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HomeMy WebLinkAbout17861-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218919 Date MARCH 27, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 910 COUNTRY CLUB DRIVE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 109 Block 03 Lot 2.12 MAP OF Subdivision COUNTRY CLUB EST. Filed Map No. 6736 Lot No. 23 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 21, 1989 pursuant to which Building Permit No. I7861Z dated FEB. 23, 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 ONE FAMILY DWELLING, ATTACHED GARAGE, DOES NOT INCLUDE DECK. The certificate is issued to SANDRA & RICHARD GANNON (owner] of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-162 MAR, 22, 1990 UNDERWRITERS CERTIFICATE NO. N1O4154 NOV. 21, 1989 PLUMBERS CERTIFICATION DATED MATTITUCK PLUMBING MAR. 26, 1990 .G~ Building Inspector Rev. 1/81 f'OfEM NO, f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na Q17861 Z Date 19..8.`.1. Permission is hereby granted to: ~...~,,.~.R...N tel... ~ :.y.:......~.~.~.~.~...... . ct premises located at ...,I~O.......4~`:~'r'~.."~C:.......~~.~'.~...!~!'~.-... . County Tox Map No 1000 Section ..J.,~2. Block Lat No ~ , pursuant to application doted ..~fuK~?N-~..... rz 1..........., 19 and approved by the Building Inspectar. U Fee S ?a~'. ~ CX I~.G . . Bu d ng Inspector Rev 6/30/80 ~r~A'/I ~~~Sj~~ t TOLIN OF SOUTIIOLD ~ ~ ~'t1._.~ l BUILDING DCPART.SLNT `+~p 'z ti7 ,~V ~j~1 TOLIN DALL l'11~ SOUTIIOLD, NEH YOILK 11971 APPLICATION FOR CERTIFICATE OF OCCIIPANCY / DATE. ~ ~.`k' . ~tr:.. N£N CONSTRUCTION ...../..OLD OR PRE-ESISTI'tiG HUILDING_.....VACANT LAND...._... Location of Property..~~~...SIV~)V~.~~_SrIJ~.~.L,~~¦....J..r.4-:~~.~:l~Sp.4?~~~~,.lv-~ DOUSE NO. I 1 STR//C': T UAHLIii Ovner or Ovners of Property.~~GR~~}'.~.~.~/.T..~/~~~. GA!~.N.~!J.._._..... County Taz Hap No. 1000 SecLioa 1~~. Hlock _Sl.~!._ Lot Su6divisioa Filed Map ........LoL._.._..._. PcraiL No. ~.(.V~~.._.Date of PcrmiC d,.~a1. B~ApPLicaaC .~lYL~:~~_f~l:~~l~:~JY"t~~ 5 Qea1Ch Dept. Approval UadcrvriCCrs Approval._._._....._._ Plaan inF, IIoard Approval RequesC for Temporary Certificate Final CertificaLC Fce Submictcd: $ APPLICANT.'~L:"7~~E.~4 ~:~':c~.+~......____. 3~a~~ ~/~a/ GJO =ev. 10!14/88 w e~ - FORM NO. 6 TOWN OF SOUTUOLD BIIILDING DEPARTMENT TOWN IIALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. This application must be filed in typewriter OR ink and submitted to the Building Inspector with [he following; for new buildings 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 of IIealth Dept. of water supply and Beverage-disposal~S-9 Form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying [hat solder used in system contains less than 2/10 of IZ lead. 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the Architect or Engineer responsible for the building. 6_ Submit Planning Board Approval of completed site plan requirements. B. For existing buildings ~PLlOr to April 9, 1457 non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property shoving all property lines, streets, buildings and unusual natural or topographic features. 