HomeMy WebLinkAbout45218-Z ���Osut py Town of Southold 12/29/2021
P.O.Box 1179
53095 Main Rd
y�j�1 Safi' Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42651 Date: 12/29/2021
THIS CERTIFIES that the building GENERATOR
Location of Property: 4001 Wells Rd.,Peconic
SCTM#: 473889 Sec/Block/Lot: 86.-1-9.4
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/8/2020 pursuant to which Building Permit No. 45218 dated 9/17/2020
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 generator as applied for.
The certificate is issued to Johnson Leung Family Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45218 11/17/2021
PLUMBERS CERTIFICATION DATED
uth ri e ignature
�o�g�FEQ� TOWN OF SOUTHOLD
aye BUILDING DEPARTMENT
' TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 45218 Date: 9/17/2020
Permission is hereby granted to:
Johnson Leung Family Trust
181 E 90th St Apt 5D
New York,'NY 10128
To: install a generator as applied for.
At premises located at:
4001 Wells Rd., Peconic
SCTM #473889
Sec/Block/Lot# 86.4-9.4
Pursuant to application dated 9/8/2020 and approved by the Building Inspector.
To expire on 3/19/2022.
Fees:
ACCESSORY $100.00
CO-ACCESSORY BUILDING $50.00
ELECTRIC $85.00
al: $235.00
Building Inspector
Form No.-6-
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 Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 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:
1. Accurate survey of property showing all property lines,streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date. , �f
New Construction: Old or Pte-existing Building.- (check one)
Location of ftperty- (� U1�2�(S Road Pe C 0 M,
House No. Street -� Hamlet
Owner or Owners of Property: 6)b AI) 1,W I
Suffolk County Tax Map No 1000,Section Block l Lot I i
Subdivision Filed Map. 1 ^Lot: rte,'__
Permit No. Date of Permit. Applicant: �(��/1f�>n Leayo fGWY1) k
Health Dept.Approval: Underwriters Approval: 42 ,VI1
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
App cant Signature
pf SOUlyol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 • Q sean.deviinCaD-town.southold.ny.us
Southold,NY 11971-0959
o�yCOUM`1,��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Johnson Leung Family Trust
Address: 4001 Wells Rd city:Peconic st: NY zip: 11958
Building Permit#: 45218 Section: 86 Block: 1 Lot: 9.4
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: BJ Electric License No: 2670ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service
Commerical Outdoor X 1st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Generator X
INVENTORY
Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches 4'LED Exit Fixtures Pump
Other Equipment: Kohler 20kW Generator w/ 100 Overcurrent Protection on Generator and
200A Whole House Transfer Switch
Notes: Generator
Inspector Signature: Date: November 17, 2021
S.Devlin-Cert Electrical Compliance Form
%
OF SOUTyp� ,
# # TOWN OF SOUTHOLD BUILDING DEPT.
°`ycourm `'� 765-1802
INSPECTI.-ON
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING -
[ ] FRAMING/STRAPPING [ ] FINAL
] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
nl A t,- OK
DATE INSPECTOR �_s
# # TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] NSULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ]: FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ]: ELECTRICAL (FINAL)
[ . ] CODE VIOLATION [ ] PRE C/O
REMARKS:
in 9A_4114�11 C4
DATE INSPECTOR
FIELD INSPECTION REPORT' DATE CoA4A.ENT8 -
FOUNDATION(1ST)
. --------------- ---- . ---
FOUNDATION(2ND) '
y
ROUGH FRAMING& : �y
PLUMBING
INSULATION PER N..Y.
STATE ENERGY CODE
FINAL
ADn I31�T ,h G`IIlVlENTS
rn
TOWN OF SOUTHOLD ' --- '' _ .BUILDING PERMIT.APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board-of Health-
SOUTHOLD'NY'11971 4 sefs'of Building Plans _, +JIL
TEL:-(631)-765-1802-- -. _ _ Planning Board-approvaP,/;.,=;
FAX:(631)765-9502 Survey
Southoldtewnnygov .- _ PERMIT-NO._ Check LR', °:.n,-•. . ,i
Septic Form
- :C[O:Application
Flood Permit
Examined --- -- -- - ------- 20= -- -- - -- -- Single&Separate 4
Truss Identification Form
j Stone-Water Assessment Form
o d' (fes r�
Approved - 20 _r ^�, X1:7, .V .. } :;Mail to. �U`� i. C1l�P v`
Disapproved a/c �,CCO 17i
1 a:
- yyyJ YY j
-- –- ----- � � - Phonek'`��
Expirati ..i UNLAWFUL t
13 t l ;p�'p-�p� y7p q y ,�.
l`w� F -Ci�8 5��'C�w®�V ATE
APPLICATII7tLDING PERMIT '
.,;. s.
