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HomeMy WebLinkAbout17071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Auilding Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18022 Date MAY 10, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 4324 ROW OFF WESTPHALIA RD. MATTITUCK, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 09 Lot 10.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 20, 1988 pursuant to which Building Permit No. 17071-Z dated JUNE 7, 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_GARAGE & ATTACHED WOOD DECK The certificate is issued to CHARLES BERNER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 85-SO-121-MAY 3, 1984 CERTIFICATE NO. H-008451 - NARCH 16 „ 1989 PLUMBERS CERTIFICATION DATED FEBRUARY 16, 1989 - CHAS. BERNER Buildinq Inspector Rev. 1/81 gosns xo. a TOWN OF 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 fl ~ 1 ~ ~ 71 Z Date ......~.~r!!~lA+.. ~ ...................... 19. ~ 0 Permission is hereby granted(1to~• /n _. { ~ ~ ~ ~~ " ..~. ~..~..., ~.7 ~ . ..................................... ...... -y-~--, to ....................................Q::....4~^:3.5...~ ... 1.~...~....~-4~.....t~~V !!!!lIJJJJJ ~ ~ U ' ~„~.~/5/SS L~ , ... ....11.,, .................................. ct premises located at ..~~~..7......~:.°.: W.:.....~~......I,N:...K:9!:. ~.~.... Caunty Tax Map No. 1000 Section .......I.+/..~......... Block .......Q.°.~....... Lot No.....~.~.:.L....... pursuont to npplication dated Building Inspector. Fee $...6~rrll~:. $.~... ........~..~ V ................ 19.~.R., and approved by the wilding Inspector Rev. 6/30/80 Fosni xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nt' 1455'7 Z Date ~~.~~-~,... s~ ............... ~9.~.4 ..................... Permission is hereby granted to: .....CR«-~.G~...~ : .................. ....`~~.. a. x...:.? ~..d .............................................. .............u ~~,~...: ~ .....,.c.s.s. ~....... .r~.~.~.~,` ..................................... ........................................... ...... ~ ( ' I 1-~ (~ p~ ...... of premises I«oted at ...7..3•.L`'I`......Z.:..°...,W ~....~~.....~4'°~,R~hatL~.alt...^"`f...........4iMeGN!*`+4 County Tax Mop No. 1000 Section ......I.I..ti~.......... BI«k .. .....Q9........ Lot No. ....~.pl.~':"..... pursuant to application dated ~ Q:)^!`~'`'.~:~.. ..~••••••• .. ........... 19~.~., and approved by the Building Inspector. Fee ~..~.1,'.'.~ r. ~. 1,... fit. G~ ..... ........................................................ Building Inspector Rev. 6/30/80 ,' TOWN OF SOUTHOLD tl,wl ~y U ~; eJ ~Y( ~ '~ BUILDING DEPARTMENT ~i~~~u]]~~{{~jJjJ y~ IL, TOWN HALL ~ ~`~ I~ ..~ ~. SOIITHOLD, NEW YORK 1197 BLDCv. OcP T. 765 - 1802 T(D1NPfOFSOttf!nLtD4,F,,~ APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE.S..'~- -•-••---• NEW CONSTRUCTION ~ ...OLD OR PRE-ERISTING BUILDING......VACANT LAND........ y32?~ wcsrp wu~4 ~zc~ , t I _ Location o£ Property... ........ ~ ......1:^!q'TT.I,TU-UG_ _ , _ _ . HOUSE N0. ~° pS~~TREET HAMLET Owner or Owners of Property..."~('tc~}R;Lt=~..!~2C2NL2________________________ County Tax Map No. 1000 Section .~~3.. Block Q l.... Lot ~ ~: ~ ... Subdivision ....................... Filed Map ........LoC.......... Permit No. ~.7d.~7.C .Date of Permit 6.~ 7~$~.Applicant:~"~p'~Z!-~~.~C2h1~:2,.. Health Dept. Approval .................. Underwriters Approval.............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate .. ~......... Pee Submitted: $.. ~~ ~ °~ ~ "~~ ................ APPLICANT..`-1t~~~?!4!~?Q:`.~~ ~~ ............. ~ec~ 3713 Ct~ ~- IBD~a rev. 10/14/88 ,;~~:~ -. THE NEW YORK BOARD OF FIRE UNDERWRITERS r'elsaa. ;; BUREAU OF ELECTRICITY 65 JOHN STREET, NEW YORK, NEW YORK 10038 Date IQr3I?