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Home My WebLink About33121-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32396 Date: 06/11/07 THIS CERTIFIES that the building ALTERATION Location of Property: 445 (HOUSE NO.) County Tax Map No. 473889 Section 75 CAT ALLEY (STREET) Block 2 SOUTHOLD (HAMLET) Lot 17.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 2007 pursuant to which Building Permit No. 33121-Z dated JUNE 8, 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 "AS BUILT" BATHROOM ADDITION TO AN EXISTING STORAGE BARN AS APPLIED FOR. The certificate is issued to JON T LAKE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C10-05-0016 04/28/07 ELECTRICAL CERTIFICATE NO. 2031916 11/15/04 PLUMBERS CERTIFICATION DATED 02/10/05 MATTITUCK PLUMBING ~ize~ Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 I I 5 2r APPLlCATION 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 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 sigoed 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 ofOccupaucy - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. 05/15/2007 New Construction: Old or Pre-existing Building: Alley, Southold Street (check one) Location of Property: 445 Cat House No. Jon Lake Owner or Owners of Property: Hamlet Suffolk County Tax Map No 1000, Section 75 Block 2 Subdi\~sion Permit No. ~ Date of Permit(,- ~ . (J 1 Filed Map. Applicant: Lot 17 .2~ Lot: Health Dept. Approval: Planning Board Approval: Underwriters Approval: Request for: Temporary Certificate Final Certificate: x (check one) Fee Submitted: $ <- I - .t.:J""" <J~~ Applicant Sigoature Co ~ 3d-~"\\o 0c I~I J'I) 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. 33121 Z Date JUNE 8, 2007 Permission is hereby granted to: JON T LAKE PO BOX 135 CUTCHOGUE,NY 11935 for : AS BUILT BATHROOM ADDITION TO AN EXISTING STORAGE BARN AS APPLIED FOR. at premises located at 445 CAT ALLEY SOUTHOLD County Tax Map No. 473889 Section 075 Block 0002 Lot No. 017.002 pursuant to application dated JUNE 8, 2007 and approved by the Building Inspector to expire on DECEMBER 8, 2008. Fee $ 300.00 ORIGINAL Rev. 5/8/02 l!I.l!I ~ BY THIS CERTIFICATE OF COMPLIANCE THE ~ ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ GOODALE ELECTRIC CONT INC JON LAKE ~ ~ P. O. BOX 1190 PRIVATE ROAD 00 ~ MATTITUCK, NY 11952, OFF MAPLE ROAD jji,! ~ SOUTHOLD, NY 11971 ~ ~ Located at PRIVATE ROAD OFF MAPLE ROAD SOUTHOLD, NY 11971 ~ ~ ~ ~ Application Number: 2031916 Certificate Number: 2031916 ~ I Section: Block: Lot: Building Permit: BDC: ns11 I ~ Described as a Conunercial occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ Basement, First Floor, Second Floor, work shop, 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 ~ ~ 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 15th Day of November, 2004. ~ ~ Name OTY Rate Rating Circuit ~ r.!l ~~~ ~ ~ as built-1996 ~ ~ Appliances and Accessories ~ ~ ~::~::~ :::::: ~:~:board : ~ ~~oo :~:: ~ ~ Pump Motor 1 0 I H.P. ~ ~~ringandD~ces ~ ~ Outlet 15 0 Fixture ~ F.!I Fixture 12 0 Incandescent F.!I ~ Fixture 3 0 Flourescent ~ ~ Outlet 14 0 General Purpose ~ ~ Receptacle 8 0 General Purpose ~ ~ Switch 6 0 General Purpose ~ F.!I Receptacle I 0 20 amp Special F.!I ~ Receptacle 1 0 50 amp Special ~ ~ Receptacle 1 0 GFCI ~ ; Service seal III ~ 1 Phase 3W Service Rating 200 Amperes ~ ~ Continued on Next Page I 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 l!I~~iiIEUii!Iii!