HomeMy WebLinkAbout17737-z
FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22738 Date NOVEMBER 22 1993
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property 255 OSPREY NEST ROAD EAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 35 Block 6 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 4, 19$8 pursuant to which
Building Permit No. 17737-Z dated JANUARY 5, 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 ADDITION, DECK ADDITION & ALTERATIONS WimH woos Rm(7VR F
FIREPLACE TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GEORGE V. McGOUGH & EILEEN F. McCORMICK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
CERTIFICATE NO. N-109060 - JANUARY 3, 1990
PLUMBERS CERTIFICATION DATED NOV. 19, 1993 - KING PLUMB.&HEAT, INC.
,
uildinq Inspector
Rev. 1/81
Poa~ xo. a
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)
N° U1 ~7~7 Z
Date ..1.,/....`'~...........
Permission is hereby granted to: /' ~
l G
.~~°
~~ ~
.......... .............................
..~rcr~~.... ....~ ................................(................
Caunty Tax Map No. 1000 Section ........,. ;3.~ Block ...........~°....... gLot No....3. ~'~ .............
pursuant to application dated ...........1~/~ ............................... 19.~.V..., and approved by the
Building Inspector~.~y/+
Fee $•.~~~'i'~~`~
uildi Inspector
~ ~
Rev. 6/30/80
SUTRO£~0.
Imes[ment 1'mfatwnak Since 1888
201 California Street San Francisco, California 941 I1 415-445-8211
GEORGE V.McGOUGH
Chairman
Chief Executive Officer
November 19, 1993
Building Department
Town of Southold
Main Road
Southold, New York 11971
Attention: Georgia
Dear Georgia:
Enclosed is a check in the amount of $25.00, per
our conversation of Thursday, November 18, 1993.
Ed King informed me that he has filed the solder
certificate, so all appears to be in order.
Please forward the appropriate certificates to me
at my residence in San Francisco:
Mr. George V. McGough
60 Rico Way
San Francisco, California 94123
I really appreciate your help. You have made a
long-distance project seem very easy.
Sincerely,
George V McGough
GVM/jmz
enclosure
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Form No. 6
~ ; ~ __ ~ ~ ~ ~ TOWN OF SOUTIIOLD ~'~ ~ ~y ,
~~~ ~~~ g~ BUILDING DEPARTMENT ~ ~~ ~ JAS ~~CL1n)CIfGG C.l-~
TOWN HALL ~] ~ ~ Z~
BaoG.pEpr. 76s-lsoz /-moo -GS'Z.-1
t@Wnf of S@uYH@L~i t O 3 0
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: j
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 I7> lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B.~ For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
pre-existing land uses:
1, Accurate survey of property showing all property lines, streets, building and
, unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
~ reasons therefor in writing to the applicant.
C, Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
f^ 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 $15.0,A,011, Commercial $15.00
Date ......~.~.'~. lU43fJ; q3 ..............
:Jew Construction........ Old Or Pre-existing Building............. .....••
Location of Property.....~S.S,,,.QS'~,CC~jI...(~.'~0..~...~~ti~............G,f-1.1:~.(t~j~'l1,°r1G~YY..
House No. 1/ Street Hamlet ~~
Onwer or Owners of Property..~R/~.-tG'_.,C:,,~~',,~jp•Nq,~,,,,,,,C~,l,~.~~,t~ ~, M~=.~v(E1!j.j~~.
..~ 1
County Tax Map Novi 1000, Section...~~.......Block....~ ..........Lot~~ ,,,,,,,,,,,,,,
Subdivision..... ~r;~'-.gw,~;~ "fi~rr
.......ff...ff.~~Fppiled Map..~:P.~~.~«?...L"ot........,{'...,~...........
Permit No.~~7.~~.~.~y:",....Date Of Permit...~l.~d.°.J......Applicant.V:yrv~fome¢rrY,~:J„°y~
ll j ~.
IIea1Ch Dept. Approval.........~111.jj~ :............Underwriters Approval..: ~d~4~0.:.t~~ly~ ,
Planning Board Approval........~YJ.~.........,, .r•
bequest for; Tempor//a~~ry Certificate........... Final Certicate...........