(„„,il Ifn.)': I; c, APPlication No. on file 9`r f.ft~`I~/7A1 fi to t~NQj{~ THIS CERTIFIES THAT only [he electrical equipment as deacrihed below and introduced 6y the applicant named on the shove application numher in the premises of CHFlRLi-7: 1:liitlit'14, 61F;S fi'iliai_ t. i1 .'#~, a » t'!lLE ~ba; i , fll'I S i d !"UiJK, 'sd. }. ~l i~1 ~ 11i'(T X G in thefollowinq location; 0 Basement ~ /st FL ~ 2nd F't. .Section Block Lot i9ia,ti;;i 1 e, I `i ', wws examined on arzd found to 6e in cornpliann with the requirements q(this Bmrd. FI%TURE ECEPTACLES SWITCHES FIXTURES RA NGES COOKING DECKS OVENS DI'iH W ASHERS EXHAUST FANS ~ OUTLETS INCANDESCENT FIUORESCENi OTHER PMi K W. AMi. K.W. AMT. K.W AMi. K W AMi N.P. ;ri .J~ :,o. 1 ~), f. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS RELL UNIT HEATERS MULTI.OUTLET DIMMERS PMT K. W. OIL H. P GAt H. P. AMT. NO. A W. G. AMi AMP AMT AMPS TRANS pMi H P SYSTEMS . . . . , NO.OF FEET pMi. WATTS SERVICE DISCONNECT NO.OF S E R V 1 METER C E AMi. AMP. TYPE EQUIP. 1.9' ]W 1 q 3W J 9 3W 3,a' 4W NO OF CC COND PER 9 A W. G. NO OF HIAEG A. W. G NO Of NEUTRALS A. W. G OF CG COND. OF HbLEG OF NEVTRAI i .: till I'i~ 1 i ' ~j ` 7 ,f ; tY ~.ttfi6;k 114 it.!:it1Pe f. 4,fiN7ti~.6 Hfi'FiPdhR 41P'EI'IFF;flI. JA fiUl;ll f5H I`i'i jUl..hT N{, I1'i 5:) This certificate must not be altered in any manner; return to the office of the Board if incorrect COPY FOR BUILDING DEPARTMENT. YNIS COPY OF CERTIFICATE MUST BE GENERAL MANAGlR k~ be identified by their credentials. ,~'~~EFnCl~col T®~rN car s~~t~s~r~a,~a ~.° ~~ ~ OFFICE. OF I3IIILDIidG IhISPECTOIt o ";, rn P.O. BOX 728 u ~ '' ~ TOWN BALL "4 ~ ~ " `~ SOiJTHOLll, hT.Y. 11971 ~,,y01 ~ ,~.~'~ C E R T I F I C A T I O N Building Permit No. / q0 7/ Owner_ ~ hfµ-r2Ltr 3 ~ E2Ntr2 (please print) Plumber C.µpi2.LL-"'S ~c=R-Ncr2 (please print-) TEL. 765-1802 Date Z - ~G r 8 I certify that the solder used in the water supply system contains less than 2/10 of to lead. Sworn to before me this ~' ~_day of ~ p .P.~_' 19~. Notary Public, !County (plumber's signature) GZ-~..«~C~~ -,cxM Notary Public __-._ Fri, r,efi_r,e rr:cw NG~ ""'. r~UL3 Li^, S'a(~ of New VOt~ :: ~, ri2 ;t3(?fl036 Q 'liii~4 ~ 4u}Polk COOOt% Q/~ Commieswi [xp~; e.. Uccrmbet 31, 19„/-y,~ •~~lti~~~~~~i~-~ f i y ~k-Y~ ---- - - - ---- --- -- - - ,~-- ---- ~ ~d'-~-~ .~~ -~ -tea ~ - - - -- - ~ ~' ~ ~ .~_ d~~a ~f -- -- ~ ~- -- - _ - -- ~ ,~~ - -- - - 3 VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (S 16) 765-1802 FAX (516) 765-1623 (`~ ~~iF4~C;~~~~ ~. ~~ ~ ~~+~_.' ®~~~.! cep ~`~'~~> OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD April 11, 1989 CHARLES BERNER ' P.0. BO% 870 MATTITUCR,N.Y. 11952 +~ Dear Mr. Berner: I am writing to you regarding your application for a Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Certificate of Occupancy. The survey you submitted does not have the Board of Health stamp in green. In order to do the c.o. please send us a survey with the green approval of the Board of Health. Thank you. I am returning your survey. =„~n,,,K,., .. ~-. , , .... ~ vY~o~urs truly. ~ / ~e~ n/ ~~ (/fG--- Enc. Secretary +il~ b'' S~~ f 01..~{~C~~ u :~ F' y44 ~ G~ R' ~ ~~Jd;l~~~ rn T0~'N OI' SOUTIIOI,I~ OPPiCI? OF PiUILDING INSPECTOR ['.0. [lOX 1 1 7 9 TOWN IfALL SOIJTIIOLD, N.Y. 1 1971 March 21, 1989 CHARLES BERNER BOX 870 MATTITUCK, NEW YORK 1]952 'Po plhcm This, May Concern, •; 4.e are unable r.o complete your Certificate of occunanc,~ because of the follocving reasons. TEL.'C,S-180_' An application for Certificate of Occupancy is not on fil.c. (ENCLOSED) /X/ `IO Underwriters Certificate on file. /~(/ 'i'he chec}: .i:: fX~~k3~~iklnat on file.) $25.00 /X/ No ]]ca].th Dept. i\pproval on file. /_/ No final inspect:ion has been made. Please r_ontact: our office on this matter. Taank you for your cooperation. Iluildir:g Pcrm.Lt-. Q I 7 0 7 I Z Builclinq Dcpt. '""'/x/ t1o Plumber :;older: Certiificatc on L-ile. ( a7.1 permits involving plumbing briny icsucd after ,1pri.l 1,1984 ) ~o~~~F01~~~~~ k?