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HomeMy WebLinkAbout17440-z FORM NO. 4 TOWN OF SOUTHOLD ' BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20250 Date SEPTEMBER 26, 1991 THIS CERTIFIES that the building NEW DWELLING Location of Property 930 NORTH SEA DRIVE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 5 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 13, 1988 pursuant to which Building Permit No. 17440-Z dated SEPTEMBER 16, 1988 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 AS APPLIED FOR The certificate is issued to JOANNE ZLOKLIKOVITS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-230- AUG. 30, 1990 UNDERWRITERS CERTIFICATE NO. N-194577 - JULY 1 1991 PLUMBERS CERTIFICATION DATED MARCH 29 1989-RICHARD ROSSI *DECKS ARE NOT INCLUDED IN THIS CERTIFICATE OF OCCUPANCY. Oy ildin nspector Rev. 1/81 FOEM 1Q0. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAIL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ o ~ 7 ~ ~4 ~ Z Date ...9~F.Cd:?~./~¢ni..........1..~..........., 19.~. Permission is hereby granted to: to ...4ro'^.^.4+1A<Nr.C.~.....SA.......~~'ti4.~....~ ...s~~`^:s:~•1.{....I..a..tir.`:R-.~I.:Q:1-:"41,. ..•°•!y'•.. l{V . \ Q ~ at premises located of ...9..4~........11~.°~!:~... ~.•l.!~........... °~'4~LW,•t 0.~~....~,~..........~ . ~ ~ . County Tax Map No. 1000 Sectionp......Q.~.~....... Block .....5?,~.......... Lot No pursuant to application dated ....cd~iF~il.,4.^.::a~!r••••••t!••3••••••••••, 19.~p.., and approved by the Building Inspector. l1 Fee $.0'21 a'U.... ......ti~f.'~-. Building Inspector Rev. 6/30/80 Form No. 6 J~~~ ~ `9 TOWN OF SOUTHOLD ~ I',,,;;~-",,.,,y,;.,,„.,„..~.~. BUILDING DEPARTMENT TOWN HALL i~(I~Y 2 Q I99) 765-1802 f ~`.~t ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY ' 't 'Y 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-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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code~Gompliance 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, 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 $15.00 Date , , April. 19,,, 1991 . New Construction...,~JCX$... Old Or Pre-existing Building...... Location of Property...... 9.30 NO,1~TH SSA „D,1~IVF;,,,,,,,,,,,,,,,,~~,~t;~;,C-0-,~~~.,.. . House No. Street Hamlet Onwer or Owners of Property.....;JOAi~T ZIAKLIi~OVI;PS County Tax Map No 1000, Section., 054 ,...,,,,Block...`~ .............Lot..12......,........... Subdivision...Alculfl ..........................:.Filed Map......... .Lot... Mr. Kenneth Gerac'~ 0174402 10/17/88 Continental Homes Permit No............ .Date Of Permit ................Applicant........N i.~~ 7 j......, ~/3~~/~7~ s.., Health Dept, Approval.... Yes ...................Underwriters Approval..Y?`N~/. ,fir .(.J ~~l.~....... Planning Board Approval tequest for: Temporary Certificate........... Final Certicate..~~,,.... / _ ?ee Submitted: ~ nn~ rF 2,5 ~.za:a.. s+~~ma.