2. A property completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ovnersh ip of the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $L5.00, Alteration to Dwelling $25_00, Svimaing Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing duelling - $100.00. 3. Copy of Certificate of Occupancy - $5_00 - over S years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy -$15.00 Residential Commercial ev, 10/14/S8 o~~FFOL~~o VICTOR LESSARD ~ < Town Hall, 53095 Maln Road PRINCIPAL BUILDING INSPECTOR ~ P O Box 1 179 (516) 765-1802 ~ Southold, New York 11971 FAX (516) 765-1823 Y~ijv~/ ~ ~~0~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD March 27, 1990 Mr. & Mrs. Gannon P.O. Box 1186 Cutchogue, N.Y. 11935 Re: B.P #17861Z One family dwelling Dear Mr. & Mrs. Gannon: I received your check for your Certificate of Occupancy for the above Building Permit. We have all the needed papers. However on April 5, 1989 you amended the permit to a full cellar. At that time Mr. Lessard marked the plans that the amount of $64.80 to amend the permit was to be paid before the C.O. I have checked our receipt book and i cannot find any record of payment. Please send us your check 3-n that amount and then I can release your C.O. Thank you for your attention to this. Yours truly, Secretary f ~wI ' _S. ~ ,~i~ inn ~P YY`~~ ~ - THE NEW YORK BOARD OF FIRE UNDERWRITERS _ ,hA(:r•. T 1.0011.05 BUREAU OF ELECTRICfTY 83 JOHN STREET. NEW YORK, NEW YORK 10038 NOYExBER 21, ] 984 Application No. on file b:158] 98<_t/89 N ]04]'T9 THIS CERTIFIES THAT only the electrlca! aqutpment w dsscri6ed helots and introduced 6y the applicant named on the a6ooe application number in the premises of ' ~ RI('HARU/SANDRA CANNON, COttNTRY CLUB DRTVF:, CffTCN()QUA, N.Y. intMfoUotcinR lacer' t ? Ist FI. ? Ynd FI. Section Block Lot _ I}~v`sxf~R~.4",`f~R9 mos a:ermined on and found to 6e in compliance with the requirements of this Board. ~ RXTURE ACIEf SWIiO1K RXTURB RANOlS COOKING EECXS OVENS DISH WASNRS EXHAUST FANS WTLLTf NUNelSCENT PlUOMSClNT OTHER NAT. K. W. AMT. K. W. AMi. K.W. AMt. K. W. AMT. M. P. 65 66 58 65 ] ].2 3 F' DRYNIS RJRNACE MOTORS 1UfIM! AMt1ANCE 1EROERf SMCIAL RECFT TIME CIOCKi ElLI U1Ki HEATERS MIIL140UTIET DIMMERS AMT. K. W. dl N. P. GAS X. P. AMT. NO. A. W, G. AMT. AMP. NAT. AMTS. TRANS. NAT. N. P. St'STEMS AMi. WATfS NO.OF RET 6 F Z - 1 SRRVN7 MSCONlKCT NO.O! S E R V I C E AM1. AMP. T1TE ~ 1 / tW 1 / tW ] 1 SW ] / AW ~ER % OND. OP C CO~ NO. Or NI.IEG Of ~MI ~IEG NO.OF NEUTRAIS W ~NEU1GtrAl ] 7,00 CB ] X 7. B/0 ] 2/(i ~ tllYNR ARMRATUS: RNIRPOOL/]5 AxP/GEC`I/(:RTAMP- 1 _ xiYft>RS:1-.75 H.P. i,,g,C.I:--3 SxOKE DETECTOR:-1 'f RACK LIGBTTNC:~6 NII,DMOOD k:LECTRTC L[C.~]563 E 4th STREET P .0. Bt?% 8 R O6iRAt MANAOR WADING k1YEk, NY, ]1792 Psr This nrNf'N:ah must not be aharad in any manner; rNurn to tM officer of the Board if incorrect. Inspectors may bs identified by their credentials. DOPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL. 765-1802 ~pS~~F~~~pG TOWN OF SOUTHOLD y~ OFFICE OF BUILDING INSPECTOR rn P O. BOX 728 ~ ~ TOWN HALL ~ ~ ~ `Vi y4~01 ~ SOUTHOLD, N.Y. 11971 ; ~ ~2 s E ~ ``i ~ ~ i it ~d~.... .wt I 11 7t,1,^,~,~ t. ~ ~ t C E R T I F I C A T I O N Date 3 a ~ 9D Building Permit No.