~~l!I ~1iI ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I 1iI~~ii!Iii!~E!Jii!Iii! ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Located at ~ ~ Application Number: I Section: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I 1iI~ ii!Iii!fii!Iii! ~ BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS 40 BUREAU OF ELECTRICITY FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by JON LAKE PRIVATE ROAD OFF MAPLE ROAD SOUTHOLD, NY 11971 PRIVATE ROAD OFF MAPLE ROAD SOUTH OLD, NY 11971 GOODALE ELECTRIC CONT INC P. O. BOX 1190 MATTITUCK, NY 11952, 2031916 2031916 Certificate Number: Block: Lot: Building Permit: BDC: ns11 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inion the premises at: Basement, First Floor, Second Floor, work shop, 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 andlor 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 15th Day of November, 2004. Name OTY Rate Rating Circuit ~ Miscellaneous Commercial Inspection Fee Service Service Disconnect: Meters: 1 200 cb An as built irispection, of the delineated electrical installation, detennined that an obvious hazard is not present and the installation is believed to be in comformance with the appllcable reference standard for the estimated period of construction of the premises wiring system. seal 2 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. E!Imi1! ii!Iii! iii 1''',.1 ' Il" TUWII HolI, 5~Oni M.III nood r. 0. nox 1179 f1nlilI1u1d. ~JqW YOlk 11971 '" :j .1 .. '\ t.. . .... . ",'Ii .(... ).,/1 " .1" ','. ,,-,rr.... .;", '1, f.'.L)'~I"\ \' "',.',; ;:":'1 \ "', r.~. " .',' .:,:;:(; ..... 'r:""""-"/':-,': ,/ " ")':')1 I :I" (S I fi) 71',1',. I ~'(',\ fr'l"lJ'l?nq ('j \ I)) 7r,r, lO'l? .. , , . . . , OFFICE Or- THE BUILDING INSPECTon TOWN Or- SOUTIIOLD c; G R l' r r- I ~ 1\ '[' 1 0 11 !J^,TP.: ';)!lqLos-_ flu i 1 ri .IIlIJ petmll:. No. :3 3/;}J -C:; U"/ler: :::}O\-.,'N _,J-o.~~.___....,,__..., (please prI/lt) Plumber! \l\{li~uG"'- P\.~_~'6~~._ (p ense prin~) 1 cllrtLty 1;11111; the soldo!' U!lfH'l 1/1 the Yllller Filll.lpJ.y sy~; tPn! l'ontnllls less than 2/10 Qr H lend. '" Cfv....} l,.;..i.L -..---. .".-.. .,..~ . - .-..- (r'llllIlt;llr~ Glqnol.III:f?) S\,II,lrll to vefore mo tlih ;'. ~TR\CIA~'1\n flolIlY ~0-4~41isr ~. NISS, IU ISIJ ExpiIIS .~. 'PF.??~ ") ...-.LP_ c.Ja~ of -,~~,_,__'J_ Notllry rl\bli~, ~__ ClIll III Y n" .. Ha~ 08 07 08:35p JON LAKE 05/08/2007 15:05 16312981130 631-734-6470 MAl IlIU~~ ~LUMO~N~ p.1 RHEEMGLAS~ Standard Energy Mise~ Electric Water Heater Available in 30, 40, 50, 65, 80 and 120 gallon tall-3D and 50 gallon medium- 20, 30, 40, 47 and 50 gallon lowboy models . 5-Year Limited Tank Warranty" *1-Year Limited Parts Warranty* * Patented A-Foam" insulation process for superior heat retention * Isolated tank design reduces heat loss . High efficiency heating elements . Meets or exceeds National Appliance Energy Conservation Act (NAECA) requirements 'Sn P.n'I"l\_,I1N~H"'~ lftlal_t,o(lI\ e'::.cI'ou"!<l' co'"DIg\~ Wl",nty illlO"",,"..n. SPECIFICATIONS ,. ~ II i' - i: L . A-/ , Tank . I , "',rtlJ. Y MIIlM'1 Cn. M.jglll H.i~lloWa1er ,>C,,, Sllptb~,ftI. p Numb.' Gill. floI"811If tClft~ecllan OQmellf , 1I1VJOO 30 ., " " 7' 811,1400 '" " t' \, " T Bl1/H~OO " 58"/; 58'/: " '" , 611/520 " ~6'1, ~'I. " 10' l l BIIJMiD " " SO ,\ '" .. u~_._.._.. 