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HomeMy WebLinkAbout17346-z ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24022 Date NOVEMBER 9, 1995 THIS CERTIFIES that the building ADDITION Location of Property 620 STERLING LANE CUTCHOGUS, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 102 Block 2 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 10, 1988 pursuant to which Building Permit No. 17346-Z dated AUGUST 24, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is ieaued ie ADDITION TO EXISTING FARM BUILDING AS APPLIED FOR. The certificate is ieaued to HBNRY RIENECRER & SANFORD FRIEMANN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-006478 - NOVEMBER 16, 1988 PLUMBERS CERTIFICATION DATED N/A Bui'ding Inspector Rev. 1/81 xoset< xo. s 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) (yo 017346 Z Date .....~/..y..'..T 19.~~ Permission is her by grante o: ~p ,moo to .~~-~:q~`,~„~........ ..h.,' . ct premises located at ~ ~Gb~~~~~.......................................................... 46 z ~ ~ County Tax Map No. 1000 Section ~D 2 Block Lot No......................... pursuant to applicotion doted .....~...../..P? i and approved by the Building Inspector. ed Fee Bu ing actor Rev. 6/30/80 's ~ Form ;ip. G , fi 'f0'dN OF SOUTEIOLD GUILDLNG DCPARTPiLNT TOWN FlALL 755-!802 r\PPLiCA'CION FOR CLRTIi•1Ce\"Lc Or OCCUPAN C'i A. This application must be filled in by typewriter OP, ink and submitted to the building inspector with the following: Eor new building yr neca use: 1. Final survey of property with accurate location o[ all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (5-4 form). 3. Approval of electrical installation Erom Board of Fire Underwriters. Sworn statement Ernm plumber certifying that the solder used in system contains less than 2/10 of 17. lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate•of Gode Complianc_ from architect or engineer. responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. S. For existing buildings Cprior to April 1957) non-conforming uses, or build;ngs,and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic Eeatur_s. Z. A properly completed application and a consent Co inspect signed by the applicant. IE a Certificate of Occupancy is denied, the building Inspector shall state th=_ reasons therefor in writing to tl~e applicant. C. Fees 1. Certificate of Occupancy - New dwelling 525.00, Additions to dwelling 525.00, Alterations to dwelling 525.00, Swimming pool 525.00, Accessory building $25.00. Additions to acc_ssory building $25.00. Businesses $50.00. 2. Certificat=_ of Occupancy on Pre-existing Cuildine - 5100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - ResidenCia//l~~$15.00, Commercial 515.00 Date f./..G~- ..~Ut /4 j.j' New Construction....!!..... Old Or Pze-existing iuilding Location of Property....... .r7 ............7............ House No. Street Hamlet ~ / Omoer or Owners of Property....'.<~N7L`! I~~~Gr~~Ec` ~ ~h'/Ud'vr`D ~~-/~.+*r/(-e~/~ Bouncy l'ax Map No 1000, Section....~.U.~....hluck ................Lol'.........~........... Subdlvisi.on ....................................r'ilcd Pipp........../J~.(//.Lot...................... D/~3~G.~.Date OC permiC..~'`~-~/~`~..ApplLC:cnc.7'~'/JI~~{Gn~~c.(~~~-r-.