HomeMy WebLinkAbout32308-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31843
Date: 09/25/06
THIS CERTIFIES that the building FOUNDATION
Location of Property: 1900 PINE
(HOUSE NO.)
County Tax Map No. 473889 Section 70
NECK RD
(STREET)
Block 9
SOUTHOLD
(HAMLET)
Lot 3
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 8, 2006 pursuant to which
Building Permit No. 32308-Z
dated
AUGUST 23, 2006
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 NEW FOUNDATION UNDER AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to THOMAS F PASSANANT
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
Rev. 1/81
'fY' r
\i\'~
-----
.
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
15
,
APPLICATION FOR CERTIFICATE OF OCCUPA.NGV
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 nse:
I. 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 fonn).
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 2/1 0 of I % 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:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features. V
2. A properly completed application and consent to inspect sib'lled by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
I. 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 - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. 8;6 5/0(;
New Construction:
Old or Pre-existing Building:
~
(check one)
So...d'4Q/cI
Hamlet
Location of Property:
A/}t!/Jec r /( d,
House No. Street
ownerorownersofPropertY:'~O~A..f.+ 4?---ce A..s.s9/7~7
Suffolk County Tax Map No 1000, Section 70 Block 9
/900
Lot
:3
Subdivision
Date of Pennit.
Filed Map.
APPlicani:;-)~A.s
v
Lot:
/J..s.$.... q~ :I
Permit No.
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
( check one)
Fee Submitted: $
...._-
(, ')--
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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.
32308 Z
Date AUGUST
23, 2006
Permission is hereby granted to:
THOMAS F PASSANANT
1900 PINE NECK RD
SOUTHOLD,NY 11971
for :
,
CONSTRUCT A NEW FOUNDATION UNDER AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR. REPLACES BP# 25207
at premises located at
1900 PINE NECK RD
SOUTHOLD
County Tax Map No. 473889 Section 070
Block 0009
Lot No. 003
pursuant to application dated AUGUST 8, 2006 and approved by the
Building Inspector to expire on FEBRUARY 23, 2008.
Fee $
150.00
.-b~ CJL-
i Authorized Signature
ORIGINAL
Rev. 5/8/02
:;2 5;2 C '7 .~
765.1802
BUILDING DEPT.
INSPECTION
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FOUNDATION 1 ST
[~UNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: ~~~ OA_
~~.
rYA
DATE II !~A8
/ I
INSPECTOR~4
/, ~.;J ~:r'
",r- I (J
/ c7
,
765-1802
BUILDING DEPT.
SPECTION
[ FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
r . I .
REMARKS. /"P !1f'jRdko (J/C
p) ~~~
~
d
[ ] ROUGH PLBG.
[
[
] INSULATION
] FINAL
,
DATE 101ft
. yVvt (~(VfL
/
32-3o?&
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] I~ATION
[ ] FRAMING I STRAPPING WINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
cc
INSPECTOR
<...
DATE
~
=
ROUGH FRAME &
/" ~" t: ~n ~_h_ ~. -L r / k ..J ...., -"
./' 1/ r u ....- /'-7/~~ (I"C-- ""'t'7Y - ---- ~ '-.J'"I
. / ~d-/,/- ~ ~ /J ~ -, ff. -fyg-'V ~~
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'OUIlDA T10N
- - --
'OUNDAT10N
(2nd)
2.
.PLUMBING
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INSULATION PER N. Y.
STATE ENERGY
CODE
.
Fly'll o / tI. r'/7c
" . I ( // 'A~ flJ/Jt.
7/ .(No V tlo o' -/S -v ,J
--- ;;/ /
FINAL
" . ..
.
. ..... ADDITIONAL COMMENTS'
1.).j~7~-~j.- ;!-tfl A /e-/ .#. ./:qJid.
. , / / /<:eA!? ~ 1/8< 2/) ~") Pel C4-
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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.
25207 Z
Date SEPTEMBER 25, 1998
Permission is hereby granted to:
THOMAS F PASSANANT
1900 PINE NECK RD
SOUTHOLD,NY 11971
for :
CONSTRUCT A NEW FOUNDATION UNDER AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
at premises located at
1900 PINE NECK RD
SOUTHOLD
County Tax Map No. 473889 Section 070
Block 0009
Lot No. 003
pursuant to application dated AUGUST
10 1998 and approved by the
Building Inspector.
