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Home My WebLink About33127-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 08/20/07 No: Z-32540 THIS CERTIFIES that the building ADDITION Location of Property: 1050 HENRY'S (HOUSE NO.) County Tax Map No. 473889 Section 74 LA (STREET) Block 2 PECONIC (HAMLET) Lot 28 SUbdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 13, 2007 pursuant to which Building Permit No. 33127-Z dated JUNE 13, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FAY ANESON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3035578 06/15/07 PLUMBERS CERTIFICATION DATED N/A ~,.~ Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT I 1..0. t I~ '. TOWN HALL '~l -- .-.--.-- . I')t II 765-1802 I uU L I I 2 2l I L::J APPLICATION FOR CERTIFICATE OF OCCUPAN!CY . _~c--J L tiLL',. Dtr", This application must be filled in by typewriter or ink and submitted to the Building Deparmrel1?-~fihQ[h~i'6~[iRg: 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: 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. Old or Pre-existing Building: Location of Property: / 0 ,f?' House No. ~""6f Street <~ ( check one) /e'-rJv/~ IVy // ~S;J:: Hamlet New Construction: Owner or Owners of Property: Pll/ ;{j-tV~ So i\...- '1'-1 Block d Lot ;JY Suffolk County Tax Map No 1000, Section Subdi vision Permit No, ~3\:l} {~J Health Oept. Approval: Planning Board Approval: Date of Permit. (.,-13>,0'/ ~ ~~)l') Filed Map. Applicant: Lot: Underwriters Approval: Request for: Temporary Certificate Final Certificate: ( check one) Fee Submitted: $ ~ 3d.':) \{U Q.ac... )+\O~ A~ tfjr;f'J'OIj Ap hcant SIgnature 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. 33127 Z Date JUNE 13, 2007 permission is hereby granted to: FAY ANESON C/O JOHN ANESON 28012 CLIMA MISSION VIETO,CA 92692 for : CONSTRUCT ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 20675. at premises located at 1050 HENRY'S LA PECONIC County Tax Map No. 473889 Section 074 Block 0002 Lot No. 028 pursuant to application dated JUNE 13, 2007 and approved by the Building Inspector to expire on DECEMBER 13, 2008. Fee $ 50.00 re ORIGINAL Rev. 5/8/02 roBII NO. . 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) . ~~~~l N!NI! 2Ub~ Date ..........kj.l..................................... 19.ik Permission is hereby granted to: ~&-.D L ~ ' ~ ............................ ......................................... ..t. .....d..!.~....~~..I!4..,.............. ......./!.1..~....!.f!.:':..~..................... to..~t!:U..~......tJ..!!L..~....~...~.~.!~7 ...........~...~~....................................................f:........./........................... at premises ~ed ot ......'L../..(2.s.J?......~.A?....~.................................................. ..................................../..................................)......~.............~-/.:....................... ...................................<::....d~#.~c:;?~... ..............................................L............................. County Tax Map No. 1000 Section ..2y............ Block .~~............. Lot No. ...dL............ pursuont to application dated ...........~i............................. 19..~A and approved by the Building Inspector. .5CJ. cIo Fee $........................ .....~....~................................... 7'.......7..~;:g Inspector Rev. 6/30/80 IID.IID I BY THIS CERTIFICATE OF COMPLIANCE THE I ~ 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 ~ ~ ~ ~ OURANIA RAUSCO FAY ANESON ~ ~ C/O MRS. ANESON 1050 HENRY'S LN ~ ~ 1050 HENRY'S LN PECONIC, NY 11958 ~ ~ PECONIC, NY 11958 ~ ~ Located at 1050 HENRY'S LN PECONIC, NY 11958 ~ I Application Number: 3035578 Certificate Number: 3035578' I ~ Section: Block: Lot: Building Permit: BDC: n511 ~ ~ ~ ~ Described as a occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ First Floor, 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 ~ il authority having jurisdiction, and found to be in compliance therewith on the 15th Day of June, 2007. il ~ Name OTY Rate RatinQ" Circuit ~ ~ ~ Miscellaneous ~ ~ as built-I 975 ~ ~ rear porch( enclosed) ~ ffi] Wiring and Devices ffi] ~ Outlet 2 0 Fixture ~ ~ Fixture 2 0 Incandescent ~ ~ Outlet II 0 General Purpose ~ ~ Receptacle 9 0 General Purpose ~ ~ Switch 6 0 General Purpose ~ ~ Paddle Fan 2 0 ~ ~ An as built inspection, ofthe delineated electrical installation, detennined that an obvious hazard is not present and the installation is believed to ~ ~ be in comfonnance witb the applicable reference standard for tlie estimated period of construction of the premises wiring system. ~ ~ ~ ~ ~ I ~~ I ~ ~ ~ I of I ~ 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 IID.IID @J.@J I BY THIS CERTIFICATE OF COMPLIANCE THE I ~ 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 ~ ~ ~ ~ ALL WAYS ELEC. CORP. . HURLEY ~ ~ 262 ORINOCO DRIVE 1100 THE ESPLANADE ~ I BRIGHTWA TERS, NY 11718, SOUTHOLD, NY 11971 I ~ Located at 1100 THE ESPLANADE SOUTHOLD. NY 11971 ~ ~ ~ ~ Application Number: 3031536 Certificate Number: 3031536 ~ I Section: Block: Lot: Building Permit: BDC: ns11 I ~ Described as a occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ ~- ~ ~ 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 June, 2007. ~ ~ Name OTY Rate Ratine Circuit ~ ~ ~ Miscellaneous ~ ~ outside rear yard lighting ~ ~ Wiring and Devices ~ ~ Switch 1 0 General Purpose ~ ~ Fixture 13 0 Incandescent = = = = ~ = ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ seal ~ ~ ~ ~ 1 of 1 ~ ~ ~ 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 @J.@J -"-"-""P"- ~ -'. "'~ " ~i1r !.e '"1" ~ ~ ~!!~ ~ GO' ~ >4: LoT' N9. 26 ~, 10 ,. (l' .... N. 47' 5'()''$(rE. lIao.o t'i ~ .- III Q ~ 0 0 \J ~ ~ ~ ; -~- ---I .... -.. ~32'- ). l' ro I-- 4e!> .j q I ~ l~~ Lor N8. 27 Iij It! c, oil. -> t 0 oj- ~, 7" 0 ~ C) !"l 'F>a...~ ' III ~ "'- (1\ I'l 0 III ~. '-'f' ~ . ). ~ ~ 0 1- ",' ~ III ~ $ d Vl Iu "}'., ~ q: ;€ Iu 5. 4""SO'30" W. 180.0 I( :.t Lor Nil. ZB V) e MAP OF PJ20P~lZr'l 5 U~ VEYIEO IIl"OIl. GEO"-'J~'-- ;.....J:J c":: /i !-...;NESON -- .-- ---~ . ---, "" --" ---- -"-' ". ,",."""-,.