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HomeMy WebLinkAbout28222-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29491 Date: 06/04/03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 400 RICHMOND RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 6 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 22, 2002 pursuant to which Building Permit No. 28222-Z dated MARCH 29, 2002 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 NEW SINGLE FAMILY DWELLING WITH ATTACHED GARAGE, COVERED FRONT PORCH AND REAR DECK AS APPLIED FOR. The certificate is issued to DOUGLAS & DEBRA BELLOMO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-01-0156 05/06/03 ELECTRICAL CERTIFICATE NO. 1080294 04/04/03 PLUMBERS CERTIFICATION DATED 04/08/03 MATTITUCK PLUMB.& HEATING J Authorized Signatur 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) PERMIT NO. 28222 Z Date MARCH 29, 2002 Permission is hereby granted to: ARMSTRONG C/O MURCK (BELLOMO) 400 RICHMOND RD SOUTHOLD,NY 11971 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED GARAGE COVERED FRONT PORCH AND REAR DECK AS APPLIED FOR at premises located at 400 RICHMOND RD SOUTHOLD County Tax Map No. 473889 Section 051 Block 0006 Lot No. 012 pursuant to application dated MARCH 22 , 2002 and approved by the Building Inspector. Fee $ 940 . 20 Authorized Signature ORIGINAL Rev. 2/19/98 Form No.6 TOWN OF SOUTHOLD �IDS� a�q�0 BUILDING DEPARTMENT �1 U C, p TOWN HALL 1 ` ` 765-1802 i 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 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 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$25.00, Additions to dwelling$25.00, Alterations to dwelling$25.00, Swinuning pool $25.00, Accessory building$25.00, Additions to accessory building$25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00 Date. �(�(� ,on 3 New Construction: V/ Old or Pre-existing Building: (check one) Location of Property: 17CO _R�CV11'11G(1Ct 26R d Sulo� d House No. S� ettreet �� Hamlet Owner or Owners of Property: houq OLS an eA J VY y-C1_ �k\O✓Y1 O Suffolk County Tax Map No 1000, Section 051 Block (z) Lot tom , Subdivision �y Filed Map, Lot: Permit No.qZ p �lT� Date of Permit. 10,?— Applicant: )NQ}9y''0. _-R '(—k i om O Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �D Applicant gna Q.a� ��fo35 eo �0? o�osuFFot,��o o� Gyp �+ x Town Hall,53095 Main Road Wp • Fax(631)765-9502 P.O. Box 1179 � �Qt` Telephone(631) 765-1802 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. Z- Owner: 'h'r—ky^CL Bc- k n M 0 (please print) Plumber: L 14 I-rUC.K PlumbIne d- 4 c"a ,q Corp . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (P umbers ignature) Sworn to before me this S day of 46a 20PI__ Notary Public, 1` 4"-County NOWY"RAN kkk,,� 1� No.01KE60Q12Y7 Term EXputem's JUno Q3nC.CnLffiI��nC.rCn�nCnCrLnLnCnLnLnCnLnL3rC3r 1�CnC.PCPLLnLnL0CnLn�nLnCnCnL1�CnLnC.l7LnLfC�C.LrL31LCnCnC.rL3PL1�L3PC .1�Gnr�CnLnL.n C.1LfC.�C.10 10 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 F3UREAU OF ELECTRICITY 5 r5j 40 FULTON STREET — NEW YORK, NY 10038 55 5 CERTIFIES THAT 5 SUpon the application of upon premises owned by 5 5 LOCUST VALLEY ELECTRIC DOUGLAS BELLOMO 5 e5 38 MICHAEL F STREET 400 RICHMOND ROAD LOCUST VALLEY, New York 11560, SOUTHOLD, NY 11971 e� 5 Located at 400 RICHMOND ROAD SOUTHOLD, NY 11971 5 5 ee5 5 Application Number. 