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Home My WebLink About33443-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32755 Date: 11/27/07 THIS CERTIFIBS that the building ADDITIONS Location of Property: 520 (HOUSE NO.) COunty Tax Map 1110. 473889 Section 103 TRACK AVE (STREET) Block 12 CUTCHOGUE (HAMLET) Lot 4 SUbdivision Filed Map 1110. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 11, 2007 pursuant to which Building Permit No. 33443-Z dated OCTOBER 11, 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 TWO ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SPENCER PETTY III (OWNER) of the aforesaid building. SUFFOLK COUIIITY DEPARTMBlIIT OF IlBALTH APPROIIAL N/A 09/06/07 ELECTRICAL CERTIFICATE Il1O. 3044737 10/23/07 SPENCER PETTY III PLDMBHRS CERTIFICATION DATED ~~ Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL r', 765-1802 ' lJiJ;~ f2 ~ If, F _: \: API'UCATION FOR CnTIFICA TE OF OC$~t:~rtY ",8 . . 2J j ThIS apphcatlOn must be filled 111 by typewnter or ink and submitted to the BUl~d~~.2'!,t ment Wl:~~fOll wing' 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. Sworn statement from plumber certifYing that the solder used in system contains less than 2/10 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 I, Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15,00, Commercial $15,00 , " I Date. \O''.l~'()1 Location of Property; S~Q House No. Old or Pre-existing Building: ~ \ <'0. c).< ~H.'. Street (check one) C~_A_L -\-"\'0:1 h.e Ha t New Construction: Date of Permit. (?e.\,l,.... ;IIL \ Block D'D \'}.. Filed Map. Applicant: Lot o () '-\ Owner or Owners of Property: S \? e....l" p r \..oJ. Suffolk County Tax Map No 1000, Section 4'l 2> ~ ~ q Subdivision ?,~~45 Lot: Permit No. :i I Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ( check one) Fee Submitted: $ d<).OO ~.73!.f'f7 Co <.. '!>.z 755 "JJJ, 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. 33443 Z Date OCTOBER 11, 2007 permission is hereby granted to: I SPENCER PETTY III 520 TRACK AVE CUTCHOGUE,NY 11935 for : CONSTRUCT 2 ADDITIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 20692. at premises located at 520 TRACK AVE CUTCHOGUE County Tax Map No. 473889 Section 103 pursuant to application dated OCTOBER Block 0012 Lot No. 004 11, 2007 and approved by the Building Inspector to expire on APRIL 11, 2009. Fee $ 50.00 ORIGINAL Rev. 5/8/02 l' ;, Ii I!I~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ ~ Located at I Application Number: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ An as built inspection, of the delineated electrical installation, detennined that an obvious hazard is not present and the insl'!JlMiPn is believed to I be in comfonnance with the apPlicablec:::::: :~::: ;::~e e~imared ;eri:: of2consUuction of the premises wiring symm. ~ 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. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by ROSLAK ELECTRIC PO BOX 164 CUTCHOGUE, NY 119~5-2453, SPENCER PETTY 520 TRACK AVE CUTCHOGUE, NY 11935 520 TRACK AVE CUTCHOGUE, NY 11935 3044737 Certificate Number: 3044737 n511 Section: Block: Lot: Building permit:OZOCi1J BDC: 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, i~ 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 Administrationb or other authority having jurisdiction, and found to be in compliance therewith on the 6th Day of September, 2 07. Name OTY Rare Ralin. Qrgill D:ill; Miscellaneous as built 1990-bedroom on sout of house-bedroom on north east corner of house Alarm and Emergency Equipment Sensor Appliances and Accessories Exhaust Fan Wiring and Devices Outlet Fixture Outlet Receptacle Switch Dimmers Receptacle 4 0 Smoke o F.R.P. 2 0 2 0 20 0 14 0 5 0 2 0 3 0 Fixture Incandescent CleneralPurpose Cleneral Purpose Cleneral Purpose ClFCI [Q]~Jrc'J@l21' r2 Q - _ 21 <iJ _IJ? ~ I ~ I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ '. ~ ~ I ~ ~ ~ ; I ; ; ~ ~ I I ~ ; ~ - - FIJf, ~@EiJ[2J@..@@@j[Q] j, ~ . ~ ~ I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Located at I Application Number: ~ Section: Block: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 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. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by ROSLAK ELECTRIC PO BOX 164 CUTCHOGUE, NY 11935-2453, SPENCER PETTY 520 TRACK AVE CUTCHOGUE, NY 11935 520 TRACK AVE CUTCHOGUE, NY 11935 3044737 Certificate Number: 3044737 Lot: n511 Building Permit: BDC: 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 authority having jurisdiction, and found to be in compliance therewith on the 6th Day of September, 2007. Name OTY Rate Ratin. Circuit Ix3 seal 2 of 2 ~ ~ ~ I ~ I ~ ~ ~ I I ~ I I I ~ ~ ~ ~ ~ ~ ~ I I I ~ ~ I ~ ~ ~ ~ I E!IE!IE!Iii! [g]~@1I@J~~ II . Pax (631) 765-9502 Telephone (631) 765-1802 Town Hall. 53095 Main Road P.G.Box 1179 Southold. New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: \ b. ~~. D, Building Permit No -3 '3 '1,:\ 3 - -z.. (fel?\ac..e ~ dO lo9.;l "z. ') Owner: S~-P("\c..'€..r L0. Pe.-~, 3IT:. (Please print) I Plumber: S~e.,(\c€..(' 0. 9e.~ "TIT (Please pnnt) lead. I celiify that the solder used in the water supply system contains less than 2/10 of 1% 'J,.i Sworn to before me this ,J,J ~ daYOf~, 20JL'l .~ .f?,f~ Notary PUbliC'~~ County ~ :;81.;. . ....'"" 'fIlll 33'fLf3'L TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING ~FINAL k> [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCT1ON [ ] RRE RESISTANT PENETRATION REMARK$; ~ ~ ;::.- =--- ~ ott~ ~~ tI-,~~. ~\cf.~ DATE 10 -/ C. -07 INSPECTOR ~~ ,._,r:"~"~";'.""!""'~ic' '~'.~ -- '; -,.......::y- - ~~~- ~-~ ..{' ReA 3i'> 4 ~~ ~CX,U ~ 785-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] I~LATION [ ] FRAMING .. [~NAL DAn: I -a)~/I,y ~ INS I I f - ~- .~ ,-,; --..c;;. " ~ t: Ik.n 3"3L{1J3 715-1_ BUILDING DEPt'. INSPECTION [ ] FOUNDAnON 1ST [ ] ROUGH PLBG. [ J FOUNDATION ZMD [ ] INSULATION ~MING [ ] FINAL REMARKS: &~ ~ czr ~ / - ~ - ~..( ~~~L '. DATE r/rl/l} " / INSPECTOR -.-=-'- -- --.--"""'-- .'