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HomeMy WebLinkAbout17862-z w r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18790 Date FEBRUARY 13, 1990 THIS CERTIFIES that the building ADDITIONS Location of Property 410 SOUND ROAD GREENPORT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 35 Block 1 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed i.n this office dated FEBRUARY 20, 1989 pursuant to which Building Permit No. 17862-Z dated FEBRUARY 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 SHED DORMER & FIRST FLOOR ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate i.s issued to DANIEL & NANCY FISCHER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-045313-11/11/88 & PENDING 2/8/90 PLUMBERS CERTIFICATION DATED SEPTEMBER 24, 1989-MICHAEL DAWSON lding Insp cto Rev. 1/81 • 1 ~'08M NO. L 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 Q 617 8 6 L Z Date ..a..L~?:. 3 19p.,T~. ~ZI/ OG~/o!J ~s~i~/~ Permission is her~~ nted to: ~i..a to .rP~CG...l.. ..R-r~. ~:~',f:~~ ........./.~!I~ , ct premises located at ~`:~Q..... s~~-><-J. r~~. . . . . County Tax Map No 1000 Section Block ...1...... Lot No . pursuant to application dated 19...~and approved by the Bwlding Inspector Fee S•..~a . ,Suildin for Rev 6/30/80 roaai< xa s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAIL SOUTHOID, N. Y. BUILDING PERlAIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1Jr~s1. Z Date ..i11..12.:µ:?~::'!:!~'~r.......~.~..........., 19.~ Permission ~s hereby granted to• . . tJ a ..H.`~?-~-.. at premises locoted of D....... .A..~+.cQ.....~-t?'o-A~....... q~~:~ . . County Tax Map No 1000 Section Q .Block ......0 Lot No. . pursuont to application dated 19 ,and approved by the Bulding Inspector Fee ' ~ ~ C~ y Building Inspector Rev 6/30/80 TEL. 765-1802 ooSQ~F~Ck~pG TOWN OF SOUTIIOLD y~ OFFICE OF BUILDING INSPECTOR z P.O. BOX 728 ~ ~ TOWN HALL "O,y~o~ ~ SOUTHOLD, N.Y. 11971 'mil C E R T I F I C A T I O N Date 9/24/89 Building Permit No. Owner Daniel Fischer (please print) Plumber Michael Dawson (please print) I certify that the solder used in the water supply system contains less than 2/10 of 18 lead. / ~ 'A'/ _'f_~ (plumber's signature) Sworn to before me this 24th day of September ~ t / 19 Notary Public Notary Public, Suffolk County } LINDA K DAWSON Notary PubIN„ State of New Yak No 4894688 Oualitied m Sutfolk County Te*m Fxpves March 30, 19 ' - ~lr~.~ ' + i,-~ qj" TONN OF SOUTIIOLO `r'~! ~ ~ 11~ IIUILDI2{G DCPAEtT:ICNT rrp y~ TONt{ IIALL ~LD ' 3 ~ ~ SOUTIIOLO NCH YORK 11971 S 0l:PT. BLDG. 7 6 5 - 18 D 2 ?DWN UP SOUTHOLD APPLICATZON FOR CERTIFICATC OF OCCOPAt{CY ' DATC .:Z/~~~p°........ . HEW COSSTRUCTLON __...__OLD OA PRE-ESISTpIt{C BUILDING .._OACA!{T LAND..._.... Locatioa of Property.,_.°_~.~~.....~lo:-fhd.?a~'~._......~~CG~~o_ r.