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HomeMy WebLinkAbout18557-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19443 Date OCTOBER 12, 1990 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 1400 WEST CREEK AVENUE CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Secta.on 110 Block L Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 29, 1989 pursuant to which Building Permit No. 18557-Z dated OCTOBER 4, 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 ALTERATIONS & ADDITIONS TO EXISTING ONE FAMILY SEASONAL RESIDENCE AND CONVERT TO YEAR ROUND USE A5 APPLIED FOR. The certificate is issued to MARY S. McGAHAN (owner) of the aforesaid bua.ldinq. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-151275 - SEPTEMBER 25, 1990 PLUMBERS CERTIFICATION DATED AUGII5T 17, 1940 - PERFECTION PLUMBING Building Inspector Rev. 1/81 f'O]LM N0. f TOWN OF SOUTHOLD QUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 1 g J J~ Z Date 19.~~.~ Permission is hereby granted to: ~~J 53.5 ........~...~....f.:~..,....~ ~I ~1,rJA~,S ,~.7L ~ t ~~~:~r.'..~ .....a~ ~~'o...~ G~.~~...`' ~~~!..~.fr!~..~.....<...... I.......... County Tax Map No. 1000 Section ........~/..1~.. Block Lot No.........T.. pursuant to application dated ..............~r~'~•t/•••••••••• 19..~~ and approved by the Bwlding Inspector. ~~Q~ a.7 ~~'7J 6~~,G ~ J~'' /D ~ ~ ~ ~l /O - FS~ X1,3/ Fee ~ ,r' ~ ~ / / `J.l.."~.~4~.. Iding Inspector /G~3alf~, )q.d0 ,3kS 33 Rev. 6/30/80 ~ Form No. 6 TOWN OF SOUTHOLD j/,(~ ti BUILDING DEPARTMENT /i Q 1990 ~ TOWN HALL 765-1802 BLDG. DEPT. TOWN URSOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY 1' ' .1. 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 12 lead. t S. Commerciai 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. ~8. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accuzate 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.D0. Businesses $SD.00. 2. Certificate of Occupancy on Fre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 L'p~ated Certificate of Occupancy - $50.00 , 5. Temporary Certificate of Occupancy - Residential 1$15.,0.-0/, -Commercial $15.00 - Date .~~V.?;L~'14~.LBj.I~FA ::ew Construction........... Old Or Pre-existing Buil~d/i~n~g.x Location of Property...l~~.Q.~:.~^~e~K.~~...4C:~C1,~D~U~~ House No~~.{~n ,p.,~ S,,t~~sreet Hamlet Onwcr or Owners of Property..Jlll,rfi;-:Y ..aS~.~C.S~~ County Tax Map No 1000, Section...~~ Q ......Block..., 1..........Lot.. T Subdivisionl..pp.~~ .................................Filed Map............Lot.............. Permit No.1.4.~.~,~,,,,,Date Of Permit,!~1~~~~.....Applicant.f.`:~LY.S"..:'F~.~! health Dept. Approval ..........................Underwriters Approval... Planning Soard A ~ PProval.. 2equest for: Temporary Certificate.........,. Final Certicate.~....... , 'ee Submitted: $„q2.~,,,,,,,,,,,,,,,,,,,,,,, (J / . ~ R1 A. I n JJ Jt 7 . ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 E 5077 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 f c SEPTEMBER 25.1990 4pplfrateonA'u urtfde 66015789(89 N 151275 ~ Date THIS CERTIFIES THAT [ r only the electnca! equipment oa deacnbed below and Nntrodured by the applmont named on the abaoe applfrahon number m the prem:aes of 4 r t r .A. MC GAHAN, 1400 WEST CREEK AV., CUTCHOGUE, N Y e in thefolluauiA breahon. ®Baaement ~ lAt Ff ? 2nd F7 ATTIC/OUT Sertmn Block Lut uos examined on SEPTEMBER 13,1990 and found to be in curnphmire uNth the rwfuimulent+n(thn lfaord ^p FlXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTViTS KFPTACLES SWITCHES INUNDEXENi fIUORESCENi OTHER AMi K w AMi N w AML Nw AMi N w AMi H P 34 8 48 34 1 1 2 6 F I E DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL VNIT HEATERS MULTI-OUTLET DIMMERS 0 AMi N W Oll H P GAS H P AMT NO A W G AMi AMP AMi AMPS TRANS AMi H p SYSTEMS AMi WAiiS ~ NO OF FEET 1 2 14 60D f SERVICE DISCONNECT NO of S E R V 1 C E ~E AMi AMp iTpE METER I ~ 7N' I ~ 3W 3 H 3W 3 B AW NO OP CC CGND A W G NO OF HI LEG A W G NO Of NEUTRALS A W G E/]ttlP P R b Of CC COND OF HI LEG Of NEUfRAE 1 200 CB 1 X 1 2)0 1 /D E OTHER APPARATUS ~ MOTORS:i-3/4 H P E G F C.I:-8 SMOKE DETECTOR:-1 ~ TRACK LIGHTING.-36 ~ ROSLAK ELECTRIC LIC #3b77-E ~ P. O. BOX 164 ~ PATCHOGUE, NY, 11935 GENERAL MANAGER ~ I 12 L~~ ~ Per C~ ihls cerb{ICate must not be altered In any manner, return to the offlca o4 the Board If Incorrect Inspectors may be Identlfled by their credentials TEL. 7G5-1802 Q~pc~~FF~[.(r ~O~~ TOWN OF SO~JT~Od.~ f'a' ~ OFFICE OF BUILDit30 INSPECTOR =o t'~ m P.O. BOX 728 u' ~ K TOWN HALL O~'~l ~ SOUTHULD, K.Y. 11971 _ C E R T I F I C A T I O N Date /9~v Suildirg Permit No. f~,~7 Owner / //1a ~~dry (please prin/ty P1ur,Wer~Ft~oN ~bup~&~,ur,y:~~Tit/G {please print) Z certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. c iplumber's siynaturel Sworn to before me this ~q~ day of ~ I9--L~ / ~ Notary Public tlotary Public,_ diua County D ~y~ ?wrwt LLu' luJ... ~~liu 'Jfl~r II liL:'Y.`IIrNI... +f 1. ~ c } ? . I ' _ I t ~C,GGe*e~_ , FOUIIDATIO:I (1~t) ~ ' .~~u'.- ~ 'OUIIDATIO:J (2nd) ` c '.OUGH FRAME & ~ PLUMBIi1G 3 , -yi a m I;ISULATIOf1 PER N. Y. ~f y STATE E;IERGY CODE i~ 1~ ~ FZ:1AL • o ADDITIQIIAL CO"1*1EIlTS: J9'~ ` .3533 ~0 3m ? ~4t? . x , 'v H 9 H H O m ~ f ~ m H f ~ 765_182 66 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION [ ]FRAMING [ FINAL REMARKS: DATE ~ INSPECTOR 1 (SSs~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ) ROUGH PLBG. [ FOUNDATION 2ND ~ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~--~i c DATE ~L ~ ° 1 INSPECTO j ~ 765-1802 U BUILDING DEPT. INSPECTION ] FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: r DATE Z INSPECTOR ~Fs~7 r~->.BOZ BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST (ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]/FINAL REMARKS: P`~~" DATE ~ ® O INSPECTOR ass-isoz BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ J i`OUNDATiON 2ND [Lyr~ULATION [)FRAMING [ )FINAL REMARKS: DATE INSPECTOR Y ~s ~ 7ss-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( } ROUGH PLBG. 