~~ owner_l~i 1Cf~lk'~~l,yt1><A (.T f1 ~ ~Oti~ (please prin/t) Plumber f m~~ r ^r~~~T~rt Lo~V (please print) v I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber' re) Sworn to before me this ~f~ day of /1~~~c~f , / ~ 19~• ~ Notary Piny }iT~- Notary Public, S~`~D~~ County ~ta~acsoH NMIry ~gN~wYak Or~rl M dulklt Carry a,.6prw F~6.1E,19i2 .~`~5~~f0(.,i(~~,ti T0~'P! UI~ 50UTIIOLD 1~~~~~ ~;l/~c~ Ol~i'ICIiOPTsUILDIi~'G I~ISPI:GTOR r=-u "a, p', y° z I'.O l30X 1 179 '4''T '~~'1 TO~yi`f BALL • O,y~ SOU'I BOLD, N.Y. 1 1971 , Yf~ ~i -RICHARD S SANDRA CANNON 43 BIRCH HILL RD MT. SINAI, N.Y. 11756 _ To t4hcm This, May Concern, 4te are unable to complete your Certificate of~~ccunancy because oL the foilo~ting reasnn~. i1n application for Certificate o~ Occupancy is not nn fi]c. CENCLOSED) _ *lo Undezuritcrs Certificate on file. / / The ct~ec}; i;s ~'3{~F3~~RJnut on file.) $25.00 t~to liealth Dept. approval on file. / / t:o _°inal ynsl'•ec:L>.on has been made_ Pease contact: our office on this matter. ' Thank you for yous cooperation. l:i~ilciir.<J Permit' D ~ ? $ b i Z IIuildiny nupL•. '+x/ r1 t!o Plumber Solder Certificate on Life. ' { all permit:: inti•olving plumbinr] being issued after ,~pril 1,1984 ) 1 ~D I6~. c .,U:~ ~LinT ~I ~i..K~''1E,NT.°. -u C7 i. S~ 9 y FOUiJDATIOfJ (1s.C} - - - N ~ FOUNDATIO;J (2A'd) ~ 2. ~ o ROUGH FRAi•1E & PLUMBING ti , Hi- } 31 3. ~ E m y IiJSULATI0f1 PER fJ. Y. ~ J - ~ K STATE ENERGY C f CODE x a r { ~y 4. V ' ~ ~ FIf1AL ~ ~ "~=y~~ ~ t ti r~ ADDITIONAL COMMENTS: ~ a~ - - , . x H • 9 . H H O z s m a r H - x d m H , 206(9,E61-25< hE11 lOR6 STAT: CEP4RiME VT OF Eh11ROh ~tE hTAt COHSE RV 1710[`1 DEC PERnt11 nVn16ER w~ EffECTIVE DATE 10-88-2126 _ ~ (/10/89 MC I L l i 71PROG R 4M ht1MBF Rls) PERM E %PIRA710N DAT E(s) Under the Environmental Conservahort Law N/A 1/31/94 Article 15, Tirie 3. 6NYCRR 327, j ~ 6NYCRR 608 ~ Artlcle 25 328, 329 Aquatic Pesticides y~ Water Ouauty Certliloauon Tidal Wetlands P otect en of [Water ~ SPDES 17, Titles 7, 8 ~ S lid Waste IMa agementRR 360 Artlcle 15, Title 15 ~ Article 19 ~ Artcle 27, Title 9, 6NYCRR 373 Water Supply Alr Pollution Control' Hazardous Waste Management Artlcle 15. Title 15 a Artlcle 23. TRie 27 ~ Artlcle 34 Water Transport Mined Land Reclamation Coastal Erosion Management Artlcle 15, Title 15 Artlcle 24 Artlcle 36 long Island Wells freshwater Wetlands Flcodpizm Management Artlcle 15, Title 27 N-New, R-Renewal, M-Modification, ~ Articles 1, 3, 17, 19, 27, 37, Wild, Scenic and Recreational C-Construct ('only), 0-Operzte ('only) 6NYCRR 380 Radiation Gontroi Rwers PERMIT ISSUED TO It- Richard C. Gannon I .\I SDRt$S VF I'tRMITTEf 43 Birch Hill Rd. Mt. Sinai NY 11766 n<,ENT FOR PERMiT. itE'COh TACT PERSON TELEPHONE NUMBER I ^'AME ANU ~ODRE SS OF PROIECTfF iCIL1T1 Ile dlfterent tram Perm„tee7 Lot 23 Countr Club Dr. -Downs Creek LOCATION OF PROrEC pFAC1U TY COUNTY TOWNICITY/VILLAGE UTM COORDINATES ! Cutchogue Suffolk Southold I DESCRIPPOh Of 4uiHGRIZED 4C71b ITY Construct a single family dwelling, sanitary system and drive as per attached NYSDEC approved plan. GENERAL CONDIT1Oh5 , By acceptance o4 stirs permit, the permntee agrees that the permH rs contingent upon stnct compirv once with the EC L, all app hcabie regulations and the condrtwns specshed heron or attached hereto 1 i he s~~<macee .hail Ne m,tu oUeve of the appmpnate regwnaf permit admsnntrator nr other ofz,ce