__••_ HOUSE NO. STRCL`T UAMLCT Ovncr or Ovncrs of Pro cr[ "~h~'~'/ ~J/4N ~'s ~ P y County Taz Hap No. 1000 Section :~5__. BLock _f Loc .~p__.... Subdivision Filed Map ____....Lot._______.. 0/78~/z Z1o23~8p-- ~anie_~~/~¢n~- Csclce~ Pcrnit :{o. _...Date of Permit Applicant Undcruritcrs Approvnl~~~?~?~l 1.__.. IIcalth Dept. Approval / S'9,'d[r lPtr~.+l°iC ahclnsa-~+ , PLann ink IIoard Approval eZequest for Temporary Certificate ._.....,Final Cercificace ? FCC S LLt1 Q i L C C d : $ . . . . ,D APPLICAN'1~ ..Y.`Y::": ~1. ~ . . _ _ _ 'cv, 10/{4/88 (~',~c+3gR77 _ IA7L /I 1nLil 1~.~. n . i~,~ ~~an.c. ~ v... .o m a r 3 H _ y 'OUt1DATI0N (1st) c ~ OUNDATIOt1 (2nd) _ _ m ~ o ~ LOUGH FRAME g~ / ~ ~ o PLUMBING ~ H s. 2 .wv( [7 Q. [+J :tdSULATION PER N. Y. STATE ENERGY CODE x a ~ _ 3 r~ H O" 7 3 tjr ~ ./,8 i L ~ _ FIi4AL l,G~. ~ CI o z ADDITIONAL COMMENTS: x p~ 3 _ O ,o a f 3 ~ ~ ' x ro • _Y H 9 H H O z x m r C • H _ ~ ~ b b H _ _ I . , ~ ~ i i i i - - _ i_~ _l .l ~ i~ i ~ i i ~ ~ I - pig ~-1- ' ~~~T ~ T _~__i k~i~ _ I I r _ _ ~ t _ _ as ~ ~ _ I _ ! PL I{/l~i ~ R~ I Aar ' nr i ~ I ~ 3; R urH FRA ~ SON QN,T~' f~'E~ ~ ~ J~ ~ ! ~ ; a.~ e~ cdMb Must ~ 1 ~~'RTl 1CA~ , t~`f` PAI~+N i i I ~ I a,•~q}' ~ icoNs Foa c 6~j - , I I ~S(hL~D US I YYAT~'~ ~ 4 ~ I ~ I I, fHE ~EQUhi e Q~ C-- ~ II ssrr~~ ppss°~ NTS ~ ~ PILL YS~E C ~ O~ i ! i 1 ~ l ! cdaes ~robr~ Fu~", ~ I eej~x I I ~'X~ E /1l~ t~f ~ i ~ ~ ~ ( Ioe~iraN a~ sus o ~I~ I I I I ` 1 R~nt1 I I I I 1 ~ M`L~ RSA 'I t } i I i ~ ~ ~ f I ~ I ~ ~"ff~,, I I G ! I ~ ; _ i ~ I rAS s~N.~~ ik6.~~r-~ _ I I I ~ .z. 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' 2~ a ny ~ . c d Y 1 11 .~,x~~ ~ 3~~~5~-*trpj3 r I ~ 4 y y y~ I~~y+Yf?~ ~ f r llP' a k*.. d ~4`'~ ~~..,,..~,~ff((#"„~,,,,d3,d~j6~ T"Et~"F `S"~'1'~t~t,T"i,.iE,.~~" r t*3C, - 6 s ~ I~ ~ ° ~ ~d ~ ~ ~ .N K ~ { ~ *'p ~ !7 'o~m~ riQ. r ~ s,~ .3 l".~glr.~•~~4C .t;-' o~~i,4 , ~w 'k~ ~ ,~x1~.- N^ ,n eq~, ~ ~ T THE NEW YORK BOARD OF FIRE UNDERWRITERS r'Itl,l t Utl(II 2 'L BUREAU OF ELECTRICITY i 85 JOHN STREET, NEW YORK, NEW YORK 10038. ~ MAt?Cli 25, L;vll APPlication No. on file 67bG 129N~4(I 1'd i19ri37 THIS CERTIFIES THAT only the ebctrkol equipment as descrihed 6ebur and introduced by the opplicont named on the a6ooe applicotian numher In the promises of hAMi]'I- i C`iClil'RI '1 t) li Qtl Pd6 NI)AI?, Hfifa hiPOKl, fd.Y. in thefolb¢ing locotion; ? Basement ~ /At FI. ? Pnd FL Ili_i I Sertion Block Lot soea examined on I-FftRUARY )U. 19~i I1 and ound to 6e in cone Iionce with Cher f p ryuirementA of thin Board. - HXNRE TACUIS SWITCHES pXTURES RAN66 COOKING DECKS OVENS DISH WASNERS EXHAUST FANS OUiIETS INCANDESCENT-FIUORESCENi OTNEn ANT. K.W. AMT. R.W. AMT. R.W. AMT. R.W. AMT. N.I. - , (t DRYERS FURNACE MOTORS FUTURE AFPUANC! FEEDERS 5?ECIALRK'FT TIME CLOCKS ~ UNIT NEATERS MUli40UTU.T DUAMERS AMT. R. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AAVS. TRANS. AMT. N. P. SYSTEMS AMT. WAITS No. oc IEEr I SERVICE DISCONNKT NO.OF 5 E R V I C E AMT. ANP. TypE METER I). ~ 1 R ]N' 7 L ]W 3,e AW ~ CC. COND. A. W. 6. A. W. G. A. W. G. PER a Of CC. COND. OE HbIEG Df NI.LEO NO. OF NEUTIIAlS OP NEViRAI fs OTNER AFMRATUS: Wit?CN, FQIt I_AUhIURY ARti:t AUU.IINI i-7 i;.f.('. is 1 - .Po'( ~ PAUL H. (iUHN:i i, tl:, p23~-'-I' ?ICI IONM IiARFtUh LhIlk 'i li i ~ l N l'U U , N'i , t ~l v 11 ONRAI E1ANAfiER ~ ii Per _ This certificate must not be alterod in any manner; return to the office of the Board if incorrect. Inspectors may be identifNd "~i' air crodentials. ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER. ~f~(~ THE NEW YORK BOARD OF FIRE UNDERWRITERS loont?1. g BUREAU OF ELECTRICITY PitTV 4;p!1t N:R 11-, ? ~S JOHN STREET, NEW YORK, N~kV?~Y,ORK~0038 A5 i I . Dote Application No. on file AA THIS CERTIFIES THAT only the electrical equipment w dsscrihed helots and introduced 6y the applicant nomad on the shoos application number in the premises of !1l1NfN;ti HTtiCHN:K, 2,Q SiT1iNtJ REId,!?. tt,u p; M:Nt?p~~!yy.--',I' N..~. in the Jollotoinp hrcal~~Y:Ml t1FR B~"~~~+i+ LJ /A[ FI. LJ 2nd F'l. .Sertiun Block Lut uas examined un and found to 6e in curnplionre with the reyuiremenu of this Buard. lIXTUEE RXTURES RANOES COOKING DECKS OVENS DISH WASNlRS E%NAUST TANS OUTURS BTAClES SWI7CNE5 INCANDESCENT-FLUGRESCENT 1 VA AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. rl I / r) t IP DRYERS RIRNACE MOTORS WTUtl ANLANC! IMDNS SlEGAL EK'?T TIME CLOCKS Elll UNIT NEATEES MUli40UTU!T DUAMERS AMT. K. W, ql N. P. GAS N. P. AMT. NO. A. W. G. AMT. AAO. AMT. AMPS. TEAKS. AMT. N. P. SYSTEMS AMT. WATTb NO.O! I6T SERVK7 DISCONNlCT NO.O! S E R V I C E AMT. AMP. 1rPE 1 / TV I 1 TV 3 A ]W ] l ~W ~NCrCOND. Of CC COiiD. NO. OF MI-lEG OF ~ HI LEG() NO.OP NEIRRAIi ~ ~P E ~1~L OTNM AlYAMTIIS: G . F.f'..l.-). `:wr NAU1, y41RN SQQ^`HOLI). 6~Y, 11 o i ! D~AI 11 ;7 t,r;'f•;Nb,N: NO. `t$~tt Prr l' This nrtiflcats must not ba aherted in any manner; return to the office of the Board if itlcorruct. Inspectors may ba idsnti8ed bytMir cr a tials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANiER. BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST { ~ OUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]/FRAMING [ ]FINAL REMARKS: ~r,( D¢~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ C-e-/~~- DATE ~0 INSPECTOR ' G~~'li" ~~sv~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST (r~]~ROUGH PLBG. [ ] FOUNDATION 2ND ( ]INSULATION [.~]~FRAMING [ ]FINAL REMARKS: ~",.~cN~ t~i~~ _ ` DATE 4 INSPECTO FORM NO. 1 _ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN BALL ""'-'k` EOU7HOLD, N.Y 11971 TEL.: 765-1802 Examined A.)