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HomeMy WebLinkAbout18053-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218895 Date MARCH 14, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 60435 MAIN ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 056 Block 03 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1989 pursuant to which Building Permit No. 180532 dated APRIL 19, 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 CONVERT POTATO STORAGE STRUCTIIRE TO ONE FAMILY DWELLING. The certificate is issued to MICHAEL THOMAS FRAxrrn (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 85-SO-38 MARCH 8, 1990 UNDERWRTTERS CERTIFICATE NO. H008876 APRTL 5, 1989 PLUMBERS CERTIFICATION DATED MICHAEL T. FRANKS MARCH 20, 1989 REPLACES B.P. #143432 uilding Inspector Rev. 1/81 R ~ rossz xa s TOWN OF SOUTHOLD fEU1LDlNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. 6UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_ Date .......~~~k')~.~rtrf....../.~ 19.$..l ° 18053 Z U Permission is hereby granted to: , ..Sa.~. `~.~5:....~'1.~...~ to u......,.....nc~ at premises located at ..~T~..`'}..~?.5.......M°::^:-...F.::~1 ...............S~~t:B-<;4!?Q~................ County Tox Map No 1000 Section .\..,..-E?~~na.. Block ........~..~......gLot No. pursuant to application dated . ~ ~ 19 L., and approved by the Building Inspector. lV\ Fee +~.~~5..:.~. /t,ll ".4 Building Inspector Rev. 6/30/80 K aosas 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°_ 14343 Z Date ....~.c~...~ 19~ Permission is hereby granted to: .l..~ ~ ~......ca.~...~.!~ `~......,...~-o .............................~p of premises located at ...~a. ........~~.:.........~.Q~4~ County Tax Map No. 1000 Section ....Q..kti.~... Block .....Q.l~i........ Lot No.....~..z":........... pursuant to application dated . 19.`.ZT~I~., and approved by the Building Ins/pector. Fee 5..42.11!.`.4 :4 D.. Building Inspector Rev 6/30/80 v ti TOWN OF SOUTHOLD ~ m ld ~ BUILDING DEPARTMENT p~ ~ . ? it-~ TOWN HALL af-, ~ ?i~jl S OII T II OL D, N E W YORK 1 19 7 1 = ~ ~ C 765 - 1802 0 ~ "1 ~ "`1~ 3 , APPLICATION FOR CERTIFICATE OF OCCIIPANCY "=.3 2 Z6 DATE NEW CONSTRUCTION ..~...OffL,,,,D OR PRE-E%ISTING BIIILDy]ING......VACrA/NT/LAND./....... Location of Property.....4'~~3.~ „~,~,~N .~'...~9L1,'1_kbL~ 7(J1CG~ ..~1~7%.. HOUSE NO.~~//}}''~~ ~ STREET HAMLET Owner or Owners of Property.. !:'~C,~l~ ~nOWtrLS ~fL~LU~ t,~. County Taa Map No. 1000 Sectioa .J Block Lot ~ y..... Subdivision. o_.......... nu.> - % gQ 5 3 - Z o,a f~ `~3- - /9~~j UY1~~14t,L• ~z~4r~l~/~ Permit No. ...3...~ Date of Permit .L...../...Applicant / HealCh Dept. Approval ~S_~..~_._.... Underwriters Approval {~.ao ~ ~h Planning Board Approval ...JY Request for Temporary Certificate Final Certificate Fee Submitted: ~ APPLICANT. Jr~L- `L.~~J~4~r. • . - - • - - - . . l~ 4-L 3 ~ ~ Cb zlSrY`/s 3/. ~/ya rev. 10/14/88 TEL. 765-1802 0 5~~~~~CO~ TOWN OF SOYJTHOd,D ~c OFFICE OF BUILDING INSPECTOR P.O BOX 728 0 ' '^c TOWN HALL ' ~~~~L/ ~U ~,`~~a"`~", 1 ~o'T SOUTHOLD, N Y. ] 1971 ~R ; ~;i ~l ~ ~ FEB 1 319 C E R T I F I C A T I O N Date J(~u Building,-,IIP,e''rlImit No. ~~~7 / - Z Owner_~~II.Y`I~il- ~ (~p11~e7ase print} 1Kc Plumber ~~~Ilit~lwz~-~ ~~I~C. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ` (plumber's signature) Sworn to before me tnhis .~r~ day of tiNU ,.r~l~- J (~v ~D~_ 19~. Notary Public Notary Public, County NOTARY P 9kIC, Sh eYo tdew Ywk Na 47W878, SU4W(k Cou Term Expires Morch 30.1 F1FLD INSPECTION llATE ~ur,r,u,,.., 1. a~ ~ H FOUNDATION (1st) a c FOUNDATION i2nd) ~ 2. z 0 Y,000H FRAME & ~ Q ,~'.UT/G GIB PLUMBING ~ ~ 1~r rir~> y 3. ~ m INSULATION PER N. Y. 