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HomeMy WebLinkAbout17184-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCEIPANCY No 218410 Date SEPTEMBER 25, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 20210 SOUND VIEW AVENUE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 03 Lot 13.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 21, 1988 pursuant to which Building Permit No. 171842 dated JULY 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 ATTACHED GARAGE AMENDED TO INCLUDE DECK. The certificate is issued to GEORGE F. & BARBARA TAHLIAMPOURIS (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-43 AUG. 15 1989 UNDERWRITERS CERTIFICATE N0. PENDING SLIP SEPT. 25, 1989 PLUMBERS CERTIFICATION DATED GEORGE TAHLAMPOURIS SEPT. 25 1989 Bui d~Insp" ector Rev. 1/81 F08M NO. Ss 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) 0 ~ 1718 ~ Z Date 19.~. Permission is hereby granted to: / ....l,1. ........Cl.l.. .......J~ ~ AS...~. $ . -F:R-v nil f3 to ..~r~?:^-n~J.~t~c..~...4.....-.~Am~o.~q....~.kM:Y~&A!rul..t...~.~-s~`..~~-~:0.fR~:j....9i..,~ U ...........................a.................1................. at premises located of .X01;1,0,,,~~Sj,4,~,a,,,-2,;,,,,,,,, A~(~- County Tax Map No. 1000 Section ~.S..I......... Block ........4..~...... Lot No......~...3..: z-..... pursuant to application doted ...........3:~ 19.~., and approved by the Building Inspector. Fee Building Inspector Rev. 6/30/80 t . TOWN OF SOUTIIOLD BUILDING DEPART2IENT TOWN HALL L Q p~ pLp ~ SOUTIIOLD, NEW YORK 1 1971 TOWN pF Spy 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION Y......OLD OR PRE-E%ISTING EUILDING._....VACANT LAND .~'4'~.-j. f? Sc9 e?y-:/ tf/ ~ccl...~1. S'o~''1~/~'t? P~ Location of Property HOUSE NO. STREET HAMLET Owner or Owners of Property.,(~,~,~'~f?-G'F. ~~~~..~~~/'l'~l!"g'~~d(/I~,~~ County Taa Map No..1000 Section`.... Block Lot l.~:~... Subdivision'".~.~~!::~-! FiSledpMapA ........Lot.,. Permit No~ l.~~L~ ...Da~t/e/~of Permit~VL~.J.~FdS~.Applicant ~.(.~.c:~..-. 1'A`L~~fL~'~,l.Y/ J' Health DepC. Approval S!../_'............ Underwriters Approval Planning Board Approval ~C Request for Temporary CertlQificate Final Certificate Fee Submitted: ~AC(rM.~... APPLICANT.. f v~SsK-i.'s-a~~~~=~~9".... _ . 3833 S 333 ~ C v z /8y/o ~,g I U /o ~.~o~ C-. d~1 r96P ~ ~ rev, !0/14/88 ,,y, .'v.t..,.,..._~ FORM NO. 6 'a,."~~.'~/r'~~"~~,~, l,~y~~~ ~ TOWN OF SOUT110LD ~ ~ •~,a`: w ~ ~ BIIILDING DEPARTMENT ~ ' TOWN HALL -•e, ~ ~ 765 7802 ;r~c,~. -"'il r ~-wF~r' o. ,w ' ~ G3!!/r .'r y' APPLICATION FOR CERTIFICATE-OF OCCUPANCY INSTRUCTIONS A. 'This application must bg filed in tgpewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual'i,natural or topographic features. 