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HomeMy WebLinkAbout18077-z r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19937 Date MAY 24, 1991 THIS CERTIFIES that the building ADDITION Location of Property 1825 TRUMANS PATH EAST MARION, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 31 Block I3 Lot 3 Subdiva aon Filed Map No. Lot No. conforms substantially to the Application for Building Peraut heretofore filed in this office dated APRIL 25, 1989 pursuant to which Building Permit No. 18077-Z dated APRIL 27, 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 DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to SOUND REHABILITATION CONTRACTORS, INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-187026 - MAY 15, 1991 PLUMBERS CERTIFICATION DATED APRIL 25, 1991 - JED PLUMBING ~GGc ~L,L7~ Building Inspector Rev. 1/81 lOSM NO f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT tTHiS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) . N 18 0 7 7 Z Date .......a.7 . 9. ~.9 Permission is hereby gmnted to: ro (~:~~.~.s.P.::..~~!xr.!?:}..... .~n.:ek,..Z?'~..,.~iT::4a:~,~../.M.. R...~ 7 ..'~?.:~sr~e.4~~ at premises located at $~1.. 0 I.1!:~.•.:.'.?:I°.:I^.:°..... ....r~,S, a;~V ......C'~.~.:4t.•ay,~, ~ Caunty Tox Map No 1000 Section 03~........ 81ock ......~....r~i.....~~.pp..gqLot No. . pursuant to application dated a. 5 19.Q..1., and approved by the Building Inspector. Fee S••*~~?.: / . . Bui ding Inspector Rev. 6/30/80 roast xo. 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~ 15374 Z Date .C~.s~...:i 19.y~r Permission is hereby granted to• / ~ ~.~jalr. , of premises located at . ~.~:'~0........3.:!^..'k?.......~::~:.....~°rft~'...~*.tS~it.4tSrd?!:5........... al. County Tax Map No 1000 Section . , w7 1~ Block Lot No..... 4.3,.. pursuant to application dated ~ ~ 19 ~ and approved by the Building Inspector. Fee $ Building Inspector Rev 6/30/BO ~ .yp p,c~, 10, - - - _ _ - - - 3 Form No. 6 ~ ~ ~ e. m. i~939 TOWN OF SOUTHOLD , BUILDING DEPARTMENT ~Y 2 Z ~ ~ TOWN HALL 765-1802 fs4_DG C~6FT. T01P1iV OF SO<<~',."MOf_[A APPLICATION FOR CERTIFICATE OF 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-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 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: 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 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 $15.00 Date New Construction........... Old Or Pre-existing Building...` Location of Property.. .).~r~..s.......... ,T/~,(/~lA/?S. /41.i{Y............ ~4`'s~d~. !f1Q~~Q?! . House No. Street Hamlet Onwer or Owners of Property..5'OU!??~..~1.~~'d~./iE~~'~~ . ~~.~C.~r.7~/IR..~~~ County Tax Map No 1000, Section...`~.3 ~ .......Block.....~.3........Lot....~.3~ Subdivision .................................../.Filed Map............Lot...................... Permit No.~~~7Z.......Date Ot Permit..Y~2,~/~,........Applicant..s~!K~.43.~C~:?T~~~1~.~1Y~ Health Dept. Approval ......................./...Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate. Fee Submitted: ,$GY/N/~ /L~i~ /C(T4~iv/~' CpyTrl/K'TO/28 l~C Cp-~ )9937 APPLICANT TEL. 7G5-1802 ~pc~~FFQC~~pl~/ TOWN OF SO~JTHOL.D ' ~ OFFICE OF BUILDIP]G INSPECTOR ' ~ ~ P O. BOX 728 v' m TOWN HALL .~O''0~ ~ ~b~~ SOUTHULD, N.Y. 11971 C E R T I F I C A T I O N Date Building Permit No.1~$'p7~~ Owner SOUTYr~ Rb'A'•rE3/c/TWIT/dN r2ry7~.4cTtl/Z: (please print) Plumber ~Uf/h'/~Y,L' (please print) I certify thae the solder used in the water supply system contains less than 2/10 of 1$ lead. (plumbers signature) ~ ©7~P Sworn to before me th s ~j//~~ ~ day of 19"i) Notary Public C ~[LJ ClOtory Public, 'I /V County NOTAIry pOB1IC, BYgTg OpFCORiDp; MY COMMISSION E7(PlRE6: SEAT. ;ggy tOkDCD TMRU kOT~RY py1LIG UROLkW WTERy, :lELD I,.s:ECTloN ~~uaTE co:;.....