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HomeMy WebLinkAbout18432-z FORM NO. 4 TOWN OF SOUTHOLD $UILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219223 Date JULY 18, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 5494 MAIN BAYVIEW ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 078 Block 04 Lot 36 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUG. 15, 1989 pursuant to which Building Permit No. 184322 dated AUG. 28, 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. The certificate is issued to DENIS MC KIERNAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-77 NLY 13, 1990 UNDERWRITERS CERTIFICATE N0. N126463 APRIL 30, 1990 PLUMBERS CERTIFICATION DATED PECONIC FLUMBING & HEATING 2/26/90 uil~spector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219224 Date JULY 18, 1990 THIS CERTIFIES that the building ACCESSORY Location of Property 5494 MAIN BAYVIEW ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 078 Block 04 Lot 36 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUG. 15, 1989 pursuant to which Building Permit No. 184322 dated AUG. 28, 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 ACCESSORY GARAGE. The certificate is issued to DENIS MC KIERNAN (owner} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N126463 APRIL 30, 1990 PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 Fosa~ xa a 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 ~ ~ 8 4 ~ ~ Z Date ..dd.~v~.....~ 191..1. Permission is hereby granted to: ...~......~°...k.~? to ..1..,~:!I:A,~.t.~-...4).......,7.Y..i.R. ..An„a e~i~..,.....1,•,i'.5n~~4.Q,~.~.....C~l........aH,... ~.~rS~... s .:.....'v' I ~-n..~.,.....~:s..... ~....C..,.o of premises located at ..~.......~7.........Q!,?....~a.~~,/.,:1:1~... Cvunty Tax Map No. 1000 Section .....Q~.g........ Block ......5"a.~........ Lot No....~.~ pursuant to application doted ......6.t1li~...~.~ 19.89.., and approved by the Building Inspector. ~ i Fee S•°~•~•+t~~•.•`~:•~- X0'7. ',F s". SS 6 a..ar ~ 9 Bu ding Inspector Rev. 6/30/80 Form No. 6 ~ ~ ~ ' TOWN OF SOUTHOLD ~ ) 71990 BUILDING DEPARTMENT 765N1802L TOWN DF SOUTHOIO~~s Iv 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-4 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Swurn statement from plumber certifying that the solder used in system contains 4 less than 2/10 of 19 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. Certifica*P of !~e.cuparcy - ;~Te:- dwelling $25.OC, Additions to dweiiing $25.0[x, 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... ~~JJOld Or Pre-existing Building~i.. Location of Property..."~.~~1............ ~r1,4d/~~5~ I!®d~!if ..........,~~efl ;E{oL~ House No, ~j treet Hamlet Onwer or Owners of Property..~t!(/~'S.."./~~~PC: ~'Vyg~?..tt// .................pp................... County Tax Map No 1000, Section..~~, ~,,,,,,,Block.. / .............Lot,l,:.d~:~~ Subdivision ....................................Filed Map............Lot......... Permit No l..l.~~,~:.....Date Of Permitl~. Z~..~~.1., ,Applicant..G!~~d~.,~~~y~''t~"'~'~~'~ Health Dept. Approval ..Underwriters Approval...... Planning Board Approval Request for: Temporary Certificate........... Final Certica te........... ~ ~ Fee Submitted: $,,;;5;,,,,,,,,,,,,,,,,,,,,,,, n ~~i~~9d _ ~6 zr9~~3 APPLICANT FORM N0. 