-. Ja..:w a:_e~,..' aa~....,..G. aw.r a~ir~., ~.o-;.-v~w ...ndl.*.a~.+~:'~`aa 83k ~ " ms ~ i~m"~`unr.~'"A` ~ gti e x ' JAMESN.RAMBO,INC. BISHOPS LANE SOUTHAMP70N, N. Y. 11968 PHONE: (516) 2831254 WUNNEWETA ROAD CUTCHOGUE, N. Y. 11935 PHONE: (516) 734-5858 January 17, 1990 Southold Town Building Department Main Road Southold, New York 11971 Att: Victor Lessard, Chief Building Inspector Re: Jol?n Zloklikovits residence, Nort2i Sea Drive, Southold Dear Mr. Lessard: The pilings in the referenced piling foundation. were driven with a Delmag D'5 diesel pile hammer to a minimum of 6' below MSL to a minimum capacity of 15 tons per pile. The hammer develops 9,200 foot pounds of energy. Pilings were pressure treated Osmose, 1 pound retention per cubic foot, :.is were girders and braces. Hardware is hot: dipped galvanized. Bracing was done in accordance wii.h standard engineering practices in residential construction in Coastal Hazard area. 6incerely, G . Thomas E. Samuels TES/cak ` c,, nt4*,i 5c`rrnU~C2~n,y tem, Exp,;.;a pdar ' -q 19~ j ~ 1;1I~ U Page - 1 March 29,1989 2 Richard Rossi 44 Starlight Dr. E.Islip N.Y. 11730 etf~•Q>:~T. (516) 277-3369 TpWN OF 54UTN(3~,~..1 TOWN OF SOUTHOLD BUILDING DEPT. To whom It My Concern Property located at tax map number,(sec 054 Block 05 Lot 12) Permit #17440-Z. "LEAD CONTENT 1N SOLDER JOINTS" The lead content in solder joints and connections from portable water supply systems shall not exceed two tenths(.20) of one centum. Thank you. Yours Truly Richard Rossi r I Plumber license #2330-P J w n rr~ ~ be? ~t~-C~ w~ `1'nt5 z~~ d~ ~ )q~~. - FRANKLIN D. BLITZ NOTARY PUBLIC, Stete of New Vork No. 62-4601546 Qualified in Suffolk County ~Lq Commfesion Fxplres hNa~pe96, 18.-:J ' mryY 30~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ L r~r,:?i11)y BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, N W YOE~K 0038 JC1LY 13, J ~DiL9 ~9 3~6'rFi fH S3 N ;bt{7 t'3 U' Date Application No. on file THIS CERTIFIES THAT only the electrical equipment as d¢acribed 6eMu+ and introduced 6y the applicont named on the a(nwe application number in the premises of .9t7HN 'hLIC7Kf,'I:Ki11i'C'G'S, )VOftF7 :;F'II iICtI'JA~, 5d7U'1h1f7Lll), Pst.11. ' OtI"!' C! r~ in the foliowinR local' went ~ lst Fl. ? 2nd Fl. .Ser[ion Btoek Lot ,J41>~~; 2'~~ , Tcos examined on andfound W be in corrtplimrre u•ifh the requirenrenls q(tltis Boord. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DIiH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FIUORE5CEN1 OTHEfl AMT. K W AMT K. W AMi K.W AMT. K W PMT N P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT NEATERS MULTI-OUTLET DIMMERS SYSTEMS AMi. K. W. Oll H. P. GA$ M. P. AMi. NO A. W G AMT AMP qMT AMPS. TRANS. AMf H P NO. OF FEET AMi WA115 SERVICE DISCONNECT NO.OF S E R V 1 G E PMT. AMP. TYPE METER 1 a, TW 1 ~ SW ~ %'JW ~ % AW NO.OF CC COND. A W. G. NO Of HLIEG A NO. OF NEUTRALS A. W G EQUIP. q PER % OF CC COND. OF HbLEG OF NEUTRAL I ;){jQ .I, ,fi A Ertl? 2fC> OTNER APPARATUS: 1 VZ?!J fS1.1V:>}?