~~ . - - -d 7 . - a H1 FOUt1DATI0N ( l st J Cil~f ~Gi '.~Ejv' ~icL 7~ ~GQGCi~6lY _ _ c FOUNDATIOtJ ( 2nd ) Z~'~ ~ +L~'~~`~''~~ ~ ~o /J o i t.v z ~ 0 P.OUGH FRAME & ~--dlL-riRVCT ~al~h' Ta ' ~ /~fcfu.% s PLUMBING p ' ~ v~ 3. ~ x ~ ~ ~ INSULATION PER N. Y. STATE ENERGY CODE x a r 4. y rr FIt1AL ' l~ S~ 3 ~ E z ADDITIONAL COMMENTS: m m ~i~ u, - v ' x ~n H 9 H H O 2 [+7 a r ~ ~ 5 . ~ [%7 b H i THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1 1440121 BUREAU OF ELECTRICITY 65 JOHN STREET, NEW YORK. NEW YORK 10038 Dare MAY 15, 1991 gpp(tragon IVo anjde 41D12786/86 N 7 $7026 THIS CERTIFIES THAT only the electrttal equipment as deacnbed below and introduced by the apphcnnt named on the afroue opphcanan number m thepremuea of JOHPI WILLIA24S, 1824r~TRUMANS PATH, E.MARIOId, N.Y. m the following h,roaon, U @aaement © Ixt F'( ©2nd F'i OUT Sertwn 17fork Lat Fraa e:arnmed an P1AY 46,1991 artdfuund to be in cortfp(wnirurth the requfremenr. o(thfa FToarrl HXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST F_AF OUTLETS INCANOFSCFNT FIVORESCENi OTHER AMi K W AMi K W AMi KW AMi N W AMi H P 20 40 22 19 1 i.2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS 'SPECIAL REC PT TIME GIOCNS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMr K w all H P GAS H p AMi No A w G AML AmP AMi APopS TRANS Amt H P NO OF FEET Am( WAFL' i 34 SERVtOc' DISCONNECT NO Of 5 E R V L C E L AmT AMp TYPE METER i N TW i a W P RW ] 1w NO OF <C COND A W G NO OF MI LEG A W G NO OF NEUTRALS A W G EQUIP pER 8 OF C< COND Of HI WG Of NEUTRAL 1 200 CB 1 X i 2/0 1/0 OTHER APPARATUS RESIDENCE PLUS ACCESSARY BLDG.-1 ELEC. ROOM HEATERS:1-.5 K.W.,3-.75 K.W.,1-1 K,W.,4-1.5 K.W. ELEC. ROOM HEATERS:2-2 K.W. PATIFLBOARDS:1-23 CIR. 200 G.r.C.I:-2 SMOKE DETECTOR:-1 ~a PAUL R. BURNS LIC.#282E 275 TOWtd HARBOR LANE SOUTHOLD, NY, 11971 GENERAL MANAGER 11 rYl . r'~1 Per TVffs cerflffcate must not be altered to any manner, return to the office of the Board ,f Incorrect Inspectors may be identlfled by then <redent,a i,~ TEL. 7G5-I80? \pc~UFF~[,~~OG~ TOWN OP' SOUTIIOLD •1~4•(~,~~t UFC•iCL'OFBUILDI:v'GINSPECTOR :rte,, T P O BO\ 728 ~ TOlYN BALL ~y1/~' SOUTfiOLD, N Y. 1197I Ol ~ April 19, 1991 Mr. John Williams 1820 Truman's Path _ East Marion, N.Y. ]1939 To Whom This May Concern, We are unable to complete your Certificate of~Occupancy because of the foilowa.ng reasons. nn application for Certificate of Occupancy i^ not on file. CENCLO$ED) /~_/f// No Underwriters Certificate on file. The check is(AiN%3il~e~;tffi)Cnot on file.) $25.00 tto Itcalth Dept. 1lpproval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. 13ui]d~nr1 Permit if 1 8 0 7 7 2 DuLlclin~' Dept. ***/s/ No Plumber Se.>lder Certificate on file• ( all permits involving plumbing being issued after npril 1,1484 ) ~ g~FFOt,+; ~o~ HENRY P SMITH, President TFt.@PHONL JOHN M BREDEMEYER, Vice-Pres ® (516) 166-1892 PHILLIP J GOUBEAUD ~~D ALBERT KRUPSKI,JR 1 ~ r 0~ ELLEN M LARSEN BOARD OF TOa'N TRUSTEES TOWN OF SOUTHOLD 'town Ball, 53095 Maui Road P O Box 728 Southold, New York 11971 September 30, 1986 Mr. John C. Williams 1820 Truman's Path East Marion, New York 11939 Dear Mr. Williams: The following action was taken by the Board of Trustees during their regular meeting held on September 25, 1986 regarding your request for a waiver for work on property located on Truman's Path, Orient. WHEREAS, the Board members have personally viewed and are familiar with the premises in question and Che surrounding area and WHEREAS, the Board has considered all of the documentation submitted concerning this request and WHEREAS, the Board made the following findings of fact: 1. By this request appellant requests permission to excavate and build a concrete block perimeter foundation for existing dwelling located at 1820 Truman's Path, East Marion and Co construct new dormers with windows. 