Loading...
HomeMy WebLinkAbout18357-z ' t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20062 Date JULY 9, 1991 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 1305 THERESA DRIVE MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block IS Lot 12 Subdivision DEEP HOLE CREEK ESTFiled Map No. 4526 Lot No. 35 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 25, 1989 pursuant to which Building Permit No. 18357-Z dated AIGIST 8 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 CELLAR ENTRANCE ADDITION & ALTERATION TO NON-HABFTABLE CELLAR OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BARBARA & FRANK MOOR JR. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE N0. H-022704 - JUNE 18 1991 PLUMBERS CERTIFICATION DATED JANUARY 23 1990 - FRANK MOOR JR. °f~' Building Inspector Rev. 1/81 n~osas xa 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°- 1.835 l Z Date )9...~.~. Permission is hereby granted t~~F~~. cG'4 ~i at premis s located of ~..~?r..-.........~. . ~~s~~.?l~?..`~ ~~~~r°..................................................................... County Tox Map No. 1000 Section .......ll.~... Block .........lv`..~..... Lot No.........1. Z:... pursuant to application doted ...~.`f 19..p.~ and approved by the Building Inspe~r, ,5a • pr? Fee j.~ &~ao.oo .,..mac.................. Bi~ Bui g Inspect r ~1~~19a ~'Rc. ,3y3.Z _ c+-~e,.~.eQ. ,a.~~~-~- ~ ~`~o. 90. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD t'~~ =a " " .~_w_. a=T_ . BUILDING DEPARTMENT ! F~ ~~y TOWN HALL 76s-iaoa ~;1 ~ ,X1N 2 81~9~ ~~_~,.~,r APPLICATION FOR CERTIFICATE OF OCCUPANCY &iLDG' DE'j}~~' ` TOWN OF SUU7tiUl_SJ .~,~~.~..-_„~...w.,~,.. A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1~ lead. , 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer resnonsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and " "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and 1, unusual natural or topographic features. , 2. A properly completed application and a consent to inspect signed by the applicant. ' If a Certificate of Occupancy is denied, the Building Inspector shall state the • reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~p~:z. ~ l~ . New Construction........... Old Or Pre-existing /Bu-ilding.....? L ccation of Property... I,J~,05 .................T~'h4~1~^'e$Q....~r)~e , . , ~Q:~ L?`~...... House No./~ / Street ` Hamlet Onwer or Owners of Property....h-~a!:Y~CV,?t„Q?~.,.~??v1./~„~paY-~t:^,.... County Tax Map//~~No 10''//00, Section.....f//~~.....Block.....~~/~-.......Lot... Z Subdivision..L~../l~/e ~r'e~K.~S~t-;'~;?~„/Fpilged Map.Yt7 2~0....Lot...~~..../J..A.,~....... Permit No. Q . ~./~l.q , , , .Applicant...~?°:':a, . ; `;i;~/(!/CVav' „ .~~3.~.7 .Dat,A~e//OfnnPermit. Health Dept. Approval....../v .~!`~QQ .............Underwriters Approval...~~.lc'~o~O:~~.......... Planning Board Approval.....