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Home My WebLink About33229-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 07/27/07 No: Z-32485 THIS CERTIFIES that the building ADDITION Location of Property: 875 HILL RD (HOUSE NO.) County Tax Map No. 473889 Section 70 (STREET) Block 4 SOUTHOLD (HAMLET) Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore JULY 6, 2007 pursuant to which filed in this office dated Building Permit No. 33229-Z dated JULY 6, 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 DECK REPAIR ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ELIZABETH VANBOURGONDIEN (OWNER) of the aforesaid building. N/A SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. N/A N/A PLUMBERS CERTIFICATION DATED ~ /;L'~,,-,=. Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL This application must be fllled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 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 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Swom 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. 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. I. (., -() 7 New Construction: ~ Old or Pre-existing Building: Hi It Rd Street (check one) Location of Property: .sot-d-A rtd ~75 House No. \! OI.flbDU,(~~ Suffolk County Tax Map No 1000, Section I D Subdivision (GI"\.R.....At-e.d.._ -fY~ ~.su lf Permit No. ?;~;). ~~_DateofPermit. 7-'b-bl Hamlet Owner or Owners of Property: Block y Lot ~{.,. Filed Map. Lot: Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Of) Fee Submitted: $ ~- UJ -2":> ~L1 'fs'5 &C l'dY,& I Final Certificate: )( ( check one) 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. 33229 Z Date JULY 6, 2007 Permission is hereby granted to: ELIZABETH VANBOURGONDIEN PO BOX 1211 SOUTHOLD,NY 11971 for : CONSTRUCT REPAIRS TO EXISTING DECK ADDITION OF A ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP # 20504 at premises located at 875 HILL RD SOUTHOLD County Tax Map No. 473889 Section 070 Block 0004 Lot No. 026 pursuant to application dated JULY 6, 2007 and approved by the Building Inspector to expire on JANUARY 6, 200 Fee $ 200.00 ORIGINAL Rev. 5/8/02 r----------:-- ,-y o.:rDJ/ t- ).. AMT. K.W. AMT. H. P. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAG/; 1 10(Hll ~l I BUREAU OF ELECTRICITY Bll JOHN STREET. NEW YORK. NEW YORK 1003B Application No. onfil. 0? 9 412 92192 N 234?04 Da.. KAY 06,199? THIS CERTIFIES THAT only the electrical equipment (18 described bero", and introduced by the applicant named on the above applkatwn number in the premgea oj C,J,VAN BOlJRGONOrEN,ItlC,. NIS RfF., l], PL 1623.4, PHONIC, N.Y. in thefollolCinlf location: 0 BQ1J6m6nt 0 ht Fl. 0 2nd ,..,. OUT Sertion Block Lot U'aS exominedon A.PRIL 27 I 1992 ondJound to be in compliance with the rPfluirements afthis Board. FIXTURE OUTLETS EC!PI AClES SWITCHES RXTURES INCANDESCENT FlUORESCENT OTHER RANGES AMY. K.W. COOKING DKKS AMI. K.W. OVENS AMY. KW. DISH WASHERS EXHAUST FANS 1 DRYERS FURNACE MOTORS FUTURE APPliANCE FEEDERS SPECIAL REC'PT TIME CLOCKS AMT. K.W. 0" H.P. GAS H. P. AMT. NO. A. W. G. AMY. AMP. AMY. AMPS. BELL UNIT HEATERS MULTI-OUTLET SYSTEMS TRANS. AMY. H. P. NO. Of fEET DIMMERS AMT. WATTS SERVla DISCONNECT AMT. AMP. rm NO. OF 5 E METER EQUIP. l)12W lJ13W 3.B3W 3.14W NO'O~Eli'.e-cONO. R V OF ~C~CgNO. NO. OF HI-lEG C A.W.G. OF HI-LEG E NO. OF NEUTRAlS A.W.G. OF NEUTRAL OTHER APPARATUS: HIGH LEVEL ALARM UNlf-l HOTORS:2-F !l.P T.H. CHF.SHIRE & 30N r.O.BOX 243 CALVERTON, NY, 1193j LtC. "839-8 I I ~-{I _l MANAO.. 