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HomeMy WebLinkAbout19428-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-24092 Date DECEMBER 21, 1995 THIS CERTIFIES that the building NEW DWELLING Location of Property 1020 PARK AVENUE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 56 Block 1 Lot 2.17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 24, 1990 pursuant to which Building Permit No. 19428-Z dated SEPTEMBER 28, 1990 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 & WOOD DECK AS APPLIED FOR * The certificate is issued to JOAN FRANCES PAVLAT (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-109-AUG. 11, 1993 UNDERWRITERS CERTIFICATE NO. N-221878 - JANUARY 27, 1992 PLUMBERS CERTIFICATION DATED APRIL 28, 1993-PEC. PLUMBING & BEATING *NOTE: THIS UPDATES CO Z-22540 ISSUED ON 8/19/93. l i , Building nspector Rev. 1/81 FORK 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) NG 942 . Z Date ......./��� ................................ 19 a Permission is hereby granted to: ......... . ...... ... ..................... to . 7- /Of ........`�✓......... . .. /-ok.................... ... . . .... .. .... ..X�f/'4dat premises located at ....../...Cl. .�...... .... ...................................................... ........................................a °.... . -.................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ......� ? ..... Block ........?/..... Lot No. ..........1�..!Z.7 pursuant to application dated .......:(. /��..11 . ...............................1 19.G.�, and approved by the Building Inspector. � Fee $••• J•lt..s�' ildin for Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22540 Date AUGUST 19, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 1020 PARK AVENUE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 56 Block 1 Lot 2.17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 24, 1990 pursuant to which Building Permit No. 19428-Z dated SEPTEMBER 28, 1990 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 AS APPLIED FOR. The certificate is issued to JOAN FRANCES PAVLAT (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-109 - AUG. 11, 1993 UNDERWRITERS CERTIFICATE NO. N-221878 - JANUARY 27, 1992 PLUMBERS CERTIFICATION DATED APRIL 28, 1993 - PEC. PLUMB. & HEATING P6ildifig Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL '65-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1 . Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of li lead. 5. Commercial building, industrial 'building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "Pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancv is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1 . Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00 , Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .Qec. .21, .1995 . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . . .1M .Park.Avenue. . . . . . . . . . . .Southold, .New .York . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . .1Qa0 .fra0Qe5 .pavi(A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . .56 . . . . . .Block. . . .1 . . . . . . . . . . .Lot. . .2.17. . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. .19428Z . . . . . . . .Date Of Permit. . .9/.28/90 . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Updated Request for: Temporary Certificate. . . . . . . . . . .XIAXV,* Certicate.XX . . . . . . . . Fee Submitted: $. . . .50.00 . . . . . . . . . . . . . . . . . . . . 1 I _ / &-,-��° �+- S�e 0 612— �.���? . . . . L. . . . . . . . . . . . . . . . . . . . . . _A'T CLIzU4 Q 0t'�4 0 1J_ APPL T r Form No. 6 n._,....."'