'j STATE ENERGY UI~J ~ ~ CODE /9'O'/~T ~ ~2nyr D ~ ~ iCi c7 ,3`G~ 7 b y tiV r 4. ~ ~ H , FINAL e--,,. , , (~~y7 f d RJr ILL O z ADDITIONAL COMMENTS: ~f 3 G/_ x ro H a H O ~ 7 _ t~ r = i ~ / G~ e~- - .cs •ti ,3/iY/yG ~~fL 6.<-L. iut<.~ J~ cd~tla- ldP.tpz ~G.~.~- . j - oc~pEFOLk~o VICTOR LESSARD ~ < Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR ~ 1~ P O Box 1 179 (516) 765-1802 ~ Southold, New York 1 197 ] FAX (516) 765-1823 VDi~o~ ~aDo~ ''77 V r OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD March 14, 1989 Mr. Michael T. Franke 60435 Route 25 Southold, New York 11971 Re: Building Permit #14343-Z Tax Map #56-3-12 Dear Mr. Franke: During a review of our files, it was noted that the above building permit has expired, and a Certificate of Occupancy has not been issued. According to the Code of the Town of Southold Article XXVIII 100-281 and 100-284 a building permit is needed far construction of an addition to an existing dwelling. It is unlawful to occupy a dwelling until a Certificate of Occupancy has been issued. In order to avoid any legal action you must correct the above violation immediately. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Vincent R. W3.eczorek Ordinance Inspector VRW:gar FORpt NO v TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ' ORDER TO REMEDY VIOLAT[ON Date September 13 19 89 . Michael T.. Franke,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, TO (owner or authorized agent of owner) 60435,.Main Road, Rte 25: Southold, NY 11971 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there ex+sts a violation of Zoning Ordnance Cha~ter.100 Other Appl+cable Laws, Ordinances or Regulot+ons at prem+ses here+nafter described in that A DECK ADDITION HAS BEEN CONSTRUCTED (state character of v+a(at+on) WITHOUT OBTAINING A BUILDING PERMIT . . +n v+olat+on of „ARTICLE XXVIII CHAPTER 281 (State sect+on or paragraph of appl+coble law, ordnance or regulotionl YOU ARE THEREFORE DIRECTED AND ORDERED to comply w+th the low and to remedy the conditions above ment+oned IMMEDIATELY The prem+ses to which this ORDER TO REMEDY VIOLATION refers are situated at 60435.Main,Road}„Southoldr ..............................County of Suffolk, New York SUFFOLK COUNTY TAR MAP 7i 1000-56-03-12 Fa+lure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or +mprisonment or both ~~GtC~!li..c~J (Cert.) ORDINANCE INSP4 Vincent R. Wieczorek ,,,.__.~.__T___,s.9E,s~„E~,,,~-..-.~. ~ i.;. t TER~'T'~'__.:5.."ff""T ~y** ' a ..1'14^. i;. t,`t i i o ' ; ~ f•) (~a~a„ ~ - ,'`r~• „off s.,5 ^ J na i I I ~ h , ,G / ui C; (i( % V i C~ / / ~ r. i ' / ' ~ ~ . •.i ~ r ~ c~.. ^ - r.rr. I : t 1 ~ P~ 4 ~ fl: ~ ' 4j J fAIH: ~ ~ . - WQIr6 Yl.~):~•~~ Jrdl Ave v . iG%" y~/ ~ ~i~ '~J Lip`' . - A i ~ l.. - ,ti- ~•y I - ~ t ~ ~ - _ - ~~J8~3~ ~ ~ .f 7 ~ ik ~ 6 ~ -E-i~/rr Arc" /H t~t^.4•~ AYT~ fG' ~~tp { ~ f"~ ir~cort a~cr lE'vr~l. ~ i . •r - - - iEDYNt 1051 N0415 ~ ~ - l 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. (]FOUNDATION 2ND ( ]INSULATION [ ]FRAMING ~NAL REMARKS: C 02 X 3-~ DATE ~ ~ INSPECTOR ~ ~fj ~f3 ass-isoz BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ~ ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL ~D REMARKS: ~ /d _ ~ ~ 3 . DATE INSPECTOR ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION !ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ INSULATION [ ]FRAMING ]FINAL REMARKS: ~ y ~ ` ~ c ~s ' ~ ,~1 L ~ s i ~ .P s P2~k'~'owt e~/ i.~o o w 0< S~2~t~ce~ ~6~P : /I,c~r ,~l~y.e p,e~~,o~vd~G e 1 5 ~'i I` id'cl ~ DATE z ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION FRAMING ~ [ ]FINAL 1~~~ ~s~~~~ ~ . C~ ~ ~ .