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Home My WebLink About33009-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32379 Date: 05/31/07 THIS CERTIFIES that the building DECK REPAIR (STREET) Block 1 GRE;ENPORT (HAMLET) Location of Property: 62445 CR 48 (HOUSE NO.) County Tax Map No. 473889 Section 40 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 7, 2007 pursuant to which Building Permit No. 33009-Z dated MAY 7, 2007 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 REPAIR EXISTING DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLIN AS APPLIED FOR. The certificate is issued to RONALD W SURPRENANT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ignature Rev. 1/81 N~ .:..:..---- Form No.6 TOWN OF SOUTHOLD . BUILDING DEPARTMENT r[.~'~.~..... @ r~ n ~1 TOWN HALL I r " \: ; 765-1802 '0, 3 0 2~~ APPLICATION FOR CERTIFICATE OF OCCUPANCY I BLO J. OEPT. This application must be filled in by typewriter or ink and submitted to the Building Department.lJlith 1QWIA~~~. OLD 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 2/1 0 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 natural 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. 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 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. .JIl ,At 1 ~ 0, ().. e)() I , New Construction: oft t"1::. Old or Pre-existing Building: Location of Property: ~ "'-Itf5- ;VpP.-rIf02. JI House No. Street (check one) GcB.Elf",4,! ftJn- i Hamlet Owner or Owners of Property: R <!:?.AI ft ~p W' S 2.) (Z,F' /e ~/tJ ^ tV I Suffolk County Tax Map No 1000, Section J..j7::? .p r 9 Block tI () r ) Lot - C. Subdivision Filed Map. Lot: Permit No. 3 ~ Q b~ Date of Permit. 16 . I") "0"\ Applicant: Health Dept. Approval: Planning Board Approval: Underwriters Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ ~ W'k,rJ Applicant S at e &.k.? .;l~~ Co Co~3;2:3>71 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) 7, 2007 PERMIT NO. 33009 Z Date MAY Permission is hereby granted to: RONALD W SURPRENANT PO BOX 717 MILLER PLACE,NY 11764 for : REPAIR AN EXISTING ATTATCHED DECK AS APPLIED FOR. THIS PERMIT REPLACES BP # 20568 at premises located at 62445 CR 48 GREENPORT County Tax Map No. 473889 Section 040 Block 0001 Lot No. 006 pursuant to application dated MAY 7, 2007 and approved by the Building Inspector to Fee $ 75.00 .. ORIGINAL Rev. 5/8/02 ..0.. NO. I TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N!N<J 2056SZ Date ..~L........................................, 19..2.2- Permission is hereby granted to: ~.~L~......~~......... &~ ..:~..tI;JI..... ....2!.. .2.................................. , ~~....~~.~...~#f."7.'176 ~ to ..~....~....~~......ll!:~~..~.4/~.....~................. .~4-....~.<............................. .... ...............................................................-.......... at premises located at ...4i..2..~'R:.~......P~.&....f~..$....f(J:.J... ........... ...... ...................... .....~~~... .................... ..................... ..... .................. ................. ..... .... .... ............ ... .......... ............ ..... ..... ... ............ ...... ......................... .... ... ........... ....... .... ........ .... ........ ...... County Tax Mop No. 1000 Section ......~a......... Block ........L.......... Lot No. ........~............ pursuant to opplication doted ...~~......................................., 19.~~ and approved by the Building Inspector. ~% Fee $............