Fee $
ORIGINAL
Rev. 2/19/98
Town Hall. 53095 Main Road
P.O. Box 1179
Soulhold. New York 11971-0959
<t.~'\)~~'
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Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
August 10th, 2006
Thomas F. Passanant
1900 Pine Neck Rd.
Southold, NY 11971
RE: 1900 Pine Neck Rd.
SCTM# 070 0009 003
Dear Mr. Passanant,
Please be advised that your Building Permit #25207 issued September 25'\ 1998 has
expired. According to the Code of the Town of Southold, a Certificate of Occupancy
must be issued prior to use of the structure.
To renew your Building Permit, please submit a fee of$150.00 at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
,-
TOWN OF SOUTHOLD PROPERTY RECORD CARD
- 9-.3
fO{)
~~ma5F(A~ ~eM bl'Dr. . Ned,,- Ref
FORMER OWNER ~ 1/' /1' N , -, I
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'-hCivlfS () Cflrisfer1SrntfWr S 1:: /YCMI? .:r;'- " W J}/f,e/ls'lk.<:l f;--:.,
~ES, b. SEAS, VL, FARM COMM, liND,
LAND IMP, TOTAL DATE REMARKS
!
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OWNER
STREET
VILLAGE
DISTRICT
SUB,
LOT
ro
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I MISe.
I Est, Mkt. Value
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Acre
Value Per Acre
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD /3 t)/
BULKHEAD
DOCK
AGE
NEW
Farm
'illable 1
'illable 2
'illable 3
Vaodland
wampland
rush land -
louse Plat
NORMAL
BUILDING CONDITION
BELOW
ABOVE
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Extension _" > I I
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E . ' 15-1<< I ~I ---
xtenslon i i E II
n______+_k..><:_L'-n"':O-___~~ : .(.:5"""0 :__~ xt. Wo s +' ~_
Extension __________~-____-l----- i I Fire Place
6vZ" ' /"} , I - -r----
B'"-"t;x:~;'L /. ,=r~i-/U;-- :::1
Garage I !
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--- . ./r Patio I Rooms 2nd Flaar
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I'ORM NO. I
TOWN OF SOUTIIOI.D
UUILDING O~rAR1~~NT
'rOWN IIALL
SOll1'1I01.0, N. Y. 11971
T~I.: 765-1802
IlOARO 01' UEALTII .........;.....
3 SETS 01' PLANS ...............
SUi\VEY ...... ~...... ",... "'. ...... "_~"""""""'"
CllllClC .................... ~ '...........................
S~l'TIC 1'0llH ...................
1,xa.i~..~/4~ 19....
~I::):~t~~.~~:::.~~::::..;.~~~:l~t ~.
NOTlI'Y' ~
CALL .. .71e:f.-. ./.7.1. ..
HAll. TO:...... . . . . . . . . . . . . . .
.. . .),r:~ tl 7. -?
....................................
...................................
..M.
(lkJlldl"ll IIUlI>ector)
,
.......................................
APl'l.ICAT10N FOR IlUILIlING l'&IlHI'f
. Date. if"lr.!?..... 19....
SLOG 0
T V'lN F SEPT.
UTHOtD
,a. to'lS sppllCDtloo llUSe-be co'Vlete1y fill~ In by t'Ypewrlter or in Ink and au\JlIltted to tbe lkIildl\l&, Tnspector wi
3 sets 0 plans, accurate plot plan to scale. 'Fee according to 6ciledule. '
h. .lot plan sl>owl\l& location of lot, and of buildb>&B on prl(lldM6, ,Telat1ooship to adj01nl\l& pnadsell or plalllc
streets or areaa, nnd llivlng a detailed description of layout of property llUIIt be drawn On tba dilllVD" ...,Ich III plJrt of
this npplicCltion.
c. 'n\e "",Ii< covered by thla appllcatlon l"6y not he courenced beforll IsllU8/lC8 of lkIildl"lll'ellDit.