2. Final approval of Health Dept, of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement fromlplumber certifying that solder used in system contains less than 2/10 of 1Z leadl 5. Commercial buildings; industrial buildings, multiple residences and similar. buildings and instal>rations, a certificate of code compliance from the Architect or Engineer responsi)ale for the building. 6. SuhmiC Planning Board Approval of completed site plan requirements. B. For existing buildings SPrior to April 9, 1957 non-conforming uses, or buildings and "pre-existing" land ,uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or Copographic features, 2. A properly completediapplication, a consent to inspect signed by the applicant and a certified abstract of title issued by a Citle company which shall show single and separate ownership of the entire lot prior to April 9, 1957. ' If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor invriting to the applicant. 3. Date of any housing code or safeCy inspection of buildings or premises, or other pertinent information required to prepare a certificate. G. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and ' separate ownership of; the entire lot prior to April 9, 1957 shall also accompany the application. If 'a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: I. CERTIFICATE OF OCCOPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swiffining Pool, $25.00. Accessory building $25,00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2, Certificate of Occupancy on pre-existing dwelling - $700.00. 3. Copy of Certificate of Occupancy - $5.00 - over S years - $10,00 4, Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial i i APPLICATION ON BACK ' rev. YO/14~/S$ TEL. 7G5-1802 oc~~FFOth~~~~/ TO'4Y~N OF SOYT~'~Od.ID 'r , . , ~c OFFICE OF BUILDIAIG INSPECTOR O ~ Y ~7 o : ~ ~ f m P.O. BOX 728 TOWN HALL y0 ~ ~ `r SOUTHULD, N.Y. 11971 $EP 2 /y~0~ r~ ~.,d0 C E R T I F I C A T I O N Date Building Permit No: ~ Owner~C~e)2.G'•~. -Ic`~ ~.~'wt~~~ipt9t'1~C' (pl ase print) Plumberl~'F,v~' Gc' lv~~z-~!iCavyl~C~u~<~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. r ' (plumber's signature) Sworn to before me this J~/Y „ ~1ky day of ~ ' I~ t.Z,,,L..t~ 19~. Notary Public 1lotary Public, County ~tpA KAgAC09TAl " public. e.. ~ ~ ,~a V9pM ~Y No. 41 ,..,un: lified m C:~,~~as ~ ~ en Etm~" . - gg7~~ Nowt P,,,~ „~g~2~~1~NwYpk ~ AemM~N~o ~~1 ~'-'`~M~~al ~ a 9' o H x w gZ;IAL Z - P O~IAL COMMENTS ADDYTI _ cis K .9 H ~rl O ..