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HomeMy WebLinkAbout17741-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18136 Date JUNE 21, 1989 THIS CERTIFIES that the building ADDITIONS Location of Property 335 OSPREY NEST RD. GREENPORT NEW YORK ouse No. Street Hamlet County Tax Map No. 1000 Section 035 Block 06 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated January 3 1989 pursuant to which Building Permit No. 17741-Z dated JANUARY 5, 1989 was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITIONS & REPLACE EXISTING DECK ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR._ The certificate is issued to KALYA & GUENTHER STOTZKY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING - June 15 1989 PLUMBERS CERTIFICATION DATED N/A ~~ Building Inspector Rev. 1/81 IP'OEffi NO. A TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TI1E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 0 ~ .1.7 -~ it ~. Z Date ............................. ... ~'.............., 19.~...{ Permission is hereby granted to:.y.} C> (~ ~~ ~`~' ~- ........~.k.ao k....`.1.~ ............................................... .................. .. n~^M:.Sin..n..A.~.a~':sa~~.tk..i.1.:~'a......,R~~t~....t7...~.~.-:~.......~?!~.....+?:~:-. ~°.^..~~'~^7... ~..,.T.4rsl:4.,~.. ~:°.. ~3.rK~:Sri-.GPU ..~~...~ ...:.................... ................................... J , U ...2..... ct premises located of ....~..,~..~........~.~,~t... ~ ~"P'.. ~..,.........:~~~•••• ea~ra~.~...~... ................................................................. County Tax Map No. 1000 Section .....Q..a~.,~...... Block ........~.~t..... Lot No.......~.~,.......... pursuant to application dated ...~.~r1.:!:k4••••~3••••••••••••••••., 19.~:~.., and approved by the building Inspector. Fee $...'~~.....~/.. Building Inspector Rev. 6/30/80 . . TOWN OP BUILDING ` TOWN SOUTIIOLD 765 ,~,~.~,.~.,.m SOUTIIOLD iip DEPARTifENT ,~~ 2 ~ IQV~ IIA L L ~~~w,_,,, NEW YORK 11971 TOWN OF~SOUTh9( 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY NEW CONSTRUCTION .......OLD OR PRE-E%ISvT~INnG/ BUILDING..~_VACANT LAND....._.. Location of Property.~:35 ,~~,~~~ [.`V~~_ ~/J~_.~~~IvpQ~/L/ •1~~~~f HOUSE NO,.r"~/ STREET / c NAMLET Owner or Owners of Property../,:~L'4 __2`-._~~.~~w~l~C7~._ Ji(J( ~~~~ County Taa Map No. 1000 Section ..`'~.'S__ Block ~ v_._ Lot-.:~._ 3---- Subdivision ....................... F/i/l///ed/pMap ........Lot........../ Permit No./,` , (, l.( .Date of Permit lL~,/.p. ,~ ~CG1DC~m/,~/ / / ///rrr ...Applicant ~f+-......::dY-.!G,~v. Health Dept. Approval .................. Underwriters Approval.._........_.. Planning Board Approval ................ Request Eor Temporary Certificate .~..... Final Certificate ................ Pee Submitted: $. ~ ~ ............. .. ~ D- APPLICANT.. ~,K!~%°;~~?/C, ~.~. , rev. 10/14/88 (fee. 3 X574 eo ~. 18136 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 50UTHOLD,N.Y. NOTICE OF DISAPPROVALq A Date ; . o ?.~(~. 4 ~ ~ .. ......, 19 ~'.~~.. . PLEASE TAKE NOTICE--qtr-hat your applicatioJn dated .. .P-~-~!