d. Upon a[ll't'OIlal of tMs appliCDtion. the lluildlng Inspector wilt 1saM a IkI1ld1na 1'el1ll1t to the appllcant. Such
permit shall be.kept oa the prenlses available for IlUlpectlon thtOlJ&!lOUt tlle work.
e. lb buildi\l& shllll be occupied or used In "'lOle or in part for 8I1Y PurJlON wtever until a Certificate of
Occupancy shall have been granted by the llulld1"ll IlUlpector. '
1\P1'I.ICfl'nm IS IEllWlY ~IIIW to the IJulldi"llllepartnellt for the IsllU8/lC8 of a Jiul1dlpg l'el1lllt pu1'SUlIIlt to the
lluilding Zone OrdillSl1C8 of the 't'own of Soothold. Suffolk County, New York, and othar appl.lc;abla Law8. QrdhlllnCl!8 or
Ilegulatiooa, for the c:onatructioa of bll1dings. addltlon8 or slterations, 0'1' for 'I"OIlOIal or deAoUtion. lIS herein
"'=1,,"," n. ."u_, ....... ~ _I, vi'" .n ..,U,,",,'" 1_. ---. ...~... -. ...
regulations"and to sault wthodzed il1llJ>ectors on premises sod in1l12i1d1\l& ti ~~ i ions.
CY24NlAJ ;)f,.,J-- CoAJOQ'N UIVSU&TlM::t .
ffC-AJ4/;1j-"n <"----- .. . ...... ........ ........................
~, ~ (Signature of applicant, or _. If a corporation)
.J I$.?. .~!H$.{)~~..'y-:t:r?.(. (!1!l!T.! M: r...
(Malli"ll addNIIS of applicant) I/"JSl
INS'j'RucnONS
Slate \O!lether applicant la "",,,,r. leasee. ll&ent. architect, en31neer,' gel",ral contrsctor, electrician, plumer or hull."
................................;................................................,......................................
NaTe of (7.o1ler of premlsea .. IHt),A1.4.s... ~.J. A.~.I.k~. .m~I.l-!.Yt.\~ ]:................................
(86 on u.. tax roll or lateat deed)
If aP\llicant ia a c01'JlOratloo. signature of duly wU.urizcd officer.
.(~.~~.~i~i~.~f.;;,;;.~~~~.~ffi~~)..................~ ~ ~ ,pcd~
J).,il<lera License~. ......................... , {JLd jJ-t/1J In ,
:~~.::.~.::: ;;:"::::::::::::::::::::: ~.2<> c~
Otller Trade'a Llcense~. .................... (~
I. Iocol:10C1 of lund on ~licll proJlO&e"l ~rk will \)Ie <lone................................................................
.., '. .. .1.~(?o... ..f.{ N. f:-. .I!.a..~. .~.? ~P................. ~ rr.tff..v.J?....................:..
llouse IOlber Street llaiIAIt
Cc>.1oty Tax Mop~. I(OJ Section .....7({....... Block .....~........ ToOt ....~.........
Sutxlivision ...................................... Filed tlap lb. .,.......~~..... wt ...............
(Na1e )
State exiati\l& use and occupancy of lJhe:J~a and intended use and occ:upsncy of proposed c:onatruction:
a. froating use aod occupancy ...../~J.f?~........."~..'1'."...,.,~~....~t.........................
Y7rrC"/V1~ *'cYw'.... ':' ',""e" ~'.'e"
1CA[,-..--;> 1/ r'l';.~. ;II:,.,.' .'\. I. . -
h. lnteoded \L88 8IXl occupancy ........... ....... ......... .... ..n. ..'":....:".., f.......I..'i~............... '0......
. t.",. ,f 10.(hi .
.... .ft" '.'i s;; l;':",~.::l 'l-I'uI'
2,
'.
It.lllra IIf I.Ork (dleCk \Aildl 8p!ltleableh tel ~Ildlnll .......... on........ Al taret Ion ..........
Itar..lr ....... ..... tlamval ........ :.... Ilennlttlon .......... .. Other lbrk MJ'?F.-..e.. t,).Ik.t:U~~ -/ Ne.iM.
ll.tln..tod Co.t k.5./.or;a.......(j) fee ........................~~~~~~~.. U~t!f6.