~ y j VICTOR LESSARD ~ 'e" :, rn EXECUTIVE ADMINISTRATOR y`~~ '._ ~ (516) 765.1802 ~~~/ '~ .~~V~,~ ~~od =~ ~,,~'` OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD Mr. Charles Berner, Jr. P.O. Box 870 Mattituck, N.Y. 11952 April 5, 1988 Re: Building Permit /I14557Z Suffolk County Tax ~I1000-113-9-10.2 Dear Mr. Berner: Town Hall, 53095 Main Road P.O. Box 1179 - Southold, New York 11971 It has come to our attention that the above Building Permit has expired. You must have a final inspection by the building depart- ment to get your Certificate of Occupancy. You must have a Certificate of Occupancy before legally occupying your res- idence. If you are not ready for a final inspection you must renew your permit immediately. Thank you for your cooperation in clearing up this matter. VRW:hdv Sincerely yours, ~U~ ~- ~ UL Vincent R. Wieczorek Building Inspector ,LD INSPECTION llATE COMMENTS :. t 5.. ~, ~' i. OUNDATIO ~ (1st) ti F °Z s, ~ ~ ~ ~' ~G ~'r~ ~ ~ L FOUNDATION (2nd) ' ROUGH FRAME & ~/ ~)~~ ~'~~ ~~/~~ L F PLUMBING C Ddi/i 9VC/fi ~~ ~Lvr~i .~ C ~!~ ~ ~T e~~ /~ ~ ~GitJ R~jOcii f`/P~'~~~1C~ z 3. ~ /~'/~ (/~RJT ~ ~ ~ H INSULATION PER N. Y. ~ ! S"~~ ~ %l~~,~~ fi STATE ENERGY c~-// ~ ~ 'r G/ eY l3 , CODE ~ ~ ~ ~ .c~~..P2. s~-,.-a.u. m y ' ~+. J // (O ~P ~ . ~^ / F I N kL ,~~ ~ k 3 -~-~- 3 - ~~~ °,ou1` ~ ~... ~ I 2 ~ ~ ~ ADD T ONAL COMMENTS: ~' S ~ { ~ J _ 1 ` ~~ • x~oo~N. r-~ ~I '~s~ QP {~? x ~ Cq V, Y ~ y U1 x o o C" F' ro H V ~ ~ ~ ~ rss-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PI.BG. [)FOUNDATION 2ND [ ] 1 SULATION [ ]FRAMING U FINA4 [) DATE C~ ~~ ~ INSPECTOR . 1 `~`~~7~` ass-isoz BUILDING DEPT. tNSPECTtAN [ ]FOUNDATION 1ST [ ] RO GH PLBG. FOUNDATION 2ND [ INSULATION [] [ ]FRAMING [ ]FINAL REMARKS: "`z~ ~~`~` ~~~''`pL' n ..~I .~ n DATE ~ INSPECTOR ~~~~~ .- 765.1802 C/.1~- ~.-GUU./~ BUILDING DEPT. i3~-c-~ w ~~ ~3~ INSPECTION ~LG~~~, ~N~' [ ]FOUNDATION 1ST [ ]ROUGH PLBC. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: 7~ ~ ~• `fir {/ ~ ~.-val . QJGxx ~,9n/ aar--~ i ~.ir,~ DATE 1` ` ~ INSPECTOR ~~~~~ 7~-1802 BUILDING DEPT. ~~~•~ [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING REMARKS e ] FINAL DATE ~~/~~ INSPECTOR ~~~~d x .ti: ~ -. _,ti_ .' T6S-18Q2 BUI4DING DEPT. INSt~ECTI [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [FOUNDATION 2ND [ ] IN5U4ATION [ ] FRAMINGi [) FINA4 r^ REMARKS: ~ ~ ~ v~" .~~:'G"aN~ ~t/R !i!= ~ /C ~- ~ f~ T~ f Cs 12.E t= ~ c r ~ ~~ DATE ___~~~~ INSPECTOR ~ ~ ~~'z~ ~' GG~ P ~~ ~ ~~ c ~ 765-1802 ~ T` BUILDINGi DEPT. °'~ , INSPECTION ;ate ~~~ ~~ ~ NDATION 1ST [ ]ROUGH PLaG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMIN~ [ ~] FINAL REMARKS: re,`' ~-~-c-~~. ~.~.vo G~e//9s-r~~ ~~` ~W ~--~s~ I o' ~uTSrdi DATE ~~ ~ ~~ INSPECTOR ~P~~j~d . a _~ 3, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...; ..... . Repair .............. Removal .............. Demolition ..............Other Work .............. . (Descniptiori) 1. Estimated Cost .......y0.~ .Q6 t? .. . ..... . ........... Fee ................................ , .... . ` (to be paid on filing this application) ~. If dwelling, number of dwelling units .. ~. , ~t?//.L~,4 ~ Number of dwelling units on each floor ............... . If garage, number of cars ...._....... ~ .......................................................... . +. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... . ;t Dimensions of existing structures, if any: Front ............ -'- '" " ... Rear .............. Depth......... Height .............::'Number of Stories . .....-::.................................. .. .. . Dimensions of same structure-with-elterafions or additions: Front ...... , . __,_ _.._ Rear . ............. . ---- Depth .........::...........Height ........~ .............Number of Stories-:': -:-: ,,.,,,............ . Dimensions of entke new construction: Front ... S Z.~...... Rear . , s; ,2,! , , , , , , ,Depth . •J: B. ~ ....... Height .... ~,~........ Number of Stories ..... ~...... ~ . ~. s?~ ;r ~ ~~ Wiz, ). , . , , , ... ,~ Size of lot: Front . . / ©i~ . ..... Rear ... , llA ........... .. Depth ~n4~: .... .......... . Date of Purchase . , ...y :' ?.~ :.~ ~...... , .....Name of Former Owner ..... . ...................... . Zone or use district in which premises are situated .................. . ................................. . Does proposed construction violate any zoning law, ordinance or regulation: ~~ i .it ...~~P.xlr;~.. `7 tw~~3,~~.,y ~ ~ , Will lot be regraded ............................Will excess fill be removed from premises: Yes No Name of Owner of premises .C= N.R~H.w'ti ,~i .4K,yL-,Z, Address Po r3a:,..97, ~ , t~h1,77":Tucic phone No. 49.fl , Ss, ~;>; , , , , ~ Name of Architect .G.~?e/t~Yr-... ~77~~t~4G...... Address .5.o4~il,or.,~ . , ......Phone No. 7.45. i~ ~!$`,~ . , Name of Contractor ..........................Address ........... J.`.(~...... Phone No............ , .. . PLOT DIAGRAM Ca l?U u'`" ~"ni ~~~?~ Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from >perty lines. Give street and block number or description according to deed, and show street names and indicate whether erior or corner lot. ,y r~ ~. `~~~ v y~' v ~. ,~ c I ~ o \ N r I~ \' ~st -_ "~ ~'3~ ~/ .AYr~. F-. GAaer3r 1 r u~ N (<r APR 4 3 4~4s~ Examined . FORM NO. 1 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ...... .. 3 SETS OF PLANS ..... .Y SURVEY .......... CHECK -•--...... SEPTIC FORM -------------: NOTIFY CALL MAIL ................ T0: Approved ................. 19 ... Permit No........... . Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 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 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 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 ins ec ns. `` .....~~.f/ .................. (Signature of applicant, or name, if a corporation) ......~a ~OX 8~.0..~~-:7.7.?Trc~~C..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. ..........~ ~K ~.c.t2- .......................................................................... Name of owner of premises .....~/ff9/?e.c~~..~.t=~L/vc~~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . ........................ . • Plumber's License No . ....................... . ...................... Electrician's License No. G `"' `" ° r~ c Other Trade's License No . .................... . ] . Location o99f la'n/d on which proposed work will be~/d{(-one/. ~ ...............~.1................................. . ..... yOG~~....... ~y`f /fF~.. J2A. ...~'. `. ..Y. L`~i ..L~...IZV........../.~.~... T.T{-~. ~C ....... .. House Number Street Hamlet County Tax Map No. 1000 Section .... ~ ~.3.......... Block ... f? % ........... Lot ...~ ~.- ~ ........ . Subdivision ..................................... Filed Map No. .............. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: v a. Existing use and occupancy ...../.!V ~Q.ws ~? ~ 4-~r=:.....~.w. ;e Lc.~.ti'.G~..,::' ....................... . b. Intended use and occupancy ......P ~~. ~.