~1 , 19g{°. Received........... , 19 • Approved lU~~~ , 19~?. Permit No ~ ~ ~ ~ ~ Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date '~L.... 19~ INSTRUCTIONS a. This apphcatron must be completely filled in by typewnter or m ink and submitted to the Building Inspector, witl sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of buildings on premises, relatronship to adlommg premises or public stye or azeas, and giving a detazled descnption of layout of property must be drawn on the diagram which rs part of this app cation c. The work covered by t}us apphcatron may not be commenced before issuance of Building Permit d. Upon approval of this apphcatron, the Building Inspector will issued a Building Permit to the apphcant Such per shall be kept on the prerruses available for inspection throughout the work. e No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupaz shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA~E to the Building Depaztment for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawe, Ordinances Regulations, for the construction of buildings, additions or alteratrons, or for removal or demolition, as herein describ The apphcant agrees to comply with all applicable laws, ordinances, building co e, housing codg, nd regulatrons, and admit authonzed inspectors on premises and in building for necessary inspectrons b . (Signat%yyyy//gg of apphcant or a~m~e~,,,if a~c~orporation) ~ D ? 9 it rrG !Joa a~ ~/•C ~ n~7or~~Y • /I,~~/ (mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or build Name of owner of premises .(/Qr~_i.C~ L ~"ls~~G/ 'P ~(~C+7~y L- C"1.JG~ie! (as on the tax rol or latest deed) If apphcant is a corporation, signature of duly authonzed officer (Name and title of copprp/orate officer) Builder's License No /l~f ~-rvw ~-S~1 Plumber's License No ~ ~czlt/SQ'7~. Electncian's License No /,r~ecl Other Trade's License No 1 Location of land on which proposJe~d work will be done ~l$~~ V .F'A 4c n f.{ ~p 44r (r k~. C /~lo O r7~ , House Number Street Hamlet County Tax Map No 1000 Section ~ 3 ~ Block ~ Lot . ~6 . . Subdivision Filed Map No. Lot . (Name) 2 State existing use and occupancy of,~^premises ands intended use and occupancy of proposed construction a. Existing use and occupancy 40" /~'l9~ r a»s~r`y. ~GSi R~4n F.~- . e, b Intended use and occupancy Sa ry' ~e 3. Nature of work (check which applicable). New Building Addition Alteratron . Repazr Removal Demolition .Other Work . ~'p/f~bc/m.•i ade/ ~x3~ Stied .lo.Yl~+tr fs i-ea.-~ toot{rnaf~.~9,q<//2..1f,4.~J (Description) 4. Estunated Cost tF a ~ 0 D . .Fee . ~ . ~ Ito be pazd 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 mrxed occupancy, specify nature and extent of each type of use . . 7. Dunensions of existing structures, if any Front . 33.E Rear . 33.:........ Depth .ZS'... . Height yo.r~a~~ra r~ ~ Number of Stones ~ Dunensions of same structure with alterations or additions Front ~t'."~....... .Rear .a~e~' -5/lcd. dvrr~ Depth ......S' at"'+?: ..Height S.a r+'~-~ Number of Stones . 2- ~2X2g' . 8. Dimensions of entire new construction Front is ~rr!4-. Rear .Depth S.