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Home My WebLink About33949-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPA/qCY No: Z-33459 I~ate: 12/19/08 THIS u~TIFIES that the building WINDOW REPLACEMENT I&)cation of Property: 310 ~V~/~S LJ% CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 109 Block 2 LOt 3 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 21, 2008 pursuant to which Building Permit No. 33949-Z dated JUNE 2, 2008 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 WINDOW REPLACEMENT IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES R & AUDREY A WILSON (OWNER) of the aforesaid building. SUFFOLK COUNR~f DEPAR/IWENT OF H]~LTH APPROVAL E~t-iaICaL CERTIFICATE NO. PLUmPnESS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT To~n Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PER~4IT NO. 33949 Z Date JUNE 2, 2008 Permission is hereby granted to: JAMES ROBERT WILSON 310 ALVAMS LANE CUTCHOGUE,NY 11935 for : WINDOW REPLACEMENT ON AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 310 ALVAHS LA County Tax ~4ap No. 473889 Section 109 pursuant to application dated MAY Building Inspector to expire on DECEMBER 2, 2009. Fee $ 200.00 CUTCHOGUE Block 0002 Lot No. 003 21, 2008 and approved by the thor: Rev. 5/8/02 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ~:~ Approved Disapproved a/c Expiration BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees /' Flood Permit ,20~c7// Storm-Water Assessment Form ~ Contact: ,20v Mai] to ;~PLICATION FOR BUILDING PERMIT ~d Date Nfl/ f / ,200~ ~, , INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept on the premises available tbr inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, tbr 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. (~ ( '~ ' ~applicant or name, if a corporation) · (Mailing address of applicant)~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: 3)o Ag House Number Street Hamlet County Tax Map No. 1000 Section 16 9 Block ,~9 Lot ,_~ Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy o r/e_ P~'~-p///- ~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building_ Repair b/~ Removal Demolition Estimated Cost If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) Fee (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth Rear 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in 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 Will excess fill be removed from premises? YES __ NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES __ NO__ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with 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 data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES__ · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) CONNIE O. BUNCH Notary Pul~ic, ~t~of N~Yo~ No. omu~m~n~n ~ed in. Suf~k~. 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 tree 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 Notary Public Signature of Applicant TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING/STRAPPING ~/FINAL ,, [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ ~"'~'~' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ [ ] ROUGH PLBG. [ ] INSULATION [~FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: DATE FOLIATION dST) FO[~DATION (2ND) ROUG~ F~G & PLU%~G 12NS~ATION PER N. k. STATE ENERGY CODE "ZOo- /c9-~2-. 3' TOWN OF SOUTHOLD 8OpERTY RECORD CARD OWNER STREET ~'~ FORMER OWNER SEAS. IMP. VL. TOTAL LAND z/6 d AGE NEW Form Tilla,ble 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House PIc~'" ~. ~6' ob NORMAL Ac re FARM DATE 7f/?'/7/ BUILDING CONDITION BELOW Value Per Acre ' k Tara I VILLAC~ LOT DISTRICT SUB. '~/,z. Pcrc, ACREAGE 0 C~,,~, ,~ TYPE OF BUILDING cOMM. I IND. I CB. ~ MISC. ABOVE M. Bldg. Extension Foundation Basement Bath Floors Extension Ext. Walls ~' ~/'-'-~/' Interior Finish Extension Fire Place / He~ Attic ~ ~v ~ Porch Porch Patio Driveway Breezewo Garage Rooms 1st Floor Rooms 2nd Floor '1 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. APP ROV D AS NOTED N~)~I(FY BUILDI,~'.~ g p-,~TMENT AT 765-1802 8 AM 'i O ,~ ~,,~ FOR THE FOLLOWING I~SPECTIONS: 1. FOUNDAT ~N - T~'~, FOR POURED CC.'..,;RETE '"~ 2. ROUGH - FRAM',?;G & PLU~;',B~NG 3. INSULATION 4. FINAL - CO',"]~rRUC~ MUST BE COMPLETE~ FO:~O. ALL CONSTRUC[Z)N SHALL MEET THE REQUIREMENT~ OF THE CODE$OF NEW YORK STATE.