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I ti ~ I I~ i ~I~~~,~~ ~I I, I ~1 I III I~ ~1 i ~ ~ n~~ ~1~~ ~ I I 1 ~ ~ I e rs I I I `"t I 1 I I r I~ I I ~ ~c ~ I I I I I I I ~ ~ ~ I I I i 1 1 III ~ I ~ I 1 I 1. I 1 1 ` ~'I I I I I I 1 I ! I I (1' I I I I I I I I ~ I ~ . `a I Irr I I ~ 1 1 I I I i i ' 11 ~ ~ ~ I ``c I I ~ I I { i ' I 1 i , 1 ~ l i i 1 I I i l 1 r 1 ' I ~ 1 i 1 1 ~ ~~EFO(~~~~ FRANK A KUJAWSKI, IR., Presrdent = ~ TELEPHONE ALBERT ] KRUPSKI, JR , Vrce-Presrdent ~ ~ (516) 766.1892 JOHN M BREDEMEYER, III O,y~ ~ JOHN L BEDNOSKI, JR '1101 ~ ~1~~~ HENRY P SMITH BOAItp OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Mam Road P.O Box 72& Southold, New York 11971 June 26, 1989 Ms. Mary McGahan 1400 West Creek Avenue Cutchoque, NY 11935 Re: W. Creek Avenue, Fleet's Neck, Cutchoque N.Y. Dear Ms. McGahan: The following action was taken by the Board of Town Trustees during their regular meeting held on June 22, 1989 as follows: WHEREAS the Town Trustees have conducted an on site inspection of the subject property, West Creek Avenue, Fleet's Neck, Cutchoque, NY. RESOLVED that the Town Trustees approve the request made by for a waiver to construct addition to single family dwelling on above mentioned property. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. Very truly yours, Frank A. Ku7awski, Jr. President Board of Town Trustees FAK:jas ce: Bldg. Dept. Board of Appeals file . , T - ? t ~ ~ 1 2C1 t ~ ~ Pel~ref,f co~~~vell ~ _ ~ ~ ~dGf1S/r5r'7' t f~RTH " ~n _ 1 ~ i r ~ ~ ~ ~ 1~ ~ ~ I ; + j j ~ ~ ~ x ~ ~ ~~s i 1~~~ i~ ~ ~ ei t ~ ~ ~ 1 ~ y~ i n! t~ F' ~ ~--~i ~ ~ l~ ~ r}• E' p~'+p tsr-r---'' r r., '1. c i ~ i ~ ~ ~ \ \ ---tat - - ~ h ~ ~ - ~ y - 'o STAGE ~ ` ~ ~ \ - - r ~ _ f \Y. ~8' RrJ' ~fd\ Kl. \ \ ~ ~ ` + ~ a;r f~errl i ~ ~ ~s - JO ~ UnH~Ntortzed droraebn a /~~}~r~, }~9 /~/?~~^+5~.y~~/~/~ , ' pp t Y~C$ bi~ rt~u MNIW VMIt f ? I.{77!' Ql'~ ~~4/r/"' Gi /'C l.: T ~ ~ r k j(rtNF ~ r ~gv+ . - _ ~ ~ Motrj`d MM wKVe~'Te^trot'baarf~g .z.,.. _ ~ v° _ tlN rif~d N~n~sNt'a intedk9n4 0 }TYT ~ ~ R- l lar/ ~r / ~ f V1 ~1, <a' ~ - _ Le, ~ ~tn0oxw10 „sl ahatl not Fe axrerr9 R~,'t7} ~ ~ . n 4e i ~1° «!?v t ~ a~+rF~l`!t 13~7"'~ NE t ~ .ih~wt96 nnv9on "s ,~j y Qf r ~perrson far wh : } F'~. Ta 1~'CK !'%a'~.~ • ejp~~ ~K V,gryAO~t ~a aaaet4w ene m Mts L ~ ~ ' • rf/ Q gt79 eem anJ pCeer~ E - ~ ir~'ry~ !fT t - Ien+uPF ;u.i4rKn+r ct ~ 'i '~~W~~i.. i7. 7 ~'t'w:-'~^~.. y r to the s.=.-gncas a tre J;;:..t ~Jb ,s tt y r n ~'4 UfJan Gcsrar -ae ere nx < ~ fAYtll~ ~ Nk~/iN0 Cj - . . - m fgauronat V+a't: (c¢iona u su4seyuerrc ~ ~ p+ 20 r 0 - y avy-tas.. 4 _ ~ ~ ~F r" _ : ~.'t'~~.