6 TOWN OF SOUT110LD BIIILDING DEPARTMENT TOWN UAL. 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS p. This application must be filed in typewriter OR ink and submitted to the IIuilding Inspector with the 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 Uealth 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 solder used in system contains less" than 2/10 of 1Z 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 hail"ding. 6. Submit Planning Board Approval of completed site plan requirements. S. For existing buildings ~Prl.Or to April 9, 1957 non-conforming uses, ar buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A properly 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 ownership 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 $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 S. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial ev. 10/ 14 /S8 U~'" ' (tip' (J ~,I~ TOHN OP SOUTIIOLD IIUILDINC DEPART:[ENT .XSI.~f ~ TONN EIALL ~l (J7Q~Q Y 5 SOUTIIOLD, NEp YORK 11971 ar 765 - 1802 JVf. BLDG.OEPT. t APPLICATION FOR CERTIF CA E OF OCCIIPANCY TpWNUFS0UTHO10~,,_„ DATE. ~6 .y . KEN CONSTRUCTION ..~0 LD OR PRE-E%ISTZNG BUILDING......VACANT LAND........ I Location of Propcrty..~.?5,(,,,,,,,,, !P!/f!!~/(3AV!_/mY>/ ~~/7~L~ , llOU~E NO/~ STR/EET [IAMLGT Ovoer or Owners of Propenty.,(!~,~y~-s,MG~j/C.~°~?/9^f i County Taz Hap No. 1000 Section a~g 81ock Lot' Subdivision Filed M i aP ...Lot../%.J.......A, PcrmiC No. ~o,7~p7~_,Date of PcrmiC ~Zb„~ „Applicant ~Y.L~~:3_~7~~~°~~ IIealth DepC. Approval ...I, Underwriters Approval....,,.,,,,,,, Planning IIoard Approval I c ucst For Tem Drat Cerj q p y tificatc Final CcrtificaCC Pee Submitted: Gv,,,,.. I C APPLICANT.G~ ?~-o~~l~ ~6~ y~ ~~qo c~ Zi~a~~ ce~• 10/14/88 I S~EFOU,'~, TEL. 7G5-1802 ~O 0~,, TOWN OF SO~JTHOLD ~~.~'~q'~p. ~c OFFICE OF DUILDI1dG INSPECTOR ~T~^t~ P.O. BOX 728 `r' t T01VN HALL o~'Ol ~ ~ ~ O~ SOUTHULD, N.Y. 11971 C E R T I F I C A T I O N , Date ~.e~~~~9/V Buildinnng Permit No/./~~~~~ Owner J/YNis /rL,-' K' eV',e~ .9 ,J ~ple se~ nt) ~ ' (please print) I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. ~,l ~ ~~ak~,Y'..a z ' (p tuber's signature) Sworn to befor_~~ myye this day of O~ , 19~. _ ,r h ~a ~,r-r.~. Notary Pub is tlotar7 Public COllRty ~ BAFsEF fiA 5"t'EPNOWSKI Notary Public, State of Naw York ' No. 4844762 ' QualHied in Suffolk County Commleaion Expires i~lJ r - _ _ T THE NEW YORK BDARD ©F FIRE UNDERWRITE~tS 1'AGI 1 t DU 1 Il / t BUREAU OF ELECTRICITY 85 JOHN STREW. NEW YORK. NEW YORK 10088 ~w APRiL 311,994() Application No. onjile t~(.GCitbtt4jN9 N tIG$.G;S THIS CERTIFIES THAT only the electrical equipment v daarikedkabte and introduced 6y the ep'lkant wamsd on the ohoty erpptlcation numker Ga the promises of EiA- DFiNNCS Mi;KCERNAN, 549f MACN BAYVTPai, SUUINDL.D, N. Y. in the folbecinS IercoNon; Q Basement DU I Af'hCL C)B.t99i) Q letFt. ? Ynd FI. Sertiun &aek Lot wes a:ermined on and found to be in camplionce ntith the requirements R(/this Beard. nxnle t Rxrt~ T EANBES ~tboxlltoEEU1 OV~Nf tl~•rrl fx?uyMtr flr= txn~li AtLf fWtIGMS HYneEICENf _ -.OTNEn-.. - M1T. R. W. AA1i N. W. - AMT. R.W. Ntlt:' t.