~'ffOT RESPONSIBLE FOR DESIGN OR ~NSTR~]tfON' ERRORS. ITEM LOCATION "UN TPR CE CITY ~' .Z I=RAME~IZE DESCRIPTION ~: , ~ ~ ' "~ ' $ 236.32 $ 236.32 Copy of Copy of MANUFACTURER: Andersen Copy of Copy of Windows and Copy of Copy of Patio Doors Copy of 0001 ROSize=3'Ol/2"Wx2'O5/8"H Unit 400 Series, PSA Single Units Unit Code/Item Size: A31 Operation/Handing: V Part Number: 0700643 Exterior Color: White Interior Color: White-Vinyl Wrapped Glass Type: High Performance Low-E4 Glass Insect Screens: White 4ardware Color: Andersen Classic Series - White QUOTE #: A31, Unit, White/VVhite - Vinyl Wrapped, V Handing, High Performance Low-E4 Glass 0700643 A3, Insect Screen, White 1505375 Hardware Pack, PSA, Andersen Classic Sedes -White 1521026 187.10 14.24 5.42 $ 206.76 $ 206.76 PRETAX TOTAL $ 4,208.70 Estimated Lead Time Page: 5 Of 5 i~ ~'R_AME~ S!~E _. LOCA~TION ....... DESCRIPTION ICE · i' Copy of Copy of MANUFACTURER: Andersen 1 Copy of Copy of Copy of 0001 Windows and Patio Doors RD Size = 2' 2 1/8" Wx 4' 0 7t8" H Unit Size = 2' 1 5/8" W x 4' 0 7/8" H 400 Series Tilt-Wash, Single Units Unit Cede/Item Size: TW20310 Operation/Handing: AA Part Number: 1611850 Exterior Color: White interior Color: Clear Pine Glass Type (Top): High Performance Low-E4 Glass Glass Type (Bollom): High Performance Low-E4 Glass Insect Screens: Insect Screen, White iStandard Hardware: Standard Lock Hardware ~ Stone TW20310, Unit, Equal Sash, White/Clear Pine, High Performance Low-B4 Glass (Each Sash) 1611850 20310. Insect Screen, White 1610113 C~opy~of~Oop~ of~ ...... --MANUFACTURER: Andersen Copy of Copy of Windows and Copy of Copy of Patio Doors 0001 211,50 18.91 230.41 $ 230,41 ROSize=3'01/8"Wx3'47/8"H Unit Size: 2' 11 5¢8" W x 3' 4 7/8" H 400 Series Tilt-Wash, Single Units Unit Code/item Size: TW21032 Operation/Handing: AA Part Number: 1600081 Exterior Color: White interior Color: Clear Pine Glass Type (Top): High Performance Low-E4 Glass Glass Type (Bottom): Hinh performance Low-E4 Glass insect Screens: Insect Screen White Standard Hardware: Standard Lock Hardware - Stone TW21032, Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass (Each Sash) 1600081 21032, Insect Screen, White 1610184 Paae: 4 Of 5 $ 216.93 $ 19.39 ~opy of Copy of Copy of 0001 MANUFACTURER: Windows and Patio Doors RO Size = 2' 6 1/8" W x 4' 0 7/8" H Unit 400 Series Tilt-Wash, Single Units Unit Code/Item Size: TW24310 Operation/Handing: AA Part Number: 1611858 Exterior Color: White interior Color: Clear Pine Glass Type (Top): High Performance Low-E4 Glass Glass Type (Bottom): Hi9h Performance Low-E4 G~ass Insect Screens: Insect Screen, White Standard Hardware: Standard Lock Hardware - Stone $ 222.35 TW24310, Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass (Each Sash) 1611858 24310, tnsect Screen, White 1610121 $ 19,93 $ 242,28 Oo~y ~f C0~y 07 ......... MA~uF~-CT~RER: A~'d~i~n Copy of Copy of Windows and 0001 Patio Doors $ 969.12 2 RO Size = 2' 6 1/8" W x 4' 0 7/8" H Unit Size -= 2' 5 5/8'* W x 4' 0 7/8" H 400 Series Tilt-Wash, Single Units Unit Code/Item Size: TW24310 Operation/Handing: AA Part Number: 1611858 Exterior Color: White nter or Color: Clear Pine Glass Type (Top): High Performance Low-E4 Glass G ass Type (Bot om) High Performance Low-E4 Glass Insect Screens: Insect Screen, White Standard Hardware: Standard Lock Hardware - Stone TW24310, Unit, Equal Sash, White/Clear Pine, High Pedormance Low-E4 Glass (Each Sash) 1611858 24310, Insect Screen, White 1610121 $ 222,35 $ 19.93 $ 242.28$ 484.58 Page: 3 of 5 I FI~.~ME SIZE LU~"ATION DESCRIPTION ; Copy cf 0001 MANUFACTURER: Andersen 3 Windows and Patio Doors RO Size = 3' 6 1/8" W x 5' 0 7/8" H Unit Size = 3' 5 5/8" W x 5' 0 7/8" H 400 Series Ti~t-Wash, Single Units Unit Code/tern Size: TW34410 Operation/Handing: AA Part Number: 1600095 Exterior Color: White Interior Color; Clear Pine Glass Type (Top); High Performance Low-E4 (3[ass Glass Type (Bottom): High Performance Low-E4 Glass Insect Screens: Insect Screen, White Standard Hardware: Standard Lock Hardware - Stone TW34410, Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass (Each Sash) 1600095 34410, Insect Screen, White 1610199 CCtV o~Co~y of .... MANUFACTURER: A~dersen Windows al]d 0001 Patio Doors $ 290.82 $ 25.96 $ 316.78 $ 950.34 RO Size = 2' 10 1/8" W x 5' 0 7/8" H Unit 400 Series Tilt-Wash, Single Units Size = 2' 9 5/8" W x 5' 0 7/8" H Unit Codelltem Size: TW28410 Operation/Handing: AA Part Number: 1600078 Exterior Color: White Interior Color: Clear Pine Glass Type (Top): High Pedormance Low-E4 Glass Glass Type (Bottom}: High performance Low-E4 Glass Insect Screeps: Insect Screen, White Standard Hardware: Standard Lock Hardware - Stone TW28410, Unit, Equal Sash, White/Clear Pine, High Pedormance Low-E4 Glass (Each Sash) 1600078 