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Home My WebLink About17577-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217525 Date NOVEMBER 18, 1988 THIS CERTIFIES that the building ONE FAMILY DWELLING E. MARLENE DR. (LANE) Location of Property R.O.W. OFF LUTHERS MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 03 Lot 7.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV. 1, 1988 Aursuant to which Building Permit No. 175772 dated NOV. 1, 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 WITH ATTACHED TWO CAR GARAGE. The certificate is issued to CYB BRANCIFORTE-BORN MICHALOWSKI (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 86-SO-63 OCT. 27, 1988 UNDERWRITERS CERTIFICATE N0. N806855 APRIL 30, 1987 PLUMBERS CERTIFICATION DATED MATT. PLUMBING & HEATING OCT. 31, 1988 REPLACES B.P.#148552 ding Inspector Rev. 1/81 . w nosas xo. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BU16D1NG PERMIT (THIS PERMIT MU5T BE KEPT ON TtiE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 0 LI 17 ~ ~ 7 Z Date ......~19.U.::...... ~ 19. d~ Permission is hereby granted to: .,j{.- ~J.....t'~~......~rf ~i ....~........~:~,,/..o... ~ yy~ ~ / _ . ct premises located at .....G....s...........f.~/.".^..:4:~!:~r ...............~~.........~..........~!.r~(~1...~rcR..~i .......................................................................................................p......................................................... Cvunty Tax Map No. 1000 Section ~t!3............ Block .....-1 L//ot No.....~~.!.:3........... pursuant to application dated 19.~lR and approved by the Building//Inspector. Fee $....(l ~a3.:.~~.~... /t~'~ Y ~ ~"Q~~"~''~'_"~' ~ ~~s'S wilding Inspector Rev. 6/30/80 Fox>u rro. a TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 14855 Z Date ............c}.r..~!~;...~ 19. Permission is hereby granted to: 3.....~.> 1 . V . . ~a ~...........,~..~.j of premises located at~:~: k?..:..... .,~•4.4.!~''~°......Sf.~.'.`7........~.;rJC~. ~s...... ~ County Tax Map No. 1000 Section~...._.~I.nw~....... Block ......a.3......../ Lot No...~.e...~.......... pursuant to upplicotion dated .....~L~.:tX.......~ 19.~.`k.., and approved by the Bui lding2glnspe2ctor. Fee $.~9.~-.~.a.... c: Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~es.~.~ to the Building Inspec- torwith the following; for new buildings or new use: 1. Final survey of property with accurate location of alt buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property Tines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $100.00 3. Copy of certificate of occupancy $ 5 .00, over 5 years $ 10.00 4. Vacant Land C.0. $ 20.00 ra S.Uodated C.O. $ 50.00 Date NewConstruction,,,,,,O1d~oyyr//Pre-existin~~gBuilding{7.....7......./V,a/cantLand ...y./~.~.fe./_.~. Location of Property /!(o~l~F2F fjKi~Fr--, ...:~-:~.Ic/, G.v1~.~~....... ~~/~///7`uC~ House No. Street ~ Hamlet Owner or Owners of Property • • ~`!OJ"~• CrF~c~1~®r^:V'•~-?• • • •~jY'~r• • r,~i~ • • County Tax Map No. 1000 Section Black ...`3~.......... Lot . Subdivision . ...........................Filed Map No. ..........Lot No. . Permit No. . ~7S?