106-: 294 Certificate Number 1080294 5 Section: Block: Lot: Building Permit: BDC: NS11 5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor,Attached Garage, Outside,Attic, 5 5 5 rr5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was 5 found to be in compliance therewith on the 4th Day of April, 2003. 5 5 5 Name OTTY Rate Rating Circuit Type 5 Alarm and Emergency Equipment 5 Sensor 1 0 Carbon Monoxide 5 Sensor 5 0 Smoke 5 Appliances and Accessories S 5 Pump/Motor 1 0 1 H.P. 5 Exhaust Fan 2 0 F.H.P. C� 5 Furnace 1 0 Oil 5 SWiring and Devices 5 5 Receptacle 30 0 General Purpose 5 Switch 31 0 General Purpose 5 Fixture 28 0 Incandescent 5 Fixture 3 0 Fluorescent S 5 Paddle Fan 6 0 5 Receptacle 1 0 20 amp Laundry 5 5 Receptacle 1 0 30 amp Dryer 5 Arc Fault Circuit Interrupter 4 0 15 amp 5 5 Receptacle 11 0 GFCI seat 5 Service Continued on Next Page 1 of 2 LSJThis certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. n LI�LPLnLnL17LnLnLnLnLnLnLnLnLILnLnLnLnLILILnLILrLnLlLnLnLnLnLnLnr Pr ffl LnLfC_prrl LrLnLlLILnLnCjLnL1�Ll�LILrLrLn LI�LrC013o O [1tJ rJrJ@P[P cPr1 PrJMrJdJMr1rJMMarJPLtPrJrJrJrJiJJr�r�tPcPrJpL [JL tJ rJ@P t�cPtJcP cPcPrJ eO 15 BY THIS CERTIFICATE OF COMPLIANCE THE NEW YOPK BOARD OF FIRE UNDERWRITERS 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT 5 Upon tl application of upon premises owned by 5 5 5 5 LOCUST VALLEY ELECTRIC DOUGLAS BELLOMO 5 STREET38 MICHAEL F 400 OD R LOC ST VALLEY NewYork 11560, SOUTIHO DN971 5 5 5 Located at 400 RICHMOND ROAD SOUTHOLD, NY 11971 5 5 5 Application Number: 1080294 Certificate Number: 1080294 Section: Block: Lot: Building Permit: BDC: NS11 5 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: CCU 5 Basevimt,First Floor,Attached Garage,Outside,Attic, 5 5 c5 was inspected in accordance with the Nal onal Electrical Code and the detail of the installation, as set forth below,was 5 found to be in compliance therewith on tht; 4th Day of April,2003. SC Name OTY Rate Ratine Circuit Type 5� 1 Phase 3W Service Rating 200 Amperes 5 Service Disconnect: 1 200 cb 5 5 Meters: l 5 5 5 5 S 5 5 5 5 5 5 5 Sea, 5 2 of 2 .]C 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. O rJgJc1 rJr1rJPCj-L3rJ'rJ'r3rL3r3rL3Pr rL3It PrJ�cP rJ�rJ rPr PrJrJ�rJ�rJ�rJ�rlr�rJ�rJ rJ� rJ�r Pr nrJ��P rJPM 0 PROFESSIONAL ENGINEER 1725 HOBART ROAD I PO Box 616, SOUTHOLD, NEW YORK 11971 � TEL 631-765-2954 • FAX 631-614-3516 • e-mail: joseph@fschettizom Date: January 28, 2003 _.._ Reference: 400 Richmond Road Doug Bellomo 7459 Soundview Avenue Southold NY 11971 Dear Mr. Bellomo, I have inspected the repairs that I requested to be made to the I"floor joists to correct the holes cut by the plumber. The repairs are adequ to to support the anticipated loads, and as such meet the NY State Building Codes. �4OF N,E1 SCHFfr' y0 NO• o525�� F AgOFESS10�1P� Joseph Fischetti, PE MGMFORM.Nc Applicanu Date Owners Name: - o _ _— Reviewed: ArcnecU n a� Date Engineer: Submitted: v4z� SCTM N: District: 11 000 SecQon: -�� 13 lock b Lot. Project , r O n n ry --- — Subdivision — — Location: U-D e.K�t.r.�:"se.