~jvs~ L~rlr h'~~~¢c~d DATE ~3 Cf~ INSPECTORS 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ROUGH PLBG. [ ] FOUNDATION 2ND ] INSULATION FRAMING [ ]FINAL R(EMAR_KS: C ~ O y~ ~ d! ~R~ W! I SAS I`4~ D . ~d~r~ ~wt~ ~ cTj DATE ~ INSPECTOR v'3L ~i THE NEW YORK BOARD OF FIRE UNDERWRITERS PABE 1 8410903 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 70038 APRIL 05,1989 / 39597866f8b k 406876 Date A°a(iep~i°~6'°• i4~'~32 THI$ CERTIFIES THAT F'EYi11l 1V only the eMetrkd equipment v dacrihed 6elote and introduced by the applkont notrtsd on the above appBwtton numhsr in the prarrtises of MICHAEL T. FRANKE, MRIN RtlAO, PQLEM817, SOUTHtlLD, N. Y. in eheJdlotetnR hx nt ~ IAt Fl. ? Pnd F1. .Sertiort b Blue K/' Lot 12 Kese e:amirKed un andfound to he in wmplience Trith the requirements of this Board. , RRTUEE ACIEf fYT1TCNK lIXT RANWf COONh10 DECKS S qSN T AIS DDTIRE ttuwxscltn rluaattenT OTHER AMT. K. W. AMT. K. W. MAT. K.W. NAT. K. W. AMT. H. r. 48 2 35 27 21 2 F DRYERS RNNAC! MOTORS IUTW ARUAttn IEEDEIK srEUU ElC~T tweCLOCKS Ext UNIT ttuTxs tA1NTt.0UT1ET gMMERS AMT. K. W. pl N. r. OAt N. r. AMT. tq. A. W. c. AMT. AMr. AMT: AMr3. TEANE. AMT. M. r. ~ 1 AMT. WATTE F 1 30 3 644 E® SERVICR DISCONNECT tq.OT S E R V 1 C E AMT. AAa. Trv! p~jRr, i ~r aw t ? eve t ~ rM t w Ave ~icecoNO. a Zcgiro. ta. a w.tt° a~w~ttco «o. ar teunAts of ~t a ~iia 1 200 CB t X 1 4/0 1 10 OTINE A/IAE/1TUS: B. F. C,1:'2 5Mt7KE DETECTtlR:-1 do~ MICHAEL T. FRANKE 1325 tlAK DR14E SUUTHOLD, NY, 11971 W11/ HOER 11 Psr This prtificaes mutt not be olhred in any mamror; return to tln offiu of tfr Board if incorrect. Itupsctort ba idethMied entialt. COPY POR NIILDIWC DEPARTMENT. THIS DOPY OF CERTIFIGTE MIKT NOT dE ALTERED IN ANY MANNER. ~D ~ caMr~~ FORM NO. 1 i TOWN OF SOUTHOLD ~ ~ S~ BUILDING DEPARTMENT I+ TOWN HALL (J ROUTHOLD, N.Y 11971 TOWNLUF SOUTHOLD TEL 765.1802 ct..,S~.w.~ / 8 o S3~ Examined4 ~ , 19~ Received..~.,.^..,~..... , 19.. Approved 4 ~ , 19a'~ Permit N~-~-~V~ ~ ~C Disapproved aJc N~ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ Date . l . 19 G~~ INSTRUCTIONS a. This apphcatron must be completely filled in by typewnter or m ink and submrtted to the Building Inspector, wrth sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing locarion of lot and of buildings on premises, relationship to adjoining premrses or pubhc street or areas, and giving a detazled descnphon of layout of property must be drawn on the dragram which rs part of this appli catron. c. The work covered by this apphcatron may not be commenced before rssuance of Building Permit d Upon approval of this apphcatron, the Building Inspector will rssued a Building Permit to the apphcant Such perms shall be kept on the premises available for inspectron throughout the work. e No building shall be occupied or used rn whole or m part for any purpose whatever until a Certificate of Occupanc; shall have been granted by the Burldrng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permrt pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demohtron, as herein descnbed The apphcant agrees to comply with all apphcable laws, ordinanceses, buil~~srng cod~~gulatrons, and tc admrt authonzed inspectors on premises and in building for necessary xr s. (Signature of applicant, or name, ~f a corporation) ~3a s~ o~.k i~,e,-de ~o(,l~c~/~ iii (Mazlrng address of apphcant) State whether apphcant rs owner, lessee, ag nt, architect, engineer, general contractor, electrrcran, plumber or builder. . Name of owner of premises ? . (as on the tax roll or latest deed) If apphcant rs a corporation, signature of duly authorized officer (Name and title of corp(~or/ate officer) / Builder's License No .