`~~ Submitted: $...cJ.v-~.: u~.' ...............
eon as ~3 ~ .- ~ ~-~-._ .. ` G ~-U..-v._ ~-~
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INSPECTORS
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Thomas Fi
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Building Inspector w ~
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Gary Fish ~
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Building Inspector ~
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
C E R T I F I C A T I O N
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
DATE: ~' ~ `Z ~'.
Building Permit No. ~ ~2 c~ 7
Owner: ~~or~ //Jy c ~'~j(p.t,~
(please print) ~
Plumber: `~--~_cj P~ (~ -~- [`Y'om
Cp ease print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1$ lead.
c
(Plumbers Signature)
Swor before me th"s
__~~_ay of _~~,, 19 `
Notary Public, ~ y(/~ County
Notary Public
~1,giRE L GUEYJ
NatarYp°Na 4879s05~awYork `~~/"/'
pbalified Tres Denember 8 19~.:.
('gmmission Exp
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Step to: Convantlonal Homes:
It using a CTD round contemporary terminatlon
1) Haltl CTB over top of last chimney aectlan
(F~gure 40f.
z) Center inner slip section Into inner flue pipe -
slip tlawn.
3) Center outer locking section over outer flue
pipe - push tlown until locking joint snaps Into
position.
4) Pull up slightly on CTD to Insure locking joint
has firmly engaged,
Nofa: A special galvanized dipped CTD is available
for added protection, for appllcafions susceptlb/B
to Conoslve BnV60nmenlS. "COnraot SupBNOr
CBBtdmBr SBrvidB for dB18dS".
Using a CT2 Chase
Termination
Rater to specific installation Instructions included
with CT2 chase terminatlon for details.
1" Mln. Nr
8pnue TO
rF3•CTY\ ~ Cmm~uNlbme
From TF8
CBlmney
Stupe Rnow
Bgol
Figure 42
rrgure au
Using a CT1 Chase
Termination
TFe
Chlmnsy
Note: Refer to'specidc Installation Instructions
Included with CT f chase terminatlon for defalla.
TFiBT1
12"I Mlnlmum
Ir apeel To
eaMBUBaueL
Pram
TPa Chlmnnp
,161orn
1
'figure 41
Note: Combustible chase components must main•
fain a minimum (2") air space to the chimney sec-
tions above the roolllne. A m/nlmum (f ") air space
4B combustibles is required below the roo/line.
Noro: Complete and inspect installation Steps 7
through 9 as required prior fo shipment from fac•
tort'. Step 70, installing the terminatlon, will be
cemplered alter the manufactured homB has
aMved at the installation sire.
Nate: Combustible chase components must main-
tain aminimum 1 " air space fo the TF8 chimney
sections above the roolline. A minimum 1 "air
space to combustibles is also required below the
raolline.
Always cover exposetl chimney sections with
waterproof protection tar storage and transporta-
tion between factory and Installation site to prevent
rain and other foreign matter from collecting inside
the fireplace and chimney, Remove this protective
covering Immediately prior to Installing the termi•
nation. Failure to tlo so will create a fire hazard
should the chimney sections and Its cooling sys-
tem became blocked.
The TFS•MH7 mobllB home torminatlan adds
7)P/i" effective helgM to the Installation. Use this
dlmenSlon f0 dBfBrmine If addltl0nal ChlmnBy SBC•
tlgRa erg rgquirgg, prgvltle g ealg end lanai lgrmi'
nation height,. Consult the ten foot rule summary
section on this page for detailed Information.
Figure 43
TFe-MNT
Termlpmmn
B•MNLB
la:klgp ama
To install the TFS-MryT Manufactured Housing
Termination, slip the terminatlon onto the
preceding chimney section. Wrap the locking
band, Model 8-MHLB, around the joint and fasten
securely with the nut and bolt provided.