., (to be [>8ld on fn Inn thl. nppllcnt Ion)
If ,~...lllnn. ,..,bar of &.elllnn .mlt. . ../. ...... l~"ber oF. ,~...lllon unit. On each flonr ................
If gursae. Illlll)e:r of e.ara. ........... ..a..............................................
'.
1.
If b,.llIe.., cmmorcl.l or mhc",!' OCCl'l"'ncy. .peclfy nature and extent of each tYTle of use......................
, 'f"'t' , " ~ . J u'1
nlt,.,o.lo"o of exl.tlng .tn"'ture.. If anyl Front..Z~:-~..7... Rear ..3;..1.-;-./...-::.. Depth ...~?!'.-..~...-:-:.
2~f~. . ~
IJuight ........'r-....":';'".......... tl.tl>er or Stories .......................
IlI.eoolon. of Jl'r:. .tnlCture ..Ith .1t..r.tIT.I\>C~~l<Iltlons, Front ..~e....... Re.r ..$:t1~~..
, tlcpll...... Snv~IE...... tlelsht .... ~ ~.. \ ,!../.... H<nh"r oF. Storl... .....'2.........
011"00010,,. of eotlr.. new con.tructlonl Front................ Rear ............... Depth ..............
llel~.t ......................... H<nl"'r oF. Storie. ........e>'........... .
Ill"" of lot.. Front... .J.~,.3. ,f)(/...... Re.r .. .t$.4~.7.. P....... Depth .. ~.~. 7~ }-:!.....
..
l.
10.
II.
12.
13.
I~ .
Ilflte ()f PUrdl8Ae .......................................... ttr.rna of l?'onrer o..nlef ..........................................................' ...
1- 4-0 :,.-,.,1
zo". or use dl.trlct In \.bId, pl'1!mlaes .re situated .......... ~........ . ..... .. . . . . ... .. . . .. . :'.. ~. . . . . . . . . . . . . . . . .
floe. propo8ed con.tructlon violate tJny WII I nil 1..... ordlTl8l~e or rellul.tlon. .. .N/?................
NO
11111 lot be regraIed ,...................11111 exc.... fin be rerroved tran pr...lse.. YJlS m
Ham. of ()mer of premlee. .r~:'!.t.!1I:!~..9.{~~!^'klre.. .1.'Nfl.l:'/~e..Ilfh.~.l?lP..... 1~1Ol'" No. 7{r.$.:.1?1J1
Nme of Archltec:t CcttmN /... ~fl'N. ~c.fr.. ~.,... Mdrea. ! l/i.r:..'5ii. fifP.(:f. .;gp, .. .. .... I'hone No. 7..l.f:.7..~$. p
A1'1'Tf17VC K--
Nl~ of r.()ntf1tCtot" ................... .....-.. .... ........ ..... 1\cklre88 .............................. .1"'1000 th. ............
15. 1. lhl. property withIn 300 feet. of a tllblllollltland1 * W..s .......... m..........
*IF YJlS. !01IlOll talf 'lWSI1!n.'l ~rr MAY 00 Rtl(mrnm.
I'\.OT OIAGRAM.
l.ocate cl...rly end dIstinctly eU bulldlll/ls. w.ether al.tlnll or proposed, and Indlc.t.. .n aeH>8Ck dl""nslon.
fr"", I'roperty line.. Glw street end block llJlber or descriptIon necordlon to deed, .nd sllO<> .treet o,,,e. .",1 lodlcate
I.helh"r Interior or comer lot.
!;\'f(1l! (X' 1'I!.1-I YlXlK,
55
<UINIY (X' .....'?,.,.~~.\~.......
....MAg.l(....t.....S:<;:;.ti~~...........b"illll dtlly 5\.'(>tIl. del"OOS ond ""ys Lhnt he iH the oppU""'1.
(NIlI<! IIf hxllvl,hJlll RIllnlng contr""t)
ubove tUJred.
........................................................................
(r.OlltrRetll"ll"nt," orpornte of.flcer, etc.)
of Mid ,,.,,,,,. or oo.merR, nnd i. duly lIUthorlzecl to perfon" or IlIIve perflll"",l the Mid work Otxl tll make a",1 file IhiR
lIWllclltl<..; Lhnt .Ill .toterent. contolned In thl. n(lplleatlllll nre. tn", tll U,e hest of his kllwledlle Dlld hullef; (ilK!