~r 11~. ~ ^Ly~~, C S 256 J~~ ~ e. - ~ ~ - "tanrrai ~ 13, 1990 49 GI. Long ?r . Laws encevi 11e, h,k7 OBb4B Mr. Tom Fisher Surlding Department Southold Town Offices Main Rd. Southold, NY 11971 Dear h1r Fisher , Enclosed are trro repies of the map showing the foundation location for the renovation/remodeling of our property located at 1400 Pf. Creek /ire., Cutchogue. I understand this will be required at the time of the framing inspection coming up soon. Would You please see that this information gets to the file far this fob. Sincerely, ~rl q Wallace A McGahan ~ ~r-e c r ~ i~~~ ~ ~~EFO(,~~o~ FRANK A KUJAWSKI, IR ,President ALBERT J KRUPSKI, JR , Vue-President TELEPHONE JOHN M BREDEMEYER, [II O,y~ ~ ~ (5161 765.1692 JOHN L BEDNOSKI, JR `101 ~ HENRY P SMITH BOARD OF TOa'N TRLSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O Box 728 Southold, New York 11971 June 26, 1989 Ms. Mary McGahan 1400 West Creek Avenue Cutchogue, NY 11935 Re: W. Creek Avenue, Fleet's Neck. Cutchogue N.Y. Dear Ms. McGahan: The following action was taken by the Board of Town Trustees during their regular meeting held on June 22, 1989 as follows: WHEREAS the Town Trustees have conducted an on site inspection of the subject property, West Creek Avenue, Fleet's Neck, Cutchogue, NY. RESOLVED that the Town Trustees approve the request made by for a waiver to construct addition to single family dwelling on above mentioned property. Please return to the Building Department for a determination on the need for any other permits which may be required for this pro3ect. Very truly yours, Frank A. Kujawski, Jr. President Board of Town Trustees FAK:7as cc: Bldg. Dept. Board of Appeals file New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11794 9 q / , , ~m~f~' ~?/~,J o~.~ DATE : U~~.(~/yC~ ~ ~ ~ l /~f(I7J ~~Z!`~~L1'v `t-~ Re: QO/ -~1~~ _ /[may ~3J~ W ~ ~ C„~~,~ommas C. Jorling / (///~~r ~ missioner Dear ~'L( ~Ci.G~"'~~„ ~ A review has been made of your proposal to: ~}~1~'~/u.~l~ ~ ~aXlL Based own ~e nformatian/~ou have submitted, the New York State Department of Environmental Conservation has determined that the parcel project is: Greater than 300' from inventoried tidal wetlands. _ Landward of a substantial man-made structure greater than 100' in length which was constructed prior to 9/20 77. ?{k Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. _ Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the protect as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional mit Administrator + Rig=F~; o ' ~ = `j i r .~cF a ~xa 9._°~- r~ y N'~ p? S J d ~ 0 6! -T- ¢M7~~z9ng ;g s iso$~w €br ~~3 ~~3 ~~~.~.am~ aaS "^a t ~~'xn~m~2 ~ ~ ~ o U _ y 1~ Jf_C'i.IhG'.Y't ~GN WA'FE2 -µA[1 i~ t + . - fy~ ~ . ~ , Nom' P~ _ ~N7`= ~ f ~ \ ' ~ rl'1 o J {mayy ~'t ~ ~ ~ ~ + ! i ~ Y _ ` ; f 1s1 to Y,S~ ? f~ c ~ ~ s o ti ( 1 ~ y~~7~1 RQUSi iY! ' Y N K ~~c~ T T G` ' ''n' aw 1.s ~ 1 V~ l e L~_ ~tgg~oRZ~B ~Q 5~3 ~R~R~~ ~4~ R`Am ~~u a +y gm ' ~ ~ - JC4NJhf1Y H~GF{ ~ Wh BR MA2GL ~ ~ ~ ~ ~ ~ m ~ ~ ~ ~ ~ ~ k ~ a ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ nX ~ .,,k ~ - „E X11+~'~`C,. r ~ i, tt ~ ~ A ~ " I I ~ i ~ ti+ Gi ~ 771 ~ < _ / f y~ _ ~ ~ r r ~ ~ ~ ~ 4 ~O 7 / ~ l ~ i ~ ~ r ~ ~ J ~4 + Sry ~ ~ R~OF• TF Ck 7.. .~icr. ~G K. e^7 il~~', i c•" ° aa~ ~ o •Y a ^t G?