~, .--' < .' 1:4'T P~C.ON'C Tow^, 0": SOU'HOLO,NY. c f....~~O'''I''t'!'''~ i.II!, l"' \"" t:r'-4'''''''7'''''''~tft3,t~.:.\;. )'c.. '- <.~ r1...-LllY<. ~f'~l~~ r.',p,ttt~m~ f":'lt ~-";r!'~ ~ ~H";"<!lyor'B '"l\.ntl 8"'<1\ 0(, .. 1: ';~31 shaH not hl:I tXlnslrlere~ i,(' t.k ':: vclid true (:Opy. e t. _~r: ~tee' In{flr.etoo herenn ",h:,,:!' r' ",' .: (I~'/ b t..a person for whr.::.': 1',0 ~";f"; b re. ,..,':~'flflI. end on his bd:~cJ~ to fJ : , ,- -.~ '"'>';1'1 goovernm....,:..t .,:-:-:~r-. :"'~ 'Y-';:,_::'i~~~on lict,~"j h:";:',n ," j .. ,';' -'~:,:. ~-~:'~:;,~)~~<~: ~~: ~~~;;~~~~::;./~.~\} ',c. ... ",;;ri;,; jr.fi.~ituUon. ar "ut.'}oO'.o':{I.,~nl ':",::,':'l;:'. ::s""le: 40'c I" G>' ;"0" pip~ Amended Mo'i ?.b. 1992 N~: Loot nv~Hr-S #how'" ~,. -to "Map 01 ~,.,Ic 1-/0""#$ - :iec.+IOI1 0,.,.,'; f i itrd in .n", ~'-'<<ol/( CDUrt+'j c/#,.j('$ oHI<fI "'$ IVI4p N~ -"lIef. as s<<,v"-loj"".::!, .J(.1",,,,, 30,19"1'(. VAN TuVI- f. 50N e.V"'-~f:-..~L L-i€401 ~d L and ~<Jrv 1/'#0"" 6,..."f"'Orl- Nlw .,.,." I I I ~ih. JAMES J. DEERKOSKl, P.E. 260 Deer Drive " ',\, Mattituck, N.Y. 11952 f\UO (631) 298-7116 To: Town of South old Building Dept. Date: July 31, 2007 Re: Inspections Fay Aneson 1050 Henrys Lane Peconic, NY Permit #33127 To Whom It May Concern: After a footing, foundation, framing, Insulation, ledger bolts, fire separation, and ventilation of roof and crawl space inspections were performed on the above structure, it is deemed that all work was done as per plan, and meets all state and local building codes at the time of construction. Any other questions please call. \: \ , \ \ erely \ \ l=kO'~ 331?-77 TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION ] FOUNDATION 1 ST ] FOUNDATION 2ND ] FRAMING I STRAPPING ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONS1RIJCnON [ ] FIRE RESISTANT PENETRATION REMARKS. ;J~ ~ -W~~) - , r;j- ~ ~~ [ ] ROUGH PLBG. [ ] INSULATION P<[ FINAL -7 . . .. DATE INSPECTOR ~r~ z .0 t- I:! ... ... c:J U .z III ! ~ A- ileft Z - . .-, '-' CI Ii; I ... z o - = CI z :>> Ii! ....... ....... '-' '-' -. ;I Z - ... ....... '-' .. tit .: i\ ... I: = a ~H___'__' ." i:L .l:. .::"1.0... ,;,....... I. / . 'OUllDA TION _ -.!..., s-U.. 'OUNDA TIOll (2ndl ~ . WUGH FRAHE & .PLUMBING 3. IllSULATIOH PER N. Y. STATE EllERGY CODE 4. LFI';IA~ -::::: .." ['J :::> -'- H >-l "" <= ~ (Il [r! D.. :z: 0 ........ . ~ .J CI:l ~.... >-l :::> ['J ~ ['J >-l , ~ = ~ ~ r- ['J >-l 0 .':E: '['1 ~ 7....... . i . . '" >< "" . ..... "" ". >-l H a - (]) . \ . ~ ;\)J '" ". r- >-l -0 ::I: :c;(' o. I ['J . . ." >-l - . "" liD.:.::: ;';0;-lW':Nr~ - ~ ~ ADDITIOllAL COMMENTS: -.J% o. '8' 'V~ \JI ..~ '0 r ~ '\jO ~~ . +p - ........~ ~ ~ ..~ '" .- ~~ \\--. .() 'V~ ~~ ~ .'1; ~- ". o~ " ", fi ,,~ f \J> ~t ~~ ... \:) ~"O- ~ ~ '" lO- r- ~~, ''0 . .I:.- ll, /1 ~<\ v_ \ ..t ~ ~,q n v ~ -\~" $6:.1 I-' ~~ --... 