- - - Date
INSTRUCTIONS
a.This completelyfilled in wrypewriter or in ink and submitted to the Building Inspector with 4 r
sets of p ..'t M.tp to scale.Fee according to schedule.
ttj an` owing-location of lot and of buildings on-premises;relatfonship'to'adjoiiling premises or public sticets or
areas 1aterways.
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!piemises-available;for inspectiowthmughout 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 Occ_upancy,:,_; '
f Every building perntit.shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has-hot-been.completed,within 18 months from suchdaie,if no zoning amendments or other regiilations .,affecting the
property have been enacted in the'interim,the Building Inspector may authorize,in writing,the extension of the permit foi•an
addition six months.Thereafter,a new,permit shall be required.
APPLICATION-IS HEREBY&kDE'to'il e,' i ildi g Department for-tlie issuance of a'Building Peim t pursiiatit`to the
Building Zone Ordinance of the'Towii of Southold;Suffolk County;New'York;and-`other applicalile Laws,Didihan
ces'or
Regulations,for the construction of buildings,additions,or-altei itions'ov''foi`iemoval•of demolition•as�hereinAescribed.The`•
applicant agrees to comply with all applicable laws,ordinances,building code;hous*iodej fid regulations;and to a
auttiorii '.F fdP tnipretitises inbuilding for necessary inspections.
l3
V (.lO.a, w Tam
„
3: n-t; ,:• i(Signature f.applicant or name,&a ration).
FEE: �f o�/:..�
TNIENIT
(Mailing address of applicant)
76x5-180 3 AM TO k F;t'i FOR THE
FOL 1W,'bett eJ,applicatiY+iCQwner,lessee,agptt,/architect r,gene contrac or,electrician plumber•or-builder
i. I r i,ninr, i d+�I l�—=�•.�ItE—:M6 ` SlFy6 7 '
r r� Po F z o fpr e����ayl to ( rl�1 �
e one of pre
2. Ro �E� - Fs l' 0 N Y WITH ALL CODES 0
'•.•�.:(As�on'th t-roll o a'`t "Y+
3. I W�Aj icc� pis a corporation,signature of duly authorized officer fJ�v v't� YC)R�"STATE &TO W U G O D E S
4. 111.181_ - CQN'7R_U i1ON NJUSI
QE COPS(Nie;and.Otle o�(corporate officer) IAS REQUIRED7�TOW
N S.O F
ALL$uderslLi�eense No u r r r TI•a
SOUtE 'Ilutn�b�er�rINR 'eC11C1at4SL1C�llSeOv _ �s,. niYO�Oth � ade' � se No"�'°�' 'r r"'� SOUNG BOARCIDESIGN OR CONSTRUC4' 1rtUrI6. ES
1. Location-of land on-whicltel sed.work- ill.be-dopej,,,.,:,,,. ,.� u ;aY: .r,• ;�L�I ,�Y•.Atnv. _ ,
CDd 1.
House Number Street Hamlet - p
County Tax Map W4000/Sectiod r D A Block, •! Lot
t
/ ;Stibdivision + ' r Filed Map No. Lot
2. State existing use and occupancy.of premises and inte dedu e and occupancy of proposed construction:
a. Existing use and occupancy_ tP_2 �d D/I/I Gf ti
b..Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition i Alteration
Repair RemovalDemolition Oth/eJr Work f
4. Estimated Cost- - Fee
DO
(To be paid on filing this application)
5. If dwelling,numberofdwelling units - Number of dwelling traits 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:Front' ' Rear
Depth Height -Number of Stories 1_
, 1 fy•
8. Dimensions of entire new construction:Front - Rear .Depen
Height Number of Stories`
4^
9. Size of lot:Front Rear Depth A i
10.Date of Purchase Name of Former Owner wtis
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_
Vt*vi14.Names of Owner of premise Address qO 0 Phone No.
Name of Architect '"Address 'Phone No -
Namebf Contractor Address Phone 146.
15 a.Is this property.within 100 feet of a.tidal wetland or a freshwater wetland?•*YES NO
*IF YES,SOUT l&D•TOWNTRUSTEES-&-D:EG:PERMITS MAY BE-REQLFIRED.
b.Is this property.within 300 feet of a,tidal wetland?*,YES NO
41F YES;-D:E.C.PERMITS MAY-BEREQUIRED.• .
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point ori 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 NO—t--
IF-YES,-PROVIDE
OL_IFYES,-PROVIDE A COPY. `
STATE OF NEW YORK)
SS:
COUNTYOF �,e�w5
`1 h i�i [�u riS �t�� being-duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,-Agents 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 belief,and that the'work will be
performed in the manner set forth in the application filed therewith.
