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Home My WebLink About22941-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25844 Date: 07/23/98 THIS CERTIFIES that the building ACCESSORY Location of Property: 415 GRANGE RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 1 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 26, 1995 pursuant to which Building Permit No. 22941-Z dated AUGUST 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 ACCESSORY INGROUND SWIMMING POOL IN REAR YARD AS APPLIED FOR. The certificate is issued to NANCY DECONCILIIS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N363290 09/12/95 PLUMBERS CERTIFICATION DATED N/A Bui ding Inspec r 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............... ..1' ..............................., 19... (,�5 NR 22941 Z Permission Is hereby granted to; s . . ...... ....d ..e . .. . .....9 ...................................................... ......./!.(. ..................... to ............. , ...... Li '�✓ / �... .1 , ✓�. ......... . ............ ........... .................................i ............. J........ ,��..: �.,..... ...............A.':�........... � . :..........- .. .............................................................................................. . ............ . ..................................................... ............... ..... .� ....(�G 'vGl.�/l rS ................................................... at premises located at.............��......... ....... .............................................. ....................... ........................................ ............................................................. County Tax Map No. 1000 Section .—X............ Block.......V/.......... Lot No. .....091�.............. 19..... and approved b the pursuant to application dated ........ l.f�l. .....��................. � .•. pp Y 7* Building Inspector. Fee .......... .......J.... .. .: ............................. )a . B 'ding Inspector Rev. 6/30/80 Norm NO. 'i ° �1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE'OF OCCUPANCY 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 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. 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 topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. 2f a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,. Swimmi.ng pool -$25.00, Accessory building $25.00, ' Additions to accessory building $25.00. Businesses $50.00. 2.. Certificate of Occupancy. on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 0—_d I.() t— J - -N, - . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . lew Construction... . �.. . Old Or Pre-existing Building Butilding. �. i .. .ocation of Property.... 1.. �- • - . House No. Street Hamlet )nwer or Owners .of Property.b.ld �.C� •.�,•IN �-1L1f•S• .!� •u�•�IN:fl• • �ou•C'.� Ll.l•S .ouuty Tax Map No 1000, Section. . . . .. . . . . . . ..Block. .. . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . subdivision. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 'ermit No. Z1�I `2:.Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . iealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . ?lanning Board Approval. ... . . . . . . . .. . .. . . . . . . . .1equest for: Temporary Certificate. . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . , PLICANT co �5S ®�ogUFFO�,�co Town Hall,53095 Main Road y Fax(516)765-1823 P. O. Box 1179 y. Telephone (516)765-1802 Southold, New York 11971 d • OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 28, 1998 Nancy Deconciliis C/O George F. McAdams 415 Grange Road Southold, New York 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) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22941-Z SECOND NOTICE Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. cz Go Town Hall, 53095 Main Road p • Fax (516)765-1823 P. O. Box 1179 y �� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 9, 1996 Nancy deConciliis . 415 Grange Road Southold, N.Y. 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) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving. plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22941-Z Please contact our office on this matter.. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 7ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: CCU l DATE INSPECT R 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE NSPECTO -;.... .. THE NEW 'YORK ' BOARD OF FIRE UNDERWRITERS PxtAGB 2 1185077 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date SEPTENBER 1.2,1995 Application No.on file 10000195I95 N 363290 THIS CERTIFIES THAT only the electric7l equipment as described below and introduced by the applicant named on the above application number in the premises of hTANCY DE CONCILIUS, S 15 CRANG'E ROAD, SOUTHOLD, N.Y. <d in the following location; ❑ Basement ❑ lst Ft. ❑ 2nd Ft. GAR/OUT Section Block Lot was examined on SE'PTEIMER 06,1995 and found to be in compliance with the National Electrical Code. FIXTURE ECEPTACLES 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 AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. N SYSTEMS O.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G. AMT. AMP. TYPE EQUIP. 1 tee'2W 1,e'3W 3,{r 3W 3,�4W PER 0OF CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: ROSLAK ELECTRIC LIC.43677E P.O.BOX 164 CUTCHOGUE, NY, 11935 GENERAL MANAGER 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. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1185077 BUREAU OF ELECTRICITY F_ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Bate SEPTaIBER 12,1995 ,application No.on file 10000195/95 N 363290 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 A NANCY DE CONCILIUS, 415 CRANGE ROAD, SOUTHOLD, N.Y. *AP/OU'P in thefollowing location; El Basement ❑ lst Ft. El2nd Ft. Section Block Lot was examined on SEPTEMBER Gab,1995 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT I.FLUORESCENT I OTHER AMT. I K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 1 1 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS, BELL UNIT HEATERS MULTI-OUTLET DIMMERS 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 SYSTEMS AMT. WATTS 1 2.0 SERVICE DISCONNECT NO.OF S E R V I C E AMT AMP TYPE ER EQUIP. 1.•3W 3,0'3W 3,B'4W NO.OF CC.COND. A.W.G.� NO.OF HIAEG A.W.G. NO.OF NEUTRALS A.W.G. EQUIP. PER AY OF CC.COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: SWT.MMING POOL--1 TD'1E1 CLOCKS 410 AMP-1 G.F.C.'..I.-1 (SWIMMING POOL) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have free{uent test/and or repair;z made by a qualified person, e« Continued on Page 2 >>> GENERAL MANAGER 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. P .