~ 6 71-n~' UY VF~'OR + ra . ~ ~ r ti l~ n O M I ~ ~ ~ ~ _'~0 2 ^ ~I ~ i ~i i ~ ~ i c~ ; ~ I~ ~ h ~ ~ ~l oIV J e ~t i ~ ~ ~ I C I _ a~~, __iY ~ ~ ~ i---~ ~i ,~i ~ k ~ V{ 2 ~ i ~ ~ d ~ I , ~ ~ < < z I ~ ~ ~ ~ ~ ~ I ~ { ~~f u ,,1; 1 i i Ems` ~ ~ f A . a.~~y 11111 i~ i i ~ h ~I ~ C w h~ ~ ~x y~ i i f ~ ~ ~~i ,i' ~ i ~ ~r ~ I ,.ae___._-...e~ . , i ti ~o Q * U33ry~ G-- W oQ~ N~4,t ya'> h ~ W a v II ¢ ~ ~ h I W L Y N 4f ~ • 3 0 ~ o ~ e~ 4 T 0 ~ ~ R r~`y J ~ 0 ~ ,a a~ - ti ~ ~ w tU ,d Q~ ~a~o v ~ ~ y ~ 2 v ~ •S ~ u~w~i ~ M ~ ~ P T ~ ~Owr3 I a ~'f ~ ~4 to ~ \a ~ t` O 41 ~ O O ~ ~ i J 0 ~ N ~ O O O 0 Q p 0 ~ai ~ z l ~ N O ~ ti ~ ~ h~ ~ ~ ~ a. 4' - C o, a ~ a rJ M r U N ~ Q Z w l ~ ~ ~ ~ i ~ ~ ~ ~m~ 4 W Q ~ ~ U ~ - ~Q aQ W w W ~ a. f '~1 ~ .n n Q - ~ Q V ~ ~ i _ ~ 4 -s i ~ O a ' ~ ~ A ~ ~ F4 (CJa•. o V V .AT.' v "J 1 ~ \ V 2 i n~ ~j ~ v ~ ~ ~ d ~ \ j ~ ~~~~z < . p[ ~ ~ 4 ~ I c~ 4 ~ ~ ~ ~ W 3 2 ~ H°"~H~z ~V ~T tl Q H~'E`'~iw~~' of V' u~ w 3. Nature of work (check which applicable): New Building Addition . v...... Alteration Repair Removal , Demolition Other 11'ork , . (DescnpIion) 4. Estimated Cost 7d ao0 Fee . ' (to be paid on filing this application) 5. If dwelling, number of dwelling units S~!U~ Number of dwelling units on each floor Ifgarace,numberofcars 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 . ~F~ Depth . Height .7 ~.wat4...... Number of Stones . d.~l~`.E . Duncnsions of same structure with alterations or additions. Front Rear . Depth Height...................... Number of Stones 8. Dunensions of entire new construction Front , 3', , , , Rear (0.3 ~ .........Depth .3~`......... . Height ~k~!A-~4~. E~f~ o: iF.. Number of Stones ..Q:t".F . 9. Size of lot: Front ~4~Q~ Rear Depth 10. Date of Purchase , J,9.~9 ..Name oC Fo~~J;;tter OwnerTTElG. ~~FT..~~1tC....... . 11. Zone or use district in which premises are situated .....~t'S'14~~L1Y.~ . 12. Does proposed construction violate any zontiig law, ordinance or regulation . . 13. \1'ill lot be regraded ..../.V~....... , Hill excess fill be removed from premises ~ ;r 14, Name of Owner of premises ./d'1Rf~,Y. -sr .~1'S=~fF~i?d! Address u'' lone No. 73.~~i..~74 .(/4OG Name of Architect ...........................Address................... hone No............... Name of Contractor .~.}.'.4R~a'G.8Y1/.~~Pc~ ....Address GJ•~,~~~' i~q~t~~ . ?~f.'4+ 7r? . 15. Is this property located within 300 feetyof a tiidal wetland? *Yes "No *If yes, Southold Town Trustees PermitPLO"I' DIAGftAMed, ~q,~t Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions froii oroperty hues Give street and block number or descnption according to deed, and show street names and indicate whethe :+itenor or comer lot. ~ TO (REMOVE EXCE3SR0~ A.r FROM ABOVE PREMISES 9Y Rt~~p,DING 40T .r pp1VEWRY CON$TflUCTfON CESSPOOt CONgTRUCYION C~t,LAfi COpI^sT UC!`!~ ,TATS OF NL~:,YOILR(~ S S ~~C '~!~!