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HomeMy WebLinkAbout18525-z . , FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildinq Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18795 Date FEBRUARY 14, 1990 THIS CERTIFIES that the building ADDITION Location of Property 1155 SOUNDVIEW ROAD ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 015 Block O3 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 15, 1989 pursuant to which Building Permit No. 18525-Z dated SEPTEMBER 20, 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 REPLACE DECKING WITH ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to JOHN ERRICO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-111221-JANUARY 22, 1990 PLUMBERS CERTIFICATION DATED JAN. 18, 1990-HENRY J. SMITH & SON, INC. Building Inspector Rev. 1/81 roaac xa s TOWN OF SOUTHOLD 6UILDlNG DEPARTbtENT TOWN HAIL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 1~ 5 2 5 Z flare ,.p.7~p.~.1~Y.t!IJe~•Sn.... 19..R..1 Permission is hereby granted to: . ~ ~.!~.....9...~..`~ to ~~~.M4lS~.....s~4R.~.F4:!~lk~ ...:....................~....5:1..1.Q.4~4:IAa....~,A...~!:1.....~1.~'.....~'`-~.....~'-.i!e( ct premises located at 5.....~..S.~~CR-x.1,b............r ...............~t~4..4x~.-............... ....~~R...........l1-Y5:?:l .....1~ County Tax ap No. 1000 Section ......~~.5 Block .......Q.3..... Lot No....y.~ Q~~~ ~ G pursuant to application dated ....Sl1RN1'...~i.....~.5:.........., 19.9..1.., and approved by the Building Inspector. U Fee 5...~~..:.. .C Cif' rid, Building Inspector Rev. 6/30!80 r r TONN OF SOUTIIOLD IIUILDItiG DEPARTt[ELiT TONN IIALL ' SOUTIIOLD, HEN YORK 1197( 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPALICY /~j,'D ~,,//DATE. /.:`I`:..~ . HEN CONSTRUCTION .......0~/LfD OR PRE-EEZ~S~TIti~G~~IItU1ZLDIHG..iC~..((V~ACAtiT LARD........ Location of Property....t:.~~_._.._~~':tiX.v.'":~`.'`~.~~....S~l.~... HOUSE NO. ~ yn_,,,~,S~TREET DAMLET Ovaer or Ovaers of Property.. County Taz Hap No. 1000 Section .V.~.~. Block .V.3... Lo c' Subdivisioa.~it~~. Filed M//a/pq~.7.1.~..Lot.o~~_..... Pcrait No.r~.S.~:~_~.Date of PcrmiC~.i~..y.~C_AppLicanL'.l^:`~:~{:=:_.:'...... Health Dc t. A royal p pp ~[~/~~:~~JJ...._....... Undcrvriters Approval..'T,~':_..___. PLaaniag IIoard Approval fY:l`~'. RequesC for Temporary Certificate Final Certificate Pee SubmiCted: APPLICANT.?