--~`"._-"'ter ~3~335 r ' . ~~--''`r x K q as SR - r ~~llATE ~ COM~SENT° % ro ti =1F:LD i,:S:'~C71UN rn ~ ~ . G~ 3 H oCS rOUNDATION ~1at) ` ~ t•- ~~Y~ G FOUNDATIOid (2nd) z 2. ~ o ~ ROUGH FRAME YF ~ 0 PLUMBING l H x CTI 3. Nom tis ~ ~ ` _idSULATION PER N. Y. ~ _ STATF. ENERGY g2?g ~ ' x CODE r MgT` ca .3 '4. ~ FINAL. ~ ~ Q. z j ADDITIONAL COM ENTS: ~ r ` ~ Y J • ro H • ~ H w( O /t/eT' d z° b " ~r,•a,y • ~ ^ • m oC a o0 r t H .r- x (A 1~~~~ 765-1802 BUILDING DEPT. INSIPECTION [ ]FOUNDATION 1ST [ ] OUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING [ 7 FINAL REMARKS: F ~ ~ J _ 2%~r/ DATE ! INSPECTOR F ~~f~~ rss-asoz BUILDING DEPT. INSPECTION [ ]FOUNDATION aST [ ] ROUG1~1 PLBG. FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: <.~'~l'_~~s~ ~ I ~/G I / • / l f U I t k i y DATE 0 jI 0 ~ INSPECTdR I a 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~ f~AL mod' ~~~l~t ~ REMARKS: q G 1 DATE / 0 INSPECTO s 7 ~..~__~-~n _ ~ ~ ~ 765-1802 BUILDING DEPT. ~7 Q INSPECTION '~4 [ ]FOUNDATION 1ST f ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~ FINAL REMARKS: ~ e~ rh-o ~ _ j s ~ DATE ~ INSPECTOR ,i,; 1~~~'~ T65-1802 BUILDING DEPT. 1 NSPECTION FOUNDATION i5T ( ROUGH PLBG. [ ] [ ] FOUNDATION 2ND [ ]INSULATION [ ~RAMING [ ]FINAL REMARKS: ~ ~ /0 tv ~ ~ DATE ~ INSPECTOR s ~~l U 765-1802 BUILDING DEPT. INSPECTI®N [ ]FOUNDATION 1ST ( ] UGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS;/ ' ~ ~ ~C~ ~ - DATE ~ INSPECTOR ~~G'yh !7/S~~ 1~~~o-l u ~ ®~r 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ](ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ -~RAMING [ )FINAL J ~ REMARKS: U c.u DATE~ZZ S'rY INSPECTOR ~ l.V 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ~'MING [ ]FINAL REMARKS: ~"u~ J~ -~j ~ . DATE i./ 0 INSPECTOR .-r.~, ~..,_~L , :.~s. /,i~ 765-1802 BUILDING DEPT. IIvISPECTION r [)FOUNDATION 1ST f ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: r~'°~-- ~ ~ , cam. "'~,~i f i t /(/bV~'° ~ .gip i t ~y f DATE l INSPECTOR 4 _ ~ a,.. 's...._~ ~ ?lg`~ ~ rss-~soz 13viLDiNG DEPT. [v~F NDATION i5T [ J ROUGH PLBG. [ FOUNDATION 2ND [ ~ INSULATION [ ]FRAMING [ J FINAL REMARKS: Cis ~C t f I DATE ~ o_ _._._INSPEOTOR ,~I~r~+!~~~ ,~e,~ i ~ ~ =x., BLDG. DEFT. . ~ rows, of soun~oLo a ~ 5y~y- ~ ~ - ~ inn , ~ r ~ ~1V~ 1 - ~ - . ~7~ ~ y~ . ~ ~a2' ~r.w'~~a -w, . ~ , . ~rznt c~,,s're'r~ i ~ vt~Lt.: i ~ '*~At~tu,IN ~ i ~Qn, f . 3~ 1, ~ ~ ~ tiw~ . j - 1 1 i ~ - - t ~ ~ %y ~ fir- r r ~ ' c' ri ~ ~ ~ ~ 'at. . . f~ ~r,~~~•~w y., .~y,. _ - _ 4e~--.n_..,. ~i,,y. ' ~ ~ ~ CAF,~.c~' ~ , ~j~liS. _ x~ ~ t(~,,~~ ns ; + f+,F . E i ~.~1 c~r~~w '~~G~~~,- I ;LEDYNE IVST IJ81919 ~ ~ _ ,._a~.~ l a;: SIMON FOULADIAN CSC lP~f Cr G°3 Op ~ `jj QQ~~~~~~Q~ CONSULTING ENGINEER 24 ESTATE TERRACE NORTH MANHASSET, NEW YORK 11030 DATE ~y JOB NO (516) 621.7036 ' ~O , ~8 N'1`TENTI0N ro 70cuN ®F SofJTyo~~ ~uiLo~tit~ ,t~~p%. Bviopins ~c-p~> RE _ Taut rV . lfA L L 6E®~@G E l A/fL./f1~rY?~a ~°%~/S f}~'~5E Sv ~t~o~~ ~®~r~ Y« .