61"'600 80 ~B'j, 58'" " ". 8lVl2QO 12' " " 21\'/. 32' "ED ....-.----.. .. 81MV3DD 50 3S',. :15'" " " 81 MvS2D " 45'" 45'1, " \\. 0"- _~___. _.. 8151/200 '" " J\ " " 81SV30D .-,.--.....---'. " 29 " 2\ 90 LOW ...-.-...-----,--.... - . ." 81SV400 -0 3~ ." 31';' 23 '" 81SV500 " J2 " '26'1. '" ..._.._.._-~._...... .... elSVS~D " 311'(, J5'/. " lJO Nons: . \.Ie.\~IS 'lIll1t$lleo ..I\n ,'anOtfO ~"O VlII{ AC, tingle ~l'Iite ~QII~;mllIWMO\l'f "'ir;nll. aM 4:'00 .......11 UDtl@fanG lowel hf~tin~ eltmrnlS . "hlilMII tlfllA'lCflII or lSlrlelchl Willi,., thn than ,ho.,.n .,. ftmlnOd by Unlleqolremtnl3. tIl~, (fIlISlDf sp<<II!l;,Ur rttwested. . S'ng" Illmenl mDOel$ a~lI,f;ole on Specllll Qr"'l (6ODOW ~,J. Swbs.titua .S" '!II "0" In mOOtl numocl. . Sllttlill Wjrm9 Ollhllll\l. ~ A 'Ihlltea lIuo\\tlcr or $oocclel wlrlnll optior,s Ire "v;~ilbIR. ConSIlII tiltloly 101 Dllee iln~ ~\I~.I~Olllty e'~l I . ~ . ,,~:It --.... . .' "'c;l\D (lllOllt"TlQII 0 ....Hit '. t<a_t(Y'1)H RH,~''''...tfl!. ~N(G1'lO" ~f1D01 ~o __tD,ot.._1 11 ~J _E"tQHt>EC'1OOf5"'~'J~.".' 'SIOE QPENINI:i FO" SlS'l~O'[) REGEIVED .. Ma~ 08 07 08:35p JON LRKE 85/88/2887 15:85 15312981138 631-734-6470 MA I 11' Ul",,;l<, 1""LUMCJ.I'll,) p.2 RHEEMGLAS" Standard Energy Mise~ 1 __-,'o_",_~ ;'. ,... t-if'~ .I~' I j ! . ., I 1 I . ~I , : I ' .1, I 11 I ~j! I ~ ~!. ~\'I ,.1.1 III . .11 '1, . ' I,i I " Io.Il ;1 I I.t';~: : .' I' I 1_ ~ t I' ~~, l j ~,,~ ..\ I ," ,~)I . ,', . 1!1. <~,",=,~'lt-I~.~ ___~_o-- 2 9 6 9 THESE UNITS ARE DESIGNED TO MEET OR EXCEED AN 5.1 (AMERICAN NATIONAL STANDARDS INSTITUTE) AND HAVE BEEN TESTED ACCORDING TO D.O.E. TEST PROCEDURES AND MEET OR EXCEED THE ENERGY EFFICIENCY REQUIREMENTS OF NAECA, ASHRAE STANDARD 90. BOCA CODE AND ALL STATE ENERGY EFFICIENCY PERFORMANCE CRITERIA FOR ENERGY CONSUMING APPUANCES. 8elore Ol,.lrchasing tnis appliance, read important energy cost and etticiency inlormation available from ',lour retailer. TN~ r1vmOfff one cNjk;e r)I p}u(rlbif'lg profQS$;onals. COtlSTRUCTION FEATURES 4 ,. R.FoIIM Insulation-Rigid polyurethane loam for improved economy and luel sallincs. 'The use of (lIJf pl,lenled insulatolloa,m 510ps allows R-Foam to be iniected dlre~tl~. between 1he tank an<l OUUH jacket. 'This unilorm R-Foam ,\PllllCilrlon minimize'S 'he possil:liti~ 01 COS~ly Ileal loss causee! by uninsulaled areas (voids) common to some Olher 10rm processes 2 RneemgtlS Tlnk-Aheem- w~lef Maler \,~n.ks are m&de 01 sPtcial materials wilh e~aC\il'lO Cire. Ttle tank ~ur1ace is coaled witn an exclusive pOfcelain formUla calleO Rheemglils ar'id fuseo 10 the solid $Ieel at 1600'. The result is il smooth, TOll'ilh, glass. like lin'llIQ lM\ et1eclively resiSts tne corrosive "tticks 01 hot water ctlemitalS, 11lereby assuring long walet heillellite, Tank. i!i. 6eslgned and tested \(1 wilnstand JDO PSI hydrostatiC leSl pressure fer workinQ pressure 01 150 pSI. Ul Standard 3, Hi,h-Eflltlencv Ht11lnv Ellmel1ts--SpeCiilUy treated, douDle layer of magnesium O~IQe an~ copper 10 reSISl corrosion: replacements screv! in easily. PalenteCl resistor desigr, ~81pS ptOlong anode aM lank hte. 4. Isolatlo link D~l'ign-Redll(;eS heat lOSS 5. Colli Wlter Inlet-Replaces water al tan\( bottom \0 prevent mixinQ wiln ilreaoy heated Willer. 