~. Date of Permit ,Applicant . Health Dept. Approval ........................Labor Dept. Approval . Undewriters Approval ........................Planning Board Approval Request for Temporary Certificate .....................Final Certificate . Fee Submitted $ . ~°'~:r' ~ . Construction on above described building and per it m plicable ,odes and regulations. Applicant 2 ~~;f~~~~ . . Rev. 16~10J6 ~ (r ~~i s~ . %"/75;25' To: Bennett Orlowski, Jr., Chairman Report No. 563 Southold Town Planning Board From: John W. Davis Date: January 17, 1987 Re: Access road - Minor Subdivision for Edgar and Arlene Marvin Comments: Map for above 4 lot minor subdivision by Van Tuyl. dated amended December 2, 1977 shows the access 25 ft. R.O.W. in a straight align- ment from Luther's Road. Another map by Van Tuyl dated amended August I, 1984 shows the 25 ft. R.O.W, with an angle to the north for a length of approximately 120 ft, from Luther's Road before meeting the straight length. The original alignment (straight) would involve removing some large trees at Luther's Road. The owners of Lot No. 1 (Mattes) did not have a copy of the 1984 amended map. Also, the deeded 25 ft. R.O.W. for Mattes does not include the change shown on the 1984 survey, only the original layout. I had assumed the deeded R.O.W. covered the revisiorti. According to your letter of December 30, 1986 improvements for the access road should be pursuant to 280-a which would require a road width of 15 ft. The cesspool shown in the 25 ft. R.O.W. has been relocated and the building with R.O.W. encroachment has been demolished. Advised that demolition debris was backfilled in probably a cellar and that there has been ground settlement there since. Recommendations: 1. Use access road alignment as shown on map dated amended August 1, 1984. 2. Varr Tuyl to submit a profile that meets the existing driveway ele- vation in the revised R.O.W. 3. Road width IS f.t. with a 2" asphalt top course an a compacted 6°' bankrun base containing 15~ or more of gravel and 107 of loam. 4. Part of the existing blacktop driveway can probably be retained with widening to 15 ft. Widening to be on a base as noted above. Provide suitable exit and entrance radii in the pavement width where it meets Luther's Road. 5. Remove topsoil for the IS ft. width east of the driveway. Replace this excavation with compacted clean material to the subgrade for the 6" base. 6. The length of the road, 450 ft.±, will increase the runoff into Luther's Road. Install leaching basins Rt. and Lt. 8' diam. by 8 ft. at Luther's Road. John W. Davis P'~> D;,yLNSI~ECTION DATE COMt4L'iJTS " F z~ { ro 7 . ra FOUNDATION l/ (~st) ~ ~ ~ a Z FOUNDATION ( 2nd ) cn l`J 2. ~ / ~ z y,, 0 0 ROUGH FRAME & t/;t-j PLUMBING 3. / y SULATION P N, Y, v y ~ STATE ENERGY ,~j ~ CODE x ~ Ca , ~ 4. y ,<%d~G . ~ 'FINAL o~ /~f ` ' ° G'' z ADDITIONAL COMMENTS: ~ ~ to / ~ , o , ~ ~ - - ~ ' ~ x i b e LtI _ ~ W ~ 6- r ~ - H (/1 ~ 6 d 1 ~ . ~ ~N ~ H ~ ` 3 ~ ~ ~ ~ i ; v// _ ~i r - _ - ~ I~ y j ~ ~ i 1.x ~ . 1r ~y ~ ~ ~ ~ ~ . ~ ~ ~ ~ ~~..~.,.....w^-^'..--....... ~ ~ ~i r.. 4 n h ~ ~ t y h ti t ~ S" ~4 h i 4 , n ~ ~ y t. D- ' K 1»3 11.