~2.\~l / Plumber's License No ~ u Electrician's Lrcense No Other Trade's License No 1 Location of land on which proposed work will be done ~~~"t f House Numbelr Street Hamlet ~ ii County Tax Map No 1000 Section `S ~ Block 3 Lot . ..t. Subdrvrsion ~~Z~-' Filed Map No Lot . (Name) 2 State existing use and occupancy of pre1nuses and intelnded use and occupancy of proposed construction a Existing use and occupancy ~~k~~~~ ~-~~ct~ . . . . . . ~ / . b Intended use and occupancy DNS I~ ~~i Wl ~ ~ll p~(S! CI(6tL~,~~fi° t V 1 3 Nature of work (check which applicable) New Building Addition Alteration . Repair Removal Demolition .Other Work / (Description) Fee 4 Estimated Cost " Q~~' ~ ' (to be paid on filing thzs application) 5 If dwelling, number of dwelling units ~ . I~lumber of dwelling units on each floor , . If gazage, number of cars ~ . 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use . , ~ . 7. Dunensions of existing structures, if any Front .Rear .3 ~ Depth ~ ~ . Height Number of Stones ~'2.- . . ..7.......... Dimensions of same structure with alterations or ad rtions Front z.. Rear . Depth .:.R . Height . ~ Z Number of Stories . 8. Dimensions of entire new constniction• Front ~ Z-. .Rear ~z . Depth S`~. . Height /7r~ . Number of Stones ~ p 9 Size of lot. Front 1. ~ ~ Reaz . C . De th, . ~ C 10 Date of Purchase ~`JFS ..Name of Former Owner ~j~11 t' iIT ~ : . 1 1. Zone or use district m which premises are situated . , 12. Does proposed constructioi~v}Plate any zoning law, ordinance or regulation C . 13. Will lot be regraded f~ v Will excess fill be rem~pved from premises Yes / o 14. Name of Owner of premises . mJ.G ~I~f~ .~7eu~~. Address f 3aSCll~ (Jl'{Y ~ . Phone No .7~t.~". <t/.~"~ Name of Architect ..Address ..Phone No~. Name of Contractor ..Address one No........... . PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property tines Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NE~,Y~)~tK„ S S CO/~U~NjjTY F . ..__..//L1 rr 44 ~ . . . !!!FL'~Cy` {'6 being duly sworn, deposes and says that he is the applican (Name of mdrvidual signing contract) above named. He is the C~^'n~12...... (Contractor, agent, corporate officer, etc.) of sud owner or owners, and is duly authorized to perform or have performed the said work and to make and file tlu application, that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be performed m the manner set forth in the application filed therewith. Sworn to before me this 3 ....-.~,/day-of.. , 19 Notary Public, U~ County ~/{~'///J hE~ENICDEVOE ~ _ .t~N"~ZGL~ Cl'~Z'~-~~~~. Npinr {PUBLIC State d IMN YMIt • PP . ~+a 4707a78,SuHdk00Wrb8"7 (Signature of a titan Term Ezp+res ldeich 30.19- / /~f?/~J~ ~ BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL UGC r SOUTHOLD, N.Y. 11971 NOTIFY 7~, _ TEL.. 765-1802 CALL .............3..... Exammed.`-~..~.9..,19~.gt MAIL T(0~: nnn~7r . (g ~ ~05~ Approved 199 Permd No......... D 15 ~ U l~.' L~'~' Disapproved a/c ' f M~tl~~ BLDG DEP; ...