~.C~-.... rev- !0/14/88 ~.38g~6~ C~ ~.1 £~7yS HENRY J. SMITH & SON, Inc. PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHDLD, N.Y. 11971 tstsl Tss-assn C_E_R_T_I_F_I_C_A_T_I_O_N_ Date_January 18~_1gQQ__ Building Permit No. 18~SZ Owner John Errico Plumber__Henry_J__Smith_&_Soni_Inc_ I certify that the solder used in the water supply system contains less than 2/10 of 19 lead. l _ Henry P. Smi h Sworn to before me this lRt.h dfly Of .Ta ni~a r~_, ~ " 1999__. __-~~2~c~s~k~~y~~ Notary Public Notary Public, Suffolk County 3ERNAOETTE L. TAPLIN VOTARY PUBLIC X4844893 State at New Yark RaidinH in SuBolk Courrty Curt:^~ssion Expires Sept. 30, I9~ p . THE NEW YORK BOARD OF FIRE UNDERWRITERS I'Arr• ~ 3.001 t1 t l BUREAU OF ELECTRICITY 88 JOHN STREET. NEW YORK, NEWYORK 10038 pore JANUARY '?2,I::)a0 ApplicotionNo.onfile bbA76889/$9 N 11.1'L~:1 THI$ CERTIFIES THAT only the electrkml putpment a ekscrihed below and introduced 6y rho opplicant named on the afAOUa application numMr 7n tM promises of t;RR"CCp, 1.155 SOUNE: Vll*N ROAD, ORl'.lCNT, N.Y. in thefdbwing bcation3 ? Basement ®!st Fl. ? Snd Fl. .Section Block Lot woe a=amined on JANUARY DQ ~ 7.99(1 and found to 6e in compliance with the reyuiroments uJ this Board. RXTIMF ACTK fYllTtallS RXTUEK EANOES COOiaNa DECXS OVENS WABM~S NAUST FANS OUTIETS NCANDElCEM FLV011!!C!m GTNER NAT. K. W. AMi. K. W. NAT. K.W. AMT. R. W. AMT. H. P. 5 8 b ti l F' DRYBlS RINiA07 MOTOES RltttEE AFF1111NCE IEEENt snau XECn iIMEt7.oCKS EEtt UNIT WATtAS. tl11AT1-0UTIlT DIMMlES AMT. K. W. pl X. P. GAS X. r. hNT. NO. A. W. 6. AMT. AIM. AMT. AAVe. TiANS. AMT. M. P. ~ a ~T IJAT. WAITe 7. 10 sNtvlw gftOtlNlCT NO. d S E R V 1 C AMT. AAa. TYP! ~ X tVI 1 X ew e / eVt e x M RR;COND. Ds CC ~ OMD. NO. q NI-lFG ~ ~ WM;~ AM). of Faunws 0 ~HEi;IGiU,l oTMell AF?ARATUS: WZRTNG PpR R(NJM E:X'Tk;. & HA'P[ilU7`T1.-1 .ers~ G & S CfSNTRACTgR 6IG.1578 ROX 'T.15 SpUT$pi,D, NY , 1..7.97 7 ~A~~/ ~ 17 ~V Psr This nrHf7caNnllnt not 6e a1Nnd in any monMr; rNOrn to tM offin of tFn Board if intoned. Inspectors may lea identified their crodsntiols. COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST NOT BE ALTERED NI ANY MANNER. ~s~ ~ TEi..7G5-1E02 ~~jF F OCk 7 = ('Yia~~:~i3~(( :.c.~ Or1'ICIi Ol' i1UILDING iIJSPFCTOR 'r Y.O. U~)i 728 ~U~ ~a~ ~tt~'~; rT, ~ t vo~`~. ° , • i 'Doti, N I I,~~ I. ~`,,yf SOUI'1IOi.U, N... l 1971 ~ j i~i ~'~-„~1~~ January I7, 1990 CHESTER ORLOWSRI BOA 949 CUTCHOGUE, N.Y. 11935 REc JOHN ERRICO To P7}u%m This May Concern, toe arc ana6lc to complete your Ccrtificato ' of Occupancy becau~c of the following reasons. /J?/ An application for Certificate of Occupancy .is not nn fi1o. (ENCLOSED) /:1o Unr.:er:ariters Certificate on file. 'I'!ip check is (cy~u't;ZTlx17~i/not o:i file.) 525.00 1 / I:o Ifealth Cept. Approval on file. .:c~ final in:pect_ion has been made. Ple,tr;e contact our office on this matter. Thank yo~.c for your <;ooperation. Builclinr Pcsmit (I I 8 5 2 S Z Buildinc[ Deft. ***/-r( tto P.L~mher SoLQer Certificate on file. ( all permits involvinc,7 plumbincJ being is:;uc<1 after April 2,19fl4 } - ~ 765-1802 BUILDING DEPT. 1 NSPECTION [ )FOUNDATION 1ST ~ ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ FINAL REMARKS: DATE © INSPECTOR .