^ '=33LfB 715-1802 BUILDING DEPT. INSPECTION [ ] FOUNDAnON 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION ~NG [ ] FINAL R_. ~tP-r~ 1f~'-I6 1)( ~ L' DATE z...-.NSPECTOR ". '1'...,," , ,',,~ ~'M"" . ,; - -- - .._-~ ~z- ~2,~ 715.1802 BUILDING DEPI'. I NS'PE>CTION [ ] FOUNDA,"ON 1ST [ ] ROUGH PLBG. . [ J FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~AL - :!-j' 6 - -:d- -? DATE 1 V 1 V INSPECTOR __~_._....c..::,,-,-___. __.J:",~ .__~__ -- ----.-.- -~.. '--'--".~ .._~ , Y<e/L 33l.fLj3 765-1802 BUIJ,DING DEPT. INSPECTION [ ] FOUNDATION 1ST [~H PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ r- jJ~ oL DAn 11[.:4 '('v INSPD:TOR ""\ --. ..., ',- .-~--- -,~~.. .",-.~._"_.-~_. -. '-",",'. ~3Lfi3 711-1812 BUILDING DEPI'. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZMD [ ] FRAMING [ ] FINAL REMARKS. /~~ ~ ~ ~J....I'! DATE t \ I~ ~-''''''''''--~.,(!,..''''''-~--''""'''; ~~ 33Y.~3 ~ 765.1802 BUILDING DEPI'. I NSPICTION fL.J--I'GIiNDATlON 1ST ( ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL R_~ fi::!;::;;; . DATE 7/1"12/ INSPECTOR _----""".:.<;L . ..2...:.. - - ~_ ~_ , ~ ."-~ - .'i:: ~ ~ .10 .~ CI>~ >-il'l\ :cr. '" '" >-i , _f - " '" 3: c- '" >-i .' .- n=:Lil ;';i.J,'{/'l[NT.:: - " t.~ .. -....... .... .Lu~.:.:...... ~I..i., i1lJ;':=: iI 1. r- FO..!!lIDATI..Q.N _ -L1s.!:l.. FOUNDATION (2nd) 2. ROUGH FRAHE & .PLUMBING 3. INSULATION PER N. Y. STATE ElIERGY CODE 4 . n.1AL ! , ~~. i. .,. ~ W >-i ~ "" ...(;. -~ ~. c::<>- Cl>0' [J:!~ .' ~ 0""<. .~, .~*' :. ~ ' \'i ' ~ +- , .1 -, - --, " ' i;; ,on. ::- ~~' t"' >-i :I:: ~'i ." <-i "" i _.r..r-.',. .~_..._.,.~ . ._~... ..-.' _.<;:'~- - : . ----cw-;::i:~~x:..;~-.. ! c"'.".;,"~ .. . TOWN ~ lOon ~ / r> 3 -I z-'i i OWNER ~. FORMER OWNER ~ s- "(1 l ".: . THoM AS RES. Ala LAND IMP. oJ }Coo /(,oa/' I-'bO ~"'oo / lOoV 3 "/',;, v Tillable Woodland . , ! Meadowklnd I Houle Plat Total VL / / TOTAL i rt \"'-~'~~ ~M'.":"9"~ "'- . " .\ } r ~ OF SOUTHOLD PROPERTY RE~ORD CARD " STREET 2-0 LOT VILLAGE DIST. . SUB. N rd. c K ve -'1ve. C (/ Tc hO t/e E T.....2. d t\ f) venl)e W U"S A Ac~e.. SCflJ;v. r/c/Jcr - F/J I- FARM COMM. CB. MICS. Mkt. Value S h . ; DATE (0 FRONTAGE ON WATER FRONTAGE ON ROAD ~ lJ ~, U,fi, @.. (1(1_. :: ,{CO, ,;~" DEPTH BULKHEAD i loft- 6Hf c~ ' , .,~""""""-'<""'~/"> r~~~'(}, .:.rV.- .in ,'" j ....-c -"-"---'~""" ....- ~>~~i~_~ ,<~r.~'" .....--~-~..... -' -'_C-C'c.~'""'-~~_'~:"~"'~~"-c-;::';;~~r.j~',~~.- ....... ....-, '-'''' '~, COLOR TRIM ~."~"--~ "'" ., -, --,.,,~,.,~ -~~~-_.,~~- '-~~T~,~r:~ ..~--,.~ -~;~-~>':~~...j -," , _... j - . -".. . ..' - '. - ,', ..... ,"~-.'" --:"':":..;.h,'.. .-. . " . --=-.......-.. . " ',' ....~~r,l~~.~''- ~~] .' ,> .. I } 'i !,~' ' ~~l .. , \h. t .- :" ~1 "'" - .. , - - fY~" ,- '.,~ o. r .~ '..', , .- , ~ '. ~ ~-:.;;-; _.# .- r '\ l-a~-~~ J ~ .,:- ~~-;;': - '~::~;i'(;:.-,~~~' " I' ,< ~ J' -('/ , -',-.- . .':n:#-'~~''''\'l''"""""" ,,:. r' >,~1!".- .-7'-~7~";~....~'" .'.~''''' .- 'I. , V ~ ']... I. ~ I f , .' I~ .r v ,- , :L- 7f" " . , , (. #1" M. Bldli};'1 ).{;I (/'.2 : IC/~"" ..3.