3 5 3 6. AnOde Rad-Eaualil';es aggressive water al;\ion. diHerenllVpes lactory-installed ana designed to matCI110cal water ct'leroical chara.cteristiCs !tHoughout the U.S. 1. Im~raved EleClrtnl Junelian B(lI-(FOf '././ anrJ %' conduil) placed abooJe htil.linO alemen1s for easy i"stalla~i(Hl. 8, OVlr lemplfature Ploteclor-Auloma\ic.a1Iy cuts or! power In eXces.s temperature situations_ ~=.", ~ ULS' g. "ulomltlc r,mp,i.turll Control- Tlleffflostal k:eeos water at Qtsirea ~ . . ..,a temperature. - R-FOAM RIGID POLYURETHANE FOAM. . McnDcellulsr ri9id polyurethane loam insulation Is lormulaled to provide low lhermal conductivity. This process forms a comp9.c~ bubble pallern' l!lround the tank.. The uniform appliCQllon minimizes lh~ possibility of cOSIly Mal loSS caused by numetous uninsulated areas discovered in earlier foam processes. '~'IJ'IllIeOI)'l"'Oll. RHE;EM MA.NUPACTURING COMPANY W/lTER HEATER DIVISION "(" kellping w;(1, ;("$ OQl;.;y Oll:On~n"eus P'0llf'l!'99 a.M 'P,GQIlDl llT\Pro...."'enl. Rheern reS"''''''5 ,t.q.ig;I\lIO rrl~k, (;h"r\SI6SWnnOUll'oQl\CIl' . ..;;- etil. Aoee PC ao~. '244(J;?O. M:lI'tOQ/TIElry. AI~Dllmi 36124.4020 PFlINTEO IN V.S." 'l).a7 'NP "OlOM NO. '0'" A&V. D DEBORAH DOTY ATTORNEY AT LAw 670 WEST CREEK AVENUE P.O. Box 1181 CUTCHOGUE, NY 11935-0876 FAX 631-734-7702 631-734-6648 March 31, 2005 BY HAND Michael Verity Building Department Southold Town Hall Annex Main Road Southold, NY 11971 RE: Jon Lake 445 Cat Alley, Peconic/Southold, NY (SCTM # 1000-75-2-17.2) Dear Mr. Verity: Enclosed please find (1) the application for a pre-existing certificate of occupancy, (2) consent to inspect, (3) the underwriters certificate, (4) two affidavits, and (5) a check in the amount of $100.00 for the fee. As we have discussed, the premises has been used for years for business rather than farming purposes. Mr. Lake's predecessor in interest (Edward S. Brush) ran his business from the property and stored/parked equipment, vehicles, trucks, etc. on the property. The enclosed affidavits attest to the history of the use of the property. We will appreciate your favorable consideration of this matter. Thank you. Very truly yours, ~ Cl~~~ Deborah Doty DD:bdr cc: Jon Lake AFFIDAVIT STATE OF NEW YORK ) ) ss. COUNTY OF SUFFOLK ) ROBERT CHILTON, being duly sworn, deposes and says: I. I am over the age of 18 and reside at Peconic, NY. 2. I was the partner of the late Edward S. Brush who used to own the property known as 445 Maple Avenue (a/k/a Cat Alley), Peconic, NY (SCTM # 1000-75-2-17.2) and am familiar with the property. 3. During our partnership, the barn and property were used for the storage of tractors, trucks, and other equipment. %~~ ROBERT CHILTON Sworn to before me this 2'i'"!!:' day of March, 2005 c7~ Notary Public ~ ~ DEBORAH DOlY NOlary Public. St2!e of New Yor1c No. 02D0482S473 . Suffolk County /' Ccnrnission Expires February 28.~t:>v AFFIDA VIT STATE OF NEW YORK ) ) 55. COUNTY OF SUFFOLK ) THEODORE SZCZOTKA, being duly sworn, deposes and says: I. I am over the age of 18 and reside at Peconic, NY. 2. My brother Edward S. Brush used to own the property known as 445 Maple Avenue (a/k/a Cat Alley), Peconic, NY (SCTM # 1000-75-2-17.2). 