2. Property is bulkheaded and all work is to be done behind same. Accordingly on motion made by Trustee Smith seconded by Trustee Larsen it was RESOLVED to APPROVE THE WAIVER of the Wetland Ordinance far John C. Williams as requested with the following provisions: 1. Care should be taken so as to preclude the entry of any construction material into the wetland/water area. Very truly yours, Henry P. Smith, President Board of Town Trustees HPS:ip cc: Bldg. Dept. C.A.C. Board of Appeals file . ~ c o~g~FFO(k~o HENRY P SMITH, Presrdent = vy ~ TELEPHONE JOHN M BREDEMEYER, Vrce-Pres o ~ rIr ~n (516) 765-1892 PHILLIP J GOUBEAUD ~ ELLEN MKLARSEN JR ~~0.~ B0~1RD OF TOVi'N TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Mani Road P O Box 728 Southold, New York 1 1971 September 5, 1986 Mr. John C. Williams President Sound Rehabilitation Contractors, Inc. 239 Central Park West New York, New York 10024 Re: Determination on the need of a Wetland Permit 1820 Truman's Path> East Marion, New York Dear Mr. Williams: Pursuant to your request for a determination on the need of a Wetland Permit for the above referenced work, please find attached a copy of the determination rendered by the Bay Constable. Attached for your convenience is a Wetland Application. Please complete same and forward to this office for review. You can submit a letter with the application requesting a waiver of the ordinance for this work. Please note that the Board will be making their inspections on Sept. 18, 1986 and they will have to make an inspection prior to granting a waiver. Very truly yours, Henry P. Smith, President Board of Town Trustees Ilene Pfifferhng, Clerk HPS:ip Attachments cc: Bldg. Dept. file VICTOR LESSARD Town Hall, 53095 Mam Road PRINCIPAL BUILDING INSPECTOR Y ' ~ P O Box 1 179 (s16) 755asoz - Southold, New York 11971 FAX (516) 765-1823 '''r ~ . w~, '%7~.. OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD DATE: APRIL 4, 1959 NAME: JOHN WILLIAMS--SODND REHABILITATION 1820 TRIIMANS PATH ADDRESS: EAST MARION RE: BIIILDING PERMIT / 153742 issued 10/7/86 addition SEC. 31 BLOCK 13 LOT 03 This Building Permit has eapired. You are now in violation of the Town of Southold Zoning Code. Please contact our office, this matter must be corrected. Yours truly, 'Victor G. Lessard Principal Inspector a 7'65-i 2 80 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: i O. ~ DATE l~ ~ INSPECT i .1~3~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( } ROUGH PLBG. [ ~ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~INAL REMARKS : Y DATE vZ INSPECTOR 1 S 3 7 ~ ass-isoZ BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: F-' DATE ! 3 0 1 INSPECTOR ~s3~y~ T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [~ULATION [ ]FRAMING [ INAL- r REMARKS: ~-w. ~.8v~^-o~ ~ ffF~~ DATE / ~ / f INSPECTOR "~s3 7 y~ 7ss-iso2 BUILDING DEPT. 1 NSPECTI4N [ ]FOUNDATION 1ST [ ] R UGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ 44~ DATE / INSPECTOR;~~C~~ 765-1802 BUILDING DEPT. lNSPECTlON [ ]FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ t'f FRAMING [ ]FINAL REMARKS: ~ e%~n~- ~ ~ J ii rd ~ ~'r'`~ DATE 3,~ INSPECTOR / 765-1802 BUILDING DEPT. INSPECTION (]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ Q~ - ,CJ , DATE Q 2-`1 ~b INSPECTOR ~~I"~ ~ ~ f THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 7 10001.21 BUREAU OF ELECTRICITY EIS JOHN STREET, NEW YORK. NEW YORK 10038 