~.. ?erm1C No.......... ' ilo;,lth Depc. Approval........N/~' .............UnJen-ricers Approval..~.~d~y7~....... 'la nning bon rd Approval.......!U./~'............ '?equest Eor: Temporary Certificat=_........... Final Certicate....~~• r7'~ -oe Submitted: 5....2"-~ Sa 39`(` C' 0 ~ ~f 0~ ~ . i COUNTY OF SUFFOLK ~ w'~J v~ BLDG. DEPT. MICHAEL A. LDGRANDE TOWN FSOUTHDLD SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES DAVID HARRIS. M.D., M.P.H. COMMISSIONER ~l~(~.tlY ~ " Ib, ~4Qg QlS Cc~TCtfOG-.t~~, ley i to ~s Re: ~fiRrn ~-A3O2. ~tin~. A representative of this department made an inspection on AI~FitYT- 4 114 at the above referenced address, property owned, managed or occupied by you. The report of the inspection indicated that you were not in compliance with -PART IS of the New York State and/or Suffolk County Sanitary Codes at that time. A copy of the inspection report is enclosed, You must review this report carefully noting the items which were found to be in violation. Prompt action to eliminate these violations is required. A reinspection is scheduled for If the violations continue to ex~is ratxt~h~imelof~ a rein- spection, this department may initiate legal action against you. Very truly yours, HOUSING & GENERAL SANITATION Charles M, Meyer Senior Sanitarian CMM/go ~ Enc, CG. 'TUtx~ ~ OF= S©uTtIDLb X1.9 ~L,1a, GG . crtpecr-s e~~b,<tL.~ , ~'h ~~2.4~~~- ~u~ bhp fFEALT+{- 3<a. 3079 COUNTY CENTER RIVERNEAO NY. 11g0~ 172 ' t NEW YORK STATE DEPARTMENT OF HEALTH ° ~ MIGRANT LABOR CAMP INSPECTION REPORT ~ c3-- NAME AND ADDRESS TOWN OR VILLAGE COUNTY CAPACITY NO. OCCUPANTS M F C ~Bu'Q~c.s~ ~o PpE 6EaSON I ~ © ~y © 18 - I° 19-21 22-2a 25-28 Q Z S , MID SEASON 2 ? KV I 3 COUNTY 5 CAMP CODE 8 POST SEASON 3 ? 10 DATE ~ IS ' REMARKS (List by numbers) velle Permit m opemle 27 Nol wamr lemperewre t m°E to Izo°E 66 s NDIIDB 01 C9naV9Cl10a: permed 29 ka No cross ar mlemann0dllpns 67 Il mgmred s ~ 9wlplmlp9 paallbaecn meals Pen 8 29 ; No common cup 68 requllemenla SupaWlslpn of c011drBn Antler I6 30 Dlsposel al all sewage end penal IIQYId 69 .Z W W891a¢ u Arnlpemen151ol Madfcal tale antl 31 ~ Sewega sy¢IOm cOnsbucllan and 70 hml em kll mamlenence Gmunde and common use 9pecee 32 N SeweBe sYSlem Irealmenl end pPerellnp 71 dean, aureate drmnepe repona Genelal wPolylplDn end mnn• One lollel er privy 6ea1 por 15 OCCN ~ ~.2 ~ tenants W perils, aria uunel pal 90 men AaequelB 11a0r else par Deleon la 34 ~ Sopamla lollel lecllllles Ipr each sex 79 'aleaplnp rpoma Cedmp nelgnl, 5098 a1 easel ] h. 35 Tolled wnnln 20011; Dnnec Delwaen 74 mmlmum 2T° deal space abme bad y 50-200 h. Slwdurea easy to Meep clean end ~a Tollels, pnwes, Ynnele prpDerly 75 prppptly mmnlaned 36 o nnalmclee, melnl9lned Sbudueelly ule, sound end m 37 ~ Ven111911on end hBDllnp el lallele. , 76 Bood reoelr etc Aaequele Norepe arse per parson 96 One Oendwasnlnq unit par IS occupand w napulred beds end meemesec plovldad Z One snower need par t5 occupants 79 ens m goad conandn 39 rA Sleeplnp quellela for galena 6epUeled 40 ~ Sepalela snower leanlme lot seen sax 79 m Irom cnUtllen m DpPOSIIa sexes wpereled escape for Al O Ory dreselnq apace aaepuela 60 Iam11198 q i {empemNle el l¢ab166•E wrists andlm 42 PlumbinB nxlmas DwPerlY memldlnetl 91 r as regwred Adequate eleclncal hpnl outlets 43 One launtlry hay