~'~ E ~ _ ~ o U ~ ~ ~ 't a C} 1 } ~ k~ ~r 4 rti ~ f. ~ ~ ~ ~ ~ ~ ~ O q z, ~t~ i ~ 1 ~ ~ ~ v. - , ~ ~ _ . r;~ to f ~ c~ ~7 ~ ty ~ ' ~ ,h `.'a ~ r ` e ~ j ~ ~ ~ 1C1 ~ ~ t 't as ~ OHli O~, u~C7 ~1M01 ~ . ~ ,°i•1 t 88611 E l~Q ~ a , _ a ~ t - - r+ ~ ~ •i, v_~w~ ,.___.~._._.~-._.._~_,._w_ s ! ~ 1 t a Vl ' t ~'1 V - r ~ r - r~ ~ , r i O ' SG Z ~ ` ~ r F - ~ ~ ~~w' W i Y J x ~ ~ ~ + ~ p n' '~y ~ r ,.54---' r r M p ~ ~ 1 } 4 , ~ i ° ~ ~~T" ~ ~ r ~y, ;i a~ i r ~ ~ .n I' "2` i r ~ i7 ~'tif nor 1 ~ fftt Y A Y 0 1~ 1 1 ~ K n1 i 's ~ p 1 ~ i ~ ~ jib ~ j ~ (t t j . of J ~ to ~ C~ `Z _ r~ • ~ © W W ~ j i o ~ o ..;,~,i.ci>~~~~ ~irnvl~ s „ ~ 8 I~„~,I~,~;w,,,,,,,.~,x. E~,~~~~~~a~;~ 51r. ?ol Hang • A • 0 ~as~-~r~st.~~~~~ 2-~a~ece steel, door/~aanb Adjusta-Fit is a uniquely designed 2-piece split - ~ / steel frame with a yz" lip which allows the frame to be adjusted to fit walls from 4ye" to 7ys" thick. The door's ' exclusive 2-piece variable width threshold accommo- ( - dates the varying wall thicknesses. i ~r~'bxR, - ~ Benchmark provides an extra measure of security with , an insulated 24-gauge steel door locked into the rugged 1Ggauge steel base frame. ' The system can be trimmed out with Benchmark's snap- y~~ on metal trim or any kind of wood trim, inside and out. , I ' Special hinge options include spring loaded or non- r i a i; removable pin. f ~ ~ ~=ir~-Fated Adjustable Steel Frame f ~ ~.-Y y_t 1 ' Combine Benchmark entrance doors with the Adjusta-Fit"0 " steel frame system to achieve a 1y, hr. Fir® Rating. Adjusta•Fit covers all conditions of walls from 4ye" to 7+/e" ~ , , hick. Ideal for metal stud, wood stud or masonry openi J_ Fire label options • Fire Label: ty, Hour Affidavit Labei •W.x~nmv,k// ~ standard on non light model doors. IM IxWAYYl rM4 41X~Y tenvwKwwxu nlxun • Also evakabla with 1y, Hr. (B, c, D an Thermal barner thmshnld design has r I„,x~ r, x E) label from Warnock Hersey Intern several sizes of adjuslrrble aluminum ex- tional, inc. or,y, Hr. Brass Labei fro tenders that slide into vinyl threshold to fit wYnr~xxesYars ~ YIRW Applied Research Laboratories. various wall thicknesses. + ~ ,w.x- ,.,MR,, , , , , f':700 e•rr"xlaun Fire Endurance and Hosa Sireem Te ? ' " under ASTM E•152, NFPA end UL70 :,~mv; °.al' end others. - A' ~ Available In: ' 2/6 x 6/8 i~ ~ ~ 2/8 x 6/8 3/0 x 6/8 C~i'j n~.:x,~rotrrtfan nr 1-1/2 hour fare rat my wrth mngnet rc TTG weal hr r+tripp snq. t W: , ROUGH OPENINGS ADJUSTA-FiT ~ I ADD TO_DOOR SIZE WIDTH HEIGHT ADJUSTA-FIT 3/a" 3/<° _ I ~ rss-isoz BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ~ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]4 II~,&l1LATION [ ]FRAMING [ FINA4 REMARKS: ~ J Gp DATE ~ 7 0 o INSPECTOR • S _ ~ f ~~~7 ~~~~Z~~ 765-1802 L BUILDING DEPT. INSIPECTlON [ )FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] I ULATION [ ]FRAMING [ FINAL REMARKS: j ~ - 3 I f ` DATE ~ INSPECTOR , ~ BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ J ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS ~ l P ~ , 1 ~ K DATE ~ 3 ~ ~ INSPECTO?