~;'ilti'.iA;R~ (.tlC:e~l4~7.3kS"T~ ~~i~~~~ ;~.l.~. sc>.x i5ts Er7a'f HFl.P;1.'~'C)f~i, lV`.t, :l 1 ?`7 GENERAL MANAGER 71 Per This certificate must not be altered in any manner; return to the office of the Boord if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY ®F CERTIFICATE MUST NOT BE ALTERED IN ANY MANPIER. o`~pEFOLK~O o VICTORLESSARD ~ EXECUTIVE ADMINISTRATOR ~ Town Hall, 53095 Main Road (516) 765-1802 y0 • O~ P.O. Box 1 179 '~Sy~l ~ Southold, New York 11971 OFFICE OF BIJILDING INSPECTOR TOWN OF SOIJTHOLD October 7, 1988 Mr. Kenneth Geraci Dogwood Street Sag Harbor, NY 11963 Re: Building Permit #0174402 Dear Mr. Geraci: Please be advised that the above permit has been revoked effective immediately. The two (2) checks received by our office in payment of permit fee have both been bad checks. When proper payment by certified check has been received and cleared, then the revocation of the Building Permit will be lifted. Do not do any work on the proposed site until such time as you have been issued a valid Building Permit. Very truly yours, SOUTHOLD TOWN B/JLD~G~.) DEPT. V UL~,Q~ ?C~,l.~t2~c,~,-~-~1.-. Vincent R. Wieczorek Ordinance Inspector cc: John Zloklikovits RD 2 129Q Bonnie Brae Ct. Granite Springs, NY 10527 VRW:smw a ~ ! ~ r z~~a w- ~ ~ h Q .ly -1 n ~ ~ ~~l1~-5 ~ ~TQ f } i ~d P.O. Box 1302 John BarylslCi 516/537-7944 Professional Engineer-Licensed Land Surveyor Main Street Bridgehampton, New York 11932 June 12, 1991 Town of Southold Building Department P.O. Box 1179 Southold, New York 11971 Attention: Mr. Fisher, Building Inspector Re: Single Family Residence of John Zicklovitz 930 North Sea Drive, Southold S.C.T.M.No.1000-54-5-12 Dear Mr. Fisher: In response to a request by the builder of the above referenced premises, George Kamper, an inspection was made on June 4, 1991. My inspec- tion was limited to the fireplace flue pipe and chimney construction and the sidewall vented oil furnace/water heater unit. The fireplace chimney flue system was properly constructed using triple wall pipe pursuant to the applicable building codes. The oil-fired furnace/hot water unit and side wall venting system was installed pursuant to the manufacturers specifications and in compliance with the building codes. This oil fired unit is mechanically vented by an exhaust fan - side wall venting - and appears to be functioning properly. This letter constitutes an inspection report and is not to be deemed a warranty or guarantee. Should you require any additional information, please contact me. t Very truly yours, ~ p`~Y JOHN BARYLSKI, P.E., L.S. ~ 'Y fi JB/jab q~~. ~~ti~~ cc: George Kamper Craig Gibson, Atty. Ir~°~~~~~.~~~~" a 'a'~ ~ ~ ~(~:w~f~ VICTORLESSARD ~ ~ Town Hall, 53095 Main Road EXECUTIVE ADMINISTRATOR ~.,~si~ (516) 765-1802 ~g~,`~'~ ~ P.O. $OX 1 179 "~3"®1 ~,p~ Southold, New Yotk 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 17, 1988 Mr. Kenneth Geraci Dogwood Street Sag Harbor, New York 11963 RE: Building Permit #174402 JOHN ZLOKLIKOVITS Dear Mr. Geraci: Please be advised that since the above permit has been paid for we are reinstating the permit as of this date. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Vincent R. Wieczorek Ordinance Inspector VRW:gar cc to; John Zloklikovits RD 2 129 Bonnie Brae Ct. Granite Springs, N.Y. 10527 (Certified Mail) ~~4~~~~~ t~ VICTOR LESSARD ~ f ~ Town Ha11, 53095 Main Road EXECUTIVE ADMINISTRATOR ~ tam r +~l P.O. BOX 1179 (sla) 755-Iao2 'd~ Southold, New York 1 1971 ~~°~1 sad ~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 17, 1988 Mr. Kenneth Geraci Dogwood Street Sag Harbor, New York 11963 RE: Building Permit #174402 JOHN ZLOKLIKOVITS Dear Mr. Geraci: Please be advised that since the above permit has been paid for we are reinstating the permit as of this date. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Vincent R. Wieczorek Ordinance Inspector VRW:gar cc to: John Zloklikovits RD 2 129 Bonnie Brae Ct. Granite Springs, N.Y. 10527 (Certified Mail) I March 29,1989 Richard Rossi 44 Starlight Dr. E.Islip N.Y. 11730 (516)277-3369 TOWN OF SOUTHOLD BUILDING DEPT. To whom It My Concern Property located at tax map number,(sec 054 Block 05 Lot 12) Permit #17440-Z. "LEAD CONTENT IN SOLDER JOINTS" The lead content in solder joints and connections from portable water supply systems shall not exceed two tenths(.20) of one centum. Thank you. Yours Truly ~ - Richard Rossi. Plumber license #2330-P ~weru ~ IYI~~v3 2,~~ r+4ar~~A, t~1~9 FRANKLIN D. B NOTARY PUBLIC, Stat® of New York No. 62-4501648 Quetified in Suffoi~ ttnty~, CommissionExpiroB h1R 30 ~ 765-1802 ~ BUILDING DEPT. ~ INSPECTION [ ]FOUNDATION i5T ( ] !ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ( INAL REMARKS: ~ DATE ff ~ INSPECTO r k'0ltM N0. 11 ' TOWI~I Ok' ~OU'PIiOLD BUILDING DEPARTMk~VT TOWN HALL SOUTI30LD~ IJY qq DE4I:I.OPMl•~dT P]i:RMI'P Ido l °~.L,.r,._~ pdto __saR~~~ 19 D'$ I'ersniaaloa Sa hereUy ~rnntod to: ~~,~s~ Goa.. n-~a ~ ~ ot'prernlaea ].ocatod nt Ccut,ty Tnx M~xp 210. 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Yt Et1Si' i': ra :t 17:~~.t-Sig itv 't %ai~K F'E:RI t<.~ I:If C<. TCiR FUTURE Rk "~kREfJt:g .,.n Form No. SE 3643 i41E?8C TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,NEW YORK STOP WORK ORDER TO: ~lsd'(,(~f~lH Cn~~~Gl Owner, Owner's Agent or Person Peiforming Work 1~~ G, ~e4J0 0 t~ 5" l fE- C, 1-E kF ~2 +301L N `l. 1 t 4 ~ 3- _ Address of above-name person YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: ~(3 D Pf U dZ.T N- r~ ~ ~ 12 (U 1-i a t,~ r- j ~ Address where work is to be stopped TAX MAP NUMBER Q O 5 Y- 5- I v Pursuant to section Q~ of the Code of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescinded. BASIS OF STOP WORK ORDER: U rQ~r r (7 j~~- l'~ I~ ~ (J C L7~ (L(~-~ j~ 1% ~-Itt t ( - ~ GI- ~ C H r~G(t S CONDITIONS UNDER WHICH WORK MAY BE RESUMED: (,e)lff~(.