~~1 Request for: Temporary Certificate........... Final Certicate.. ; Fee Submitted: $.....2~rs~ ~ ^DO ~ ~ APPLICANT 5 co THE NEW YORK BOARD OF FIRE UNDERWRITERS rAr,E 1 $025?,4"l BUREAU OF ELEGTRICRY BS JOHN STREET, NEW YORK, NEW YORK 10038 ~ JUNE, 18 1991 b8750990/90 N 022704 Dote ~ Appp/icetion No. on Jfile THIS CERTIFIES THAT PP~RMIT N0, 1A357'L - only the electrke/ equipment os deecrihed 6eloto and introduced hY the oppUcent nomad on the eftooe opplicetion numher in the promLea of _ MO(JR, THERESA D6+.I:VE, POLE#513, MATTITUCK, Id.Y. ~q in thefollouinq locetion> ® Boaement ? lot Fl. ? Ynd FY. OIJT .Sertitinl] 5 BloekJ S Lot ] 2 teea examined on JUNE 13 ' 1.991 and found to 6e in compliance with the roquirementa of this Ruerd. RxiuRE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTIETS AgES SWITCHES NCAHOFSCFNi ~ FlUOI1E]CENi OTHER AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. l0 2s ~ s 4 1 F DRYERS RJRNACE MOTORS RITURE AMIIANCE fElWRS SHOAL RlC7i TIME CLOCKS pLL UNIT HEATElS MUlil-OUi1ET DIhIMlRS AMT. K. W. Oll N. P. CMS N. v. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. R, v. SYSTMIf AMT. WAT/S - No. a IHT SRRVIC! DISCONNECT NO.OF S E R V I C E AMT. AMP. IYPE b p, 1 / t\V i / TV ] / ]\V 3 / IW NO' PER BCONO. OF CC. COND. NO. M NIAFG a'H '~G NO. Of NEUTRALS Of ~NEUTGWU OTHER AP?ARATUS: NOTORS:].-F N. P.,3.-.50 N.F. C>.F.C.I:-4 _ ~ .'d( I[ - BARBARA A.MUOR P.O.BOX 2d6 HATT]'TtJCK, NY, ].].952 oEIEBIAt MANAWR 11 V Prr ~ This certificaN mutt not be alMrad in any manner; return to the office of the Board if incorrect. Inspector: may be identified by :Mir cTedentialt. = COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT Bf ALTERED IN ANY MANNER. ' ~ INSPECTORS Victor Lessard ~OOgQFFO(~-C Principal Building Inspector p Curtis Horton = Gyp SCOTT L. HARRIS, Supervisar Senior Building Inspector y x Southold Town Hall Thomas Fisher P.O. Box 1179, 53095 Main Road Building Inspector 0 • Gar Fish 'y6j O~ Southold, New York 11971 Building Inspector Ol ~ ~a Fax (516) 765-1823 Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspectrn OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD June 28, 1991 Ms. Barbara A. Moor P.O. Box 246 Mattituck, N.Y. 11952 Re: Building Permit #18357-Z Premises: 1305 Theresa Drive, Mattituck, N.Y. Suff. Co. Tax Map #1000-115-15-12 Dear Ms. Moor: Pursuant to our telephone conversation of today, I return herewith your check in the amount of $50.00. Please submit a new check to this office in the amount.of $25.00 so that we may issue the Certificate of Occupancy far the above Building Permit. A Certificate of Occupancy is not required for a fence. Also enclosed is your original Underwriters Certificate for your records. Thank you. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Georgia Rudder, Secretry encl. ~~1L'~~r,- TEL. 7G5-1 E07. ~~~E~OCk O .t~s'.:" j~}' 1,c1 T'0~~'rI (~T' SOTJIIIOI,d3 ~l~;ytl4~aY~tp~~~'~i Or1'iC1i O1' fiUILllING IIJSPECTOR i .O. IiOX 7~8 41~.T~~~ *t~'~~~' 'I'OPJiJIIALL ~ti. ~/~1~`+~,~~j!