°i'r?- Height s``.'!'.'?'?' .....Number of Stones . 2- . 9. Size of lot Front .7S Rear r.S . D.e~+pth f4~`f 10 Date of Purchase /978 ........Name of Former Owner 4 s~rx..P .~~Clr.......... . 11 Zone or use district m which premises are situated r'SS. d,e.n.f't 4,! . 12. Does proposed construction violate any zoning law, ordinance or regulatron . Rvo 13 Will lot be regraded rJ . ..Will excess fill be removed from premises Yes P 14 Name of Owner of premises L ~!d r-yGr , . , ,Address 2q J'akro :Q•'. Gpl` phone No. ".77-A.42n 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 ma be required. PLOT DIAGRAM Locate clearly and chstinctly all buildings, whether exrsting or proposed, and indicate all set-back dunensrons fro property lines Grve street and block number or description according to deed, and show street names and indicate wheth interior or corner lot S~.¢ t~/F+rtil+~a[ Scwr-ty ~ 4lfc.~a~t+-... ~n Yr/cue ~n~. ~ t`J ~ ,~'d'n /~..-a" star door' ~ a axo(c~o+. y~' czs .20 ~K~ 1~e~.ea.ca. .tx,w~ do wale. 304 t ~ 1) ~~r 6~_ , ~ STATE OF NEW YORK, S.S COUNTY OF being duly sworn, deposes and says that he is the applica (Name of individual signing contract) above named He is the . . (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 ti application, that all statements contained in this application are true to the best of lus knowledge and belief; and that t work will be performed m the manner set forth in the application filed therewith Sworn to before me this ~y ~ . .d~ay/of , 19 .QF' Notary Public, 1 . TC v~ County ~ Sean F4x~ . ~ `6j . (Srgnature applicac II1I ~ BOARD OF HEALTH . IJ r~ ~ FoRMN0.1 SURVEY OF PLANS ` F~~ ~ f 1` ~ , TOWN OF SOUTHOLD CHECK . 1 BUILDING DEPARTMENT SEPTIC FORM TOWN HALL TOWN OF SO F7. vOUTHOLD, N Y. 11971 NOTIFY - . 7EL. 765-1802 CALL _ p/: MAIL TO: ~~Q -Q_-- _ n p a Examined .~6...~-3.. , 19 ~lkk7gg yy/ ~~J~TV'°.""~ ,~-o( 71~proved ~ . a3 , , 19//(Permit No ' Y /~y~ . Disapproved a c ~~:~OZ-LL j~" _ _ ~,t/ ~~ls~~~! (B ding In ec or) APPLICATION FOR BUILDING PERMIT Date :r~. 154 INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit 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 strc or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap cation. c. The work covered by this application may not be commenced before issuance of Buildmg Permit. d. Upon approval of this application, the Buildmg Inspector will issued a Buildmg Permit to the applicant Such peu shall be kept on the premises available for inspection throughout the work e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupai shall have been granted by the Buildmg Inspector. APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Biuldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constructron of buildings, additions or alterations, or for removal or demolition, as herein descnb The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and m building for necessary msp trons (Signature o£ applicant, or name, if a corporation) ~ls-4 ~ ~f:.Cda.