-V% FIELD INSPECTION REPORT DATE _ COMMENTS II �I FOUNDATION ( I ST) II jl III_ _—II 11 — In FOUNDATION (2ND) —II --------------------- ---- — — — — ------------------------------------ {I � �{ II ROUGII TRAMP, & -- —�� PLUMilLNG { INSULATION PER N. Y. (� -II H STATE ENERGY CODE i� p { I ol f I{ - --------- ------------- -------------------------- ---i} III H FINAL ;! '} 47 u --- � - ----------- -- ---------- ---- -------- --- ------ ------- --------- A TIONAL COMMENTS: V ri H \ ra - H U ripIS- r, •`� - ,-s--;.:,�� Via. t _,S U GRANGE I : 71 y, i UNDERWRITERnERTIFICATE c < 1 REQNED POO I • f "IMMEDIATELY" La I ENCLOSE POOL TO CODE Lo.; C`'n& UPON COMPLETION i C1�- = BEFORE"WATER" ;i 1y.85°2d 40' E., 2 2, i 97?6 J.OW. \IOG OC is -_.,•.I. .._._<.M--_............-..c.—,_...��...mv...;a.,.::..+.:.s:a.c::.:<--...�,....•- z.s,y.ira'e — �--_-_ vvzy;:.[. �.f_� J jha,•�-..�:_ •t,..I.-,...,..rW:^+7..-V.�:./'t.II ...< ..1 � :ry J n ��•r P R W StBQnn'./lSk1 ,+.! ,nc+�•�• - ..> J'.n...,....- V I SURVEY FOR �' �' S1 � �: ;.K;. ALFRED C. a H E L E N R0WONLT`'-' SOUTHOLO s TOWN OF SO(Jr OLD `: SUFF. CO.' N.Y. . GUARARM,a T0, THE TITRE suARANTEt.Cfk:',• '' fi SCALE ' I" =40' � NOTE�t - OIF M S.R F, R .TO. i:A'C OF�M'I'T¢r kY�4.�-d'r: .s = ?-_ c;•p.4-,"v�J-� pi•�RO�fr E R-Nr..°•i� �ICE OF E € U A3 MAP110. 40" ON JULY 14.19 `. i ..... `\,_ .. �aci�.,+';"�e we':R.k'Q$3S`:r'.i"P d''1�� _ 1- -�^ •t_ � ~x- rl:�l� .__-a..�.-1m1,••.:a•nNraMaaM I.L:I...,.u�1:., -.•aa...a.fu-,1.. , , _•••••...••..' CER ,a, VPJDERWRIREQUIRED TIFICATE MEDIATELY ENCLOSE POOLTO CODE/ LL i 1� C PLEMN LL BEFORE "9� ATL 41 LIGHT STEP B �. A —'� APPLICATION APPLICATION , 1 0 -� H 4` 6' 6' 6` 4' 14 x Ld' Y.lil','1'Ad LE '1'YPL D T 2• A-6' T'iJJELS r 4 2I ra fi 4-G" RADIUS 01HEJEY. PIsIJY.LS L _IGHT 4 6' l_IGHT D 3t_• / 1-90° CQE'iLJG t:�omm'. STA.3s 1_1s, = '�,• L•.ortrJc: s'MMORT SE1Iq' .�� 1.8 3' L-t'IIJYL LIVER �—E F . �— G --�I H - J I-' K J 4' 6' 6' 6` 4'1 NOTE.TYPE 0 POOL -11VSTALLA71ON OF DIVING EQUIPMENT ISPRONIRITED SIZE A B C D E F G H J x L 6' 6' 6` fi' 6` 16'> 32' RECTANGLE 14'x 28 14' 28` 7' 3'4 0' 12' 4' 4' Il 5' 3'8" Now Qiagonals given to Ifi' x 32 1s' 32 B' 3' 8 14 5'6 4'6 4 6r 7` 4`B 12-6' PANELS TV PE TI 90` n{D{COTneCS. 16'x 36 + v + v " 1 18' 36' 8' 3`4 12 k4' 5 6 4 fi 4 6 9' 4'8" 4 " 4 3` 4` 4-4' PANELS pl 4-CORNER PANELS 2Ox 4 20' 1 7` 4` 6' B' S'2 �� 6' B` 6' 20-BRACES LIGHT I -g0° COPING CORNER SET CENTERED 6 �5;9 a'cuKRETt cca 1 -L6 X 32 COPING STRAIGHT SET �---- a=o' AIEultstEEn wwlr ' I -VINYL LINER pzp I],ho•J h�F 4 4 3 4' �Jr ALLMcllY caaw i 6' 6` 6 6 6' POLYSTYAEHE - ;•��• :. + / 1 Q p PANEL 4 .•':"�.t•-r DW2')(W.,-AV-F 6' 6' 6' 6` 6' 4' 10' >t 3G/ RECTANGLE z;aa,e;a.PANEL 0 4 / .LR no E1w�irai4M 14-6' PANELS TYPE TL Lre"xz +4 EIJLs ZF<♦TEAWSFOfiEIOGFLL + 4' S` 4-4' PANELS 0 PTAkET :it 6 y��y 6 22-BRACES ChLy RMU �E13IR U A-CORNER PANELS UfIY RECtTIX 11 VI4ri LIRER _ EfATAY15T47E5 + COPING CORNER SET LIGHT / 4 8' 6` �' _ �IrpusTrErn PIN CENTERED 4 1 -16 X 36 COPING STRAIGHT SET i>'f RlJicuBQT OR i 11J / I -VINYL LINER aTa.Da•°a•:c SAtt]flpTTON i' y 6�f£�G7H 1,174. If 40- 'Y! a .srnr•E L Ij i _ _- exllr.tlw[cu ul rota.." '�. 'I`I :.tD..°ri.c w,r,l,L(aeae c•nnr. f:�''' \\ t.l�u,CTOr10r ImL AT Er•n e•.[wc r `I / Wrn YI•talD lxl LL[1r1Y. IT4 fi 6 6' 6 6 4 a.ucwuar twat re i un[ae wlr rola- V5E rJ CpJTral.7ls YRCGPESSCrI x[AwAl ILL saw urea a.rc v ,dA:I.lsa)FERIHFTEH N EY.kD EiEAM IINL.ul?I— .L,[I[ll 1HiltD t u[a:La '.lN •aNar .4 ll5al eIN-C Mt [u[r!,rWls er llul<P!