+~:~p^r . TOW"1 OF SCiSTNGcD (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date 151:7 INSTRUCTIONS ! a. Tlus application must be completely filled in by typewriter or in Ink and submitted to the Buildtng Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shown; location of lot and of buildings on premises, relationship to adloinmg premises or public stre~ or areas, and giving a detalled 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 Permtt. d. Upon approval of this applicatton, the Butldmg Inspector will Issued a Building Permit to the applicant. Such peiir shalt be kept on the premtses available for inspection throu;ttout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan~ shall have been granted by the Building Inspector. APPLICATION IS FIEREBY MADE to the Butldtng Department for the Issuance of a Building Permtt pursuant to ti Budding Zane Ordtnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Re,ulations, for the constmction of buildings, addittons or alterations, or for removal or demolition, as herein describe The applicant agrees to comgly with al! appttcable taws, ordinances, budding code, houstn~ cods, and regulattons, and admit authorized inspectors on premises and m building for necessary inspec s. ~f (Signature of applicant, or name, tf a corporation) ....E.......~ ~...1. • (Malling address of appltcant State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or butlde l I L , Name of owner of premises ILILC'41}~4 !~t~l ...Y)~~t!.l~ . (as on the tax roll or latest deed) IC app[cant is a corporatton, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . Plumber's Ltcense No Electrician's License No . Other Trades License No . . I. Location of land on wtttch proposed work will be done . House Number Street Hamlet County Tax 41.tp No f 000 Section ~~r Bluck Lot / Z......... Subdivision Filed Atap No. Lot . ...............Name) State e~IStmg use and occupancy of premises/and intended use .ind occupancy of proposed construction: a. Existing use and occupancy "gyp *~TO S-fCre1A ......~C"~ 1 N % ...I`'~Y.l! L~ ~lOh-rte b. Intended use and occupancy 3. Nature of woe ~ (check «tttch apphcabte). New i3uilSmg Addttton ,Vteranan Repair Removal Demolition Other lVork . (Descnptto d. Estimated Cost Fee........... (to be paid on filing this apphcaUOn) 5. If dweihng, number of dwelhng unus ~ Number of dwelling units on each Moor , . . Ifgaragc.numbcrafcars 6. If business, commercial or mteed occupancy, specify nature and extent of each ty e~ of use j , . . 7. Dimensions of existing structures, tf any Pront ,;~;Z.. , Rear De th . , , , , , , D Height .....{.Q:....... Number of Stones ............~~.7.............~ . ~ Dimensions of s tr~ructure with alterations or additions Front 3. Rear ..r 1 . Depth Hciglit t"~! Number of Stones . 8. Dimensions of enure new construction Front Rear Depth . Height ...............NumbcrofStones...................................... ~ ~/f/y..... 9. Size of lot. Front . , Rcar ........lIX~'........... Depth ~ , . e. 10. Date of Purchase Name of rormcr Owner .S..-~ t .~rE.~'~:..`~~~ ~ti'~!y!~ 1 1. Zone or use district m which premises are situated r~~~?-~:.:. qFS~ ~V~ip1!-, , , , , , , , , , , , , , , , , , , , 12. Does proposed construction violate any zoning law, ordmarYcc or regutatton:.. N..~CC7 . . l3. Will lot be regraded ~ ~ . , . Will exec s fill }ie removed from premises: e ~ ~Gr-'Y. ~ ~ x/33 14. Name of Owner of premtses . {~1~~ltaL~ . ~e~u~5s.~. Address ~S ~?Q'!N!~~+~ Phone No..r ~u........ . Name of Architect .Address ...................Phone No............ . Name of Contractor .Address ...................Phone No........ . tS.Is this property located within 300 feet of a Cidal wetland? *YES....NO. *If yes, Southold Town Trustees Permit may be required. _ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fry property Lines. Give street and block number or descnption according to deed, and show street names and indtcate when interior or comer tot. STATE OF tiEZV~E~(fi`~)r S'S COU;v-L'Y QQF ~ f~ ~ ~"4'J~~e+~CN~~. ''~6d({1:5, ~l y?'