� ` - TOWN OF SOUTHOLD F s2 BUILDING DEPARTMENT ! Sf� TOWN HALL p TIP 9 1 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY �• 27fT§ 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 Annrovaj from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3•XApproval of electrical installation from Board of Fire Underwriters. is4. worn statement from lumber certifying that the solder ysed in system contains less than 2/10 of 7. 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. ' 3. For existing buildings (prior to April 9,"pre-existing" land uses: 1957) non-conforming uses, or buildings and 1. -Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 'a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate .of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $J115�.>0/0, Commercial $15.00 jn x Date . . . . . .NJl.C1.� ?.l 04 l`l_ 3 'w Construction. . . .!, • , , , , Old Or Pr exinsting Bluiildi/n ' ) 77-7/ �� n ,cation of Property: . . . I r)2 0. . . . . A.��S ; .�V !N,Q House No. Street 4. . .' . /� Hamllet - wer or Owners of Property. . . . . ,-fo,4ff J. . . �I �A V LK1 I unty Tax Map No 1000, Section. . . . . . / . . . . . .Block. . . . , . L��'� .� . . . . . . . . . . .Lot. . . . . . . . . . . . )division. . � Sf;� / � ,Filed Map• , , , , , , , , • Lot Date Of Permit. . ,/„f; /,hJ. . .Applicant 11th Dept, Approval B .. :>l.:,�. Underwriters Approval. . . . . , inning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . west for: Temporary Certificate. . . . . • y • • . . . Final Certicate. . . 11. „ o Submitted: $ c 15, / C6 -Z�05 D APPLICANT . . . �O��EFO��COI/ TEL. 765-I 802 TOWN OF SOUTHOLD .c OFFICE OF BUILDING INSPECTOR P.0. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date!/.��f%6 Building Permit No. / / Owner �JL��I T h1 V L /� (please print) �v Plumber J�PI�����s/7�.U/h/�y�NC/'i `(please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ( u er ' s ignature) Sworn to before me this day of 19lJ �� i Notary blic Ilotary Public , L � � L County Noq pIb1814 a SKI 52 Commis 6&dl*County �. Sept.30, ' 1 = THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 • 1001071. BUREAU OF ELECTRICITY F— 88 JOHN STREET. NEW YORK, NEW YORK 10038 Date JANIJARS 27,1992 Application No.on file 72687691/91 N 221R78 THIS CERTIFIES THAT ;€ only the electrical equipment So described bolos and introduced by the applicant named on the ubote application number in the premises of 6 JOAN PAVLATT, 1020 PARK AVERGE:, BOB KEHL JOB, SOUTHOLU, N.Y. �ry 1�--7� �] GAR/ATTIC/OUT. in thsfoDawinp kRcation• y gge�e t L'"I [At FI. LJ Ynd Fl. .Section Block Lot ilia JAN�ARX 16, �2 was examined on analfound to be in complienrr with the reyuirements of this�Boord. _ FXTURES RANWf COOKING DOCKS OVlNf DISH WAfh1M5 EXHAUSJFA�N�Sl— RXTU111 OUTLETS At' f1MITCMRNCANDESCENT FLUORESCENT OTHER HAT. K.W. AMT. K.W. ART. K.W. ART. K.W. AMT.44 6 4b ] 3r).] 7 1 . 2 6,FURNACE MOTORS IUTUR1 APPUAIM RMDEK SeEC1ALRRC'ET TIMIECIOCKS EEU UNRM4,TERf MMT14UTIET DIMMAMT. K.W. On M.P. GAS M.P. ART. NO. A.W.G. AMT. AMr. AMC AMPS. TRANf. ART. M.P. o.OFART. No.OF RRi 5 E 1 30 1 a SERVKZ DISCON NICT No.Ca S E It pp�� V I C E _ ART. AMP. 1TR SIR 11 tW 113W 7/3W SX AW �'PEM%COND. Of c&&ND. NO.OF MIAEG DF'MI IRO NO.OF NEUTRALS OF NEUTRAL 1 200 CH ] x 1 4/0 ] /O WHERE APPARATUS. G.F.C..I;-7 SMOKE DETECTOR:-4 s — a tw — G & S CONTRACTOR LIC.#578F BOX 215 SOUTHOLD, NY. 11971 OENOM MANApM 11 TV Per This certifiuob most not be abated in any manner; return to the office of the Board if incorrect. impactors be identified by their credentials. - FOR NIILSING DEPARTM!lIT.79Ni COPY OF CERTIFICATE A�fT NOT ALTlRiI�MI A111f MANNER. 