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HomeMy WebLinkAbout29875-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30112 Date: 03/30/04 THIS CERTIFIES that the building ADDITION/ALTERATION, SLocation of Property: 1145. HENRY'S LA PECONIC (HOUSE NO.) (STREET) (HAMLET)'. County Tax Map No. 473889 Section 74 Block 1 Lot 13 Subdivision - Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 3, 2003 pursuant to which , Building Permit No. 29875-Z dated DECEMBER 3, 2003 was issued, and conforms to all of the requirements of the applicable L.. provisions of the law. The occupancy for which this certificate is issued ... is DORMER ADDITION AND "AS BUILT" ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. CONSTRUCTION CERTIFIED BY REGI WIELE, ARCHITECT ON 12/12/03 . .' The certificate is issued to JOSEPH L & CAROL LYNN BETTY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 1193508 03/08/04 PLUMBERS CERTIFICATION DATED N/A ut riz d Sign tore 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 lio 29875 Z Date DECEMBER 3 , 2003, f i Permission is hereby granted to: JOSEPH L BETTY & WF 1145 HENRYS LA PECONIC,NY 11958 for DORMER ADDITION (REPLACES BP#9300) & "AS BUILT" ALTERATION TO s DORMER AS APPLIED FOR. ADDITIONAL CERTIFICATION MAY BE REQUIRED. q � r at premises located at 1145 HENRY' S LA PECONIC, County Tax Map No. 473889 Section 074 Block 0001 Lot No. b13 T I pursuant to application dated DECEMBER 3 , 2003 and approved by the a Building Inspector to expire on JUNE 3 , 2005 . ry Fee $ 300 . 00 rl Authorized Signature ORIGINAL Rev. 5/8/02 FO'Rn NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTH'OLD„N, V. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE.PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED}” O 9 �o Z Date .... . ::, 19 Permission is hereby granted to: ... I�.a D ........... -.................... to JM ..... .. . ...... : .. .. ;. ......—........... .:... ............................................. of premises located' at .... D 8 .#: I................................................... t ''D C ............................................ . .... .... ..... ....... . ............................................ ......... ......... ....................... .... pursuant to application dated .. .. •••••••, 19�..:, and approved by the Building Inspector. 4100 Fee $... .5.. ........ ............4w-V1 -� .....,. .....„., ....... Building Inspector, ,' w . r f _ IM1 _ 4 { - Form No.6 I°IAR ! U 3 TOWN OF SOUTHOLD BUILD ING DEPARTMENT tr WN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installationsb 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,budding and unusual natural or topographic features. 2. Aproperly 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. i C. Fees 1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25,00,Alterations to dwellang$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$15.00•• � __''� Date. 2oj 1'O AN to New Construction: Old or Pre-existing Building: t/ (check one) r Location of Property: (4 J ��V� S LAW- artl CJ House No. Street Hamlet Y Owner or Owners of Property: &R 40� cz;(fl� Suffolk County Tax Map No 1000, Section .4!JS Block ' Lot -40447 �3 Subdivision "" Filed Map. Lot: 1 Permit No. 2g�T5� Date of Permit. Dec 3103 Applicant: Vw:i 6yLI 400 tucrlt_7• 1 J Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ trek GG Ap 1 ant Signature i BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by JOSEPH BETTY JOSEPH BETTY 1145 HENRYS LANE 1145 HENRY`S.LANN 'i PECONIC, NY 11958 PECONiC, NY 1195 ' j Locatdd'at 