MR I
Sworn to before me this ^—•
(9 day of SC ",`,CC;M�
a"ERAPEREZ
ublic-State of New Ycrk
Vb.OIPE6290642
s County
Notary lic ?y mission Expires.Dec 14.2021 ". Signature of Applicant
i BUILDING DEPARM
TENT-f{ectrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex-54375 Main Road - PO Box 1179
Yy- Southold, New York 11971-0959 {
J Telephone (631) 765-1802 - FAX (631) 765-9502
roQen&-southoldtownny gov seand0southoldtownny.4ov-
. ........ ......
APPLICATION FOR ELECTRICAL INSPECTION
.......:............._:._...._.. .....-
ELECTRICIAN INFORMATION (All Information Required) Data:
Company Name:
-_ --
Name:
pr 112 110 dt -t
License No.: 26 -7(o hA email:
Address: �G ._... ..
� .
Phone No.:
_.. .......... _....... -
JOB SITE INFORMATION (All Information Required)
Name: . D . . I.�. ....... .I�I/1..�. .... ..::G_� .... UrV
Cw _:. ._ .. )A _
Address:
Ad-
Cross Street:
........_........... ......_._ .
Phone-No.: .- ( - _f
..
Bldg.Permit#: email: C I Ul - (D v--o l ,Lt�
. Tax Map District;_ 1000 Section; Lo: _
BRIEF DESCRIPTION OF WORK(PI ase Print Clearly)
..... ..
Circle All That Apply:
Is job ready for inspection?: YES-1 IO> Rough In Final
Do you need a_Temp Certificate?:-
YES/ NO, Issued On.
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: _. A #Meters .. .. .. Old Meter# .
New Service-Fire Reconnect-Flood Reconnect-Service.Reconnected- Underground-Overhead
#Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional'Information:
PAYMENT..DUE W TH APPLICATIOAt
Request for Inspection Formals
BUIiDING=DERARTMENF ElectflitbFIMpector
� . TOWN OF SOUTHOLD
Town Hall Annex-54375 Main Road.-.PO Box 1179
Southold, New York 11971-095.9 f
T lephorle(fi3_.)...:76'5. _.__.0 :- FAX 631 76 9502 '
A..
:roQerr0_Southoidtownn goy-wand arC�sotrtholdtownnY ttov t
_._. _.. :_. . ..._ . _ .. .. ..... _ _.. _ ... ._. _.. . _
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} PPL#OAON—FOR ELECTRICAL 1N� ECT10hC
.ECTRICIAN INFOMAr1O..ft tM lh5r=tion"tt-equifecly Date: 3: ZpZU
f
44 —.._ _
Cornan Name: :
p Y
-.Name:
License'No.: email:
•
Address:_ ...:.... . p _::....::.::._� - - C.. _ we._
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... ..., ...-...
......... :
Phone No.: [. :.
.._.. ............... ... :..... '......... ........... ...... .. �- .. .s ...
jOB SITE INFORMATION ' (All`information Required)
Name: .. 1
_ c
................ .Q.;._....._.
: . Address: IJ:D
Cross Street
PF�one-.-'
,r
.�
Bldg Permit#: email C
Tax Ma Drstnc�t._ 1000 Section-' BFock� — Lo
BRIEF DESCRIPTION ORWORK(PI; se Print Clearly).
---
`
... __...- - - -
. �.... .. ._ .
EigA1l�That�lprply:
Is-job-ready for inspection?: YES/: Rough In- irmf
%Qov Certificate?.:_ YES!_ NOLIsseied:On:.
_ . . . .........
Service Size-l-Ph 3-Ph- Size: _A #:Meters .. .. _. OId Meter#
Mew Service Fire-Reconnect-Flood.Reconnect. Service,-Reconnected Underground-Overhead:.,
Under round:Laterals 1 �2 H Frame . Pole Work done on Service? Y ,N
Additional 4riformatIon,
- :PA1fMENT.. OEM Ft RPPtJEA'-ION- `-
Request for inspection FormAs :s
Chinita Leung Hard
4001 Wells Road
Peconic, NY 11958
September 3,2020
Town of Southold
Building Department �QC�
Town Hall ®
Southold,NY 11971
9
SEP 4 2020
RE: Installing Standby Generator
To Whom it May Concern, ITROLD
I spoke with Sue at the Building Department about our desire to install a standby generator at our
property at 4001 Wells Road,Peconic,NY 11958. The owner of the property is the Johnson
Leung Family Trust and I am a Trustee for the trust. As per her instruction,I am enclosing the
following documents:
1. Application for Certificate of Occupancy
2. Application for Building Permit
3. Application for Electrical Inspection
4. Copy of the survey with the location of the generator marked
taa.th5ec�f Nti"wtfafatligenmrata Y`dlile - 31as `c�la�err �W +
autoa =stag day 110- ., —ene=ator with O, OQ-watts + anc� s d� Il �s
Thank you for your consideration.