( P~ ~~fUB-~ J P S ~t-.rLyk?z~°~ ~-~tf~ ~uj~Diu~~ f'~z~cu~ i tS ~,~c~esYu+~hS Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. DATED: J1IJ'7 S`D , BUILDING INSPECTOR / C E ENFORCEMENT OFFICER ~~DATG ~ COMMENT° -1::LD I~ .:CTi(7~i ~ J f H _ b /'H r0U[dDAION (1st) ~ ~ ~ ~ l+l ~ rOUNDATION (2nd) f G z 2. ° ROUGH FRAME & ~ .PLUMBING p ~ Q/)A H iFrJ ~J 3. . • y A IidSULATION PER N. Y. STATE ENERGY x CODE r 7 ~ ~ ~ H 4. ~i tN FIi~AL ~ ~ r' x ADD TIOPIAL COMMENTS: ; ~ r.• $ r - v 3 ~ g x / ~ ~ ~ H Q O +9 ~ p. r • i x oa _ ~ J • r 5 O t . ~ m ~ p~ .a ~ i T'0[tM N0. 11 TOWid Ok' ~OIP}'IiOLD BUILDIN4 DEPARTME7~IT TOWN HALL SOUTJIOLD, JiY q DEVI:I.OPI~ILTIT I'E:FiMI'P Ner.4laaioa Sa hereUy ~;rnnted to: ~~vn~s7~j G~.a ~ i 1~n4 ~ ~ d Sti'. ,c G •,a ~ 63oz~ n"t premiooa locatod nt „~,.~D A~r?~~ c~2~.7n ~e-~-t~~~ ~.~k tom. Ccui,ty 7'na Id~~p tto. ).000 S®otion ~~o.GS~~,.> )jloclc off'' I~ab ~,_,._~,,,M purn~:runt to u~pliontlon dntc~d \f ~ 19$x., and nppc•oved by the fiuilding I~~npactor. ':,zilding Pcaznit No. DulldinR Inspector 4/UO TOWN OF SOUTHOLD • BUILDING DEPARTMENT SOUTHOLD,NEW YORK STOP WORK ORDER TO: 1~-tr-1(r~l %Et C~~2~GI TO5~wner, Owner's Agent or Person Performing Work 1~O uJ0 a t~ s I S~-C, Hr'k2P,on 1J t(OiG3• TAddress of above-name person YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: ~ ~ o Nc~ 2rF1- ~ ~ 121 v~= S~ ~ fro c.S., Address where work is to be stopped TAX MAP NUMBER ~d p Q - 0 5'Y- ~ - % ~ Pursuant to section ~GQ -l yl of the Code of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescinded. BASIS OF STOP WORK ORDER: (j, tl I~r 1~1~- l'!J nC. C L~l L(~~ L , ~t,~ t 1 - ~ ~ C ~f r~ G!t S • CONDITIONS UNDER WHICH WORK MAY BE RESUMED: (,Q~ 1ft~_ 1~d} }'l~[r 6.t % t S ~ t-.1~ V} 12i~ S i~-~ ~ r~ f~ ~ r ~ ~ I ~f h I' iz i~.U„~ ~ i ~ S E t ~r s r~-Tl: rS . Failure to remedy the ctinditions aforesaid and [o comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. DATED: d 7 .~CJ ~ BUILDING INSPECTOR / C E ENFORCEMENT OFFICER BOARD OF HEALT}i . FORM NO. t 3 SE'T'S OF FLANS • , SURVEY TOWN OF SOUTHOLD CHECK ~ . . • BUILDING DEPARTMENT sEFTIC FoR.i . TOWN HALL EOUTHOLD, N.Y. 11D71 NOTIFY , • TEL.:7G5~1302 CALL ...~.rt~.^«".'(::'`'1 Exami ?:`^.`r"•ti..1.4., 19~~. MAIL T0: ~~°4 Approvt9ti..;-~,~ tn., 19~ a. Pcnnit No. ` , D ttQG3 DisaPProvedalc ` ~S~°. 4'.~.. .?-•y~a aA oL.__ 70WN pF SOU7}IOLD ~ljl (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..~e~.. ~~.6...., 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 tvotk 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 Petmit 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 par[ 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 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 insp[e~7cti ns.• ~ ~ 3S 3 ~ (Signature at" applica or name, if a corporation) (Mailing address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber oz builder. ~.'ame of owner of premises ~ ~.1,1, Y~ .4-~.