~W. AMi. X.I. 2'1 ;t4 !V 'lS I 7 il.f 1 1.7 h.. h. T DRYERS RIEIIA IUtWE AMl1ANCR IMOEK tlC?i 71ME tyCSFIfS pLL IMMi MAtgi MIB~Y~t MMk1~E ' :wt. R. w. a; X.I. apt X. r. NAT. XCI. A. w. o. Arr. NN. NAr. MAIL. tAAW.. twr. X. r. NAr, wATn S t` C Sq an SERVICE DISCONNECT S E R V 1 C 1, E NAT. NM. 1M ~~'Il tw t/TV t/tW tXAw NO.Oi C~COND. Aw. - ~ - rM __a cc.c~ito. no.a ~x-eta I a'~~ ~w.otXtunAU~ ~ ~u~ t loo c~ t _ x 1 otttn ANARATUS: `rMOKF DETFCTbR:-1 ,P 1; h S (;1)NTRACTUk I_CC.fl5l8-F HOX ?S w SUIII'NULD, NY, 1.t'd1i 8/~ILLMIWAMI 15 Pn 'ihis artifkab not laa allsred in a'ry manner; rNurn to 1M offiu of tlr Board if incorretl. Impeclsrs._leay Ip11 ~e tlrir,_~,N ' COPY POLE ~IRL.DING DEPARTMENT. THIS COPY OF CERTIfICATI! MUST NOT ~ kLY ~ ~AIIM A~ ~,,~~~-rtr''?r~. TI:L. ?!>5-1802 ~~~~fot..~~G~ To~rrr or souTUOa,~ r.~ ~~6uw•t~ f•+~ ..c OPPICI;OC:IIUILDINGiNSI'ECTOR ~~~+~~4 ~ C.O. UOx I 1 7 9 c2. n~. f1 ~ TOWN IIALL ' ;f,-yo~ 3 SOUTIIOI.D, N.Y. 1 1971 November 9, 1989 Denis McRiernan 1100 Beachwood Lane Southold, N.Y. 11971 To [whom This May Concern, 47e arc unable to complete your Certificate of O~ccunancy because of the folloc~ring reasons. • /_t1/ An application for Certificate of Occupancy is i~ot nn fil.c. CENCLOSED) / / PIO Underwriters Certificate on file. 't'he chcc:}: .i:; (IDAXx1~7ex1/not on file.) $25.00 Dlo nea].th Dept. Approval on file. Nn final insl~r_ct:ion has been made. P]c;a:;e contact: our office on L•hi~ matter. - Thank you for your cooperation. IA;.il<]inq Perm.i.t-. I 8 4 -3 2 Z ACCESSORY BUILDING ONLY Building DupL'. d k~k/_/ tlo Plumber 5oldeJ: Cert.if icate on L-i le., - ( a].1 per;nit•:; involving plumbing being iasucd aft.cr April 1,1984 ) - TEL. 7G5-1802 o~UFEOCk O TOWN OF SOUTIIOLD ~ , :~a ~;a, ~ y~ OFFICE OF BUILDING INSPECTOR ~ P.O. BOX 728 ~O~ ~ ~ TOIVNf[ALL ,~OI ~ ~a~~ SOUTIIOLp, N.Y. 11971 Sune 15, 1990 Mr. Dennis McKiernan 1100 Beachwood Lane Southold, N.Y. 11971 To 4lhom This.May Cohcern, We are unable to complete your Certificate of Occupancy because of the following reasons. - An application for Certificate of Occupancy / is not on file. (BNCLOSBD) / / o ilnderwritcr~ Certificate on file. /~}ie check is (~Y~d;~t$IXc~/not on file. ) $25.00 for house No ftealth Dept. Approval on file. $25.00 for Accy Garage No final inspection has been made. Please contact our office on this matter. 'Phank you for your cooperation. Build9.nq Permit 1 $ 4 3 2 Z Build~.n< Dept. ~ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,19II4 ) ~ r'D~Y ~/fA-r+7 ~/y.S` ~~C /'"C~.BGIG~/!PJ/I/ lake and stream floodplarns, earth fill is the preferred method of elevating. Fill should be placed in layers and compacted to prevent settling. Other options include elevating the structure on columns, piers or shear walls. These methods are often the most economical in areas where flood waters reach depths of several feet. In coastal high hazard areas (Zones V, VI-V30 and VE), neither use of fill for structural support of buildings nor floodproofing is allowed and elevating on pilings, columns or shear walls are the only options. Non-residential