3. In the 1950s, I visited 445 Maple Avenue on many occasions. At the time of my visits and afterward, the barn and the property were used for the storage of tractors, trucks, and other equipment. fLj&e 9. ~ ~~SZCZOTKA Sworn to before me this :z:f!!;L day of March, 2005 ~ '- l ~~_~ Notary Public ~ DEBORAH DOTY Notary Public. State of New York No. 02[04329478 . SuHolk Coun!Y. Commission expires February 28, ~ t, ,20_ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, be/ore npplY11lg'J Board of Health 4 sets ofBuildjng Plans Planning Board approval Survey Check Septic FonD N. YSDE.C TI1.1stees Contact: '1 D. Doty, POB 1181, Mal to Cutchogue, NY 11935 Phone 631-734-6648 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. norlhfod{.neI/Soulholdl PERMIT NO. 3 ~ )c9- \ ':2::. ------ l~xfllllincd rJ:L : ~~ ?- Approved Disl.lpproved fl/e l~-xpHnlinn " APPLICATION FOR BUILDING PERMIT Date 5/15 __.' 2007 .. ! 15 2[ INSTRUCTIONS a. ThIS applicationhi'~LST be completely filled in by typewriter or lJl ink and submitted to Ule Building Inspector With 3 sets of pl~'llS, accurate plot planto-scaie. Fee according to schedule. b Plot plan showing location of lot and of buildings on premises, relationship to arljoining premises or pubhc stTeets or arens. and wflterWflYS. c The wOli covered by ulis application may not be commenced before issuance of BuildiJ1g Penui! d. Upon approval OfUlis application. the Building Inspector will issue a Building Pennit to the applicant Such a penllll shall be kept on the premises available for inspection throughout the work. c. No building shall be occupied or used in whole or in part for any pml'ose what so ever until the Building Inspector Issues (l Certificate of Oecnpancy. f Every building permit shall expire UUle work auulOrized has not conullenced within t2months after the date of issuance or has not been completed wilhin 18 monUls from such date. lfllO zoning mnendments or other regulations aJTecting the property have been enacted in the intenm, Ule BnildiJlg Inspector may authonze, 1Il writing, 111e extensIOn ofthe permit for an addition six months. 111ereafter, a new penl1it shall be required. APPLlCA TION IS HEREBY MADE to Ule Building Department for the issuance of a Building Pennit pursnanl to the Building Zoue Ordinance of the Town of Southold, Suffolk COlUlty, New York, mId other apphcable Laws, Ordiuances or Rcglllatiolls, for the COllstTIlction of buildings, additions, or alterations or for removal or demolition as herein described The apphcallt agrees 10 comply With all applicable laws, ordinmlces, buildillg code, housing code, and regulatiolls, and to mlnllt (Iulhonzed inspectors on premises and in building for necessmy inspections. ~ '- ; ~,., _ ~~.-?~ ~/'nrn..r (Sig.nature of applicant or me, jf a corVOnl~l) PO Box 47S, r:ntrh1"p II[Y 11935- (Mailing a dress ofapplicnnl) Slale whelher applIcant IS OW11er.Jessee, agent, arclutect, engineer, general contractor, eJectnclan, plumber or builder owner BUIlders Llcense No Plumbers License No ElectnClallS LIcense No. Other Trade's License No. Name of O\Vller of premises Jon Lake . (As on the ta" roll or l:v~d,'n'd) II appllGlIlt t5 a cotpOlatton. Slgnatme of duly authorized officer At't'K", \IE'"' 'S NOTED (Name mldlllle of corporate officer) DATE~- 6 # ~EE:' ., 'v ""C>l pP? OTFY BU/LOn'le, LCP4 - 765-1802 8AM ~.