11 p" This certificate must nat be altered in any manneri return to the affice of the Boord if incorrect. Inspectors may be identified d by their credentials. I COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. J Town Hall. 53095 Main Road P.O. Box 1179 Southold. New Yark 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 27'\ 2007 Elizabeth Van Bourgondien P.O. Box 1211 Southold, N.Y. 11971 RE: 875 Hill Rd. (deck repairs) SCTM # 70 4 26 Dear Ms. Van Bourgondien, Please be advised that your Building Permit # 20504 issued March 26th, 1992 has expired. According to the Code ofthe 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 $200.00; 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. lOBI( NO. . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N. Y. 8 Q ~Iii BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N!NC! 2050fZ Date ...o/~~................................... 19.f.:::?- Permission is hereby granted to: . ~/~.~...t!..~~ ...~~..~...................................................... ~ /....~~....?:/~..r..lL.?~8 . to..~~...~....~..~~...~..~~:. ~tL'''~'--h4;,'''~~''''Z........~4....;?b.......... ot premises locoted atf2'~(j~..L~........:~............................................................. ..................................................~~~..................................................................... ................................................................................................................................................................ County Tax Map No. 1000 Section ........7a......... Block .......~........ Lot No. .....~........... pursuant to application dated ............~.............................. 19..~nd approved by the Building Inspector. ,~ Fee $...~___~. m .......... ~t/r~...- Rev. 6/30/80 332-2- ~ TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] I~ATION [ vr'FINAL [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT PENETRATION REMARKS: DATE ~/; ~/o7 INSPECTOR ,'ELi) I:~S::2::2.~:, II'" .,.- il ;;i.;,'{!'lLllr:: "-in..:. A .." . I '" 1. '" I H , , " ., -- ~ ,OUllDATION (1 s t) I . "" - -- - -'- I ~. I 0 0' ~OUNDA nOll (2nd) I 2. l- I "" 0 I . ~OUGH FRAHE & ,PLUMBING I . . .. I en ., J. '" I '" t':l mSULA TION PER N. Y. I o. ., STATE ENERGY II ~ I > CODe: /I = .. ::: 7;/$ f<77 ~/.'f'n ~I/h . --<.1./-.. ,---f ~ 'j. I / I" // " ff / .. I // ,.. ~ FI;IAL I t/ ~b' '. I .. I~~ ADDITIOIlAL COMMEIlTS: I~" "'~ './~ ' ~\ .. , " . . - ,. 0, . . . - . '" >< ' '""tI " H '" . "" ., H 0 . . - . ~ . '" j' "" r- ., , :I: . i "', '" ' . ." .... . . - . - ... I . w \.N ~ ~ l ~ ~ ~ ~ ~~ ~ ~ t .::::::... ~ ~ ~ I ,..-', ;....- FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOA~D OF HEALTH ......... J SETS OF PLrlNS .~....... SURVLY ................... ClIcCK .......~........... SLPTIC FORM _............. E . dEl ..,? C;7 xanune . .....;:.........., 19 /. !-.... " A 3/7A" ..4'..... N ~5C?;/.;i pproved ..;;: .