28410, Insect Screen, White 1610181 $ 267,77 $ 23.93 $ 291.70 $ ;~tl ~2 page: 2 Of 5 CUSTOMER: Home Depot Store 1222 1550 OLD COUNTRY ROAD RIVERHEAD, NY 11901 (631)284-2530 WiLSON,JAMES 310 - ALVAH'S LANE CUTCHOGUE, NY-11935 (631) 7346084 SALES ASSOCIATE: P.O. #: Thank you for shopping The Home Depot[ We value your busineasl ITEM LOCATION FRAME SIZE DATE: 04/19/2008 0001 Re Size = 3' 6 1/8" W x 4' 0 7/8" H Unit Size = 3' 5 5/8" W x 4' 0 7/8" H MANUFACTURER: Ande~en Windows and Patio Doors 400 Series Tilt-Wash, Single Units Unit Code/item Size: TW34310 Operation/Handing: AA Pad Number: 1611882 I Exterior Color: White I interior Color: Clear Pine I Glass Type (Top): High Performance Low-E4 Glass Glass Type (Bottom): High Performance Low-E4 Glass Insect Screens: Insect Screen, White Standard Hardware; Standard Lock Hardware - Stone TW34310, Unit, Equal Sash, White/Clear Pine, High Performance Low-E4 Glass (Each Sash) 1611882 34310, Insect Screen, White 1610146 256.92 22.91 $ 279,83 $ 839.49 Page: 1 Of 5 NO. · TO~FN OF SOUTItOLD BUff.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency No.. Z.8930 ..... Date .Februal:.y. ..... X4 .......... , lg. 7~. THIS CERTIFIES that the building located at . 3lQ ,Al.v. ah~ s./~mn~ ........ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...Apr.~.l .... 12 ......, 19..7.6 pursuant to which Building Permit No. ~.5. Q3~.. dated ...Ap~:il ..... 16 ....... , 19.76,, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... Accessory..Building. ........................................... The certificate is issued to ...... W. illtam. I-L./~cA~e ............................. ( owner,~_f~t:~ of the aforesaid building. Suffolk County Department of Health Approval ...... I~/I~ .......................... UNDERWRITERS CERTIFICATE No ................ ~36.896~ ..................... HOUSE NUMBER .. 3.],0 ........ Street .... Alvab,*.~. l, ane ....................... .......................................... .CUtchc~gue.,..N · Y. ..................... Building Inspector FOP,~ NO. ~ TOWN OF SOUTHOLD , Building Depo~tment Town Clerics Office 5outhold, N. Y. 11971 APPLIt:ATIOH FOR C:ERTIFICATE OF OCCUPANCY Insl~uctlons A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pro-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn sta'tement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or s~fety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or iond use $5.00 3. Copy of certificate Of occupancy $1.00 Dote ..=J..e~.u..~.~Y.... J. ~.:!.~ ~.~ .... New B~ilding ................ Addition ...~.. .......... Old or Pro-existing Building ..:.:'~ ........ Vacant Land .............. :~1o A~~-~ L~e ~ Cuq'c,~oc:u~,N.~ Location Of Property .................................................................................... ,, ............................................... Owner Or Owners Of Property ~ ,~,~.~r~ ~ ~ DO~L:S ~'~ ~0c~3~FEtE- Subdivision ............ :~ ........................................... Lot No.......--': ..... Block No ............. House No..,...3...!?.. Date Of Permit .................... Applicant ................................................................. Health Dept. Approval .... .~..:...I~.. .............................. Labor Dept. Approval hi · ~-- Und* ri Approva* ................ P*onn ng Bo rd Approva: .... ........................ Request For Temporary Certificate ........................................ FinoJ Certificate ...... ..~.. ................................ S bmi ed $ ........................ Construction on above described building and permit meets all applicable co(les and regulations. ...................................... . Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or B.J, Elec~rlc Co. Stlll~aTer Ave. Cutchogue~ L.I. 11935 Llc. ~05 [his certificate must not be altered in any monner,~ return to the office of the Board If incorreCt. Inspectors may be identified by ~H~, N.Y. ~~ IN~RU~I~ b. P~ot plan ~ing I~ion of I~ o~ of buildings ~ premises ~lotionship to odJoinl~ p~i~s or pubfi¢ ~ o~ ~ d. Up~ o~mvol of this o~lication, t~ Buildi~ In~tof will Isle ~ Buildi~ Permit to t~ o~lico~. S~h pe~it shall ~ve ~en g~nted ~ the Buildlhg Ins~ctor. APPLICATI~ IS HEREBY ~DE ~ the Building D~m~t for ~e tss~nce of ~ Bul~i~ Pe~it ~uont ~ the Building Zone ~dinan~ of t~ T~n ~ ~thold Suffolk Coup, N~ Yo~, and o~er ~icoble ~s, O~ino~ or (A~m~ of opplicam) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ........ ~ .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's IJcense No ............................................... .