~t? `z-r:. . , . , , , being duly sworn, deposes and says that he is the applica (Name of individual signuig contract) above named. r L(~tj~i?~~. ,icisthe (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authonzcd to perform or have performed the said work and to make and file tl -pphcanon, that all statements contained in tfus application arc true to the best of tits Lnowtcdgc and belief; and that t. work will be performed m the manner set forth m the apphcauon Glcd thcrcwith. iwom to before me this gg .owry Public, ~Ch-art' ..,71.-..~/¢.U~"........ County !/,~~7.~~ ~ NELEN k DE Y6E • . ~No~4707878 Su~4ktktA~iiii (Signature of apphcar 7errc, Expires M>cich 30,1 _ ~.F._._ . s,,...,..,~.,--~,-_ . _ T~~ ~ - . SUFFOLK CO. HEALTN DEPT. APPROVAL _ H. S. NO. % ! - _ _ DEPA~?rME?~'f Ctf yEALTH ~ r, {`J :~~a~n~+~ fl7 , STATEMENT OF INTpy3 r ~ rh- na i 1 THE WATER SUPPLY A~10 EEW/tQi DtSfOSAL v,ai11 ~ N' SYSTEMS FOR 7NtS RESiOE.NtE WILL ig CONFORM TO TM~ STANDA1~i OF TH! f .°,~1~ O+c" PROF ~R T Y'' StlfRtiL,K E'JC~.T SEAY1C6f. ~ ` ,~u~tvE~-°E'~ F'nR Asa ~ ~ - QJ ~ (I/'",~~11"~~~+~'.- FRA/vIC,G SUfFQLK GOIJNTY DEPT. OF HEAITI+ Q 1 ~ 7~" SERVICES - fOR APPROVAL QF ' ^s _ CONaTRUCTION ONLY 1; L N. S. REF. NO:: R, + u~'h~ ~lleoVli;D: r g~ FAMii.Y ' Ll r •1 u ~ D- ' ~ / I K CD. FAX MA? 6~lOlIAT10N; ,~k ~ ~ ~ ~ i ~~V O!!T. SECT. il.OCK lCt. `l / t ~ -29'-- ~ ~ ~ /'J/ /~D.~ ,~3' fit ' n OSIINEItS ADOREfIS: ::~c,~r 40 ~ / h ?o _ ~'r~,: ~ ~ s oak E~r~'~~ F . T.H. ~ o I , .Sou odd, /(,eau Yor,E h'i ~i'r'+~' .C G7, C>C?~ ~~r~%as e~ t~97~ s th~`~ - Si.~ 41 DLED: L.6T`ffiI P.'.IIGI Z walla .uuuuw~ ~w.++~ ~ 91I~ ~VN H A YIOLATIOX Or s _ ~~O ~ O LION rgp q r~@ IiW rOM! Awn ~6 ~ (,pUr"~ ~"1d' - ~ ? !JL's f'O so { ( m16AAO/I Mw. r 1093. - - S~ ~ fs•• ®pa a nXS suevsr w Ioi r+w.r. ` ~~-q L' ~ NRVErO['S IN(~ iFAI. Ol l~ p ~ N r~ lOdm sEU sXAU rar r caa~ro , ry ~ / A VALID TRUF COIL. I+~ ~ - ~ ~ ME~RSON F WXONN IXF M'R . _ a MA71~, AID ON X15 191AU r0 a,~ N1 R ~C ? - ~1 (pWAM', OOVFIWAYRµ.A0~16t a~ row - ' ~ rannlnoX ~ A*IOIlN Oi iXE (~O~i N1F Tf-/~fe /vb. G 6219~b sand ~^d" SEAL 1 / -_~ua~arr(~esnf -fa Cornrrrc~+rw~arlffr 9r''"'~~ E/c ~ Gr7_'> rd.:%E,v,., ~I f r~• ~ p~i%~ rC~C r Land Trt/e lnscrrartce Ca~r~?'iif fir. rrlcary.7 :~~c7 lever! and ~U Stxrlfidd 5a!virrgs E~nk: as :>ur-+.tsy~d ~.b. 2s, l~f3s. e RI VAN TUYL. P.C. heavy( ~l~..,,. T- gramme LICENSED LAND SURVEYORS GRi~NP'EktT NEW YORK 4• ;Mona roA wws _ _ ~ _ - _ . . - ...~...____...~__r,~,....„___ a r J. ~ SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO. 8S-SO- j8 ~ J f ~ ` _ n r+r ~F~ g~ STATEMENT OF INTENT = nyil ~i r,g " . ' .j. THE WATER SUPPLY AND SEWAGE DISPOSAL nail ' ~ SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO THE STANDARDS OF THE ~ ~~'t~,t~%' ~ /`~R~~~''~~T SUFFOLK CO. DEPT. OF HEALTH SERVICES. ~ APPLICANT Q ~ , ~ ~ i r~'~i~ 'y`~ ~J~'n ` SUFFOLK COUNTY DEPT. Of HEALTH C 4~ ~ l4 T po SERVICES - FOR APPROVAL OF i ~ , / ` ~ ~ ~ y o CONSTRUCTION ONLY .!t / t~UCJ T.'-~D~ L~ ,~V , T ~ ~ o ~ G DATE: ~ i-, l `Wn c .W d N. S. REF. NO.: 8S~ d0 ' 38 ~ _ j ~ c APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: b ° t ~ z ~ „ ~ DIST. SECT. BLOCK PCL. ~ 4 sr C i ~ ~ ~CGZl~m 4D / a ~ ~ o ~ OWNERSADaREffi: ~ y0f !'diary Q+ 0 LL r c m ~ u~ baass ~ i z~ t N d ._oufiti~-~l~, A/ru.~ York _.-.~i'~_~ CyOAr s h' /-'7Y•"~? ....C.~,::"1Ci~i ti.TrG' ~F~ ~v~ ~L~v ~ .Yl~/ cools ~ " ' Y ~ ~ ~ r LL N ~ ?7-6okaey v=i c ~-s o DEED: L.6-751 P•!" Y ('~lef~ 1093.3 ~4ir~ _ - \A ~ ~ - liG io soil ~ . a~~r 4„an na ~~r!~e~ - i . / % +a cur.•ewofe itdted ee•^.4 d ~l `ry~0 ~ /a A m 2 rfd#d ~e / 9~0 f o an: s ~,e a v~eli~trwahep0w u. mrrot~ ~ ~ 3i0MB0{~MIlOII a~1E'1 R"`A ~ ~ ~ f c w is tha F~ Tor urban Me ni: "%9' ~ ~A+ 3' 2 !P RvN9lC..8fidal~l~4's'~4ofiD W _ 4 3C ll~.Ftrt.