~.. Rev. 6/30/80 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. cP1 0'2) BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~~ ~~ ~oS6!"~ Permission Is hereby granted to: Vii,Wi ~ .. .. . .. ' ().J &, . .......-tt/............. ...... .. ,;t? .4. ...................." ...... ./...~.. ..e~.... 7/ .Z.............,......,...........,.......... . "~~"~~"J">.2~.~. ..((?~.~..... to...~.:h.JA. /l- ~~ ~~ ~4L ~","I'"III'~t':l....... II ~......", .... iW'4F.............::::......::::::::::::.........::::::::...::.. ....:.:::::::::.::::::........:::~:::::::::::: Date ../A~.Z............................................ 190'2 '1'~ I."~.... :.~;::.=.:...:...~..;.:;.:...t.:i...::..:..~..:....J.;3(.....;;~..:....~.....27/...:7~.h 6J, /~...&r''7...~..Aq".L..~.....r... ...........................""." ,.", .......... ................~ .~~~;t- ~........I..I.I......................I............t..1................ County Tax Map No. 1000 Section ......~o............ Block. ...........(,........... Lot No. ....~................... pursuant to application dated ....~.................,..................... 19..?.3..... and approved by the ~ BuIlding !nspec''n: ,.~-/ Fee $....zq;;~ ,/ ~/79fl ~ r//:2aSb~~ ~ ~er ~~ <::::;7?f"~" uiidl~gi;"~;;;"" ................., Rev. 6/30/80 ~~~ ;-' 1 :: L J I:;S::2C:l~:4 liD;.:=: il :';v:'"f..:.tLNT:: c./77..,~tA ~ . I /){:oJl/KJ iP 'l4R ~/~~ ~ 1 . '~I . ~ I '~ ...... H -- - . . - j~ :OUUDATIO~ -.L 1 s-U. I - - - - . ~. I - I . c:: .. C.iJ ::'OUNDATIOH (2nd) [z:! 2. I - z 0 . ?OUGH FRAI.1E & .PLUMBING . .. j en 3. >-i :;::, [1'] tIJ rUSULATION PER N. Y. . . >-i STATE ENERGY I CODE I .. .' ~~ {~OA :, _Hh/... CLI 4. 0, .---J ~ ~~ I 7 /I /v6 E' 1/h ~ .A~~ . '"i~, . .; I //. 7/ ./ -, .., I {/ - FI;lAL . . I . . -. ., .. 0 ."::: - - ADDITIONAL COMMENTS: '[1'] :a . ~ .. .. " . - . . . . . , ......., , ." ~" .' ~~ . 1~~ 1--4 0 - - , 1 - . :c ['rJ . :> , . c- - -'i :c - . o. . ['rJ . I ." ~ . . .4 . ~ . . :::=0 I I"l (}) OJ ~ 11. ~ '" } ~ ~ ~~ ~ ~~ ... ~ . -...J f ~ ~ ~, rr-;' .>~~-~~., BO,\~O Of HEAl.TH ......... I~i rnfS.~':i @ (~1' i' FORM NO. 1 ~~J SETS Of PL.\:IS ......... 0 I r---'" TOWNOFSOUTHOLD SURVEy................... !I'"'/i " CIl K ;11\\'., f\PH'.; BUILD~~~~E~:~ZMENT SE~~IC.;~~:.I.:::::::::::::: U Ii . U~_~,,_ SOUTHOLD, N.Y. 11971 [;,.. TEL.: 765.1802 TOV.%",; . . .~~ ! Exammed.. . ........... ..19~ . Approved . ~/. . . . . . . . . .. 1#1:" Pennit No..%'? ~.$.'~ ~ -I o' I Isapproved a c ..................................... ..........AP.PR mAS.NOTmii.'~~"""" 0 DATE: ~I ~ z.. B.p. #~'iIf./ .... ~Q~4. .. ~~~IFV :~ ~~PA~ AT . ,fluil~nspector) 765-1802 9 AM TO 4 PM FOR ThIlPPlICATlON FOR BUILDING PERMIT FOLLOWING INSPECTIONS: . ~R I L 1'< 9;L 1. FOUNDATION . lWO REQUIRED Date . ..(:rf~..... . .'-rl.., 19 .. FOR POURED CONCRETE 2, ROUGH - FRAMiNG & PLUMBiNG INSTRUCTIONS ::Ll!~SULAf;flOt~ h- """". fi I . b . .. dOh B Old' I t 'th 3 a. 4f ~<J~P l~a ~~~,1'\(joi l{Ql!ijl"".t;QlY 11 ed m y typewnter or m mk an submitted to t e UI mg nspec or. WI ;::ts of pl~,&';~HHlerl~l~lRIsrf.)to scale. Fee according to schedule. . b. i~p.t ~OOS~}tinIDk>c8t-ifAJll.l.Pf!\Jdif1ind of buildings on premises. relationship to adjoining premises or public streets Ir areafh'~lcRGijHU~~:r$:cbdes'CMt>ti~rf.of layout of property must be drawn on the diagram which is part of this appli- J tion. '~'""i\Ti:; Gftj"b%1mtfnTlfi\I~...~N E RGY c. i~:\l~~o~f~lid;{fr~n may not be commenced before issuance of Building Permit. d. it1mJlePel'1m'c:vMJef!fdf.Jrlp~i€B66th:'the Building Inspector will issued a Building Permit to the applicant. Such permit :-tall be kept on the premis~.available for inspection throughout the work. , e. ~gl~1!