•_t c_. 1 _ - 1L ~ 1..u V.. IIJn. u:`Jl't Jd l.. ' ~ r m I a 1 ~ ~l c0U17DATZ0:J ~ (15~C) ~ - - I _ c 'OUtiDATIO;J (pn~ m --a - ~ / ` o 30UGH FRAi-1E~iE~ PLUMHI;iG ,~LG N H 3. ~ m n ISSULATIOi1 PER N. Y. ++I `j STATE EPSERCY I CODE y D m 4. y FIIIAL o ADDITIOSIAL COMMEt1T5: x M ' x ro• H 9 . ~ H O • m • r -9 O m - - ^v .-3 _ ~ . MILLWORK CORP. 75 N. INDUSTRY COURT /J Come home to uali DEER PARK, N. Y. 11729 ~ l Windmva~PatioDeas COmehomeLOAndelseB. PHONE 516-667.6700 ~/,(_,~1_-t~~C~.~~~p „ ,~}n~M ~ n,t ~ DATE JOB ~ jil i _ ~ I i ~ 1 i 1 I I ~ i I~ 7 I_ ~ i i o+ i~~ i I ~ rt- i 1--~~ ~~-T ~ I_ _E_ ~ , r _I_-i-rt-= T ~ 4 _ ~ a ~ r I _ r- -j - . r ~ -t _ 1- ` T - ~ ~_1_ ~ _ 1 _ _ ~ ! 1._ ~ _ I ' , ' { ~ ~ j , I - _ _ , _ ,_.~_s_,~__-_ i_~._ f_~ - - - { - ~ ~ I ~ I ~ ~ ~ C ~ 7- f ~ I 1 I w ~ ~ j ~ ~ _ ~ y ~ 1 ~ ~ -i i ~ M I f - p - ~ - ~ ~ 4 i - ~ ~ _ ~ i _ _ i I ~ -i--1 ~I p~ ~ r I ! I ~ ~ r i i { I ~ I I__ i ~ I I.. I I I ` ~ i t _l. G _I _ ~ 1 r i i_~ a. ~ _ I ~ t _ i i ~ -t 1 [ I _ _ _ ~ 7 r ~ ~ t _I r _ _ - l i, ~ 1 1 i I I 1 I ~ I t i ~ E I t F ~ ~ i ~ ! - ~ i ~ I ~ ~ 1 E~ ( ~ I i I r i l j ~ l~ I ~ ~ I I ~ L_~_.~_.~..~_!_ 1 4 I A ~ I I l 1_~ I i I f -~--I ~ I I i 1 i~ ~ I I i, I 1 1 ~ I r _{_._I_ i_ ~ ~ i .L i _f_ ~ _r_~ .j_~ i__lli_ ~ t I ANI)ERSEN® ['ERMA-SHIELD® ;WINDOWS & PATIO DOORS- FOR COMMERCIAL & INSTITUTIONAL! t" ti ` ' ~~+'L ~ I ~ISn''IV~(Otll1lLI.bN1 ?'IVla~i1WW0~ 1~Ud sugoa 01~4W 1P sMtxINIM ~anaies•vwa• a ,Nasaac~NVI f ~ I I i , I I j ~ ! I f ~ I I I I I ~ I ~ I ~ ' tF _ f` i i j f f U 1 I I I i ~ i f i I ~ I I I I ' i ! I I i ! I I t I ~ I I 1t'- I I t _ , I I ~ i I ~ i I i i ~ ~ ( ~ _ I -t a ' ~ I I i~ I 1 ~ I I ~ i ~ I; cr ~ l f .I ~ I - _ I I ~ I ~ I ~ ; . I I~ I I1~~ / ~ j r ' I, i I ill I1I - ~ 1I a I I 1 _ . - I i j i I 1 I ~ ~ I I 1 ~ ~ i I I I ~ I ~ ~ I I I I ~ ' - i ~ I I i ~ i! "1 ~I I ~ . ~ T:1-~' I I I I I~~~ ~ I , ~I ~ ~Ki I I~ - -j- f I ` ~~`,r 1 I ~ ( ISI ~ ~ I i I ~ _ *"-1 , ~ I I ~ I i I ~ ' I ~ I ~ I r i ~ , I ~ ~ .j I I I I f I I I i- i i i ,7 is 8 I ~ I - 4. I ~ I I I , ~ ~ ~ ~ ~ i , I. i ~ - ~ r I i y~;+- ~ { , I I I ' I ~ I , `J11` I , I. ~ I I I I I I I I j] r'~1~ ~ I A J ~ ' ~ ~ I ' I ~ ' ~ ~ I ~ ~ ~ I I I i ' ~ I f; 4 ~I I ~ _ i l I ~i. I I r ~ 4 I j ~ I I I I i I i 1 I I I i' i I I ~ I I I ~ I I I , ~ I ~ ~ I I I ~ ( I I I I I ' I i I I ( i I I - YQf 9.r.`.:e ~ 765-1802 BUILDING DEPT. INSPECTION [ ]~F UNDATION 1ST [ ] ROUGH PLBG. [ ~,~OUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ DATE 'd INSPECTOR v - ILLWORK CORP. ~ 75 N. INDUSTRY COURT Comehometo 11311 DEER PARK, N.Y. 11729 w~:~r'~a~ Come hometo Ander eD. PH E 516-667-6700 DATE " ' - " - - JOB ( 1'1 D f ~ i ~ i , 1 I ~'°a-1 t ` t V NI ~ , ~ ' i ,13 i , _ , fry- _ I i I 1 ~ I I ~ I , ( f 1 i i I ~ ! ~ ~ I I ~ , I i I i ` ~i _ ~ I ~ i ~ . i i 11 ~ ~ _ ~ U ~ I , (p.