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HomeMy WebLinkAbout17224-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22839 Date JANUARY 18, 1994 THIS CERTIFIES that the building ADDITION Location of Property 360 PRIVATE ROAD #8 EAST MARION N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 23 Block 1 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8, 1988 pursuant to which Building Permit No. 17224-Z dated JULY 18 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The accugancy for which this certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to COSTAS W. & JOANNE TRATAROS _ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-038884 - JANUARY 3, 1994 PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 aosai xo. s 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 O 01.7 2 2 Z Date 19.~~J Permission ispe~reb~y~granted t ,...~i..~ , to .~`~i .~.......v .......e~~ at premises located at ......r~.~~?......w~~~.~.... y~,~~~c~,,,••®•.• Caunty Tax Map No. 1000 Section. Block Lot No........... pursuant to application date.,l./../,~ 19.5~~ and approved by the Building Inspector. ~ Fee $..~i„~ s :~~e~"~J,1.~...... .K Buil g Inspector Rev. 6/30/80 D ° FORM N0.6 ~C~ ~ f~~ 70WN OF SOUTHOLD Building Department s~.oc Lr~^r. Town Hall rpwN of so~rwaLD Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CER-fIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted w to the Building Inspec- torwith the following; for new buildings 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 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 p,mperty showing all property lines, 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: 1. Certificate of occupancy New llwellin~,$25.00, Accessory-$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 9 . Vacant Land C.O. $ 20.00 rrj S.Undated C.O. $ 50.00 Date ........k 6. Alteration 25,00 NewConstruction,,,,,,01dorPre~-jaxistingBru~ildping Vacant Land Location of Property ~ ! .'~uu~..IS4r.~~1. IM¢':':'°. ~c~.... "_"'t'"~'-~- House No. `-~Et~eet Ham/et Owner or Owners of Property G~:-?:- ~/t!:?- . County Tax Map No. 1000 Section . ~ , . Block c........... Lot 1. . Subdivision ..........~-............~.7........Filed Map No. ; : , .-....Lot No. .~'t.;......... . Permit No.~. ~ Date of Permit ~.~f. .A licant . Health Dept. Approval (Z . .................Labor Dept. Approval ~y::2.':................ . Underwriters Approval . . ..Planning Board Approval , , . Request for Temporary Certificate .....................Final Certificate . Q Fee Submitted $ , ~.5.~, fem . Construction on above described building and permitrym-eets a~llryapp~licable codes and regulations. nw. 10~10J0 , Form No. 6 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 17 lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance 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 c~ 1 of 19 q 3 . New Construction.........ff.. Old Or Pre-existing Building.,/ Location of Property...~.4.C), , , Pr i; -rn~~... R.d: ~ ~n.I?" Nt AR: dr House No. Street Hamlet Onwer or Owners of Property... I ~ . aN... ~ ~ N~~ ~Y` a !``~Qk c~/ ....Q County Tax Map No 1000, Section....... ~ :..Block . .............Lot... 1.)............... Subdivision ................Filed Map............Lot...................... ia?:2.~z ~~~.s~ Permit No. .....Date Of Permit ................Applicant............................. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate. FeeSpubmitted: ~ p U . V~dl.'C.o ~~yo(~ ~ ~ APPLICANT THE NEW 1lORK BOARD OF FIRE UNDERWRITERS nn~io pt 111T~j !?fS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 Date JAfd CI}}(l i` !I'{ I)r1 gpplica[ion No. on file f+75~43b ~?4j~')~ ll (h3$3R?)~} THIS CERTIFIES THAT only the electricol equipment as described 6ebu+and introduced by the applicant Homed on the o6ooe opplicotion number in the premises of I>0;1 1'tt;4mATu7:nU, 71, t7 P1219:1`l'bl IrORi7 I~t.CIIiT, RF19T MftJ?I't3~r N.Y. in thefollouing location; ? Basement © lst Fl. ? 2nd F'1. Oll .Section Block Lut uws examined on ~ P1 I i P(P; Hi CZ r 7 ~ 1 9 3 and found to be in compliance widh the.National Edectrical Code. FI%TURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACIES SWITCHES INCANDESCENT FWORESCENi OTHEfl AMT K.W. AMT, K W M1i. KW. AMi K.W. AMT. M.P ~ G I 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EEII UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. OIL H. P. GAS M. P. AMT. NO A. W. G AMT. AMP MAT. AMPS. TRANS. AMT. H. P SYSTEMS pMi. WATTS NO. OF FEET SERVICE DISCONNECT NO.OF $ E R V 1 C E METER NO. OF CC COND. A. W. G, A W G. A W G AMT AMP. ttPE EOUIF 1 ~ 4W 1 p 3W 3 $ ~W 3,e' 4W pER A' OF CC. COND. NO OF HbIFG OF HLIEG NO OF NEUTRALS OF NEVTRAI OTNER APPARATUS: ;imf,v~l~,r~ Iln~;~n ~t z7 rnf~[-, er,seN, 1),q KI7 h, I,. k;, IJV, 111ti7 OENERAI MANAGER 11 Per This certificate must not ba altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 'r~`~°: TEL. 7G5-I Ro?. `~O ~EFUIk~~ 1'O~C~N t.~I' S(~UTIIO~,dl ry~c~,:~ll~, ~ Or("iCli (71' IiUILUiNG ITJSPi:CTOii t~w~t~'~ ~.•+•,~i- '!'OP.TJIIALL ~`ay~/'`~c^~~~,:;` SO[II'IfOLD,N.`:.11971 January 17, 1990 CHESTER ORLOWSKI, BLDR. P.O. BOX 949 CUTCHOGUE, N.Y. 11935 RE: TRATAROS To 471wm This May Concern, Pie are unable r_o complete your Certificate of Occupancy becauae of the following reason:,. /1n application for Certificate of Occupancy ~ .is not nn file. )Io Under•.oriters Certificate on file. The check is (~~telatcd/r#XHCFi~XX1~iC$~CRyC II8395 dated 10/I1/88 i:o !Ic~nlt}t P,ept. Approval an file. PLEASE SIIBMIT NEW CHECK IN THE AMOUNT OF $25.00. t:u final in:.pect:ion has been made. Plenr;e contact our office on this matter. Thank yo,t for your cooperation. auildinr, Permit (1 1 7 2 2 4 2 Dui1Qi"Ci Dr_•pL-. fio I'.lumbcr Solder Certificate on file. ( all permits involving plumbinc7 being ia:-•ucd nftcr April 1,19II4 1 NOTE OUTDATED CHECK RETURNED HEREWITH. I\ r'1ELD it:S:'ECTiUtJ ~~llATE ~ i;OMMLNTS 1 . ~ ~ FOUNDATION (1st) c ~ ti ~ FOUNDATIOIJ (2nd) ~ C7 2, z o fi ROUGH FRAME ~ @~~, -PLUMBING _~D ti y ~ 3. m ItJSULATIOAI PER N. y STATE ENERGY m_ CODE x b Q ~ H 4. FIiJAL z o ADDITIONAL COMMENTS: x m . x~ ~v H ~ 9 y H O m~ a V1 x ro~ • r '-3 s~ - x °I~ d ca -o H _ ~ _ :Srii '~1{yf w, 1A . 1 ~ ~ ~ ~`(ti~`~ ~ Wyk ~p~~ 1 ' l ~F ~ s~ i Y Y F.) ~~AtFi~ ~a s ' Y 4[ r w S n i 11 h. ~ i ~Rq ~'~~~~k' .n , ~ s Ysat$`~ tl p'.4s 'js ~ ~ ,Y ~ t hW'`gtd~. ~i w ~ '~+M1Y tit ip ~`fi ~f~~ i i ti' a Y _ x ( raYF;4 ask (`~sa : i^`~s s{rte {~tvt qF~~j ~ss d;?X~~3~ph t! "h, r Y J, t i r a it x *„h• a ~,yy4 a y "'skd tP 1_ ~ v l~ P d}~ ~ X.~ 1 S'1~y t~Y S ~ t ~Z ~~~4t4 nZlrt a°k• 4'Yty T 'tr cti~~ ~ 0' X* .f.~•~~ ~ .5ti* ~ i°M ~ ~ M1~ 4. ' t k. , Y• ~ x"4s vq y ~ s' ~ ~ a ~FSS ~ r aY! i-.