~t~/- i J ~~~s =a. rss-~aoz BUILDING DEPT. INSP~C~'~~N [ ]FOUNDATION i5T [ ]ROUGH ~LBG. [ ]FOUNDATION ZND [ ] INlI;ULATIQN [ ]FRAMING [ ]FINAL REMARKS: ~m2 ~u~,C~ 6~' .t - ~ ~ ` DATE ~ l ~1 INSPICTpR . i = a ti~ _ _ w 765-1802 BUILDING DEPT. INSPECTION C ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION C ]FRAMING [ ]FINAL REMARKS: ~ ~ DATE ~ 4 " INSPECTOR ~ ~C 765-1802 18UILDING DEPT. ~uS~L `~NSP~ECTIN ~ a [ ]FOUNDATION 1ST [ ]ROUGH PLBG. ~f [ ]FOUNDATION 2ND [ ]INSULATION " ~1~s v`13/ [ ]FRAMING [ ]FINAL REMARKS: n -G~ CJ cr w r CD u F ~ ~'~-r~s~_ DATE INSPECTOR 'f6S-112 BUILDINg DEPT. INSIPECTIPJ [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: Gv ~ C'~-raj ?Y~S'u DATE ~ ~ 3~ l~ ~ INSPECTOR I T6S-1802 BUILDING DEPT. 1 NSIPECTION [ FOUNDATION 1ST [ ]ROUGH PLBG. ' [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING / [ ]FINAL r ~ y~ REMARKS: ~ Y i DATE ~ INSPECTOR ~ .~.R~,-. _ iuuusss THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 8UR£AU OF ELECTRICITY ~ ~ BS JOHN STREET, NEW YORK, NEW 38 April :3U, lyY7 pp f 4',s3~#`ay~t$ N 6 ~ Date A lirotion No. on ile THIS CERTIFIES THAT onl the electrical ui ment oa deycribed Belo aR rntrodu d 6 the a licdnt nomad on the alcove application number in the premiaea of r alb ~yd b'urS3ALiya Mil Ltd. SOU~g:/t3~rirc~~~C.water, acrosa from .~acksoaa LattdlnFS, Mattituck, MY in thefollorving locatiunl ? Basement ? lxt FI • ? 2nd Fl. Sertion Blork Lot rude examined on .sprit Z3 a ayd / and found to 6e in emnplivrre ui th the requirements of this Board. ~ FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT v%POa` AMT K W AMT. K.W AMl K.W AMi % W AMT. H P. ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULiI.OUTLET DIMMERS A PMT. K. W. Oll N P. GAS H. P. AMT NO A W. G AMT. AMP AMT. AMPS TRANS. AMT. H. P NO. OF FEET AMT. WAiiS 'J SERVICE DISCONNECT NO.OF 5 E R Y _I C E AMT. AMP. TYPE METER 1.0, 4W I .e' 3W 9 9 3W 3,6 dW NO OF CG COND A W. G NO Of HI-LEG A W G. NO OF NEUTRALS A W G EQUIP, ER % OF,C OND OF NI-LEG OF LRAL t? OTNER APPARATUS: +~FuturE~ appliance feedrars:l-2U12,1-3#f3 E Motor6:1-3/4hp.a 1-Smoke detector ~ 3-te.I+.G. "t. ~ f x. k'. plaloney fitt` Y.U. b64 I" Miilur Ylact:, NY 11714 Lic~F2z91E MANAGER 11 P~ • ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idI ntified by their credentials. COPY FOR BU.ILDIHG DEPARTMENT. THIS COPY OF CERTIFICATE MUST_NOT BE ALTERED IN AHY MAHHER. ~ . _ . t ' Ci 0'"""'~~ ~~w,d r d oc13 t leas ~C~: [~,rir1G'.~'t ~rlow5~,lJ~c.~Clnc~rme4 Bi.oG. oe9r. ~ ~ rov~~~u of sourHOR,~n ~ .ry 1~-~~(~ccess Rc-~.-~1~noY' S~~OC~~U~s+on ~~r ~cb~ot' grlev~e Ma~ir~ i:: C omme.~-~s; I . ~lad~'~v~ ~ns~a.ec{-~o~ a.~- a~nove r~~c< <~n :^,5~i3/~7. CUnIY frocd woY K to dale Is ~rowl -~~ne c~vc~l4~ ~as~G~C-~ ~,~~°c~veu~a.y east -Fn e~~, o'~ -f~~t{? 25•~'C°', C~~ a.W , Wikln~'.n -~In~S [e~~d~~t C/~~~'vox. 30,o t_.~) T~c~rv ~-oed w 5 -I it • Cvtc !~d~~f~5 O~ cL S~'o vt~ b~ivl-C~ -4'0~ Go~^r5e GS ~o C [VUJS '~I I . I; 10.5' [ 2, 1 l~ 0~ 3 3.',. 1~~ti~ 2,i No ctc~c~t~~e,ne[ ypq.nle Y'uh 6a~Q ~ ; ?l,0 5 ; tl.c~' 3~~ `tt<ie~'2„ ~s n.. l o~ ~~ce_q tint ~~v~~' sod-[;, eosk ~YOw/ -t-lris~. o apG~Q.C k- c-6^r ~ uJ a.~t,~ -b- Cn n + c~ ~ p~ n ~r ~ n h o I d w ca Y'. Nohe2,,, ! ~'l~ ~~ov? "'POG~~ 4~er~6 , ~5, ~.cCnY~-ovtC-¢~, W~t- 2n.pcs~~- 1Jo. X63 ~~I~~ wog a~.