- . RTMENT AT FOLLOWING INSP'~T16N~' FOR THE 1. ~g~N~~J~~~ -/WO REQUIRED 2. ROUGH ONCRETE 3. INSULATI~~RAM/NG & PLUMBING 4. ~~N'tOdl"filJ1i1STRUCTION MUST MPLETE FOR C 0 Block ~LL CONSTRUCTION-M!.J} 1~ Filed MIilt;:Cplj(jREMENTS OF Hi'" eM': Ef ml: YORK STATF N c !:S OF N~ DESIGN OR -CO~STT:~SPONSIBLE FOR UCTION ERRORS. Locallon of land on whIch proposed worlc will be done' ___ 445 Cat Alley, Southold, NY I-louse Number Sheet COlllll)' Tax Map No. 1000 Section SubdiVIsion 75 (Name) 2 Slate existing use and occupancy of premises and intended use and occupancy of proposed construction fi HJliQling me and occupancy barn b Intended use and occupancy barn . J>lt.r-'/ 3. Natme of work (check which applicable): New Building Repair Removal Demolition Addition Other Work u Alteration rade, elec., HWH, Plumbing (Description) 4. Es tnnated C os t Fee 5. If dwelling, number of dwelling units If garage, number of cars (To be paid on filing this application) Nwnber of dwelling wlits on each floor 6 If bUSllless, commercial or mixed occupancy, specifY nature and extent of each type of use. 7 DimenSions of existing structnres, if aI1Y: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8 DlInenSlOns of entire new construction: Front Height Number of Stories Rear Depth ," " <) Size of lot: Front Rear Depth III Date of purchase Name of Fonner Owner J I Zone or use district III which premises are situated 12 Does proposed construction violate any zoning law, ordinance or regulation? YES_NO_ 13 Will lot be re-graded? YES_NO __ WiJI excess fill be removed from premises? YES_NO_ Phone No. Phone No Phone No 14. Names of Owner of premises Name of Architect Name of Contractor Address Address Address 15 a Is this property V\~thin 100 feet of a tidal wetland or a freshwater wetland? *YES NO '" IF YES, SOUTHOLD TOWN TRUSTEES & DE.C PERMlTS MAY BE REQUIRED - b. Is tillS property within 300 feet of a tidal wetland? * YES NO - - " IF YES, DE. C PERMlTS MAY BE REQUIRED 16 PrOVide survey, to scale, ~th 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 clala on survey. STATE OF NEW YORK) SS COUNTY OF Suffolk) . Deborah Doty being dnly swom, deposes and says that (s)he is the applicant (Name of i.ndividual signing contract) above named, (S)He IS the attorney (Contraclor, Agent, Corporate Officer, etc.) of sHld owner or owners, and IS duly authonzed to perfonn or have perfonned the said work and to make and me this application: thai 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. S\V,oJ1~ t' before me tlus I~ day ot M"y ~/ __ J-llI.W-1 I Nota&P lie 20 --DL .- ~~~ - Signatme of Applicant -~ ------ - MELANIE OOROSKI NOTARY PUBLIC, State of New'tblll No. 01004634B70 Qualified in Suffolk County Commission Expires September 30, 2:Qj () AFFIDAVIT STATE OF NEW YORK ) ) SS. COUNTY OF SUFFOLK ) ROBERT CHILTON, being duly sworn, deposes and says: 1. I am over the age of 18 and reside at Peconic, NY. 2. I was the partner of the late Edward S. Brush who used to own the property known as 445 Maple Avenue (a/k/a Cat Alley), Peconic, NY (SCTM # 1000-75-2-17.2) and am familiar with the property . 3. A bathroom existed in the barn in 1978. Its location within the building has remained unchanged since 1978. r;( ~?j C~ ROBERT CHILTON Sworn to before me this 7"' day of June, 2007 --- ~ ) ~/^". '~ Notary Public DEBORAH DOlY York Nata~~r~~~~VCounty ~ Elcpl_ FebrulllY 28. 2O.JA. ----+-_.'--,..:::~::L_~._._.L_4_~-.-~- I p p r., -i--.-~-- -.-....--~-~..........j.--- " --'oF " -_...-..---..------~~...__...,. . . . , ..1- I t I 'ir I I .~ I .. . .~ 'n:' 9 :, h -...;" ~: a.._. F>-1 ~t>__. 8 P ., 1 \ff'. ;.- ... '" .", -:- 8) I --1--- I _-4_~~._;'_ ., .. 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