~d.v[ .t~i:' S . (as on the tax roll or latest deed) 1f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) e a , Builder's License No. . [:~f . ?°~1. ~..2:{ Plumber's License No. .t+~.7~~ .~i~+-H`"~``" ~ ~ ~ d Electrician s License No. Other Trade's License No . 3a Location of land on which proposed work will be done. V,<?'~~~ , ,,~Q•{4 • , . • F{ouse Number ..(.R.~Str[ce(~................f.......Hamlet , County Tax ~\iap No. 1000 Section .....l./.~~G .t, • Block , , , , , , , , , , , , , Lot l . Subdivision Filed M1(ap No. Lot . ..~N:unc) State existing use and occupancy of p~ mi~se~d intended use and occupancy of proposed construction: n y~ / + P a. Existing use and occupancy ©n • •~"•~t'~ ` ~ ~ • ..71.t~Sle-,l,t J,/t b. Intended use and occupancy 3. Nature of 4vork (check which applicable): New Building . , Addition .Utcratlon . Repair Removal Demolition Other 5vork . j (Description) 4. Estimated Cost 1.~~/.,,~,~.~,~7 Fee (to be paid on filing this application) S. 1f dwelling, number oC dwelling units • . Number of dwciling units on each Qoor . _ If gara;e. number of cars T . . 6. If business. commercta] i~xed,occupancy, specify nature and extent of each type of use . 7. Din r, t ~ ~.e-~t~,r~S; if any: C'ront Rear Depth . Hei k4~~C• .a,,~ NulrrStscr of Stories . Dim dons of same st rei with alterations or additions: Front Rear . Dep ~i;.~.'.. ~.~~..I,J.. , IIcigktt Number of~torics ~ h; . Dim ~ipns oTentire new c_on~titiction: Front , ....~f3~. Rear • • . • • • • Depth . Hcial t.; , ,..,vr+~¢,"'~tt~ N mb~ef of Stories . l . 9. Size lot:ek'P:9~~ti~.:,,.,::-f''..'T~........ Rcar.........f,©s~.~~..... Depth .....^..Q.~....... 10. Date of-PutdCiase . .Name of Pormcr Owner , . 11. Zone or use district in which premises are situated • • • • • • • • • • • • • . 1 r. Does proposed construction vial to any zonin6law, ordinance or regulation : . 13. Hill lot be regraded °4 ra.... Vill excess fill be removed from premises: Xes N. 14. Name of Owner of premises ~ . Z~1 K~,r) Kt~~dress .RQ', ~~~Q~. L ..Phone No. '%r1S Name of Architect , .Address ~Or'tt2..~trla~• Gs'\ : • Phone No. Name of Contractor . ....Address (,'!'M:~~SPIswS,~ . 1~SZ,? Phone No . . 5 IS.Is this property loaaCed within $00 feeC of a rid 1 wetland? *YES....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAhI Locate clearly and distinctly aJ! 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 whethc: interior or corner lot. j STATE OF NEN YORK, S.S =OUyTY OF I . , • ; , , , , , , , , , , , , , , , , , , , , , , being duly sworn, deposes and says that ha is the applicant (Name of individual si;nidg contract) bout named. ~ icisthc I, (Contractor, agent, corporate officer, etc.) C said owner or owners, and is duly ',authorized to perform or stave performed the said work and to make and ~Glc this :plication; that all statements contacted in this application arc taste to the best oC his knowledge and belief; and That the ork will be performed in the manner set forth in the application I;lcd therewith. •vom to before me this ...........E-3..i./.