` SOU I'IIO1,U, N.y. i I971 APRIL 30, 1990 BARBARA A. MOOR BOR 246 MATTITIICR, N.Y. 11952 To whom This May Concern, :c t•7e are unable to complete your Certificate of~Occupanry because of the folloo-ring reasons. /1n :application for Certificate of Occupancy /is not on file. (ENCLOSED) /_?/~to Undcrariters Cert-ifir_ate on file. '1'hc check is (35~i$$+.$~~~/not on file.) $25.00 Itn Health Cept. Approval on file. t:o final in:,pect:ion has been made. P)eare contact our office on this matter. Thank you c'oz youz cooperation. Duildi.nr; Permit 1 8 3 -5 7 Z building Ur•pL•, tto I'1i:mbez Solder Certificate on file. ( all permit:: involving plumbing being ' in:;uc<1 after April 1,1989 ) ~VF~~~~C TEL. 7G5-1802 O D,, TO'4Y~N OF SOYJTIIOd.D per. - „ r •N~^~' ~ OFFICE OF BUILDIIQG INSPECTOR ~ ; u~., ; ~ ~ ; P.O. BOX 728 ~ _ ~ c~? -e TOWN HALL %.i SOUTHULD, N.Y. 11971 '~pl r~a y,'i> C E R T I F I CAT I O N Date ~G~.cccerN Z y l9RD Building Permit No. Owner~gy.,(.Iara /~/~oc~ fir' (please print) Plumber {--v~GC vt D~j { (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. 0 (plumber's siyna re) Sworn to before ne this day of 19~, Notary Pu is Notary Public, ounty Mewl mow NMR (IUrNrM1 4~a>~ MN 1ELD I;:.°.:.. .~u;. ~~J,;:~ I~ :;UMMENT~ 1. I ~ C@ c0U17DATI0"7 (1st) ~I c ?OUNDATIO;J (2nd) m o w ~OUGH FRAME & tp, .PLUMBING v, 3. y a y m IIJSULATIOPI PER N. Y. y STATE ENERGY CODE H FI~JAL ADDITIOPIAL COMMEPlTS: m~ x D ~ d QCs P~ v/~o ~~ti.~ ~q ~ a a 30.3a x . ~ t ^o H H N m a • ~ ~ H \ C7 m ^o H r~ e • nor 32 seotn.~eg LQT 3l ~7•d 8vt,~eavtevg iasaua lei yq~ g 3pRU°f rR ~ •~O. ~~••(iSO1D4 S ko of Pii E ~ ~ Kltioa Pva 3uaml.~ada S t3as eq o3 ~~`^p31~ E b~aneq vot:RDO P st43 dq PelDadsgj f; s,/L~-- i~$ns Za3Dn, Pv8 sT43 sod seT3TitJe~ ~ IasodslP a@aass eqy MON. FNO~ .a~^~.~^~ '332I 'Q 'H £8sI ~ y ~SYQ ~ ~ :N3YiS2! 3Q HSZV~y dSN1100 H2O~Igl1S GP ~e'~ O S r• a ~ { h ~~ako • ~ ~ w ~,,;1,~ 3y's f ~ ~ ~gE 4t ~O • fp• 25.p 2 r+3 ~E,6 gt{' Ep. t~0 L ~ 1) 26 9' ~ f•F 20,1 NG ~p V h Y ~ cDB gtE 5 u W 1 •U, r lD `J\\ M N O~5 ''D1 O ~ F~°~ n E s' v Y ~ • N W 'k0 O o O ~ c4 ~ I~ f ~ ~ ~ J . ~ ~ • o ~E ~ ~ Doll' ~ //79.33' Sao Njd°' ~3 c P J E ~E OF NEK, ~ E* S~P~ow.DpN~~T,~ ~O 9 * Q MAP OF- ~ LOT 35 ~ - ~DEEP HOLE CREEK ESTATES" ~~2Se~~AND2`~V~~~yO~ ar MArTirvcK , f _ - ~ , ~ ~ , . _ A~ AS NOTED DATE: ~ B.P. # '3'-~ 7~ NOTI B ILDING DEPART N A7 785-1802 9 AM TO 4 PM FOR THE FpILOWING INSPEC710NS: fly( G~ 1. FOUNDATION - TWO REQUIRED ~ i FOR POURED CONCRETE 2. ROUGH - FRAMING ~ PLUMBING 3. INSULATION j ri. FINAL - CONSTRUCTION MUST ~~®U~ C ~~~jC ~ ~4LLFCpNSTRU 7pN SHALL MEET F GUP Y -111 REQUIREMENTS OF THE N.Y. c,"t~TF CONSTRUCTION $i ENERGY ;'~"~C+ES. NOT RESPONSIBLE FOR ;E4:yN (?R CONSTRUCTIpN ERRORS y`~~ _ _ 96" G~ s,~xm"raat~rs , - 'w" <i&~~or SHea.(4~sO - roo{ sh.y lrs 1 .r 3 p~k~h sF~s 1~'~0.~ I - - v?.~a~ ~ - !lz e~~r~or - - Sltco{i.,,,~ 24~j~~lB~ ceda r skat'v5 X16 it - /oo _ 170o r - ~o"X3~~~ i Ov so" S'vJr ?t~ I S IPI ~"Y8" ressuie IreaCc ~ ~ - nc{nlfla6~~ ~ 84n - - door - - - ~"e - ~ g~ -<< P ---eo~r : ~ Pgo~~~z ~ zsew~,Y Cerre+c{. ~a 1! $I oc~' wal ~8 ib `X 8"SI«Ks~ P - d•:.. ~ ~ - ~~^cfa.