~~~ ~ ~ - ~ i t y ~ ~ ~ ? I I i ~I I ~ , ~ ~ i _ , i ~ ~ i ~ i. J , ~ I I ~iANtiERSEN® P1;RMA-SHIELD® ~'WIP(DOWS & PA'C[O DOORS'. FOR COMh~ERG~IAL & FNSTITUTIO$iAL'~:l' r_,~°= ! ~sn vrytoi,>onlr~s>va M ~iviyr;rtWw4~ dud sy o~lw sMOUNiM .a~aius~vsva~t .xatduagrn+ i i ~i^~'° i ~ t it I , ~ I i I I I I ' i ~ i ~ l l! I I I I~ I ~ I I I ~ , r i~ f ~ ~ ~ ~ I I i `~•-Y' .tom ~ ~ ~ ~ ~ i ~ I I~ i F ~ i I i ~ I i I~ f i ~ I i~ ~ I I. I i i i ~ I I ' ~ I ~ ~ f I ' I j! I I I I ,I I I ' I i~ I_~i ~ i r i~ I I I I I I I N . ~ + I I f ~ r . ~ C. ~ 1 I ~ I ~ I 1 ~ I I t I f I l i i ~ ~ ~ I ~ $ _ d i Vii' ~ I. j I ~ i r. ~ ~ ~ ~ i I i ~ I I I i _ - - C~~ FORM N0.4 TOWN OF SOUTHOLD BUiI_DING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...~r~Q~.~'~.. , oats .....9~t~~~~. ~.Q~ . . 19 .<.~A THI5CF:R'fIF^tliSthatS5thehuildin{{ iocation of Prt)party kuwiNc . SAl3ttd1?~.@W. RA$4R.... Simi , ' •Or~.Eirltr. IZ.Y., 'iJimltr County Tax Map No. 10(1[1 Section ..01$ ......Block p~..... , ....Lot A~4, . . Subdivision ..Qi',t.®r}~, aY..Thi~. ,$~P.........FUed Map No. .79.7, ..Lot No. ...~9........ conforms aubstantiully to the Application for Building Permit t~oretofure filed in this office dated ,~NT>,S , ~ , , . , , 151 ,QQpursuant to which BuUdio4 Permit No, . , ..1Q732..z , dated .....~4tt~f? 'l3 . . . . . . . . 14 ,$Q , was isauad, and cwtfurms to a4 of the requirements of the applicable prowswns of the law. Tito occupancy for wWch this certificate is issued li . , , . ......Deck Addition .to Exlstin$ Dwallin~ . . . . The certiftcate is Issued to . , John. F.rrico. , . , lawni~iiL~43~ . . of the aforesaid buildinu, Suffolk County t)c{tarbnent of t#ealttt Approval , . , . , , , N/R UNDEttWRiTERS Ctat"[IFICATE NO . . . . N/R.............................. . Building Inspector Itw 4/7f r - FORM Np. B TOWN OF SOUTHOLD Building Department Town ell Southold, N.Y. 11®71 APPLICATION FOR CERTIFICATE OF OCCUPANCY inaruations ' A. This epplicaifon must txr filled in typewriter OR ink, end submitted in dupllcan to the Building Inspec- tor with the following; for new buildings or new use: S. Final survey of property with accurate lacstion of elf buildings, property Ifnes, struts, and unused natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S•8 form or equrl). 3. Approval of electrical installation frorn Board of Flra Underwriters. 4. Commercial buildings, Industrial buildings, Multipb Rnidences and similar buildings and 9nstalis tians, a certificate of Coda campliana from the Architect or Enginwr nspondble for the buiidtng. 