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HomeMy WebLinkAbout18615-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20882 Date JULY 23, 1992 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 1225 NORTH SEA DRIVE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 4 Lot I4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 24, 1989 pursuant to which Building Permit No. 18615-Z dated OCTOBER 31, 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 NEW ROOF & ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANN & ISIDORE HANDLER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-170698 - JANUARY 24, 1991 PLUMBERS CERTIFICATION DATED JULY 29 1992 -ISIDORE HANDLER Building Inspector Rev. 1/81 YOEM NO. A TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N ~ Z Date fd ~..3.~ 19.t~1 Permission is hereby granted to: ~rr........~~~~~...~..........~ .~~.~P.........~c.~u~h,~ ~i~~ .....~m ...............~~-i.:~:y,l.-. : , at premises located at ........~/.~f~f/..L~ ..~~~...~,1.~~............................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . ......J~ . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section Block ........7.:.......... Lot No........,ly~......... pursuant to Application dated ......./..s~~ 19..t~:.~7., and approved by the Building Inspector. y +y r Fee $...l...lA.~.. ..~i..Gl............ Buildl Inspector Rev. 6/30/80 -~q~ ~ ~ Form No. 6 lll~~~1/py ~ / TOSJ~I OF SOUTIIOLD r ~ ~ `?.~~''G~ ( BUILDING DCPARTPtLNT Vr//~ TO[JN IfALL 765-1802 l ~ f ~ APPLICATION FOR CCRTIPICATE OP OCCUPANCY 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-O, 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. S. 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: r 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 Co 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 $115`.00, Commercial $15.00 Pate New Construction........... Old Or Pre-exi/s tin Building.../........... Location of Property..~Z~"5..........1~;0:.~4°I4.b!~sI,1pG .............~U'~~F?L-Z~....... House No.' ~ Street Hamlet , Onwer or Owners of Property.....~:`.N~..'.~..!'S~~i~~~, . . Councy Tax Map No 1000, Section, a~.1~,:.....Block,....~! ~.......Lot...j.~ Subdivision ....................................Filec~d Map.........~~//..Lot. Permit No. ~~~0.~~.~.....Date Ot Permit. ~0~3~~~y...Applicant~JR'~~.~~~~~~~.~~w~LC~ llcalth Dept. A~~proval ..........................Underwriters Approval.../. Planning Board Approval 2equest for; Temporary~--C-ertificate........... final Certicate.,~ 'ee Submitted: $...~~.'J,i {L . L/ J~~1/ ~ _ ~,7yN1'-~ APPLICART ~o~,aog~ Ic:La c...,~:. I~~n:.. II ::i:Ni4LNi.. 4 'ty I~ _ I _ _ 'OUIIDAT20;1 (1st) ~ a ?OUNDATION (2nd) --i - ~ / ~ D sir o p y 'OUGIi FRAI~fE & r G .PLUMBING Sr ~ _ H Y/ a ~4\.T,O 3 . (7 I m H ~I3SULATIOP3 P£R N. Y. STATE EPIERCY CODE I ~-~~~I .s.J y 4 . FI;lAL . x~ art w s`'~"k~ c`'~ ' ADDITIOPYAL COMMEi;TS: c l r~6 S - ..C . ~ a ,Pa. ~ 3~o v 7 ~aa ,yn m a W 9~\\. . H \ H O ~ _ m d\ m _ - -o 1 [[(7 T ~'tT~i (~,7r~ /~T ~ TEL.7G5-1802 O~UI I U~~/,O~/r 1~ 1Y 1~ Vl' S,JU 1~~l iL~ C ~c OFFICE OF BUILDII~IG iDSSPECTOR f ~ = c-.. - P,O. BOX 728 ~ 3~rN~j; rn ~ TONN HALL "O/~~~~ x ~~~'Z- SO(ITEiOLD, N.Y. 1 1971 . '.~s.'' iita~p y d C E R T I F I C A T I O N t+..l ia~:.~,.sdetl cti::~:"s:ri s`~ i'~, t ra 7{51-~'J4,jt1~~,:~~DS.J'~t.i~,,,~ Date r ~ Building Permit Noy./~r~ Owner /~//~U~~ /`f"6~+~~G-~~ {phase pr/i~nf/t) Plur•.ber ~ll~ct~G- f7°9"~©~"~. (please- print) I certify that the solder used in the water supply system contains less than 2J1~ of to lead. . G'~~" (plumber''s signaturcl Sworn o before me this ~~'~day of 19 Notary Public ttotary Public,_~~'~-r~~-~_~_,~~ ' . HELENE HORNS Notary Public, State of New York No,A95f36A Qualified In Suffolk Coun p~ Commission Expires May 22, t~ David Lee Fulton ~lumbin bleating p. 0. BOX 706 RIVERHEAD, NEW YORK 11901 SHONE 727.654 i'lumbi_np; ~,ic. ~7.35`~f' - '~ietl Dri1.li.ng Re~ti. ;;/1.