{o,-~12~~h 16~W ~'~oureL~ Cev~c v2~C - ~ ~ ~ i AP VED A& NOTED DATE: ~ ©o ~ B.P. # ~~35'? a , NOTIFYVUILDN6 OEPARTM AT 788-t80$ 8 AM TO 4 PM POR THE FOLLOWING INSPEC710NS. 1. FOUNDATION - TWO REQUIRED g~ FOR POURED CONCRETE i~ 2. ROUGH -FRAMING & PLUMBING '6A ~~6~ 3. INSULATION ~p ! A. FINAL - CONSTRUC710N MUST ~ ~ 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHAI.I MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION 8~ ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 4~,,, - ~ ~1~~ 96" ~ <y&~~or S~+ea1 ~~v~ -roof S~ ra ~e5 1 in 2'Y41' _ _ _ _ L~~~ _ ~ S4'-~)S Ib~~o.c ~ - - rior i I ced~+ s4,akP5 ~I " Joo" Ilb ° - _ ~ 17oov-- j ^ II `do"~3Z i i y/~. n-nwo S~ I PI ~"Y8" res ~+e IrrA1r ~ - ~ I nc{.141 ac4.',~~ I - $0~~ - - - ~g" yep ; g~ s4 P $o,~X 32~cQoor - - EhYS.~91-._ eo e+i sk~w~ ,~i~ B~ ~ ~ wall ~ ~O ~ N ~~~G!~ /a If $I oc~' wal l C~ X iE `x 8"BIo~Ks~ s - d.:.,., L ~ - - "~~-~n.{.o,-.l2f~h'K I6 ~w ~~oure~ Cm+c rP'fC BOARD OE HEALTH (IJ/ 3 SETS OF PLANS D " ~ ~ V ~ ~ FORM NO. 1 SURVEY • - • . • • - TOWN OF SOUTHOLD CHECK - - ' ~~~-ZJ(~ BUILDING DEPARTMENT SEPTIC FORM TOWN HALL q4p ~ NOTIFY GI1~` .~3~ OUTHOLD, N.Y. 11971 BGOG. CIEPT. CALL ~ M T~f1WN Q„ F SO,.U7NOLp v TEL.: 765-1802 " " " " " " " ' / MAIL T0: Examined . ~ ..Fj. 19~~1. Approved 19a./..Permit No. ~~`3r!7. Disapproved a/c (B ldingctor) APPLICATION FOR 6USLDQNG PERPv7iT ` Date ~4[E~..G~. ,Jr.~......., 19~R. INSTRUCTIONS a. This 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 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 necessary inspections (Signature of applicant, or name, if a corporation) .:P..o~;3 Q,c . 2~.,. ~k.,N~. r~9;s z.. . (Mailing address of applicant) State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....©lv.`~~~C Name of owner ofdremises ~~tr~cercz.ftti.~.QC?!r' " (as on the tax roll or latest deed) If applicant is a corporation, sigitatuie of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SU FOLK COUNTY LICENSED Builder's License No. --..O%'L-? Plumber's License No. ,i(1. . Electrician's License No. ~ ~!4....... , . Other Trade's License No. ~ . 1. Location of land on which proposed work will be done . . . House Number Street Hamlet County Tax\Map No.'I1000 S/ection ~ Block ~J.......... Lot /.Z . IJ2t~~ fro~e, C:r,e~.~~... ~5'~:~ 5 Filed Map No. ~ Z ~v ~ Subdivision Lot ..:~J , . , , . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~?s ~~:~~d ~ ~,v, , r''~~s 3~~~a+~.aiat , Y~.Ga`3S.5.U4# YF!A . ~L~Sd(A~P.rt'~l~k ~ iirm,~;„;,yzaab".~roi',~~i b. Intended use and occupancy . . c .:''.~`~'rnY.s,;~;t~srz5~~~. . 3. Nature of work check which a 'plicable): New Building Addition Y . 1 Alteration . P Repair Remqval . Demolition ..............Other Wo"rk . I (Description) ~ ~ ` O Fee.......::.._r..•.•:'........................ 4. Estimated Cost ®®s ` (to be paid on filing this application) 5. If dwellin , number of dwellin units N. Number of dwelling units on each floor . /i!~!~......... . g S, If garage, number of cars i .~!~.fj . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..../1~~1~........ • ~ u r r ~r 7. Dimensions of existing structures, if any: Front ~.2 ..3....... Rear ..62:. Depth 2ln ~ . • . Height ../.~..7.:....... Number of Stories ~ . ' Dimensions of same structure with alterations or additions: Front . 7! ~./1.~:......... Rear . Depth . zb !z'; ; z7,' 3 , , , I , ,Height 7. " Number of Stories • . • • r r, ~ „ . Dimensions of entire new construction: Front 9.. Rear ...9.. ~ ........Depth . 6... . Height .9..8..........NumberofStories....! 9. Size of lot: Front !!f,Q~ R ~ . : Rear ~D.~ ~ Depth ~$2tz9' - l,S,6,~,N,', , , , , , 10. Date of Purchase k f Name of Former Owner, .1~-.4a~ ~2s . ~`QO"~~ ' 1 1. Zone ur use district in which pr~;mises are sif.uated ~~(~.yo(D~Sb^rt~. ?f7a 809,- , 7-rn, ~..~~~.~c~(, . 12. Does proposed construction violate any zoning law, ordinance or regulation: /1/,c? . 13. Will lot be regraded , .ya Will excess fill be removed from premises: Yes Nei 14. Name of Owner of premises r>~a.rft... /.~~0!':... Address P<Q•.~4K, z'f6. , ......Phone No. ~y$: 5; ~~3,9, , , . Name of Architect X14 Address ...................Phone No............... . Name of Contractor ..............Address ....:..............Phone No............... 15. Is this ro ert locatedlwithin 300 feet of a tidal wetland? *Yes No P P Y y~ *If yes, Southold Town Trµstees PermitPLO'I' DIAGRAM ed. Locate clearly and distinctly alb buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block's number or description according to deed, and show street names and indicate whether interior or corner lot. I 22 ct'f'{-2~(~.ec{ ~!~S J APPROVEp AS NOTED DATE: B.P, H I FEE: -----~.BY: NOTIFY BUILDING DEPARTMENT AT 7Ab-1802 9 AM TO B PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION 7Wp REQUIRED FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING 3. INSULATION i 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & NERDY CODES. NOT RESPONSIB~ FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW~O~~ I S.S COUNTY OF , ~ y-.~QG( V,7R„~, /~~7D Y-, , g , , , , , , , , , , , , , , , , , being duly sworn, deposes and says that he is the applicant (Name of individual si ~ing contract) above named. 5 ~isthe...~.wY!~.'C' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned 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 manr4er set forth in the application filed therewith. Sworn to before me this W-, ~9 02~r.... .day of 19 !.y'swF.~ Jl' Notary Public, r.~1~ J ~~1'¢?'rc County ~~119~ (Signature of applicant) l ~ ~ ~ 22~ ~0 O I ~~O y~C MSS ~a$ o-c~ ~o~ s3~s ~ N~ ~yy ~ n om~ r?~~ b`'•rn ~'pp ~0°~ CO©~p hmZ ad p 70 = = N N v fF Ui ~ i ~=,v 1 N ~ U ~ t~~ i A ~ ~ .a ~ I ,y. ~ ddd~ N .rt~ ~ °R'~ ~ ~ act ~ ,6 h S g ~ ~ U.