6. Submit Planning Board approval of complead site plan requir:menu when appNceble. - B. For existing bulirlings (prior to April 18671, roon•aonforminp uses, or ltuUdinga awir'IKing" land uws: t. Accuratr survey of peopersy showing all property Ifneb strrau, buildings and unusual nsturai ar topographic factures. 2. Sworn statermnt of owner ar previous owner as fo use, occupancy and condition of buiWings. 3. Den of any housing cede or ufety inspection of buildings or premiss, or other pertiMnt Informs lion required to prepare a certiticen. C, Fees: t. Certificate of occupancy 56.00 2. Certifican of occupancy on pre•exlsting dwelling or land use 55.00 3. Copy of certificate of occupancy 51.00 Date ..iq.~r~.......... New Building ~ . , , .Old or Pre•existin Builds ~ VadYnt Land . . g ng Location of Property , .,SUt 6t~ ~.E.yJ... . • .....p,rQ/,~•~• r ff sStr ,Namer Owner ar Owners of Praparty , e-wrp,y~rl...,~ . . . . County Tax Map No, 1000 Sactlon . Q./.,S Block ....tJ. ~ , Lot „p.,rf/ Subdivialon .,.,,;~,.PiledMaRNo..n,;..~-.,...,. Permit No~~. ~ j;}, ,,~eN of Permit r/~~.ppllcant ~--s, ,Q'p~,G • • J^, ..~jyfu,~,~ . Health papt. Approval.., ..........Labor paps. Approve! / , . Undarwrinrs Approval , . ,G .Y, ,1~ . .Planning Board Approval , , . Request for Temporary~Gartlfi//c~~ata . . . ..Find Certificate .......1,~.. , . Fee Submitted S ?.Rif .sr' . . . Gonstruction on abavr dascrtbed kxtildlnp end p It meets all ep cable codas and regulationR Applicant ;/dhC/G • ~~idl~~-+-~-- w«. to•toaa I 4G r~ a / h s ~ Ander~se~lr STURTEVANT MILLWORK CORP. 76 N. INDUSTRY COURT wwv..•var»... C(MiICIlO111CWgU~lllx DPHONE 610•tl 70700 C.OIIICIWRIC IDAIIdCnuL DATE JOB I I I ~ i ,-i ~ I j I I } I i f ~ I ~I - I ~ " i t ~ J j ! ~ I ~ r j' ~ ! ~ ~ ~ ~..rl~ I ~ i I I ~ ~ l~ ~ I ~ I I I ~ I I ry I { I ~ ~ I `N, 1 S `I " ` ~ } I ~ ~ I; I i~ f i f I i - I 1 I ~ t 1' f u~ j ~ I ~ I I ~ ~ I ~ I~ . ~,~~I r,1j I ~ I I P~' ~ ~CI" j 1~~ ~ I~+.4'" ~ ~ ~ ~ ~ j I YStG tAY R~ 1 I ~ j I ~Lx ~ ! ~ ~ ' ~ i ~WtTN~10 G t~' C E ~ ' pis. w;vN`~ Nk c ~ ' 0{~ P K I ' 1 " .~f~ f'x~ ~ ~ I i ~ ~ APPROVE A~ ~ I 1 , E N E I ~ .sx;,,T,(i G " ~ i DATE: ~'0 " B.P H S f ~l { r ~!,"y " ' FEE• SQ • I B i , (j_,~ I f ._.,.,,_,,.,.~y.-....~p_.,-..-.d ~ NOTIFY BUILDINC4 D~PA E AT ' ~ ~t~" 'j~ t~dr " ~ I i 785•tr~2 9 AM !TO P R ~THfi ~ _Q,,,,,d ~ ~ U, J~~(i _ ~ ,i ~ FOLLOWING INISPIE ON I I I ~,,.O.,S. y ~tc^?`' I 1. fOUNDATibN ~RE~3UI~2Eq ' `i'rl.{'a-µ 9»°~X Qa..