•w�aL aT u:.t 510 sYNPTEA URIYE TRRT MJ.TIE. WpTA1A �6� 6' 6` 4` 20'x 40' RECTANGLE TMN"°' I11i11IE)1 .'... I'IO eLi�Nl�n[r•.'liii.in[ml n.r01w�ilii.rl_ i110d.tlSA. •�� Ifi-6' PANELS TYPE ME ol.+T„Nr uwllew I:+u ons+.Ll-�'/ G 5' 6' 4-4' PANELS PR�QQ .r.e avrN w 4-CORNER PANELS 7 24-BRACES *e: rl,�! 1-90" COPING CORNER SET RECTANGLE LIGHT 5 6 B' 6' 1-2,0 X 40 COPING STRAIGHT SET CENTERED \� 1-VINYL LINER T RI7 OROCINR!le[OIL u1Ul>•[IeTIVE 1'ultpeE3 ObLT �9 ' #O T E L rr..e,nde:l..e.nw.Df1;m:a nI•+Iw,wuro.acns•I eu.t n CF. ! �• 6 6r ^- m ru[n„Imn) Arc(orer np�s[nuwm[mamnn D'NNL[I[ IT, /r 9 5' m,d[Dr mr tllWra•tl allro arr*.cl[rmn[[u[s:rc,11,p[,dnP uy ALL CORNERS ARE 6/' RADIUS, EVERY nrllatPlmc.°n.m. ..laln:a+l.IwnuelllDnee...•rn• JOINT USES A BRACE, ALL CORNER ;.Ime nae lass T+e da«alemn/enr.no-tea Dl mvxn r„+ 1 SECTIOIJS ARE I` X I', 'N,4an H!P[I Derl[n lrl:):r•IV nPI[n.gmlp.nPb([r pIIH p) 4 6' 6` 6' 6 6 4 rrarN4om.,Tre C:nlYfsWnmallWa,NtllY.r lr'.wppr,cmN.M .m4'lnA le r,°InY 9'°•nD[afntof[ih[n ml)De aShcnNltryrav I Y_el Yf°11„•fnW I[/C:nlhlLlgn Tn1 re[PnrN:rR(alA[ODHIKIpn LL •? MAIE:IDESt�J dintl19:as tonVl arh Ih:I1T1:n)I Sn ud M1:(i Im9R1t s1ueslEd n[nuflm sst•d1•:s UI:esllUUr T[uK II dnvg DaNs Al fides al!R)G!ustn will Rent D-ds pt".EOl)IJI ItP IMILOU1131 s Irsllu:)Eas am ht 4)IUIJ Sµµt R Nc II['Jiul[3 mualn 9arl:.;<ds eu:r IP nsnirq dnnp bomEK tr sLlks la nisr In:K r°I rftrn,lo,c:,,xwoE CJfr1 n[u°Dq s'JI ,ds r'+t'"210'al Ela p P[Of IwIINr,21A Elttl/wet kMme,Ayuaddl,iM 223H•7WT!!Y`[IfE3 7`'_ �"- �I FORM No. 1 BOA1;D OF HEALTH . . . . . . B SETS O�PL.\?7S . . . ... . TOWN OF SOUTHOLD SURVEY _ _ . . 12:if tt ;6 ;. BUILDING DEPARTMENT CIIGCK :.}�.�$ : 1 TOWN HALL SEPTIC FOR:i —_- SOUTHOLD, N.Y. 11971 6LDG §?E�'t sOVIN OF SOU'�"B 01D TEL.: 765 1802 NOT FY ; Examined . . . . �F ��. . . . . � CALL .��$.��ok . . . . . . , 19 MAIL TO : Approved . . . . 1 . . . . . .. 19 /0.. Permit No. 9 � . . . . . . . . . . . . . . . . . . Disapproved.a/c . . . . . . _ _ . . . . . . . . . . (I� g Inspector) APPLICATION FOR BUILDING PERMIT G Date . . . :� . � . . . . . . .. 19 / INSTRUCTIONS a. This application must be completely filled in by typewriter or iri-ink and submitted to'-the Building Inspector, with -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 street 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 permi 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 o� 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 ' spections. PUY (Signature of applicant, or name if a corporationPAO (Mailing address of applicant) State whether applicant 'is owner, lessee, 'agent, 'architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .. . . . . . . Name of owner of premises' . . . . . . .'. . . . .11'. d�C.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If aptC"a rporati si ature f duly authorized officer.and title of co a e officer) 17?eDER4leiITERS CERTIFICATE REQUIRED Builder's License No. ... .. l` , '� `7 ,' , , Plumber's License No. . . . . . . . . . . . .. Electrician's License No. . . � ENCLOSE POOL To CODE .12. . . . UPON-,COMPLETION: I.EEOkE "WATER" .. . . , Other Trade's License No. . . . . . . . . . . . . . . . . . l. Location of land on which proposed work will be done. . . . . . . � . . . . . . . . . . . . . . . . . fin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . : . . . . ?i . . . . . . Block . . . . . ; , , , Lot . . . . . . . . . . . . . . . . . Subdivision . . .. . . . . ... . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot (Name) 2, State existing use and occuppticy of premises and ,intended use and occupancy of proposed construction: a. Existing use and occupancy . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and oc_c.u'p:ancy_ . . . . . . . . . . . .irzo/ Li/ l�`�. . . . :P {--. . . . . . . . . . . . . . . S�(M-4 rAfr, -3. Nature of work (check which applicable): New Building . . . . . . . . . .. Addition . . . . . . . . . . AlterationF - Repair . . . . . . . . . . . . . . Removal . . . . . , , . , . , , , , Demolition Other...Work . . . . . . . . . . . . . r- y • ;: 4. Estimated Cost . . . . . . . . . .�100.0 c�?. . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . (Description) (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 Depth . • • • • Height . . . . . . . . . . . . . . . Number of . . . . . . . ... . . . . . . . . . Stories Dimensions of same structure with alterations or additions: FrontRear • • • ' Depth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • • Height . . . . . . . . . . . . Number of Stories . 8. Dimensions of entire new construction: Front . Rear Depth � • .Height . . . : . . . . . . . . . . . Number of St ' •. * ' * , . . . . . . . . . . . . . . . . . . . . 9. oriel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . 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.viola e,any zoning law, ordinance or regulation: � • . . • :13. Will lot be iegraded' Will excess fill be removed from premises: Yes 14. Name of Owner of premises . ,%�•, ,QFGod�&,J/ /,5'Address No Name of Architect . . . , ' ' ' ' • • • • • • • • • • • • • Phone No. .... , r�?r��1r •S Address Phone No. Name of Contractor .�. . ,' ,�,[,� -�• , , , Address �,'''),'��fjA442&. ,Phone No. .• ,� . ,� 15. *. Is this property within 300 feet of a tidal wetland? �� ` • • Yes.. . . . . . . . No. . . . . . . . .*If yes,- Southold Town Trustees Permit may—be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines..Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. S /77 0tV fin U4-7 • ROY�AS NOTED g " DATE. B.P.# FEE of .:��•i BY: . .NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,. A. FOUNDATION = TWO REQUIRED FOR POURED CONCRETE 2. ROUGH ="FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION;•SHALL MEET,, THE REQUIREMENTS,,OF'''THE' N:Y. STATE -CONSTRUCTION. & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR;CONSTRUCTION ERRORS ` TATE OF NEW R OUNTY OF . . � '�?JLk S.S L/• • •�J•' •.• . . . . : being duly sworn, deposes and says that he is the applicant(Name of individual signing contract) pp nt >ove named. is the . ... . . . . . . . . . . . . . . -` '. - (Contractor;agent;corporateAofficer,.etc.) said owner or owners, and is duly authorized to'perform or have.performed the said work and to make and file this plication; that all statements contained in this-application are true to the best of his knowledge and belief;and that the )rk will be performed in the manner set forth in the application filed therewith. iorn to before me this . . . . . . . . . . . . . . . . .day of. i Q Mary Public,"� `,�- / . . . Cou' �' n.ty'� HELENE D.HORNE �..�. Notary Public,State.of New York Y' -N6i 4951364' `• ', . . . . . . . . . . . . . . . . . Qualified in Suffolk County�F (Si e of applicant) Commission Expires May 22019