~... ~?......, 19 ~ g . . for permit to .~.awo~¢~ „b~~ -.1,J!s'^.~uy-~-- ..~. ~ /J/~ .................... at Location of Property ~ a 9,go ...j„Zcu,,,; .,~.~:......~g-*~:,r:Q@~-~ :.................. . House No. Street Hamlet County Tax Map No. 1000 Section ...7Za........ Block ....~ b...... Lot .. ~1 : ~ ....... . Subdivision ................. Filed Map No. ........... ..-.~. /Lot No ......'......... . is returned herewith and disapproved on the following grounds .l~}~-~4~:~~. ~ `~- 30 C,~° ................................................................... ................................................................... ............................ ...................................... Building Inspector~~~~~~~ RV 1/80 ~~~ .x/Y~ FORM N0.3 TOWN OF SOUTHOLD BUILDING DEPARTM)rNT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL G% ~... PLEASE TAKE NOTICE that your application dated ..~0°~./~ ........... 19 ~l~. for permit to C..'i"~/~~Q^'~'/...~~~~?..`4..119~-~..~~®~d~.~./~~~~'?~at Location of Property ..~ :3/.......... .. .Y~.-~!.. ~~ (>'~ . Nouse No. Gj<~, Street amle[ ............ County Tax Map No. 1000 Section ... c.3cJ ......Block ........~? ....Lot 3 3. , ... _ . . Subdivision ................. Filed Map No. ................ Lot No. .......'......... . is returned herewith and disapproved on the following grounds . 1/iIL~.P/. f, ...:.~/. [!W!~,(,..~. ................................................................... /--' B ~' ldi In pector~ RV 1/80 ~~~~~n . Cry To~rrr or souTUO~,~ +a f~ 6;,:~~r.~ '~ ~ OPi'iCE OC GUILDING INSPF•.CTOR u-, :~`.. a~;;~;f; z P.O.ISOY 1179 `;, d ~'''i~ ~ TOSVNIIALL ~~~©1 ~i r~~ SOIIT ItOLD, N.Y. 1 1971 JUNE 7, 1989 'Po {9hcm This Play Concern, 4;e are unable r.o complete youz Certificate of Occupancy because pf the follocoing reasons. TEL. 7C,5-180? /%~ An application for Certificate of Occupancy is not nn file. ENCLOSED /%lf ao Underwriters Certificate on file. /Xf 'Phc chccF: .i:;(rn:ldaLcd/not on file.) $25.00 EACH 1_/ D:o I!cal.th Dept. Approval on file. /_/ A:o final insi~ecLion hay been made. Plc:a:;e contact: our office on this matter. Thank you for your cooperation. 1)uildiccJ PcnniY. U 1 7 8 1 8 Z 1 7 7 4 1 Z Building Dupt. ""'/_/ tlo I'lr:mber Solder Certificate on file. ( all pnrr.:its involv.i.ng plumbing briny i~sucd after ,1pri1 1,1984 ) SENT T0: OTTO SCHOENSTEIN BOX 95 EAST MARION, N.Y. 11939 r'1ELD Ii:S:'~CiiUid I ~UATr. ~ i;OMMGNT° -'-- ro 1 ~ 3 . - - H H FOUNDATION (1st) = ~ ~ FOUNDATION (2nd) - ~p _ ~ y; 2. a ~„ ROUGH FRAME & U ~ PLUMBING J 3 ~ y ~ 3. ~ ro m y ItdSULATIOP! PER N. Y. t STATE ENERGY f CODE m S ~ e ~` ~~~ 0 A [rTl~ 4. ~- y f FIiJAY, y o { z ADDITIONAL COMMENTS: x . ~ A ' _~ ' t~7 I X ' b H 9 _ y N ~ O ~., Z ~ 1 C _ [~] • A ~ r H T- x v m -a H i~ ~~ 1 ~~ _.... _____.r_.. _._,.._._ .~.._~¢ _._. ...._. _,w_.~ _. __._._ t~(EtV DaNiN~.Pe~A +~~vJ Ni~,°t~2.. l "~ ~.D l~o~ "'~ ~ ~ ~ t . - _:: ~ fki'~~4'2{~'„Z C.'uJ1~k .~44 ~Wi4 ~ ~ u ~~~ A - ,, ^i ~ ...,e,,,,,r '.c.ik'~I P,(~.. ,~°~ I~1~i~"'1 ~' 1~ ~' ~i'a'r"lp~~ 1'~1 ~~ ~. _, ,_. _... ..~...