~./ .....~... 1. Lo~:afion of land on which proposed work will be dor~. Mop No.: ........................... Lot No ................ Street and Number .....~..I.~,.....~l~.q...~..1-).~.....~....~.~...~. .................. ..~..?...~...c..~S..?..~.?. .................................................. Municipality 2.State existing use and occupancy of promises and intended use end occupancy of pn3po~ed construction: o. Exisiting use and occupancy ....~...~.~Z.~-.~,.N...c...r~. .......................................... : ......... .;.....~ ................................... Intended use and occupancy ....... ''~''~l~l --~1' .,'~".,.',~.'~''~ ...... ........... :''~'''''~''''~ ............................ 3. Nature of work (check which applicable): New Building . ................. Addition ...~,?..,,~,. ,~,,,. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ , .... .~ (Description) 4. Estimated Cost ..................................... 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 cars ........ / ................................................................................................................................... 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if c~ny: Front ......~,~....~... ........... Rear ......~.~...~.,.~. ..............Depth .... ,~..~.~.~, .... Height ........................ Number of Stories ~ Dimensions of same structure with alterations or additions: Front ..,~.,,~.~,.~, ................... Re~3r .....~.,~.,.*~r.~ .......... Depth ..~,J ........................ Height ............................ Number of Stories ......... J ...................... 8. Dimensions of entire new construction: Front ......... I~..~..~ ................Rear ......... ~..~.'~.-'..... Depth .......~..~...~.~ .... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....... LO...~. .......................................... Rear ......... J...o..~ ......................... Depth ....... t~.~...~.. ............... 10. Date of Purchase ......~..ll.~..~e ....................................... Name of Former Owner ...-~£~et.l,.~.....~:~.~.~ ............ 11. Zone or use district in which premises ore situated .................................................................................................... ]2. Does proposed construction violate any zoning few, ordinance or regulation: ....~Le ............................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~') No 14. Name of Owner of premises ..~,~.~,&v'~...,~'~.,...~...J~.~... Address ..~.1~..'~.~.~...,.. Phone No. '/.~..~...~....~..~ Name o{ Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Nome of individual He Js the ............................................................................... .~ ................................................... ; ........................................... (Contractor, agent, ~orote officer, etc.) of said ownor o~ owners, and is duly outhoriz~ to ~ffor~or h~e perfor~d the said wo~ a~ to ~ke and file thor the work ~i~J be ~rfor~ in the manner ~t fo~h J~e application filed t~rewith. Sworn tn ~f~ me this ~ ~ /~ (Signature of ep~ant) FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OGCUPANGY THIS CERTIFIES that the building located at ~.~,..~l,~.lrah.!~..~. .................................... Street Map No.~ ............. Block No....~ ........... Lot N~.....g.~..t'..?~.°..~...e...~....~;.~...~. ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... ~..V~.e....~,~ .................. , 19.~jc~..., pursuant to which Building Permit No..~,..~...~ ............... doted .................. .~..q.......~.. .................. 19..~.c)...,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occuponcy for which this certificate is issued is ................ ........................ l~,~m~.. ~.. ~'m~Ll~.. ~t~l,~x~ .................................................................................. This certificate is issued to .....~J~...~Jg~.J'.t~.~L.....~g~#~'.). ............................................................. (owner, lessee or tenant) of the aforesaicf building. ' Building Inspector J FO]~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 725, Z Dote ................................... ~r.~.,e....,~9. ...... 19~ .... Permission is hereby gronted to: . .~.t..t...,~..t.~....~.?.~ ~. ~. ................................................ .............. ~,.~b~..~.~ ............................................ ............... c.'.~?.:L*!~.;'t.:....::.::..: .................................. to ....~ ,.~ ..**.~,~,t..t.,.t, ~. ~.. ,. ~...~..,e.~,.t,,~..~.~.....