~?q Home Improvement C,ic. -;'ll-?42HT T.)ate: Dt~;~,. 1~' 1491 U'^.'ner: ISA~6~~. k~ANDI P~_a___ Premises: 1e71j~{'~oYt11 ~af.:e~ A+2 _ 5'o t~i~lj plop 1~11~ TO lti'HOtvl IT ivlAY CONCERN: Al.l domestic water 7.ines, at the above- referenced premises, have been sweat ~~!i.th a lead free solder. Very truly ,yours , llavid Lee Pul.ton~ Master Plumber .A/, ti. 51'/3'r~ at= Nov yoel~; SS... ~uvey oc sttr,~oc,~: - 0~1 ~/aE /a~ Acv ar ,O~e,~m8~~ l99/~ ~~Fo,~E m~ 1~~,~sD~/,~~y ~i~na~ ,D,~v~e G~~ I=u~Tn~l ~J~~krJorv~l l~~ /~ex,~~~v4e-,6G~ lyl~ Tlfy-r h`~ G~X~ C~uT~.~ 7~rs In15~U~n~?% ~ce~ f~f~~'7 T~` ~2,r1 ntJc No,Ft.¢y 5%~~ dGy~ Ya~ek • L~ugc~G/mot l~rl Sl1~~t.C c'oudTy No. ~5•'~ga&ao Comr.~~ssrd~l vXPie~s F~~~/G 30 199E ~G THE NEW YORK BOARD OF FIRE UNDERWRITERS ~~IIL,~ .I t~~<,~r~ BUREAU OF ELECTRIGITV 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date J'~S.Ni1.~R'l' :i ~3~4~'~~l Application No. on file ('Rti,~`ij5i3 ('1!317 IL t~i (1€)'1a, - THIS CERTIFIES THAT only the electrtcol equipment as described 6e/ow and introduced 6y the appBcant Homed on the above application number in the premtaea of %riR tit#i~I:Lli:k, 12.)rT Ai. ;F:A M?St, i,.61r 1.'i1, :iC,tt'?"f$t)llfl, N.'t. in the follou:inK locations ~ Bartement ~ 1st FL ~ 2nd F'l. i1T;t e.' .Section Bloek Lot uxta examined on ct l~14y11 f'I't' l ~J l~ l and fouad to be in complimLCe ceith the requiremenLS o~ this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FWORESCENi OTHER AMi. K.W. AMi K.W. AMi KW. AMi K.W. AMT. H P. bQ 7fJ ~fa ~ ~n ~ t5 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. Oll H. P GAS H. P MIT. NO A. W. G AMi. AMP AMi gMPS TRANS. AMi. H P SYSTEMS AMi WAiiS NO.OF FEET "S k~" .1. P ~ ~;tttr SERVICE DISCONNECT NO.OF $ E R V I C E AMi. AMP. TYPE METER I ]W I a, 3W ~)Y W JW NO.OF CC COND. A W G. NO OF HI-LEG A M' G~ NO OF NEUTRALS A. W G~ EQUIP. PER% OF Cf. COND OF HLLEG OF NEUTRAL f. zno ct~ i ~ ~if3 ~i+? OTNER APPARATUS: IYr S'.\.x i ~.••f fib{{)T.Zfi ~t~~('}'~l, ~X~Q~".'~, 7'Ct~1Ctt !rf(iHT]BfS.,-t3 s~;~N, ilaiax;i~'~r:e~ il~r. x,~i~.~:i~„~~r. fr.Ct,N{.LX L'lfi8 S CtiT~ IfQt,i} , iii Y , i 1 SI' 1 $ GENERAL MANAG@R S:1 _L, Per r This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPECTORS Principal Building Inspector p~ aUTFU~sC~~ O O~ SCOTT L. HARRIS, Supervisor Curtis Horton ~ ; u_ ;;3 1 Senior Buildin Ins ector o 8 p Southold Town Hall rn ~ ` a Thomas Fisher ~ ~ P.O. Box 1179, 53095 Main Road Building Inspector ~ ' Gary Fish •~`~dl Southo N)w York 11971 Buiidin Ins ector Fax 516 765-1823 8 p Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assismnt Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD .THEY 15, 1992 ISIDORE 6 ANN HANDLER 131 ,TERICHO TPRE - JERICHO, NY 11753 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: - gg% An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. ggg The check is not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 18615-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. IFJIDORE HANDLER PROFESSIONAL EN OIN EER 2080 KINLOCH ROAD WANTAGH, NEW YORK SUNSET 5.7314 May 16, 1990 Town of Southold Building Department RE: Insulation of residence at 1225 North Sea Drive Dear Sirs: I hereby certify that insulation used in the above building meets all New York State energy requirements. Very truly yours, Isid6~Handler, P. . # 28265 Memorandum from . r ' ' BUILDING INSPECTORS OFFICE ` TOWN OF SOUTHOLD ' TOWN HALL, $OUTHOLD, N. Y. 11971 765.1802 FEBRUARY 15, 1990 DEar Mr. Handler: Your permit has been amended to include alterations and the solarium as applied for. Please submit specifications for construction of the solarium, size of foothings, floors, walk and roof etc. Very truly yours, f~ Thomas J. Fisher Building Inspector 0 - r ~ rr~~~ ~ 3~7~47 - ~y ~O ~ 8 -.