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Home My WebLink About29754-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29946 .Date: 01/07/04 THIS CERTIFIES that the building ALTERATIONS Location of Property: 270 STERLING PL GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 4738.89 Section 34 Block 3 Lot 28.1 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 22, 2003 pursuant to which Building Permit No_ 29754-Z dated SEPTEMBER 23, 2003 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 RAISED TERRACE ADDITION, ROOF TOP DECK ADDITION AND RENOVATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR, The certificate is issued to ANDRZEJ & SANDRA GRZYBOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1169109 11/17/03 PLUMBERS CERTIFICATION DATED 12/31/03 HSM LABS �f c Authorized Sig ture 1 i Rev. 1/81 FORM NO. 3 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) PERMIT NO. 29754 Z Date SEPTEMBER 23 , 2003 Permission is hereby granted to: ANDRZEJ GRZYBOWSKI 504 STERLING PLACE GREENPORT,NY 11944 for RENOVATE EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES EXPIRED BUILDING PERMIT #23672Z . at premises located at 270 STERLING PL GREENPORT County Tax Map No_ 473889 Section 034 Block 0003 Lot No. 028 . 001 pursuant to application dated SEPTEMBER 22 , 2003 and approved by the Building Inspector to expire on MARCH 23 , 2 Fee $ 423 . 00 v ut i d Signature COPY Rev. 5/8/02 FORM NO. f TOWN OF SOUTHOLDQl ' ni BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. d u �_. BUILDING PERMIT o (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL Cj COMPLETION OF THE WORK AUTHORIZED) M23672 Z Date ...SEPT.....10................................... 1996.. Permission is hereby granted to: Mr.& Firs. Andrzej Grzybowski ................................................................................ 504 Sterling Place ................................................................................ Greenport, N.Y. 11944 ................................................................................ RENOVATE EXISTING ONE FAMILY DWELLING AS APPLIED FOR. to ............................................................................................................................................................ ................................................................................................................................................................ at premises located at .....270. ..STERLING..PL....fi..505..CHAMPLIN..PLACE.,...GREENPORT. . . .,...N.Y..... .. ................ .... . .. ...... ................ .......... . . ....... . ..... . ... .............. ................................................................................ ................................................................................ ..........................................................................................................................................I...................... County Tax Map No. 1000 Section .........34........... Block .......3............. Lot No. .....MA.l pursuant to application dated W-j.r,. 199Z........................ 19........, and approved by the Building Inspector. Fee $......257.00 RENEWS BUILDING PERMIT #20602Z G- .. .. .0 ...................... ilding Inspector Rev. 6/30/80 Foam NO. 8 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) WN9 206022 Date ..........�. ..I..................... 193.3.. Permission is hereby granted to: I-:.. ..... �-� a ..J�. 0. to ...... ........... ...y1rl ...... . ........... ... .............. ...:CX .... .......... . ........... at premises located at . C.....Z4"* ... ....... . ....... ... .. - .............. ............................