designated m the speuat condrtwns a nonce of mtentwn so commence wort at least 48 hums in ads ante of ,he time of commencement and shall also nouiy hlmfher promp.ly m witting of the completion or the work 2 7 `e pr emitted wurA shall be sublet[ to inspection by an authonzed representative of the Department of Envuonmensal Conservation which may p•der the work suspended d the pubh< mrerrsr so renwres pursuan* to FCL §T-030t and $APA §x01[37 s fhe pumuler. has aa, ppd. xprtuly Ly th\ cxecuuon of the appbca UOn the full le%al ruppnsibiLty for all damages dutu or lnd,rtc[ o! whatever nature and by whomever sutre•ed ammg out or the protect descnbed herein and has agreed to lndemmYy and case harmless the State ream suits actions damases and costs of every name and destnp~ trait resulting from the Bald protect A The Department reserves [he nght to modify wspend or revoke thu permit at am time after due note and d requested hold a heanng when al the scope or the prole<t s exceeded pc a vwlauon pt any condaion of the pemu or promswm of the ECL and perment regvlauons are round, or bl the perm,[ was obwmed by misrepresentation or failure to dlsdose reles mt .acts or cl newly discovered mfgrmaGOn or sigmhcant phyvcai changes are discos Bred since the permit was Issued > The penntltee rs responsbh for keeping the permR acme tit submitting a renewal apphcabon mdudmg any Eorms fees or supplenental lnfonnaLOn wh¢h may tit rtgmretl by the Department no later Char 30 days (180 days for 5PDE5 or Sand or Hazarduous N'aste Management Dermits) pnor to [he expira UOn date b Thn ry rm,l sh 311 nnl be construed as conveying to the appbc ant any nght to trespass upon the lands or interfere with the npanan nghts of others m order to perform fhe• permitted work or as au,honzing the impmrnent of any ngMS title or interest in real or personal property held or vested m a person no[ a pa rtY to the permit , The permrctee n respons hie for ob[alning any other permits approvaS lands easements and nghtsroi way wh¢h maY be regwred mr thu prole[[ 8 Issuance of ,hs perms 61' the Department does not unVess expressly pro^,ded tot mod,i7 supersede or resnno an order on consent or dettrmmation by the Commrsssoner issi.td heretomre tit the Department or any of the terms condmons or regwremerb contained In such order or determ lna[ion 9 Am mode matron or this permit granted by the Departmeqt muse be In witting and arached hereto I PERMIT I<SUANCE DATE PERM AD. IN[5T ATOR ADDRESS ]/10/89 Christine Costopoulos Bld 40 SUNY RM. 219 Stony Broolc, NY 117 4 ' AUTHORIZED SIGNITURE ~I~- . - ( ~ "T~ Page 1 of 3 cc: BI4HP v~ ~ 5 ' FRANK A hUjAWSRI, 1R ,President o ~ v~ ' . ~'i ALBERT) KRUPSKI, jR , Vice-Presdent _ TELEPHOKE r1 s `~r t• ~~l (516) 765-1692 ]OHN h7 BREDEAfEY-ER, III - _ „M;,"• ~ JOHN L BEDNOSKI, JR ~ ~~,1~`tj~ HENRY P S51ITH r/'~ f30.