1.,1.45 HGNIRY-SL ANF—,PEGONLG,KY41.958 i Application Number: 1193508 Certificate Number: 1193508 1 Section: 074 Block: 0001 Lot: 013 Building Permit; 298752 BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of S electrical devices and wiring, described below, located in/on the premises at: a Basement,Fust Floor, Second Floor,Outside, A visual inspection of the premises electrical system„limited to electrical devices and wiring to the extent detailed r herein, was conducted in accordance with the requirements of the applicable code - and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 8th Day of March,2004. Name. QTY Rate Rat u CircuitType Miscellaneous as built-whole house-1977 defects removed' r self contained spa with dis. 1;975 NEC Appliances and Accessories BxhaustFan 2 0 F.H.P. -. Range 1 0 9.8 KW Furnace 1 0 Oil Wiring and Devices Receptacle - 47 0. General Purpose Switch 30 0 General Purpose Fixture 12 0 Incandescent Fixture 6 0 Fluorescent _ Paddle Fan 3 0 GFCI Circuit Breaker 1 0 50 amp Pool/Spa Receptacle 4 0 GFCI seal Service Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. zJ�cII�Ic�clrJ�r11r?i�c t�rJ3r�rPclrJ nr�r�rm rnrJ�rJrJ�Pr�rPrJr�rSarPNPLrSlPfflJ--d3 ac it i i�rJ�cla rr clrSc�PrJ�c lcPrla�Pc fr�cNcPrP rr -}. @' C CPLI�f[PGI[P[I[-�@PC[I i:3 j pr PLrEff ill IAC I[I�GP[fLI��CJ�fC fC fCi Vflii V 01C.I�C111.11 Clo[ 11111fCPCIS[jrL3 nL rL3rEJ'CJ'LI@PCnLfCJCfa[I�CPC n[faCP[f U BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 ' 5 CERTIFIES THAT i Upon the application of upon premises owned by JOSEPH BETTY JOSEPH BETTY , 1145 HENRY'S LANE 1145 HENRY'S LANE PECONIC, NY 11958 PECONIC, NY 11958 1 i Locbted at 1145 HE-41RYS LANE-PECONIC, NY 11958 Application Number: 1193508 Certificate Number: 1193508 Section: 074 Block: 0001 Lot: 013 Building Permit: 29875Z BDC. ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement,Fust Floor, Second Floor,Outside, { A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard I promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to,be incompliance therewith on the 8th Day of March,2004. j Name QTY Rate Rating Circuit _TYDe ' it Phase 3W Service Rating 100 Amperes 'Service Disconnect: 1 100 cb !Metersc 1 An as built visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation,is `.' !believed to be in comformance with.the applicable reference standard for the estimated period,of construction of the premises wiring system. "Defects previously reported,asitems of non-compliance,have been corrected. A visual inspection made of the exposed electrical equipment in the premises indicated found no obvious unsatisfactory condition. i seal I . Sri I 2 of 2 I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I n[1cl�[l�Pcl�cl�rncl[P r�CJ�c3r�[1c1 [Pc farJ�[1[nc l� [ncltlSCPcJ3[![l�r�[P[J@totPc{�rd [J�[!a[J�GfacPcfrJ�CI�[IrPCf� regi weile architect R 3 ' DEC 15 2" 22 east 22nd street • new york 10010 i 212-982-4884 i� ,�,�„� � „ r,ar box 223 • east marion, new york 11939 --- ,�:m'rgC]la "j-j 631-477-9735 12 December 2008 Southold Town Office of Building Inspector "Town Had. Southold,New York 11971 RE: Permit#298752 `GTAA 36&"Z4 -013 _ J. Betty 1145 Henrys lane Peconte, New York 11958 Final lnspeWon; To Whom It May Concern, This is to certify,that to the best of my professional knowledge,the Scope of Work related to the above Permit,for the addition of a Dormer and related work has been completed. Construction work related to the addition of the Dormer including coordination and reinstallation of items of Framing,Insulation, Electrical, Plumbing