76s-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ SULATION [ ] FRAMING ( ] FINAL REMARKS: -�-` i i i DATE INSPECTOR Aa4� �D M-1802 � a S BUILDING DEPT. 3 • D i NSPECTION�' 39 [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION ) 2- [ ] FRAMING [ ] FINAL REMA KS: qo oaf DATE 4 2 INSPECTO ��-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE �� O INSPECTOR 765.18022 BUILDING DEPT. INSPECTION [ ] FO DATION 1ST ( ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: - .. DATE INSPECTOR M-18a BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND I INSULATION [ ] FRAMING [ ' INAL Ca REMARKS: DATE INSPECTO 765-18W BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ROUGH PLBG. [ ] FO DATION 2ND [ ] INSULATION FRAMING ( ] FINAL REMARKS: y DATE INSPECTOR II / '��. / / FOUNDATION i \ • • • � IL/J� i�2. M. 'OUCHSTATE ENERGY cn 3 . INSULATION PER N . Y. 4 . Elk -- - - FINAL i ADDITIONAL A AVOW/ - ORN NV .a. �l SITUtm E A+ SOU SUFFUL(c: CC)UAV-r Y, N-'s . —.—._ Unnshorra!aherethn or eddhIon to this 9W.W b a vleiaon of Section 720e of th,tbeYatl Side Edumtllt Laos. CaDNie d 1hM Lnnvq mR not be"rirt@ the Ind"MVVWS Mud on"or ;;WNEv_ -DE VcLGPt!iii_! Y . wnemeadted shdt not be coed Y yi t_\N' LAND tebadsapdi V• t3A p�eto Ntmmullep ad tureen AMn 0 S nin I?Q M,INFC}( ,A B7ULFVAi. ii 1.pmt tsaido ponm tilor ebd*""the I propated,artd on tale b,h"a to the 11501 t a0"�°"v a0"P""M11°I°9°"nd"°d tenting hrtft Mm Neled hereon snd to the male,,,,of a»tending imd- tutMan.au,rants,,are not transferablo to atdiiimmv institution w subepuent SCALE ' 100'- I" ----100 --------2C70 9Q0 A2EA 31.Q i _ACIc'E_:� ' I, l'rIE. WAt ( ._v' _.. - THL_ G� T VIL_A�r= f NO LUi ON THIS MAP ri-iL w i L .� i - _. F ALL : i-t _ �• 'F w� t?OOOO SQ, FT. fN A2EA, G 1=F .INUIVIL UAL) L : F:DQA. J . __. .___._. _ "'�.Y WI ' r+ NI :IAI�. '.�:. i- t• SAVE BY US F2OM __- -- -- - - TEU NOV. 15,1 77 - -- - - - GLt''1 r r1t At. i --i D THAT CONC U �F --- — SET AT PUINTS CNUWN A TUYL P.0 r _ t. LfNp cI- - NL SUQVEYOQS WILL APPLAL_ ON 7 HE � _' `- _ _ Tv Vv LA.vi',j. v_r f :_ •. _ -1AP IN DI�—Trjc IpO) CECT. / BLOCK-T$ l_756`BLDCK. I. 7����� !kvN MT OF HEALTH SERVICES P-ElJ15E11 -, Ig79 CAUG 2919�51 --f arrangements for water supply 'DOD vith a total of -24 Ictlt its approval shot be valid only id ily filed with the County Cark `iling of the map on which this the County Clerk in accordance h Law and the Suffolk Count$ z ` r. ,entol Health ` i Y FlLU15HEU !=RAPE S�f�� i k STATE Of NEW YORK, COUNTY OF SS: STATE OF NEW YORK, COUNTY OF Ss: On the 7 V7�_ day of //� � 19 before me On the day of 19 before me personally Came (( personally came Conway B. Mc Mahon Lynn C. Mc Mahon to me known to be the individual described in and who to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that executed the foregoing instrument, and acknowledged that executed the same. executed the same. No ry Public dFr�A E t1 / ry1 y STATE OF NEW YORK, COUNTY OF /� �/ / t L /ss: STATE OF NEW YORK, COUNTY OF ss: On the day of II��JJ 19 before me On the day of 19 before me personally came personally came to me known, who, being by me duly sworn, did depose and the subscribing witness to the foregoing instrument, with say that he resides at No. whom I am personally acquainted, who, being by me duly sworn, did depose and say that he resides at No. that he is the of that he knows the corporation described in and which executed the foregoing instrument; that he to be the individual knows the seal of said corporation; that the seal affixed described in and who executed the foregoing instrument; to said instrument is such corporate seal; that it was so that he, said subscribing witness, was present and saw affixed by order of the board of directors of said corpora- execute the same; and that he, said witness, tion, and that he signed h name thereto by like order. at the same time subscribed h name as witness thereto. 