~."':......., 1!~/"~PenTI1t 0.. ........1; Disapproved ale .... _ . . . . _ . . . . . . . . . . . . . . . . . . . . . _ . . . . . ............... ................ .;;;~.~:.~- 4-4 ....... '(B~~'I~~tii~ ./... .t~ APPLICATION FOR BUILDING PERMIT t: DT ! F Y : CALL MAIL . .. . .. .. . .. .. .. .. .. .. . .. '.' .. .. . TO: ......................... . . . . . . .. - .. .. .. . .. . .. .. . . .. . . Date :~~.. .. .. .. . ., 197-?,- 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in bUilding for necess~ ~nspect~o~ J. . - '~;~!:~i ~~;;::7::::;;;e', ii ~ ~~~;~;ati;~)' . . . .... /(J!.~~~'-f..~.. dc/J.Z.'~.... /!95:s:......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .~.i(\.: Nc;./?.................. _........ .~_.................................................... Name of owner of premises .n.-.17(~(~I{T)f.... /tt.l(. B9.1!.i;.rf.c:-:1(I!'. ~i:F:"'f. ...... .... ... . .. . .. ............ (as on the tax roll or latest deed) If :!pplicant is a corporation, signature of duly authorized officer. . ...... ...... ... ....... .... ................ ... (Name and title of corporate officer) . B'l 'L' lQ CJ'LS--\.J\ ~Jljq\ Ul der s lcense No. .. I <,.:j >. . . . . . . . . ~~-+-. . . 'I' . Plumber's License No. ................... _ . . . . Electrician's License No. ...................... Other Trade's License No. .. _ . . . . . . . . . . . . . . . . . . I. Location of land on which proposed work will be' done. ................ ... .......... ... ..... ............ ... 9'.7.~...... -.......... .I!J~_~.. .R./).................. .$c?f/7.7t().~D..................... House Number Street Hamlet County Tax Map No. I 000 Section .... 7.1). . . . . . . . . .. Block .....r............ Lot...~ k. . . . . . . . . . . . Subdivision _ . . . _ . . . . . . . . . - . . . . . . . - . . . . . . . . . . . _ . . Filed Map No. ........... _ ., Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi?n: , h;";,,,~ "d o'''P'''Y . ~;i~/"4(' . . "~<!1.1~:""f .. ... .. b. Intended use and occupancy .. ,$ f1 ," . ., .lz.;,C~~ .a-e;t-,?J7~(.-<(,1:!:(.-:-:.... ........... . 3. Nature ofW~ (check which applicable): New Building...... . . .. Addition.... . ..... Alteration ..... \..... Repair .~ ~ ~7' Rem~al . . . . . . . .. . .. .. Demolition .....;,.;.. ~~Other Work.. (D~~~ri~t'i~~) . . 4. Estimated Cost. . I .~.~'7?.~. ..................... Fee...:... ~ !.~.. . '" .................. (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 ears ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................. '" 7. Dimensions of existing structures, if any: Front. . ..,J ~ .'. . . . . . . Rear .. .4d. "I. : . . . . .. Depth /~. t. . of: ./1. ~ . . . Height .... .-::'. . . . . . . . Num ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.................. Depth. . .. .. . . . . . . . . . . . . . . . . Height. . . . . . . . . . .. . . . . . . . . . . Number of Stories.. . . .. . . . . . ., ~. . . .. . . 8 0' , f . , . F "" t /. L/ I /.;;z.. 'r u I . lmenSlonso entire new constructIOn. ront....""'''''........Rear...~.7.........Depth. .......(..... Height ....~.......... Number of Stories. . :-: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front. . . . . . . . . . . . . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. II. Zone or use district in which premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ./JI.t? . . . . . . . . . . . . .. . .. . . '" .. 13. Will lot be regraded .. N~ '€ . ./. . '/1.-;,;,' . . . . iI' . . . Will excess fill Qe remqved from premises: Yes .@ 14. Name of Owner of premises. . :v.9:tt; ry~~..1f~~-;'Address ff.l.>:.tlr:-r(. Ai. . . . . Phone No.?:'f.S:-~t: ?;~.:;;. ... . 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 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 N~R.\{,['_ LV S.S COUNTY OF .~"'T1Q. '" . . . . . . . . . . ..~~.V:.k . . ~. ."\>.<;\ Y.l. .'? . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the. .. . . . , . . . . . . . . . . . . . . . . . . . 0o~ ~~~~t, ~~~~~;a't~ ~'ffi~~;, '''t~.)' . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 thi~ . ... . . .. . . n?f . . :-", /.;~ .f:,Yf dJ,., l''1Y :--iotary PUbli~L-.f. .. .. .~) .. County ,~ " Notery ~1~~~~'oWtew'York \ . . . . . . ~-~'A~S::;t):~. . . . . . . . . . . . . . . Qualifi:i~~~~5countv q ~ (Signature of applicant) Commission Expiras Dacembar 8. 19_ Print Key Output 5738SS1 V2R3MO 931217 SOUTHOLD Page 1 04/17/96 14:32:29 Display Device User ... X5 CLAIRET 70.-4-26 875 HILL RD = OWNER & MAILING INFO ===I=MISC VANBOURGONDIEN ELIZABETH IRS-SS MAIN RD ! 1 PECONIC NY 11958 I BANK DATE: 4/17/96 ROLL SEC TAXABLE TOTAL RES SITE TOTAL COM SITE ACCT NO 08 1======== ====== ASSESSMENT DATA =========== * *CURRENT* * RES PERCENT 2,200 **TAXABLE** 11,800 COUNTY 11,800 **PRIOR** TOWN 11,800 I LAND 2,200 SCHOOL 11,800 I TOTAL 11,800 ==DIMENSIONS ===1======= SALES INFORMATION ================================== ACRES .44 IBOOK 5 SALE DATE 00/00/00 1 PAGE 00099 PR OWNER =======TOTAL EXEMPTIONS 0 =============1== TOTAL SPECIAL DISTRICTS 4 ===== CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE IFD028 IPK070 IWW020 I SWO 11 F3=NEXT EXEMPT/SPEC F6=GO TO INVENTORY F9=GO TO XREF NYSRPS ASSESSMENT INQUIRY SCHOOL SOUTHOLD SCHOOL PRCLS 1 FAMILY RES 473889 SOUTHOLD I LAND !TOTAL F1=NEXT PARCEL 75.10- 03-013 F4=PREV EXEMPT/SPEC F10=GO TO MENU 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 June 27t\ 2007 Elizabeth Van Bourgondien P.O. Box 1211 Southold, NY 11971 RE: 875 Hill Rd. (deck repairs) SCTM # 70 4 26 Dear Ms. Van Bourgondien, Please be advised that your Building Permit # 20504 issued March 26th, 1992 has expired. According to the Code of the Town of South old, a Certificate of Occupancy must be issued prior to use ofthe structure. To renew your Building Permit, please submit a fee of $200.00; at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. 1/& vi-u~ ~(J 8/lGJf" TOWN OF SOUTHOLD PROPERTY HeaRD CARD s aLt/-/'.'/)'" ,/ ACR. ,"7'"/0 TYPE OF BUILDING u 000_ OWNER -2' VILLAGE DIST. . I ._ Et./ZPSG7rt' VI1NBOVR.Go1,J b ~;t.J i J " FORMER OWNER N S W CPFD I1HI-ERS SEAS. J>/'tA/'O VL. RES. N () LAND FARM COMM. CB. MICS. Mkt. Value / IMP. TOTAL DATE 00 o&J Tillable FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD Woodland Meadowland House Plat Total -' 11) /VI-;L~ -- SUB. LOT ..,L,:S- r a f .~, , ;, ~ ~.. ~ ~;p.~' , / ~ , - -.-- .~ -;; COLOR ftlf./;;f?! 1-+ ~rle. I iJ' . L p~ I ~ I .~~.....,. ." - ' .,--- 'Ii: " ~v~ TRIM wC ,<re. I. ./ I. /v /W J ~ _ b. ~ II ~I "",VI'- ~J J II ~ 3:1 I l/:r~ ':> l<_ Lr~ 1;.Al-.s1 - . -- ~ .. .j..