~W~~' Y Des,. /eoa SELo / ~3/ae~~ 3 ,vc~ l3n ~ WE ARE SENDING YOU ~ Attached ? Under separate cover via the following items: ? Shop drawings Prints ? Plans ? Samples ? Specifications ? Copy of letter ? Change order ? COPIES DATE NO DESCRIPTION 1 0`1~,~~c~ ~ P~~ / z ~ NY/a,~c slgjE' ceo DE ~o ~Es . M,@ f18~~~ fJaaS~ . THESE ARE TRANSMITTED as checked below: ? For approval ? Approved as submitted ? Resubmit copies for approval ~or your use ? Approved as noted ? Submit copies for distribution ~i As requested ? Returned for corrections ? Return corrected prints ? For review and comment ? ? FOR BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US REMARKS ~~e~~ C/~c~ ~,e ~,vy Qv~v'r~o,~~ yvv ~-y ocr-rte SLOG p~r~~f m,:, TOWN,,_,d~sSJ{i7±~C~ Cj)~ COPY TO SIGNED: /fl ll enclosures are not es mled, bndly nofily us of onpa. . y N~I.v Yo~r~ Sr'gT~ ~'tiiE~~..~Y C©U~ 1~U~•~'c _ __T_..~..._.__d... ~l•/~ Ppop~s~© Coi?sr,~v~-ridr~.~ CDn~/~~~c-s krlry THE .r ir~CGG~/~l~fl.l~` llG~ ~[~5/GN ~IEyI~DD OU%LIN~J.~ (N ryt tVE~v? Lfu~r! STf{7~ SN~Pr}~ CauS~~~,~7/0~~ Cabs e_T 5 ~ 7~ /4~ 9 SF~Ec ~/U~` ~i Pp i/_ / s' 19 ~ l ~uaws9o[ e` T/~Ep.~4AG Pe,~-FoQ.M~rNcr" ~!+cUE 0 As TA6cE 5-I ~F Coij~ ~ ~ Rr7o1'~ GEI~-iIJC Uri a.n5 FGOO Q-- _ o ~?~Ti Yti.9 UW ~ o. oS G[A2/N~ v©~ o•S8 NoT~ ~ ~ ~ PG!/-- ~~GE 2-4 ~ NC'W YU~{' SiAT~ ~~f~~fY GPJG~~ SUF"FDGK.. 6000 ff~yT/tiC7 1,jGC~~'G-'E' ~/1):~. z. A ~ ~ r.-c~ rat..t ~B ~q. ~ C , ~~R,r s of ; P~~~ ~ e 5~ ON Fo4<.v` ~j. .'F ~J -J.r iK f ~ i` do 61 6Z• 'N Y ,n SIMON FOULADIAN aRaECr CONSULTING ENGINEER n~E 7R t/~ i t3 m~Uv~?J S NC j u~~~~(/ 24 EStATE TERRACE NOR(H DAT p MANH/SSETNV 11070 /ledsE (v~cd, /nom, S~7 os/ 0.~~~ 3 aL i3~~.~ 0 3o O 1 ~-uA-~v~ ~i/7.IGK. U1~G&i~ 1. 11 ours~oc A,r~ Ftc.v» 041 A-lt~ 5/vF~cF, 0.42 IIJjUC f)%'/OnJ /Co ~s 20.,3 Uu~ ~ o.D~~ Uw 1--~ o ra,~__ . 3~ ~~~--J°-c~c~Q o,gP~ Pt,Y Wvo G ~Nldl(, F~, `-"o"n a, qt3 /NSvcf~~/v,~/ ~ Tcov~- /Gj ~rnJ57w ~ ° ~ ~ ~ n. o~ ~ ~l CUr- ~s T~~~-E d,,~, Pao ~ OFNE~+rp ~a ,~P"~~,~ouc.a '9~i' ~ 7~' in F e t 862, ~'~OF~SS1p~~ SIMON FOULADIAN aRaECr sua,ECr: ~ uew~r~~ ~r~Te e~~rr ~f,?E, a~~~ p CONSUITINGENGINEER ~ f ~ "~R ~ I-~ fl (Y}'~UV-Ij I y~ DATES: f2 ,Q a. 24 E~ ATEH~T~RACE ~ H UE{0 UN57E ~ D isT ~ooa, S r ~S1~ T/1 QG~f 3 yt+~.. 13.2. ~ / • 3Q'~+ ~ o~~EFOLkCO D VICTOR LESSARD ~ EXECUTIVE ADMINISTRATOR y ~ ~ Town Hall, 53095 Main Road (516) 765-1602 O~ P.O. Box 1179 ~ `r Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD December 14, 1988 George & Barbara Tahliampouris 1726 Astor Avenue Bronx, NY 10469 Re: Suffolk County Tax Map #1000-51-3-13.2 20210 Soundview Avenue, Southold, NY Building Permit #171842 Dear Mr. & Mrs. Tahliampouris: T investigated a complaint of flooding on Soundview Avenue just West of your property. It appears that the storm water runoff from your construc- tion has carried silt which has clogged up the drainage sewers. According to the Code of the Town