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Home My WebLink About17119-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22001 Date DECEMBER 4, 1992 THIS CERTIFIES that the building INDUSTRIAL BUILDINGS Location of Property 22355 COUNTY ROAD #48 CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 84 Block 1 Lot 26.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 1988 pursuant to which Building Permit No. 17119-Z dated JUNE 17, 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 INDUSTRIAL PARK BUILDING COMPLEX AS APPLIED FOR. The certificate is issued to PURGE CORP. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C-10-88-009-JAN. 23, 1991 UNDERWRITERS CERTIFICATE N0. N-140798, N-140800, & N-140801-7/19/90 PLUMBERS CERTIFICATION DATED ~ 0.(. Ot~1--O~ Building Inspector Rev. 1/81 10)!,M NO. f 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) ND 017119 Z Date ........~..~sf-n~-.~...7 .................. 19.$.g Permission is hereby granted to: `-~ "71~ ......1........~.~,....... ~-C1X.[..aM ..~ o.a ~.......-~-~~ ..................................... to ...~i^:t-9M:4Lst:....5+11M.....,fer4~~~•.:V~"!!~:4Q...~44NG.....~r~,7.cG...~.I.SI~N.:stA.AXr.J`.. at premises located ot ..zZ.~ii5.~t~............S.R~rr~A~...~.......~ ..............s~i4.4:1....~ ................................................................................................................................................................ ................................................................................................................................................................ Coun Tox Ma No. 1000 Section O.Q ~ P/e,,,, ty p ..................... Block .......Sa.~......... Lot No...,l.. ~,~+. p o ..... pursuant to application doted .......~i{t.!1:1R....~..~ ..................... 19.A0.., and approved by the Building Inspector. Fee s..l..~ ~a o,. .... ...... ....... Building Inspector Rev. 6/30/80 Form No. 6 ~ ? ~ ~S7 -., D ~•~ b ~' ' TOWN OF SOUTIIOLD BUILDING DEPARTMENT L ~E~ - 3 ~ ~~ • TOWN HALL .. . 765-1802 L-._._ _ _ ...,._~.J TOWWpi'SUS~aOLD APPLI~ATZON FOR.CERTII•'ICATE OF OCCUPANCY •~• 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. S. Commercial building, industrial building, multiple residences an~ 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., S• 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 a If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writin to PPlicant. g the applicant. • 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 Euilding - $100.00 . 4. Updated Certificate of Occupancy - $5.00 over 5 years - $10.00 ~• 5. Temporary Certificate of Occupanc- $50.00 Y - Residential $15.00, Commercial $15.00 'w Con Date , , , , , • • DEC'.. 3,• 1992. • struction.. Old Or ~ " " '••••••••••..... ••••••••• Pre-existing Building,, cation of Property:..,,22355 CODNTY ROAD /48. CDTCHOQTE, N.Y.~ ... House No. •..... .. .....Street ................ ................... Hamlet •.rcr or Owners of Property.......PUIH:g,CORP:•._• . inty Tax Map No 1000, Section......!......Block....• ..:................................. ,diva ............Lot......26.3.... ... lion .....................::....:........Filed Map........... .. .Lot., -m![ No..~Tjly;$,,,,,,,Date Of Permit.,6/16/68• ~ PHDGE CORP..••....••~•.• • . .. .. .....Applicant.. lth Dept. Approval.......... ..... ................... '• " ••••••• ..Underwriters Approval.. nning Board Approval ......... ............. ....................... pest for: Temporary Certificate........... Final Certicate........... Submitted: $ „ •••: 25.00 (SAC, y ~a a~ ~ •~~ ,~ . l O 2ao~ OQ I .... • ' - APPLIC ................... THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000930 BUREAU OF ELECTRICITY 65 JOHN STREET. NEW YORK, NEW YORK 10038 Uare MAY 22,1990 .4pplicationNo,onfile 63820089/89 N 130236 THIS CEFLTIFIES THAT only the electrkal equipment as described bebw and introduced by the opplicont nomad on the oboue application number in thepremises of PUDGE CORP., MIDDLE ROAD/SOUTH SERVICE, CUTCAOGUE, N.Y. in the following hNration: ^ Basement ® /at FY. ^ Ynd Fl. OUT .Sertion B/ock Lot waa examined on APRIL 23 ,1990 and found to be in conlplionre with the reyuirententa of this Baord. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH W ASHERS EXHAU ST FANS OUTLETS FCEPTACLES SWITGNES INCANDESCENT fIUORE5CEN1 OTHEN ANC K. W. AMT. K. W. AMT. K.W. MIL. K. W. AMT. N. P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEll UNIT HEATERS MUlTI.OUTIlT DIMMERS AMT. K. W. Oll N. P. GAS M.I. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. N q SYSTEMS NO.Of FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E ANT. AML. TYPE METER EOUIP. I F tW I $ JW ] P ]W ~ J AW NO. of [c. COND. PER$ A. w c. OF CC. COND. NO. OF HIdFG A' W' G' OF MLLEG NO. Of NEUTgAlS A. w G. OF NEUTRAL 6 100 CB 6 X 2350 2 350 OTHER AP-ARATUS: SERVICE ONLY-1 ~~ ~ ~j~ ROBERT AEDDERBURN LIC.#910-E C 219 PIDGEON HILL RD. HUNTINGTON, NY, 11746 GRFERRAI MANAGER 11 ,! Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be anti' by their credentials. r, THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000930 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 Data MAY 22,1990 ApplicorionNo.onfile 63819989/89 N 130076 THIS CERTIFIES THAT only the electrical equipment as descrihed beloEe and introduced by the applicant named on the strove application numher in the premises of PUDGE CORP., MIDDLE ROAD-W. SERVICE, CUTCHOGUE, N.Y. in thefolloreing location; ^ Basement ~ /u FI. ^ 2nd F'1, OUT Section Block Lot u~oa examined on APRIL 23,1990 andfound[o br in cornplianre with the reyuiretttenls of this Board. FI%iURES RANGES COOKING DECKS OVENS DISHWASHERS E%NAUST FANS FIKTURE ECEPTACLES SWITCHES OUTUETS INCANDESCENT FIUORESCENi OTHER AMT. K.W. AMT. K. w. AMt. K.W. AMT. K.W. AMT. H.P. DRYERS RIRNACE MOTORS FUTURE APPEIANCE FEEDERS S-ECIAL REC'-T TIME CLOCKS BFII UNIT NEATERS MULTI.OUTUET srsrEMs DIMMERS AMC K. W. CNl N. P. GAa N. r. AMT. NO. A. w. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. NO. OF FEET MAL. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E MIT. AMP. IYPF METER EQUIP. 1$ ]W 1 $ ]W ] $ ]W ] $ ~W NO. Of CC COND. PEP $ A W. G. OF CC.COND. NO. OF N4lFG A' W' G' Of N4lEG NO. OF NEUTRAIa A. W G. Oi NFUTRAI 6 100 CB 6 R 2 350 2 350 OTHER AKARATUS: SERVICE ONLY-1 ~j-~~"l ~~ ROBERT WEDDERBURN LIC.NE-910 G~~ 219 PIDGEON RILL RD. HUNTINGTON, NY, 11746 GENERAE MANAGER 11 ~ ~/~-~ Per This ceAificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. f, THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000930 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 Uate MAY 21,1990 ApplicotionNo.unJile 63819889/89 N 129991 THIS CERTIFIES THAT only the electricol equipment as described 6ebw and introduced by the opplicont named on the oboDe application number in the premises of PUDGE CORP., MIDDLE RD., CUTCHOGUE, N. Y. in theJoflouing location; ^ Basement ^X tat Fl. ^ 2nd F1. OUT .Sertiun Block Lot u~oa a:amined on APRIL 23,1990 and found to 6e in compliance with the reyuirementa of this Board. FIXTURES RANGES COOKING DECKS OVENS DISH WASNERS EXHAUST FANS AXTURE FCEPTACLES SWITCHES OUTLETS INCANDESCENT FIUORESCENi OTNEfl AMi. E.W. AMI. R, w. AMT. R.W. AMI. K. W: AMT. N.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT 71ME CLOCKS 6Ell UNIT NEATERS MULTI.OUTLET DIMMERS AMT. R. W. Oll N. P. GAS X. P. AMT. NO. A. W. G. AMT. Mfr AMi. AMP]. TRANS. AMT. N. P. SYSTEMS NO.OF FEET AMT. WAI15 SERVICE DISCONNECT NO.OF 5 E R V 1 C E AMT. AMP, TTpE MITER EQUIP. 