~ 8484 h1am-mn r.,jQ... ._l~ -Y_Y - _ c~:~axadfYS la.Gna!";1- . 's. r i.c~a:-ices nre mt SYl`u.:e5i~:o ' Tr-f~e t bb. G 62 (98b ~ c .et inanalwon «auUir9aent /houses? nand ~ SE L cvchxs^aln~f»cl -fa Colnrrrv!-nv~cxlfh 9''~'"'c~ ~/~I.,?~.•OfrC ~-f.~:r~,:,; f-, i~~~ ~ n~~~ rr~c°r [_.dnd Trl-!e lrsur~rrrce Colr~n~~ %`~cK",EwYO~ rrr ®a r, :sea l~ val. dnd ~v Scxiflx~d 5avirx~s ~rrrlc '~S~PO Pic atiT fi~ R~ERlC)C VAN TUYL. P.C. ~«v~( ~1ti% ~ ,o~~ LlCEN~D LAND SUR YORS e "us ~La~so s~ ~ (iREENPORT NEW YORK TEIMYNE IOfT WN35 SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO. ~1 r . (i~J { 4 ; va„7ni'- ~ i ~ ~ STATEMENT OF INTENT - s'„u:-•~= ~ ~ nom(' THE WATER SUPPLY AND SEWACfi DISPOSAL yp,f ~ ~ ~ SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARD`S OF THE ,j iti'I~~ ~~c' SUFFOLK CO. DEPT. OF HEALTH SERV{L''L:9. APPLICANT ~~1' ~ ~ J`~'- '~~,1-•~- SUFFOLK COUNTY DEPT. OF HEALTH ti ,•c! SERVICES -FOR APPROVAL OF • Q ~ CONSTRUCTION ONLY a~ T~ .SoLJ TH'©4 L=; Y. ~ DATE: L, / H. S. REF. NO.. APPROVED: - s ~ ~ ~ ~ r SUFFOLK CO. TAX MAP OE5i6itM7'ttiN: ~ a ~ % t b T ~ u ' GIST. SECT. {LOCK PCt. ~ ~,1 ~ /040U`~d r r 4~it_`R / c / " OWN[RS ADORE34: - V~ C ~ G r.. f"~' j._i w, /~.K~.. ~ Qi.'S~ IC V ~h T•Ff. ~ i'f ' ~ - .:;oc.~fi4of~, it/eua Yve°~ ~ ~ /~Y"-^# E7,'c:7~r .'"C%t.~cl7''R' ~-t~~--~~ J/97J (s/c) 76 S -/6136 e h'y 37i- - DEED: L.6T3f P.9l5( y ba leOrreJ; ~ r CQgL ."i who W,M'a^. a` v v fo93•~~'fo ,2• io EOf! 6y; cd MN aairw raR'rgt ta.-r~~ - . _ ~ t ~i ~ Icd surveyor s inkaa aoaf a - ~ ~'1 ~ { r c Laaamd seal aha!f rwt Oe aa~ealern< v ! _ ~ ~ ~ 1 ~ ~9. IOa»7 :a 5u a vrJid tna eooy t3 arantesa In0lcsteC heroon ah ~ ° ro ~ Y m the on for whom t~ ITr A ~ ~ - ~ ~ a corn ~ ovcrnrrr ^ r~ bt1 Dt _ - _ . ~ ~ ~ he 4 A85 6I C ` _ _ _ _ (~ou~°~ Tf-ffe /vf7. G 6~l986 sand S[AL C~ua~nf~rl -fa Colnr+l~+-TVtrealf1, 9'~""ej !_ar~d Trtl~ !n: rfrrxrtce Carr~eyrr F. ^ ~,,a E~C Ov~.~ r-~,.^. i+t~~.+'r r c° i~'~ f~rc° ~ i~r r'1 iC? r Y and •#o ~ou~Hza/d : avi s ~xnl~f ? c rt,? TG ~c, mecrr~ .-spa lwc~l. ~ n9' ~~i~• -a's sur~lsy~ ~6. ~.'8; l985. _ e' ~ ~ R~[RICJC VAN T YL, P.C. heav ~ ~ rte; yra va~ ~5 ~t s 25 yj i%, LfCENlEQ LAND 9Ult YO[i'S L~' GR8'ENf?ORT NEVI YORK ~lenrra rosy wteu u, ~ _ r "k ~ - ~ - t,` ~ ~i i ~ "i i ~ ~ ~ ~ ~ ~ - ~ - - ' - - I~ . ~ ~ - - di~~r'r,~. ~ . ~ ~ ~ - - V'~ ~ ~ - ; _ j ~ f M~ ~ ~ ~ - - - ~F'~ ~ ~ ~ - r r--•m--~--- ~ ~ 1- e ~ ~ .g'Cy`t'~:-~' A ~ '~tt ~~S~~ 1 'FS~~S.'~IZ',P4+w ~ ~ . y ~i a , _ ~ i ;,,i T f ' _ uN ~'t I ~ ~ ~ -~c~3'H'Ka~ti~. ~ . , . _ _ ~ I 1 ~ ~ _ i ~ -r-.. ~ _ _ ~ - _ . ' ~ i. ~ IIMIIOYFO R~. j! ~ .Y sl 't ~t'._ pPaMµjy~44.~Snk~=~la - - -~-'mil Q'~'~- ~ ` T ..,-.--n._..~ ~C'Ifi1~~.7~. C"L6i.~'.~~,X1+~S~' : ~!A ~i't~t 1~i~ - .52~ . - ~ ~ .1 so `L a 4'~_.'s_~~3SJL 5tk' e ~ ~ ~ b ,p r IS cE~'f-~1 ' ~Pv~ I °~s Y---._._. ~ (2o5F .~~.il^1G 11s .(T1'F" i ?y 24`PC1 . ~ I_ UM1~F1~~A^~i~ ~ PLS ~~[F:.4t_ 'v - - - - _ ~ ~ ~ _S_ .Y DRY l-~nu- ~,<r<-w'oc ~ -i ' i4 maw (~NI ~ ~ ~ ~n154i ~n r~c.l - r' .,~11/, 'r.ox LiJ ir.l ~ .C o... `~>v xlv ilrln I ~~~xv i;,~ o L>LL 1 Kp Er ~,w Ux nC tt' i . ~y~ r ~S ~ ~ ~ I1~Su~vSK ur] 1~. 1~< ~1F~y'/,'~ ~ i I Fy '~~1'~Ci~a Y2POe- , y ~ i ! j I o I _ , 21P Cud ~ 1 V I\x. I _ _ _ _ , n r - ' - Sd 1., ~ „t . S.' _ _ '0?~t A i'f far Rr Ct-~~re r~t I:;.r ~,~-r:. Ji u~,. ..c. n~ 2x4 _ N>•vu EFS p9 J4Y is~ IJic pro Cop ~1xLi r~[il &ieNT"'ra I Y~.fi L1"~ q~.rl ;i~N,, Of C~141s1q .YJ r=, r' _ SK~4V BC Na~t_ts~~~s~--~~r 9FCZPCt^^.u,£~~ Nr11~5 ~`'~Ir~ !`~~S .i'FkCL_ ` t'f':t"'.::~' ANt'~ Ci,uc~~ _ Sr=t-no,-' _ h(uir- 13 - Qpu Y-,~~ P,.k'(7~•k ~ AS >ia D~.