of Southold Article XI 100-119.3 "Rainfall and stormwater runoff into roads or streets is prohibited from existing on proposed residential or commercial construction". In order to avoid any legal action you must correct the violation immediately. After the runoff problem has been corrected you should contact the Southold Town Highway Department Supervisor, Mr. Ray Jacobs, so that he may advise you of the procedure to clean the drains. Thank you for your cooperation. i Very truly yours, Southold Town Bldg. Dept. Vincent R. Wieczorek Ordinance Inspector cc: Ray Jacobs, Highway Supervisor VRW:smw ti W. ~y 4 (r a iy5 ~y lr .}may;, 4 .l ti r h y Y I . ~ ~ j r,= r ~ : s~ i ~ ~ a ! < h +4 tis~ a r J^Yl 1 R. 4 Y f 4, t i J 5 ~ A i ~ I 1 ~ t l ! i ~ C w.. ~ f r ~~";.5~¢. F p ~ t ~ rd °Z'x y .r w. .k i ` e at CD v t r _ 1 z~ ~ a F r t ,*t t ~ "+~jx i + 4 d Ir ~ t Y' Asn' i. ~ 4 iii(((,,, ~m Sx; 3 ~ w t~+~ ' S ~ Y. ~ i k~ ~ ~ _ , f IT~'VT Y 'T i ""f [ 4+~'^~""s"""'T n'.. j` ~ t it ra, y ~ _ ~ ~..i 3 ~ . 3.1 _ y r ; _ J.~..~.~~ j~fj1 5 t II Y~[" ~ ~ . ; r y _ _ THE NEW YORK BOARD OF FIRE UNDERWRITERS i'nGr ' 3 i l I I 1 U~ 1 BUREAU OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 ~ NOVtMBLK 0},~9gy 5R173'1.BA189 N iUO657 Date Application No. on file CRi THIS CERTIFIES THAT ewly the aMetrical equipment o descrihsd helotsrand introduced by the appficattt named an the akose applieation number in the premiw of EORG1: tANLIAMPOl1R1S, ?Ci21U ~IUNOVI@U AVE""., PULE k16, SOOrMOLO, M. Y_ in thefolbteinR location; ®Basement ? lxt Fl. ? Snd Fl. GAR Section Block Lot tKw exomined on 0C r0Hh.K 19, 1949 and found to 6e in rnmplianee frith the reyairementx of thu Board. R11111W RXTURES RAl10B COOR1116 DEOlS OVlNS DISH WASIINS EXNAt1ST _N1Mf a O{RtE1{ ~ ~TL11ES SCFNf rOlOtESCFNT OTHER AMT. K. W. AMT. R. W. AMT. K.W. AMT. K. W. AMT. N. r. - h5 p 3b h5 1f7.2 i i.7 If ORYRDi RlMEACE AIOTOIIS RtT11M uttutttE tNEE6 srEtulttx'rT tuleetocRS ERl U/NTIiATEEf tMRll.0uftlT DIAMI!!S AMT. K. W. pl n r. GAS X. r. AMT. NQ A. W. G. AMT. AW. AMT. AMtx. TRANS. AMT. N. r. ~ NE1 AMi. WAIn s t° 9 t SERV1Ct OIEfO4N1lCT NO.M S E R V 1 f E AMT. AMt. TNt ~ 1 / ]v/ t / 7w 7 ~ Dv? 7 / nv NO. p tCOND. Ot CC C NO. p NHEG NO.Of NEUAMS of NWFi Ml „ 1 200 CkS 7 X 7 ?ICS 1 /0 OTIIN AffARATUS: MOrOHS:l-O. 1S H.1'. ~ G. 6.C.I:-4 R+~ SMOKI: DETECTOR:-1 TKACK (IGHr1H6:--~16 ~ ~ rr: 1 G & S f.ONrRArrOR I G;.g125 fIO7( '115 SOOTHOLD, NY, 11911 s 11 y'-f% Per ? - Thk urti(icota Tent T1O1 tH ollerad in a^Y tTlaMer; Morn ro 1M eNior of Nts Beard if incwred. Inspectors apY be idanKfied by tMir cradantiok. - - - _ Ci1PY FOR WLDUIG DEMRTMENT. TN11 C(IPY OF CERT MUST N0T EE ALTERED IN ANY MAIMER. t ~~T BOARD OF HEALTH Y. , . D I ci `-;Y~ 3 SETS O F PLANS tl . v"°" FORMNO.1 2 ~ ~ TOWN OF SOUTHOLD CHECKY ~y3.?' BUILDING DEPARTMENT SEPTIC -FORM , TOWN HALL 6LD~~~G.D~''T. SOUTHOLD,N.Y.11971 N TIFY TOWiv Uf SOilT1iOLD 0 QQQ Q TEL.: 765-1802 CALL Examined ~ 199 ~ MAIL T0: .J7 oK ~i • Approved 19~ 0. Permit No~ . ~ ~ t Disapproved a/c ~C~IUZZ~.P~ ti (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19 . 