36aTgain anb #Dale Meeb SECTION 056 WITH COVENANT AGAINST GRANIOR'S ACTS TITLE No. =1 7 C-. _ / BLOCK 01 LOT 002.17 TOW Conway B. Mc Mahon Lynn C. Pic Mahon COUNTY OR TOWN Suffolk TAX BILLING ADDRESS TO JeQn Pavlat Recorded At Request of Ticor Title Guarantee Company RETURN BY MAIL TO: Ms. Joan Pavlat library Lane J� Plaineview, New York 11803 TICOR TITLE GUARANTEE Zip No, 0 V Z is K O V W 0 Q W n 7 6' Q V Q N _ ` W 0: N Form 8002- 8-87-20NT—11,1116o i"ul salr D. d, with Cn{'rlllplt against Grantor's Acts—lndivldual or Corporation. (niogIt she,tI CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. 10969NJ46 / j0983 THIS INDENTURE,made the day of 17j-e,-<Y�tt , nineteen hundred and eighty - nine BETWEEN CONWAY B. MC MAHON and LYNN C. MC MAHON., Residing at Pipes Neck Road, Greenport, New York 11944 party of the first part, and F, JOAN� PAVLAT, Residing at 1 Library Lane, Plainview, New York 11803 party of the second part, WITNESSETH,that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the SEE SCHEDULE A ATTACHED RECEIVED REAL ESTAIE Nov 20 1989 art TRAi,iSFER TAX SUFFOLK Cr tiIIr • �uUY t[�, 1r 4 V� TAX MAP DESIGNATION D'st TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and Senor/ roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances ` and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of f31 n �0� the party of the second part forever. AND the pares oy,��e.fazci.pack covenants [ha[ the party of the first part has not done or suffered anything whereby_.4,s4j&prarwiSes,Wve been encumbered in any way whatever, except as aforesaid. AND the party•of the fir�j,p��t in compliance with Section 13 of the Lien Law, covenants that the party of the firstY tP iy ecpive I Amisideration for this conveyance and will hold the right to receive such consid- eration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above ,. I written. IN PRESENCE OF: p- /{ Conway B Mc Mahon LYnyf C. Mc Mahon D LS Ua L5 U BOARD OF HEALTH PLNS Q• K _ I ►I FORM NO. 1 3 SETS SURVEY . . . . . . .0.}�; • '( TOWN OFSOUTHOLD CHECK . . . . . . .fF,7,YF , . . , BUILDING DEPARTMENT SEPTIC FORM . Q-.K . . . . . , BLDG.DEPT. TOWN HALL TOWN OFSOUTHOLD SOUTHOLD, N.Y. 11971 NOTIFY , ��G TEL.: 765-1802 CALL 2 . . . . . . . . . . . . . . . . . . . . . Examined . . . . . . • • , 19W MAIL TO : qqq . � . . . . . . . . . . . . . . . . . . . . . . Approved . / .yr� , , , , , , . 19/� Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • (Bu'. ing I pectoz) 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 R"ulations, 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, housi code, a regulations, a d to admit authorized inspectors on premises and in building for necessaK 7 . applicant, or nam tf a corporation) (Ma' ng a dress of applicant) State /�w�hethheer applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. !` .!� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . (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.Q9A- rCA4iAvv" -4 Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . I• Location of land on w ich proposed work will be done' . . . ./. ou . . . . . . QJI � . . . . . U � I louse Num bcr Street • " . . . . . . . • • . . . . . . • . / . .Ham � County Tax Map No. 1000 Section . . . .