~ ~ ~ ~ ~ ~ . F ~ ~ I ~ ~ la 4~r'~ ~ ~ I° ,z _ _ \ 3 3 ~ Qo g~ r~' , ~ ~ S C=~ I~ ~ ~ ~ tl~U ' ~ ~ ~ ~ x ~~i ~ ~ ~ ~ m v ~ ~ ~G~ ~ ~ V o X c1. h N<-d ~ w F ~ k' F i' frZ 22 ~ - /0 i _I 6. n p s_ ]9 7e = _ ~ ~ ~ 8 P ~ 00 ~ ~ ~ ~ _ X d ~ A' d+ U v r ~ ~ ro ~ - - N I ~ ~ ~ s. W N s. c .r, p ~ z~ ~ ~ ~3 I x ~ ~ ~ ~ (s~ x ~--~~f ~ ~ - Ur7i S . ~-~LI ~ I ' ~ ~ ~ ~ s~' ~ ~ ~ cn _ n ~ _ V,Cr` ci. p ° - X bJ r W P g ,~Z z~' ~ ~ ~ d 3 ~ ` e~ M - `Y ~l x U ~ ~ ; 3~ ~ ~ - ~ ~ ~ e iiFi~ x e\ ~ z,-- ~ ~ ~ ~ ~ ~ ~ gg s s 3 $ ~ s ~ ~ ~ ~ ~ 4 b ~ ~ J ~ ~ In ` ~ p ~ ~ a~~~a~~ ~ ~ d O 1 41 ~ ~ ~ ~y- _ 'p 3 ~ ~ ~ ~ M \ ~ ~ p N V ~ t'"7 V _ I i 3 ~ ~ . Os Ly µ Q; - ~ Zz' J BOARD OF HEALTH R 3 SETS OF PLANS ' ~ ' D ~ ~1 L+ FORM N0. 1 SURVEY , .;UL 2 ~ gag ~ TOWN OF SOUTHOLD CHECK • • • - • • BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY ~Q~' ~ 3b'~( Bt.OG.OEPT. SOUTHOLD, N.Y. 11971 CALL T WNOFSOUTHOLD TEL.: 765-1802 MAIL T0: Examined . 19`1, Approved 19a./..Permit No. ~~`3:~. Disapproved a/c .~1~~......,.. (B ldingJ pector) APPLIC/~TIC!N f-DR BUILDING PERI49iT Date ~Ct~~. ~5.~......., 19~'R. INSTRUCTIONS a. This 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 azeas, 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 necessary inspections ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....Q~L~.~.E'~C :.........................p.AA........................................................ Name of owner of premises .~ctr~nr~,A,,/`'I,OC?Y' (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 CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. ~-..Qw'n?!t~ Plumber's License No. 1'9.......... . Electrician's License No. y . Ot]ier Trade's License No. . 1. Location of land on which proposed work will be done . . House Number Street Hamlet County Tax Map NoI.I1000 S//ection < <`c........... Block Lot ~.Z . Subdivision~~~..~le ..4~~ k.. E.5'`ze ~ 5 Filed Map No. ~ 2 Lot ..:~g . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . t"h~tiYV..~ a. Existing use and occupancy ....2?s~~~'~.~.~."• ~ .............~'^~iwt~e, r~.k;~ , , n ~ r; +~frN............ - S ~ a'L' e~ let { e~°muc"; 4 Nu n,iu,hM{rQ b. Intended use and occupancy • . 3. Nature of work (check which app,licable): New Building Addition Y Alteration . Repair Removal Demolition Other 1York . Q (Description) 0~ Fee..............'........................ 4. Estimated Cost . 60 ~ ` (to be paid on filing this application) 5. If dwelline, number of dwelling u' If arage, number of cars nits N. ~ ~ Number of dwelling units on each floor . ~!~A......... . g ~!~9.. 6. If business, commercial or mixed',occupancy, specify nature and extent of each type of use ..../L~~:'~ . 7. Dimensions of existing structures, if any: Front ?C.Z :.3.`.`..... Rear ..6i?,~. Depth 2(c~~, • • • Height f.~ ~ ,7, : Number of Stories ~ , y............ . Dimensions'of same structure with alterations or additions: Front . 7(. J[ Rear ...7J. . Depth . zr; .?7.'3 ; .Height {7.".. ~ Number of Stories . y....... . 8. Dimensions of entire new constn}ction: Front I.. Rear ...7 . ~ Depth . kl.. . Height . 9.. B.......... Numl}er of Stories ! . 9. Size of lot: Front (!fq, o' Rear ..Y9rA................ Depth ;zy ~ - l,SE,~,r! ' , , , , , ] 0. Date of Purchase ' ~ ~ ~ Z X33 Name of Former Owner .l~-..44`.`j.~.