Date MAY 15,1.997. APPlirationNo.onflle 4161?.786/86 N 187026 THIS CERTIFIES THAT only the ebctrical puipment as described 6ebw and introduced by the applicant named on the above application number in the premises of _ JOHN WILLIAMS, 7.80 'CRUNANS PATH, R.NARION, N.Y, in theJolbwinq hrcattRp., OLJ1Besament ~ Iat Fl. ~ Ynd F'!. OUT .Berrien Block Int 1f1L T b ~ YY'71 um examined un and found to be in complianre with the reyuiremenM uJ thia Board. _ NXTURE RXTURK RANGES COOKING DICKS OVENS DISH WASNlRS EXHAUST FANS OUTtRTS ACIES SYFITCNK INCANDESCENT ftuDRESClNT OTHER AMT. W. AMT. W. NAT. K.W. NAT. K.W. NAT. M. P. 20 40 22 19 1 1.a DRYERS fVRNAC! MOTORS WTURE ANOANC! iM0lRS SFlgAI RRC'/T ilhlE ClOCK4 RNL UNIT NUITRRS MUlil-0Ui1RT DVIIMERS AMT. t. W. ql H, P. GAS H. I. AMT. NO. A. W. G. AMi. AMP. AMT. AMTS. TRANS. AMi. H. P. ~ ~y AMT. WATTS 1 3a SRRVICE DISlbNNECT NO.OF S E R V I C -E AMT. AML. TYPE MR~Ir. 1 / ]•e 1 A a'N S X 3W 3 / AW ~M B.COND. Of CC COND. NO. d XIdEG W ~ NO. Or NEUTtAlS Oj 'NEUTRAL 1 aoo ca 7 x L zoo 1 fro O1NER AMMIATUS: RES1'.DENCE PLUS Ac.CF~SSARX BLDG.-1 ~ F,LIEC. ROOM HEA'LERS:1-.5 K.W.,3-.75 K,W.,1-1 K.W.,4-L_Ci K.W. ~ ELEC, ROOM HEATBRS:'1,-2 K.N. PANELBOARDS:1-2:i CIR. 200 G.F.C.I:-'l. - SMOKF, DETECTOR:-1 PAUL R. BURNS LII:.}?.82E 275 TOWN HARBOR .LAN.E SOUTHOLU, NY, 11971 p~µ MANApb I1 Per This csAificaN must not bs aherad in any manner; rWurn to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OP CERTIFIGTE MUST NOT BE,AITER~ IN ANY MANNER. • FORM NO 1 • ~ T^ TOWN OF SOUTHOLD E BUILDING DEPARTMENT TOWN HALL . _ _ °OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ,19 Received...........,19• Approved , 19 .Permit No Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ ~ ' Date 5'/ ~ 19 . INSTRUCTIONS ~ a Tlus apphcatron must be completely filled in by typewriter or m ink and submrtted to the Building Inspector, wrt sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of buildings on premises, relationshrp to adloinmg premises or pubhc stre or areas, and giving a detailed descrrptron of layout of property must be drawn on the diagram whrch rs part of this ap canon c. The work covered by this apphcatron may not be commenced before rssuance of Building Permit d. Upon approval of thrs apphcatron, the Building Inspector will issued a Building Pennrt to the apphcant Such per. shall be kept on the premrses avarlable for inspection throughout the work e. No buIlding shall be occupred or used m whole or m pazt for any purpose whatever until a Certificate of Occupar shall have been granted by the Burldrng Inspector APPLICATION IS HEREBY MADE to the Budding Depaztment for the rssuance of a Burldrng Permit pursuant to Burldrng Zone Ordrnance of the Town of Southold, Suffolk County, New York, and other applrcable Laws,'Ordinance~ Regulatrons, for the constructron of buildings, addrtions or alterations, or for removal or demolition, as herein descnb The apphcant agrees to comply wrth all applrcable laws, ordinances, building code, housing code, and regulatrons, and admit authonzed inspectors on premrses and in building for necessary inspections (Srgnature of apphcant, or name, rf a corporation) ..Z39..~:?~?..w~sr (mailing acldress~of applicarit)~ State whether apphcant rs owner, lessee, agent, azchrtect, engineer, general contractor, electncran, plumber or burld 4 4ii?C r( ' Name of owner of premrses . (as on the tax roll or latest deed) If apphcant rs ascorporatron, Srgnature of duly authonzed officer (Name and trtle of corporate officer) Builder's Lrcense No Plumber's Lrcense No . . Electrrcran's Lrcense No Other Trade's Lrcense No I Location of land on whrch proposed work wrll be done . . House Number Street Hamlet County Tax Map No 1000 Section C>r'r Block / ~ On Lot ~ Subdrvrsron Fried Map No Lot (Name) 2 State exrstmg use and occupancy of premrses and intended use and occupancy of proposed construction a Exrstmg use and occupancy - f~i~~Gr ~LJl~ ~ _ , J• j, b Intended use and occupancy ~O~'~`L'~`.