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Home My WebLink About23005-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24074 Date DECEMBER 11, 1995 THIS CERTIFIES that the building ALTERATION Location of Property 900 GIN LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 88 Block 3 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 30, 1995 pursuant to which Building Permit No. 23005-Z dated SEPTEMBER 11, 1995 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 ALTERATION TO CONVERT GARAGE OF EXISTING ONE FAMILY DWELLING INTO BATHROOM, LAUNDRY ROOM & STORAGE AREA AS APPLIED FOR "AS BUILT". The certificate is issued to MARY F. FREER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-047207 - OCT. 3, 1995 PLUMBERS CERTIFICATION DATED N/A Building Inspe or Rev. 1/81 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) Date............... .... .......5�.............. . 19.0 N 23005 Z Permission Is hereby granted to; Xpil ...e.6�..... �........... ... ............... y . .. ..... ....... ....................I.......... �: ... ,.. s............................ to ele- -e..... .............. ..: .:.................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ® ... ......................................................... at premises located at............... . • ....... .� ............................. . ................. ........ ....... ..............I....... ............ CountyTaxMapNo. 1000 Section Ug Block.........3.............. Lot No. &..................... pursuant to application dated ........................ ... ........ 19.... ......, and approved by the Building Inspector. Fee$.....7,,..��.... Bui ldin In ector Rev. 6/30/80 No. 6 • �L '��5 � � TOWN of souTIioLD BUILDING DEPARTMENT a TOWN HALL [ 765-1802 - - APPLICATION FOit CERTIFICATE OF OCCUPANCY -'--- - .- A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1 . Final survey of property with accurate .location of a_d buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from 'Health sDept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 6.. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate -of Code Compliance from architect or engineer. responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9 , 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and- unusual natural or topogrn.phic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied , ehe 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 $30.00. 2. Certificate of Occupancy on Pre-existinQ .Buildine - ,$100.00 3. Copy of Certificate of Occupancy - $20.00 4 . Updated Certificate of Occupancy - $50.00. 5. Temporary Certificate of Occupancy - Residential $15.00•, Commercial $15.00 Date . . .r. . :. .:4:15 . . . . . . . . . . . . . . . . . . . . . . . ,New Construction. . . . . . . . . . . Old Or Pre-existing Building,/J . . Location of Property. . ?�ca_ : �� .!� � . . . . . . . . . P.. �12gXV. . ./.u. . . . . .`l? f. . . . . . . . Mouse No. Street hamlet Onwer or Owners of Property. Y. ,.`. �'!�e�' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,ounty Tax Map No 1000, Scctiorr. . gl;.l�� . . .` . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fated Hap . . . . . . . . . . . .Lot. . . . .. . . . . . . . . . . . . . . . . . "ermit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ileslLh Deist. Approval . . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . Pia? . . . . . . . . . . . . . . 'lanning Board App rovol. . . . . . . . . . . . . . . . . . . . . . ?equest for: Temporary Certificate. . . . . . . . . . . Finril Certicat-e. . . . . . . . . . . FJ B3 -ee Submitted : 5 . .. .