(Figure 43).
notr nmcnnMS a n t usmnrlnu~ nnr ro cral r
MULTIPLE
TEflMINATIONS
If mare than one terminatlon Is located on the
same chase or within the same general proximity,
we suggest they should be separated in distance
at least 24" horizontally from flue center to flue
center and stacked, or soldiered vertically at least
1a" apart, from terminatlon smoke exit to termina•
lion smoke exit. See (Figure 44) for detail.
This suggestion is in the interest of satisfactory,
operation and use. If terminations are located toe
close to each other, smoke may migrate from one
flue into the ether.
Figure 44
TEN FOOT RULE
SUMMARY
The minimum chimney height above the roof is
speclfiatl by all maJor U.S, building Cbdea~
If the horizontal distance Irom the chimney edge to
the peak of the roof is less than 10 feet, the top of
t41d a~lmngy must b9 gt Igggt ~ fg®{ ~~gug tN9 9gek
of the rbof,
If the horizontal distance from the chimney edge to
the peak of the roof is more than 10 feet, a
chimney height reference point is established on
the roof surface 10 feet horizontally from the chlm•
nay edge. The top of the chimney must be at least
2 feel above this reference point. In all cases the
chimney cannot ~be less than 3 leaf abovB the roof
at the edge of the chimney.
The 2' in 10' rule Is necessary In the Interest of
safety and does net ensure smoke•free operation.
Trees, buildings, adjoining rooflines, adverse wind
conditions, etc., may require a taller chimney
should thBtkeplace not draft properly. See
(Figure 45).
TFS CHIMNEY
COMPONENT CALCULATIONS
Minimum installed height of the HCE and N series
fireplace systems (Including fireplace and chimney
components) is 12' 0" In conventional homes and
72' 0" in manufactured housing. The maximum -
height is 80' In conventional homes and 20' 0"
in manufactured housing.
9
Y
sEUa~uc sr°s
~. -..cnrmney ;
',:: ; All ,UL Rel
.This catalc
°`~~ Model SSII~T~
size), and ,Mo
14" ,~s¢e} _ahir,
Type HT has
~~2t00°F. This
ture.test opt
Laboratdrie~
r.lninrv t~tl lli
INI tb f ra~At
SSII (1Q' ,12~t & * u
tys, Model SSII ~ ;.
en testeld t9 `'' r ":
the htgh telnpera~~..
of ~.lndeCti#IrdeCs, > r;
ttety Standald toC3 a.
hironeys~,tiL~~(#~ ~t
1te~MoACI ,SSI} 1
The rigged e11 stai~.~~~s
steel chimney that ~a.~Ces .
every ~nstall~nd ~~~nd, ~ ~~
simple, fast
IMPORTANT U~
This catalog references Model
SSII Chimney Systems with iwo
maximum lest temperatures under
Underwriters Laborai~rie Safen ~
Stanaaru 1 «~•~•. --••• - -
(UL•10 .
ODEL SSti -TYPE HT
Diameter Sizes: 6", 7" 818"
Part Identification: Letter "7"
Clearances: 2" to Combustihles
Temperature
flatings: 2100°F (Maximum Test}
J,nlll Sul, f ~ U-~' ,
Chimney saps 6,'7 and $ ipeh H,~'='` MODEL
~~ pot only UL,Listed as ~ ~~~ n
' ,Chimney but these sizes 11~yB f Diameter Sizes: 10 ' LeUar ~S"
Part Identlllcation:
F pad ed add~tl6psl eK~ausltue and.