~k.-L (Ilmg address of applicant) h~/u ~S'auN~ ~iosD ~r~iEE~•,~a,~T N~Y ~~%~/~l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, jilumber or build Name of owner of premises - (as on the ta~c roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No /~,,SC;;~.'7r?-''. /3~.%~ /~Z~ Plumber's License No !7::/.RYt~S~?'i. Electrician's License No j ~u~~ . - Other Trade's License No 1. Location of land on which proposed work will be done - - , . House Number Stree[ Hamlet County Tai blap No 1000 Section ~ Block . Lot Subdivision -Fled Alap No Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constnichon• a Existing use and occupancy _ S~n~-~e. ,far?!/X, , rr•s!dfh ~ ~ , . b Intended use and occupancy -so-~Y3¢.-,~-U/~la, , 4~~j,y<«rl , Lthal, ~a hP~fpfq~ fJ`~~/a~~ - - 3. Nature of work (check which app~(icable): New Budding Addition Alteration . Repur Removal Demolition Other Work , . 0" u /0~-6" /6und~~~mudroo~ w;fh rfu,V~p wsle~f J~(Descnptio, . 4. Estimated Cast r a ° ° Fee ~`.~r-:'. , , P , , , , , , , r,,ti 't ]1C3tlOn) 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. Dunensrons of existing stivctures, ff any Front ..~°y... Rear 33 Depth ;Zar," . Height 1a.r~dye..?j! . Number of Stones /.z . Dunensions of same structure with alterations or additions• Front s.Qn? Rear ~~n~-?:....... . Depth F' Height ~?'f~'^."a-~ Number of Stones . ~S'."~' 8. Dimensions of entire new construction. Front . .Rear . 8~ Depth gyp',-, 6:: , , , , Height ..............NumberofStones. ~ • 9. Size of lot Front Rear De th _ 10. Date of Purchase !9.7s~ .........Name of F rmer Owner . 1 1. Zone or use district m which premises are situated !-A: lax. - • . 12. Does proposed construction violate any zoning law, ordinance or regulation iL,4 . 13. Will lot be regraded ~V ....Will excess fill be removed from premises• Yes 14. Name of Owner of premises ,I~F: YH F=: F~S~yF~.... Address .44•Soua~ R~. G/'l phone No. fri.~'./~.~ZQ, • . Name of Architect .............Address . ...Phone No . Name of Contractor ...Address . ........Phone No........ , IS.Is this property located within 300 fee[ of a tidal wetland? *YES....NOt~.. *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly alI buildings, whether existing or proposed, and. indicate all set-back dunensions fr property lines Grve street and block number or description according to deed, and show street names and indreate whet interior or corner lot. STATE OF NEW YORK, S S COUNTY OF - • • • • • • • • • . • • • • • - being duly sworn, deposes and says that he is the applic, (Name of individual signing contract) above named He is the . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or leave performed the said wort. and to make and file i application, that all statements contained m this application are true to the best of his knowledge and belief; and that work will be performed in the manner se[ forth in the apphcatron filed therewith. Sworn to before gme this Notary Public, !ate-~?~!. Ll N1,4-. U~- County ~ {p ~ HELEN K DE VDE . : ~ : . NDTARY PUBLiC, State o+ ite~ York (Signature of apphca Ho.47a78T8, Suttaik tAUnctyy~~ Term Expres March 30,14• . , - - 1 _ ,:i _ - - - _ - - - ~ ~ _ - r i- ~O~cK ~~ENTF~'F,~j ON >]pp,~ 6 z'id' n COppN 1Ubing Is Used BF ~7i~~rp ' isI vwtsr distributing tysbtn; plping shall be of types K or L only J 4Y~ ~ ? ~ 's ` ~ OCCUPANCY OR I,:.~+iiP=v o;:~,,.t~~i:,r.. ,Dr=r~sw;rneEiaT ~r USE IS UNLAWFUL "+F= 9PitZ +a Ann vQU 4 -Ch~q FCiH "e'Nc F"s~~^.avri°" WITHOUT CERTIFICATE CERTIFICAflO RE Fvuia~~*IC:,,, rKrn+n~;ye~~a~ra ~3rn:a3-r Fr<Rivacic, .a v?„11:~9n;3 OF OCCUPANCY ON LEAD TE OF p CUPANCY a r~.~-;i r~-.,, e9c~ CERTIFICA /v12 ~/N~s F.SCAErT~ .p n+, •s~ ^:.r`~STR4lCTi+-,q'~ h'!?A6T' ~'q'ua~.`o r"iE FC7,u, C ib. ~o;.NO 1cA L/2PT-.VyC~T -...~t;a(i4,'Yd;"Yt,~Ci~;6r!-GS,?Ik~T I scn,e vrnoveo ar oenwnn -I"'-i1: ±t;idUa~ 5~~n,7i=E+'o Sr JP'- rhR"~ R7 Y rG ,t", 1'h-1"i: :~'~;I ~7;-""~XI~C'Y'?~Av~ k, ClvicF;j'i~ Dorf e/ .2 `y g~ aeriseo r rc~la-;. I~~,, ~ t r~„~~~a~„~cEO, ~ SOLDER USED IN WATE?t ~~e;,.;;rs „rf.: cr_...,t$c.~ rroa;,,..,, _ rh©tas. SUPPLY SYSTEM CANNOT EXCEED 2/10 of 196 LEAD• /~~>,e ,Eta?aTio.t/ oxnwwe rrunoex / Oi nV i~ - I ~ F<to7,' ' N j Z- Y~HZ _I __i_ - i L-Yisri I Sorr;r i ~ c-ss .FACES ra Br YENrI/~r~.J" ~ - ~i - . EXiSfIN~ Rr-Haim _ FH/r'ovdFl ~4SC/.l - F~usr+ C~I SUIY ~ I i Y •v ~/lFr ~rayr. ~ 1 \y _ ? ~ ~ - I-' _ - _ I y _ _ ~ t144dtFD 3~~{z ~ _ I_-._. _ - - _ _ ' - - - - _ - d-b~RSEN [isF/LIEMrnr~.~1 ~ ~ . _ - _ _ _ _ _ _ - -...~__.__.___..~._-!1 ~OrGNP ~Xa~_ _ _ ~.?,E.ENP02T_ - ~ . sGtE yF /l~~G~ ArrAGVEO ev I4 UIIAWN AY ^ Dare: . ry Zrt 66 ~ eevls[G - __.Y-_ - GNAWING NUMAEA 2 9F Y ~ - ~a~~io i N i a~ //'~~~~/~~c~ rnnrc- ~ 11 ~ ,\p ~m ,.rt, ' 1.~ Gxh c~ ~ I ~ R1' ~ ~1n~ ~ 0 ~ ' 9 y ~'~~..f~ ~EDKOOM " ~ N S,EpQpPM '~,Z. n H J~ ~ I n ~ ~ I W ' 0 VNk.ERTE4 A'7/L N UN 1#EATFd A77'YG _ ~ ~ a a i _ ~ 32 ,_8,. I I i I _ /YIR 1~ Nles ~.*.u. Fise /+~a _ T ~ _ scn ~ y.._ na~oveo er oxnwx w-- _ - . ~ - ouwiiw rw.nYG ~ ~ ~ ~ ~ - I / .I,.wUR~ ~ E ur/,vy 2 x 8~. 7t~oy,~ ; ' 3 Tq6 fr'~L.a=¢yt/t5s .SH/uC~4LJ ~ ~ Ta W6grKER. ' 3 v /5 ~~.T UNi~F.4rr-o ~TT/C. ~.q _ . - - ~ ,..~arNau-~ ~ . ~~_"sLG.IY~-.~.~Y~.Sc7F.Fir_V=.vr (Corvr,~ / .7/-~SucAn~w - t Z,y_ti., c ~ GDS - . 8~ e° _ /Y P.C4 shi-F./SC/.! Ta . r~" YPM%//„17`-Q ` Fi/FH i('hi/~n~ ~7Y - - - a ~ l~ lN3u~AT/+N /i''-o ~B-LR.t 2^ v ~ _ ~u c' t. ~ 6X/57/NG ~I- •L E,ti~'?' ~ .7ol5 rJ - ~Y`Q 4- ~ - _ a'. x/fib/M~ ~ ~ t ~ - ~ / tit ~C~l `j~~ _ I M R Mas D~,~ ~'.cs<kE~x. SGtE_ey ry MFlIOVFD{r pEAWN{Y oetF - ~ {FViseo . _ _97~/8ii . _ ,S F_GTio,~.~, I pMW~N6 NUMIEII S•~r-y