~ i ) 1.Sd i ~d i 'Pn~tt°~~p`.j, ,~P~a u}t tj s^9 i'' ~ eyyT \ v a~~~ e~t$ a aaY ~ ~ a ~ e4 a} ~ .........{:a +{lYs v ~ t{ a SYi 73 ~1~„°sh ixR tc t r ' ,;'sr its x ' ' h MNPf~~TM+'V YXAS\ Fh ~ CI A bt`_ A ms'~' -~-}r t 1S4 L 1 Y ! ~ f'^' ~ } S } _~~';~r~~rs ~ ~ ale ,~.~zg y a 1 tsp zr ~ Nr .a5-t s*° 4 &tii )}/a~'~.Y~ja~j~~{.({J~~e 3~~ ~ vp y7 e"~l 9?x5131 ~ t 4 s I~fi~y iG1~F(/ , X.~I) ~ ~6~S~G~G~h.~I o t z t~ r n a ~ , „ .a, , iM' vxs S fat Q sa,r..,`., Y , ; ,.yt ~i tX tilt a S S Y i' ~ ~ ~ ~i ~f ~ I w t -.r-+~-.,..-r, ~ r t to r M_ ~ pi , y 41 ~ ~ f ~ _ i none. S ..m...... ..e...~ ~ ~ ~ ~ ' p1 a~ . ,^rw~~~ ry~EW4'.. _1 +..+n < . w.. ~ p~ 4 _ _ '1 ~h~ xt ~B~r ' /j - - __..._.__W.._,_. _ _ ,,t,, ~ ~ ~ ' a - :2 .~~~~~it ~ t ~ ~e~ ~ , ~ OCCUPANCY OR USE UN~WFUL ON LEAD CONTENT BE ORE ~~TH®~ J'j' ~'ER~'~~"~~a'~'~ CERTIFICATE OF OCCUPANCY OF OCCUPANCY su °cY svsr M cANivor ~ ~ . EXCEED 2/10 of 1 °6 LEAD. :,r~ r fir, ~~FZ ~ ~.rZ% , TEL. ?C,5-18Q~ Toy rr or sou~og,~ l :.'•'t7~6;;:~~• ~cS OP}'iCE Ot: BUILDING INST'F.CTOR v 'i'~ 4~~G4 ~ 1'.O. [SO}C 1 1 79 ~~~~j ~ TOWN [FALL t- SO[ITIIOLD, N.Y. 1 1971 (?,rte ~ a2~~, l90~ CR.~~w rL~~.o~~, ~i,~.a.o~.~~..t~~. i~9as To L'Ihcm This May Concern, 47e aro unable r.o complete your Certificate of Occupancy because of the follocoiny reasons. An application for Certificate of Occupancy is not nn fi].c. /?I Flo Underwriters Certificate on file. / / 'Phe cbeci: .i:: (rntCdafed/nut on file. ~ Dio Ik:a].th Dept. Approval on file. t`:o final insi~ect:ion has been made. Please r_ontact: ouz office on this matter. Thank you for your cooperation. l:uilc]ing Permit: it ~ :Z ~ ~ 2 lluildinq Wept. tlo I'lt;mber Solder Certificate on file. ( n].1 permits involving plumbing being issued aft.cr April 1,1984 ) INSPECTORS Victor Lessard ~~~Jl"Fll~~-`y Principal Building Inspector ~ 'J Curtis Horton N~~° SCOTT L. HARRIS, Supervisor Senior Building Inspector r•~ , :n ~ ~ r'" < < ~ Southold Town Hall Thomas Fisher w ~-t~, r+r P.O. Box 1179, 53095 Main Road Building Inspector ,i r~i, , u „ } Southold, New York 11971 Gary Fish ~ `.73 :j~d-~ Fax (516) 765-1823 Building Inspector Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD December 2, 1993 Mr. Costa Trataros 29 Milden Ave. Staten Island, N.Y. 10312 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) %xx No Underwriters Certificate on file. xxx The check is (~-/not on file.)$25.00 FOR EACH CO OR $50.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # BPI/ 172242 ~ 172562 Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 2."' a ~«ve3n.•`a~eLESffi161~3~:,~x INSPECTORS Principal Building Inspector O~~SUffO(k~oo Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector y = Southold Town Hall Thomas Fisher v- P.O. Box 1179, 53095 Main Road Building Inspector ~ • ~ y Southold, New York 11971 Building Fspector ~~l ~ Fax (516) 765-1823 Vincent R. Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD October 25, 1993 Richard Ward 1500 Lakeland Ave. Bohemia, N.Y. 11716 Re: TRATAROS To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is not on file $50.00 (2 CO's at $25.00 each.) No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # BP #172242 & 172562 Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 7651802 ~ BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. ()FOUNDATION 2ND (]INSULATION [ ]FRAMING [ FINAL REMARKS: _ C e. DATE I3 ~ INSPECTOR 17zYy 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ] F UNDATION 2ND INSULATION [ FRAMING [ ]FINAL REMARKS: ~.