ L D I!V ~'t7L-CilOiV I DA1 ~ I COIF-lli\/i r hl t S i;,^. i /4 J i ~ - E ~ vi ! ~C~v E, H FtZA(~~~ (i n~ t~Lc~Mi~iNC M~ z - ~ 3 I r ti j s~ ~ ~i E !mss ~ 2 c Y Co D` ' - n t I f- - - a~ ' ~P. i 7r - .7°- ro: x~ _ _ rl t - --~+r. - - ? 1'~. I' l8"~e~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. ]FOUNDATION 2ND[ INSULATION [ ]FRAMING ~NAL REMARKS: ~r ~i~ DATE INSPECTOR ° 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INSU ION [ ]FRAMING [ INAL ff REMARKS: ~ ~..r mZ DATE ~ ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: 3 ~ r~ ~ -e ~ /ZJ~w~ ~ Li, DATE ~ INSPECTOR BOARD OF HEALTH 3 SETS OF PLANS ,FORM NO. 1 SURVEY _ „ TOWw OF SOUTHOLD CHECK • • - • . BUILDING DEPARTMENT SEPTIC FOR,t . TOWN HALL / SOUTHOLD, N.Y. 11971 NOTALL - . . c~C9 tO TEL.: 765-1802 MAIL T0: ,~`~Jt9 C Q~~ Examined . Ue~;?~R.!.;u.,,~~t, 19a'~. -1 ~ 2, Approved .O?~t.~ti,. Z~P,, 19~9,PermitNo~.~(e°.~.'~.. Q ` Disapproved a/c Wl . . . . . ac .Rya ...F ...<i.t` (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~U/.!~........., 19~.~ 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 ad}oining 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. 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 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 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 necessa - p tions. .1 'gnatttre of applicant, or me, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...-~01~'N mot- ~`~I h1-(<'.`( fit ~~.(J , , .C`,U !J nJ 0 / .......j.............................. (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 COtiTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber s License No. ~ 9 7 Electrician's License No. . ~Jf. ~ . ~ , . Otltcr Trade's License No . . 1, Location of land on which proposed worTtk will be done . . . . . 2 7 ~O .......................t! I ~ N Fl: N $ !~.i7................ ~',tt.TGf~U ~y,rf~...... . House Number Street Hamlet County Tax blap No. 1000 Section 3, , , , , , , , , Block .......Z- Lot . (~C~.; ; ~9~.T 0'~..~j. . Subdivision Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use artd occupancy of proposed construction: a. Existing use and occupancy e`t:~~ ~i~iFC~ 1~JW~) ~In1(p b. Intended use and ~ ~P >f~' ~ T,,..sd occupancy O N 'E-- t 1. ~UJ ~1 ~ 1IJ ~rsv~.,~~•fl . ~9c+Nv.~ e~i tswC441 axwew f 4'~lKSkSIl4eb~ 3. Nature of work (check which applicable): Iv`ew Bi Iding Y...... Addition Alteration . RcP~ • • • • • • • • • • • • • • Remova~ Demolition Other 15'ork , . (Descriplion) 4. Estimated Cost ! ;ySf'OQO Fee . ` (to be paid on filing this appli a on ND 5. If dwelling, number of dwelling unitts S~U~AI Number of dwelling units on each floor . ~ 57: ~ If garage, number of cars %VP. . 6. If business, commercial or mixed o~cupancy, specify nature and extent of each type of use . 7. Dimensinrts„pf'~xl~ s, i~ any: Front . Rehr 5 Depth . Height I:.. ~::_°;a 5 be of Stories . J`~hit:....17.~~J l.N. . DimGri~ions of same struct th alterations or additions: Front . Rear . Dey~ . ~icight Number of Stories . 8. Dim dons o enttre new ctaon: Front Rear ...............Depth . Height~.,~.--, w be~ of Stories . . 9. Size of ~ ~ .iy" Rear . ~V ~.F Depth ...~~q: . 0. Date of Purc rase ( . 7.~R........... Name of Former Owner . ~;onl57<1.1~('F,~, • K(q;l~i~%~, , , , , 1. Zone or use district in which premi es are situated . 2. Does proposed construction violate any zoning law, ordinance or regulation: ltl0 . 3. Hill lot be regraded ......!?a Nill excess Gll be removed~rom premises: Yes No 4. Name of Owner of,premises ,-~?f~. ~ ~P~:t!~,~5~....... Address.~,{~ ~9,D~ , W~v/;~/y°,+~~•~~aPhone No..~/. ~.9'.lv~~P.... . Name of Architect .~N~~ ..1? NiS, , , , , , , , , ,Address ~~v<E~~y~ ......Phone No..'7.zZ -~.~.~L. . A'ame of Contractor ...~Off/.•-~ . ' /~.~~~tl ........Address ' ............Phone No . Is this property located wi hin 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trust es 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 Unes. Give street and block nu ber or description according to deed, and show street names and indicate whether ~terior or corner lot. S~~- 17GL9~W ~ti1(o s I rATE of l:E~R~ s. OUA rY OF . pp • , , , , , , , , , ,,,,l~.d. t~. ~ . ~ 1:1 ~ L; y, being duly sworn, deposes and says that he is the applicant (tiamc of individual signing contract) •ovc named. a is the .....Q fd.1.N. ~-.r..~.. ~ frt. ~ (;h;~'.~'.~ . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly uthorized to perform or have performed the said work and to make and file this plication: that all statements contain d in this application are true to the best of leis knowledge and belief; and that the irk will be pcrCormed in the manners t forth in the application filed therewith. :orn to 6cforc ~~this ~ • ~ , ...,...1.~ .............day of.