and Ventilation have met all Government Code requirements. Fire Underwriters Certificate will be submitted under separate cover, If you have questions related to the above Permit and or inspection of completed work please do not hesitate to contact me. Respectfully, DA C- F is ��r`ch' qtr u m � 77921 r_R r�� BY THIS NOTICE OF DEFECT THE 8W YORK BOARD OF FIRE UNDERWRITERS Fi3 7 ` R BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 ( TC3t"✓�J flf S�SUT i�3I�. j on tTie.'apphcadon of upon premises of I JOSEPHBETTY JOSEPH BETTY 1145 HENRY'S LANE 1145 HENRY'S LANE PECONIC,NY 11958 PECONIC, NY 11958 Application Number: 1193508 Located at 1145 HENRYS LANE Section: 07131e Lot: 013 Building Permit Number: 298752 Regrets to advise that the electrical.installation of the statedpremises�i"m� 'n compliance with requirements of the reference standard as set forth below: Item Location . Description Reference Std. DISCO NNE, - o spa disconn ct 680-12 NM-conductors Porch/Deck expose conductors in wet 336-4(a) location GFCI 1st Floor kitchen counter gfci missing 210-8-6 i This notice of defect is issued by: ROGER RICHERT on the 12th day of February, 2004. ns11 SOUTHOLD,TN TOWN OF SOUTHOLD P.O.BOX 1179 SOUTHOLD,NY 11971 Paae 1 of 1 1 FCFCH EEIRM #1 , KMEN MUM elcs N cim FEIUCM #2 ISVIIB RCM c cs ED M`S I REc Ar?, or, cics ' ¢t ti Sp 1.1921 Q oft4eNyo FR2E EMM a MUM #4 tics BST4" #3 dzyml cics cic TOWN OF SOOTHOLD, PROPERTY RECORD CARD JR, OWNER STREETf1VILLAGE DIST. SUB. LO) / T ..t.; °.` ` U,p-1C:;_.' cj ' e. A.r 4d 4 �. ,t: `. c,, .'� / .C' Z! F P`. /�'7' � )•°a'.t �" FORMER OWNER N E ACR: S W TYPE OF BUILDING _ i M r d (w 7 6 ZES. SEAS. VL FARM COMM. CB. MISC._ Mkt. Value LAND IMP. TOTAL DATE REMARKS,QZ ,6 , IJ Olt / co Cy y, e s �i� _ D stirdw e _ CC. �_ � ooc; WQ,Lf, .' aa. /39 fsCrap _idea6 Qr _ 760 S56,0 7e� 59 s" �.. . r w.. _. U B1NGVtONDITI vz� NEW R AIS FLO �B �f3S /3,f' /'/kr�/°�`� � .=-uG +f� �a�drl` I` /qu a ✓ Value. 7/ /So 7,1 co-a Sfr. o%cfzlaa v f,% x:' Tillable 1 tillable 2 , :. Fillable. 3 . Noodland r,w• iwam`pland:- " ' "' FRONTAGE ON WATER 3rushland - -- - - FRONTAGE-ON--ROAD-—— - -_ louse Plot DEPTH BULKHEAD Foto DOCK . . ■■.■■.. .■■■.■■■■■■ ■s■e■® „/ ■■.■■ ii■ri�u■n7■..■■■■■■■■.■■ ■■■■■�■ ■■■■I■■■.■■.■■■■.... C ■■ ..C.G�CL.■... .■..�■■ • :: .■ ■■ .C'.®■■■■ ■ ■..■ No �■ ....e eer■...■ ...■■■e■.■ .... lio..■... ■■ ....■■ ■■■■■■■ ON ■.■■.�.■ ■....■ ......■ ..�.■■..e■. �■�ot�® asement • xtension ®�■�■Ext. Walls h orch Dormer • ,�_Driveway . ` aUk'PDLN CCDryT RF 1A 1 bZPARfMEN4 REF. "< \ 'bo semape d'SPosal and waten..e.PP Y $da,(2,it{6 por Lhia lDoation IT beaD V to b, oats pg ocpy gpart"'t and found. Y, _ a � to be'satis8actpxy. ""'' 11 t�TiE"eE\NI C§Set of GServioea g3Deanieg 1\V t o oAe P � i e�2 a T� w 1 w 4s ' PtYP 0,� r 4 £L lY O 9888 Ex'AP 0 6 � 16 II ."s 2 as F9< c ko s F @l 9v �C h MSD° `, RMMON5 YOUNG & YOUNG tJ 00L4/976 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK EN W YOUNG HOWARD W,YC pCs9q E xefq IN LAND 9'RAYIjTp16 6 ti9fivvredA.N S.(9c.kDA 93s1r c. wvxDnxmxx hN A9h IDE w SURVEY FOR; or AY/TE: rx a..' A n x Ar.E.oE /N'sT CDN,ST�UCT/DN CDRR 8 6+.5 { .=MONUMENT u. x e oN tt E 9wx DDT NCI./D�P�CDN/C NOME ,SPR- K'./, 0 6p .SUBD/4'/S/ON NAP FRI OINTNEOF'FTCE S OF 7NECLERKOF TFOLK COVATYON ac wrxi Nu r reixh Y LCL 14 1064 AS a.-NO..4181 E LAND mxVEmx•9 MAO%NAL 0 xmsm xu mux xm EE mxeme.m ELEYAT/ONO ARE REFERENCED TO AN TD aE,9 VALID TARE wr AT LAA 109 PECON/C A.59UNEO047UN. a.nurcEe. TEE xEnEax NHEE wx E SADiq . Dri :.Y t0 tNE PNAADM PoN.NE THE y`L1WN OF Etryr9�No� A (L(Nbl aE LOCATION OpNELZS T.'"