structures include commercial and industrial buildings, stores, banks, factories and other similar structures. These structures may be either elevated on fill so that the lowest floor, including basement, is above the 100-year flood level or floodproofed. Floodproofing is a method of protecting the structure by excluding the entry of floodwaters. The structure must be designed to be watertight below the 100-year flood elevation and be capable of resisting the pressures of flood waters without sustaining structural damage. Utilities and sanitary facilities also must be protected from flood damages. A floodproofed building must be designed by a registered professional engineer or architect who must certify the design (see (h) at the bottom of page 50). The lowest floor of a structure is defined as the floor of the lowest enclosed area (including basement). All floor levels of a new or substantially improved structure, except those used exclusively for parking of vehicles (i.e. garage), limited storage, or building access (i.e, stairs, elevator shafts, etc.) must be elevated to or above the base flood elevation. Thus, for example, any floor level equipped for such uses as a kitchen; dining, living, family or recreation room; bedroom, bathroom, office, professional studio or commercial occupancy, may not be permitted below the base flood e]evation. Abasement, meaning that portion of a building having its floor below ground level on all sides, is never permitted below the base flood elevation, unless an exception has been granted to the community by FEMA. Only the towns of Amherst, Erie County, and Southold, Suffolk County, have been granted such an exception in this state. The allowance of certain reasonable uses below the base flood elevation, such as parking of vehicles, is permitted because the amount of damage caused by flooding to these areas can easily be kept to a minimum by following design and construction requirements contained in the floodplain regulations. The conditions outlined below must be met whenever such enclosed space (i.e. used for parking of vehicles, storage or building access) is located below the base flood elevation. (a) No machinery or equipment which service a building such as furnaces, air conditioners, heat pumps, hot water heaters, washers, dryers, elevator lift equipment, electrical junction and circuit breaker boxes and food freezers are permitted below the base flood elevation unless an architect has designed an enclosure which prevents water from entering or accumulating within the components during conditions of flooding; and (b) All interior wall, floor and ceiling materials located below the base flood e]evatinn must be unfinished and resistant to flood damage (see Technical Bulletin 88-2, page F-79); and 32 i LD i C: ~v'; IJni ~I ~;"v.YM[:NTC _ . _ ~ c' e.., _ _ _ H OUIJDAT20:!-., (1st) ~ 9 ?OUidDATI01d (2nd) _ °OUGH FRAME & ~ PLUMBING "1 3. ~ n IIJSULATIOP! PER N. Y. STATE ELlERGY 0~.. CODE p 0 ~ r 4. m H ° A FZ;JAL ~ z,Pe W ~ ~ ~ ADDITIOifAL COMMEIJTS: x I! L J' Q m ' x H \ a N ' .