1 F ]W t F ]W 3 6 ]W 7 / ~W NO. Of [C COND. PER a A. w G. Of CC. COND. NO. Of NbIEG A' W' G' OF NI-LEG NO. Of NEUTRALS A. W G' Of NEUTRAL 6 100 CB 6 X 2 350 2 350 OTHER APPARATUS: PANELBOARDS:6- CIR. 100 _ / ~~ ~ R08ERT WEDDERBURN LIC.BE-910 C/~~ 219 PIDGEON HILL RD. HUNTINGTON, NY, 11746 OHiERAL MANAGER 11 Per This certificate must not be altered in any manner; return fo the office of fhe Boord if incorrect. Inspectors may be identified by th ' edsntials. r -, THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 00930 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date MAY 22,1990 Application No. on file 63820189/89 N 130074 THIS CERTIFIES THAT only the ebctrical equipment oa described bebw and in[roduced by the opplicont Homed on the above opplicatbn number in the premisea of PUDGE CORP., MIDDLE ROAD-E. SERVICE, CUTCHOGUE, N.Y. in the following location; ^ Basemen[ ® lst Ft. ^ 2nd F'l. OUT .Section Block Lot uns exornined on NOVEMBER 22,1990 and found to be in cornplianre with the reyuirenten/x of this Board. itXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS KEPTAClES SWI7CNE5 INCANDESCENT FLUORFSCENL OTHER AMT. K. W. AMT. K. W. MIT. K.W. M]T. K. W. MIT. N. P. DRYERS RIRNACE MOTORS PUTURE A--IIANCE FEEDERS 5-ECIAL AEC'-T TIME CLOCKS gEll UNIT HEATERS MUITI.OUTIlT DIMMERS AMT. N. W. Oll N. P. GAS N. P. AMT. NO. A. w. G. AMT. AMR. AMT. AMRS. TRANS. AMT. N. R. SYSTEMS NO. Of FEET AMT. WARS SERVICE DISCONNECT NO.OF 5 E R V 1 C E AMT. AMP. rypF METER EOUV. 1 ~. ]w 1 / ]W ] L ]w ] / IW NO. Of CC COND. NRX A. W G. OF CC.COND. NO. OF NI-LEG A. w' G' Of MI-LEG NO. OP NEUTRALS A. W G. OF NFUTMI 6 100 CH 6 X 2 350 2 350 OTHER APPARATUS: SERVICE ONLY-1 ~~ ~ ROBERT AEDDERBURN LIC.~E-910 `~~~ 219 PIDGEON HILL RD. HUNTINGTON, NY, 11746 tiE1ERAl MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. InspeNOrs may be identified by their credentials. r-, r1ELD 1~.~:c~•-~•+ ~°-s ~~llni;, I ~ ~UMMENT° .. , -v ~. !U a . ~_ ~ - _ H H ___ C FOUtJDATION (1st) ~ a ~ ti~ FOUNDATIOtJ ( 2nd ) _ m/f 2. ~ IL z ~ 0 P.OUGH FRAME li . ~ G PLUMBING ~ . 1~RQ N ~ ii ~$ r_ h7-. . y . i 3. .. ~~ ~~. m IIJSULATIOiJ PER N. Y. i ~ a ~ ~ .. y STATE ENERGY a $¢ ' CODE x 4 . -~ r- m H ..? j h FI;JAL OMMENTS: m x °0 v.v. m ' x ^o H r ~, y J H ~ z IQ .~ s m a ~ r H x m -o H _ _. THE NEW YORK BOARD OF FIRE UNDERWRITERS YAi.I i 0111 .SAi BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date ,11,I1Y t%,1991) APPfication No. on file fi95]i79(l/~0 M ikl'17~IN THIS CERTIFIES THAT only the electrlcd equipment u described 6ebto and introduced by the applicont named on the abode application number Jn the promises of friY LANE: YNCIII£tTRTAI ('AkK. tiT.P1, UMIT ktb. Ct11C'HO(IUF;, N. Y. in the foilouirtp bcation> ^ Bosensent © /st Fl. ^ Pnd F!. Section Block Lot ~utr o;,IV9rl reas exomined can and found to 6e in campllonre with the reyuirements of thu Buord. RXNRE RXTURES RA NGES COOKIN G DECKS O VENS DISH W ASHERS EXHAU ST FANS OUTLETS EPTACLES SWITCHES I NGNDESCENT FlUOI1ESCENT OTHER AMT. K. W. AMT. K. W. AMT. K.W. NAT. K. W. AMT. H. P. ri i t 5 4 i F DRYERS RJRNACE MOTORS PUTURE APNIANCE RIDERS SPECIAL REC7T TNAE CLOCKS Elll UIR7 HEATERS MUlil-0UTIET DIMMERS AMT. K. W. Oll N. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. N. P. ~ ~ AMT. WAT15 i SERVICE DISCONNECT NO.OF 5 E R V 1 C • E AMi. AMP. TYPE lOUIP. IAT`M 163W 993W tX AW ~' Rk gCOND. OF CC COMD. NO. OF NI-lFG Oj'MI ~N:G ND.OP NFUTENS Oi HEU MAL OTHER APMRATUS: IMTER1SlR OYt~IGE. W[RINfs-I EIEC, k0(IM HEATEkS:I-2 K.W.,1-.5 K.W. PANEI_BOAftC)5:1-7 CIR. It)0 EtEC_ WATER MEATERS::]~-~ K.W. TkACK LTI:MI'SNI:_g ;IODY Yl1MIl.l.O F"A'1 I. ANE MATTT'IUCK, NV, 114-`.i? This certificate must not be altered in any mar COPY FOR BUILDING DEPART .c~o'~ t. Tr. hZJUi1-E i tiR11NAh MANAGER 11 ;) Per j"~rX-'' return to the office of the (bard if incorrect. Inspectors may be identified by their crodantiDls. ,. _. _ ~ __. 