__ m..,a, _,.,,-._. ...~._-_a,_s.~._..__.~~a__~,~__~_ ~ a ~nC~'~ve ~L4C`!G ~ !, 1 I . ...~. _ ~ ..~., .._ ~.... _.. ._. _. ~ ~. ...... _., ~ __u.... ..~.. .~. _..::. _:.._ ~.~ _ .~~ 1 . _.._ ... ..... _._ ._. _ ...~ - "emu i L i U 1~ -f°- ~»~o.'~" ~pf~ w~ Z X + iv Q •~~ ~r ~~ ._, . r I! ,~ ~~ {_ i~ , i o^ Sr ~i ~~.., ;1X + . ~~.,C '~ _.. -~.._ ~~x rte., k` 1 (+t,(C~,U(,,. F~ .r «' i `-I `. nJ<a..~l.. ,~ s , ;.., ~.1 ~ 11JSl.ll. . ft~'t'Y f`ovC2 ~~,r ~ .. C~.U ~L~a. s-'` f 'j ~ I ;~ L`; _~ ,,. _, , , , .., _,. .._- c {~. x { ~~ ~~t ~! `~.1 { ~Y ll^{~1 ~ {U~1 /t. t l,''~.{~lt~ ~ xl J{{Ncca ~+l~o+.~ s~EC~G. ~ ~ 7 7 ~/ 765-18U2 BUILDING DEPT. [ ]FRAMING [ ]FOUNDATION 1ST f )ROUGH PLBG. [ ]FOUNDATION 2ND [)INSULATION REMARKS INSPECTION [~NAL DATE ~ I~ INSPECTOR ~~~~1 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ] ROUGH PLBG. O FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL DATE ~ INSPECTOR ~%~ T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING REIIAARKS [ ]FINAL ~~ ~ DATE 0 INSPECTOR ~ ,~/ N~~ a'-~ i r r. ~~ L n G O G N ~_ ~~" i ~~~ 1 u g ~~ o ,\ ,~c ~, ~ Q q~lY ~ ~sv :, % .~. ~: ~ _ ~ +~ c ~ ~ ,- _-~_.. - N ~~ ~ - - - Gti~ ~~'ov,n.~~ aWt: ~ ~ - ~ ~ ~ :r Y Q oec s°{~~`. 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FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ....:................. SEPTIC FORM ................ NOTIFY CALL ..................... MAIL T0: Examined .:~,';~~ ....., 19 .'!!~/ Approved .................19...Permit No............ Disapproved a/c .~ ~V/~"y, ,~ . .............. . (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ,(1~ 5~c Date r. ........, 15 ~~ a. This 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 tlus 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 shat] 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remov 1 r emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build' f ng code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp c ~ . s y . -. n •r.-n.. .... ; Y . (Si at re of ap ica t, or ri me, ' a corpor~uon (Mailing address of applicant) • State whether appplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....~.1~1.~1:E!~-. ....................... ~.................................... . ~y ~/ ................. Name of owner of premises ~k:~T~Q..~ ,~~'~~..~T-t9( ZI,\Y,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate officer) Builder's License No. ~2J ~ 7s - ~ . J, , , , , , , , Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1. Location of land on which proposed work will be done.3.3~. . ~.~(n. ~;~ /~,~~ v ~Ff~ ~~~ ..................................... ~.~-~~/~a2~ ..................... House Number Street / Hamlet County Tax Map No. 1000 Section ...~~.......... Block .... , . tp, .......... Lot .. 3~, , ... , , , , , .. Subdivision ..................................... Filed [\tap No. .............. Lot .............. . (Name) 2. Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~~~ll,~'~~.~ ...'4l(!~ .;y.F~. ~L,v((~DstQ .. ,3, a.'.k. t,+~, ~. f1 p,~i(l4~ b. Intended use and occupancy ... ! \ ~ { !/.