-3 •G H \ O ~ A ..O r 1 / H - r/1 ' o O m ~ ^e y ,,,J J ~~3~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] iN ULA [ ]FRAMING [ FIN REMARKS: G DATE ~ INSPECTOR / 765-1802 GG BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] BOUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: /1 ~ DATE ` l"i' INSPECTOR ~ 7fS-1802 = BUILDING DEPT. tNSPECTt®N [ ]FOUNDATION 1ST (:~~ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION ~,~fftAM1NG (]FINAL REMARKS: _ ~ DATE ~ ~ ~ ~ ~ INSPECTOR ~ 1 ~ 765-1802 BUILDING DEPT. INSPECTION [ ] F UNDATION 1ST ( ] ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING (]FINAL REMARKS: DATE ~ INSPECTOR l~~ ~ r~-18U2 BUILDING DEPT. 1 NSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: 1'A-~~.~a;; ~ - ~ DATE f L INSPECTOR f J Z rsS-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ ]FOUNDATION 2ND ~r~}"(RSULATION [ ]FRAMING ( ]FINAL REMARKS: r~ ~ ~ 7 'f~ DATE INSPECTOR i sac r-* U, _ ~m 5 ~ ~ o~ ~ V ~ ~ `or co ~~`'F~ fC 0 ~ om O~ ~ n 2~ ,t' ~n z A ~ Q C7 ~ 9A~ ~ Gnu (~1 ~ ~ g ~`~r. ~ _ _ _t 3 m to - . r' rtl O lJ / ' r N S I N Im O E r, i i l r ZIrn I~' n, ~~r13 E of , . ~ r ~ I ~ ~_.i ~ ,p@~. 'S N.48`p71O~`ti -ICO.OO o ~ o ~ 1- ~ ~ ~ 7 ~Gl ~ r~ ~ oc-~ -r 4~ P ~JF. WF,I.I- N I ~ N i~ a' ~ L f~'. Z/ I~~ r ' o - ~ ~ I ~ I. ID ~ 13 'o r? 3S 'w ~ 2 t'o . i rd ~ n m ~ ~ ~ ~ ~ ~ I ro~ "d ~ r ~ I 00 YI~'3 3 ' _ _ p ~p 's 1 ~ it a I L ~ ~ ~ • j ~ ~j • ~ _ ~s.4a°oi to"e. loo.o ~ ~J I -T iZ i, r. ~ Ali M1 i, n~ ' u m ~ . ; E No w N 8 j< rn c r i, ~Irnt i ' ~ m ~ ~ Z y~ I ~ p~' (Q ` , ' p [ A ~~p ID ~~'t. Q ~ ~ ~ i. i~ i ~ ~ IaoucE ~ i ~ ~~Imi ~ iv~m'a O y t'_ kl, w IN ~ m n O ip 'pIU tTt U" Q~ ~ a° t~ 11 1. C~ I m (1 D ~ ~ . _ _ y Itt { ~ m ~ _ corzve z . r . - -r~l.zz m ' C ~ p D z ~ B. I °..SInOQ E. CANN.1° COREY C2Gt~. V.Nt. a 4 ~D. 'p ;Tl ~ (3.02 iy m A <I;i~~3 INi~ `~i" ti. ~ EAYVIE~n.' f20AD A O ~Q I IN ~~I9 n £ ~~I~~x ~ r ~ ~ - - O O D2°nln u~ ~nn~-i HH m 2 v7n DO m r +Oi ZNm ~ Z ~~pi ° ~w -~i ~ .0 A~ y m O p m~< O w O O m F ' m~ ~~A p~2~ OnN '•1-D ~ m~ cn~ ?y ~3~m Z S { r . J Cb ~ ' , O O 7C ~ z -ni ~ v n ~ Z N m LO o n O n r. O-~+iN~ ~ w-ni~ O'jz z v ~ r 3 D z O i ti ti m ti< m = ' r' ~ x ~ A I Z Z YI 820?.'--. 8 i~ a'^3~ 3 ?i 1I~ ~ ~r,~n';~~. Fmk r`~~' N i~~, m ~ D m x D ° ~ o r! s ~`N ~+'np~ X43 f.t'~~i y 1 '.OJ'~ ^On vmi A~ r°>"F-1 i:IN i'F IID ~'~s=s~8r, °`r3g 's,~q D ID ~ O O O ~ m 61 z ' o'N C. '.,_j dlr 5.a. sa~'d'~~~"4 ~'i y ~ ' Z <'i INZm~ \G~`e in~> o`' R-r'~'~~'~ ~Sg'q ~ O ~ r x m O m° »a o,~ A ~ FYOH . Y. m ~ 3 II~$ i y;°~ w O m < m m'~3 $ ~ ~ rx to m~~ - - - BOAFD OF HEALTH FORM NO. 1 3 SETS OF ~1NS . SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N. Y. 11971 NOTIFY TEL.: 765-1802 CALL /y fp . ,1tLp'~.e1'1~.., 199. MAIL T0: ~1/lirl ~L- C•xaminc n _ q \pproved~.~^^"~M;ed;', e~.Q.., 19~.t. Permit No. ~~~c~;~~ _ ,.-.-e. r j~ ~i~' . e Disapproved.a/~ ~_4 i~ ~ ~)J~(~~ AEG ~ -1[~ y~~ 1~ ~ (Building Inspector) TQWA®j pF • OEpr $aU11i0Lp APPLICATION FOR BUILDING PERMIT Date 15.. . INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 permit 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appticable Laws, Ordinances or Re;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i pe ~tions. ~ (Signatur~t'applr name, if a corporatton).. . I~60 ~G'Y)GC-CN?Dui' ~6uTr?c`Q N, //~'J/ ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....044? u.?.? . Name of owner of premises !