�� K--fir, _,Jlf"'� / Name'. _ utile & separate Required S�ru fi4ation. Yes /No _ Req Req. •I �— G r 7_olimp 9ismc( RTJ ILolsize'. Actwal ,1 ',�( (Lal coverage Props: d Deli —'i Req. / - Req. _/ Req. (r wo (YarY.,#0Proposed: P (Side Yard Proposa 11 [[R"" Y �/-���Yard _ hoposed Project Description: N1'/ / ✓ - Sz:A AGENCII[.$ERMITS Permi REQUIRED FOR REVIEW N.A.. NO YES Numb r Suffolk County Health Dept- Ne w ept.New York State D. E. C. ✓ _ Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? C Flood Zone: l OteS: SAFE HARBOR TITLE AGENCY, LTD. Title Number SH220347SS 1529 MAIN STREET * PORT JEFFERSON, NY 11777 Application Date 02/27/2002 - (631) 473-0800 FAX (631) 473-7685 Report Date / / Underwriter Underwriter Number APPLICANT PREMISES Karen Napolitano, Esq. Premises 548 Roanoke Avenue Town of Southold Riverhead, NY 11801 County Suffolk Tel (631)727-7345 Fax(631)727.3575 S/B/L 051.00/06.00 1012.000 District 1000 ATTORNEY ATTORNEYSELLER/OWNER Aileen Murck and Patricia Broadbridge ATTORNEY INSURED MORTGAGE COMPANY • AND TYPE OF Mortgage Premium Fee Premium Fee Policy Single and Separate 402.00 1 ADDITIONAL PARTIES • TRANSACTION ADDITIONAL IN • ' • urvey nstruc ons: N/A Notes: TOTAL PAYABLE TO COMPANY $ 402.00 SAFE HARBOR TITLE AGENCY,LTD. 1529 MAIN STREET PORT JEFFERSON,NY 11777 VARIANCE SEARCH STATE OF NEW YORK ) TITLE NO. SH220347SS COUNTY OF SUFFOLK ) ss.: Lori Colletti,being duly swom, deposes and says: That she is over the age of 21 years and that she is Vice President of Safe Harbor Title Agency, Ltd. who has examined title to the Parcels of Land described on the annexed schedule and labeled Parcels: A, B, C, D, E and F That said examination, made to include 2-1-2002 to determine that no contiguous property was owned by the owner of the property involved since the date of any previously Applicable Zoning Ordinance as of 1-1-1983. And, that this Affidavit is made to assist the Board of Appeals of the Zoning Board of the Town of Southold to reach any determination which requires as a basis therefore the information set forth herein and knowing full well that said Board will rely upon the truth thereof. Indemnifying to the Town of Southold, with insurance, liability limited to $25,000.00. SAFE HARBOR TITLE AGENCY, LTD Sworn to before me this day of /LZooZ by Lori Colletti Vice President Notary Public, Ste o New York DENISE FURLONG Notary Public,State of New Yak No. 01FU5047903 Qualified in Suffolk County Term Expires August 14, "06 TITLE NO.: SH220347SS PARCEL A: (Subiect Premises) ALL that certain plot, piece or parcel of land, situate, lying and being in the Town of Southold, County of Suffolk and State of New York, known and designated as described parcel on the Westerly side of Richmond Road. Also known and designated on the Real Property Tax Map as: District: 1000 Section: 051.00 Block: 06.00 Lot: 012.000. PARCEL B: (Adjacent North) District: 1000 Section: 051.00 Block: 06.00 Lot: 013.000 PARCEL C: (Adjacent Northwest) District: 1000 Section: 051.00 Block: 06.00 Lot: 003.002 PARCEL D: (Adjacent Southwest) District: 1000 Section: 051.00 Block: 06.00 Lot: 041.000 PARCEL E: (Adiacent South) District: 1000 Section: 051.00 Block: 06.00 Lot: 011.000 PARCEL F: (Adiacent East) Richmond Road SAFE HARBOR TITLE AGENCY,LTD Sworn