~.-...dayyof . . 19~~ Mary 1'ubiic, 1r!':'..~l• ~ • •h'!~4-. (f~'e-~ • County ~ J~ HELEN K.OE VOE ~ NOTARYPUOUC,Sta[eofNewYork ! (Signature of applicant; No. A707878 $uNolk CaUrdYf~9 j Term EzDires htesrch 30,19.--.=,! HUFF. 00. XEALTX DEPT. APPROVAL X. 9. Nb.~"1P• ~~~Si oWN -~•.I'-," = k"1.~'~'f t SIJFPOtN COUNT'![)EPIrRTMENT bF HE.41.i hI SERVICES ,C',1j ~ !T_,+a2 60;JNlE I7lc'A~CT, SIPJGLE PAMII;'~WcLLING OY`1LY - e7~ ~ r•~,rt: aw~trrrE~, N. v: to5d~ nn~?UG 3 0 19,~Q ti,e, REF nu. ,,y r,,...,$r£-529-15f5 OFF.) Tha sev;age tlc;, r5al eeP Ivrtel cnrtV~Y Izcllitles for this ~Ye - locutlen i.me 6. =n los d 6y tn~r~ h'P~ir4udnt and/or s'~-, ~ v' _ other ~r°nc~ s:~~d `/~~~mtl (1~'~~~ anyy~}ter Y. ;n AREA: .7t ,'"`l C1 3G! r r tJ,• . lO+~~'~ G~ O ~ Chla r:i 2ln ran nl ',l o' rater i\~zneGement To DEED:r.-7f ~d't ,°.ti ~~O:L,+,+; m".. ~ a ~ .E ,t:- A c c I t^ ri ~ 1` 5 i.~,. ;r o C ah I o ~ ~ ~ ey,~., ..,r ~ wa LrTGS--- O J.d u6 DlJ'.='OSRI. 15Y•5:*UY;)_~ r„r 1_T e fop= i'r - - y9yefd i0 kj. ~ 'P - r .C:'.: Y t ~ r~.Jelr f T'N''o 1, n Jwe!! i u ` ~ . rG' ~r I ~da.'x, ii ~J - Dt-TA,I:L ~ I ! ¢crl,~• .;r`. p, ~ ~ 'L ~ ~ ri ~y FrNI sHE'D Hnus,~ iM 111 (3~~''d l KI L; a sagle_ SQ,_ r.. I , . _ , _ / 1 l i ~ I i V'. ~ U%. _ ' i' t` .rn r: Lr ~ I ~ f r i . h t - I W 9 N' - - i,~ .°Y•r.I ~i ~ . 9 i I l ~ Ir; ly ~ ~ QI scALr `-z rrrs.ted S ~ flyl, crv ~ ' O_ won ~.+i~'ie J ' „ t.~~xvnsmr. rieelc--1 ~ _ _ 4i .n z - 1 Laa'fratn fpr e/e4ariongi I M - . 3.0 dt ieat male • m.n~~`u~„kna melt" - ~ .-fin la}'~( 'Mono Na'wYm+9 Smtc .,^~i ,Jf' ncrmm~ few. 1 _ ~pQ 30"w v"~~.~en rr vnio wn+rrmeo nm Ds:_d+rti~ t ~J•~ .I yy ;x.~rd cacev flint rn p - ' ~.r~? ` \ •.-~•rO~ Y'1h..L:Af:LL fl 'Jh E(eVVLEY npi~ePlYI t, _ Lo,hae mll6 vae coP, r'!~'3 . N N 4Cr~/- ' ~ v~{7.Q1' w 2 ~Ut~~ fumrcntosn lndl Sn herenn ehcn cr vq , Q mnlY Va vha per n(ar wham lho~ i~ , tYacdlt{') ~ ~~t a, mana:~::a an~aa hip M.+vaorca a,~~,~ „ midslenW t~'a cnn*renr•r?d:e{nmanUl r.,lane/NOD . ~ O ~-ndn[• i:uX:krf.°FI O~sfd'il hpso:i 6LJ l ~p ' - ~AO SiSe a:. ;gtmva ai 5hfllarxPad'prmF 7i TITL3, ~OERITP. AiR'PlltlriE!l fr~A;t3,LAl7j 0s:nn. ctc:arncaa are naa eranair:npip ' 4a cdd;.,arcJ tne:~av0ane6r'evLFe`~aarif' +yr'~ „ Fsb. Z9.7it nn:re:a, .;:J p, - May a7.1~s8:.lukJrr,igee,Fya6. [7,t9d9.' - ' ' f v tH~ Pr4Ga~'"'~~:T~`~ GlIOYCrN t'6'~9' .I'r7 h K ~Rhr ~ I~ The 7'i'~':~e SrlePSOrtfs6 'CO. ~ j' oa`~~~i9v,,°it ' AT _ S:,P•~r•eyrd ,fr.rne °w-~;{9TT 9d ° rc "'~~;~.;~nr K * a r ~JC.JTf~ICa~G7 " RDDE'Ia/eR vfw~TU-nv+-L P. c ~ r~z~ls~~~~ t~ i S t. ( N < ~ ~ .~KCOLIALTY,I`J.Y~ /G. YLvr-:-' % -+~4nr~ ~J~ F,~ZS6~/' t9' . i ' LIG LAND4Ulltt Itll•6RE~ ,N. Y. ~ dal+15]P~ i' i ,:cD.77Pa Ma rxes; aa;«~r : o,~~r.loao, :,~t.o~~: ar~~r.e, apt r~. 'Tf/T~NOLI 9{JPP. CO. DEPT. OP HEALTX fCE9 9TATf~M 'OR FN7'ENT POR'APPROYAL OF COX9TtUCT10X ONLY F-', '~I~ ,ard~ ~ TXE WATER, 9iJPPLY AND 9EMtk~re% d::'. , r:> 3' ~ D/6P09AL 9Y9TEfq! POR TMI# ~H~'•,'._ y ~ rvd.