~?f/•~%. ~'~/..... ~ +~ ~ `~- ~ ~ ......................... ~~: 3. 'Nature of work (check which applicable): New Building .......... Addition .......... Alteration .:`....': ~.. . Re air Remov - p ' ' .............. al ..... , ........ Demolition ........... , .. Other Work .............. . ', (Description) 4. Estimated Cost ..............'........................ Fee................~.1,................... ` (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... . . .... Number of dwelling units on each floor ............... . If garage, number of cars ......! ........................... . 6, If busingss, commercial or mixed ,occupancy, specify nature and extent of each type of use .................... . 7, Dimensions of existing structures; if any: Front ...............Rear .............. Depth .............. . Height ...............NumlierofStories........................................................ .Dimensions of same structure with alterations or additions: Front ................. Rear ................. . Depth ....................... Height ......................Number of Stories ..................... . &. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. . Height ...............NumberofStories........................................................ 9. Size of lot: Front ............'~ .......... Rear ...................... Depth .. , .................. . 10. Date of Purchase ............. .............. . ..Name of Former Owner ............ • , .............. . 1 I. 'Zone or use district in which preri~ises are situated ........................ . ... . ....................... . 12. Does proposed construction violate any zoning law, ordinance or regulation : ............................... . 13. Will lot be regraded ...... .............Will excess fill be removed from premises: Yes No ] 4. Name of Owner of premises ....,I ................Address .................. ,Phone No............... . Name of Architect ' ................Address ...................Phone No............... . Narne of Contractor ..........' ................Address ....:............. ,Phone No............... . 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit ma be re uired. I PLOXI' DIAGRAM 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 deed, and show street names and indicate whether interior or corner lot. ~~ i STATE OF NEW YORK, S.S liOliNTY OF ................ . • • • . • • • • • • • • • • ~ • • ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe ..................... I ................................... .. ........................... (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 contained in this application are true to the best of his knowledge and belief; and that the work wfll be performed in the mannerjset forth in the application filed therewith. Sworn 'to before me this - ...............~3.1l~~~~...day of; ,/.~..G~f~a!?/-<~:........, 19~~ Notary Public, .....f~~:~r~!.~j ~!~j/v/'~.... County ~~~ ~, ~n' ,,' ,, NELENRDEVOE ... ~c) :~C ; :'::~.:~:Y° :: :.................... NOTARY PU8U0, State of New YaAc No.470787A, Su9latk County~q (Signature of applicant) Term Expires Mareh 30,19~1t./ --~---~-~"'..a , a' F . ..,~,~. ~~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined'... a-~ ., 19~.W?. Approved ~~~ 4?:`~ .., 19~.~4 . Permit No........... . Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT l Date .....I./ , .g........, 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 adjoining premises or public streets or azeas, 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 pazt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION TS 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, buil g code, housing code, and regulations, and to admi# authorized inspectors on premises and in building for necessary insp c ions. ~a. (Signature of applicant, or name, if a corporation) c (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... p v~rx~(C ........................................................................... Name of owner of premises ...~.Hr'h1Z,t,~f-+.. I~c?I~ErJ.4f>r ................................................ . (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.'s ....................... ~t\. /~~ ~~ l~c TZ~fd.~~,~rt; l~ .... / Electrician's License No. / .................. 1 Other Trade's License No . ....................: ~ 1'. Location of land on which proposed work will be done . ................................................ . House Number Street Hamlet County Tax Map No. 1000 Section ...../. ~ ~ ......... Block .....C`~`.~ .......:.. Lot ..../.O.m'Z., ........ . 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 ......~4 ~1=, ....Y/~c(.~ t~C~.. 1-1`4 (J ............................... . b. Intended use and occupancy ....1~..~~•+`1!`kP! ~N7:.....-t,~.?^^'. L.~4 ~ t-(.~ ... . ............................ Received...........,19... ~~,,~.. ~~;K~. f ~ V ,~.. ~f-S ~~ ~.. ~ _ i,, . - ~ ',, 3. Nature of work (check which applicable): New Building ..../..... Addition ...! ....... Alteration .. i ...... . Repair .............. Removal .............. Demolition ............ ..Other Work .............. . . Fee ...........I',. .............. (Description) . . 4. Estimated Cost .......!7.'O., .QaO ................... . t`to be paid on filing this application) g g 5 If darallennumber of cars ellin .units .. ~; ~ FF? M.r 4 j/ Number of dwelling units on each floor ............... . ... g g •• ....... ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... . Dimensions of existing structures, if any: Front ............... Rear ...... Depth .............. . _..__. Height ..............:'Numberof-Stones _~_:-:......_.' ......... .............. Dimensions of same structure wath-alterations or additions: Front-:-, .-. _ , .__,, ... , p _~ _-- ~ ........ LZ .... Rear ..........:...... . De th .• .........:....~....... Hei t ...........r.. Number of I t-~ones':.T.,~...... . a ...... 8. Dimensions of entire new construction: Front ....~ Z........ Rear .. S, , , ,! , , , , , , De th r~8. ~ ....... '. . . Height .... ~~ ~ ...... Number of Stories ......?..... , . C, 5~~ ;r 1.,~~~z!~, , , „ , . , 9. Size of lot: Front . . (d~ ~. ... Rear .... l ~p ~ ............. Depth C24~~ . Z0. Date of Purchase ......`?. -. 2 3 ~.~~............ Name of Former Owner ....... . 11. Zone or use district in which premises are situated ................ . . ..... .~' 12. Does proposed construction violate any zoning law, ordinance or regulation: ~VT.I{ ,', ,~Lp,~gr;t„ ~ tN~~.~~1`f r2 T" 13. Will lot be regraded .................. .........Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .~ N.A&!-.4~i .~.~K.Mea~. Address PoF3ax,$24 . M1~7'F:TUCfc phone No. Z.`r.$ . 5S~,s:... . Name of Architect .G.s}2~2~TT...~7'R~rtt~4G...... Address . S.oo'r6ot.;a ....:...Phone No. 265. ,S4,S5; , , Name of Contractor ..........................Address ...........nr..:I ...Phone No............... . X91-1-c c;c ti1o, .3(~ 9 G l A3 PLOT DIAGRAM ~' Locate cleazly 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 deed, and show street names and indicate whether interior or corner lot. ~l N' 1 0` G~' ~ E2AL1~ l.4 `LZ~L ~Q t r `\I J{ E ~ v k (,oo i~,roposr;a ~- 8 i ___._-- o z n~ 1 STATE OF NEW YORK, S.S COUNTY OF ... ~.`!~I~N4.... . ~v1.1 L~12.CW tJlgL ~/IIXi ~~~, 4> 1~2E6a -~ S n ~>D ~ry ~`6 ` ros~~~.,,~ ~.