#! .tl!~ b ~......' , d in whole or in part for any purpose whatever until a Certificate of Occupancy :1a11 haVf6l~I:kPP\ylA~~d ~ ~~I<F~~lffigector. . APPI5ttlA-,y~ trs~ERTge.l\fSMADE to the Building Department for the issuance of a Building Permit pursuant to the ,uilding.zBgbl~IH;ihbe .of1fiVtfJ~18~'Southold. Suffolk County. New York, and other applicable Laws, Ordinances or :egulatio~PMQlti~fiC6fr~~tb1f of buildings, additions or alterations, or for removal or demolition, as herein described. he a PP1i &f?rJ. ~:f~a~. ..~ ~M-l.v..mNJPplicable laws. ordinances. building c.o. de, houLsin17 code, and regulations, and to jmit a~h~lpl'il~~T'i,~Hjlf~S~11g1 in building for necessa~pecti~"h '. ~ BE COMPLETE FOR l,.O. . . /. ~.0. " .. . .. ................. ArL CONSTRUCTION SHALL MEET (Signature of applicant, or arne, if a corporatioo)' THE REQUIREMENTS OF THE NY STATE CONSTRUCTION & ENERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CODES. NOT RESPONSIBLE FOR G"Iailing address of applicant) DES!GN OR CONSTR~RRORS tate whether applicant iS~lessee. agent. architect. engineer, general contractor. electrician. plumber or builder: ::07! F.f : C J\ L L ................... ~I^ I L TO: . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . ............ ............... ...... .......... ... ....... ...... ... ..... ............................ :am~ of o~ner_.QipreE1i~e.:>_ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .' . . . . . . - (as on the t~ roll or latest deed) : applicant is a corporation. signature of duly authorized officer. ......... ........ ......... ................ ... (Name and title of corporate officer) Builder's License No. .. .~........... OCCUPANCY OR USE IS UNLAVVFUL WITHOUT CERTIFICATE OF OCCUPANCY Plumber's License No. .. .~.. . " " . . . Electrki3n's Ucc::sc No. ..~......... I Other Trade's License No. " .tJ..:~~. . . . . . . Location <?fland ort which proposed work will be d'~ne. " .C;;.?:C;~.~.. .&C?f2:T/t.. .f?lt................. . . . . . . . . . .C;.f? ~ PC? f?T. . . . .~ . y. . . .(! ~ f Lj . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section ........ 7' ~ . . . . " Block ........!......... Lot... ~ . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . Filed f\fap No. .............. Lot............... (Name) State existing Use and occupancy of premises and intended use and occupancy of proposed construction: E . . (J'y\.J.... t~'ltJ ~~1) '.. JiI<1','')Io''''''''C a. xlstlng use and occupancy ........... .......... ............................. (lV-..r. '., .t.~. ....~. ....:.4<.-....It~. . . · 1/ c4? ~ . #1 ... '~~'.t,<-;' ~,~' 0 'n bId d. /l......-..A. I fAr-. tJf\.. C A..eP/1",_",,,;':)~.fi"';;;";l1$W:nD.. . nten c use and Occupancy ... ......~Y':' I!~:. . . . . VM :. . . . . . . . . . " .....,.. St~~.ull!3~~c:.'.~,...J~I~~..~~ .. . 1 3. Na'ure o(..Work (ehtek whkh appileable), New Buil~ing .......... A~diHon ..... . . . .. Alteration .,........ Repair 1/.'.. .d!...i~~.. . . Removal. . . . . . . ..... .. Demolition .............. Other Work. . " . .,.'. . . . .. .. . . -IJ ..f'1) .' . (Description) 4. Estimated Cost . . . . . . . . .~ . . . . . : . .~:t? . . . . . . . . . . . . .'.. Fee . . .;;?? -: PJ? . . . . . . . . . . . . . . . . . . . . . . . . . . - ------ -.----- - (to be paid on filing this application) 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 OCCllpancy, specify nature and ex tent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height ............... NUln ber of Stories. . . . . . . . .' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structur~ with alterations or additions: Front ................. Rear.................. Depth . 0 0 0 0 . . 0 0 0 . . . . . . . . . . . . Height . . . . . . . . . . . . . ... . . . . . . . Ntl/ll ber of Stories. . . . . . . . . 0 . . . . '; . . . . . 0 . 8. Dimensions of entire new construction: Front. . . . 0 . . . . . . . . . . Rear . . . . . . . . . . . 0 . . . Depth ... 0_; . . . . . . . . . . Height '. 0 . 0 . 0 0 . . . . . . . Num ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . 0 . 9. Size of lot: Front .. . . . . . . . . . . . . . . . . . . .. Rear..................... 0 Depth .............;....... 0 10. Date of Purchase ..0.. 0 . . . 0 . . . . . . . . . . 0 . . . . . 0 . . Name of Fonner Owner .........."...."............. 11. Zone or use district in which premi~ec; are situ:ltcd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. DOt:s proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ..... oR4,i" . .. . .... . ...... . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . .S.~ rJ..P.r1fN.~T: Address .f?Q.~ ()~ .7.1.l. . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect ........................... Address M.{J-.k rn. f.~~ti: Phone No. . . . 0 . . . 0 . . . . . . . Name of Contractor. . . . . . . . . . . . . . . . . . . . . . . . . . Address . ).). ':10 . . j {':7 ~ 1. . . . Phone No. .. . . . . . . . . . . . . . 15. Is this property within 300 feet of a tidal wetland? *Yes........ No......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM 01 .' 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. 17..' -1.'_ rs l.,. D G-, /(; I z.~ t9 ~ 22- IItJ (J~-p: ~ --z6z; I~ It /0 C;)c Tlu,JJ .s . ~ ~ Deck. '1.-. T?E' () 1PG~-~ t l~ of - .. ~o U IV -Iy -"/7---'- K j) 47t" ---_.__.._._--~ ~ATEeFNEWYORK, S.S . )ll~f/?~' _';, 'iI"" - - ., . . p.. _ . ,'. . t.":"':.'~.~. '. .:4-:tKl~~ . . . . .. being ~uly sworn, deposes ond says that he is the applicant :. (Name of individual signing contract) ove named. : is the. . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . .0. AJ 0;<.) ~. . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor. agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this }lication; that all statements contained in this application arc true to the best of his knOWledge and belief; and that the rk will be performed in the manner set forth in the application filed therewith. om to before me this ~ a LJ/JJ ;J . . . . . . . ./5:. . . . . . . . . .day of. . .__'71~ -:- ~.{ . . . . . 0 . .. 197. .:J- . /() /I_If/>~, :aryPubhe, "~~~""\"'" County ~hj ~ . -"'~iI__ . . . . . . . . . . . . . . . . . . . . . . . . .. (Signature of applicant) c..~~~c.;n~ . . , , .. Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 5, 1996 Mr. Ronald Suprenant P.O. Box 717 Miller Place, NY 11764 Re: Building Permit #21798-Z Premises: 62445 County Road #48, Greenport Suff. Co. Tax Map #1000-40-1-6 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284, it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD April 24th, 2007 Ronald W. Suprenant P.O. Box 201 Greenport, N. Y. 11944 RE: 62445 CR 48 (deck) SCTM: 40 1 6 Dear Mr. Suprenant, Please be advised that your Building Permit #20568 issued November 27th, 1993 has expired. According to the Code of the Town of South old, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of75.00; 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. fIffi~ <~llm TOW:~::~~';HOLD Ii 1\: APR I 6 10.02 BUILDING DEPARTMENT Ul l~\ It > 1"".1_ TOWN H L !; \ If] AL !U UL,_..