^':E--l'S smimHv 71111 , mhx NsscxAL JVV s _HD "'vNXEREfX ARN FROM.:. -'"-"'A,I ro THE r nr o e xr awENHxE`�i D ^FIM bATAO$TAit.'�. ...i XmExti pN¢To r rq _ I: Ehx,uw m A E a rxr SGFfOLK CO„ 1$E EOCAP)ON OP WELLS AND CESSPOOLS Eexh N. N9ri x au ' BROW..TT NSREfR AAL PROM FfELDOeSERVATLONX N6T raANEFANA0LE rDA roxa( 84ALE: GATE• NO,., 7k. ANO/OH PROM DATR OETAfNSDFApjd,R}JLEAS I DN a9.M.E awR.E. /��40� j� N. 7i 19U BUILDING DEPT. lNen-'ECTION [ ] FOUNDATION 1ST ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION r [ ] FRAMING [ ] FINAL REMARKS: roxi /J d n P1 e .7 K, DATE �� C INSPECTOR/ � 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ } INSKATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARKS: - _ f r a i r DATE l`/C73 INSPECTOR I. FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) \ xr ------------------- ------- FOUNDATION(2ND) _ p� i 1 . d ROUGH FRAMING& y PLUMBING w .'c INSULATION PER N.Y. STATE ENERGY CODE I' n ` _ t FINAL ADDITIONAL COMMENTS 01 `-1 0 Z m z I 9 �rm rm wr. x Hd TOWN(=F,SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following;before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631)765-1802 vainv" �g87S Planning Board approval FAX: (631)765-9502 Survey www. northforkmet/Southoldi PERMIT NO. 9300 Z 6/10/77 Check Septic Form N.Y.S.D.E.C. Trustees Examined 20 Contact: Approved 20 Mail to: Disapproved ate �} I Phone: 12 Expiration 20 r zi 1't 2 1'"R i Building Inspector } 20w I N t APPICTION FOR BUILDING PERMIT r Date 1 D=di,ar 03 120 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 waterways. 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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted is the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months. Thereafter,a new permit shall be required. 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 inspections. (Signature of applicant or name,if a corporation) IU Bcm 223, Fast N1zim, NY 11939 (Mailing address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eler7m�jkEG/Aq'�e' N, uilder wile ardiitect M Name of owner of premises ics2rh patty (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officerOF (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: Henry Earl zti, House Number Street Hamlet CountyTax Map No. 1000 Section Block a rn, Ixta013ss k Subdivision Filed Map Nof,, (Name) - 1A 2_ Stale,existing use and occupancy of premises and intended use and occupancy of proposed 84frucfion: a. Existing use and occupancy 'nesidert a1 I b. Intended use and occupancy m die 3. Nature of work(check which applicable):New Building Addition xx Alteration Repair - Removal Demolition Other Work (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units cm Number of dwelling units on each floor If garage, 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 36 Rear 1 Depth 24.1 Height 20, Number of Stories 1 -5 Dimensions of same structure with aiterations'or additions Front rr,amp= Rear :Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 3. Size of lot:Front 121.58' Rear 122.21 Depth 195.63' 10.,Date of Purchase 1975 Name of Former Owner Nil 11.Zone or use district in which premises are situated R a 12. Does proposed construction violate any zoning law, ordinance or regulation?YES_NOS_ 13. Will lot be re-graded?YES NO x Will excess fill be removed from premises?YES NO r 14.Names cf Owner of premises E d+. Address Famr,Iem Phone No.631 7652610 Name of Architect :4 -ILQ . AddresseastRBnajPhone No631-47/9735 j Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO--x— * -r*IF