©�� let Block . . , , , , . . . . . . . . . Lot . . . . . . . f?:JZ P. . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No.(N . .ame) Lot . . . . . . . . . . . . . . State existing use and occupancy of premises and intended use and occupancy of proposed construction: A. Existing use and occupancy. . . . . . .�..,r ' ,� ,� J� ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. Intended use and occupancy. . . . . ? 1�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . .Swi=I 11 , Tennis Court . . . . . . . . . Accessory Building. . . . . . . . . . Fence . . . . . . .Other Work: . . . . . . . . . . . 4. Estimated Cost . . . w la 5 00. . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.4. . . (to be paid on filing this appfiication) 5. if dwelling, number of dwelling units . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . Rear . ... . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . llcight . . . . . . . . . Number of Sto es . . . . . . . . . . . . . . $, Dimensions of entire new construction: Front . . . .7�.�0 . . . . . . Rf ar . . . .��r.rO / . Depth �Q Height . . . . . . . . . . . . . . . Num er of Stories . , . . . . . . . . . . .. : /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . fir. Rear . . . . . . .�i? .N.2;. . . . . . . . . epth 10. Date of Purchase . . . . � . . . . . . . . . . . . . Name of Former OwneraU_ 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 . . . . . r k Will exc ss 11�'eerree ove om premises: Yes ... . No . ! 14. Name of Owner of premises lA✓ Address .�� � n���. Phone No. . Name of Architect . . . . . . . . . . . t? Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . : . . . . . . . . Address . . . . . . . . 0 . . . . . . . . . . Phone No. . . . . . . . . • • - • • • . 15 .Is this property located 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, 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 NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis 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. Sworn to before me this . . . . . . . . . . . . . . . .4 y. . . . .day of . . . . . .7"" . . . . . . . . . . . .I 19 Notary Public, . . . . . . . Lt . . . .. . . . . . County HELEN K.DE VOENOTARY . : . .: . • • • • . ft 47078/9,SSuflA Nellyffik Meet (Signature of applicant) tam Expires Much l0,19� I am familiar with the rt c . a .. -I ind IConstruction Ci �, d�?i. �,y ✓ - /�/O"'E—op for Single Fan y ,,t co ine y nditions se,3toruiti 'd t; on L� ����;n;it io j eonstrucL signature �l VICES SJFF01 K GoGNTY DEPART%'ENT GF IiFAITN SER No FOR APPROVAL OF G^"�STPOGT`OPd Of a1 Farely Res e ira Gray . eia;te SQ _�Q9 DATE li APPROVED ExPIRES TiNO YEARS fFCPd DATE OF APYRG'JAL AN oy Dopt er>Wft"ervicim `V �V'` 40e 11. LEWD A t a3E ee r t JSLY Cl'AV ,&/.ty�'Fx• ✓Agl/P�9✓LAT __ /�i7.y4vY h: L�J�IfXi�:Ci� / L 164Ak / //oN� ,per /N 01'&-IV Al //fyj C��r��kcuuvc�v.�J.+Faw.v�.y1 a TOWN Z 4 Z3 ZZ h i -;F a V 1 Ljr�;9�� F',q,P.r AvE,uvE „Scitr�'/6e• ,/G39,C/.�i9✓LET ___—_____--- /�inYavY `✓ s /� GoT Z3.L.quG AgWP 63r±?Aa,AM, _-.- ------ G9 O ` 74 � C o �vrrw LatyTnr/..�v2,/yqi w9 � - - �111r••9uG.cN1/L��jb ��, 3 Bs 6 ia��uvE•v.�iJ.+Ww.v7�u1 a � �� /1 _ _ 90 so - io nuC 11 1993 S.C. DEFT. OF j HEALTH SERVICES Zy ; Z3 ZZ I ��ygC LANO3G vO J �• l.E CW*4LK CIU IN DEPART MEN 1 OF HLAftH SERVICES Z �p o &MCL: FAA Y DWFLLi* C*U �9 O � � " -_ — II,. rt .+s❑trill . :' �„i� �a70�b ter,;IFit,S FJr this lt:�':.'I 1 tbId�Bt Ou:E?r K. .1 p1'1/'" Fai lU [lv $.]byi7�4j+1dJ1�/. F Op NEW Y g9 P� Chia of Sixeeu ol Wmq"4pr h% agemOM � I ,!, o FPi1Mf — — Q h L�.vy D9ll SytIEYA4'C, ✓GJ9.C/roi9!