~,P U"/L-• r DATE d" ll~ INSPECTOR ~ ~_E 'r;~a ~~..a 1f'Tr~~y/ ~ BOARD OF HEALTH '-=?_4~!..L=~~"-' `-~~r~ 3 SETS OF P ANS .O,•K•• _ . FORM N0. 1 SURVEY ...O:..... . 19$$ ~ TOWN OF SOUTHOLD CHECK •~~5 • • - 4.{, BUILDING DEPARTMENT SEPTIC FORM ,I W..._,..„„„.,.~ ~ TOWN HALL pLi3~Ci. UC''. i NOTIFY 7C1lr~rh~ d.;t= SOUfPIt`rLt' i vOUTHOLD, N.Y. 11971 CALL r,.....~.....~.r_.__.._..._._. TEL.: 765.1802 - ,,~~1~ MAIL T0: Examined . 19 Q~~{~ Approved !/./..e........., 190.7/ Permit No. ~.7.°~..~~~ , / o.~. ` Disapproved a/c ~/~/~D " (Burg nspector) ~ • . - APPLICATION FOFI BUILDING PERPAIT /j . ` Date ~~..`.5....., 19~iy1 INSTRUCTIONS . e r.,. 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~whateve~until, a Certiftcate.of occupancy shall have been granted by the Building Inspector. ~ • APPLICATION IS HEREBY MADE to the Building Department for the issuahci; 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 cans, mctian, o,_ ,;~~tildings, additions or alterations, or for removal or demolition, as herein described. The applicant agre~'~~b`"comply vitf all' applicable laws, ordinances, building code, housing code, and regulations, and to admit authofized, iltsp~ctars+on pz~ldses.and~lr' building for necessary ins ec~'ons. x~•. ~ ? i~:~g, `~f;=-_~ • ~ ~ ~ (Signature of applicant, or name, if a corporation) a '•.9 'la b~g€ ''t r1 s;•=«,1t~x#+a~i~~3 §1r +l~d:e=?.•+~~ a= r (Mailing address of applicant) State ,w~fh/e~th~@$'t"~'p'j~liea`~~''i§^tOeL~~ieP,'Iles'see; 'agent, architect, engineer, general contractor, electrician, plumber or builder. - r..q ,rs Name of owe}' ~f ateIT~,ices r: . - ~ ~~~--5..~!~•~! . Yzi~0`~A# ~x4~~• _ ~ Ll; " (as on the tax roll or latest deed) If applicant is+a~o~Ipb:E9~tiS'si;lsi~fiat~Sr'0 `of duly'authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. ~ 3 . . ~ ~ Plumber's License No. . Ste.. Electrician's License No. /.L ~ ' ` ' Other Trade's License No . . A 1. Location of land on which pro osed'~~,~ork wil e done. House Number Stre Hamlet County Tax Map No. 1000 Section ...a . ~ Block Lot~~~~. 1 . 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 C~i ? .~y-~' ~ p t jI , Q ~ ~p~,,~ - p b. Intended use and occupancy •U • •~`~'.GY• • •-i`"•'• ,r~"`•'~•/~'1?~'S !n' ! 3. Nature of work (check which applicable): New Building Addition > Alteration . Repair Ren}oval , Demolition L Other Work . Fee .I (•Di~ripSion) . . 4. Estimated Cost t~'.~..t.l'~~ ~I....~5..p ; . (to be paid on filing this application) 5. If.dwelling, number of dwellinh+ units welling units on each floor . If arage, number of cars , , , , ,p , Y, p Y Number of d g d occu anc s ec~f nature and exten~ 6. If business commercial or mix ' ar Depth . 7. Dimensions of existing structures, if any: Front Re' of each type of use . Height Nurhber of Stories , . Dimensions'of same structure ~yith alterations or additions: Front L . . Rear . De th ......................Haight Number of Stories , . p ruction: Front Rea# ...............Depth . 9. Size of lot: )~'ront , , , .t.~N~~ber of Stories i................... ~ . 8. Dimensrons of entire new consti, ~ ~ Rear . . . . . . . . De th ~'•f................. . 