Sincerely,
Mo - Gk .-W s
15D Oct .
Chinita Leung Hard
Trustee,Johnson Leung Family Trust
Mobile 206-853-3731 Q 1rJ!/;1 kSI �
�Omt 6?,1 - T�4 �
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R i INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS UHALF TO THE TITLE COMPANY,00',MMENTAL AGENCY AND IENDMG INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.,(S)THE LOCA
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400 OW—der Aveme,Rlvorhaad,No.Yak 11901
WELLS t.L 691.927.2503 Fax.691.'121.0144
admtnayoungenglro ertngaom
RpA p Howard W.Young,Land eurvoyar
Thomas,0.Vblport,ProPesalonal Englnoor
Douglas E Adams,Prot—slo—I Q112or
v Robert O.Tact,Architect
S 5
N Q SITE DATA
AREA-2.5926 ACRES
/ •SUBDIVISION-'RICHMOND CREEK FARMS,SECTION 2'PILED IN
THE A5 FILE OFFINO.102CE OF THE CLERK OF SUFFOLK COUNTY ON MAY 18,1999
2.
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WE C ` 1 P /� �� •Y@ HEREBY CERTIFY TO ER LIN DA LEON 13 THAT THIS SURVEY
PREPARRV ACCORDANCE WITH THE!CODE DP PRACTICE
•, 1 P• 0/ l b 'FOR LAND 9URVEY9 ADOPTED E THE NEW YORK
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PROPOSED POOL EOUIPMEN
LOCATION OF 4'x 9' O Cw
at P6onla,Ton of Southold
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n9ERCRETE PAD OF SIMILAR 1• �y� U) Suffolk County,Naw York
PROPOSED FENCE P .•2 2
LANDWARD
DAL 1'- "�• EX15TINO 0ONDITION5 SURVEY
SANITARY MEASUREMENTS BYTYOUNG LIMIT& YOUNGSDETERMINED /� LA LOt ml County Tax Map om. 1000 s.o0aa 86 8-01 uw. .q,4
FIELD 9URI/Ey COMPLETED -SEPT,O0,1014
A 8 1 Q MAP PREPARED SEPT.09,2014
� Record of Rovi91on9
�- RECORD OP REVISIONS
;I S.T. 61' 3T ......••. .` �• Are
C.P. 1 79' 53' _ — ' /' TIE LINE ALONG
1444*2g�05'W
_ APPROXIMATE H.WM. 232.51
C,P, 2 78,5' 54.5'
6.P. 3 70.5' 49' RICHMOND CREEK
loo o SO loo 200
' Scalea I"= ICO'
JOB NO.2014-0175
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W 6 FOR LAND SURVEYS ADOPTED BY THE NEW YORK 5TATE
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+5.48 `� ..� SURVEY FOR
6 X3 FEt \T 8 NDWARD LIMIT OF
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�6 4� a.54 a s5 WETLANDS AS DETERMINED _ y_ ERL I NDA L�uNCf
�s % FES S Y EN-CONSULTANTS ON
10 04/11/18 1 LOT i, "RICHMOND GREEK FARMS, 51ECTION 2"
ON % �� ; of Feconic, Town of Southold
5uf f o I k County, New York
BUILDING PERMIT SURVEY
•° ter,,,_•--
��rrr Lot I
Subdivision - $ County Tax'Map District 1000 Section 86 Block OI Lot Q.4
"Richmond Greek
�/ Farms, Section 2"
FIELD SURVEY-COMPLETED!
MAP PSEPT. 08,2014
REPARED o SEPT. 01, 2014
i?ecord.of-Revisions
RECORD OF REVISIONS
-DATE a
ADJACENT LOT COVERAGE BO ABUILDING PERMIT DATA 5 T- IS. 2018
- o Ari a JAN. 16, 2014
ADJACENT A.R=A - , 20 5G- 77-
- 864
FRAME HO,1$- = 6ARA5E = 5,025 50_ FT. = 5.59n
ROOF OVA YtiOG;FOR:14
= 434 Sa =1. = 0.596
SG?Z�-N = 560 SGc. ` = 0.4%
I66 5G. =;. = 0.2%
_ �Q��K �= _ 'TZIO 5C.=1- = 0.495 SO o 2s 50 Ioo 150
RICHM{SND t`
_ _
-�< < a.>:. PAN-710 463 50. _-. - 0595
� Scale: I" = 50'
IJOB NO. 2018-0166