strtngent lador'ator~ to;rt,~ ~a}led~~ ~ Clearances: 2" to Combustibl
for imthe SiJCth,~ditl6n of 1,145 Temperature
x 1700°F (Maximu Testl
Model SSII ~ixes,l0, ~ ~~~ j03 ~ Ratings
tpeh~;haVe ~Y,e9n°tasted„ I °~ :, ~ ~,; ~ rr~ e ~ ~'~w:
maxtmutit ~mperatttt~`o~ 15~(~ E ~` x tests h~p~ p A~eh
and also cr~mplY. wltb dll td~~b~IF4 ~1 °dama9et?r strustura~. ar ~
sixth,Edib4n~',~Q4}re~ler~t~~.Jnstt~~ ~ ~ ,dungg t~ilafi perlpd5~~f~,,~
Fatian and CnamtenaD~4e ins}rug • cttt~rte~ ~SemP~~~p, ,'~`~"~';
ions for (Model a~l~ I>xuJllY~ ~ ~
k
py5t
provide installers anti p"set's ugtth" "' M1'Jde1~~'~Si a ,,~ ~tS~ ~ ~"'
d~t~fled a~d~ accurate Irlfarru~iAn,+ ~ = w '~11e Model SS1I,Ctiim0,P~y~tn ~A
nn important aspsct~ o~opepat~Ig ~a~
s~iety an~~pr$f~~~~b,'bs~ , `; S~r'~an ~~d'i sizes~s~a}sa ttttent
s ,,t ~~ fia~,~r ~ ~ fof p4~h1d(0~11t~~;uUItS tk96 ~t Da
~'f! Y~-e H'~ ~~ ` ~ • 's , ,~~ ,~ ~ ~ouar 10,OU°~ Thp 1 ~nrt4~'t
'Q~titper~uK~ ~'e~t~ . ~; ~~ ' ~, tqr thesd{ lar9e~ siYu~S itiyd,~e ~°
n?i ~ + '' t~tat Q~'.:iour Fy ~ts~t v i ,
Tlae Model`-$SIl Type;~1T C~htrft '"r ~ ~z ~,f e ~00~
~,'~-~,ne is. intAnded fqC normal con JZ00°~±?~ > ~ ry ~ t
' tinuous operatio0 ~410~1~~F tltae ' ` ,,..;" I ~ ,
".gas temperature at tW~~tnehes ~ Tie ~4~&~~4:4~t~~~~~ '
clearance,~to enclosm9-cpmbus ~~" Model SSII arid~Mo~,~~`t
lible test structure wdh9tat ex ' T. e ; ChtirEneys ar ~"~,~~
~caeding.~mperature Ilrp~ts Addi Yp,, ),{T ~ ~,;
tiona0y, the,ehimn~Y, is, Seated at :~ desigh~d for gravity y
~~~~1400aF f4,r a one h0urpCripd The = ysnttng only Thpy,'~~,
~importal.It Type HT.tests Consist ,_ hreusabls o0~nl~ ~'~``~~~
of three lmngs at normal 1000°P~tEr appllahce hau)ng~~ ~~-
11 ..long enpU9h to optain sieatly powet~burner (suath 05 `
conddions. ~>=ach of these 1000°~ oil furnace) Ythatappltane&^~.
~ firings is foilowied,=ammedtately operates wrtq ~no~tr1, tl~~
by ten minutes at 2100°F. These" t drafYat its outlef.
~a7ad~~a~r~~
December 21, 1988
Mr. Victor Lessard
Southold Town Bldg Dept.
Main Road
Southold, NY 11971
Dear Mr. Lessard,
~~,~~n~~
~~~
r.!_~ , ~ 2 2 ~ , p..._~
Environment East, Inc.
R. R. No. 3 - 3075 Indian Neck Lane
Peconic, New York 11958
516-7347474
Enclosad is a copy of the bedroom area of the McGough residence
on Oswprey Nest Road,East Marion. Please include this drawing
with our application for a building permit submitted this week to
clarify the existing goraditions.
Thank you for ~our~ assistance in this mater.
Sincerely,
Teter k. Stout burgh
President
Environment ast, Tnc. /
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765-1802
`°®"-^BUILDING DEPT.
[ ]FOUNDATION iST [ ]ROUGH PLBG.