— . . . . . . . . . . . . . . . . . . . 5 a-i`h Fa,� !► tl ?c ��' 7 �'� dtom.�. . . . . . . . . . . . . . . . . . . THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8056570 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date OC`.COBER 03,1995 Application No.on file 1.0292295/95 ff 01-17207 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of 14+.1.1RY FREER, 900 GIN LANE, SOUTHOLD, N.Y. in the following location; ❑ Basement 29 Ist Ff. ❑ 2nd Fl. UAR Section Block Lot tcws examined on SEPTEMBER. 27,1995 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E AMT• AMP. TYPE METER EQUIP. 7W 1 0 3W 3%3W 3,e'4W NO.OF CC.COND. A.W.G. NO.OF H AEG A.W G. NO.OF NEUTRALS A.W.G. EOU1P. PER% OF CC.COND. OF HIAEG OF NEUTRAL OTHER APPARATUS: SMOKE DETECTOR:-1 *NO VISUAJj DEFECTS: "An electrical survey has been made of the r�xposed electrical equipment in the premises indicated. " "No obvious unsztisfactory condition was found. t9A.RY FREER 900 GIN LANE SOUTHOLD, NY, 11971 GENERAL MANAGER :l 1 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT: THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEFT. INSPECTION [ j FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] �NATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY R ARKS: r /e7 �.c DATE l INSPECTOR FIELD INSPr TION REPOR'P DATE COMMENTS ----------------- ----------------------------------------- u u w II II II FOUNDATTON O ST) II II IIII--- - ---- --------- -------- FOUNDATION OND) ----------------- ------------------------------------------------------- ----------------------------------------------- II i u z ROUGH FRAME s _— PLUMBING jl � n-- cn II II II iNSULATTON PER N. Y. II________.ii ----- ------- t7 STATE ENERGY II II H CODE u u. --a------ -- - ---- -- - ---— ---_------_____ ----- _ --------- ---------- tri it II H II FINAL ADDITIONAL COMMENTS: Pd t� _ns H \\ z r 110 J C+d{.1}I;!^'i• } iA��. 1• `i,^:�}-+ 1,'�r: '1' r:. '!''� �, ID 1 too 03 MID '.�" ;.a' ' S.5Z '05 '�0"E. - MZ30 WA MAI o iSr' r,. ;��' :A'IH,,•:. I '``:: �". 1{kj ". ..:+1�:��.tl?[>' t,s' .5� ,;:.;•;-i: .. t,,,•_:;f is J4 (Y) ti Q1 Pospisil VIP S U 2 Yaw D FOR- 4 r-,. .•-••rir.•'. •'�:: .;; . AtS (, 'K M. 11�. ( hw/\. •Ii�A.Y'I'1./,i�'�t:11.,::. 4 t ,, � A?'hJa 3.! 'fk:ii;• •.1.M.•�S8•M 1�,::'•Y;iM'!t�l!�}4�1�^i.l;;.'i4ly}{r.'' f 1 1'�f , i. � ' a �f'b: SHOW /yl y'r}'Ya �,�, + „I;a`1 �A.1 " .,• ? .y.;?, ' �:rr�;, 1`'iI:1'1�a r�:,"f�c"r::... L•_ ..,.•:'r{. f iCl�! .l 1 1 i 1 +' ioPill lc. G4 . Mp NQ f Ti 9J0> 4 .t;� ougrarrt�ad to Caudre;iritegcd y? /a Arnari,rart..7"it/e . lrfesura tie e co. arid. �`0 5:ouho/d 'nys �QriK \sa.vr Iron e ds : sur;✓,. Ycd :I�RaC, 147.8 71- , ;Q" �* Mory4nr N Y A.T� ,1'SON A\ VP, � ,- Lie�sA�s�ef l.a►rd S �r9 I Gr'c�rr�iort, N. Y. I /,in. y � �, w irc/ D�� - 8 l995 Der (z 17-) 6g,2 --czl.,-- __.._._-r-- 300 poll 4. Ao �GW U zv� �i - 13FF01/rcoG o� y1 y 2 Town Hall,53095 Main Road p • Fax (516)765-1823 P. 0. Box 1179 y� �� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 14, 1995 Mr. & Mrs . K. Freer 900 Gin Lane Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file.• xx The check is Ot on file. $25.00 No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. < (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23005-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. AUMAN LABOR ATORIES 10 WELLS 1N23 5NE BETHPA P OG BOX 23511 71 4 DIV.Or C.W.1.AUMAN d Co. INC. ANALYSES OF WATER . WASTES AND SOILS CERTOCATE OF BACTERIOLOGICAL ANALYSIS,:-;. CON'IRMCD T[ST • STANDARD METHODS PROCEDURE Date: ....4/13/6 5................. Harry Goldman ... Source of Sample TO 26 .w....Mrtiu Street....................... ............................................:..