~,-1 mJ G' ttue 8 ' I u` errnaveo ev ~tl' 2F.' onewxe ( -H -C~' - _ o° OeTe- -Ser"('- ~-r newssx I-7=h11'Kll E3C~ oxrwixc xuxes~ i j .a ~ ~ ~ ~ ~ ~ ~ ~ i ~ _ _ 1 I'. i ~ ~'f ~ 1 ~ i I # ~ ~ ; ~ ~ ~ I I, I ~ II ~ ~ ~ ~ ± ksTi~1K . f s:...C"L~om'_ - - M1 ~r I ~ i ~ ~ ~ ~ ~ ~ ~r ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ f t I f ~...~,rp c~a~E~s- ii ~ _ 4 z,,,z ~rt~zn~a _ 1 ~ ~ I _ ~ ~ ~ UxTS~t'rr3~ _!3~,~tr ~h14. was ~ ~ _ ' - ~ ' - ~ ~ ~ Vie', - . _ L~'~a ~ ~ ~ ~ - - ~ _!S -u . , ~ ~ ~ ~s- - ,,a _ ~ I T ' ~ ! ~ Uni~st,~tero~ .~~ss~?r,~j' ~ ~ ~ L s ~ s ~ 6Y ~6 .~a c~ . ~ - ~ ~ ~ ~ uG~ ~Q~~z:_i~..r-9yy_ ~m ono;.r,~,, ~ oneww.v- l~ R)'t? 1 - . ~ ~ . ~ ~ ~ ~ - ~ 011EwINE NUM.E11 r . „'I i - - ~ • _ L _ _ _ _ _ _ _ _ _ - _ - _ _ _ , ~ - - _ . Y ' - _ - - ~I ; ~ _ _ _ - - - - - - - - - . - - _ - , . - a m~ - ~ - _ ~ . ~4 ~ ~ p~~ P' F R U$E9 ~)N WATER' ~ ~ ' . ~ ~ ~ ~ ! . SS ~ygWSTEM~%~~ - ~ ~ zito o~ OCCUPANCY qR ~ , : ~ ~ ~ ~~~~~a~F~ QS Norso ~~as~~ ; ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ a ~L k E. G.P D 4T FL USE IS UNLAW U ~L-- WITHOUT CERTIfICATE NoTI~ a ~~~~~r e"P ~rM T fla". - /fir p I ~ ~ ~ Q~ ~OVVUI-~~V 1 ~ ~ ~ 70 OUN ~ TIO~NP~1 NIO~ M UIRED +;a- - ~ - i - _ d.ux-~ . ~ ' ' ~ r-n ~ ~ '~o2J ~.~,r"Fr+ n~~i~1.~ GZ, FOR POURV"0 C ,NC.RL t-. ~ ~ , it - ~ ~ . ~r - r . ~ ~ M?4 R'r:'.. _'S'k.YYi.~.'r ~:LI~S~4p1 ~ ~ - ~ ' ' 2 ROUGH FRAPh~iv:~ ~'rLG t2-fP9G ' I - , - . ~ . - _ 3. INSUI,.ATION ~ - , ~ ~ ~ - ~ N. FINAL CO vSTRUGTIQN MUST' ~ ~ ~ 3 + . u w pox~a ew - „ , I ~ ~ BF COMPI.ETE'FOR'G.O. - ~ "^t .v_ aai.Wx ix~'i~t_., r„_, ',I xcrdiyu . iS.7NVd/I~~O iD ~ll~/.~lL~l3~ ALA COf^aSTRUCTION SWAIL MEET ~ ~ ~ ~ S~ ' ~a.,n ~9", ~~e'~''~'{ 3!/b~391N31NW Q~•b'37'IVL1 ~~?HE REOUIF,EMENTS OF 7WE N.Y r ~ , _ STATE CONSI NUCTION & ENERGY ~ ~ ~ 9 pj~it;F..S. .~;~~';~~Y'.$f~ ,1`~fia iF„~ C~~!!,!? ~ SSS GS'Ykl',.oip ' ~ NGILY` /~uN~. ~~Y/YQT~~ , ,CODES. NOT RESPONSIBLE FOR - ~ - ~ ~ ~ . ~ . e~J TRLICTVS? Rf ~~,r/, " ~ on~wiNa xuErere .'I ' , v @..~.,.. _..~~.~.~,~~._..I"~.a=,.. ~.~...1..,3....~~s_...,~„'~.u._.~..__~..w ..._.._..,.._s. ~ ~ . __a, _.4u.. _ _ _.L~=....._ J..._... 3U.,.. f."~. y.._.u~L.~:_._.~,....~.w.. i ..~.i ~ J ~~i ,a ..«~..x l e~ - - ~ _ ~L r""""te- r'..-„' -L ~ J ~ ' 4_~_ ' ~ I i ~ ~ ~ ~I' ' _ ~ - _ ~ i ~ ~ 1 _ it, p,~ ?..RGYFD _ _ ~ ~ ~ - o1UM1N0 NNNRpR ~a-: - L~ I• .1.., so .a d~~ 4~ ' g ,ti +6 ~ a 15 5c ~~rA~k~s~rrsu~'FTJ 2x to "Ktrzczs I a JS~~-FELC- 2q'4t~=~i-Y~~.-ir;c. _ te`''a. '(<U'~~ - - _ - _ - - - RseE-" 41 Wa~~s ~CTYP j ~ r,,, w - urlu~ an~o • iSI~ CE~r- 'g _ ,L ~~ry,~ 13 R''( UAu_ ~ -R=~'~ foie, LM1h_ir hnd -._ti r-ply nq,~N znL ~~o~ ~ c`, ` ~ ~ L;J;n~14 itn, y ~C~'~;dSa ~ i zX,e:_- i~'~ t>o~~ V C 'P.'N¢C" rJ~ p f'i ~f ~ / Ur1 N2 TES ~i- p - A \ ~ %!!}-1l,"4z _ R-IJ _3~~a' col-C(~r~_ ,'i ~ ~ x10-Ib O C. F~ I+~- ---iTJ 4l?~. v~-rlorJ p1 ~3Pn ~a.a,~,~ - t; a w h L,~ o ~ ZIP Cup ~ C-c"` -I ''`EAi3'f'IP-~(r. i=ou,LIC~R77r.~.- } I x c,--- ~ ~ ~ ( ; fug-~nY-~Ec SL.1f3'ICkI->i', rJ°..___.~_._._,___'!_-__.- 1. vLE~. - P~f_E M~ Fr lq, ~,,'t . ,i~~~ ~I: ' Y .paYt~rt".F °t~E I'V - 'Ii'~ X 51 PLY c.t.. 4 ~',S 6"I- La cnrep AI'~'Mas nr ~~rtr; rt ,PC Hn. ("tE;'-- Aoc.i r, -o .;kt. 2.4 ~ war nl q;~EFS ryt rl? i.^ NEE D;D rnR:".-t>t~4 TSryIL*lT""'"'Tu PF.c.1~;7T T!.u=..i;;.i r~ aF--CEtC ihlq ~~'n~'. C,s~55<v> - ;Ha;_~ BE N?+; 1. C,a w~l~/~~i ACr-SY26~~x s~r~~ "r1 Y~i~5 N~r. i'; _'s~ACd_. ~ r:A ~~y;;,;;' 1{oi[ t3 - ilo~~1.~...7 g'.. ~ Agcgweo ar r~{ir2 H _ FW, (-'fd f( A'iS SN O!J ~d l~ P_o JCS etA,E~ ogAwxe o" - ocrc-4. `.s4'D'r BS q¢nsES 1`Y'RI'><'1~ f3`..s OgAWIMC NUNYEII s° c~R J