to before me this /5{ day of Q[ _200 Z by d U-' Lori Colletti Vice President otary Public, State ew York D E FURLONG Notary Public,State of New York No. 01FU5047903 Qualified in Suffolk County Term Expires August 14,-O s TITLE NO.: S14220347SS CHAIN OF TITLE FOR PARCEL A Subject Premises Deed William A. Richmond Dated: 11-16-59 To Rec'd: 11-20-59 Madeleine Richmond Armstrong Liber: 4729 Pg: 60 Madeleine Richmond Armstrong died 6-1-93, Suffolk County file no. 256 page 97, devised all real property to Aileen Murck and Patricia Broadbridge. LAST OWNER OF RECORD --------------------------------------------------------------------------------------------------------------------- CHAIN OF TITLE FOR PARCEL B Deed Albert Conti and Theresa P. Conti, his wife Dated: 10-27-82 To Rec'd: 11-18-82 S. Edmund Resciniti and Jerlene Resciniti, his wife Liber: 9272 Pg: 336 Deed S. Edmund Resciniti and Jerlene Resciniti, his wife Dated: 3-20-85 To Rec'd: 4-5-85 Joan A. Dorobkowski Liber: 9766 Pg: 478 Deed Joan A. Dorobkowski Dated: 10-31-86 To Rec'd: 12-9-86 William O'Connor and Louis P. Pastina Liber: 10186 Pg: 256 Deed William O'Connor and Louis P. Pastina Dated: 10-5-90 To Rec'd: 10-16-90 The Dime Savings Bank of New York Liber: 11152 Pg: 594 Deed The Dime Savings Bank of New York Dated: 2-26-91 To Rec'd: 3-20-91 Henry F. Santacroce, Jr. Liber: 11234 Pg: 528 PARCEL B CONTINUED SAFE HARBOR TITTLE_ AGENCY, LTD Sworn to before me this .Q Cif Z/ `day of �o Z by o- I Lori Colletti Vice President otary Public, State w York DENISE FURLONG Notary public, State of New York No. 01FU5047903 Qualified in Suffolk Co Term Expires August 14,-M. S TITLE NO.: SH220347SS CHAIN OF TITLE FOR PARCEL B CONTINUED Deed Henry F. Santacroce, Jr. Dated: 2-12-96 To Rec'd: 2-13-96 Rumen Spasov Liber: 11762 Pg: 179 LAST OWNER OF RECORD --------------------------------------------------------------------------------------------------------------------- CHAIN OF TITLE FOR PARCEL C Deed Frank Sawicki and Edith Sawicki, his wife Dated: 9-21-76 To Rec'd: 10-4-76 Henry C. Doering Liber: 8116 Pg: 461 Deed Henry C. Doering Dated: 5-2-84 To Rec'd: 6-12-84 Robert E.Doering Liber: 9578 Pg: 378 Deed Robert E. Doering Dated: 1-5-99 To Rec'd: 1-15-99 Robert H.Doering and Amy B. Semcken Liber: 11940 Pg: 14 LAST OWNER OF RECORD --------------------------------------------------------------------------------------------------------------------- CHAIN OF TITLE FOR PARCEL D Deed Frank S. Sawicki and Walter Sawicki Dated: 11-10-72 To Rec'd: 11-13-72 Frank S. Sawicki, Jr. and Leona Sawicki, his wife Liber: 7280 Pg: 512 Deed Frank S. Sawicki, Jr. and Leona Sawicki, his wife Dated: 8-22-86 To Rec'd: 9-24-86 Nick Markadakis and Maria Markadakis, his wife Liber: 10131 Pg: 490 LAST OWNER OF RECORD --------------------------------------------------------------------------------------------------------------------- SAFE HARBOR TITLE AGENCY, LTD Sworn to before me this L% day of CEGB/ Z-0oz by Lori Colletti Vice President Notary Public, S of w York D NISEF URLONG ublic, State of New York No. 01FU5047903 Qualified in Suffolk County Term Expires August 14,-005 TITLE NO.: SH220347SS CHAIN OF TITLE FOR PARCEL E Deed Marion D. Papavasiliou Dated: 11-2-64 To