-:`~.~r?!s..~... I.~Y.N.kaC.~S-! (as on the tax roll or latest deed) !f 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 . . 0t}ter Trade's License No . . 1. Location of land on which proposed work will be done. ~ . House Number Street. Hamlet County Tax M1iap No. 1000 Section Q .7.~ • • Block , , , , , , , , , , Lot ....`3 . Subdivision Filed M1iap No. Lot . (Name) State existing use and occupancy oaf premises and intended use and occupancy of proposed construction: a. Existing use and occupancy f,,,l.a`1:~.I'9. P1.~ . b. Intended use and occupancy • re+~f{a:!/>! ..k!C'i.'1.~ ,.pp~~ , Mtl~. ~N~IIf.. 3. Nature of work check which ~iapplicable): New [3uilding , ~ , , , Addition Alteration . Repair Rc{noval Demolition • .Other tVork . 4. Estimated Cost ,~.~?.~,~~~,P.Q~.~,4.d • • • • • • • • • (Description) i Fee (to be paid on filing this application) g ttg units , ,I , , , , , , Number of dwelling units on each floor , , • , 5, Ifdara'lennumbcrofcarswclli'N. 6. If business, commercral or miffed occupancy, specify nature and extent of each type of use , • 7. Dimensions of existing structures, if any: Front . ~ , Height Number of Stories . Rear Depth . Dimensions of same structure with alterations or additions: Front • • • • • • ' • ' ' ' ' ' ' Depth....... Rear........ • . 1 Height , ,Number of Stories . ~ • • • • • • 8. H`mi ~sis pf~ sire new construction: Front ....<fh.`, , , , , , Rcar . , , ~ , , , • , • . • ' ' ~i . Nu'~nber of Stories . / • Depth .v?7 ; 6 ,j'. 9. Size of lot: Front . ..1.'Pr.s : ! . 10. Date of Purchase . '7 : !3 :.•~.9.......... Rear ....../,4, s~, Depth ~ r ~ ~ . ....•••••••......NameofFormerOwner .l {,~..f.~Tr~.G.IZ.......... 1 1. Zone or use district in which p~'remises are situated . 12. Does proposed constructi ~ S iplate any zoning law, ordinance or regulation: . , , tJ .d• , • • • ' ' ' ' ' ' ' ' l3. Nill lot be regraded • • • • • • • • • .............Q Name of Architect ~ J• •I ~VdI excess fill Ue removed from premises: Yes 14. Name of Owner of prcm ses . ~e w i s ,[ti1 ~;;214V,~y,y~padress Q~t~c ltwgq d 4Fl Phone No..? ~ ~ ,Q~, • .Address , -Ao ~r}eo ld' iv . Name of Contractor • • • • • ~ ' ' ' ' ' ' ' • • • • • • • Phonr. No . ................Address ...................Phone No......... .~y 15.Is this property looted with in 300 feet of a tidal wetland? *YES..,,NO.,I~. *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether. interior or comer ]ot. / 5 .~_._-i, - - - --,t_. ~/.5~-~- I~ , . ~ ~ ~ F-~ °f I ~Y ~ - - ~ 35 i COUNTY OFEN YORK: $ S • • • • • ~ • • • ~ • ' ' • • • • • • • being duly sworn, deposes and says that he is the applicant (i\amc of individual signing contract) above named. -fie is the , .(Contractor, agent, corporate officer, etc.) • ~ ~ ~ ~ • • ~ ~f said owner or owners, and is duly~i,authorizcd to perform or have perforred the said work and to make and file this application; that all statements contai~ted in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner $ct forth in the application Glcd therewith. ~wom to before me this i • ~S. ....day of . . l/_ " , 19 ~.y ~otaryPublic, ,,,4?';;{~(J;C;Q~;-~•,, County ~~y~+~~ N1MM~ (Signature of applicant) ~T \ ~ ~ . ~ ~ ,f ~'a.. . ~?S1 ~ `y'~ pl ~ ~ ~ tip - ~'~R~ / _ p rd? ter 't7 ~ ~ N f,~~ ~ t ~ ~ y ~ ~ / < ~ °1 ~ co i ~ ''Y,~ - ~ °fl,v b x i ice.. `3 M ' ~ a~ ~~~a~ m il_,f`) ~ ~ ~ \ l ~~,i, i~ ~ } VA CD N 117 `R"i ~ ~ i , 'l . ~ l ~ ~ t' ° ~ i . ~ 7 i ~ ~Q, 1 5 V1 ~7 ~ Y d x ~ 'TM '4 v 7r ,4<~ t', 1 i ~ I ~ t hac ~i~l.