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 schedute, 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 t}tis application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept an 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 gr~ted by the Building Inspector. APPLICATION IS HEREBY MADE to t}te 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. Tlie 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) i C) L} 6 State whether applicant is owner, lessee, agenf, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~G:~~~.r.L!S,`,rl~({~!!~`~1,~~.i~a.1.~.~.5 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .~'~:d KG.r,o.~ ..~'~lf4l,y~~lia.~.v~.,. S . (Name and title of corporate/~offi"cer) Builder's License No. l;°' S . Plumber's License No. r . Electrician's License No. . S° L ~~.r........ . Other Trade's License No. Lai- C ~~i~~ J~ 1. Location of land on which proposed work will be done....•7.Q L! ~ 17 , ~(f~'~, , S'C?t,r~,P~pZ p House Number Street Hamlet / ~ County Tax Map No. 1000 Section Block , , , , Lot . ; , Subdivision Filed blap No. Lot . (Name) State existing use and occupancy of prem,i~s/7e~s and intended use and occupancy of proposed construction: a. Existing use and occupancy , . ~r~~ b. Intended use and occupancy ~ 9v.. , F~..... ..~~e~u.S',`_ 3. Nature of work (check which applicable): New Building Addition Alteration . 'Repair Removal , , Demolition Othgla`~Y'otk~'.»:~,.~;,.......... . ~ (Description) 4. Estimated Cost , .~~.Q~ .040 . Fee , , . 5. If dwelling number of dwellin (to be paid on tiling this application) ~ units .'1 Number of dwelling units on each floor . If garage, number of cars .a • 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ; , , , , , 7. Dimensions of existing structu;es, if any: Front . , Rear . . Depth,.............. . Height ...............NumberofStories.........................................,............,., Dimensions of same structure with alterations or additions: Front . Rear , . Depth . ...............Height , ,Number of Slories , . 8. Dimensions of entire new cons(ntction: Front , Rehr . . ...Depth , , . Heigftt . . Number of Stories,t , ; , , . 9. Size of loi: Front . Rear , Depth ~ . • . 10. Date of Purchase , . ..............Name of Former Owner , , . 11. Zone or use district in which premises are situated . . . . . . . . . P P g 'late any zoning law, ordinance or regulation : . . 