~,.. SOUTHOLD, N. Y. 11971 Exam~~dT~p(....... ..19f.?-- TEL.: 765.1802 Approved . ~/. .. .. . . . , .. l~?' Permit No..ff? ~S:G. f;6 Disapproved alc ..................................... B 0,\ ~ 0 0 f HE A L T 11 ......... ~J SETS Of PL~NS .......... SURVEy................... CHCCK ...... _ _ _ _ . . . . . . . . . . S E r TIC FOR ~I _ _ . . . . . . . . . . . . ::071 F"': C^LL ................... NAIL TO: . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . .... .... '~7AS-NonD.. .,~.......... ........ DATE: ~ B.P. #9t16b~_, ( &tJ- ~1~~i~~G ~lPA~ AT' . " ,~'I~~~e~t~~)"""'" 165-1802 9 AM TO 4 PM FOR TH~PPLlCATION FOR BUILDING PERMIT FOllOWING INSPECTIONS: Lp / L I Q 0. :J- L FOUNDATION . TWO REQUIRED Date. ./..'rn-. .... . .'--rl"J 197. . FOR POURED CONCRETE 2. [-lOUGH -, !=R.A.M~NG & PLUMBiNG INSTRUCTIONS '.~\f(~~r i~ '''',''}'''"tf~.':\'' a. .... tJ~s',app'i{~~t~J')!:m"~J@(~~nm)mly filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts of pl.~n~",(~~l\':tJr~~p1q~di?!~1J. to scale. Fee according to schedule. b.:Plot:e..~Il.'1llQ.y.t~gjO<;lltiCi!n O'fiil:il5t and of buildings on premises, relationship to adjoining premises or public streets lr areas"an~g;~"lmgi~~etaile.d;.deootipNdn of layout of property must be drawn on the diagram which is part of this appli- Jtion~ ~ c. The wOibW~~~lication may not be commenced before issuance of Building Permit. d. Upon a~lo~!t'lv8Pt1ti'?;'1i'pph~ation, tl\e Building Inspector will issued a Building Permit to the applicant. Such permit ~all be ~&JE:on th~ pr~mis8~#aiJOlbl~ for inspection throughout the work. e. ~building shall beY:'~. cuppied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~all ha~~\1 !lJ@HI!~ ~~~811nMCctor. , . A!'1~~~fll~ ~.(.1:hlc . ~tJA15'ET~Jthe Building Department for the issuance of a Build~ng Permit pursu~nt to the ,ulldm'7 ~btlel ~ (&~re ~ " ,~Wild;~k~outhold~ ~uffolk County, New York, and other appli~~ble Laws, ~rdmanc.es or :egUlatIb.:nl~'.~l1 ~rf8 '8S.Wf. &fE?'(ouTI.'ffiJ mg~, addItIons or ~lteratIons, ?r .for removal o~ demolItIOn, as here~ descnbed. he apPlic.1 · "h\9-I.~ g; ll'~UMlll.;wphcable laws. ordmances., bUlldmg co.. de, h.ousm; COd.. e, and regulatIons, and to jm,' t~I'j;~~~:~;R~J~~~~s:~:~ m buIldmg for neces~~~W,. .~ ':~ ^, .- .~..f-.. . . . . . . , -"BE COMPLETE: FOR C.O. (Signature of applicant, or Z:'~=~~;atiOn) ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE NY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STATE CONSTRUCTION & ENERGY (1'.lailing address of applicant) CODES. NOT RE~~~... FOR ,tate w9~tH@N<@~IRQN~1~~~gent, architect, engineer, general contractor, electrician, plumber or builder: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [ame of owner of premises .....................................................................'..... (as on the t~ roll or latest deed) :: applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. .. .~........... Plumber's License No. .. .~.. . .. . . . . . Electrkiao's U(;er,sc No. ..~......... . Other Trade's License No. ...~....... Location of land on which proposed work will be d"on.e. ... <? ~'7. C(.~ . . . J) C?f2:Tl-f. . .~l? . . . . . : . . . . . . . . . . . . . . . . " .<:;.f?~ fq(?/:. . . . .~ ."1. . ./~1 rCj. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " House Number Street Hamlet Counly Tax Map No. 1000 Section ....... :'1 ~ . . . . " Block ......../.......... Lot... 0 . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed f\.fap No. .............. Lot............... (Name) State existing use and occupancy of premises and intended use and occup::mcy of proposed construction: E" ~ I~~ ~~ ~~OO a. XlSllng use and occupancy ...........0......... ............. 