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section .....Q i..... Block ........ ..... Lot No. ... ............ pursuant to application dated ........ .CLI..... �....................... 1913,---end approved by the Building Inspector. Fee $..�. .:. .. Bui ing Inspector- Rev. nspectorRev. 6/30/80 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' 765-1802 APPLICATION FOR CERTIFICATE OF OICCUPAI �i ~ This application must be filled in by typewriter or ink and submitted to the ilding Department witlf the following: A. For new building or new use: / 1. Final survey of property with accurate location of all buildings,property lines, streets, and unrtsual;3ratural 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 1%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 natura'or topographic features. 2. A properly completed application and 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. 1 C. Fees // 1. Certificate of Occupancy-Newsy elling$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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.60 Date. 1 �� New Construction: Old or Pre-existing Building: y�✓ (check one) / Location of Property: c-0'� �T1y>�v c &CP_ Q�/� /a 1 /1 �l 57 House No. ((Street // Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section `j Block Lot Qn ' / Subdivision Filed Map. Lot: Permit No. �3' Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: (check o Fee Submitted: $ 00 �� pl tS' tur AH2M "USS INC. 575 Broad Hdlow Road,Made NY 11747 (631)694-3040.FAX(631)420.8M NYSDOHID#10478 LABORATORY RESULTS HARRY GOLDMAN WATER TESTING Lab No. 0312668-001A Sample Information... MAIN ROAD Type : Solder MATTITUCK,NY 11952 Origin: Distribution Attn To 631-298-4640 Routine Federal ID Client ID. : SANDY GRZYBOWSKI Collected :12/19/2003 8:30:00 AM Point No: 1 504 STERLING PLACE,GREENPORT Received :1019/20033:19:00PM Location: SOURCE(CWL-KS)(29754) Collected By :JD99 Copy : Original CC Parameters) Results Units Limit Method Number Analyzed. Lead 0.05 % 02 SW6010A 1 2122/20 03 10:17 PM Result(s)reported meet(s)Regulatory Umit(s). Result(s)Flagged with * Exceed Regulatory Umit(s). Limit noted. Date Reported: 12/31/2003 Page 1 of 1 Laboratory Manager -1-2M "US, INC. 5756road Hdlm Road,McMtle NY 11747 (631)6949040.FAX(631)42964.36 NYSDOHID#10478 LABORATORY RESULTS HARRY GOLDMAN WATER TESTING Lab No. : 0312668-001A Sample Information... MAIN ROAD Type : Solder MATTITUCK,NY 11952 Origin: Distribution Attn To 631-298-4640 Routine Federal ID Client ID.: SANDY GRZYBOWSKI Collected : 12/19/2003 8:30:00 AM Point No: 1 504 STERLING PLACE,GREENPORT Received : 1D19/2003 3:19:00 PM Location: SOURCE(CWL-KS)(29754) Collected By :J099 Copy : Original CC Parameter(s) Results Units Limit Method Number Analyzed Lead 0.05 % 0.2 SW6010A 12/22/200310:17 PM Result(s)reported meet(s)Regulatory g /w Result(s)flaggetl with ;p Exceed Regulatory ry Limit(s). Limit noted. Date Reported: 12/31/2003 Page 1 of 1 Laboratory Manager p :)-C�� D r nznrTrJrJrJ�oPr��Pr!r�cPrJ�r�r�rl�ncnr nrJL�nr�cPPrJrJpnrJ@rrJ�r�r��PrJPff@PtnrJ�r:11 :1 Pr�r��PrJ�r PrJ�cPrJrJ�rr nrJ�rJ�rTr rrJ�[I�ePrJ� BY THIS CERTIFICATE OF COMPLIANCE THE 5 NEW YORK BOARD OF FIRE UNDERWRITERS5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET - NEW YORK, NY 10038 5 CERTIFIES THAT Upon the application of upon premises owned by SABAT ELECTRIC ADREZES GRZYBOWSKI 50 PAT LANE 504 STERLING PLACE MATTITUCK, NY 11952, GREENPORT, NY 11944 Located at 504 STERLING PLACE GREENPORT, NY 11944 S Application