- .._...... 'Wm....�etls •- . .... -. ..... ... Riverhead..,New'York_-.-••.•••: ................................................ I.Ot:6• Bayhaven)•Gin..Lane, Southold 4 8 65 11t15 65 ...........4ni 5................... DATE: Collected................/ ..._.Received............ 4.... .................._.Reported. Cold Water Faucet ..Collected by.............................EG................. :.......................... Samplingpoint................................ , .......................................... COLIFORM TESTS LACTOSE FERMENTATION CONFIRMATION ML 24 hrs. 48 hrs. 24 hrs. 48 hrs. 10 0/5 0�5. 1. 0/1 0/1 0.1 0/1 0�1 "Most Probable Number" (MPN) of Coliform Group per 100 ml....................... Standard Plate Count per a, 350C.;24 hrs......................................... 26.0 Nitrates as N.......:.. 6'1 .............................Mg/1 Chlorides as CL--------- - mg�i Less Than 0.1 Anionic synthetic detergents as ABS............................. .................................................. REMARKS: These results indicate the water was of satisfactory sanitary quality when. the sample was collected. AUG 3 0 1995 LAUMAN LABORATORIES B-12008 ; Lab. No......... ..._...:._.._.�..................... ............. .............................. .t::= , ..._. ........ Director .i.. • NNW YtbpfW' r rr.5 ,BUREAU OF; ECECTRICITtiY ' :JONN STREET. .IY O ,I „, . 8YRi NEW - 4 J 1 O PP I 565. 06730 Date :Apr11!,.19 ,1 Application No. � iS TpXtifTPS That the Electric E ui snent " as.described below and introduced Thai , . .. , __ .. q. p • .., . :_.. ...: i._. ... , .,_. .. , :' ,.::'{ ' I" is .1 .i .ii. ! 1-. _... ... � ' _ F W .. .Brudi. .. by iri,preinis'es,:of i I 'W•' on the basement '& ls;t fl: ' f ' =f' W:/S. ,G n .Lane opp.: Midway �_ loot o IVo, - . as per application on file in thss o f f ice,;and conssstsng b f; I I; E I ' I•XTURES ATTACHMENT RECEPTACLE. SWITCH OUTL 1 i ' o nTuwv REC EPTACL ES OUTLETS WITH RECEPTACLES WITR'9WITCN C9! FIXTURES`AND`LAMP.:RECEPTACLES � ' ', 'MOTORS 1 i 4 .. .26� i . ., •f$ -� -1-A. R�'•' 1-2,O.f' _` .I ` •LAMPS, '1-11/2HP� 1. 2=1/8hp H. P. HEATING APPARATUS ,oil-- furnace '& controls 1-5.:8 k:w:, 'cook�ng ideck 1-4.8 k:w. oven:.,.. Service 1 Yphase 2#3 & 1#5~;+ 7 lOD amp.` main' was examined on'date•o • Ap ri'1:..1'4,19`6: and, d.to bein compliance,with th'e requirements-.o f this Board as of this date.. N4.315.96 , F. W. Br,udi. .. :. . Box. 85! , _ u _ STATE SUPERINTENDENT Holts :h.L,, ' . ; .' , I. . i- ',_! -'.'1I •`.. I. i.. ., ` " ,..: _ �i i' :l ia'. '•;•'� wi ;K :i i' �`. 'Per' This Certificate must not,be altered.in apY:manrle�;TetuYrlao tl7e pfficelof thn;Boatd`if_inyorrect. Lrispectors'rnay,be.identified by their credentials. v C-0 71c- - OLla 17 ci 14 �'��:•_ � �� ' � ��a.[� � �%•^— may` ,��:J �� {— AUG 3 01995 / FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK`S OFFICE i SOUTHOLD., N. Y. CERTIFICATE OF OCCUPANCY No. ....Z..208. ......... Date ..................X=.......AP;:11.....I..... THIS CERTIFIES that the building located at ....)hll ..GiA.1ane..................................... Street Bay Haven `@ Southold Map No. ...................... Block No. ..XX............... Lot No. ... ..........S.4uthald.q....I,.Yo.................