m wa¢MUD per 25 62 provltletl end workmq ¢ occupants Well type eledtlcal cgnvemenge OuUed 4 2 One mecnanwel wecnw pet 50 83 'wrists requited 4 O aceupenl9 Nalwel IlBhl atlequala wrists laqullad 45 3 II mBCnenlCel waenere, 1 laundry Imy 94 or tub Del 100 occupants Nelwal venhlelmn el deal a09p of I ' ` ~ 46 W Slompe el Bemagn and olnar mluse HS IBQYIred WlndeW aIBB ~ Screens prondetl for ell exlenol 47 ¢ OleDOSeI of gBrbape end 018a1 relusa 66 opamnpa of IlvlnB quartets Proledlon Irom peal mleedllpn A9 Aaequele area end aeellnq 18dhlms 87 fire leslelanl canalmdmn Omvlded $apalele Iwm Imiel and sleepln9 In noualnp for IS or more 49 IacUllles 68 Oul¢Ide sell above Bround Moor; ll SoPamla alga 1011 per gcaupenl for wmddw. max a n. abovo swans 50 cooamq In Inmvleual quenem 9B At IeaJ 2 doors Imm sleepln9 roams c Aaequele cooklnB laclnnos for 10 or more people , 51 W 90 Endpaea ¢Imn above aecontl Moor S2 LLo Aaequele mecnanmel mbeperehpn 91 wlln Orpper hm conalrudlon . Slpvae ens naelon of epprov6a typo; 59 4 Olanweehlnp lacllnlee 92 alecnlul IyDe grounded C Sloven hle plolede0 and vaned 8a s Food ens ulensll tlora9o anelvoe ~ wgmmd 5C z end counter apace 93 ~ Hot weal end rise\Inq lacdnma ptopetly ~ Nomabsolbenl, eamry deanapla well nslelled 6 vented wlln ¢¢lery conlralf 'S5 Z suNace where requue0 94 ' ~Elagrlwl wnlnp propotly madlled Y Pmpedy suaened and melndlnea 56 ~ 95 USE GEN 5121NSPECTION CONTINUATION P.a SNEET i0 DESCNIBE EACN VIOLATION AND Slmage PI loxlc end IlemmeDla Cenlml Fllcnen mgwremenle of fOfl OTMEfl flEMAgRS subadncee 67 Pen Iq met 96 Fm IIBMmp egmpmem 59 Cpmmwsery ammge of mnk, mda 97 PEgSON INTENVIEWED AND 11TlE prodbds, toed Weill al aelmledary qualery, Commeseary only paeleuniea mIIN, , Pens wmDnance 59 mnx prptluda ems or lurmanetl ~ 98 Walar source and alpupe prpledea OweIIInB antes memlmneO In mean 60 end eenllery cpndulpn ~ 99 WMENE INTEflV1EWED~ DATE INTEflVIEWED Wa4r Ilealmam- COalmuoua, uNnbP Illegal neel8ra hnl In ate d ruPled Pme CL2 DPm 81 Mw_ ~ 100 - p Tleamronl rotates melnlemetl ens P~ ~ Cook slaves pr Durneu not u6ea 101 m evallebla. eempllnq ragmremend met 62 ~ m neallnq 701 INSPECTED BY ISIGNATUBEI DATE INSPECTEO Walor memry evmlaDle within 100 h ~ i GemeBe end reluse alore9a and ~ 63 e-a o elsposal 102 Memod of mxpenNnp water ~ W Plumbinp hxluree and nouemp plpperly 61 ¢ uea0 antl weed lot 103 flEP. flEC'D BY I$ID I - DATE pEC'D. ~ Aaequele not antl goes mnnln9 water 65 Ineada, mtlenu, omen pea cpmrmlea 104 t wnem requnetl DON 145 (11185) ~ ~ Formerly GEN 111 and 112 P •A NEW YORK STATE DEPARTMENT OF HEALTH MIGRANT LABOR CAMP INSPECTION REPORT .y NAME ANO ADDRESS TOWN OR VILLAGE COUNTY CAPACITY NO. OCCUPANTS ~R~~ n~ M F C O~ o O ~ ~ PflE SEASON 1,8 Ifi - tB 1g-21 22-21 25-26 l MID SEASON 2 ? I 3 CDUNTY 5 CAMP CODE B POST SEASON ~ ? 