Ihnt the wrk ..Ill be perl'onred In the mnOller set ['Drth in the nppUcntl(m filed ther""lth.
:-MIni In herure ~ u,ls
\~
. . . . . . .. .. .. .. . .. ..day II .
Notnry l'Id>lIc .
/)IJdf.~uuu
(Sll\tlllttlre IIf ^Pl,llclIl1t) .
,FORM NO. I
TOW OF SOUTHOLD
BUILDING DEPARTHENT
TOW HALL
SOUTBOLD. N.Y. 11971
TEL: 765-1802
BOARD OF BEALTB ...............
3 SETS OF PLANS .........~.....
SURVEY ........................
CUBa ..................................................
SEPTIC FORM
....................
Exanined.................. 19....
Approved.................. 19.... PeDDit No. ................
Disapproved alc ..................................
,
NOTIFY:
CALL ..................
MAIL TO:....................
j~5:;.:i.if~::~::::::: ::::
......................................................
................................
(fuilding Inspector)
APPLICATION FOR BUILDING PERMIT
Date. .I.? I!). 'J. r. . . . . 19. . . .
INSTRUCTIONS
a. This applicatioo DUSt be COIp1.etely filled in by typeWriter or in ink and subIlitted to the adlding Inspector wi
3 sets of plans. acaJrllte plot plan to scale. Fee acconling to scheWle.
b. Plot plan sboiliDg l~ti,.., of lot and of b1ildings 00 prenises. relatiooship ,to adjoining pmnises or public
streets or areas. and giving a detailed descriptioo of ~ of property DUSt be dtam 00 the diagran ToiIidl is part of
this applicatioo.
c. The wrk COIIered by this applicatioo ITB';/ not be camenced before is~"'nt'P of Building PeDDit.
d. Upon spproI181 of this applicatioo. the adlding Inspector will i8Slle a adlding PeDDit to the applicant. &lch
peDDit shall be kept 00 the preidses available for inspectioo th~t the wrk.
e. No building shall be occupied or used" in 'lilole or in part for tmy purpose ToiIatever until a Certificate of
Occupancy shsll have been granted by the adlding Inspector.
APPLlCATICN IS lEREBY MAlE to the adlding Del""tweut for the is$'''''''''' of a adlding PeDDit pursuant to the
/luilding Zooe Ordinance of the Town of Soutbold. &Jffolk Cooney. New Yon. and other applicable lais. Ordinzmcesor
Regulstions. for the coostructioo of b1ildings. additions or alterations. or for MIDI1ll1 or dem>litioo. as herein
described. The applicant agrees to CICJItlly with all applicable laws. orrl1....."...... b1ilding code. housing code. and
regulations. and to aciDit wthorized inspectors 00 pmnises and in b1i i for t
CJ2,g N IN ~ CIIM9 /lV (JONJ ~ T fEN {( /AlUtZ}-... .... . .
(Signature of applicant. 0' . if a corporation)
..1. 7.[ E.. ~w.!. P.€.(. fY."'fi? -(. .("!~TJJJ::. c:-k
(Mailing address of applicant)
State ..bether applicant is owiler. lessee. agent. architect. engineer.' general cootractor. electrician. pluJber or builde)
.........................................................................................................................
lime of lXJDer of pmnises ....1Jft I!l.trl..lfM?.. . .ltkl.C:E... . e.1..~ [1:.t::.k!.T. ...... . .. . .. . . . . . .. . . . . . .
(as 00 the tax roll or latest deed)
/
If applicant is s corporstioo. signature of duly wthorized office:------_
//-/ ~
.(~.;.;,d.~i~i~.~f.~~~~.~ffi~)............>...-::.~ ~~
Builders License No. .....................~... '!}rd~ il,at1./>
PluJbers License No. ......................... ~
Electricians License No. ..................... ~_ q;;: J2>
Other Trade's License No. .................... / ~_ ......
I. tocatioo of land <Xl ToiIidl proposed won will be dooe..... .,.............:.................../... ...............
.........!.~~~............J:7,,~l:...~~...~??...........~~~:::~:~......................
lkJuse Ib1ber Street Hmilet
Camty Tax Map lb. UXXl Secticn ......1.~...... mock ........2...... Lot ........J........