`t~ . i1iLQ~`dc~, • • • • • • ] 1. Zone or use districi in which pre~i~ise~ are situated Ss~(Lca~ ~I,ytS;r~f, !f73 8oq,- , Lcq~~f, ,~31C,tJ~'-=.c~! , , , , , , , , , , 12. Does proposed construction violate any zoning law, ordinance or regulation: /(~0 . A, ' Will excess fill be removed from premises: Yes o 13. Will lot be regraded ar,~......... ~ 2.1~'; S;~j,9, , • . , 14. Name of Owner of premises r;~R art... /.1'f ~P!^... Address p<~~. pX. Zit: , , , , , , , ,Phone No. ~ Name of Architect .........~!~.Q ..............Address ...................Phone No............. . Name of Contractor ........4'l~.'~ ..............Address ....:..............Phone No............... . 15. Is this property located cgithin 300 feet of a tidal wetlandl *Yes No .11.. *If yes, Southold Town Trustees Permit ma be required. PLOXI' DIAGRAM ' Locate clearly and distinctly, all '~buIldings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. see u,E~fcce.(ti~cE APPRDVED AS NOTED DATE: B.P. t! FEE: BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 Q AM TO A PM FOR THE FOLLOWING INSPECTIONS: t. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGW -FRAMING & PLUMBING 3, fNSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW O}?j~, COUNTY OF ~'~!-T.~1?/? (I4..... S.S ~Q y-.ba VtR ,~,,Il~l t~D Y-.... ~ . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. is the ...P.wne.'r...........I~, . (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 manned set forth in the application filed therewith. Sworn to before me this ~ &9 02-oY.... .day of!.... ~ wI 19 Notary Public, ;~~~~/l.a'?a-C County ~ICann~rg~ ~ (Signature of applicant) . THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8025242 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date JUNE 18,1991 Application No. anJile 68750990/90 H 022704 THIS CERTIFIES THAT PERMIT N0. 18351Z only [he electrical equipment as described bebw and introduced by the app/icont named on the above application number in the premises of MOOR, THERESA DRIVE, POLE#5/3, MATTITUCK, N.Y. in the following location: ®Baaement ? /st F'l. ? 2nd F'l. OUT Sertion115 6(ork15 Lot 12 was examined art JUNE 13 ,1991 and found to be in contp(iaru•e with the requirements q(this Daard. FI%TURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECK$ OVEN$ OI$H WA$HER$ EXHAUST FAN$ OUTLETS INCANDESCENT RUOPESCENT OTHEH PMT K W AMi K W PMi NW AMi K W AMi H P C 10 6 9 6 4 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CtOCK$ BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi. N. W. OIL H. P. GAS H. P AMT. NO. A W. G AMi. -AMP. AMT. AMPS. TRANS. AMT, H p SYSTEMS qMi WAitS C NO.OF FEET SERVICE 015CONNECT NO.OF S E R V I C E AML. AMP. LtPE EQUIP I .e. 4W t .e 3W 3 9 JW 3,e' 4W NO OF CC COND A W G NO OF HbLEG A G NO OF NEUiftALS A. W G PER b OF CG COND OF HbLEG OF NEUfRAI nRR1VY. " MOTORS:1-F H.P.,1-.50 H.P. G.F.C.I:-4 _ , BARBARA A.MOOR G~~~~ P.O.BOX 246 MATTITUCK, NY, 11952 GENERAL MANAGER 11 ~y Per This certificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.