~~~~rZ " _ °' U, ~ic.K o N u r -: ~ (Name of individual signing•contract) • ° ' ' ' • being duly sworn, deposles and says that he is the applicant auove named. He is the ........................................................... .......................... (Contractor, agent, corporate officer, etc.) I 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ y .~ o '~ 19 ~L } 1t~~p Ut: ~c?!ta..3v~i ~." ;ti ~ ~~ Votary Public, ....... I~~-~?~'.. l(.:. R!~ /~ , c ~ .»~...a..n,. , . County ~ ~ ; N07MY Nw1Mk ~.. ~ ~' ~.»- _...(~,jgnature.of~~pPl{jJicant) ~y~y~~ A 1 ~`A.Y `tiM Tire 1~.,~'L,/ ' '' •' ~ "~ (,~'%~~..~}.~t!.,~' .?:'.~ ;W °E fOTm~~ew ,~ ~°\9°~°~r. nav+ @~ A~d~ ~~dtev15< ,-~ mv. sh`d 'lest HOLE -__~ 0.0 vfr _ a. n SAND A GRAVEL 17 0 O O \i Y / Apo .~p~~I 0 v~ G C (Ti 0 O J0~£' N 68 '', ?29U ~-e--- w~s r~N~~ A q vc.. N ':'"^I" ~'~UNTY OCPARIMENT OF HEALTH SE"'?'"?:S fOR APPROVAL Of CONSTRUCT:" ~~ Single Family Residence ; . ~' TE _~. c~~ HST. NO tit ~ROVEo ~HEAl7H DEPARTMENT-DATA FUR APPRUVAL STRUCT ~ N NEARElT WATLII~ gAIN.~NI Y N SOURCE OF WATER: IHIIMTE / PUBLIC _.. M lUFf CO. TA% NA- DIfT ~SLQ SECTION _~, EXACK .,Q~ LOT .jQ,2_ I NTM[RE ARC NO •DWEl LIN9S WITHIN 100 FEET OF THIS PROPERTY OTHER THAN TNOlE 4NOWN NCREON, N THE WATER fUPPIY AND lEWAGC DIfPOlAL 3Y37Cq FOR THIS RClI OE NCE WILL CONFORq TO TN[ 9TAN DAROf OF (H( lWFOLK COUNTY DLPARTNCNT .OF N[AL TN fERVICEf. APPLICAMT~ AOOREYS NOTF_' ^=MUNUMENT p~STAKE YTNf LOCATgN OF WELLIWI, 9Eh,,,; TANNIST)q CESYMOLS(CP) fHOWN HCRFON taE PROE! FIELD OOSERMITIONS AND OR DATA Ol iAINCD fRON OTHERY Y®UIVG ~ Y~l1NG ALDEN W.YOUNG, PROFES510NA1 ENGINEER AND LAND SURVEYOR N.Y.S. UCENSE N0. 12845 HUWARO W. YOUNG, LAND SURVEYOR N.Y.S. LICENSE N0.45893~ ~5 35~'6V F W PY 4~GH'~ n ,CSC 0~ \ D .$ i0 AK ~p0 ,_~I "o' %'', 'S.~~aS°c N~' DWELLIN suRVEY FoR __~" CHARLES BERNER,JR. , AT MATTITUCK ~ '7271YN (~ SOUTHOLD SUFFOLK COUNTY, NEbV YORK N p UNAU1HOR12E0 ALTERATION OR ADDITION ro THIS SURVEY R A VIOLATION OF YECTIDN 7209 OF THE NEW YORK STATE EWCATt ON LAW )N COPIES OP TNI! 4VRVEY NOT REAR WG TNf LAND SURVEYOR'S INKED SEAL OR EMBOSS ED SEAL. SHALL P NO7 DC CON YIDERED TO RE A V4L10 TRUE COPY 1 S N GV ARAN TEE! INUI CA TEO HEREON SYIAI I. RVN (ALLY 10 iME PEWSON FOR WNON THE SURVEY 13 PREPARED Y AND Otl HIS BEHALF ro THE TITLE CON PANY~ GOVERN- O NENTAI AGE NCV AND LENDING INSTITUTION LISTED ~ r HEREON, AND PO THE ASSIGN EES OF THE LENDING INSTITUTION, GUARANTEES ARE N07 TRANSFERA RLE 70 ADDI TIDNAL INS TITUPIg15 ON SUDSE OUENT OWNERS , M DI iTANC[S SHOWN HEREON FROM PROPERTY LINE! TO Ex Il TING fTRUC TU RE3 ARE FOR A SPCC VIC A~I 9 N T E O T PROPFRTY NE OH OR NE EREC TION OF f ENCEY ~`Tfn u~...~„~., a suns lnc; ToaG f t~ MHYtJ GKttK _ --~ ~-~- --.__ _'_ - N.82°1 , ~~E X110.00 - ~- ~' }ine -~ pia W~deo~~ Area :1.406 acres " 0°~ °~ p Greys JG G°~9°~° n p~dre~ sh`d A b, i~s`" O ~ii~ t . O n'` `.7 t , • a c1c n°`s ~ poi' „6 . cad '~ <,~Nf" sec a oPN '. ;„ , ~.~WE~~ ~~ ~. O ,~ / u L o30,50 ~ /~ . ~ ?2g0, / \ / ~51~ 04~ WA~f e2 fie, ~~ ~ g. 15 ~IGN WFSTPHgCOe~D f Nq0 A9 A a v fN~e '., SURVEY FOR _._.._.n_._._.~______. ~~ ro~~ cour~TY D£PAi7TN1.ENT OF H(?I.TH SERWCES HARLES BERNER, JR. r ., ~, v, SIrJ~LE , hill Gtl~L~IN(; OrdLY =, ,~-` .r, ~ j~~,_D...~,..~~''s. I~~~_ . ~IQ SS SD !~ l T MATTITUCK r., .. ti ~-, w:' eN ;^ ds!~~.,.al r~r~ r:' :e. s~.~(:p'ry (a,£Iliries for this WN OF 30UTHOLD ~~ '~~ In,,~a lon t~~~~te he:^n ir;sp~:a;c+l h; (~I~ ~~Partrnerttandlor tIFFO[.1( COUNTY, NEW YORK 44 }; ;Y: t 1•• `~,r'. o her a$prc~£s,anli 1aund to i~ s~i~s;;a4or~ ;, ~,Y, ~'~-_•'~, j UEMUTN01112E0 ALTERATION OR AOOITION TO THIS ~ ~~' ~ ~ 9 RVEY EE A VIOLATION OF SECTION 7209 OF THE ~~eT.