(]FOUNDATION 2ND (]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~G%6"~~_~~~
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DATE ~ INSPECTOR
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PACx
1,QOUl.?, 7.EYREAU OF ^t sGTRICRY
86 JOHN STREET, NEW YORK, NEW YORK 10038
h07.()4389/89 N 058855
azl]BRRUARY ) 5 ,1989 A
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THIS CERTIFIES THAT
only the deetrled equipment w described 6eloto and introduced 6y the applicar]t named on the ahoce application numher in the premises of
.EURG}; Nr.GU/1GR, USPRFX NKS'f kUAD, tr. FiARtUN, N,X.
in theJdblelnR bcation me UUT
~ IRtFi. ^ Ynd FI. .Section Block Lot
~
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X Q6,7Y7fN
tUAR
leas eramined on and found to 6e in rnmplianre utith the requirements of this Board.
RX RANOES OOOIIINO DECItS OVlNf qfN WAfMNf iX11ATKT FANS
pXTYY
Aft LYYITCIBS
OUiIlTf IIGNDtSCSM HIIGSlKlM OTXEfl MAT. K. W. AMT. N. W. AMT. [. W. AMi. K. W. AMf. X. r.
ORYEES RBBUCE NgTORS lYTIIN ANIIANCE IEEOMS fMOALMC'Ii TIME GIOCKS ENi IXET IIEATElS AIUlT401111lT OIEIk1ER5
AMi. K. W. ql M. r. GAS N. R AMT. NO. A. W. G. AMT. AMr. AMT. . AMTS. TRANS. AMT. N. r. W ~ AMT. WAITS
SMVIQ OMOONNECT NO.OF f E R V 1 C E
AMi. ANr. irN ~~ 1 / t'M 1 / ]W ] / ]W ] / AW ~' G jERf+,COND. ff CC. ~ D. NO. q X4LEG 01 ~ IWN~~IGKi NO. p NENRAIS Of NWEiITIIAI
7 20~ UR 7. X 7 2(0 7 )/0
OTNlE AF-ARATUk
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PAl1L1 R. Ri)RNS i,LC.{282 R
275 TUNN RARAUR ),ANf.
SUi1TNULD, NX, 1.1.971 OMAI
11
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This arKlicab mutt not ba aMarad in ally manner; raWrn to 1M oNia d the Eeard 8 incareet. may. M identified by tMir cradeMiab. -
j COZY FOR EINLDM~i QjlARTMENT. TNIS COr1f OF CERTIF~GTE AE1iT N1-T EE ALTERED IN ANY MAIi+IER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS yAC
~.naol2t .
BUREAU OF E1.EGTRK:TTY
65 JOHN STREET. NEW YORK, NEW YORK 10038
JANUARY a3,199U 61:47AG$9/$9 N 109UFU
Date Applintton No. on file
THIS CERTIFIEEi THAT
only the dectrled egntpment v drerl6ed 6etote and iwerod!lcad by eh. opplicgtKt nerrtedon tfu show oppliceeiow number in the prstnigee of
GkARGiti NcGOUGH, USPREY NF:31' RDAI), GRk:F.NPnRT, N. Y.
OUT
^
~
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8...
.Sertion Block Lot
in thrfdbtoittR locgt'
/At Fl.
tnd fl.
',~~~i9
RAIN%R 14
togs examined un and found to bein complignre frith the reyuiremena of [hG Bogrd.
gXTIRE RANORS COOKW6.DECK4. O DISH W UST FANS
OYTYT{ ACIRi EYATCIIlf INCANDlftlNT PlUO!ltCINT OTNER MAT. K. W. AMT R. W. AMT. C.W. NAT. K. W. AMT. N. P.
7$ 21 ll 18 ~ F'
DRYY6 RM!-ACE MOTORS lUTW! AFNIANCE INRMt SFRCtAt iRIC'FT TUIE ClttGt4 BBL UNIT IRFATlRS kMµT40YTYT
~ DDAMlRS
AML K. W. dl N. P. OAS N. P. AMT. rq. A W. O. AMT. AW. AMT_ AMPS. VANS.