Number: 1169109 Certificate Number: 1169109 rS�� Section: Block: Lot: Building Permit: BDC: NS11 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor, Second Floor,Attached Garage,Outside,Attic, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was found to be in compliance therewith on the 17th Day of November,2003. Name QTY Rate RRA Circuit Tie rj Alarm and Emergency Equipment Pj Sensor 3 0 Smoke Appliances and Accessories P�] Furnace 1 0 Oil 5 5 Exhaust Fan 2 0 F.H.P. Dish Washer 1 0 1.2 KW Hydro Massage Tub,Residential 1 0 C, Wiring and Devices tj Receptacle 37 0 General Purpose Switch 41 0 General Purpose Fixture 21 0 Incandescent CJ' g� Fixture 10 0 Fluorescent �5 C5 Paddle Fan 6 0 5 CNU Lighting track 6 0 ft Switch 1 0 20 amp Laundry Receptacle 1 0 30 amp Dryer = - GFCI Circuit Breaker 1 0 20 amp Appliance sea/ Receptacle 4 0 GFCI 5 Continued on Next Page 1 of 2 �y This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. O rJ�[ [��[PL.PLrJ7rrPrSJrJPLLPLJ-J7[PrPrPaIdLl�rJPcPrS[P[1�[&�e9�r1�cP[J�[�J7r17[S7rS[fa[PcI�rJ7r�r riVrP�PrJ�rScPcP[P[PrJ7rJ7�1:11i R11231?I�EPI-Mr-3fcJ7 0 � rJ'r1�r�r�r��Pr.Pcl�r.!'rJ�ePrJ�rJ�rJ�rJ'rJrf�ePr�rJ��PrSar�rfrJrJ�rSJ�PrJ�r.fcrcP rJ�rJ�rJ�rJ�r�.Pr_Prffr?1r�r��Pr.PcPrJ��.Pr.P�P�PrfrJ�cPrJ�rJ�r�rrJJ?Pe.ff�f� � SBY THIS CERTIFICATE OF COMPLIANCE THE 5NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON,STREET — NEW YORK, NY 10038 fj c7 CERTIFIES THAT Upon the application of upon premises owned by SABAT ELECTRIC ADREZES GRZYBOWSKI 5 50 PAT LANE 504 STERLING PLACE MATTITUCK, NY 11952, GREENPORT, NY 11944 Located at 504 STERLING PLACE GREENPORT, NY 11944 SApplications Number: 1169109 Certificate Number: 1169109 e7 Section: Block: got: Building Permit: BDC: NS11 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 Basement,First Floor,Second Floor,Attached Garage, Outside,Attic, 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was 5 found to be in compliance therewith on the 17th Day of November,2003. Name QTY Rate Rating Circuit Type Service 5 1 Phase 3W Service Rating 100 Amperes 5 5 Service Disconnect: 1 100 sw 5 Meters: 1 A visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation is believed to be 5 in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. 5 5 5 5 5 5 L seal 5 5 5 2 of 2 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. e 17 rP�nrJ�t 9�rJar��r�r,MQ!r�rsat nr�rJ�rSr�iPrlcntnr�rJ arSrJ��nrSrJ�rJ�rs3lcJ�r��nrPr-a ;; ; cJ;;:1;! rJrJ�rJ ar�rJ ar�rJ�inrJ�rJ arJ�rJ arJ�cnrJ�rJrJ arJ�cPrPrJ arJ a �5 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 085085 BUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NY 10038 Date AUGUST 26,1996 Application No.on file 12251796/96 N 395333 THIS_C18RTIFIES THAT only the 411ectrical equipment as desert and introduced by the appliaiust named on the above application number in the premises of GRZYBOUSKI,A. , 504 STERLING PLACE, SRT, N.Y. in the following location; ® Basement ❑ lat Fl. ❑ Pnd Fl. OUT Section Block Lot was examined on AUGUST 22,1996 and found to be in compliance with the National Electrical Code. RXTURE ACLM SWITCHESXTURES RANWS COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLUTS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. I H.P. DRYERS FUMIACE MOTORS FUTURE AF/UANCE POWERS SFECIAL RWPT TUM CLOCKS FELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K.W. OIL N.P. OAS M.P. AMT. NO. A.W.O. AMT. AMP. AMT. AMPS. TRANS. AMT. N.