+.fi,, i ~ ~ S v ~C. E.~. _f' 1X1 ` t ~ _ ~ , . _ ~.7, ] ~ ~ ~ i ~h.7'x,,.,"/s«..w,s6-'~ tit ~ i t Y K7 ~ji' ,~y SJ p`/ i i';1 ~fl i 4- i i"7 ;~Y V~ _ ~ t ~ ~ f L ~ ~ - .3X7 a _ M..; c , - t ~ ii'., i t ~ ~ L..,~._t, CJ ~ 1 rrt # S . .l ~-w' ~ n a'..~~ r o ~ ~ 1 f r a. i ~ i ~ 'Z7 1 _ +'U' , ! , t ~ ~ ~ i jJ , I Y 1 .`Lys L r T 4+j y _ ~ m ~ !.'~gt aN i- -`i y Si ;r. iti ~~i/`? _T_f~- i R N yr p _ ~ ~ cc rrr " tugi^ ~ ~7 E, [Qt~,t~ # CD r C '7 ~ r ~ ~ e~ , ~ i }c-~, _ _ - '.'~~`~r-';ie&. eR42r. Q ~ m.G` - ~ 1 _ _ _ ~ ur~te.-~ ",t~a' - 4 .~F. n ~=v„ ~ ~ ~ ~ ~ i 5 f1~3: ~ ~ ~ i'- 1 N ~ { w ~ C7 ....t ~ ~ 2b L) ~ ~ ~ f ~ n ~ ` ~ ~ , r ~ - ~ 5 C3' I w' i { ~ 1 ~ t , ~ ~ r ~ i 1 ° ~ ~r dip ' , r R a„~ ? ~ l~~iD. 'vni 1 i~_ _ ~ ~ 06 ~ 7k{~y a ~ ~"f~ST. i 1Ii y ~ C~%i a ~ ~ k 4~.} ~ ~m o ~y7 'Y i i ~ ~ ~ ' ~Ij~Cti ;61 ~ ~ ' ~i ca c ~ ~ 'T6t,22 -R"J ~UVEx n °7 f~ :g+ ~ ~.v o _ _ y'fjs~,t~t-.TL? C~1CZ:F*.Y ~C.G4FSa,'?._ c./k b+ ~S v rid' 1 i } +`h b ;sax" ' p ~ O.~ V1 N t/l f7 w -1 ~ i . ~ ~ p p7~, ~ A ~ ~ 'C O ~ O O ~ ~ ' ' t3 ~ ~ ~ ! ~ m ~ n ..~0 O ~ ~ b c~ tsar" n : ~ reb ~ _ ~ O - ~z i ~ n p ~ ~ "O vim O '4~ O ~ninD-i dcp~ s t f ° ~ r < c rkC '7 R r u l;1. ~ ' `iY.. - 7r1 ' 'fl fll 1C ?3 _ o i ' o m ~ v y m':r ~ ' ~ ~ ~ m. (A r.` M m O RI 5 'Y ~n } i 4 4 ~ ~ !i ~ to 9n u. a a i> v 3~a.. ,F"" ~ ~ a ~ Y, 1 1~ ~ ~ 1 h O A' N f ~ N 0 ~ F. ~ tyi 'KFa pV+• ~ _ !!y ~ ~ ~ ~ ~ a ~O a \ ~ ~ ~ ~ ~ ~ ~ ~ N .y x.17 ~ ~ ~ ~ ~ > ci~\. ~l ~ ~ ` ~ s o i ~ -r ` ~ u $ "N ~ ~ y# Ill Z ~ ~ (P~ ~ Il J' ~ ) _ q d l9 .'qO r Y g i ~ - - f ~ SUFFOLK CO. HEALTH DEPT APPROVAL ~ 1' .•rJ ;ar- P~MF' ,iq. ~ n 6 1996 I .'(1 _ ;o \ _ i ~ ~ 4 v(,aRg ti'EFtCtr u.oFUKE' ` t~ f " STATEMENT OF INTENT ` , ,+3Wesio~3 5 l ® ~ ` THE WATER SUPPLY AND SEWAGE DISPOSAL G~~ ~.,lt~t,df°52~5£i^~~___~_ 15.0 K_~____ !3- _ _ "ALL } I,} ~ SYSTEMS FOR THIS RESIDENCE WILL cis CONFORM TO THE STANDARDS OF THE ~'h p +r~ 6iR'¢' ~ n ~ ' ~ C,~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. SS'si - tS1 ~ 1 ~ ~ ~ wn6 ~ g ~ APPLICANT ='CS t: ~ ~ ~ "r~ ~ ~W ~ ~ ~2 SUFFOLK COUNTY DEPT. OF HEALTH cesSPO!~~- • r ~ r r; - APPROVAL O ~ y~- SERVICES - FOR F ~ ~ ~ ~ y1~;'. ~ ~ ~ CONSTRUCTION ONLY • _ i _ c.iar ate; ~ ~ ~ DATE: r SEfl?C:: 5'"s.-1 ! ~ F.,~' I' jL.SV E - - -165.0 .REF. NO.. ~ S~ - :.li -T7 - H S . ~ `i jfr f _ r _ _ . QF r . _ WAY ~ ^ l _ +t APPROVED: - i3 1 r _ _ _ _ _ _a _ ~ . _ _ _ _ - _ roc. v±9 5.41':;2 ~ ~ ro~-e vo+.E _ 33t;.6E ~ SUFFOLK CO. TAX MAP DESIGNATION: ~ DIST. SECT. BLOCK PCL. o ~ OWNERS ADDRESS: we_.. ti~.J x o. ra.: n. *r» . -s ~ ,r ~ ~y~. ~ ji~'77 , - - - - _ a~ DEEO• L 13 t, ~a' f t . ~ Y• i •~w~. s.:~ _ ~ ~ TEST H E - _ i , a - t r i ,w ,I inn ar ndiltlgl ~ ~ f 1 r-~ ~ ! , 1~^ r v ~y ' v \'urk Ststt I . - L 1 1 t j'.w1 i ~ 1 4 ~ ~ ~ ~ ~ ~ ` , . c~ ~ ~ ~'J~ ' ~ LDR'[Y rye - _ ~jrln ~ S~IH:iE ~ ids r ' r.::, ~ , ~ ~ ~'.SiWD _ .c rsr ervd 25 _ _ i r., .:I~,., r T 4.: v~/r~ ^t' ..