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ .....D.4'.M.e MbAr.......2� 19.615.. pursuant to which Building Permit No. .2622„Z dated .......................Du..n1p.ex..... L., 19..6?' 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 ........ .....PrIvat e...one...f ami ly....dwe lli ng............................................................................................ The certificate is issued to ......WilllaM.Xells.....................__o finermbuilsder.......................... (owner, lessee or tenant) of the aforesaid building. ........................................,....... ................................ Building Insp ctor -------------- c W 0 SPECIFICATION FOR DWELLING FOR MR. FRED FREER TO BE ERECTED ON LOT 63 BAY HAVEN AT SOUTHOLD Building to be a one story ranch of frame construction on concrete block foundation. Ground floor area to be divided into living room$ kitchen, 1 bathroom, 3 bedrooms, and garage. FOUNDATION: Footings - 8 x 1611 poured concrete with 8 x 16" concrete blocks 5 course, with 8'x 8'sub cellar for furnace and pump with Bilco exterior cover. Cellar sash - steel CHIMNEY: Facing - brick with &'x 81,flue EXTERIOR WALLS: Wood framing -r #1 construction limber common Cedar shingles - with Celotex undercourse - with 15 lb, felt paper SUB FLOOR: 4 x 8 x plywood FINISHED FLOOR: i Clear red oak in living room, halls and bedrooms Kitchen vinyl tile Bath - ceramic tile BATH: Wall and floors ceramic the 41 high - ownerts choice of color American. Standard': fixtures .• or equal - owner's choice of color Formica .van ity and 'mirror � C Ps 3 �A o .Shower in' garage - "terrazzo base and steel walla CEILING FRAMING: 2 x 60 on 16" centers #1 common 1 ROOF FRAMING: - 2 x 6" on 16" centers #1 common Ridge - 2 x 8" WALL FRAMING: 2 x 4" on 16" canters #1 common 1st floor joists - 2 x r on 16" canters All framing material will be #1 Douglas fir® ROOF SHEATHING: plyscore CD w D.F.P,A. ROOF SHINGLES: 235 Asphalt Seal«Owmatics with 15 lb. felt GUTTERS: 4 x C" wood or aluminum LEADERS: 2 x 3 aluminum INTERIOR WALLS AND FINISHES: Walls and ceilings in living room, halls, kitchen., bedrooms will be J" sheetrook, taped, 3 coats spackling and sanded, Exception% Front wall in living room will have 3/8" sheetroek under J" mahogany panelling. Walls and ceilings will be painted with Sherwin-Williams paint, or equal$ ownerts .choiee of color, INTERIOR DOORS: Mahogany flush panel. with natural finish. WINDOWS: Rouble hung r 100% weatherstripped two over two Complete screen and storm combinations will be provided for windows and exterior doors on house. EXTERIOR DOORS AND FRAMES: . Front - 1 3/4" "with 6/4 f rame s. AUG 3 01995 Weatherstripped 'With aluminum saddles. Picture window will be theriorpane glass .. 2 �, y !i i KITCHEN: Cabinets tl Birch or ash Formica counter top- edging stainless - ownerls choice Stainless steel or enamel sink Exhaust fan - wall oven and counter top range Built-in breakfast nook 4 x 6 INSULATION: Walls .. 211 Fiberglass semi-thick Ceiling - 311 Fiberglass - full thick FRONT STOOP - Front briek GARAGE: As specified on plan Door size - 8 x 7 - 4 panel - 3rd panel glass - Overhead Door Corporation Exterior finish same as house Interior - ceiling and walls covered with 3/811 sheetrock EXTERIOR CORNICE AND MILT WORK: Idaho pine fascias with 1 x 211 flat crown molding, 4 x 811 wood gutters or aluminum Idaho pine fascias and soffets HLU&IBI NG: , Al1G 3 O 1995 All faucets American Standard or equal Piping - copper for hot and cold water Waste line to. be #. 