- I II I. b .. 11r. ,~~ I '- xH I'" I . / /'1 ~l I;'"; -~ . ~I II' 3' ;r411 1 ~ , , I .;:<-..kt~~';' '--'r . L,;~' - ., ,~,"i':!~..\;:lt;\;.>:,'.t.; -.;- .." y. ,;::~ - .1t ;.,.. ~~>'~/'\~;~:rb~.:;"":> "'<~::7;~"':';:_~:""~""":';1,Y:..;,'5<-""'t M. aldg.'~J7x W;'/2.7;-J'/';'~ '.' ',' ./ ext..ion l~ks.2}'M.4ltso~ r/77S' 4,15" ~4J/ Extension ..... 1 ',~$,;~','.;i~1 ",",: ,pl~". .' . . '. . . ..' ~'; ..' '.r::' 'Extension:> 1.l.)",L~ ......;.,;i .... .'. ." '. '.. jP I> p-d .' '!Jeck. 'hX!tj~;;,~.,(."""'~-,ll.'u> 1<1 Foundation:," l?C';( Both"'':'~i'J/~V Dinette', Peid! I\,,~:l..tt~.z~~-f;:.ltl'~~ ,.~f~~~'.' I'd. Basement" rl-fl!' Floors .i. 17L!n~k' K. I18n:h "".r 'Gt 'i;;.'??:~';:~iJL,'.1ff,~" }'So '12.. Ext. Walls' " I ~:'3.e.~T;;<L Interior Finish f ,~,(7,L PA,tL LR." al'1NlZewayitI16;,~.~i:'~""~."~i:R<'" 1)'<; .' Fire Place' .... '.' !,Si-< Heat ,.." ',,+ R R lJ,W DR. Garage""!' '11/ 1ft./-;;':tr'7k~r;g~~:;t' lso:I~'jlLtf.lType Roof/.9kl-IL4... Rooms 1st Floor. ....... BR. 'Patio"C;\'.lff'<:~? ~6Il!'''''';';~,;' ,{ I:; "l~1ii~ .......~... .,' L/"i:.,......~ Recreation Room 1 ,<' VA, I>' Rooms 2nd Floor "'C FIN. B ../',.... j',YJ::J' ~:".[j ""'."..,t;(~':.. 2:(" I""'y~ . . "." 0, B.T)~f'~/n<~';Y+:""'i' I f( Dormert' h.I/Rut> Driveway ../ . :rCjfal . I'" """:";-t"<~i 'j.:il,. ..... If 57 ,/",,; . .. ' .,--~, . ';Y; ;!; '... 'i' ...~, .. ;;, 'f'::~ '., '. ; .c' ,~. ..' y" . '. . r", " .. ., . )11.:':"'1 I~ z..J . . I. " IVi 1 I .' '>".:: '. 't. :~:" 'C:- ." . ,( . ',';'.' ""'.;, '.J.' . -' '..; " " : .',:~ " 1 ,. '.' " . : .,-;: . ;.;. L.' '~' ~.' -" . c .' ..~ ,'S:f") .,''-'''J .' '!1~~~.::';~:t' i I .-: "".--"',.......,:.., " Examined.p. .~k.. .... .. 1991-- Approved. . y.~. . . . . . .: 1~~Permit No. . ~~~/ Disapproved alc ..................................... MAR 2 61992 FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL. SOUTHOLD, N. Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... J SETS OF PLANS .~....... SURVEY ................... CIlCCK ....... ':"': . . . . . . . . . SEPTIC FORM .............. BLOG '~;:,\;~i'''''~''''!: _.- TOWN OF SOUTHOLD -~;,',"" t:OT 1 FY : CALL.................. . MAIL TO: . . . . . . - . . . . . . . . . . . . . . ...... ........ ...... ...... .... .~.~ ~ ~ . . . . . . . . (B~~'I~~~~) .~~ APPLICATION FOR BUILDING PERMIT Date :~C:.. . . . . . _. ., 19l'>:- 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necess~.. ~nspectio~ J . _ . .<k~'{;4-:~!.f6!m-lf,{':'Il.'-".<-,.................. - ignature of applicW, or name, if a corporation) .... /(J!.t?q'-f:.~.. t1C/(l.t~.... !!9s:<f:......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .~.w.' Nt;.R........................... .~..................................................... Name of owner of premises .f."!-.IX~(~l!.7)f.... /!I)(. 8~.I!.i<';.if.~:I(~ ~~^!... .... .... .. . . ... .. ...... ... ... (as on the tax roll or latest deed) If c.pplicant is a corporation, signature of duly authorized officer. . ....... ............................... ....... (Name and title of corporate officer) . B 'Id ' L' N . Q CYL S- - \oJT ~ J Ij'"' \ UI er s lcense 0.... ~ :-. . . . . . . . . ),)i4-. . . 