►. N'Y$ T AMT. WATTS SERVICE DWCONIMCT No.OF S E R V 1 C E AMT. AMP. TYR 1/2W 1/3W 3/3W 3 0 4W NO.OF CC.COND. A.W.O. NO.OF HI-LEG A.W.G. NO.CIP NEUTRALS A.W.G. PER,e OF CC.C 0. OF NI-LEG Of NEUTRAL 1 100 CB 1 X 1 2/0 1 2/0 OTHER APPARATUS: ALAN MWARD, ELECTRICIAN LIC.44285 L L P. O. BOX 2241 AQUEBOGUE, NY, 11931 OMURAt MANAGER 11 This certificate must not be oherot in any manner; return to the office of the Board if incorrect. IRspoows may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BALTERED IN,ANY., MANNER. x !V, � --..,,t��` �x,�.�• RF$�fl1f�AS1Yi}TEA _ 6]ATI fl FEE ._ NOTIFX BUILbiNG NR 765-1802 9 AM TO 4 FOR 8 ; FgLLOWING INSPECTIONS: j 1. FOUNDATION - TWO QUlRED �y FOR POURED CONCR j` 2. ROUGH - FRAMING kPLUMSING gr 4y 3 INSULARON ! ! q 4I FINAL - CO UCiION MUST 3 8E COMPLETE GO. 4 AJ L CONSTRUCTI�SHALL MEET THE REQUIREMERM OF THE N.Y. STATE CONSTRUCWN & ENERGY CODES. NOT WWPONSlOW FOR DESIGN OR ERROR$ scale 4 r ' j - Unavfiorzed aRaratlon aaddNa+ ® �ca 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST jj ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: DATE it 4 2 INSPECTOR Y �- 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS-. r -40 47 4 DATE INSPECTOR 0 0 M-1802 BUILDING DEPT. INSPECTION ) FOUNDATION IST [ ) ROUGH PLBG. j FOUNDATION 2ND [ ) INSULATION [ ] FRAMING [ ) FINAL [ ) FIREPLACE & CHIMNEY REMARKS: awcry t �4�—�coz m , l DATE INSPECTOW; .� M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [YFINAL H PLBG. [ ] FOUNDATION 2ND [ ATION [ ] FRAMING [ [ ] FIREPLACE & CHIMNEY �� REMARKS: � o�P�� m- � �f ox � DATE_ J INSPECTOR 765-1802 BUILDING DEPT � '�'` ' INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ FIREPLACE A CHJMN]EY ,7EMARKS ,7,f Z1 DATE INSPECTO 7W-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH P G. [ ] FOUNDATION 2ND ( ] IN TION [ ] FRAMING [ FINAL ( ] FIREPLA C NEY REMARKS: q � DATE INSPECT =1c:LD i�:.°.: c _ iJ:i. I�Dni... I� .;U:•ti•tLNT� >:. - �----�-��-� 'IbUNDATION ( 1st ) - I --- 'QUNDATION (2nd ) ?I !1 tPUGH FRAME PLUMBING I 41 � S - 6 n _11SULATI021 PER N Y. .l I, STATEEi1 GY CO FI;IAL f ADDITIONAL COMMENTS : Of aza4c r _ 6 6 x ¢} H 262, �r I .9 H BOAFD OF HEALTH . . . . . . . . . FORM NO, 1 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT Cllrcrc . . . . . . . . . . . . . . . . • TOWN HALL SEPTIC F0R:f . . . . . . . . . . . . . • SOUTHOLD, N.Y. 11971 r;oTlFf TEL: 765-1802 CALL • . . - • . Examined.. . A . . . . .. 19TZ MAIL T0 : \pproved .I. . . 1 19�. . p .O 2� ( Permit No. )P 6. . . . �� .. . IDisapproved a/c . . fir. . . . . . . .. i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . .. (Bui in- Inspector) APPLICATION FOR BUILDING PERMIT i Date . . . �. . . . . . ., 194�. . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 �ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. I d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit iall 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 loll 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 ;nilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ^he applicant agrees to comply with all applicable laws, ordinances, building code, housi , c e, d regulations, and to mit authorized inspectors on premises and in buildings for necessary insnect',bns (Signature of appli t, or name if a corporation) . . . . pa.... . . . . ..��. . . .c/�?K.�6/.!. . i>y � (Mailing address of applicant) >t�ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. lame of owner of premises . . . . . . . . . . .J. . . . . . . . . . . . . . . . . . . . . . . . . . (a on the tare roll or latest deed) f applicant is a corporation, signature of duly authorized officer. .ISL . . . . . . . . . . . . . . . . .e. . . . . . . . . . . . . . . . . . . . . . . . . . {Name and titlof corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . ! . Other Trade's License No. . . . . . . . .. P14d4j)7 �c�y�� Location of]and on which proposed work will beCo— done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Ilouse Number Street Hamlct County Tax Map No. 1000 Section . . . . • . • . • • . Block . . . . . . . . . . . . . . . . Lot . . . . P? . . . . . . . . . . . . fiubdivision . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Cxisting use and occupancy . . . . . i . • •,-��. . . . . . c, use .and occupancy AIL- . . . . n 3. Nature of work (check which applicable): New Building .. . . .. . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . • . . . • . . . . • • . Removal . . . . . . . . . . . . . . Demolition . . . . . . . Other Work . . . . . . . . . . . . . . . 4'D (Description) . . . . . Fee . . . . . . y '` 4. Estimated Cost . . . . . . . . . . . . . .f+�.� . . . . � V. ji.7. . . . . . . . . . . _ . . . . _ . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . ... . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . .. . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Num berofStories . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . Depth 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded '. . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 1!,4. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. � � f Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . .5. Is this property within 300 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, andindicate all set-back dimensions from �toperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or comer lot. I K 'ATE OF NEW qo ff Ss r NTY O mss. . . ... 4N ��7� . . C;J. . . . �' �` �. . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) )4e named. - isthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6.? J! ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this Iiication; that all statements contained in this application are true to the best of his knowledge and belief; and that the -k will be performed in the manner set forth in the application filed therewith. m to before me this . . . . . . . . . . . . . . . . ..day f. . . . . . . . %. . . . . . 19 q2 aly Public, . . f¢. . . . . County I • I ROBERT 1.SCtI . . . . . . . . . . . . . . . NOTARY PUBLIC,State of N.Y. (Signature of applicant) No.4725089,SON*Coil Term Expires May 31.19 --- � I I I I I{ 1 \ / OCCUPANCY OR --- / USE IS UNLAWFUL WITHOUT CERTIFICATE r - OF OCCUPANCY ----- -- - - ------ -- ----- - PLUMBING ALL PLUMBING WASTE &WATER LINES NEED TESTING BEFORE COVERING �1 UNDERwgnlRs Li I�QUUI El - -- f APPROVED AS �1®TF.0 I 7 DATE: BPN o o ni__ BV y. V 'I FEE' • Sh .L i NOTIFY SUpLDIN6; DEPARTMENT 765-1802 B AM TO I - --- --- - - ---- FOLLJiro'IIVG INSPECTIOPTHE M FOR 1. FOUNDATIOPJ - TWO REQUIRED - Z ROUGH - FRAMING R PLUMBING -- ---_-- 4. OF FINAL - CONSTRUCTION C 0TION MUST FINALCOMPLETE CONSTRC -- ALL CONSTRUCTION SHALL MEET tf I THE REQUIREMENTS OF THE N.Y, J"'' PLUMBER CERTIFICATION STATE CONSTRUCTION & ENERGY P s CODES. NOT RESPONSIBLE FOR ?,, MooPPSrhditIsund ON LEAD CONTENT BEFORE DESIGN OR CONSTRUCTION ERRORS Pbone 477-0400 g,,; Mai R03L1 forwowdiskibuting CERTIFICATE OF OCCUPANCY oySbm,piping*MII be SOLDER USED IN WATER ofvp"s2 Lon GREE:NPORT, N.Y 11944 SUPPLY SYSTEM CANNOT EXCEED 2/10 OF 1%LEAD. -� rz - �rzC_F�;--. i�we E�Evl�ilot�S f G GHW E -- - - - =i Sir o Ty EnA�cu W To W FU.t NEW Vcxcm� FoSc Nrw Sra,A vcu. �(D00 N II I L I D I o 6k },liT( ...' I d b 1 6 10' M I KI l 2_UL • a u l l L 1 - ' �_ ILI -9+ DINFNG I w ' I,y a I q it I I ♦ I tY i - r I L -n . 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