AMT. N. P. a ~T AMT. WAITS
SIRVIQ pfOO~NiECT NO, OF S E R V I C E
AMT. AW. Tree ~, ~wtw lwaw twaw 3w AW ~~ ~~/COND. oP GC CooitD. NO. OF N4LEG ~~HI~~ No.a NFUnA15 aF 'NWFUIOMI
1 zao cB 1 x 1 z/n 1 z/a
O71gR AloARA7Uk
PANELBAARflS:1-27 C1R. 2aU
TRANSFORNER:1-4.5 RVA
G.F.C.1:-3
4Nf)Klt ASTRC`TOR:-.1
~~
PAUL R. BURNS I,I:C.~2$2 K
275 Tn{IN HARBbR LANE
S4UTNOLO, NY, 11971 ~ p~Af MADIAORR
11
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This eertiiiegN mutt not M oltsred in any mgrgeqry rNUrn to the oNiw d 1M Rotnd if incorred._ Im~eclon maf be idenNfieel by their erodentigk. ~
COFY FOR BUILDING DEPARtMtNT. TMIE COPY ONI CIRTII~ICATI AtKT ltafi E ALTERiB31N 1NY fAi<IBIER.
~~~
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FORM N0. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TDWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 7651802
Mined l~.!~ , ..... , ,, 19
proved , . ~,/.~1 ....... 19~Permlt No. ~ ~7`:37~
s~pproveda/c ,......,...' ............. ..,.,.....
APPLICATION
Racaivad...,..,.,.,19. „
o~v\,`~
BUILDING PERMIT
Date .Dee.:.9o....,..,., 39 ~F3
INSTRUCTIONS
p. This apphcation must be completely filled in by typewriter or in ink and• submitted to the auilding inspector, with 3
s 4f plans, accurate plot plan to scale. Free according to schedule.
p. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premtscs or pubUc streets
areas, and giving a dekailed description of layout of property must be drawn on the diagram which is part of this appli•
jtall.
" p. 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. Sugh permit
J,t be kept on the premises available for inspection thrpughout the work.
qq~~ No building shall pe occupied or used in whole of in part for any purpose whatever until a Certificate of Occupancy
~fiave been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuaitt?~f6~thn
ilding Zone Ordinance of the Tpwn of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or
yylations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
0 applicant agrees to Comply with all applicable laws, ordinances, building code, housing cede, and regulations, ~Ad to
t1~t authorized inspectors on premises and in building for necessary inspections.
environment least, Inc for Owner
(Signature of applieant> or name, if a corporation)
3075 Indian Nock Lane
Pe•co nie•; • ?~' •2195$ .... . ........ ... . ...... .
(Mailing address of applieant)
~tR whether applicant is ownec, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder.
General Contractor
~)4tl of owner of premises . , , . , Ga,gx'~~. ,M4RAU~kr, .. . , . ~.. .. , , , ... , , , ,
(as on the tax colt or latest deed)
~ppli ant ' corpontt'on, signature of duly authorized officer.
„Ppesident,,,,
(Name and title of corporate officer)
Builder's License No. ,~5$.6~iI ............. .
plumber's License No. . ~ ... ................ .
u,i~ ~`~d`f .
Electrician's License No . ......... . . . ......... .
parer Trade's License No . . . . . . ............... .
~,gcation of land on which proposed work Will be done . ............. ................... , . , .......... .
255 Osprey Nest Road East Mariorn
~ousc Number Street Hamlet
County Tax Map No. 1000 Section ... , .~5....... Block ... ,. ~...... Lot.....~,~34... .. .
1 ,.•
SNbdivision .. . ............ ... .............. Filed Map No. .............. Lot . , . , .. , .... , .. .
(Name) ,
State existing use and occupancy of premises and intended use and occupancy of proposed conStructlonl
g. Existing use and occupancy .. `~~-n~1e Family. dwoll,ink,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,~,
'.
b. Intended use and occupancy Single.family, dwellin~;,with, additi,on,,,,,,,,,,,,,,,,,,,,,,,
Nature of work (check which a 1~licable): New Buildin Addition ,
P ' B ..':....... / .Alteration , , , ~, .. .