'I. . Plum ber's License No. _ _ . . . . _ . . . . . . . _ _ _ . . . . . . . Electrician's License No. ........... _ . . . . . . . . . . Other Trade's License No. ............... _ . . . . . I. Location of land on which proposed work will be done. ......... ...... ......... .......... ..... .... ...... ... '1.7~................. .I!J~.~.. .R.}).................. .$cJ..C!71tt?~C?.................... House NUI11 ber Street Hamlet County Tax Map No. 1000 Section .... 7/). . . . . . . . . .. Block .... .r.. . . . . . . . . . .. Lot....;2; k . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy. ~~-1': -1$ fttk.. . ~~~'C~~Jc: . " ... . b. Intended use and occupancy ..:5.;: j i~... ~~. .. .~. .~.~..Z. ,..:,:.:.,:......... '~ .. 3. Nature of work (check which applicable): New Building. . . .. . . . . . Addition.. .. . . . . .. A1terati~n .......... Repair .. V . . '~f . Removal. . . . . " .. ... .. Demolition .............. Other Work.. . .. . . . . . .. . . . ~ ~?f -f 53 tr" ,.\. (Description) 4. Estimated Cost. . . .'Ji!-.S::C;?.:-:-:-:-: " . . . . . . .. . .. . . . . . . . . Fee....... ~ !.~. . . . . . .. . . . .h . . . . . . . . . . . (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.busin.ess, co~~er.cial or mixed o.ccupancy, specify !1atuJe and extent of each tYP,e of use ........../..... ./... 7. DimensIOns of eXlstmg structures, If any: Front. . . c?.;? . . . . . . . . Rear .. .~. "(. . . . . . .. Depth />?. . . of: ./(. . . . . Height .... .-:-:'. . . . . . . . Number of Stories. . .7-:-:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.................. Depth. . .. . . . . . . . . . . . . .. . . . . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . .. . . . . . .,. ....... 8. Dimensions of entire new construction: Front. . . . :o3i?'. . . . . . Rear . . .,f" "/. :. . . . . . . Depth . I.P? . <f. ~ ~ . . . Height ....:-.......... Number of Stories. . :-: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . . . . . . . . . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase .............................. Name of Former Owner .....................'........ II. Zone or use district in which premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ./.11..". . . . . . .. . " . . . . . .. . . . . . . . 13. Will lot be regraded .. N~ '€ ilt; . 'Il.-;';~i . . . . if." . . Will excess fill 4e remgvyd from premises: Y es ~ 14. Name of Owner of premises ..:. fiKr,<,c,o.(f":4L:'!-:'Address ff.?>:.tfy((. A'd..... Phone No:":'~.s.:':t: ?;($..... Name of Architect ........................... Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . . IS. 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 property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATEOFN~R~'['_lV S.S COUNTY OF .~-r.rp. ... . ......... .,t:\~.v:k..~. .'\>.Q,~.l..'?........... (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the. .. . . . . . . . . . . . . . . . . . . . . . . . 0o~ ~~~~t, ~~~~~;a't~ ~ffi~~;, 'e't~.')' . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 thi~ .... .. . ..: ;y1J.... .day of. :~.. ):W ~.., 19CJ.:r NotaryPUbh~..7.~.).. County ,C0- " Notery~~~ewYark \ .. .. .. ::\~ c:ill~ . .. . .. . .. .. .. . No. 4879606 Qualified in Suffolk County q ~ Commission Expires December 8. 19_ (Signature of applicant)