Rec'd: 11-6-64 Marion Dorothea Richards Liber: 5645 Pg: 479 Deed Alvin Webb Richards, Executor of the Last Will and Dated: 12-20-83 Testament of Marion Richards Rec'd: 1-20-84 To Liber: 9499 Pg: 399 Patrick J. Carrig and Marie Carrig, his wife LAST OWNER OF RECORD -------------------------------------------------------------------------------------------------------------------- CHAIN OF TITLE FOR PARCEL F Richmond Road -------------------------------------------------------------------------------------------------------------------- SAFE HARBOR TITLE AGENCY, LTD Sworn to before me this 1.10 ` /') J� "WA e/L yo 0 2 by 6-1.(..� 1 Lori Colletti Vice President Notary Public, Stat N w York NISE FURLONG No ary Public, State of New York No. 01FU5047903 Qualified in Suffolk County Tenn Expires August 14,zon M-1802 BUILDING DEPT. 1 NSPECTION ( ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE �� Q SPECT M-1802 BUILDING DEPT. INSPECTION [ ] ��UNDATION IST [ ] ROUGH PLBG. [ d ]/FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREP CE & HIMNEY REMARKS: DATE / �/i'NS PECT0 Ire d M-1802 BUILDING DEPT. s TION o G ] FOUNDATION 1ST [ ] ROUGH PLBG [ ] FOUNDATION 2ND [ ] INSULATION [ M---�FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARK : /v �-�2e�,¢f-�siur� lio.zCP litZ `? �� IX-3 DATE �o�u�dv INSPECTOR//""""" � 0-2 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ) ROUGH PLBG. [ ] F NDATION 2ND ( ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE ACHIMNEY REMARKS A// Z,:i& �zo�� DATE v`l S D"NSPECT 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] FOUNPATHW2ND SOLATION RAMING [ ] FINAL [ ] FIREPLACE & C IMNEY RE RKS: DATE E 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUND TION 2ND [ ] INSULATION [ ] F MING [ ] FINAL FIREPLACE & CHIMNEY R ARKS: DATE �:71J INSPE �_ 76 AW2 BUILDING DEPT. INSPECTION ( ] FOUNDATION IST [ ] ROUGH BG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY J� REMARKS: DATE (/ INSPECTO / FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) ------------------------------------- FOUNDATION -------------------------------FOUNDATION(2ND) z 021 0 a x ROUGH FRAMING& PLUMBING 1, y w r INSULATION PER N.Y. STATE ENERGY CODE r 2PG' FINAL Ole r ADDITIONAL.COMMENTS 0 m tr k b o n y C z o x c. y IUWiv Vr �VvinVLt�INNT _ _ tSUiL ..NIiYbKN111 AYYL1( A1'li)N ( H1 CKL1J BUILDING D7PART Do you have or need the following,before applyinf TOWN H '`: R''12 2(1112 ✓Board ofHealth SOUTHOLD, NY 119 3 sets of Building Plans TEL: 765-1802 ✓Surve►¢I v2 �a� ✓Check ✓Septic Form N.Y.S.D.E.C. Trustees Examined 31>4- ' 20 per- Contact:. Approved 3�J i , 20 Stail lv..' Disapproved a/c Phone: (p Jc—a\( t 0 Up ?'ev-nivit- Building APPLICATION FOR BUILDING PERMIT Date r C e,6(LlA 0.v'U_ O90 , 20 0 a INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to scliedule. 