+.i4 ti~ J "'~l.'~ r 1.~- ~ZNF'.. v $iiAlO. ^ ~ :'1'.,'2+., .J.. • _ + i - G~ 5Gr.X)l_ ~Pt .aF F~:u~-- YSiN"f9Et -ttr~ , ~ ~ Pf?l., . ESCr~Atv~'~:!v PCx1E. R1L1@ TO MA.1 -v~'E,,r..t:, T~:~~Y'P~`._'-- _ _ ~uM 7r - JUNE ~xtQf3~3 ~ _ _ PINE Ttl k v, , ~ ~ F`v ,:UA~'.Ahfl•F;E:t;,r Ct1 ~JMC ~ON`.vF~t `r+__ ~.23S5Ud " ' QGT.Z5~IQ8~ LANG _T!T!_E tCl~tli?lal~IG~ C~tF3'1l~lY ~ , ~ JIILY_2~,I_Q~O A? Si)(Z_V_E_YEO MA4Y `I ~ ~ ~ i ~t~EVAT~ONS G?.Ei~.T~ M~R.ti SEA ;.~.'vEl~,ht G _•1.0• _ RODER{GK v~uYL. P.C. , , 1, . ~.;aiCJ,TtONS QF WELL51tCE95_PJOL.S ~N 80lihiG>iNG '~^'y`"'~ i 3~PJ2~Ei.°.i A12~ f1c:FU'"F %_d; gVltvEt2. - LIGENSEDLANDSURVfYORS H GREENPORT NEW YORK TLLLOYNt q5T NBIl79 - ` ~ SUFFOLK C0 HEALTH DEPT. APPROVAL ' ; i- ~tz•~ `~c' .?t!I. 6 1990 . _.f _ ~ ~ ~ g~L %:S'- fig . ~I ~a '~~'r~ ~ i' ~ % ~ucf N. aFUUE, + ~ STATEMENT OF INTENT ~ ~ ~ THE WATER SUPPLY AND SEWAGE DISPOSAL ~ ~.._r_- - ~ I 0, Ot SYSTEMS FOR THIS RESIDENCE WILL :J' ~~s.i_ I`~ ~ ~"~~p,~3t+g,- ~ ~ - CONFORM TO THE STANDARDS OF THE 4~' r.AR. ~ ~ ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. 4 ~ ~ 1 ~ ~ ~wrt~'"o ~ ~ (S~ APPLICANT ~ ~ ~ ~ _ - _ PO1JIJaA. 1~! , ;~t } SUFFOLK COUNTY DEPT, OF HEALTH spot ~i ~r - m SERVICES FOR APPROVAL OF ' , ~ ~ 'b:. ~ ~~1P~ ;r CONSTRUCTION ONLY ' '`I r ~ ~ _ aar DATE: / ~ - .r' S~'l~ Ws.1_ - i .N.~I+S'~5Q -1-65.d~_ W H. S. REF. NO.: :l0-T7 ~ - - - - - - - _ r _ QF- I . WAY,. ~ _ 13_ _ _ fl~ 1'~~ APPROVED: _ . J/ _ - '..~q}Q ~ ~,~1~.~~~~N ` ~ SUFFOLK CO. TAX MAP DESIGNATION: ` DIST. SECT. BLOCK PCL. / R , i i , Cf.~,CCA~l~3 OWNERS ADDRESS: ~ ! j }i ~ - 7, r. ~ ip^~ , ~ A~cr.r*~ 'r°., ~..atNir~ DEED. L. P. ~ ; TEST HOLE STAM ~ t i ~"S~ i' f 14. 4,r ' I TAAItL f0 ~~i.~! u^ ~ L_ ~ " , _ _ b t~ . ai.1~V~Y~:.~ - O.D- D.O trae,tti=xr..a.!aMar^frontu addition /IP10Y 'r t"'~ ru~'~ is s ~+'~atio~ o! s Q/~?'1 F~,~,~on ct~e Dtaw fork Stall SE,FfOIK, ~ r-. ~ r i - _ rSii~~LED~i:~~'f u'd+'ELLi1Vt, OP~l.Y S~.~tdil.tS ~`../a.~..~'_~_.~ ~ , ~+mta~l~,Un,rnot~~rity 7 ~ Q ` ~~-j i~~ _ (~~~G _ ~.y r' S_s~ s~ n.. he enneldered A ~~'i1~~-.ir4/Y ~ ~f ~Er. I~~ ~ 1 ~G ~ L ~y ~V~ J~-.-' tr . vBUtllt~3 p r { ~ ~ M~ ~V ~ F1NE TO C,: rhaU run T i 9b tnu' ~~V' ~ ~ V`l' ~2 s°lMa~e disp~~ul „ ,:,.-r s~tr I~ t ~~::;i2~ ¢t~r "r,~s 0: ' ~ . _ ?~IEQu,J~d ~ :~1,,. ,o,",~ti ioc;.tren sere ti,~~~, r + , ~ ~V?~j ~F ~i?~..ETf'~.:' 1 ~ ~ ~ ~ 1SC t. y r J i ~'ti~I ~fIG10; t~ ~ ~~I U _ _ t]I1'IEi 3g4 1~ iCJ' IU f+i't 1J~ ~ ~ b.~l ~ la:, - - ~ ~ ~ i.n. , l„yi~J. 1, ~ ~ GES~F'cX~~S.Ui- i'vG~._ YrA~Ea tKi _z 1 P~' o QQ~17. ~1~~~ -~Oi'.?I... FINE fi~ _ . Chef of 6ur~~., ~,I ~~..r~:,.fv1a~., ;F'.-r;: t ~ "tfQ~`~t-•- 7. , : _ . v~LAS.E1+; IK .1Ut~lF tG(~ CINE Ti3 K „a Li.r . AUL~ y1 ~::'l.)A+.'•~ai~i`l'Ejf.:~. i ~r If ~ON1ti'~'i~l ~ 11 ~~T Lit .(11 e QGT. ~5~1Q89 I.AN(~ T'(T.:»E ybt~U~1~NG9rs GOt`~IPA!`:(`r w t~. ~ ? j` ~ I:_ ~I. ~ JC7LY 2 I~ P,~ '~i ~`'l ~G ~Y ' } r i ~~r~ ~ , i ; J w#, V N ~ V _ RODERI[K YA TUYL, F.C. l~ v.,.,... ~ _ ~~Ul'lQNS C?F' WELLS ~CEBSPOOL9 OtJ BG~:I ~w~,' ~C, y i' . LICENSED LAND SURVEYORS • ~A~~~i.~ ~ ~7v1Ni . GREENPORT NEW YORK reuorwe tan ++n~tv