~RD OF TOR-\ 'CRLS'FEES T01Y'V OF SOUTHOLD Town Hall, 53095 11fam Road P O Box 728 Southold, New York 11971 December 16, 1988 N.Y.S.D.E.C. Regulatory Affairs Unit Bldg. 40- Room 219 SUNY Stony Brook, N.Y. 11794 att: Cathy Russell Re: Richard C. Gannon, File No. 10-88-2126 Lot 23, Country Club Drive, Cutchogue, N.Y. Dear Ms. Russell: Please be advised that the Trustees have reviewed site plan and project description on above referenced property and it was determined that the project proposed is out of our jurisdiction. This determination is only a determination rendered by this Board. Any other approvals that may be applicable are required prior to the commencement of the project. Thank you for your courtesy and cooperation in this matter. Very truly yours, Frank A. Kujaw ki, Jr. ~j\ President ~PJ Board of Town Trustees FAK:jas cc: Bldg. Dept. a Board of Appeal Richard Gannon / ~ CJ / / 765_18U2 ( 0 (9 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: ~ti _ DATE ~ INSPECTOR l ~ vG / 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [~I~NAL REMARKS: a.C.~l+., fit,;` ? Ct17.~, DATE ! a INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ~ ROUGH PLBG. [ ~ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: U~11.~t~ -E~~~rc~e~~/~ DATE t~~b' g% INSPECTOR 7 U 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. FOUNDATION 2ND INSULATION [ ]FRAMING ( ]FINAL REMARKS: DATE oZ INSPECTOR j~ l 7 D ~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 15T ~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~RAMING [ ]FINAL REMARKS: .~ce,.~ DATE b D INSPECTOR ~~'iI c~ 765-1802 BUILD{NG DEPT. INSPECTt4N UNDAT{ON 1ST ( ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ 9~K. DATE INSPECTOR M D W i» a r s n' c ~ ~ ~ f N Fri ~ ` ~ N 7 ° 36' S0'~ W ~ f65 OQ~-~~~~- s ~ B l.~P o Vl wG fonds ~ Z 9 m N ° ~ / CA1 D V 8 / N 3N a.c,E' iiil'`/~ /Git~ ~O~r F~/rd /hA Q 7 / m A J r r / A ~ / y, ° o r s o ~ ? Q , ~ M C 2 ~ 9 / ~ ~ a r o ® __._..~~.-ice 77A' ~ _ z a c c N i 3a o' ! i N G U ~ _ 343' 4 F~yp~710N u y /2~ _ °i / f r b v yp` 6.0, 13 3' s p o 243' ~ ~`3' ~r 3RB•. 140' .3N~ F \ A ~ o ? ~ / 4 a, t N tp \ N .A r - ~ ~ \ w em a~t~2 / ~ cn / f q ~ . ~ ~ - 83 OQ , if ~ _ 7v~ ~ ~ _ 7 0 00 ~ ~z " 73 3d' ~ UNr~Y c~UB r x 1. # t0 to ' fOWELLiq q! O ( CP OV pq 7D° V - S O ~ O ~ Jy 1 m f < q~ C ~ v~ u> Z o v n o~ ~ a r c LINDEN AVE. • ~ ~ r tp ~ ~ C7 v Z 0 .U A/K/0. MOORE lAN E rn - _ C W - ~ ~ ~ v ~ m C ~ tV ~ ~ Z O o T ~ Crl , - - 22 ,~.e.c. LS i BOARD OF HEALTH . Q. . . 3 SETS OF PLANS .Q• K !°:e~. , , FEB 2 t 1989 FORM NO 1 SURVEY ~SS$~ ~ ~ ~ • TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM BLDG, DEPT. TOWN HALL TOWN OFSOIJCHOLD SOUTHOLD, N Y 71971 NOTIFY --••1~___000~~' TEL.: 765.1802 CALL Examined 19 MAIL TO : `j-3 1~,~,~c-~ nvxe ~~i Approved U.~.,3, 19~ Permrt No. I ~ g~a,I Disapproved a/c . ~C~ u.a; (Budding Inspector) APPLICATION FOR BUILDING PERMIT ~ Date . ~.U~.... ~ ~ 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or to ink and submitted to the Building Inspector, with 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 premtses or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this agn catron. c. The work covered by this appltcatron may not be commenced before issuance of Building Permit. d. Upon approval of this appltcatron, the Building Inspector will issued a Building Pennrt to the apphcant Such perm shall be kept on the premtses available for inspection throughout the work. e. No building shall be occupied or used m whole or m part for any purpose whatever untA a Certificate of Occupan~ 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 ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances . Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and m butldmg for necessary ~/e~/~ttions.~ . l~~F~Gk~~cd...... R?Y:'§~:Y. . (Signature of apphcant, or name, tf a corporation) y,~ /~,~«i /fit..: t2~ _ !?1r, , S~.~„ iv y.... (Mailing address of apphcant) ~ ~ C•'G State whether applicant is owner, lessee, agent, architect, endneer, general contractor, electrician, plumber or buiIde . . Name of owner of premises J'.".Gj'~.~~ ./JKO `~"!t^.'~!'.'~.. ~."~!'!S~!~! . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No . Plumber's License No . . Electrician's License No . . Other Trade's License No . 1. Location of land on which proposed work will be done . House N Street Hamlet County Tax bfap No 1000 Section ...I~ .Black Lot ,2• Subdivision ~~(NN'y .C~./l3 si'si)-is-S~ Filed Map No G 7,~. Lot . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ~~~C~~!v T...`/3^.~~Q . b. Intended use and occupancy ..~~!P. • 57~+~~ • • .!/ir'~L*~- • ~j!'°.i~~ • , ~,~U!'.7TC~ . 3. Nature of work (check which applicable). New Building .!1.~..... Addition Alteration . Repair Removal Demohhon .Other Workt..... y,~/ (Descnptton) 4. Estimated Cost ~,.J ~ ~i~ E ~,l Ps Fee . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . ~r Number of dwelling units on each floor If garage, number of cars 41 t? . 6. 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 . Height Number of Stones . . Dunensions of same structure with alterations or additions: Front Rear . . Depth Ileight Number of Stones . . . 8. Dimensions of entire new construction. Front 7~?~r ; Rear ; ~6~:'. ~ .Depth ~ • . , • Height . Number of Stones TC., C'.... . 9. Size of lot. Front Rear ~4J..~ Depth ..~.`~`l.4S......... . 10. Date of Purchase l,1.6,l~f 9 .Name of Former Owner . ~'~1+'r f~'~.... !T.'+.{ . . . 1 1. Zone or use distract m which premises are situated /~'T~! •v,.ra;. . 12. Does proposed construction violate any zoning law, ordinance or regulation. N O . 13. Will Iot be regraded ~JF.S . • Will excess~tll be remove from premises. Yes p ~IL~// .,i..t.., 5'3 /IZt1{ I~{/tc 1 .12 14. Name of Owner of remises !~v.. G:~.... .Address • tnt •5rrv.u •n.• ' 1!)'ctPhone No.. Gi . d :.7... Y. Name of Architect ..~v[r.~n... gN.° ..Su.t,~ .....Address .C .arz_~a.,.rrt_ ~hurc".. Phone No...t~'r8'.. `7'6©.?,• Name of Contractor . ~tiSNrtrto...~~.~:K:y...... Address . `~}'.''.'.'`z"":`i Phone No. IS.Is this property located within 300 feet of a tidal 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 dunensions fro. property lines. Give street and block number or descnption according to deed, and show street names and indicate wheth• intenor or corner lot. STATE OF NEW YORK, S S COUNTY OF . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the appltcat (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authored to perform or have performed the said work and to make and file th apphcaton, [hat alt statements contained in this application are true to the best of his knowledge and belief, and that tt work will be performed m the manner set forth m the apphcatron filed therewith Sworn to before me this q ~ .da~y/of . 191, , Notary Public, %S GQ`E-- County f~TARY Pt18tIC, Shte of NeN W>rk PP . 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