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 for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupan is issued 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 building for necessary inspections. �\ a �ec (Signature of appli"Lridit or name, if a corporation) -7Y54 Soundyt�w Avg, - So1Nyld by 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premisesA i-&w mld r c4< and Rzttict o. Egon d brl dA (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. NptJ (e 6-Nc* R tt„r�TJ Plumbers License No. ca&Dco- P Electricians License No. E -L �)L4 (.p Other Trade's License No. 1. Location of land on which proposed work will be done: *0 R.Chmor,) d Qd . IS9 w-fiald House Number Street Hamlet County Tax Map No. 1000 Section ©5I Block ©so Lot - Subdivision Filed Map No. Lot (Name) >. State existing use and occupancy of premises and intended use and occupancy of proposed c&hstrup`ion: a. Existing use and occupancy b. Intended use and occupancy St o Q (e B YVh h1 M'-U i%, V Q. >. Nature of work (check which applicable): New Building��Addition Alteration Repair Removal Demolition Other Work (Description) Estimated Cost �D(ol 50-0 - 00 Fee (to be paid on filing this application) If dwelling, number of dwelling units / Number of dwelling units on each floor f If garage, number of cars 9— If business, commercial or mixed occupancy, specify nature and extent of each type of use. 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 Dimensions of entire new construction: Front &( O- l ® Rear &(Q ° Depth Height as I Number of Stories I Size of lot: Front /99. 699 Reaz C20 r (0(D Depth la3 ` / -7 �✓ ' 0. Date of Purchase Name of Former Owner I. Zone or use district in which premises are situated R q0 2. Does proposed construction violate any zoning law, ordinance or regulation: /UD 3. Will lot be re-graded � e,S Will excess fill be removed from rpmises: YE NO — I fplilecn Murce- fiY31 `f/arSi= N�W - W Ct t/tA1q'lAy,�_ ,0d I S 4:Names of Owner of rremisesPn+,ziao,bfoadWdjt:A esci� 1�OF lS1Qnd Qrfl�1N 9A.I's Name C'JDOfoa- Name of Architects stn G AddressPhone Nolo - -OyrpQ Name of Contractor SkWf--Wi (bY)S+•Xne- Address �qLPhone No.6- - 5. Is this property within 100 feet of a tidal wetland? *YES NO ✓ • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: 'OUNNTTY OF &ed L 40`a fi • being duly sworn, deposes and says that (s)he is the applicant (Name of individual lsigning `contract) above named, ;)He is the (Contractor, Agent, Corporate Officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to snake and file this application; iat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be erformed in the manner set forth in the application filed therewith, worn to before me thi .Lo r' 4 day of c(3 04L 200• SIJ a t.•— Q, .tom Notary Public Signa rturtu e o�Applicant MARGE ROSWORTH NOTARY PUBLIC,State of NewYmk No.8245480 Qualified in Greene A ntyt Commission ExGirea' ,t� • 0.3 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 02/25/02 Receipt#: 1377 Transaction(s): Subtotal 1 Septic Permit-Construct- Resid. $10.00 Check#: 1377 Total Paid: $10.00 Name: Bellomo, Debra Mom 7459 Soundview Avenue Southold, NY 11971 Clerk ID: BONNIED Internal ID:50245 NIF SPA SOV RESIDENCE SURVEY OF N 77 ' 47 ' 30" E- - ab 756.67' _ DESCRIBED PROPERTY SITUATE SOUTHOLD, TOWN OF SOUTHOLD -- SUFFOLK COUNTY, N. Y. Do SURVEYED FOR DOUGLAS BELLOMO 40 DEBRA BELLOMO _ N/F DOERING _ RESIDENCE SEMCKEN RESIDENCE ,PROPOSED SURVEYED 1 MAY, 2001 .,3 BEDROOM SCALE 1"=30' m u ry -- = RESIDENCE -, _ px7 73 H w'f F. F. b p w ` - ` -u' � EL 280 AREA= 25,592-98 SF ;V C �.' i'; �' .5 _ lro' u L .