~~~• • •~KQ.. Y~ 05 L ~ f , ,, (lueac[ddedo ain3eu3t b~ uno[ O¢NoIS~SBIIGM~. WAB~ ......... S) .......: y,o~ eN ~m~0siws"•a una ~e ioN • ~ O7 °~~r~~,Ln/r,Dt/~ 3UA 3U 71 N313H~ ~~ 61 .............. . ~~ .. do ~Crp• ..... ......... . ~. s[q3 aufaio]a9 0; womS a43 3c 3 uc' at a I • '43?maiaq} PaIJ uollcatlddc arl; ut g1ioJ }as iauucw acp u[ pauuo,~iad aq 1pm .yiom 4 P ) I q pus a9pa{mou~[ str[ Jo;saq aql o; ani} aic uopca[Iddc snll u{ pnnrluoa s;uaura;c}s i{r, leyl :uo{lcar[ddc srtt; air} puc aXew o} puc .yiom pies ay} pawio3iad anrr{ so wio,{iad o; paz[ioylnc llnp sr.puc `siaumo so iaumo p[cs }o .................(ra;a `iaar~}3o a}ciodioa `;ua9c `so}osiluoQ) ``~ " ........... i .................... ....................................al{lstaFl 6617 ',/tr9??9~/Ll/~lS-6~~ S.t'j 9'OC~ 7tyo?~~/il/ Ski gr/ 'Parucu anogc ;uearidds aq; sr at{;cq; s,ics pus sasodap 'woms ,(inp Sulaq (3°ti3uoa .,u{u.,{s ienp[nrpur~}o awr.Nj ..................S S j~,~.... ,~... . s/~ o~ ~" .... .......... ao ~irtnon `x210.1 A1flN 30 3,LV.LS ~~ a •;01 iawoa so ioua;ut iaq;aqm a;sa}pu[ pus sawsu;aai;s mops pus'paap o; ernpioaas uol;duasap io iagwnu ~[aoiq pus }aai;s an1O •sauy ,S}.radoid woi3 suocsuarucp ~{aeq-;as 1p: a}sa[pu};I pus `pasodoid so Sut;stxa iaq}aym `ssu{pltnq Ip: ~Si;auc}sIp pus ,Ctrsala a;cao7 Y~IV2IOVIQ.LO'Id P o auo T ~=?nbax aq 6sm atmaaa saa~snay uMOy pjoganog 'sa6 3Ia ...~`. ~11.•..',S~]C~ iPuE ]an', Zep?a g 3o aaa; 00£ n?y~?M pa~eaol S~.tadoid s?q~ s;•S[ i ...... N Hd' ... ssaiPPV ........................ „ , io3asi;uo o arus .... •011 auor{d ......', ............. ssaiPPV • ...... ;aa;tgaiV }o auisN ~iJ~~._~~.5 ~~,~~•oN auot[~/0p~/t(~ ~ ~y~~3~75 BI/ SsaiPPV ' ' ::~a!Z O,LC~ .. r~. , sascwaid 3o iaum o awsN 'bI °I~I sel sascwaid woi} panPw'33 aq Ili ssaaxa IIIM • • • • ~ • • ~ ` ~• • • • • • papsi9ai~q;o r ' ' ' ' ' ' ' ' ' ' ' • • :uo[}sin5ai so aaueu[pio 'msi Su[uoz 6uc a;cloTn uo[;ani;suoa pasodoid saoQ Z I , ............................. !.............. • ........ paasn}cs ais sasrwaid i(atym ur;arilstp asn so auoZ ' I t ...................... ylda iaumo iauuol ~}o awcN ; ............................ ascgaind,}o a3cQ '01 .............. Q ' ' ' • ica~ .......... ;uoi3 :3oI )o azcS •6 ........... .. Q ......... >1 ~ %~2r1 S%t'v'J' '%yl~'~' sauo3S Jo iagwnN ............... ;q~taH ' q3 a ? ica ....... ... d ....... ..... ............... ~ luoi3 :uot;aw}suoa mau aipua?o suo[suawlQ •g ~~t7... sauo}SaoragwnN ...................... 3i{9catt ................ .. y3daQ lb`J~ ... ... . ........... isa2l ' ' ' ' ' ' ' ' ' ;uoi3 :suo[;[ppc io suo[;cia c r rm ain on.r s awls o suorsuawr ............ 11 A. 1 1 3 .Q ....... ~ ....:.........................sauolS3oia wn q N ............... 111s1aH Q ' ' ' ' ' ' ' ' ylda ~ 1 • • • • isau • • • • • • • • • • • • • • • ;uois :,Cur. Jr 'sam}atu3s Sups{xa do suo{suawtQ ~ ...............................lyasa ~o lua;xa pus ain}cu ,(J[aads `.Caucdnaao pax[w io It:raiaunuoa 'ssautsnq JI '9 ............... asn oa .. ............................. sica3oiagwnu•a3cic83I too[F t{aca uo slluq Sur tm o is wn ,G .Il• P 3 q ty • • • • • • • • • • • • • • s}tun 9utpamp ~o iagwnu .,urpamp 3I 'S (uor3c~r{dds s{q} 9uria uo prsd aq!o}) ............ ....... aai .......................... E ' ...... S ... 3soQ p~3ewpsg •y (uonduasaQ) J, C~BO ..... , ......... • .... XiopC iaylO~ ....... uory[IowaQ cnowa ..............1 ~ .............. ireda~ ......... uot3cia}il+ ..... .not}rPPV .......... Sm m ma ' .Pi. fl N :(a[gca1lddc ganim ~[aaya)yiom,[o am3c~{ '£ ~~a~ ~. ,. BOARD OF HEALTH ...... ~a("~\"'.l;f~ 3 SETS OF PLANS ....... ' "' FORM N0. 1 SURVEY . ~.~.ws?. ~,. i ........ . D TOWN OFSOUTHOLD CHECK •••••••••- • fj~ ;I jj BUILDINGDEPARTMENT SEPTIC FORM .............: U TOWN HALL NOTIFY ~OUTHOLD, N.Y. 11971 CALL ' T765-1802 MAIL Examined ................. 19 ... ~ ~~~~ Approved ................. 19 ... Permit No......... . . Disapproved a/c ... ~~ ~4I ~ ~...........p-•~~...II ..[~°°......... . 1~.~1...... ................................ (Building Inspector) APPLICATION FOR BUILDING PER~AIT INSTRUCTIONS T0: - ~n~~ ~ Dzt~. ~c.Giv~,. ~1 , / p ~6- l1 /C7~ Date ~. ~.p. ~.. `O......., 19~~. a. This 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 applicable Laws, Ordinances or Regulations, 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 insp cti~ts. (Signature of applicant, or name,((i~f a corporation) Ivl~l11 ~`~,~ ~14,W ~~ .'JOU~ ~Ut~ , (Mailing address of applicant) State whether applicant is-.owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Ss~,h Card v . ........................((~~........................................................................ Name of owner of premises . 1-'. V .VY1'a ~n.~ ~ .. l...~". n .n.'~ ............................................ . (as on the tax roll or latest deed) If p ca~n~t`is a co/r~orati n, signature of duly at~orized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . ........................ . Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1. Location of land on which proposed work will be done . ................................................ . ...............................................................................:............. House Number Street Hamlet .......... Lot ................... County Tax Map No. 1000 Section :.... ~. G .~.'....... Block ...... ~. Subdivision ..................................... Filed Map No. .............. Lot............... (Name) 2. State existing use and occupancyCOl1f premises and intended use and occupancyLof proposed construction: a. Existing use and occupancy . ,1, .~". V ~d" 1 V) ~7... '~vY~ c~...v a. Q,'~y~'1 ...... • ............ . .......... . S t (.}. ~ .. b. Intended use and occupancy ...~ ..... I~.~ C.vrl)s t, . -? Lej,h..... ,, , , , , , , , , , , , , Repair ( ~plicable): New Building .....'..... Addition .......... Alteration ..... 3. Nature of work check whiRemoval .............. Demolition .............. Other Work .... ~. I, (Y N, , , , ~ (Descripi}on) U 0' 4. 8stimated Cost ...... ~ .............................. Fee ................ r~. `.".... ~ ~ 3.... . (to beyg'a, id~o~filing this applic ' 5. If dwelling, number of dwelling units ............... Number of dwelling un' s on ~ .... . If garage, number of cars .. ~' , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... . 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. . Height ...............NuipberofStories........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. . Depth ................... j... Height ...................... Number of Stories ..................... . - 8. Dimensions of entire new construction: Front ............... Rear ...............Depth .............. . Height ...............NumberofStories........................................................ 9. Size of lot: Front .......... I............ Rear ...................... Depth ..................... . 10. Date of Purchase .......... ',................... hLame of Former Owner ............................ . 11. Zone or use district in which premises are situated .......9 1'n. ~1;1.Q,1~. C, \ ?u ~ ....... ............. . ........ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... \j 4..5 ............... . ]3. Will lot be re raded A ... ....... Will e ess f'll be re oved from premises: e ~To .. ... 65Y~ o U 14. Name of Owner of premises V, YCI a k~.~,G , ~"a Y>. p;I, Addrass~fl. U ~. ~? G ~ ~....... Phone No. ~ .... ~ .. ~... . Name of Architect ...........................Address ...................Phone No............... . Name of Contractor 15. Is this ro ert located.•~••.••.~. " " '••Address ....:............. Phone No. ............... p p y I~within 300 feet of a t__gqiuudal wetland? *Yes ~... No ..... *If yes, Southold Town Trustees PermitPLOYTDIAGRAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ---- - ~~ ~ ~~ N--s~W~'~ ~-'' .~~ N Clcelt,lrlo RGSTAV 2>,N ~ '1 C ~'~ `~' l ~l~ ~ ~,~H~~elr~a~~~ poMll~b ~~ GFF '~(L~MIS(. D1RraloNr,1. L S~c~e~ ~yvflu>'1f~S1Gh Sae 3~k$~ (24SQfT) BOUNTY OFE~n Y{G ~ k.... ''~ S.S 2~, ~ Y, ,!-~ , ; ,~ ,2,C U Q, S, , , , , , , , , , , , , , , , , , , bein dul sworn de oses and sa s that he is the a hcant ••CK~•• g Y , p Y PP~ (Name of individual signing contract) above named. Heisthe CGvi~"V,aC~;b.~.:~IL....... ....................................... ..................... (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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the wprk will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...:..................day Notary Public, ....... . l/~~`' . ufw• • wnwe ..~~c~.t.>y~>.., 19 ......... county .~.. c~::. ~. ... (Signature of applicant) Term ~ r rc~ a~~ ' ~~~ FORM NO. 1 ~ `~ ~ '~ ~'3 ~~~9 & BUILD NG DEPARTMENT ~~~ eo „i TOWN HALL 1~. _~~,_,,.a.~.~.~.~.~.~.~a' ff11.CJG. i:iNP~f, ~ SOUTHOLD, N.Y. 11971 1`C~4'ini i;;-. „~;:!~P-!t)!.n TEL.: 765-1802 Examined.~.••. •• ~ 199 Received,,.........,19... dIl ~...., `, ~ v~)-psi Approved ./.-.... ... ~ ., 1979. Permit No. 4 ~ ~ .T ~ .'~! 7 '.. Disapproved a/c ..................................... .... ...... (Building Inspector) APPLICATION FOR BUILDING PERI411T Date ................... 