~...~.~? ~.;~..-.~ ...................................................................... at premises located at .~./~...,.~...]...V?...~.~.~..~.~)~ .......................................................................................... .................................................... **c.~.t****~ ,,. ,.,.,,~..~,.. ............................................................................ pursuant to application doted ............................. ~.....*,~. ................... 1 ~.~,.****, and approved by the Building Inspector 11 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ lc? ........ Permit No ............................... Disapproved a/c ........... ~ ~ .~:. · :..~=~..~..7~:'....~... ,~..~...':=. ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector, 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 port of this location. 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 issue a Buitding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 a Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with all appllcoble laws, ordinances and regulations. ........ ......... (Address of opplican~)' State whether applicant is owner, lessee, agent, architect, engineer~ general contractor~ electrician, plumber or builder. 77..~ Name of owner of prem ses ........................ ~,.,.~.'. ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .............. .~:.."~::;.....::[~ .......... Lot No: ...... ..~...:.::~.i.. S,ree, amd,umber.... ........ ................. .......................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: ,/ a. Ex/sting use and occupancy ........... ~/. ................................................................................................... b. Intended use and occupancy ......... ~.'~ .................................................................................................. 3. Nature of work t'check ~hich applicable): New Building .................... Addition ....~x, ..........Alteration .................... Repair .................... Removal ....................Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...,.,,ff.. .......... : ......................................... Fee .,.'~Z. ................................................................................... (to be pa~d on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ......... ~,~., ............ Rear ........ ~....~.. ............ Depth ...,.~-.~ ................ Height ...~. ~,.. ................ Number of Stories ........ .X/~ ................................. ; ......................................................... Dimensions of same structure with alterations or additions: Front ....... ,,~....2~.. ................ Rear ......~/~T.: ................. 8. Dimensions of entire new construction: Front ............ .-~...'.~ ......... Rear .......... .~....; ........... Depth ...(..,.'/mT-.. ................ Height ............................ Number of Stories ~"'""~ 11. Zone or use district in which premises are situated ....................... ~ ......... .{~...,,~.~.'H ................................................ 12. Does proposed construction violate any zoning~ law, ordinance or re~u[atign? ...... ,~ ........................................... 13. Name of Owner of premises~: ,~. .... Address ~... Name of Architect.......~......,t ......... , .............................. Address ................ ,~ .......................... Phone NO ..................... of Cantroc,o ............ Address Phone PLOT DIAGRAM Locate clearly and dlst[nctl¥ all buildings, whether existing or proposed, end indicate ali set-back dimensions'from whether interior or corner lot. ~t0~ / STATE OF NEV~-xYQRK,~ I ) S S COUNTY OF ...~¥~.~...~.,......) ' /~ ............................ ~.--.......~.;......~ll~.~;.T.= ......... being duly sworn, depos~ and says that he is the applicant (Name of individual signrn~ ap~) above named. He Is the ............................ ~./~......~.~.~;',~.~ ............................................................................................. (~ntractor, agent, co~orate officer, otc.) of ~id owner or ownem, and fs duly au~ori~d fo per,tm or have ~rfor~d the said work and to make and file this application; that ~11 statements contained in this application are true to the best of his knowledge and belief; and that the work will ~ ~rformed in the ~nner set fo~h in t~r~li~n filed ther~ith. Sworn to before me this -x ~ ru~l~c, stye of ~w Y~ ............... ~. day of ......... ~ ........... 19...~..~. ~m~,,~ ~,~re o~pa~,c~) _ ~