�',� OR CO < 0.588 ACRES ® -1 n0 \3 p a r p r �''r?QO CAF ,E, 'i A O �; I'. TROP. DRNEWA Nc _ TOPO FROM EAST END > —. m It C7 ' 'N - - TOPO MAPS !m :J rl w y L ZONED R-40 C3 0 '� © 1 RESIDENCE ))) r Cl z x �L, z �'� '7 �h� AnANr F m ICAs =`Iv �,A _,� p N�F MARKDANIS j P T THF F rfv F N >N -PVT Y1 d N A� x RESIDENCE nv N N F !!! ,7 [b ce �� T �� C vLN N,�T T N✓FENL E[, ✓An rAN-' C. to G O O I O Q' TO TI4EIhN 1r „N- \ AF f l TFAlFCFA T FC ATCT'OAAC IN. . CN, cn e -ON.N l F" TWl Z \ \ \ O tv. _r < I izeu ✓C� ATION 3K ADD d Cry nils _ `�i ✓ l A ( Ar l4 OE f T r, . ,)l ')F `-T TIE NCW YON{ /TE EDUCATIOM1 -AN j A L - i r)"!F- O " u6✓F MF N/I DtArINI ---- FR, T\ / in L N ,, ,i.F r °M2( Al h( be ( "51C Fl iO b'F A T,4 IRU, WELT- VACANT o� S 71 ' 47 30'-„W 99.67' SURVEYED BY � of v VY.' �FE� ( NIF CARRIG vo rn STANLEY J_ ISAKSEN, JR. FI '� = RESIDENCE P.O. BOX 294 TM 7000-051-06-012 - - - - - II 1 ; �� NEW SUFFOLK, NY 77956 GUARANTEED TO 631 73 -5835 K DOUGLAS BILLOW) - i ICEN$_D LAND JTZ VL YOI ' DEBRA BELLOW ^.11h� r ';:; �q �� �. _ NYS LIC. NO. 4 _2�3 US DEPT, OF ACRICULTURT M��� 5. 17 JAN 02 RFVI E SAN. LOC. RURAL HOUSING SERVICE - 'ATE HARBOR TITLE AGENCY "!' - 2- 18 DEC 07 REVISE WF-LL IOC., ADD WELLISANITARY OF OTHERS v - "Id NOTE: 7. -M JULY, 7001 REVISF "' TIT'. LOCATION & SANITARY 01C10L' NIF SPASOV TEST HOLE DATA RESIDENCE wrll _ e PERFORMED BY McDONALD CEOSCIENCE - 27 APRIL, 2001 0 ` /'OOLLL EXISTING GRADE FR SURVEY of 2 -- I, DARK BROWN SANDY LOAM OL N 71' 41 ' 30" E 90 156.67' DE CA113ED,, .,PROP�R Y TtStBROWN LOAMY SAND WITH HEAVY GRAVEL SM7�yA- LO 3' m BROWN FINE TO COARSE SAND WITH HEAVY GRAVEL SW SOUTHOLD, TOWN OF SOUTHOLD 6 _� z.D' 46" , B'" I9<' _ SUFFOLK COUNTY, N. Y BROWN FINE TO COARSE SAND SW co 03 7.4' ✓ SURVEYED FOR DOUGLAS BELLOMO WATER IN BROWN FINE TO COARSE SAND SW C� , I POURED � �� DEBRA BELLOMO CONCRETE 74' FOUNDATION FOR SC.D.H.S .USE ONLY N/F DOERING o RESIDENCE 16 SEMCKEN RESIDENCE 46' O SURVEYED 1 MAY, 2001 6.10, Yom,✓ SCALE 7"-JO' oc CESSPOOL AREA= 25,592.98 SF OR 22 D' O 0.588 ACRES yyELL SOF NOISE) TOPO FROM EAST END (IN FRONpNER TOPO MAPS AS PERW ZONED R-40 CESSPOOL / RESIDENCE LOACTION N/F MARKDAHISO GUARANTEES INDICATED HERE ON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY APPROX RESIDENCE 15 PREPARED, AND ON HIS BEHALF TO THE ^� `> TITLE COMPANY, GOVERNMENTAL AGENCY, O LENDING INSTITUTION, IF LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. N GUARANTEES ARE NOT TRANSFERABLE TO W TEST ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS � HOLE UNAUTHORIZED ALTERATION OR OTO THIS SURVEY IS A VIOLATION SECTTIONN OF z (��T' THE NEW YORK STATE EDUCATION LAW.72 CIO COPIES OF THIS SURVEY MAP NOT BEARING HE THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE ` COPY. WELL VACANT S 71 * 41 ' 30" W 99.67' SURVEYED BY F F. EL. 28.0 MIN. NSF CARRIG vo FINISHED GRADE EL. 26 rn STANLEY J. ISAKSEN, JR. TO loon-osl-os-ole r RESIDENCE FINISHED GRADE EL 2 tl P.O. BOX 294 +Nl K, NY 1 56 INV EL 23. IN EL. 23.0 835 GUARANTEED TO IMV EL. 24.6 //4/FF /a"/FT INV EL 24.3 1/ D�S. I UAGUST 02 LOCATE CONC. FOUND. DOUGLAS BELLOMO REEK ND 'RVEYOR DEBRA BELLOMO 4. 22 MAR 02 SHOW PROP. HOUSE US DEPT. OF AGRICULTURE 3' MIN. GROUNDWATER EL. 14.6 . 73 ^��L 3. 