100'1381 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK f00~8 PACE a ~~ dUL.Y i'7,79~30 APPlicetianNo.onfile t,95f.~41?0/9U W ]4.(180) THIS CERTIFIES THAT only the electrical equipment ae descrihed below and introduced hY the opp/icont named on the oboDe application numher in the premiaea of I'O is LANE: TNIiU`=•TRTAI. PARK, fOx LAtlE, UNTT sla, CU ir,rynGUf-, N. r. in [hefollowinq location; ^ Baaernent ~ let Ff. ^ 2nd FI. .Section Black Lot 1 UE 1' 03,1990 wee examined on ~ artd found to 6e in compliance uif.h the reyuirementa of thia Beard. q%TURE RXTURES RANGES COOKIN G DECKS O VENS DISN W ASNERS EXHAU ST FANS OUTLETS EPTACLES SWITCHES I NCANDESCENT Fll10RESCENT OTHER NAT. K. W. AMT. K. W. AMi. K.W. AMt. K. W. AMi. N. P. ~(i 7 4 4 h DRYERS WRNACE MOTORS RJTUlE AFFUANCE REDEES S/FCIAL R[C'FT TIME CLOCKS Yll UNIT HEATERS Mlllil-OUTLET 1 E DIMMERS AMT. K. W. Oll N. P. GAS H. I. AMT. NO. A W. G. AMT. AML. AMT. AMPS. 7RAN5. AMT. N. P. srsTEMs ~, ~ RiET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AML. AMP. TYPE METER FWIF. 1 R SI/ 1 / tW 3,4 ]W 3 p' AW NO. OF CC. COND. PER D A. W. G. OF CC. COND. NO. OF NI-LEG A. M'' G. O/ N4lEG NO. OF NEUTRALS A. W. G. OF NEUTRM OMER AMARATUS: INTtRIOR i}FEICE WTRTNt;-1 EIEt, RUfJM FtEA'fER5~7.-.5 h;.W.,l-1 K.W.,1-:I.25 F:. W.. i'ANtt.80ARDS:1-12 Clt?. 100 ELEC. WAFER MEATE~R'>.;l-2 k.W. -7017Y PI,IMIt_L.0 t.tc.#2."i[117-E ~~ - F'A'1 LANE MATTT'IUCK, NY, 1!962 ~ WN@At MANAOH IS ~ Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspetlora may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. COPY FOR BUILDING DEPARTMENT THE NEW YORK BOARD OF FIRE UNDERWRITERS ''"~~ ' Snrusa3 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK. NEW YORK 10038 7;1IY ?7v 14sui fi9537N40/90 N 7r;gR00 Date Application No. on file THIS CERTIFIES THAT only the electrkal equipment os descrihed 6ebw and introduced 6y the applicant named on the shove application numher in the premises of CO}. LANE. I.NDU:;TRIAI. PAkK, I:OX LANE, UtdII 'it3~, I;iiTI;HOGt1E, N. Y. in the folloTCing loco g ant ~ 1st Fl. ^ Ynd FI. Section Black Lot f1Y[`Y .14 l ~~1~ , roes examined an and found to 6e in compliance with the reyuiremend of this Board. RXTURES RANGES COOKING DECKS OVENS DISN WASNERS lXNAUST FANS RXTURE FCEFTACLFS SWITCHES OUTUiTS INCANDESCENT - RUGIIESCFNf OTHER AMi. K. W. AMT. K. W. AMT. K.W. MIT. K. W. AMT. H. P. 3O 5 1 6 I E DRYERS FURNACE MOTORS FUTURE AFPUANCE FElDERS SFEGAL REC'-T TIME CLOCKS RFII UNIT NFATERS MUETI.OUTIET DIMMERS AMT. N. W. Oll H. P. GAS H. v. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. v. SYSTRMS NO.OF F@T AMT. WATTS SERVICE DISCONNECT tsO. OF S E R V 1 C E AMT. AMP. TTpE MFTER LOW-. 1 / tW t / tW 3 6 tW 3.e AW NO. pi CC COND. VERB A. W.O. OF CC. COND. NO. OF HLLEG A. w. G. OF NI~IEG NO.OF NEUTRALS AW~ G. OF NEU1RAl OTNER AMARATUS: IMIER [OR OPF TGE: 41IRIMG-1 F'I EC. ROOM HP~:fEkS~t-3..5 K. W., I~, `.; K.W. PANEL BOARDS : 3 -8 I; IR. 11711 Ei.EC. W1+.TEk Ht:ATE`R`::3...2 N,.W. ~J~~ ~(/~ ~/ JOUY FUMTIJ.Q LSC.N'L3t30-E `/ Pd.1 LANE MATtlTUC.K, N~i, 11y5~ O~AI MANApER 31 Per This certificaro must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identffied by their crodsntials. THIS COPY OF CERTIFICATE HEIST NOT BE ALTERED IN ANY MAINER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . ~ dtM~.. ~ 7..., 19 4. Approved .. ..~.7.., 19~$.~ Permit No. 1.?~.~.9. ~.. . BOARD OF HEALTH ... ....... 3 SETS OF PLANS .U:/.~•....... SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL T0: Disapproved a/c ..................................... ................................... .::....:.!tn.o 0.t .. ,~~..~'.I>~.. ....~., ... . (Building Inspector) ,, ~, INSTRUCTIONS ~4 ~ Date ................... 19 .. . 