/L.9T �9vrHovYli; Lf�A.vcl iy�ri" GOT•' TryNr RJf/D EFTA_ J /�$11p BUR✓El�'JG^ r�xevmv�er Laey�rl/ 2%�% c �uiuvcv T,r�D�a I i i; I' z- to i j; 11 �� .% �� LIN Nr i•Pu _ No �fc ca VPr j � ' NP4 Pklru( I �' i it , ✓1r ror � I - \ i _ +�� \ 1 , HE - - - - - - _ _�"- - — — OtCUPANCY OR � 1-g — _ _ U 6S UNL11lI�UL - - I kfffllCUT CERTIFICATE r �7- , � , . � __ _ — -----__._._ __.__ _ ___ _ . _____�� __�/( p , �`� ,�♦: ' qq���;a • �'F OCCUPANCY - y�j, t� � ��iYr�� �f . ^r-' + , ' _��_( � Iw` '"% �/"?.>I+,<�i! � � � Q „% � � I_ --7 .A,, � i � ' '-{�'y.)�y . CJ,( 1 �t' ,' �q� ✓ �� `t'_r.j... ,� � ' �" t l % (�� - I '��,,,,�U�./, r{ i � �.r 7.,� � I r'��..1 � �ti,/ -�...-J ��rl ,�LJ DATE: 7J ,y'�:.T" '.a �,t I,� �_�_-. I i.i f �) /J . 'i') 'J '��, -,�. f'. 5 l„ . h l✓"�,.� 1 FEE:tw �ZL�BY: } NOTIFY BUILDING DEPARTME �•f,� 1 I� �jl v.' G . }'J'n'•y.A � ! }�,dl r �.'_•� LJ W ` �-r l.�' d ; + ." I „ //'�� E.1 ,�' /` "��_ .+' • I t ''� ��� y V LS '. _� )b� /. + ; J l�f '' ✓ �" / �(.j l I 765-7802 u AM TO 4 PM F THE t�j -. >"C'w�r' Vr + .V_L? 1 ✓1�/ "�, . ty_.,111�{ 1 �1✓. _� �) 1 y .�i - ,j �', �.... _ Il 'll ��__ ./ 1 1 I �' qi. FOLLOWING INSPECTIONS. !- t l /•1 t �.w+ 14 1�-{- T� _J' M/I .' �r U' �'} ) l,.r✓ j` __r=t _P"}'`.)'" J I r ` �"' C�/ L"` .J 1.. lJ � r"7 �'�J 7. FOUNDATION - TWO REQUIRED n. r ll i r..,,,.. ✓ ,... :J . ^ � r ./� —,..... ., i�C7" ` �r-^ .-r.� t U �/1. .� �.' ' rC }.. / �✓� _ P F V 1 ROUGH - FRAMING C - •� C��'>;- '~. __4-^•`Fe .. - _:�. SL--, ?.,__-- . ..4 4 F ...�._ t.,..i-: L.:-/.1 `•w 1�_... ,'.. - 2�-ROUGH - FRAMONG & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. DO NOT PROCEED Lc11Tt�F ALL CONSTRUCTION SHALL MEET R11MN UNTIL SURVEY OF � � THE REQUIREMENTS OF 6 THE N.Y. - - _ _ �KMrNNN�1� FOU STATE CONSTRUCTION RGY CODES. NOT RESPONSIBLE FOR lume locwjmwm HAS BEEN APPROVED DESIGN OR CONSTRUCTION ERRORS A copper tubing Is used for meter distributing -.�.^ -... system; piping shall be PLUMBER CERTIFICATION o}types KorL only h rc, \ / tE`,+ I> .r�CE, M 14An! ' kry J1 WI IDN LEAD CONTENT BEFORE 1 azo 'VhRn ✓tic- CERTIFICATE OF OCCUPANCY `s y _ .}. 5C.E I APPROVED er oMwN�Y J 1 r•{I �( SOLDER USED /N WATER t�1 y" =r- SUPPLY SYSTEM CANNOT \• curs rw 7U DAM -saL�" �o .MSED EXCEED 2110 of 1%LEAD. QPkv % ° � r '5 y yf OMWING NUM\fR u. f , i t) , r kA L1-_ - - 1 pol 11 �° P -,�� �f' ,i� scn�er wveaaveo er �, a , aevisso - DRAWING NumeEa r � 0 r -- — � �� xwcCbobB � i 4-w C,�oLBR � ^G+ �ry � ICI � � � '��l �• 3 'I 3 I ,y,"at�"�� , , D 1� I r� •.� � �". I � c • r-d � ",: � I ti ' I m 3 I I I �I tA �•r A tl � II I I II �' L,, - ._. _.- - - . -t'•-t-d-___--.- -_ __ - .._ .. _ - _•�"_�'-,- -.-__1.-� - . 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'•,f`— ' 1_lA P_ -_J�,, r— -''� _ _ �I r I111 I CI ° ➢ f � C , C C , I 1 �`1 ,l UR4 42ATF15 . � I • � I I � ��1XIC�14d`G-NYt��7A"14-�' ' I I "CC,,�I _ � ' ' ��I�I : � I �i � I ; �, i , ' I� • -LELFIL_o� fi � 'h � IS& U�owl^1 �I 'I •iI i PC X10 ;Vu•SPC•-r I I I � {�zxq I I II — � u -� � �1 II i Yruo_, L 2-2a4 - _ 2tiro-- r4'oz- — ,� 6'-R=s, f>'re �➢ewryl ;t-c•b _._ >, i I� j � I CooF Jo rsr____ Inlsul.rtrlsN oc MAP`jj6r. .73¢�RcNr_f 13) : i �iep(Zoar, lI I I I I I f 1, ll I �:n2ar,E r7 -- ?, l ; 1I r -'f� 1 � 1 - �-} t,, H GrT --�Cetd L-oKe rl3 . Pwx11T� Q� I n� �/ 3 PG I�w * 11��9 t I`IvY IIr19 GNI tb Ioru JZAB _ MIL�o�I-a Ms I � � /yv_ , / .✓ `yi -;i P �� �iEnr arty;o� f.1P'JCGC'U fG *"�/rs�� r3� ♦ p\C[. !i is l.;%•I: - �,_:.- AS JOIN FAILA i . . ..._...-._ .. ., {TSG O5,zT'�41 TO 4 oAe J 3 AWN eAPO tv '_"____ p "VISFo L--- com os onAwwe Numeee - SO:J TI-(o�l> Lul�1 P�C'r� !_J Trji_ chi or= `U P ' Y