10 GATE 15 ' ' REMARKS (List by numbers) Vella ermll to oDerele L7 Hol walel lemperalure I10°F 10 t20°F fib NOlla 01 COnabpp1100. p0rmlb 2B 2 F ND noe6 or mlemonnecllons ~ 67 ~r tlre0uhee O' SwlmminB gaol/Daecn meele Perl a 29 3 No common cuD ,fib requlramenle W $upemslOn OI cnlltlran under 16 30 Dmpwal 01 all sewage ono other IlOwtl 89 W ~ ya Waaln9 u Arranpemenb for Menial cam end s BawaBe 9yslem ponsvucllon Ono ! Inel ale kn 31 ~ malmenence 70 Grounoe eno common uN a ep9e ' ~ ti $BWapO ayelem uaetmem entl opermm clean, Nrlece malnaga p 32 1 repose B ^'71 3 General euperwaron end me1n. 1 ~ - ~ One Imlel ar puvy sOGI per Ifi occur 1 lenence 33 pema; one asset per 38 men 72 rv AEequale Ilaor area Per par6an m 34 ~ Sepal9le whet lecnnres lOr oats sex 73 'eleeDln9 room! Celllnp nelpnl, BOW PI IOeel T q. d Tallela wrlNn 280 n: pnweB belw0en rmum 2i' clear apace above bee 35 rA 50-200 u. 74 Suuduras easy t0 knep Glean eno ~ i011e1E, prrnea, annals progeny 0 Dmpeny melnMlneo 38 o conevumea, mamlalnee 75 slmcmany N19, 6ouna ens m ~ YBnlllellen an011BnIlOB BI Ip11016. Bode rapes 37 etc 76 ApequOe elOrBpa area per parwn 99 one M1entlwasmnp unit per 15 accupanls 77 N .r Requneo been ens manreeea! provbee 39 s One shower neao per 15 occupems 78 one 10 p0otl contllllon m SIe001np quubm br droned Nparale0 y $eperela answer IBCIIIIIe! IOf eats sax ~ Irom cnrleren ~ 40 3 w ~ 79 = ODpOSge vexes NpwUee exNpl tot 3 Dry tlreaeln0 space aeequ9le o bmlbea 41 3 80 s Tnmpemlwe et Iaea18B°F wM1am eno/pr 42 ~ Plumbmp 1lxlurec DloperlY me1n191ne0 81 es requuetl ' Atlequele eledlmal Ilpbl Oellnlc One IauntlrY pay pr wNn1u0 per 25 'prawoee eno worxlnp 43 s occupama 82 ' Wan type 9leclrlcel oonvemence o011eb ¢ one mOChen¢01 waenar per So where regwreo 44 o pccupema 83 Nelwel 11pM11 atlequela wM1ew mgwree 3 II mechemcel wesnere, 1 laundry bey 45 or wb per t0B occupemq 84 • Nalurel venblelmn al leael IOW 01 W Si0lapa 01 garbage eno other raluee - mgwmtl wlnaow ame " ~ 48 yn ~ 85 Saaene prowtletl Ior ell egvmr W Oupo9al D19arbega eno 01M1ar raluse , ~opemnpa of bvlnB quanera 47 s 68 Prolecllan Irom pe611nlNlelmn 4B AOegpale erne and eneuna bcllllles ~ B7 Ftm meblenl conelmtllOn proweetl $epam101rom 101101 entl 619emap n nounnp Im IS or more 48 3 18c1b0ea BB OulBrae ex11 ebOVe pr0untl Ila0r; 11 ' ~ Separel6 erN 10 n per occupant for D wlnaow, max. 11 n above ground S0 cg0xlnB m melweuel quarter! 89 Al leeel2 tl001a Irom lleepmg rooms ~ o AeepuePo COOkmp temlmes ter IO or mou people ~ 51 ~ 90 Encloeatl alms abpva aecon011o0r a'~ y, AOequela mecnenrcal ralnperahon 91 er wM proper Ise contlmcllon 52 J o . 51mea one neabre m apprpvetl rypa: ~ Dlanwesmng laomlea elemnal type prountletl 53 ap gp $IOVBB BN protected ens venletl ee Z fooe one ulnne1161oreBe anelvef s requnee 54 z and coumar space 93 M° Nol webr one neehOp leglllbes propOtl ~ NDn- Y eba0rbenl, eesrly cle9neble well mslellae 6 vented wnn Neely convela 55 s surleca where requueo 94 EladOCel wlnnB Oroperly malelletl Y Pmpe<ly ebeeneq ono membma0 58 ~ ~ 95 USE GEN St21N5PECT10N CONTINUATION SIOIB9B OI 10lIp end Ilammeble Cenhel ketches roqunemenla of SHEET TO DESCRIBE EACH VIOLATION AND subslenas 57 Par111 met 96 FOR OTHER REMARKS fim flpnllnp egwpmanl 59 ~ Cpmmisaery storage of m1lk, m11k preoucls, loge 9T ~ PERSON INTERVIEWED AND TITLMAH..