-iWemorandum from . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 r , ELEVATION CERTIFICATE OMB3dB7.a97 EXPIRES; JUNE 301990 q ~ FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM , Thle form Is to be used for: 1) Post-FIRM construction only when the base Oootl Inlormabon Is available for the bwlding site', and 2} Pre-FIRM butldings rated using PosbFIRM rules. Insiructwns for completing this form can be found on Iba revefse side. Kart Lundell ,BU/ILDIN WNER S NAME P 1 Y NU BE ,~f2~J North Sea Drive STREET ADDRESS Ap4AlUnit-U Sufle-SlBldg: B NO. ROUTE BOX NUMB R ' 1000-54-04-14 ' OTHER DESCRIPTION (Block and lot numbers.. etc.) ' Southold I3Y 11971 CITY STATE ZIP CODE This form is to be completed by a land surveyor, engineer, or architect who is authorized by state law to certi/y elevation information when the a/evatlon in/ormation far zones A7-A30, AE, AH, A(with BFE), Vf-V30, VE, and V(wrth BFE) is required. In the case of zone A0, the building o/hclal, the property ' owner, or the owner's representadve should complete the m/ormation in Section I and may also complete the certiticahon. Community off/ciafs who are authorized by local few or ordinance to provide / oodplain management m/ormaticn may also complete this corm. SECTION I BUILDING ELEVATION INFORMATION t. Using the Flood Insurance Manual or the NFIP Flood Insurance Application-Part 2 Worksheet, indicate the proper diagram number 2. FIRM Zones At-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of 1 1 •50 feet NGVD. far other datum-see #5) (~~urrace, well & sump area 6.5) 3. FIRM Zones V7-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level floor from the selected diagram is at an elevation of feet NGVD (or other datum-see #5). 4. FIRM Zone AO. The floor used as the reference level from the selected diagram is W feet above highest natural grade next to the building (also enter in line 8). This value must be equal to or greater than the AO Zone flood depth number listed below. If no - flood depth number is available, is the building's lowest floor (or reference level) elevated in accordance with the community's floodplain management ordinances? ?Yes ?NO ?Unknown r 5. Indicate the elevation datum system used in determining the above reference level elevations:[ NGVD ? Other (describe on back) . 6. Indicate the elevation datum system used on the FIRM for base flood elevations: ~ NGVD ?Other (describe on back) (ATTENTION: ll the elevation datum used m measurin the elevations Is different than Thal used an the FIRM, then the elevations provided ' must be converted to the datum system used on the F~RM.) 7. Is the reference level based on actual construction? ~ Yes ? No' A "No" answer is only valid if the building does not have the reference level floor in place. Fifl in the olovation based on construc- tion drawings and do not complete question #5. If "No" is checked, this certification will be valid only for buildings in thB course of construction. After construction of the reference level floor is completed, apost-construction elevation certificate will be required for' continued flood insurance coverage. 