10. Date of Purchase ..a,.p~. S"r/, ~ ,g', , , , , , , , , ,Name of Form~~r Owner ,Q.~.c,tse~'x,-. •~!K<G.' . 11. Zone or use district in whic ~,emises are situated R„tp.sQo.~,.Sl. ..................................t 12. Does proposed construction v'olate an zonindinance or re ul~ tion: - • I • • • • • y g...... • g be removed from premises: Yes No , 14. Nama ofOwner o fpremises ~ ~ Addressxcess fil^............ Phone No.. n . Name of Architect ::.....::Address I, Phone No............... . Name of Contractor ~_,Q,.s~:~?'~-`n~-'~.'. 15. Is this ro ert located' ~ " Address ..Dnr~?-, t~?;'~>. Phone No.~3.Y.-.4 .'1.$Z . p p y within 300 feet of a tidal wet~andl *Yes No *If yes, Southold Town Tr~stees Permit ma be re uired. PLOyI' DIAGRAM it 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 dead, and show street names and indicate whether interior or corner lot. 'i i . . e I t~ J r AP ROVED A8 Nf/IED ~ SEE ~ B G bEPA TAT 788 1Bg2 8 AM TO 4 PM F THE ' ° ' ~ FOL N© MISFECTIONS: 1. FOUNDATION TWO REOIJIRiD F~R POURED CQNCRETE 2. ROUf3H - FRAMrNfi IA Md1MBIN0 8. INSULATION 4. FjNAL - CQN~TRU~TION MUST 9~ CAMW,EYE F~1R C.O. ALL CONST(II,~CTIQN BHA1U. MEET THE RE(1lNREMENTB OP THE iN.Y. STA1~E CONSTRUCTON i lBIEI10Y CODES. NOP RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.S COUNTY OnnF ~4h~~~!v ..~-!~+SJ.+NS~,d being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named./ ~ i He is 'the.... l........ ~ ` (Contractor, agent, corporate o ' ~fficer, etc.) of said owner of owners, and is duly authortze'd to perform or have perfp~Xtned the said work and to make and file this application; that all statements contained in this application are true to th~best of his knowledge and belief; and that the work will~be'perfomned in the manner set fgrth in the application filed there ith. Sworn to before me this ! i ......................day of.....~~s~.........,19 i~ ~ ...,~/.~-4 :.00,r./~'. Count ~ Notary Public, ......!V!e~,µ/. ,Y( H/ U Y _ I ~ HELEN K DEVON ~ (Signature of applicant) NOTARVPUBWC, State of New Kork 1Jo. 4707878, SuNolk Coun I _ Term Expires March 80,1 i f t ..rv r 1 ;.t { iFl S,. ~ il3 s i+ eie s4, x , 'Y§t~4 . r ~M1W J' ~ f ,q^ a "~Y !t ,Y µr~, iF' l.r~ 1~~Y r t 1.~. _ , f t'# r' ri•:, r~T' 'gµ. 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Fit r'~L~ ~ ~ $UF ~ IC ES~' : DEPT OF F11~~1y~3 ~ i - - ~af..: ` Q ~ ~y1J tii, ° ~ rd ~ ~ E, ~L~iG,a4MT . ~ t h ~ _ \ ~ :'if~ 1, f~~{J ~ /I i I , ~ "~'i ~ ~ ti ~ _ ~ ~ih ~ obi ~~t ~ SUFFOLK CspUNTr DEPT: O~' rh t! ~ ~ ! ~ ~ ~ ~~:~`Att,, ~ ~ ~ Tom. ~ I SE:RVttES.- FOR APPRO~d ~t~r s,. ~y~ 1 ~ 'e 3 z' ~ P CONSTRUCTION ~ ',ti Q ,F m . ~ 6 ~ Qom. ~ ~ ~~U.'.. ,rsr_ ~G 'V DATE: ~r ~N t$~• a, r y'h F s~y~ Via/ Kt'1, H. S. REF.NO.:,~'1-,5~~ r, ~:n { • r\ y ,~Li ° ` q¢" ~~`fiG t~Sp~~ ~ APRROVED: < , Y. ~ ~ y r ~ t ~n~ - •SUFFOLYC CO. T}19C NIAP, 5 ~ .:L, s. ~ 'tP ` 1a~.~ t ~ t~/. 1 DtS7. SECT. Bk.49CK s y r yq';., a ~ ~ n ~ °o,,` OWNERS Af)DRESS # ~ , 't Y S A ' : ` ~ ~ ~ i - _ -.x[+44 3C ,r r L; x i r ~ o~ED: c. 625~If~ p. ':r, 4 'y~' 5~ Cr Y#' It : '`f ~1 . Sz j - ~ n t is s_irie-y a+glat7ar~A~ ,r tT. ~ A•~ ~ ~ ~ ~ ion 12:1801 tAe"t~~W 'T y ~ r. (y 4 tt : N lOQrtf y ~cn~s~ MS ~vrvey neil)e#rtq~w 3 "1~2 ~~(J' ~ t ~ Q - _ ~`/S i/47~70 rtS .Y~°~Enr if"c ~rflBflr SC.: ~rr?i~e:~. 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