'CI' .... .. .. .. . .. :l.trl',^_. .. , .fA. AJ.... L . ...... aue .. oM b. Intended use and occupancy ... ~~. . ... f../.Ln. " .... .~.y~. ~~~~~~.. 3. Nature of/Wor* (dirk which appIlcable): New Building. . . . . . . . . . Addition. . . . . . . . " Alteration .......... Repair 1.(. . .~~ . . . . . Removal. . . . . . . . . . .. .. Demolition .............. Other Work. . . . . . . . . . . . . . . - -I; f1) " , , (DeSCription) 4. Estimated Cost. . . . . . . . .~ . . . . . .' . .~:C? . . . . . . . . . . . . . .. Fee . . -?"?? -: {JJ? . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 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 ............... NUln ber of Stories. . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structur~ with alterations or additions: Front ................. Rear.................. Depth. . . . . . . . . . . . . . . . . . . . . . Height. . . . . . . . . . . . . .'. . . . . . . . Nll/llbcr of Stories. . . . . . . . . . . . . . ; . . . . . . . 8. Dimensions of entire new constmction: Front. . . . . . . . . . . . . . . ,Rear. . . . . . . . . . . . . . . Depth ............... Height ............... Number of Stories. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front .......... . . . . . . . . . . " Rear...................... Depth .............;........ 10. Date of Purchase .................... '. . . . . . . . . Nanle of Fonner 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 14. Name of Owner of premises. . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect ........................... Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . 15. 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, and, indicate all set-back dimensions from ?rop~rty lines. Give street and ,b, lock num ber or deSCription aceo~. to dee) ~.~,' ,"~" ot.= esand indicate whether Intenor or corner lot. '/,; ~ . /' ~, _. , 7~ ~ / j .. ~ / '-' , . . . .~ ( ?. I f, _) 4!::- G ~ R:> t-. D G-, Ie, ( Z Jf' t9 22- It::. LJ I t.Jf' IIU fJ~...~ I~ N 5;;t=;c, Tl U /J ..s '/~ Clc.. Deck- lSo1.---17El) 'iPG~-~ r ~~ ~ t le:, ., rATE OF NEW YORK, S S ){JNTY OF . ' . . 0 0 . 0' 0 _ 0 . ' ,. .' '. . - - . ~,~.'. .~~~ . . . . " being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ove named. , ~ is the.. . .,. . ... .. . . . . .. . .. . . . .. . .. .. . . ...A) O;<.)~. . . . " . .. . . . :.. .. . " . . . ... .. " ..... ... . .. . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this Jlication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the rk will be performed in the manner set forth in the application filcd thercwith. om to before me this ~ a~/,l;/ ....... /.5:';().... - .day of.. -~r""~ -..... .,191:.~ :al1'Publle, ..;V!:14..~_ coun:~...~;.0!:..b~..... . -&-..... , e.~~_......~ (Signature of applicant) $~-.-~.~~~~~:~~."',: . ~ '_;:~..J, "'". V' , ....; ., - .. "\1]) .' L ,. ~'? i . · TOWN OF. SOUTHOLD ~OPERTY RECORD CARD \ \. M - If IJdO- '/ tf-j- 6 OWNER /, . " . 0 IV /1/ ]) (. S' fifE /I A II l' FORMER OWNER ~ FVEf,[Tt j, WAtNEif' 4-tvF RES, I SEAS. VL. S~ FARM LAND IMP. DATE TOTAL . 00 :2. '1 (f) t) ~t?~ 'LlftJO ./ ~ :!;()o z. () AGE NEW BUILDING CONDITION BELOW ABOVE NORMAL Farm Acre Value Per Acre Value Tillable 1 Tillable 2 Tillable, 3 Woodland' Swampland Br~shland House Plot' .~ ~ .' '. ';' ''.''.:~-. COMM. IND. REMARKS DISTRICT SUB. LOT I () ) t!~~. ACREAGE \. ~ 50 TYPE OF BUILDING CB. \ .t \ " ,. 3 "" () r/hJ /;L() : ~"""I