13. Provide the following measurements using the natural grade next to the building (round to the nearest foot). a. The reference level is: b. The garage floor (if applicable) is: feel ®above ? below (check one) the highest grade. ~ feet ~ above ? below (check one) the highest grade. Wfeet ?above ?below (check one) the lowest grade. Wfeet ?above ?below (check one) the lowest grade. SECTION II FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions on back-Date of FIRM) and accompanying insurance application: COMMUNITY N PANEL N~~l1FF x I DATE OF IH FI M ZONE BASE L O LEV. MM NI IMA A E L 6Ul (In AO Zone, use depth) ELEVATION ESTABLISHED FOR ZONE A 3608 1 J 00 (8 L 06/ 18/8'7 ~-7 ~l 11 I Oft ZONE V, IF AVAILABLE Elevation reference mark used appears on FIRM ?Yes ?NO (See reverse side for details) ' SECTION III CERTIFICATION This certr Icehon /s to be signed by a land swveyor, eng near, or architect w o 1s out ooze y sta, a aw to cart y e evat on n drmat on w an r a elevation Information for zones A 1-A30, AE, AH, A(with BFE), V f-V30, VE, and V(with BFE) is requred. In the case of zone AO, the bwldin o/bcial, the property owner, or the owner's representative can sign the certilicafidn. Community of/~cials who are authorized by local few or or ids llocdplein management inrormation, may also sign the certdication. f certiry that the Information on this certificate represents t / ~ ref the data available. I understand that an false statement ma be unishable b line or im risonment under 19 U.S. Code, S , Joseph Ingegno, L.3. j~~ CERTIFIER S NAME LI NSE NUMBER (or Alh>t Sesp J ~ President Peconic Surveyors, P.L. # TIE 0. Bo 90 54655 lYlain road a'out~o~lFd, ~ 9~1 Q~ ADDRESS IT-~-------~` STA 06/?_8/89 (516) ~ eIBNATU ~ DATE PHONE The I r tics gent should attach Ina odglnel copy of the completed form to Iha rlood Ineuranca policy eppUcplon. The aecorM copy ehoutd be mpplladao the pokcyholder end the 1h rd dopy retained by the agent. Tha /ourlh copy b for the local community permll oalce, Ir required. THIS FORM MRY BE REPRODUCED. FOR OP NAL COMMUNITY USE: Is the reference level also the lowest floor under the wmmunity's Pbodplam management ordinances? ?VES ?NO If NO the elevation of the lowest floor Is feat NGVD. FEMA FOflM Bi~31 (tBlBll 593-117 (6/87) 765-18®Z C ~ ,7/~ BUILDING DEPT. ' ~ ~ NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~_~.=,Qa.P f_ - ~ ~v DATE ~ INSPEGTO~ T65-18®2 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST (e~'T ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING / [ ] FINQAL RE ARKS: ~~C 1 ~ v i ~ DATE ~..J INSPECTOR " 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: T DATE % INSPECTOR BOARD OF HEALTH 3 SETS OF PLANS FORM N0. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC r•oart ' TOWN HALL ~ J-1~.~1-N1JLtr . SOUTHOLD, N.Y. 11971 NOT Y TEL.: 765.1802 CALL ~ `6j~'S ~9 ~ ° ~ . / r L T0: Exanuncd .e~/1 . 19 U~ ' Approved ...~d~~~......, 19 ~ Permit No./ ~6~~j~ R 15 ~ d l~ Disapproved a/c . tDWN OF SOU7E Bui 'ng Inspector) HOLD APPLICATION FOR BUILDING PERMIT ~ry ' Date .G/G,j.ZC~....., 19g,/. INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink artd 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 streexs ror areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- I 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 avai]able 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 app]cant agrees to comply with all applicable laws, ordinances, build code, housing code, a d regulations, and to admit authorized inspectors on premises and in building for necessary inspe do s. ~ gay /~e of applicant, or n/a~me, if a corporation • (Mailing address of apglicaht) ~j,?