Repatr ,,,,,,,,,,,,,, Remayal .......,...,.. Aemolition ...........,.. ~~,..,,..,.,,,,.
r7 ~ (Description)
~stimatedCost.../..d~.~o~ .......................Foe..,......,,,,....,. ., ..,,..,
(to be paid on ltling this application)
if dwelling, number of dwelling units , . ~ . , , , , , ~, . , . Number of dwelling units on oag~t floor , , . , .. , , • , , , , , , ,
if garage, number of cars .....:.................... .,. .,.,.,..,,,,,.,.,,,.,.,.
~, 1F businoss,.eommercial at mixod'~ioccupancy, specif~~ utu~o and extent of eacl~~~+p~er~of use , , , , , , , . , ~ F t~. , , , , . .
, Aintansiona of exlating structures', if anY~ Front, . . 9, , ...... •77 . .. .
Height .. ,,. ,. .Numberof Stories ,.. .~. ..,Rear .............Depth,,?,;; ,,.,,,,.
Aunensions pf some structure with alteratiogs or itio ~ F i
N Q ~~} ns. rent ,.N~.C....,, ..., Aoar,Nl;j,~C .............
,Aepth.. ..............:.Height.,, .~~6tr•~~6t~yr...N~rgt~,r~S~t9rbe,q. ....//.15r.~e'S.,.~a..
iAimonsionsofentireneWCOnstrtiction: Front ,,,,x,,.,,,.... Roar ,,,,,,,,,,,,,,,,rt?epth .,,.,,.,,,,,,,,
Height , . .... , ....'... Numtfer pf Stories ... , . , . , , ... .. . , ,
,:Sizeoflat: Front ............:.......... Rear. .. ... .... Aepth ,.,,,,....,..,,.,,.,..
~,.'Dateofl'urct;ase ,,,,,,,,,,,,,,,,, ,,,,„ „NamoofFotmerQwner .,.,,,,.,.,,,,,.,,.,.,,
, ..,.,.
, P P R miSesarosituated,$esp.,c~ent~.,q? .......................................
floes ro osed construction viola , , , , , , , , , , , , , , , , , , ,
Will lotrbe re radod m~wQ ich re to any zoning law, ordinance or regulation: ~O , , , .. .
B . , .. , . , .:... Will o a dl bo re ved fr m premises: Yos No
`Name of Owner of premises a, Mcaou~h . , , .. , ... Addressrr~~~, ~ spry ~s t x,~`~•Phono No . .. . . . .. . . ..... .
Narno of Architect ; , Address`' ag £ ~ t7ari o ii,,N Phone No.
~NwnaofContractor~nvi'ronmprit;l~,ASt;'~'ric;Address3,OZ~~~ndi.an Idk~Lr~hongNp.7r~,~~~4,`~I;.,,,,
,, ....... ., ..,,., Peconic; ~N'X~~1~~~5
~, :~
~~~~ PIAT DIAGRAM
j.ocato clearly and distinctly all buildings, whether existing or proposed, and indicate all aet•back dimensions from
sporty linos. Give street aqd block tiumbur or doscripUon aceordinK to deed, and show street narnas and lndleata whodtor
or corner lot. ~
~,
pRQPOSCO
..- .. ~R+~NT .-._ .. .
;~ i
ATE OF NEW YORK, S~S
t~VTY OF .................
(Name of individual signing contract)
vp named.
;r the ., ~ .................. 'I ,,.ir.
aid owner or owners, and is duly iauth ize
iieation; that all statements contained in t
k wUl be performed in tits manner dot Earth in
,~ to before mn this
CtopoSEO DecY., A'UO~'t'~oni
being duly sworn, deposes and says that ha is the appUcant
tor, ago t, carporate'officer, etc.)
or have performed the said work and to make and file this
licution are true to the beat of his knowledge qnd belief; and that the
upplication filed therewith.
.,,...... ~~, ....,;~.d/ay of ,.,/,r.~~,.,.,.,....,19$~
'M~' Public, .``~:`:...~.•, . ~.~ U~:,. .... County
HELEN & DE VOE
7e~ ~Exp~ es Mo chff30t1 e0 York ... ' ..... ... ... . . ............ .
(Signature of applicant)
~ i