Subd. . . '.led
l~SlOO ...................................... Pi ~.No. ............... Lot ...............
(Nme)
2. State existing use and .........V"""Y of pmnises and intended use and occupancy of proposed coostructioo:
a. Existing use and occupancy ,..... "W'. ~l""'. ..~. ...;~...... ..... .... ............. ..............
b. Intended use and occupancy' ........4...~.......~~.~..............................................
/7.!.(p~,( fl~"~
=pect-. .
I. Hature of writ (chedo.bicb applicableh tel aJildlll8 ......... ilddJ.tlon .... .. ... Alteration ..........
Repair ............ Bemoval ............. Demolition ............ r~rk ...,..............................
. ~Iption)
i.
Estimated Cbst ............~............
fee ..............................................
(to be paid on filing this application)
J. If dwelling, tUIber of dwelling mits ............ Iblber of dwelling Units on each floor ................
If ~. number of cars ......................................
6. If b.uliness. .........~~lal or mbed 0C0J!l8IICY. specify nature SDd extent of esch type of use......................
7. Dimensions of existing structureS, if say: Front................ Rear ............... Deptll .................
l1eigbt ......................... ~r of Sbories ......................
DiIIlensions of SlI1Il! sl:l:uCtUl:e with alterations or edditions: Front............... Rear ...............
Depth .................... Be~t .................... lbIber of Stories ...............
8. Dimensions of entire ~ CODStruction: Front ................ Rear ............... Depth ..............
Heiijnt ......................... lbIber of Stories .....................
9. Size of lot: ~t .................... Rear .................... Depth ....................
10. Date of PUrchase ..................... Name of Former Owner ........................................
I J. Zone or use district in wtch prauises are situated .. ....... .. ...... ... . .. ...... . .. ... . .. ...... . . . . . . . . . . . .. .. . .. .
12. Does ~w~ IXJII8truction violate say ZOIIing 1.... ordinance or regulstion: ........................
13. will lot be rqy.aded .................... Yill excess fill be xemved frail prenl.ses: lI!S ro
It,.
Names of Owner of prenl.ses ........................... Address ...~.~..~~~.....~..~~..~~.~.~. Phone No.
Name of ArChitect ~..~...........................~.... Address ....~....................~.... Phooe No.
lOne of Ccx1tractor ................................~.. Address ..~..................~...~..~..l?hooe lb.
. . ~ ~ . . . . . . . . .
15. Is this property within 300 feet of a tidsll'etlsnd1 it YES .......... ro...... . . ..
*IF 'IES. &mlIID'llHt 11<lJljJ,u.$ l'I'aflT MAY BE HI!QJImID.
PLOT DIAGRAM
Locate clearly SDd distinctly all buildings. 'Il1ether ~sting or proposed. SDd indicate all set-bsc:k dilllensions
frau property lines. Give street SDd block tUIber or description sccordill8 to deed. SDd sboir street omes SlId indicate
whether interior or corner lot.
SfE-
PCIPJ S
-
Sf Am ll' l'&I YOOK,
ss'
CUlNiY ll' .......................
...MAU..j{.~.);.Cf/V.I}l?IL..............being duly sworn. deposes ancI says that be is tllE! applicant
(Hare of individual signing contract)
above oared.
: ::.~.=:6Z=;;::;;~.=.::=.:.=.==.~=.=.;;l. '"to
application; that all staterenta contained in this application are true l'O the best of his kDooIledge ancI belief; and
tl18t the work will be perfumed in tilE! manner set forth in the application filed therewith.
SIoorn to before Ire this ( . . .
lbtaIy Public ........ .. ..tl/.Jk!:?~;
() JOYCE M. WILKINS
olary Public. Slale of New York
No. 4952246. Suffolk Cou~
Term Expires June 12, 19~
.j!(d.. . ...........
(Sigriature o. Applicant)
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1/4 in = 1 ft
Existinll House
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CCA (5/4 X 6)
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(2 x 6) @. 16" on Center
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Existing
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Grownl Surface
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FILE NO. .'6,,,,' -5 J'
PAGE
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