311 copper —cast iron trap WATER SUPPLY AND SEWAGE DISPOSAL: To be laid out to Suffolk County Board of Health requirements after building has been placed on lot. I'.EATING: Hot water heating system - oil fired with convector radiators. American Standard or equal cast iron furnace, 550 gal, oil tank installed underground® w 5" l ELECTRICAL SERVICE: Inspection and hook-up - New York Board of Fire Underwriters i Certificate. GRADED AND LAWN SEEDED M)G :, 0 1995 J. k 3 STATE OF NEW YORK County of Suffolk I, in- G Ho-1 st Clerk.of the County of Suffolk and Clerk of the the State of New.York In and for said Count Supreme Court of HEREBY CERTIFY tnac i have compared tfie n ' y (said Court:being a Court of Record) DO a e copy of DEE PAGE and that it Is a just and true co `'' " " — � of the Whole thereof. . py of suchrt (nal --- RECORDED and IN TESTIMONY WHEREOF, I have hereunto set County and Court this) my hand and affixed the sea C� I of said / day of 19 Fo .f rmNo. 104. • • • • • Clerk. is-ioa:v84 I' W , O ;� .fit 'Ar 1 r. • /. 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'�' rr'M',� � 5,rv"� �t 1 1� • y; �, I 'r�� '�l tf1Wt�'f�e� d�!' 1 I t r • '�( • `.. c'+�`, f r ,��it�tf17 xj� '•ir J r .'S`+ y, ^ll tv r ♦ -I I ,>1.�Y..�' ry -:eC( •t. „ `y. + rfv� �"�. (.t- ��fh. tp. t`a# ' ; .t + 1 Nh •.., r r\,t��f•Y r ,+ , {' f ;� .fit rf{trA1' i�' ^ '.. _5 j�7t . r +• ' ..I ^ f '[.-. �.�'iY,; t,:.'� iy 1.1:.;f t.��+i♦�'��+�., t f li /t+y��' a iyj♦r, -�' ,{..v- Y 1 .r. � �7 � ... £f;,y,�,�}� y��y�■Z,�N�C�jr'��•��a, �, , r �. °vw 1� i ' �� r rfy(;1 +1, 1 K. u. '��r• ''^ t B f�S r{... a 5v 6�r r✓tiK' ,•�t • � r• ,: , k+� r �;'•h+ �ii x��r & y, a+�J�;�} t �r 1 fr�i; h� � { i t': �,., 'l� (f. �� ve rt +da�cv Sf �r�pTa}e + �♦ 4r ai + • 1: g¢ y - Zs .... y�)t$}��t �;+j��y'`3+ `k341{`�' �tiit gar r �.s y 1 7yHt .f Y h.t �;1. �• - >S�' � � r► yr;�a�r .: N' �7,+in�I+,4 ,/ da}''3/ R 4,y.k Su �' 7 � S 1 f ",".; � ., a �',, � Ld'.'y.,.-+ 17t' -�'•i' 1 • �c.'•'s� V. a"' c�')y T h • �� ;v, r. , h • , e•Fr7: .1 N. , f S ?'A Yl','. + a• ,� rJY •:� 'n.••.:p3 -^t,..d'. ♦ .i •iys:.:i"tF91t k; :C^.i:?ynU. Is �' BOARD OF HEALTH . • • • . • • . k"'.,gFORM NO. 1 / 3 SETS OF PLANS `0TOWN OF SOUTHOLD SURVEY . . _ . . . . . . . . . . BUILDING DEPARTMENT CIIECK :r�7�o.� . PAUG 3 O 1995 TOWN HALL SEPTIC FORM _ . _ . . . . . . . . . . . - SOUTHOLD, N.Y. 11971 . TEL.: 765-11102 HOB I F'Y CALL Exam ��. MAIL 0� S16 Fr eel . . 889 68%i�Examined 19 Approved . . . . 19 ✓ J .7��. 1� .�Cord, �'/Y s: �1. Permit No. Disapproved a/c . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . (Building Inspect LICATION FOR BUILDING PERMIT Date . . . . :`?. . . . . . . . ., 1975. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,,V-ts 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 bunding for necessary inspections. (Signature of applicant, or name, if a corporation) q®a ,� a (Mailing address of applicant) State whether applicant is ner, essee, 'agent, architect, engineer; general contractor, electrician, plumber or builder. : . . . . . . . . . . . . . . . . . . . ..A ® ED MGM* . Name of owner of premises ./�.f.e/- . F*rAi q-f�, , , , (as on the tax roll or late ed) �- BY If applicant is a corporation, signature of duly authorized officer. NOTIFY BUILDINd DEPA 765-1802.9 AM.TO 4 P FOR.THE f4' ff 7;, 4" ti FOLLOWING INSPECTIONS: (Name and title of corporate officen),;� ,�t �i 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Builders License No. 2• ROUGH - FRAMING & PLUIi/d131NG 'L 3. INSULATION Plumber's License No. . r 4. FINAL — CONSTRUCTION MUST ; i j I a a BE COMPLETE FOR C.O. F ' Electrician's License No. ALL CONSTRUCTION 'SHALL MEET ^_ tj THE REQUIREMENTS OF THE N.Y. Other Trade's License No. .. . , , `` ';`i STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR l. Location of land on which proposed work will be done. �G?C3. I�?.A.'