~.5' .3ft/ ') " 1../ 11- ~ian Extension , Extension \ Foundation p. (', Bath / Dinette " Porch tf /1": Basement ;( ,,,)/ Floors I II :z.. , ,.$ c; ...5, {J {.f:- K. 1 I llarch , Ext. Walls ,- / Interior Finish S. ., lR. jI./, '/ ' /~ ~.J/ // 71 Breezeway Fire Place ;I/rJ'-<" Heat 4'>v d / DR. Garage /t"'I(' l~ ..( Eo /CJf) ,.:;Fo Type Roof r' , Rooms 1st Floor BR. - lJ-- (f -,1-_' I Patio Recreation Roam Rooms 2nd Floor FIN. B I , O. 8. Dormer Driveway , l' Glal 3[ r;.5 - (;. ~_"'J"1..c 'r=:5 -I ,...; ~< (, (/' r 3"z>'" - '>, 1 Spet!CL! 'W. PdtlJ 3ra 520 'T1iu:k.9lve. 'lIef.V. 21ot23X Cutdiogue, 9{9' 11935 :r ~ ~>= ::c:z a. <ri on ke .+'0/'6 3:::; ~'~ :~-~ oj' o,~ OS' s. 0- -54-Ad" i C; r._/ 17.0 NOTE' . z MONIJMENT NEAREST PlJIJL/CWATER MAIN ='f MILES t WATER SERVICE. PRNA1E WEU TIE LOCATION Of' WELU "NO CESSPOOLS SHOWI\! HEREOf\! ARE FROM FIELD .005ERVATIONS ANO/Oft AtOM DATA OBTAINED FROM OfHf:RS. ^ '''f ......... I' ,,<~ f.O' ~i~ / ,rJ. -.)," 0< ~i -~ O~ ..~ q. "\.~ ::Lq,~.......-~/.;;.-;, ~"b'~-t", ,~,~ /"'-;:e~ ~ ne' ,....~ erl ,- I ~,'i'j , .' ''''0-40. i>~ ,'" #(} / ~.~' <;9 . ~ , ~ "~, ,,/ "~/ "', " .' ~ ~ / c;:..~o Q.. ~o 'lMAUTl<<lIIlKO .....TEItATIOIl OffAODITIOMTO _ TtIII8URYITIIAVIOl.ATlINII0FlECT\OIIII -<' ~ 7_ 01' THt! JEW TOll" ITATE t!DIJCATlON "'0_ _:::;: Ull CMIE1OP'THlllUlIYU_MlTlrUIHI ~r.."'''IUIIVI!:YOR'''NllrDR'''''OII ~IEO XAL IIW..I,. IIOT II: caIlOUtD TO."'VALIOTlll,lECOl"t. / ~ THE '/WATER SUPflL:Y AND SEWAGE OISPOSAl... SYSTEMS FDA THIS RESIDENCE WILL CXlNFORN TO THE STANDtoRDS 01' THE SlEFOUl COUNTY Il[PARTMDlT Of HEALTH RIIIVlen APPLICANT: - - - - - - - - - - - - - - - - - ADORESS--------- --- - ------ SllFF~\"-"" DATE Ft8".. H. D. "I'. # 7..J~ -J ~ " 1918 . 1'bD SCT.:\G? dlsiJO~l.f'J t',' '~.' ~- "1~:;ply -1'n0111 ties fer" t~ls ]., "'1 ,,(~ve been inspected by this dl:)p:~:.t:..;:':lt a'.1d fCl.'nd &0 be Sat1Btaotory....-~ -' , ": '" <:......-1- /) ...,! /Z' !Cb1_et ot Gener31 EogineeriKg L.:~-.t'.{ Services . ~ ~ ^"', V (~.~ ~ V el' ri~ ~~~ ~ ..... ;... '.. .... '. ~ tuIlJlAffTrntfllOIC4TEONIEJlEOfIlIHALL_ ONLY TO TNIE N:JllIIO.. ~OJl WIlOlll THE aJIl'iIEYII__EO,_ONNI'KHALf TOTIlIETITL.iECOM"",",'lM!"",,ENTIIoL AllIENC'I'....OLiEND'...'NST'TUTIONLI.TlED HlEJlmM...... TO TIllE An....IEU Of TIllE LiEIIOl".'NSTITUTIOM.eu,l,IUIfTlEn AJlIE MOT TUJri.,U,I,I:LIE TOAllOITIONAL ,"STITUTION. OlII___MT OWIlU" '7~ ~ ~ REVISIONS SE,PT. I, 197' r..c+- ~~r :' ~v(, ~\!~ . I YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVER HEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG "ROnt..,aNAL IlNGINlllER AND LAND lIIUflVlfYO'" LAND 'URVIlYOR. N.Y.'. LI,C. NO. IZ'." N.Y," LIC. NO. .....a SURVEY FOR: SPENCER PETTY, III AT ClJTCHOGVE TOWN OF SOVTHOLO SUFFOLK CO., N. Y. SCALlIE': I": 50' DATE: \ GUARANTEED TO: 1NE TITLE 6UARANTEE GO. BY IIIAR.l7,I977 . 126 A ,~ iD (g [gO ,~' ~~I JJf -' 3 mz IWJ BLDG. DEPT. TOWN OF SOUTH OLD FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined.. k 11'........,191'1:-- 33 ~ V3 Approved..... ~r......, 19f~Permit No.