19.. . INSTRUCTIONS a. This 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 applicable Laws, Ordinances or Regulations, 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 inspecti ns. (Signature of applicant, or name, if a corporation) (mailing address of ap~icant)~~~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises / .:....................................~................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of c//orporate officer) - ` Builder's License No. ../..C~~ . ~ 7.~ • `~•'• .~ Plumber's License No . ....................... . Electrician's License No. ,~4ar-Q..j. • • • • • • .. Other Trade's License No . .................... . I . Location of land on which proposed work will be done . ................................................ . ' House Number Street Hamlet County Tax Map No. 1000 Section ....':~.~ ......... Block ..... ~ ........... Lot .... ..''.~ 3 c r,~ Subdivision :-?~. I r . ~ ..C.v~~•G.~~ . tr oC.~/.T ..... Filed Map No . .............. Lot ..~.......... . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .c~l~~~..~ ~`?~1.~~ .~. /.~~~.~~-~. ~/r~G^...... . b. Intended use and occupancy ... t~....... , c~ ii 5G i'0¢ 4siaW se~~Qz3 vial ' weal dde o azn euBl (} I 3 } S) ' ~UunoatllWleS BLRtOL4'eN M+oA Meld ie e~eu'~nand A8v1 .......... . ............ . ..... . .. .. . .... 0N 30A 34 71 N313N ~-~~~~~~~~%iJ~ ,t;uno '~~%~~'r ~ b~11r ~` O ...._~n .~~..~ ..~~ , / y ..... .oclgnd,tze;off I ~~• 6I ~............// //._._..p...3o.Cep.. ~ ................ ', ~"~' ~. slq; aui'~azo3aq o; uzomc 'u;IMazaq; palg uoI;ealldde aq} uI cp}zo};as zauueuc au; uI pauuoJzad aq IIIM ~jzonr aq};eq} pue `.3allaq pue aBpalMOUK sIH3o;saq aq; o; anz; aze'~uol;eatjdde sIq} uI peule;uoo~s;uauca;e}s IIe yeq; :uolleallddc snI} aI13 pue a~Ieuz o; pue ~jzoM pkes aq} pauuopCad aneq zo uuo;zad o; pazrzoq}nE ~Slnp sc pue `szaumo zo zauMO pees;c ~!i (•o}a `zao~33o a}ezodzoo `;ua8e `zo;oez;uo0) .. ... ... . ..................... . ~, •paureu anog .......... 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I II u~FrEOI-fumel,~h I J 1 De-.~:xi I - l.a~+ 43 /il/ i i ~ ~ ~rvt.Aas~ ~~~~ I_,~.rile, ~~' 'su~yvevE~ ~~-ar I I N~AtZ I "("c~wN ~P 54uTHiC~r_A~, ~l.Y. Tii (~ I ~1, I t ) r i , II ~ _• _ y t- I. 3rd >= Z ~_ v~Ni `~u.,, O 30 la ~ ~ H O I ~ } p ~ 'a ~ r .[ U1 I I 30 j; 9) J ~ Q r __ % ~ y 3 a G 4:Ir;=-±:~, I -t`awwl f ., ~..-'F 53..,.x". ~ 5.c rl~ . qt]l. r' ~ • VNnV fHORIZER AREI1Ai1ON Op AOplllgl iU iHL sYCYEY IS A VIDUi1pN DF __..~_.~. ~.~...~.~~.... _~._.,..~~i._apulWLlpnV-pPdHF HEW'YDMSTATf •~•.'~•.•. EbVLniDN LAW. IuPIES OF iH15 supVEY MAV NOT ¢ARltp i lHE LANp surv[rorcs wY.m "vuL Dn EMYDSSEp S[pt SHALL NOr pE roN51UE0.F0 iU pE A VA4p ILV[ CD4Y. ouenAl uses womanp xePEDN snnu nuN ' OIJLY io 111[ a['sUl`I FUrt WLNM 111E sIIRYLY S VnFpFI'[p. A1.0 uii f115 p:I1ALF !D }11E LIPIE COMPANY. ti'IV~pNMEpGAL AGFNGY AM L[NOING IYSLrutlJp L'4EG If nION~ AIJp ro nls Asst .rs uE n1E nl. mac wsn. runolu, ew;.n„EIS ALE Nor rpnesemnpu rU AppIiIUNAL Ih5111111IDN5 OA SVIISLQYIII[ OWNERS, ~... 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