-. ~ • F ~ - 3. Nature of wor)1 (check which applicable) New Building Addition ~~~~~eratlon 1', Repair • . Removal Demolition Other Work (Description) 4 Estiniated Cost ~Q.?~~ .Fee ' (to be paid on filing 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 use . . 7. Dimensions of existing structures, if any Front~r~ 3 ° ....Rear .Depth ~ . Height ..Number of Stones t..7! . Dunensions of same structure with alterations or additions Front <<? 3 ~ Rear . . Depth 1.'r. ' .Height ......Number of Stories . . 8. Dunensions of entire new construction Front . Rear . ...Depth Height .Number of SYenP~ 9 Size of lot• Front Reaz . Depth . 10 Date of Purchase ...Name of Former Owner va-rP.+`a~>fq' r;u ec iu u . . 1 1 Zone or use district m which premises are situated . 12. Does proposed construction violate any zomng law, ordinance or regulation. . 13 Will lot be regraded Will excess fill be removed from premises es t 14. Name of Owner of premises ..Address . ..Phone No Name of Architect Address ..Phone No . Name of Contractor ...Address Phone No . 15. Is this property located within 100 feet of a tidal wetland? Yes No * If yes, Southold Town Trustees Permit map be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunensions frc property fines Give street and block number or descnptron according to deed, and show street names and indicate wheth interior or corner lot. , Yy rG' T- ~ ~J ~ gr ~r / r 9 } , i - °RD~Ne?y Nips Wa%z.? i`9,d~'~ SXR~i.~ER f ?$AY STATE OF NEW YORK, S S COUNTY OF . l~~N ~ ~/l-~,{X/y~ • being duly sworn, deposes and says that he zs the apphc (Name of mdrvidual signing contract) above named. He is the ~~'/~l~T (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 i application, that all statements contained in this application aze true to the best of his knowledge and belief; and that work will be performed m the manner set forth in the application filed therewith Sworn to before me this ?.7.7~ .day of .Q.,C.~.~.c.c..... 19 ~6 Notary Public, County (/~/jJ SARAH J. STEWA ~ ~ ~ •~~~v NOTARY PUBLIC, State N L%'~~i~ (Signature of apphc. No 31-4831 92 Qualified in New York CountJ( Term Expves March 30, 198x/ nM,n FORM NO. 1 T€ l~.z-- W -AI~Yr ! E I ~,n.-i f'' ~ ~ I \ \ t i I '1`i E TOWN OF SOUTHOLD ~ ~ i, - ` 11 ~ I+ BUILDING DEPARTMENT TOWN HALL r' ~ 1 ~ ~ I ~i SOUTHOLD, N.Y. 11971 i~ TEL.: 765-1802 '1' °"'m""~ t.:.L~~ v~; t. Examined C?.G~..'`~!~:.~T...., 19 ~'~a e c e i v e d , 19 - Approved .Q.r-[ •7• - • 19p~? .Permit No. J.$ 3~y.~:. ~7'~~ ~ ~"Q"~~ - ` Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..Y/.'.~~ 19 INSTRUCTIONS ~ ~ - a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspecto?, wig 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 str- or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this a= 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 pe. shall be kept on the premrses 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 Certrficate of Occupa shall have been granted by the Building Inspector. - APPLICATION IS HEREBY MADE to the Building Department for the rssuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws,'Ordinanc= Regulations, for the construction of buildings, addrtions or alterations, or for removal or demolition, as herein descn""~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an~ admit authorized inspectors on premrses and in building for necessary inspections. ` ; ` t .S.gr~•~b. ~F7S'9~3./lC~~l.