~ W016101 NIbI0ClelY gnellly; COmmraNrY a01y p9il0Yllaee meek, ~~//'-1IfG.a Pen 5 compbence 59 m4x protlucN solo or Nrmenetl 9fi 3 _ Water a08me ens n0rape pmlecb0 6,D Owelllnq anted mamlalne0 m clnan end Nmlery conOnlBn 99 WHERE INTERVIEWED DATE INTERVIEWED Wslar Ireslmsnl - anbng0ua, unmbr- ay Illegal neabn not m use ~j mpletl Frea CL2 ppm 61 /3 ep W 1g0 p Tlaalmam raCOree IMInIaIOatl one a-~ j COOk BIOVe9 Of bYII101a n01 u9ae IOr c avarllble, Nmp110p regwmmenM met 62 ~ ^y M1eallnp r 101 INSPECTED BY IGNA1DflE) DATE INSPECTED Webr restlrly avalNDle w1Nm 100 M1 ~ ~ GerOepe ens reluea elorepe ens 63 1j mepoNl 102 - McNOtl 01 meanwnp webr 89 O p Pcptl enlpf area lame noualnp pmpetlY 103 REP, flEC'0 BY 1SIG1 - DATE RECD. r Aeagnale sat m0 SaW Nnnlnp Webr Insecll, IOtlenls, OIM1ar Deal conlmlleO ' where regvlree fi5 lOq I DOH 145 (11/85) Formerly GEN 111 and 112" , THE NEW YORK BOARD OF' FIRE UNDERWRITERS. PAGE 3 SQUB?.4?, BUREAU OF ELEGTRIC.ITY'" 88,JOHN STREET, NEW ,YORK, NEW YORK 10038 - - I Dote NOVSMBxR 16,1988 APPIie6tion"No.onfile ' S8b?088$(83 ` A-OU6878 _ 'I THIS CERTIFIES THAT ~ - ` ~ ~I' . ~ ' ~ _ a' i, only the electrical equipment as deacrihed 6ebu+and introduced 6y the applicant named on the a(iove opphcution nugrher m thepremwea of~' N" ~ S A$S~CZATES, ~ -,'~STEItt12NG EIANF, CU;GCHOGGE . N,~.Y. ~ in thefolloTCing locotioay O'Sasement 7,Rt F(.' ? 2nd~Fl:= Section BL)ck ~ Lat ~ N/~VEMAER 1..1,1988 Teas examined on artd found to 6e in compliance with the~requirernen(x of this Roard..'' FIXTURE RECEPTACLES SWITCHES - RXTURES RANOES COOKING DECKS 'OVENS,' DISH WASHERS'EXHAUST'`FANS OUTLETS ~ INCANDESCENT. FWORESCENi VAFOR AMi. K. W, AMi. K. W. ~ AML N.W. AMi.'. K. W. AMT.. N. P„~ Y, 9 22.'~ 6~ '9 ` ~ ~ 3. ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL "UNIT HEATERS MULTIAUTUiT " ~ DIMMERS ' PMi. K. W. OI l H, P. GAS N. P. ~ AMT. NO. A. W. G. AMT., AMP AMF. AMPS. TRANS. AMT. N. P. SYSTEMS AMi. WARS: NO.OF FEET I ~ ~ , .....SERVICE,DISCONNECT-,...NO.OF~;:':~._~...-.; ..5_>.. :-a. E_._...,_-,-.R-...-«R:.y.,_~.,~...k<k...r-._;,,_:>;..,_,;,. METER NO. OF CC. COND. A. W. G a: W. G.' " A. W. G: ~ AMi. AMP. TYPE EOUIP, I,a'YW I,a 3W 3R 3W 3~'AW PERK OF CC. COND. PLO. OF HbLEG' OF HI-lEG - NO. OF NEUTRALS ~~-OF NEUTRAL''' ' - - Ck Z: _ OTHER APPARA7U5: - ~ ' I o ~~,a z ` ~rs~ .AMOUNT € ' ~ ~ - - PLEASE REMIT BY CHECK OR MONEY ~ ~ + ORDER T6 THE ORDER OF THE NEW r , C ' ' ~ ~ ~+r' ~p~~ YORK BOARD OF NRE UNDERWRITERS IEHHHy H S ~ ~BSUC ~~~NS . ~ ~ ~RISN OFHSENDER Y MALI WILL Bf AT ~ ~ P.O+.AJX, 935.- ~ cy. _ CUTCHUGUc+,' NY -'319'35 ti„ 37 s " ~ - ,6' ; Per' ~k, . , ~ _ ..C~, THIE IS YOUR BILL iOR SERVICE RENDERED AND IS NOT A CERTIFICATE OF COMPLIANCE. THIS BILL PAYABtE AT THE NEW YORK OFFICE, ES JOHN STREET, NEW YORK, N.~Y~70038 C_~,___ - _ r'1ELD I;:SP~~::Ua ~~Ui,ir. I ;;OaKMENT° ~ -a W m ~a gip, ` ~1 ~Go - _ y FOUIDATION (1st) FOUNDATION (2nd) - ~3~1a _ ~ . ~ 2. z 0 P,OUGH FRAME & ~ PLUMBING ~ ti H 3. m ' IIJSULATIOII PER N. Y. y~ STATE ENERGY CODE A 4. FINAL z ADDITIOIIAL COMMENTS: ~ v ro x~ r x c~ A • r H x - o ra b H 1~~~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ FINAL [ ]FIREPLACE 8 CHIM/'NEY REMARKS: DATE ~ ~ INSPECTO C ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION FRAMING [ ]FINAL REMARKS: ~ ~ ~ ~ DATE -INSPECTOR ` i~ w~~ , ~ . - r_ rl ~i~ ` U BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK '`~5 IE~ BUILDING DEPARTMENT SEPTIC FORM BLDG. DEPT. TOWN HALL TOWN OF SOt1THOLA SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL G' ~ GS,~ MAIL T0: ~-~~I_ ~c~~~ Examined 190.0 2 `7 Approved 19LlU. Permit No. ~ ~ yr~ Disapproved a/c (Bu ding I ector) APPLICATION FOR BUILDING PERMIT Date !