~rt bATet i z ' f _ OrCNOE WILL OQrFPORM 'IO`',TN~r° -~En ..~~4 ~ ' H. 6. REF. NO.: S7- SO ~ .Z,3S 9TARDARf@9 OF 6UFPOlE" PA. +.p-,rs G OP, H6AtTH. HERV[pE9. - 1"}fir ~'~'j -.__I_ JOr APPROVED: ~ ~`f. wIt) SUFF. GO. HEALTH DEPT. APPRDVAL ~ H. S No. .,,A~ --'y-._W..` i 1' . r ;j P, i ; i : •~trr 1. , ~ R., ~.M~.,. ~ ~ AU6 3_0,1990. • _ . r!~. ~~_~__~_3G • ~ 4 ~OiuliL:, 1 ~ ~ : ;it;i1T c~flt~iJOr a' e 1 (VIA' ~ _Wy . ~ L. p p - min ' ~ ~ , is ,.:r~.a ~~rrd.5 ' a -r - - - - --T- - - - - - • ) L. Iu~G.I . " T.N.' •~,kj. > - . . r `@~ "d.ivt" it 7 ~B f. ~ c~ - ~ r F"r t S~ J~., i i 1 ~ n - y ~ t i t h~. ~ t U~ . • , , 4 ~ . - : scALE: .r. - ~ J - :t k i i ti tsuc~Cfr'~'J. im_;:L~te. ? - . GERTIF. Araanded' Nov. i y~?: . - - F~ b. z9,. 9B , • . ~ !uK~ rr.;9i8d; f'ab.1t7,~969 STAMlP c9U o roar ~~8d . r'u SEAL - . • a rid: " RODtR~CK VAN TUYL. P. C. , • ~ ~ , f(r 1 ~ r a...~-.~~ s LIG. LAND SURVEYORS-~iREE RT. N. Y. - TEST HOLE SUFF. CO. DEPT. OF HEALTH SERVIGE3 STATEMENT OF INTENT - a• ...IS•Ur, POR APPROVAL OF CONST4tUCT10N ONLY '',c.~t~;/ THE WATER SUPPLY AND SEWASi ~ DISPOSAL SYSTEMS POR THIS RE3i- ~ ~I ~tl DATE: r DENCE WILL CONFORM TO THt r ~ ~ c STANDAlRDS OF SUFFOLK GO. DEPT. H. 8. REF. NO.: ~ OF HEALTH. SERVICES. X , 1 APPROVED: ~ l$1 APPLICANT - 17' _--___1-- r. r~ _ _ h . ~s suPP. eo. Nw.rn osr. >1. lilpi. ~ ..11Th' L.`~l-.:i,..: k::~7 t' 1 : 2 ~ ~ dl .BQNAitE ~QRE CT. ARM: ~,T4$ SG.rT Des 1.. ~'/~a-f',". ~Q~'~. , i ~ »8113. ~ ! ~ f fbo~rr.o n_ i«.. +o. , F T,,. 1 ' o ; 'r.S 5." _ ' i j 1~ ~ ~ - ~ I Ac~.~t 6 peelsCS~ . O C t7 + t`7 C q II .w gY fi vE" C/At"OifgL 6Y.S7 !(1Yf - _ ~ .-F i~ - .f _ _ - i ~ $y I _ ~ f I ` I ~ ~ Z ~ ttfC ~ pI Oyar P~wCII I , ~ ~i '<3 ~ 1 - ~ N ~I ~ k?. 6 v JUl 15 1988 WQ~'• yd' z ~`.f, ti'G!/ ' , fi,~`~r~,~ ate' -~4^ , fft,fi,~ ~ HEALTH SCRVICCS ~ _ r t 1 :f ~ l~ u i Xr^f,n ~ I f 2XrY'tn.,..,. ~Onfs ~ lfj I zi r~'.~,.,.: gip.. P: PL'n i ~ I r 3 ~t ~C!$t" Hpl@'. I ~ n s 'Y +~~d-n~a4ion of ' ( - I .,an h ^ of the New fork State ~ i ' `'y.. t . ` A,;c .sw ' ~ . ' NAT- - - ~ o rv rhes,rvuv ma;+nM. bearin bF~< s 3 a~ not .re tronaioer Requires septic tank ~ ~ 3v~,+n eras (oY ntc s .i i.a: hereon shall ru cover to grade. = ~ n or :or whom tha surv . r r r 1 is or. h+s Rehaif b ffia -y~ nen7(onml aa0ncya 'S1B~i<lu v. ...C' t.on +:,teS na: ecn entl ~ ~ -::e;+ of era IanG7ng insti- ':5 ArB MI ItdnSffirdhf TITLE p QiRTtF. Bmardad Nav. r~ 1987 i ns'ri[iona ar subc0pua ~J~, re 6. r9,; 9d ~9 ~`c"-~"`~7 j Mof/:r~,l9R&~.kf4, ft, .'9B8 STAMP / tl i F-i ' ~~~;S~"i 1/AJ'~67 d~ F N E aT ~h~ ?ff~`c 6uwrnr~fcE Ga, rFz~~~~'~~a1.~~p 1' . ' RODERICK VJW/TjU'Y~L. P. C. r \ ~~u* Orr O LIC. LAND fURVEYO ~ N. Y. SF~lANO SJPw Co. [:7~c Mo ~ !]r+*~;,~rvu~tr<"r . Disr-. ~~aC3 ,:C-...~-.:~,?.'r, ~~r >t:.c." _~ut' i TENT HOLE SUIT. CO. DEP'T'. OF HfALTN IiRVICp 1TATEMLNi OP INTlIii a GIEO? 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