?. ?!� 4 . . . .✓ � T �ON E R AS House Number Street Hamlet UNDERWRITERS CERTIFICATE County Tax Map No. 11000 Section •.... . .. . .�.' 3 Bloc . . . . . . . . . . . . . . Lot REQUIRED . . . . . . . . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . ... . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . p �'.r• a r�, �� . . .`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... b. Intended use and occupancy ;ZYv,6, 'G �G�. . . . . . c1,7 / .rn r/ •3. Nature of work (check which applicable): New Building . . . . . . . . . : Addition . . . . . . . . , . Alteration . Repair . . . . . . . . . . . . . . Removal . . . . , , , . . . . . . . Demolition . . . . . . . . . Other Work . . . . . . (Description) 4. Estimated Cost 5/i • . . . . . . . . . . . . . . . . . . . . . . . . Fee f��. .b�. . . . . . . . . . . . . . . . (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 any: Front . . . . . . . , Rear``"`�" Height . . . . . . . . . . • De th1,:: . °1 `J!.' �% • g . . . . . . . .`Number of Stories . . . . . . . . . . i;�•p •d.;,.4.. Dimensions of same structure with alterations or additions: Front Rear Depth . . . . . ... . . . . . . . . . . . . . . . Height . . . . . . . . . Number of Stories . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . Rear Depth' .Height . . . . . . . . . . . . . . . Number of Stories . . . . . _ _ ,,•i:. 9. Size of lot: Front . . . . . . . . . . ... . . . . . _' 10. Rear. . . . . . . . . : . . . . :.. . . . . . . . Depth . . . . _ . . . . . . 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 regu}ation: 13. Will lot be regraded . . . . . . . : . . . . . . . . . . . . . . . . . .. . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . ., Address . . . . . . . . . . . Phone No. Name of Architect . . . . . . . . . . ... . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. ' Name of Contractor . Address : , . . . Phone o. 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 dim 6h,§io'•hs,from property.lines. Give street and.block number or description according to deed, and show street name.s.and indicate.w.hether interior or corner lot. may N � C� 7;V ON LEAD C0111TEAfT 13EFORE SOLDER USED 1A1 �q1A TER --- cop i� is used �'�,�� Y��"�i' CANNOTforsDf2r ditrei►�jtsa�€� ;TATE OF NEW YORK, � V !�! 1% LAD :OUNTY OF . . . . . . . . . . . . . . . .S.S ��st�er�t; �l�ire� 8h�11 1�� of types K of L only • ?�''""• " � • • '-P�?�•. . . being duly sworn, deposes and says that he is the applicant (Name of individual signing cofitract) bove named. PLUMBING ALL PLUMBING!!!WASTE :e is the . .f d vt?.r. �. d!`:�2 \>. . . . . . . . . : . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . &.WATT�R Lj1NE §VEE® . . . . . (Contractor, agent, corporate officer, etc.)TESTING BEFORE COVERING 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 •ork will be performed in the manner set forth in the application filed therewith. worn to before me this . . . . . . . .day of. . . . . . . . . . . . . . ., 19 `otary Public, . . ;. re—county DAWN A. LLOYD 'Y ' ' • .'• •': ..Gv.� Notary Public,State of New York • • • • • • • • • • • • �. . . . . . . . . . . No.4883005 (Signature of applicant) Qualified in Nassau County 9.7 Commitsion Expires Jan.I 1"