~ 19 nary f ublic, /~C,-.. Count .U~ , ~~-d~- . (Signature of applicant) ~~~iii 000~444444~~D/ FORM NO. 1 ty.5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 / Examined 19 Application No. ~l Approved ~ 1~~PermitNo..~t.~~'L~.~ Disapproved a/c ' ilding Inspector) APPLICATION FOR BUILDING PERMIT J r~ ( r, Date r6....., 1S~ INSTRUCTIONS a. Ttiis 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. 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 issue 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 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 ar alterations, or for removal or demolition, as herein described. The applicant agrees to comply with al] applicable laws, ordina ces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nec ssa inspe ions. (Signat re of applicant, or ame> 'f a corporation} 5z/U ~ ..~i~P~o-e, Q,u~e,~ ~a-elut~~rP,~. f2~ . (Mailing address of applicant) ~ State whether app~lican^,t,~is~owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ ~~~1_.._. 1..... Name of owner of premises . w`'`G ~a ~~C~.~~~ (as on the tax ro 1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No. ~ . Electrician's License No. T~ S. ~ . G . Other Trade's License No . . . 1. Location of land on which proposed work will be done. . 3d 3G '-~?~_a~rta~~~ ,~~J-r House Nurnber Street Hamlet County Tax Map No. 1000 Section (7 Block Da Lot ..~T~~.~O~, , , , , , Subdivision Filed Map No. Lot . (Name) a 2. State existing use and occupancy of premises a1n1~d intended use and occupancy of proposed construction: a. Existing use and occupancy :-tt: . b. Intended use and occupancy :.:n~~... , . ~'~t~«.'~`~~Zu`-;~~....V.t7...~~rJ~G~........ . ~i.;tp~2 ~i pp~ica / 3, Nature of work (check which a I ble): New Building ...Y Addition. • • . • • • • • • • Alteration . / • • • • . • al' . Demolition , ...Other Work . Re alr Remov ~ (Description) 4. Estimated Cost...•~~.. OOU ....................i Fee ~ ' If a umber of cars (to be paid on filing this application) ` 5. If gwelghn number of dwellin r~ s X ; : Number of dwelling units on each floor . • g, g U ara ,n 6. If business, commercial or mfxedoccupancy, specify nature and extent of each type of use .~.~gY!:'~4~..... . 7. Dimensions of existing structures, if any: Front ...............Rear Depth , Height ...............NumljerofStories........................................................ Dimensions of same structure with alterations or additions: Front Rear . Depth .Height ......................Number of Stories . . 8: Dimensions of entire new construction: Front Rear ...............Depth . Height ...............NumberofStories........................................................ 9. Size of lot: Front Rear ept l A. Date of Purchase l ame of Former Owner . ~l I. Zone or use district in which premises are situated • • . • , . • • • • • 12. Does proposed construction violate any zoning law, ordinance or regulation~G 13. Will lot be regraded I Will e c ss fill b emoved from premises: .Y/e~s,, Nq 14. Name of Owner of premises . ~ ~0 ? Address . .........Phone No. . 5~..~1,~i.... . Name of Architect ..Address . .Phone No Z Z ~ .'a l.-~:y ~ . Name of Contractor . .Address Phone No..~(?,~l..~4.~j1~(y.. . PLOT DIAGRAM Locate clearly and distinctly all„buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block pumber or desoription according to deed, and show street names and indicate whether interior or corner lot. I ~I STATE OF NE Y RK, II COUNTY O ~ S/.S //Q_ • • . • • • . i,~,.r~l-Yia2~~~=~J..... being duly sworn, deposes and says that he is the applicant ( ame individual signing contract) (/JJ above named. i 4-Ieisthe / (Contractor, agent, 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 of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this I r No Public, County G MKr pueur, stele or new '(ark (Sign of applicant) Ng, s'tt•6125850, Suffolk Gw~{(j '~(}d ~ fa YY~I~I' 'I" L~r,- Ul~i{~?l.t~ hrm EMoif9s Mery1k 89, e$l~'( N p~ r 0 o C N J U L- o w p 7 ~ w ~ ° i m i ii w a w f > ~ ^ -1-~. ~ z m z ~ z o _ _ N I `)~l~ 171, ~U~'7 t° C`°. 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REF. NO. 415.~.~ ~ ~ The sewage disposal artd water supply facilities for this ~ 1 IIII rotation have been inspected by this Department and/or other agencies a d found to be satisfactory. I 7np OF LANK! `,1 _ ~ ~ Chie of ureau of asttwater anagement fZ _ TANK ~ , \ J [mma v~. 'Ait• ~ ~ i N 'J4 ~ 3YS , hStc~_;_i~ ~ ~ 1 ry I v I N ~ ~ w .o Q ; ! r ~ •1^ I Z ~ t° ~ SCALE - 50 ° I • [7 P'lOtiv M ~ (~i ? 9j~ ~ RTLEA _1.027 A~2ES ~ , ~ {TO TIC LINE} 3 `-o L-~ 4.. ~~1~• ~ ~ Sl!F E'JLF~. ~'Q. NE:a !-l"N Utf FT~. F"k'G.._+'A:_ 4 ~ \ ~ \ ~~Q b • ~ ~ Q ~ 2~ ~ ~ ~~n Ly 'b ~ ~ cyT O. o ~ \ ~ 'rte ~ J/~~ ~~p~, ~.c. ,sc ~ Qp 4-1 I ~ ' t~ .yo, i- .`r ~ j;~`l' ~ , ~ i if t r .~c ~ ~ i a~. - - ._.d - ,_„1n101S 1C5 ~utlfti , i l t.E~. 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