~x ~~ L~~.~ EW YORK STATE EDUCATt ON W $ilf£i £~ BLIf£~U UI WdSie'CJ2iQY I'1.18ft2$CII1QNt ~C011 ES OF' MIS SWEVEY NOT~tlEARWG TNf LIND HEALTH DEPARTMENT-DATA FOR APPROYIDL TO CONSTRUCT eeo cN"~ N NEMlfT W~}~R •AI NI. ! N SOURCE aF WATERS PRIMTE / PUtlIIC. N NNf CO. TA%MA- gIfTT4.Qfl.tEC TION 113 tlLOCK .~B_ LO7 1nE MENTAL NEREON, NTNCR[ ARE MO OW[LLI1Mf WITHIN 100 FEET Of TINE -ROPERTY WSTITUT OTHER T AN THOlE fNOtTN NtREON. TO A001T N TN! ~YLR fY/PLY AND flRMtl! DIfFOIAI EYfTEM f'OR Mif RRIDENGE OWNERS 1EIL4 CDNFORN TO TNL fTANOMOf Of THE SUFFOLK COUNTY 0lMRTNENT * DIDTAN TOE%IfY W N[ALTN tlGVIC[f. -UR POSE ARLICNI7, PROPER? AODRff! TtL. '- - NOTE ^=MONUMENT p =STAKE=STAKE ATNE LOCATpN OF 3YEll(W),fEp„C TAMKIfTItl CEfiPOOlf(G-) MOWN NUEON NEE PIIOM ~fl[LO OpERMT10Nf AND OR OATA ONTNNEO FNDN OTNERf \ BRANDIS 4 SONf IMC. 3048 To S SNOEYN HEREON fRON PROPERTY LINEf f fTRUCTUREt ARE fOR A SPECIFIC AND SAE NOT TO tlE USED TO ESTAtlLIfN LINES OR FOR THE lAfCT10N Of FENCES N~ \ A .A 10 x_ > ~+:< N r; O' c 9~ O 99 z ~,F ~` b ~~ .. ~~£ O H 4 ~b, 4 ., ~~ °%. w D~~ O O~ ~~ b- // ~~~~ 00. i0~ ~°w OT fMo eho p ~pOes SEPT. 23 ,1988 APRIL 7, 1986 DATE APRIL 29,1985 SCALE I° 0 80~ N0. 85 - 327 S~PSE OF N8 " r\ O PµD W y ,2O~ `OG ? '* 2 W ~ ~~ 45 ND SURE YOUNG a YOUNG ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. LICENSE N0. 12845 HOWARD W YOUNG, LAND SURVEYOR N.Y.S.LICENSE N0.45893 X00 OSTRANDER AVENUE RIVERHEAD, NEW YORK TE9T HOLE O.O VEG. 0.9 EAXD e GXFVEL vo ~~ ~~ '3 y~ L Z m 0+\ A U) N ~ ° ~£ y P O '9 L~ (olme<\Y Gp1gT 1 ~ o a Pe`T`olo ~f~0 Gel~~~ N 65c 30 5D E TzeD O'NE~V`WG `~` 82. TQ, wesrPHgC/ 9yD„e N A A vim... LK \DD " ~~ ~ ~ ~p",~1 ~~ / 3 6~ ~IGNt 15 ~~~W. •~ E~:~ e<IY ones 57o°a5 ooW Dr EMa oo P No o d C,1~ DWEILIryG SURVEY FOR CHARLES BERNER, JR.,9-L-91'" "~ I~;;r-?~Y COUNTY DEPARTMENT OF HEALTH Sr^;r~^F$ FOR AP'FiDVAL OF CONSTRUC' ~~ ' :: Single Family Residence :.~ ~'TE N N[MfIT WATF11 RAIN _wl ~ VI SOUPCE CF WATEP~ MIMTE / FUELI[ _ N WF'c0 TN%MAk 91ti 1000 Sec Tlox ~_ ELOCN ~_ Lor 1Q2 M MCK AK MO •DWCLLIKt WITXIN IDD fEET OF TNIt PPOFfPTY OTXEP TXAN THOSE fXOWN XFPEON • THE W1TF11 tUIFLY 1MD tEWEGf DItFOtxL SYSTEM NN TXIt IIOIDENCC WILL COIIROIIM i0 TM[ lT1N WPOt OF TXE CUFF0.% COUNTY DEMPTMCNT OF HENLTN tONIC[t ARLIDWIT~ AODCFIt TFL NOTE: ~=MONUMENT p =STAKE •TIE LOr1TCW OF WfLL(WI,tEE~I. TAMNIlT1•<EStFOOLt(O) tMOWM NF11[ON ME FI1DM (ICED OpE1rWTlglt INO OP GATE OFTYKD FROM OTHEPt BgAND15 4 SONS INCj lOAfi wooddock y Area =1 406 acres "- \ N ~O ar 1, m. W Z ~ ~ A (~ 0 ' W. ~90~° o ~, w ~% 13~ i f EormDr\ w do g°~0ooo g oov+ 00. Podre uWELUx 6r PodreW ~IFi °W~,WD ~~~ Ora AT MAT TITUCK DATE APRIL 29,1985 TOWN OF SOUTHOLD SCALE 1"=60' SUFFOLK COUNTY, NEW YORK ND 85-327 «uIYUTNO1112 ED ALrGAIIDX Dn ADmrIDN N LNIS sugvfr e A vla AnaN aF tE CTIDN nDD DE THE NEW YGNN liNiE EWCATIOM LAW k [OFl ES OF TXIS IlMVEY NOT NEAPWG THE LANG .c/ pp „` NGUAPANTEE! INOIUTED HEPEUN yIALL PUM dLY ro PµD W QP THE FEPSpN FOP WNON iXE SONJEY IS VPEPUPEO AND QI XIS IEMALF 1D THE TITLE [ONPANY OOVEIIN- ~ OI LD } , ~ ~ 4 y ~- G NENLAL AGENCY AND LENDING IN]iITV iI DN LISTED ;, 2 NEPEOM~AND TO THE AS]IGN EES OF !ME LENDING f.~"p ~ C ~• INS iIiUTION GUAPANTEES APE HOT TPYISFE PAILE 'I ^ 'l` T01001 TIDNIL INSTITVTIp15 OP SV CSEOUENT ~~, i1f OWNEPS ~^~~ll P DI]LAN[ES SHOWN HEPEON FPOY FPOPEPPY LINE! ^, TO E%It TIN4 ELPUC NPEt APF FOP A SPECIFIC 9 PVPIOSE AND 4PE NOT iO IE WED TD El T4FLIlX P T ~'YF P DPEP Y LINES OP iDP THE EPE[TIOH R fEN[ES p G4 X ' I AHD SURNr. YOUNG ~I YOUNG ,V E N E RHEAD R NEW YORK ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N V.S. LICENSE NO 12e45 HOWARD W YOUNG, LAND SURVEYOR NYS LICENSE N0.15e9} z