YES, SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? *YES NO * IF YES,D.E.C.PERMITS MAY BE REQUIRED. rl 16.Provide survey,to scale,with accurate foundation plan and distances to property'lines, 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. r STATE OE 1�tEW Y9k COUNT E being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, a � � r' (S)He is the�4'"rs lu'b`t k,a F- _ (Contrador,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 bis knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swore to before me 's 1 day of 20 All Ig i NotaryPublic ignature of Applicant LYNDA M. BOHN - NOTARY PUBLIC,State of New York i' No.01 1306020932 t Qualified in Suffolk County Term Expires March B,<D i -- �� F Wo I TOWI VVF -SOUTHOLD F BUILDING DEPARTMENT _ TOWN CLERK'S OFFICE '�LCI%1-1 7 SOUTHO,L�D04.. Y. Examined �.�...:.., 19,71, `" ` __ , f`�Sf Application No: 41: L a Approved .....5. .. l 197 Pemlt No © ....... Disapproved a/c ........ . ....... . ........ ' ., ...................... ............. ................. .. .... Building Inspector) q { APPLICATION FOR BUILDING PERMIT i Date ............. .......... ........, 14 :.._. h INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to. the Builkling Inspector,.with II. 3 se¢s'of :plans, accurate plot plan to scale. Fee according. to schedule. b. Plot plan showing location of lot and of buildingson premises, relationshipto adjoining premises orpublic;'!streets or areas, and j giving a detailed description of layout_of property must,be drawn on diagram which is part of this application. `c. The work,covered by this application may not be commenced before issuancL"of'Building Permit. I - d. Upon approval of this application;.the Building Inspector will issue a Building Permit to the.applicant.Such permit shall be kept on the premises.available for inspection throughout the work.:, ` e., No building shall:beoccupied or usedinwhole or inpart for any purpose whatever until a Certificate of Occupancy shall have been i 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,for6the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lauds, ".ordinances,building code,housing code.,and regulations,and to admit authorized inspectors on premises and in buildings for ri�cessary inspections.- 72 (Signature of applicant,or name, of a corporation)'r .................:"�,*s.i,-::'�:xro (Address of applicant) 11.tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. s'".'..b'��« z 4'L 9"ed.,�% =4 w,3 tax" „„. i .................. .............I...... ............................... ame of owner of premises ...... ? a . .=.%,/....................................... ....... applicant is torporate,signature.�o„ duiyauthorized-officer. (Name and title of corporate officer) Location of land on which proposed work will be done.Map No.: ..... ......... Lot No. ............................................. Street and Number ........................ d j ... ... A. tai ...... . ^ . Municipality 2. State existing use and occupancy of premises apd intended use and occupancy of proposed construction: ,y y a. Existing use and occupancy ........ ,.r. `a .. „f t ' r ?.. . ....... .............................. b. Intended use and occupancy ............ „I .., .. •..••:.......................... . .... ..... .... work (`check which applicable): New Building ....................... Addition ..................... Alteration $. Repair :...........:............ Removal ......................... Demolition........................ Other Work .................................... (:Description) �4 'Estimated Cost .................. ........ Fee ... � .:........ ..... �l f (to be paid on filing this application) If dwelling, number of dwelling units ........ Number s?1 dw�IGng units on each floor �., ... . .I garage, number of cars ................... ........ . ......: . .\......... . ,.... . .. ......... .......... i �buiness, commercial or mixed occupancy, specify nature and extent of each type of use ilmensions of existing structures if any Front ?:, .... Rear Depth ° .... ..... 17,094. ......... ..... .... ............ . ..... Number of Stories .. ..... ...... . .. ...................... -ti`-grisions of same structure with alterations or additions Front .41 ,........ Rear 17 h )gip. ................. . .................. Height...... ......... .............. Number of Stories ....: ........................ tfnsions of entire new construction: Front ......................... Rear ..... Depth ......,.......................... t : ', (it .. ................................. Number of Stories .............................. .............................. Willot. Front ...................................... Rear .......................................... Depth ...... ...................................... dight..................................................... Number of Stories ........................................................I........................ .of Purchase Name of Former Owner ..........:..................:................ � # . Dior use district in which premises are situated ........ .......................................................... ............... Jpjioposed construction violate any zoning law,ordinance or regulation: .............. ........................ be regraded ..............................Will excess fill be removed,from premises: [ ] Yes [ ] No of Owner of premises ...... ... ... A.. ...,.... € (Address) (Phone No.) pf Architectdre.... .................................... >1 ,,r r, (Address) (Phpne No f Contractor ................. .s, ..rr� t ........ (Address) (Phone No.). PLOT DIAGRAM by tete clearly and distinctly all buildings,whether existing or proposed,and indicate all set-back dimensl, nsfrdrn pernes. Give street and block number or description according to deed, and show street names and indicate n* r(oi corner lot. i I S-,ATE OF NEW YORK, ) SS CtL1NTOF )- .... ................. being duly sworn deposes and says that he is the,applicantabove named. (Name of individual signing con/trt) ! � T®�L- ......... 1! FIx 6s the ... ..... /..... (Contractor,agent corporate officer,etc.) j 0 said owner or owners, and is duly authorized to 1 y perform or have performed the said work and to make and file this application; that all st' KemAts contained in this application are true t the best of his owledge and belief; and that the work will be performed in the manner 1 s fiprt in the application-filed therewith. MARY E. DA4YSON - NOTARY PUBLIC, Slate or New Y t J y ....... .. / ........ 19 ./....(...... 52-464372 XPiSu`tolk Co: .......da of ... (J/7 Na.JAMI Expir S rc 3D O . Ijl,otary Public. ................ ... . .. .....:..:........ County ........... (Signa r ofapplica Hyl lye,- e7 1 v( of 1( , . -.., � + l Ji 1300 A4PPjRt &Vs 70 B IL .t. �ddPi$��f iBd31� 1� DEPAPTA AT 4PM PSR RE=R- Vc,"FILLIN(", wO,', aDA 3 ItEFCSiFR CCA �P, S6SP P 9".° CAP AN Pa3�,lA4 +Ad°{SSI 300 Cn' 4PLETE® � �• 9 Y � �Q��� �� <���� jl� � 'r PEaP(A6B . Sii3LE FOR DES&CsPJ 041 CONSTRUCTION ERR.OPS CONSTRUCryloN MUST MEET _ — e rgSTSr'p pNgn.Y. STATE CODE 4 p '