~~•rave.eC ~ c~ v~h ~ ~t~c C~®o~c` d ~C o (u O c+e fie d~.. ~cccs~ -p-o +h e, ?~G'.W ho~ra~ o~•Lv~- 4 ?s now 'brow( l CC i f~ J~csa ~VI O ~ ~ "'1"U vl c~1 11C~ t 64 ~ `C r ~~ti~~~ - .,.~.~..._..,...~._...~.,.,_~.~.~...~..~~~..~.._..~...~._.~._..~..v..__~___._~....,......._._..~..~:_..._._...,...d.~.g.. ~;~wa//~~,9 L °rj r •______~___.~____1 • 2y~~, 4F ',eft ..y ~ ~ M1\. ~I b/~'l~"P. ~ II M.p I' ~ tg <f Wr~`.V '~~M 9'il1 } II ~ ~ }`r o ~ C} ry. ~p b ~ 41 w cv O Q9 . ~ ~ it ~ J rTl c• K Q 7 3 ~ o ~ ~ tx ~ ~ ~~rc>p~sm .t to fA ~ py.n V h,<. ~ Q ~BJ ~ < tl Gnrrnc~ ~ _ ~~~~'t to .a . `Y ~ ~r ~ w ru O mop. Zy r ' 2~3 76. ~Yi r83 fl h M 1 ~ fi rr fir,-~,~rRr, nrr~. In zer.zq• s;~. e' ok A a . g, 6 U APR 2g 1J8R i9 9 „ yy. p p r- , Qi~/~OpQ~4~ Uli~ Q~! ©1 q s.84 ~ ~HkAl.Tt1 ~:RVYCES ~ ~ ~,p ~ 4/.g0' ~ ' the wa!er supply & sewago disposal sys- roo^~ !ems fur t(ds residence will conform to tho v standards of the Suffolk County Depart.-- V.~ f a ry { "STe^s ment of Health Services. 'rJ . / ~ c ~G~ AREA=43,445 SQ.FL f sever ~wq , ~~C~ C(~ YD`_~~'+~a?~~(!I£/l~'ORTE i.~ A9ARGgT ~Ll~S'~,~'Y' ~ ~ ~ ~ MATTI~~'U~'/t'~~~ I ~ ~ 4E OF NEW Y DWti+,;GF'$U4lTl~ldlD y~P ~9 ~ „(TI"_ ~ ~J L~f'~'f~~;°~;!~~IYTYk'N.1~. ~p~~RT A. ,~~T a~~~,a ~~~~m~srar,~Cr•CpRP . ~1~I wA~nf ° 4" a, 4NY A.~J, ~ M9TV, ~ ~ r , $ ;y ' s FO. Rt `x - , ~ d7p Y St, iL14°, lriG+. ~&7~'8 , u+ ~ a n ~ o ~ ~ G ~ ro ~ q Y~ R ~ ~ ~ ~ O ~ V ~ ~ ~ R 8 ~ ~ .'w~ ~b 8S .S ~aA~ ~ n 1 I~ . N A ~~j" (.L S~ ern ."1'~ tn1. A'y es' in .4 X71 ~-~1 T' ~ ~ ~ s` ~ ~j'' ~ ~ Y ~ ~ ~ Z ''t. c7 w ~ ~ ~.a I ~ ~ ~ ~ 3' .~Ci 1~~. qo TaNr ~ q~ twpny ~ p>°~ ~ b ids' b ~ Q ~ _ fP Z Q..-. . O ` O. 5.8 c? <A ~ v~, ~ mr y4',Y ~s~ ~ .Q D Q w ~ ~a < VWWd ~ -'y'V c~'.~ i-,.c~S r~N ~ d~~~ A ' ca ~,9 W ~ 3 G) Z ~ O \q u~ z ~ ~ 4 _ o ~ N o CA L ~ ~ ~b ~ C~ ®Mf~ , _.•1~ - ~~,>+,~"t~~+:«< TOWN OF SOUTHOLD ~ ~ ~9a~t BUILDING DEPARTMENT 99 TOWN HALL ~-°"®gl.a~. o~PT. SOUTHOLD, N.Y. 11971 tOW~ pF SOUTNOLD TEL.: 765.1802 Examined rrl.~ g....., 19~~'. Received........... , 19.. . ~ is 1,,, l~BS'~~ _ a' Approved ! I'.~ ~y,~...., 19 Permit No........... q dd Disapproved a/c ~.J o{ ~,7A /2~y~~~- (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ??U 19 fro 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 llepartment 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 ins ctions. (Sign ure of app ant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...O.c.~:Y.~-~! ..............g..................................................................... Name of owner of premises . ""y~ ~ .~l'L!-K141.~!`~%. ~ . .~:~5~ • • • . (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..Qys,lp,~(-~G~,~:IZ, , , , , , , . Plumber's License No . . Electrician's License No. a~~ E Other Trade's License No . . I . Location of land on which,pro os~ ill be done. - . House Number Street Hamlet County. Tax Map No. 1000 Section ~ Block Lot . ~ r.~J............ . Subdivisiw7...... 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 .......v~:r'"~a~-~ . b. Intended use and occupancy r~`~.I~{,VL~ICI,,d..-..~.:KA.VL'11... . y . 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