0 ~ ,; y ","" r;::. .I- ~ . s-- J t . ., ~ .4 Town Hall. 53095 Main Road P.O. Box 1179 Soulhold. New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD April 18th, 2007 Fay Aneson CIO John Aneson 28012 Clima Mission Vieto, CA 92692 RE: 1050 Henrys Ln. (Addition) SCTM: 74228 Dear Ms. Aneson, Please be advised that your Building Permit #20675 issued June 1st 1992 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 50.00; 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 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 February 14, 1996 Mr. George Aneson 1050 Henry's Lane P.O. Box 293 Peconic, NY 11958 Re: Building Permit #20675-Z - (Addition) Premises: 1050 Henry's Lane, Peconic Suff. Co. Tax Map #1000-74-2-28 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 Southo1d, 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. . . Print Key Output 5738SS1 V2R3MO 931217 SOUTHOLD Page 1 02/13/96 14:29:26 Display Device User ... X5 CLAIRET F1=NEXT PARCEL 75.10- 03-013 DATE: 2/13/96 ROLL SEC TAXABLE TOTAL RES SITE TOTAL COM SITE ACCT NO 10 1======== ====== ASSESSMENT DATA =========== 1 * * CURRENT * * RES PERCENT !LAND 700 * * TAXABLE * * I TOTAL 5,800 COUNTY **PRIOR** TOWN I LAND 700 SCHOOL !TOTAL 5,800 SALES INFORMATION ================================== 5 SALE DATE 00/00/00 00186 PR OWNER 1 =============!== TOTAL SPECIAL DISTRICTS 3 ===== TERM VLG HC OWN CODE UNITS PCT TYPE VALUE !FD028 !WW020 !SW011 ! F3=NEXT EXEMPT/SPEC F6=GO TO INVENTORY F9=GO TO XREF NYSRPS ASSESSMENT INQUIRY SCHOOL SOUTHOLD SCHOOL PRCLS 1 FAMILY RES 473889 SOUTHOLD 74.-2-28 1050 HENRY'S LA = OWNER & MAILING INFO ANESON GEORGE J 1050 HENRY'S LANE PO BOX 293 PECONIC NY 11958 ===!=MISC !RS-SS ! 1 I BANK 4,700 4,700 5,800 ==DIMENSIONS ===!======= ACRES .46 IBOOK I PAGE =======TOTAL EXEMPTIONS CODE AMOUNT PCT INIT 41101 1,100 86 F4=PREV EXEMPT/SPEC F10=GO TO MENU STREET / D VILLAGE DIST. SUB. e..r>r,-I / c.. 7 N E ACR. ,"1'(;01 S W TYPE OF BUIL~G <11-' 'dad FARM COMM. CB. MISe. Mkt. Value IMP. TOTAL DATE REMARKS /, OWNER or-&> . 0 '. ".' - AGE NEW FARM NORMAL Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Total -- ''!:''(~~;!,i'i;~f .JSj., 1"_"t'1 ML~ /1 I ~ .~~ '} i ~ff v TOWN OF' SOUTHOLD PROPERTY RECORD CARD .' fi~ ~~ ~ 1'/r7/7. e "'I BUILDING CONDITION BELOW ABOVE Value Per Acre Value ....... FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK A_ , ~f, , '1' --- - .< , ,'I , ~'?~:"~ "i.."l",~,...t..,~,,?1 COLOR , n ",.,' ~:_::!:: ~"'oc.v" . ....UJtrj1e TRIM Whde , ~ II Y , I~\ ;If ,J ~ .;l. , --- --.---- -_.-----,-.-- .~---- ,- . ..~---------_._- >\ , ' I "7 M. Bldg. ;J.:tj'f}. 'f ~ f~8' S.(J. ,/toq Foundotion CSt Bath I Dinette I. .to Extension " "'v, ~f Basement ,:.,,(1 Floors JJ.W. K. . Extension .\ Ext. Walls Vu:r+ I1SJ Interior Finish sA. II./l. lR. Extension Fire Place I Heat fHIf DR. " , Type Roof Rooms 1 st Floor - BR. " Porch &.{././f -- \ (( fl (l.f Recreation Room Rooms 2nd Floor FIN. B. Porch Dormer '. Breezeway Driveway Garage J-vi ), 'V 'J-' f J. 0 · ~{tf " " , - Patio . , , I O. B. , Total 4~b / / " '--.~ r I . -:-~~. ~, ,:~0?~_r'" >_.. ~4~<,}-~j~,,4: ~.. ...'....-....'.'.-':',..,.' ", '",," ....."