13. Will lot be re rage P . . Will excess fill be removed from premises: Yes No 14. Name of Owner of sremises Vlo . . ...........Address ...................Phone No............... . Name of Architect . ..Address , ...............Phone No, , . Name of Contractor , .....Address .Phone No..... . 15.:[s this property located within 100 feet of a tidal wetland? *YES....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alb buildings, whether existing or proposed, and, indicate all set-back dimensions frotn property lines. Give street and b1oc1S number or description according to deed, and show street names and indicate whether interior or corner tot. ~~-f~ V r i STATE OF NEW YORK, IS.S COUNTYOF.,,..,.. , • (•e`'' • ~tt-1 , . , , being duly sworn, deposes and says that he is the applicant tame of individual signing contract) above named. i , . Iieisthe I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dull authorized to perform or have performed the said work and to make and file this application; that all statements contq'ined in this application are true to.the best of his knowledge and belief; and that the work will be performed in the mannef set forth in the application bled therewith. Sworn to before me this ~ / S ........day of I...... ':~S-....... . 19 !p~ Notary Public, . , , . , . ~gLK.t=/~'Jti . `.~.~....~S!Qr. 4 County i ~g 1~~'~I~ofiNewYork (Signature of a p scant) 47878/A, Auflirik ~uoa , ~etm Expit9s hlrrch 0,19~~ i - C7 y J J W 1/i = 4 (V ~ •a ~ r .r ry~ W A. s~ T Le - ` C ~ w ~ ~ d ` ? ~ ~ ~ ~~a0~~~ RQd rAT Q ~ yyi~ ~ ~ ~ ~ C'!I Op ~ , d i y~, F„ q~~ J ~ \ ~~C1 ~ t, v~ n m y~ y1~,11 4 ~ G 16 } ~ ~ iA U ~ Vii. v1 D Z ~ +4Y/ ~ ~ ~ - rv r r } An rM. ~ wi' ? ~ e x hy.}.~. _ ~a ~ ~N f. 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W (ate r ~ ~ A om ~ 6 ' ~ >i~ r ~ r. ~ s_ _"~~.~1,. - i~si ~ a 7 r, f4C+~• ~ c~ t 4 ~ ~ ~ .1S~~ `n ~ t e e~ ~ v z j+ ~ M r ~ I ~ 1` ~ t yyk,~ ~ ' ~ 3 Z i ( y nr ,r.... a ~ ~ I ~ ` 4 ~ e~ R. i ~ a. L 1 ~~ee~ ( ! 4 ' ! 94 _ ~ d { t VFW jtk q~t 9 5 {k 4 1 { " ~ t. ~ j.~ P3" tiA ',34i f °v (-i~5 ~ p3 ~ - Il.`L < .f~~y~ { ~i _.i. _ l ~ S d ~~~~t k. ~ ~ 5~1~. q y~a ~ ! 1 1 ~ ~ ~ F ' ~ t < ~T e e~ - ,T~,w. ` ~ T.; ~j SUFFOLK COUNTY DEPNRTMENT OF HEnLTH SEt~tVrC?.$ , ~ ` z ~ ~ ~ ~ - SINGLE FA6ULY DWELLING ONLY ~ ~ k i , ~ DN~UA 9 5 1989rLS. REF. NO..~SD y3 ~ y,. e The sevaage d+sposai and vratsr supply !acihties for this t i s ~ ' ~ ~ ~ ~ ~ locatian have boen mspacied by this Cs1;a!tn~ent and/or iV ' `s~ y ~ ~ ~ other ages 'es and nc?,tn.be satz~~e~dry, E - - - A L v ~ ~ " h' ofi Bureau of Y4as~orra~er hianagernevd _ j~ A S O !1 ut ui N l1 { 2 i ` F.$ V V t~ ~ ~ p~ ..~<O ~O ps^~ ~ to i4.. A m C 7rC X ~ tin -pj O ~ _ t.,. ~ ; ",v+,,~ ton m ro D ~ { ~ r ~ %V, Ey . 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