~~~~~~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ J,~`' i ~ui'~~ . (as on the tax roll or latest deed) IC 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 . . Otter Trade's License No . . 1, Location of land on which proposed work will be done . . ~Z?:~/V~,.Sum,~.,~.z~v~° ..................G`~.~nvr~~©GO~,!t/f House Number Street Hamlet County Tax 11ap No. 1000 Scc[ion Blpck Lot Subdivision Filed 1`fap No. Lot . blame) State existing use and occupancy of pr/emises and in [ended use and occupancy of proposed construction: a. Existing use and occupancy ? • ~ ..~~:.f J~~/?`C-~ . b. Intended use and occupancy 5~~~"•••••••'•••-••••••••••..... 3. Nature of work check which P~O~' ( Ry aPPlicable): New Building Addition Alteration , . Repair , moval Demolition Other 1Vork . (Description) Q. Estimated Cost . . 3aJ~t'~~ . . . . . Fee . . . (to be paid on filing this application) 5. If dwelling, number of dwclli~tg units Number of dwelling units on each door , . Ifgara;c,numbcrofcars 6. If business. commercial ar miffed occupancy, specify nature and extent of each ypc of use , . 7. Dimensions of exiling structiFres, if any: Front ...~~e~~`~.~..... Rear , ~~7..... Depth .~.3 / !Q, ~,,,,.,.Elei~hSS~;a°::;,~~t., . N~rmber of Stories y. ~ : . . y. .n....... . ~~n ~t~~mexlsiohs'of Sdm~s}~cture~,with alterations or ad~itions: Front . Rear . ~,~~5• , , • . , • • . . iiptli. .'Z'a..(Pi,. ,Iieigh[„~Q,,,,,,,,,,,,,,,,NumbcrofStories..,l... ' 1Dy~~sntirc`,rC"w construction: Front Rear ...............Depth , . . i t , . Number of Stories . . t 9. ~ Size of lot: Front Rear . . . . Depth . ~10. "T)ate'',of Pu~Ghase,:...,,J , /y .C9~9 • . Nama of Pprmcr Qwner .~C,'r. ','4 . ~ ( . ,1,1, , Zone or use district in which Rremises are situated Sl~cq . u,! ~ : . . . 1?. Does proposed construction v{olate any zoning law, ordin nee or regulation: . h~...... . 13. ~Vi111ot be regraded ~f?. Nill excess fill be re oved f~9m premises: Yes Nc 14. Name of Owner of premises .Ft...~ ~•~tKA!ar, Address~~.fr~~~~?;°QA~~~~'?!~.~ Phone No5~6/~:4.q4?? . . Name of Architect ,I, ~~?ra ~ lg?; , , , , , , , , , , , ,Address ...................Phone No.............. . Name of Contractor , • . k .Address . ..Phone No.. ~i..... P P Y IS If qes, Southold Touted with in~00 feet of a tidal wetland? *YL+S....NO....' * e1 n Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. > sP~2. s'LC.. r V ye. a ~~-~l~-c-~ ~.,q7 ~7/ ~9 L~ a v~ , / ' I I STATE OF NEw YORK, IiS.S COUNTY OF • • • • • • • ..jc%7.~k,~ f~.i~• • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of ictdividual stoning contract) about named. Hcisthe......~~n'~''~.......~L (Contractor, agent, corporate officer, etc.) of said owner pr owners, and is duly authorized to perform or have performed the said work and to make and file this application; [hat 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 bciore me this . . .`C ....day of I ~'~Q.~!.-: ' , . , ]9 4, I Notary Public, . iy" " County JgHN J. CARIELLO . PUBLIC, State of NeW Yor>? ^ . . NOTARY' Ne. 4897125 Qua'itied in SutfoVk Cout~J (Signature of applicant) ' Commission Expires Jety 27, 19~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [r~]w-INSULATION [ ]FRAMING [ ]FINAL REMARKS: - ~ ~.,~h,~ ~.f 1~ - ~ A.r ; DATE ~1 ' INSPECTO~t~-- 1. David Lee Fulton Plumbing & Heating P. O. BOX 706 RIVERHEAD, NEW YORK 11901 PHONE 727.7854 Plumbing; ~,ic. lj5`~P - 7:~e11 Drillinl? 3ec~:. 1.5'9 Home Improvement Gic. ;'1i-242HI llate: 1' :'~^ner ;'remi^e~: J~Jvlll~aYt1'1 S~r9- /7?L TO 1'dH0I4? IT TflAY CONC ~,2N: P~11 domestic ^rater lines, at the above- referenced premises, have been s~,veat ^rith a lead free solder. Very truly ,yours, David wee Fulton ~ ::aster Plumber , - I