+,..F,••+~_ " ~ FOR POURED~7n-N R ~ E I I tir ~ ' ~1, ~ 2. ROUGk - ~RAMBN~i PLr1MBINt,~ , I i ~ 3.INSULATiOki t I ! i ~ ~ i " " I I I I q. FINAL - COr U M ST i I ~ ~ ~ ' ~ ~ I li " i I 4 1 i i i i - ~ f ~ , I i I ' II ~ ~ THE REQUIREWI 'N.Y~ l I ~ ! ~ I ~ suTE CON I ! cdoES. ~Ot w ~ ti r ~ " ' i ~ l I ~ DESKiN OA ' ~ ~ ~ ~ i ~ _ REQUiRRR~f IGyTE , ' ~ j I ~ ! l ; j ANUkKSEN• PkKM1iA•S IBLU• WINWWS dt< PKC1U UUUKS H'O~i CpMMEKCIAL 7k iNST.JTUTIOMAL~US6 j I h .r c , . a Ande~rr STURTEVANT MILLWC7RK 'CC?RP. 76 N. INDUSTRY COURT CORlC~IOIDl,tO y,, DEER PARK, N.Y. 117?4 Mado~~. PNla ~b.n r.Oi1C ~lO01C l10l~1lCkYI`•rCll• PHONE 616.8876700 DATE dDE _ - I ( I I I~~ ; ~ I I ~ ~ t ~ s., , ` I I I I I ~ ~ ~ _ I, i i ~i~' i ~ ~ I i I ! ~ , I ; j I ; I { i ~ I t I { I i ~ { ~ I ~ t { ; I I I I I i i .2~s~ i i I j 1 ~ _ t I I ~ i I I ( I I I t I I ~ ~ I i I ! i ~ I t ! ! I ~I I t ~ I I { f I t I ` 1 t . 1 1 I I t I is ~ J ~ t ~ ..j t j-._ , ~ ~ , „t ~ ~ I I i~; ~ j~ ~ j I . ! ! i ~ { ( ~ ~I ~ i I I j i` !~I i t I i I ~ I I ` i 1 ~ II ~ I ~ Y'~ ! i ~ ~ ~ ~ ~ ~ ~ I i i ~ ~ I ~ ~ I I~ ~ t ( ~ I ,L. 1 i I I I 1 , ~ ~ ~ ~ I ~ t I { I j~~ i I I ~ t { ~ I ~ i i t ; t I I ( ; t I ~ ~ ( p `ter .~"'~t, I ~ I + ! ; t 1 ' 1 j j ~ h~ I ' t I I ~ I F ~ t I I f If i ~ 1 ~ t ~ r~, , y I ~ I r ( 1 t { ~ jAND6 ENS P~RI1~A•eMIR.LD~ wINDO1VS ~ rAT~o Donne rok caMMKNdiAi, k iNeT>:TV1'tOWAL Uet BOARD OF HEALTH , C~ avu~ '1 ~ 3 SETS OF P,ryANS . ' ' FORM NO. 1 SURVEY ~M1 b I S 19Bg TOWN OF SOUTHOLD CHECK J? - BUILDING DEPARTMENT SEPTIC FORM BLOC. DEFT. ~ TOWN HALL T01NN OF SOUTHOLq SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL q MAIL T0: Examined ~~J~!: t~,~~., 19 ~.1 Approvedo~ ~v~W! L~.., 19~~. Permit No. j. $ a~!Z~. Disapproved a/c ...,~.~0-.t : . ' (Building Inspector) ' APPLICATION FOR BUILDING PERMIT * Date 19~J.. INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, will 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 stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app 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 per 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 Ce tificate of ccupai 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ .,.The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspectit/S s. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State w}retlrer ~ap~pl~icaQnt/is2ow-n~egr, lessee, agent, architect, engineer, general contractor, electrician, plumber or build r Name of owner of premises ..~~c-~!W .~C~~i1.u.-.4~.'T . 1 (as on the tax roll or latest deed) If applicant is a corpoxation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. ~..~rj.~........ . Plumber's License No. ~ ~F,. t . Electrician's License No. ~ .k Other Trade's License No . . 1. Location of land on which proposed work will be done. .UU.>...~. j l.J~, House Number Street f Hamlet County Tax Map No. 1000 Section ..-;j. b. l Block . D..,'y Lot ...~...~T.... . Subdivision .l• "t~¢.',}~-.......... Filed Map No. ~ Lot t! . (Name ) 2. State existing use and occupancy of premises a~'}nd intended use a/nd occupancy of proposed construction: a. Existing use and occupancy ....