., i ~ J, f, ,'j .1 'i~\ ~ ,- V ---=c:-''-~'f;.f~;'-::-:-=-- " '--0 FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BLOG.DEPT. SOUTHOLD. N.Y. 11971 TOWN OF SOUTHOLD ~ , TEL.: 765.1802 Examined ..." .r........, I~~):- ~~J_') Approved.... ~//......., 199't: Permit NO.<?'(~ Disapproved alc ................. " . . . . . . . . . . . . . . . . . . . -- '):; r~l ~ ~ lli ~ W ~ ~ ~~I MAY29_ ~ BOARD OF HEALTH ......... ---J SETS OF PLANS .......... -SURVEy................... ----CIlCCK .................... SEPTIC0Ii'o/tII .............. NOTIF'f; -7'Q.tJ <4.{"f/ ~).. .9<". o'(J.:-: /$. /~... / li7iT1:: TO: . . . . . . - . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . .. .. . .. .. . .. . .. ... .. .. .. .. .. . .. .. ..~.. '" ... .~, ~" '" ," .... ...... -?~........... o ' , ( i1ding Inspector) " APPLICATION FOR BUILDING PERMIT " , r- f"e- Dat~ . ..t1ll7- ... .. :1.8. .., 1992. ~ '~ 0INSTRUCTIONS " " 'J ,( '""" '.' "", '. r'I a. This application must be completely filled in by typewriter or in ink and submitted to tlte 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 whatevtl 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 necessary inspections. . . . . . . .Inland .Ho.... . Inc . . . . . . . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) . .. . Box .117. .Matti.tuck.I.Y.. :1.19~2.......... (Mailing address of applicant) State wbether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... . General. .coll.tr.actor....................... AP.P.RQV~I)AS.8pn{)...~... DATE: 2-B.p. # ..Jo,(,.J.:J- i'- Name of owner of premises ....... George. .1D.e.o.n .(~~ ~~. the' ta'x' ;~Ii ~; i;t~~< . '. . BU:t::~ 'g~~~~~' If applicant is a corporation, signature of duly authorized officer. 765-1802 '9 AM 10 4 PM FOR THE . FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULAI'lON 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSmUCTION S!-lALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR I 05VOESIGN OR CONSTRUCTION ERRORS I. Location of land on which proposed work will be done. .F.:ut. .Ili~,. .o.t . ~~AJ;';T. ~.. ~5.5.~ ~ . '!llo. . ~~... .~. . . .. . . 'R~~~~~~;dZ.titi; ~i: ~~;;~r~i~ ~ffi~~r')' . . . . . . . . OCCUPANCY OR . , . USE IS UNLAWFUL . Budder s License No. ..1.97~6,..HI.......... WlTHOUT CERTI FICATE Plumber's License No. ........................ OF OCCUPANCY .. , . UNDERWRITERS CERTIFICATE Electn~lan s LIcense No. .. ?i6.~5.,.E. . . . . . . . . . . . . REQUIRED Other Trade's License No. ..................... . . . . . Paeonic. . . . . . . . . . . If...!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Num ber Street Hamlet County Tax Map No. 1000 Section ... .714-. . . . . . . . . . .. Block... 2 . . . . . . . . . . . .. Lot.. .28' . . . . . . . . . . . . . Subdivision. . . . . .l,f~P. .o.~. ?e.~qJ;l~~.~ql!l'''. .f?<:... .1 Filed Map No. . ~~a.1 . . . . . . .. Lot.. 27. . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....t . Family .]Melling . . . . . . . . . . . . . . . ._ . . . . . . . . . . . . . . . . . . . . . . . . . . . b.lntended use and occupancy.. ~. ~...~.~...................... 3. Nature of work (check which applicable): New Building........ .. Addition.. .XXX.... Alteration .......... Repair .............. Removal . . . . . . . . . . . . .. Demolition .............. Other~k. . . 'Va.. . . . . . . . . . .. e S(IJeftription) 4. Estimated Cost. . .~h900. .. . . . . . . . . . . . . . .. . . . . .. . . . . . Fee. . .~t1.,.tP. r? . . . . . . .. . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dwelling units ort each Iloor . . . . . . . . . . . . . . . . . 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. . . . .51. . . . . . . . Rear. B-1 . . . . . . . . .. Depth . .~9. . . . . . . . . . . Height ...:'18......... Number of Stories. . . . . .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . S... hint..... Rear.................. Depth. . . . . . . . . . . . . . . . . . . . . . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . '. . . . . . . 8. Dimensions of entire new construction: Front. . .1;11; .x. 2.'7. . .. Rear............... Depth ............... Height ............... Num ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front.. . .~1?.... . .... .. '" Rear..... :1.1:?.... ...... .. Depth ... .1~P.... . ... . . ..... 10. Date of Purchase ..... .June. . .1976 . .. . . . . . . . . Name of Former Owner . . It.. .lfar:tin..n . . . . . . . . . . . . II. Zone or use district in which premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. poes proposed construction violate any zoning law, ordinance or regulation: ...... No . . . . . . . .. .. . . . . . . . . . . . . 13. ~Willlot be0r~graded .~..".. .l'O. . . . . . . . . . .. " . . . .. . . Will excess fill be removed from premises: . YesXX No No 14. Name of Owner of premises . ~IlQ:rg... .4:Q.'#J.~~. . . Address .~'~9P.:l.Q. . . . . . . . . . Phone No. . .age~9~9Q. . . . Name of Architect. . .. 'iIiiiUici' Homes" . .. . .. Address . 'i1:'~~ilkrtucli:' . . Phone No. . .. . . .. . . . . . .. . Name of Contractor .......................... Address... ?V/i':":........... Phone No. .......... ..... 15. Is this property within 300 feet of a tidal wetland? *Yes........ No..X...... *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. 'IT :>9 077 r_(~;" IrrI ':,:1 ~~ rtl~'+n ~~~ ~r~, . , :0 0'~' n) r ~9 eJ ("\ 3 - 8''':'--("'8 ,'. r r rfn I _ -:-\1'--', ,\ r\ t or:: ' Ie is the. . ~ . . . . . . . . . . . . . . '",';:1;;:":" STATE OF NEW YOR~ :::OUNTY OF .. .:. .......... ........... "0 .............. ....... '" being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ,bove named. r., _I.~.- (Contractor, agent, corporate officer, etc.). -. .' '." ')9 ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the lark will be performed inJhe manner set forth in the-application filed therewith. ., '.' .worn to before me this 0" o. 0 ," I'"' \ .. ~9 _:-::~ () ') r 0" I........: ":F'0. .~:... ~d)Yof.... ~......... .,199'Z/ otaryPubhc,. ... .t:.~........... County SYlVIA It ROUSE \ '~--.eJ c .0. NClllIryPublic, StateofNewYcllt ..... :~.. No 4674306. SuffoIkCou"1Y.o",./ ppIicant) eomml8sion Explres.JuIy31.1r .... .... ..... .... .......0.' ..0.0 ......... .0'.. ........... ..............