~'v.4 ~ s. ~ /.k, 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 ad}'oining 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 inspections. . (Signature ot" applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. cJ Name of owner of premises . f~N.e:Y. r~ l~.t,e.N. ~Kf~G.t._..:f.N. ~iF+~r°~ ~ . ~!~f'~!t;^.~~ . (as on the tax roll or latest deed) If 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 . . Other Trade's License No . . 1. Location of land on w]tich proposedCwork will be done . . House Number ! ~treZet b~ Hamlet a U County Tax Map No. 1000 Section .....-f~`.'~ Block P.S Lot r , , , , , Subdivision 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 ..'G!~`:f'• • G/F`a~3L • b. Intended use and occupancy ~ ~;'IF _ Itcable New Buildin Addition I !1 ~p 3 Retuarii of work (check whine op g > P val , , Demolition , i; ~Other~.f . ' `~w- (Description) 4. Estimated Cost. s.~~: Fee f.•....,._C:'.": ~ . (to be paid on filing this application) 5. If dwelling, number of dwelling units , , Number of dwelting units on each floor 1 , . If garage, number of cars . 6. If business, commercial or mixed occupancy, specify natur ~ and extent of each type of use ~ . imenstons o existm structure Height ...LN. n Nurps, if any: Front ,3?- ......`Rear . • • ....Depth , • , , , , , , , , ' ~ / ber of Stories . Denth Sons of same structure with alterations or additions: Front ,3~......... Rear , . , , , , , , , , ~ P ~ } ............Height ...../.4~ . T Number of Stories . S Hemh~sions of ent're new construction: Front /.!f. ~ Rear • De th ~ p ...7c~........ g °f........ Number of Stories ......,r'....... . ~ .....r 9. Size of lot: Front , Rear 5.~~.......... De th l.y, .`1~ V . . 10. Date of Purchase ~ , , ..Name of Former Owner .!~!./G~f ~!t . S'am'!-.':!~!s. ?T/tir,.t~3 P P P ises are situated eE: s7N.'s4GTV4+A'S-......... o . 12. Does ~ o os ~d constructhon vtol'ate any zoning law, ordinance or regulation: ~ 13.' WIIl lot be re raded Y;~ , Will excess fill be removed from premises: Yes No Name of Architect P ,~'t""~'a`'~~.~ddress ...5/~.":''i-.........Phone No..7.3,Y-6. 9f . 14. Name of COontractor remises, ' ..L • . • • . • . • . , . • . . .................Address...................Phone No. Address . .Phone No . 15.Is this property located within 300 feet of a tidal wetland? *YSS....NO.... *If yes, Southold Towr; Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly al] I'~ buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior ar corner lot. I, i II STATE OF NEW YORK, S.S COUNTYOF,,,,,,,,,,,,,,,,, (Name of individual signi. ~ ' ' ' ' ' ' • • • • being duly sworn, deposes and says that he is the applicant . • • • • ~ ng contract) above named. He is the ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and. to make and file this application; that all statements contajned in this application are true to the best of ]tis knowledge and belief; and that the work will be performed in the mannen, set forth in the application flied therewith. Sworn to before me this ~ ~ .....da of I 19~~ y ~ Notary Public, , , , , , , , , , County ~I NELEN K DE YOE I . NOTARY PUBLIC. Sbte of Yalt T~•Fipra7M~ir$ch30.19=,-=,/ (Signature of applicant) ~ I 5 „ i ~ r O ~?-~SL.- - a .i" E 1 < j e gv/v GfG~Gf ^a [/y~~~. 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