~.f;:. Disapproved at" .,........ . . . . . . . . . .'. . . . . . . . . . . . . . . . . .........:.... ...................::: :~~l~~;~~t~~)"""" APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH~........ . 3 SETS ~ PL.\NS' .......... SURV~Y .v.~............... CIICCK V.... - . _ . . . . . . . . . . . S E P T IC FOR ~l _............. N01"I F1 : CALL MAIL . . . . . . . . . . . . . . . . . . . TO: . . . . . . . . - . . . . . . . . . . . . . 6 f3/92 Date. . . . . . . . . . . . . . . . . ., 19. . . a. This applicatio,n 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,~ng code, and regulations, and to admit authorized inspectors on premises and in building for neces~~~e~;~. .t;::f: Pi. . . . . . . . . . . . . . . . . . . . . - (Sign~r:of apPlica!Z~e, if a corporation) ,520 .tr.a.c.k Av.e... .C~t.c.b.og,u.e... ~.~... ~~9).5. . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . BI11lder.-.t . Qimep ''8 . ) . . . . . . . . . .. . .. . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . .jPPROYEP. jS.NOT.ED . .. . .. . DATE: to /'i/Q z.- B.P. # .kJ~q-Z- C Name of owner of premises .B:me11ne .Pett;j\'.&i .~... ... .. . .. ....... .........,' '~BY: ';A',,?-~" . (as on the tax roll or lates~~ BUILDING DEPARTIIiIENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM 10 4 PM FOR THE . FOllOWING INSPECTIONS: . . . . . . . . (N~~~ ~~d titi~ ~i ~~~~r~t~ ~ffi~~;)' . . . . . . . . OCCUPANCY OR 1. ~g~~:T~~~ C()N~E~:EQUIRED r- e::.- / ~ USE IS UNLAWFUL 2. ROUGH - FRAMING & PLUMBING Builder's License No. . ~. . . f-:-. . . ~ . . C"W"ITHOUT CERTIFICATE 3. INSULATION 4. FINAL . CONSTRUCTION MUST Plumber's License No. ........................ OF OCCUPANCY BE COIViPL~tEFOR C.O. All. CONSTRUCTION SHAll MEET THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CC1!)[S i\JOT HFSf-"GNSl8-i F FC,q nr::S.I,::r,: ('jQ (...(^~~~,'-'THUf':TIl)l\' Fi:f,::,--' I. Location of land on which proposed work will be done. .. ?~? ~~~~. ~~~~. ~~~~?~~~.~'~~~': . . .. .... . . . .. ... . 5?!>.. .'. . " .... .. '" .... . .. . ~~~~. ~!~~.... ... ... . ... .~~~~~~! .~~~~. '" ....... .............. House Num ber Street Hamlet County Tax Map No. 1000 Section .... / ~. . . . . .. Block.. /~. . . . .. . . .. Lot. .7<.. . . . .. . .. .. . . Electrician's License No. ..................... UNDERWRITERS CERTIFICATE . R~I~ Other Trade's License No. ..................... 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 " .P:'.~~.~. ~.~.~... . . . . . . . . . . . . . . . . .. . . . . . . . . . " : ':"~"k . . . . . . . . . . . . b. Intended use and occupancy ... s-a__... a.b<w&....... .... ............ .......... :':'-; ~:,;. ............. I ,";rl"t~~ ' . 'I + 3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition.. . ~. . . " Alteration ........... Repair .............. Removal . . . . . . . . . . . . .. Demolition .............. ~etVWWJ; . . . . . . . . . . . .. . " " , (Description) 4. Estimated Cost...~. .~~!~~~~~~. . .................... . Fee. ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units. . . . .1 . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . . If garage, number of cars .........................................,.............................. 6. If.busin~ss, co~~er~ial or mixed o.ccupancy, specify na~~and extent ofeac~lW of use . . . . ... .. '26.4. . . . . .. 7. Dunenslons of eXlStmg structures, If any: Front. . '1' . . . . . . . . . . Rear .............. Depth............... Height ... ~~... n,.. . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . 6' 4' . . . . . . . . . . . . . . . . 76 . 4' . . . . . . . . . . Dimensions of sa~e structure with alterations or additions: Front ....7. ~ . . . . . . . . .. Rear..... ~ . . . . . . . . . . . . Depth. . . . . ~~~. . . . . . . . . . . . . . Height. . . . . ~9. fh. . . . . . . . . . . Number of Stories. . .1. . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. . . fO' . . . . . . . . . Rear . . . .29. . . . . . . . . Depth ... 2f./f. . . . . . . . Height.... .~6.f~.... . Number of Stories ......... .1......................... .19S.24.rt.......... 9. Size oflot: Front.. .120... .. tt.~... ..... Rear.. ~?P. rh............. Depth ......~.....~......... 10. Date of Purchase .. 'J'/26./17.................... Name of Former Owner..... t.Gagel\1.........'........ II. Zone or use district in \vhicli premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 12. Does proposed cons'truction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .... fee. . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: :34 ~f1f, No 14. Name of Owner of premisesE.. ~t:1;iJt &; .a,R.,s... . . . Address . ~.o. ~!l!l.k. ~Y~.'. . . . Phone No.7. . .-. . . ? . . . . . . Name of Architect ........................... Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone /ia. ....... . . . . . . . . 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. '". ", Y'H' Atll! :)"'0 j-. '..I \,1 fl ~~ ~i \;.,.;., J.j ,., ,. I i ~?,U "nl ? rhH1L~L{",f -~ 'l.:r STATEOFNEW}'O~'J A ss YOM<iUO:;OiO ' COUNTYOF'~f)' . . . . . . . . . . ... . . S . . 0,. . ,: etl01:\:::~ ::r :;'~~ri.n1;~ltng duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the. . '. . . . . .8 !-i.I.~b.I;:..r:. . .. . . .". . . . . . .'. . . ... . . . . . .. . . . . . . .. . . . ... .. . .. . . . .. . .. . . . .. . . .. .. .. . (Contractor, agent, corporate officer, etc.) 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 this ....:J.~.....d."f.9~.......19fP.-- z. tfJv;~11 Pf Notary Public, ~ 1!!'~1.~nty Q /1_ ' ....L! HElENE D. HORNE . .4 . ~ ,A/..J ,#: / <> .' NoI1HyPu:~~~N8WYork .. . . . . .. .:. " . .. .'. .. . .. .E'(.2:... . . ... . .. OuaIme3in'suffoIk County 9.P" ~ignature of applicant) Commlsalon expires May 22. 19_ 11 !1 SJ F~ tf ~'b'i'i3 52Q /<./TCK AV~. C VIle:: h c) J U\ 0 #;y' , fI i:J ;IV/sA r;.~ftdE 1< / I --* I . III~Jj;)f ~4e I . I -II ,I ii II I, " ii " " 'I il I! ,I il ~ ?f II c o N G !< f 1 f 1 jl \ , \ \ \ \ " ..Ii"< ,C:-,-- - ---, , ~ \' ~, 50 ~~ J)(~ "'i '1 ,~ -r-i .... ~ ., ... , j I} .. 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