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 ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for r~,ecessa ins ections. ~i ~~I~~S .. .~. !- .. ......... .. igryature of applicant, r ame, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................................ Name of owner of premises . ~i44Qt~ SL.... .................................................. . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate offic•~e~r)~ ~ ~ ~ Builder's License No. ~4..~2.~-`~•!`•!+'!'!~.oi Plumber's License No . ....................... . Electrician's License No . ..................... . 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 ...... A?? ~ ...... Block ......O. ~ ... .... , Lot .. ~o , ~ •(p, , , , , , . . Subdivision ..................................... Filed neap No. .............. Lot .............. . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...U.0.......n._...(........- .................................... b. Intended use and occupancy ...~4'tr~~~ • • •V -~-~C• ; •C.~4. •-~?C. , l-.~!~N, t-~!• V.4~~ APPLICATION FOR BUILDING PERMIT 3. Nature of work (check which applicable): New Building .....~..... Addition Repair .............. Removal ..... , ........ Demolition ........ . 4. Estimated ..~~,..G~Z~ ........................ Fee ........ ~ (to lion ) itign) . • • 5. If dwelling, number o elling units ............... Number of dwelling , .... . If garage, number of cars ... ............................................ ................. .. ..... 6. If business, commercial or mixed upancy, specify nature. and extent of each type of use .................... . 7. Dimensions of existing structures, if an ront ............... Rear .............. Depth .............. . Height ...............NumberofSton ..................................................... Dimensions of same structure with alterations or 'tions: Front ................. Rear ................. . ... .. Depth ......................Height .. ...... ........Number of Stories ..................... . 8. Dimensions of entire new construction: Front . ........... .. Rear ...............Depth .............. . Height ...............Number of Stories .... ... .... .................................... . 9. Size of lot: Front ...................... Rear.............. ..... Depth ...................... 10. Date of Purchase .............................Name of Former er ............................ . 11. Zone or use district in which premises are situated ....................... ............................ . 12. Does proposed construction violate any zoning law, ordinance or regulation : ..... ......................... . 13. Will lot be regraded ............................Will excess fill be removed fro remises: Yes ~ No 14. Name of Owner of premises ....................Address ................... Ph e No............... . Name of Architect ...........................Address ...................Phone o............... . Name of Contractor ..........................Address ...................Phone No......... .:.. . 15.Is 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 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. STATE OF NEtiV YORK, COUNTY OF ................ . S.S • • • • • • • • • • • • • • • • • • • • • • • • • • ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................... ............ ........... .........:.... (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 will be performed in the manner set forth in the application filed therewith. Swom to before me this ..................~.~ ....day of .... ..........., 19 .~~ Notary Public, , . , , ,~(,~/ ~: ~ UUU/'~ , , , , . County ...... ....e'.V. HELEN K. DE YOE NOTIVRY PUBLIC, State of New Yak No. 47678'!8, SutfolK GW- fdy Term Expires Mueh 30,1'x..-~-! ( ature of applicant)