%7V . being duly sworn, deposes and says that he is the apphcan (\mne of mdrvidual signing contract) Dove mm~cd. :c isihe (Contractor, agent, corporate officer, etc ) f said owner or owners, and is duly authonzed to perform or have performed the said work and to make and fi]e t}u cphcaUOn, chat all statements contained in this apphcation are true to the best of his knowledge and belief; and that th ork will be pcrfonned m the manner set forth m the apphcation filed therewith. ,vorn to bcCore me this , ( .11C-~. day of ~ 19 otary Public, . ;(~i, , .{fi~`f~~.'-~< .County [~IwoeYPubNO.~ ~NMnYa1t (Signature of applicant f11M1Mfad in Suffolk Coemty ~ yt_~ Commisekm ExPfras i7eoember 8,19.._ r' BOARD OF HEALTH 3 SETS OF PLANS FORM NO 1 SURVEY TOWN OF SOUTHOLD CHECK • - • - !~~y BUILDING DEPARTMENT SEPTIC FORAI TOWN HALL , °.OUTHOLD, N.Y. 11971 NOTIFY y~~ _ C ~ TEL..7G5-1802 CAti~ y~G MAIL T0: Examined . ~ .7';/. , 19 ~f Approved ~/Y........., 191. Permtt No. /.~`~~~'jT Dtsapproveda/c ~~j -1~ (Bu,l~img Ins ctor) APPLICATION FOR BUILDING PERMIT Date s~~ . °t'~......, 194; INSTRUCTIONS a. This appltcatton must be completely filled to by typewriter or in tnk and submttted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee accordtng to schedule. b. Plot plan showing location of lot and of butldings on premtses, relattonshtp to adjoining premtses or public stree os areas, and giving a detailed descrtptton of layout of property must be drawn on the diagram which is part of ttus app cation. c. The work covered by this appltcatton 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 perm shall be kept on the premtses available for inspection throughout the work. e. No building shall be occupied or used to whole or m part for any purpose whatever until a Certificate of Occupan~_ shall have been granted by the Building Inspector. APPLICATION IS HEREBY h1ADE to the Building Depaztment 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 demohhon, as herein descnbe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authonzed inspectors on premtses and in building for necessary inspections. , (S,gna~~tur~+ of applicant, or name, tf a corporation) (Mailing address of applicant) State whether applicant is owner, Iessee, agent, architect, engineer, general contractor, electnctan, plumber or builde, D l(~~r2 . . . Name of owner of premtses /,l'l A'?Y- S (71c' ~!g-f><i¢yy . . (as on the tax roll ar latest deed) If applicant is a corporation, signature of duly authanzed otficer. . (Name and title of}c~orporate~/o~f5cer) ALBuilder's Ltcense No .M(~~rJ'J.t~/7-~FFOLK COUNTY LICENSEn Plumber's Ltcense No Electrician's Ltcense No . O[}ter Trade's Ltcense No . I. Location of land on which proposed work will be done . . . . . . . . House Number Street Hamlet /L County Tax hiap No 1000 Scctton l~~ , . Block I............ Lot ..7 , , , , , , , , , , , , , , Subdivision Filed \fap No .Lot . (Name) State existing use and occupancy of premtses and intended use and occupancy of proposed construction: a. Existing use and occupancy SUMME?R:. (26y/IJG~!!C~.. , ;e • V S,. b. Intended use and occupancy . Y~~ • R~UAJO • ;!~~S(DEiI!~F„# ~f } w ~ai~-