~C-ff:~J~k. t'.''!.!??".~~n:" . b. Intended use and occupancy J.. ~a-!Z~..C.'-. 4.11-!L4'Yt^^~',^!Lc~c'?~;-, ^ . . 3. Nature'of work (check which applicable): New Building Addition x...... Alteration . Repair : • . • Removal . Demolition Other 1V i.. . tY ~ 4~ (~pSion; 4. Estimated Cost ~ err! Fee . S o . cN . (to be paid on Piling this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars - . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of us0 ` . 7. Dimensions of existing structures, if any: Front :'~:5'...... ,Rear ~ S.......,... D_ epah l .z.~'....... . Height Sf. j......... Number of Stories ...j ~ ~ . Dimensions'of same structure with alterations or additions: Front ...7 Rear d~.......... . Depth 3.2t'. ~ ..............Height 1.&'................ Number of Stories ! y.............. . 8. Dimensions of entire new construction: Front Rear Depth . Height ..........:.....Number of Stories P.......... , . 9. Size of lot: Front P'u . ~ Rear , . , De th G a • • ]0. Date of Purchase ..la-1~~.3z~r.~`1,•~l.......... .Na eirl of~rmerOwner ~'r3~y.?~.~?~-....... 1 I . Zone or use district in which premises are situated . ~,~e~.1a . 12. Does proposed construction violate any zoning Iaw, ordinance or regulation: .l:ti.v-., . 13. Will ]ot be regraded 4zv-.., ...................Will excess fill be removed from premises: es' i 14. Name of Owner of premises ~yr.... Address L?S'S Ss~' I~.+!:~! ~ .Phone No 3~a.: h$ .Y.G, . . Name of Architect ...........................Address ...................Phone No............. . Name of Contractor .C,L.~e.~'.4`%nQ.rwsl~; .......Address ::Phone No.'7.3.y.-.4 7b: Z. 15. Is this property located within 300 feet of a tggiuudal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO'1'DIAGRAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frc property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lotp. -q-' ~l .,t,ti..~.q.,,vv^- .i,~ ~ (2.f"' ''~'~'-'`^'-e.7 ,~+^-e.i~a-.ee~ _ K rl-w! ~ t<- '1-s~ ~ + v ~ r3 STATE OF NEW YORK, G COUNT..... S.S (J~j.. ~ 1 h.. `~Cr-~,~:-w. ~ being duly sworn, deposes and says that he is the applica (Name of individual signing contract) above named. ]ieisthe....~er~rXJl..~ (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 rile t] application; that all statements contained in this application are true to the best of his knowledge and belief; and that t work will be performed in the manner set forth in the application riled therewith. Swom to before me this p ...............(~7........day ofy~...((~~} 149.1 Notary Public, ........J.I[.GGr<l..71.•.11~L.~/1.L_.... County HF1EN K. DE VOE NoTA,RYPtIBttC,sptaofMewYak (Signature of applicar Na. 47f1787& Suffolk CaaMy Term Expires klzrch 30,191