~A'f'.CGYY.T~f~'GT.4~S../.~Y (Srgnature of applicant, or name, if a corporation) ' (mailing address of appl>.cant)~ State whether applicant is owner, lessee, agent, azchitect, en~neer, general contractor, electrician, plumber or buil. aLwYt ~ . Name of owner of premrses . . . (as on the tax roll or latest deed) If applicant is a corporatron, srgnature of duly authorized officer. ' ` (Name and trtle of corporate officer) t \ Builder's Lrcense No. -bb Plumber's Lrcense No . , f . - Electrician's License No . sn$. icy ~ ~ . a. ~ ~ . , ' Other Trade's Lrcense No . . 1. Location of land on which proposed work will be done . . . . /F~~-v Ti2u~-aN!S, . ~°,r~~ T.~~.d2.~o.~ - House Number ~ Street Hamlet County Tax Map No. 1000 Sectron .U<?....... Block , /.~°..4R Lot .G~3: 4P.~?..... _ Subdivision . Filed Map No Lo[ ---==Name)-===-- - - - - 2. State existing use and occupancy of premrses and Intended use and occupancy of proposed construction. - _ ^w,.~ a. Existing use and occupancy . f~~~~r. J{/du ~ . b. Intended use and occupancy x~ ~ . x,_ 3. Nature of work (check which applicable): New Building Addition ? Alteration . Repair Removal Demohtion ...:.........Other Work . j (Description; 4. Estim ~°ostellC.6.?~ . Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units I......... Number of dwelling units on each floor . If garage, number of cars . b. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any. Front Rear Depth ..Z~/..3 . Height ...............Number of Stones l./. Zi . Dimensions of same stmcture with alterations or additions' Front ...?..°.:.3.~ Rear . . Depth Z.Y. ~'3:' Height ..............Number of Stories . ~fZ-............. . 8. Dimensions of entire new construction: Front Rear Depth . Height ...............Number of Stories . . 9. Size of lot: Front Rear Depth . 10. Date of Purchase ....Name of Former Owner k€tq?:-i,F4A~l'. Fu CC /[c,tt , , , , 11. Zone or use distnct in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : . . 13. Will lot be regraded .Will excess fill be removed from premises: es 14. Name of Owner of premises ..Address . .................Phone No...`... ' . Name of Architect ...........................Address ...................Phone No............ . • Name of Contractor ................Address Phone No.........?.. . 15. Is this property located within 100 feet of a tidal wetland? Yes No ,t, * If yes, Southold Town Trustees Permit may be required. _ PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions fr• property lines. Give street and block number or description according to deed, and show street names and indicate whet interior or corner lot. ~ ~.y/. ~y~jZUM,I.v S Pdifl y~yl, Eke" l ~ . . /C~~~T ~A/ ;:a.. ~ ~ ~ r JiD ~ o - rt - • ~~(~c- /y~~ ` mod'`' ~ ~/~J ` ~ N ' ~ ~ 5~ ~ ~.J ~ . /,~iKFF/~iid oaDi.vrt2Y HicN Wv?JI er9is~ \ 6x/lDia£R'r i3~ty STATE OF NEW YORK, S.S COUNTY~O~Fy . ......t:~..!1!. !~~~>!/.y,5. being duly sworn, deposes and says that he is the applic (Name of individual signing contract) above named. He is the ~?f-S/I~'!T!T (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authonzed to perform or have performed the said work and to make and file application; that all statements contained in thus application are true to the best of his knowledge and belief; and that work will be performed m the manner set forth m the application filed therewith. Sworn to before me this _ _ . - 7f~....dayof.. ~ ~4:..- ~ 19... - Notary Public, County ~ ~~/J SARAH 1. 57EWA • • • • • • • • L~~~ C~G~C•v--~~.......... . NOTARY No 31-0831e92 Ne G%'~~~~ . (Signature of applic: Qualified in New York Countx Tam Exp+~es Mach 30, 1987/.