77 JAN 02 REVISE SAN. LOC. RURAL HOUSING SERVICE fir^' m SAFE HARBOR TITLE AGENCY SEPTIC TANK 2. IS DEC 01 REVISE WELL LOC., ADD WELL/SANITARY OF OTHERS CESSPOOL NOTE. 1. 30 JULY, 2001 REVISE SIR. LOCATION & SANITARY 0107006 N/F SPA SOV I llu/ / 0/1 /A RESIDENCE wl l I e PI /tl (,/,'Ml Il Il) M<II(IN/V/I /+l!),`,C//N(:I i Ll ':':/'DIA " I"oWll I SURVEY OF + - i� 71 ' 41 30" E 156.67' DESCRIBED PROPERTY / IJANK HROWAl ';ANI) " I OAM T)I g0 (IRUWN I UAMY SANO WWII 0 AVP G;IFAW i SJ1,-_. _ SITUATE ITH'OWN L/NL to cOAN°i/ ',ANO WIIII Ill-AVI ( N�AVLI sW 23SOU THOLD, TOWN OF SOUTHOLD '� B_7 1'9 19.5" - ^ SUFFOLK COUNTY, N. Y HN�nwN FINE To coAPSE SAND 1-w � x � SURVEYED FOR DOUGLAS BELLOMO N 56 ONE STORY p DEBRA BELLOMO ,VAILO' /N HKUWN TINT IO GOAKOL ';ANL) SW / RESIDENCE -,p — 4' n TANKI C °a FOR s.CD.11.5. u E ONLY NIF DOERING 72' ° RESIDENCE — _. — -- — SEMCKEN o\ WOOD e o RESIDENCE JI// DECKp 40. SURVEYED 7 MAY, 2001 U.c. 6,5- — — Q) SCALE 1"=30' 50= GARAGE N J DRIVEWAY UC. V) — — — — — AREA= 25,592.98 SF CESSPOOL OR O 22.3' 0 588 ACRES �1 0 WELL of HOUSE) TORO FROM IN OVER TORO MAPS EAST END I-RUNT a AS PER OW ZONED R-40 T CESSPOOL jtRESIDENCE LCAC70N N/F MARKDAHIS GUARANTEES NDICATED HERE ON �F L! FUN ONLY IF THE E,? ON FOR WHOM HIE s.RVEY APPROXRESIDENCE _ IS "dFP RSD AND ON HIS BEHALF TO THE �L O u TITLE VSMPAN. G IIE NMENTAL A ICY, Y 'U _ To TH( IAS I TILN IF USITO , NN AND TO THE ASSIGNEES OF THE LENDINGG IN.SlII000N. ^� GUARANTEEi ARF NOT TRANSFERPBIF TO ADDITIONAL INSTITUTIONS OR FU©SEOUCNT OWNERS TE$T ONAUTT� n'(JLE O OIRVEY ORIZFO ALTERATION OR ADD17IGN TO THIS THI NEW ISA ur"I rION O SECDON W OF �) THE NEW YONK EIA IF EDUCATION LAW z \ 00 COPIE O TPI, SUI VEY VAP NOr B APING ER. TIIE I ANL RUEYOR EMBOSLEL, SFAL SHALL HE NOJ OF CON-111LIERLD ID FIE A VA ID TR/E E' WtCL VACANT ,o S 71' 41 ' 30" W 99.67' SURVEYED BY M/N- G _ �`' N/F CARRIC � STANLEY J. ISAKSEN, JR. I NISErD .INTIL L Ll 2U RESIDENCE TM 1000-051-06-012 ' --- - --- ---rNl;IIFFL_ I ALL FL. '�_--1 P.O. BOX 294 NEW UFFOLK, NY 17956 INV F/ f, INV Ll T-10 631- 34-5835 GUARANTEED TO INC tl h� F+'T=1 C,� -��. �� � �� ,.n SET Ir O¢.6. 26 FEB 03 FINAL SURVEY. V / `t- F - S. 1 AUGUST 02 LOCATE CONC. FOUND. DOUGLAS BI, �L-:= '� -- �E� 4. 22 MAR 02 SHOW PROP. NOOSE LICENSE AND S RV DEBRA BELLOMO MID F0�lN.'WAr(l F, 1�7 C� NYS U N0. 49273 US DEPT. OF AGRICULTURE - A ^I�L J. 1 JAN 02 REVISE SAN. LOC. RURAL HouslNc SERVICE / vl v' 2. 18 DEC 01 REVISE WELL LOC., ADD WELL/SANITARY OF OTHERS SAFE HARBOR TITLE AGENCY l'1.-0OIC7006 N Lir NOTE: 1. 30 JULY, 2001 REVISE STR. LOCATION & SANITARY ��s 1 o-ol- c) vs 7:1 -- � -1�l 7=1 777= 3 141 77 * J� 2. , II L 7z cl F1 :1 J -lef < I. i71.— 4 IF i 14 it 91, T' j� 4.1 F 0 a F ic, is LI �T tr -tt L ot; IF RNED AS NOTM PLUMBER CERTIFICATION k ON LEAD CONTENTBEFORjF BY: Jv- 7 BY BUILDING DEPARTMENT•AT CERTIFICATE OF OCCUPANCY 1802 9 AM TO 4 PM FORJHR WING INSPECTIONS: 1&4D,- I ROUGH - FRAMING & PLUMBING 4''— INSULATION -.7 46 FINAL - CONSTRUCTION MUST N ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTIONS ENERGY IF,,1�1,w wco. 1,101' RESPONSIBLE FDA Ull CONSTRUCTION EAROR9 6 system; piping snit PRDVK S FOR p �.'oe onLv,, L,-I­FL T 'UNDERWRITERS CERTIFICATE REQUI BY PA 7140 vv� REQUIRED STATE BUILDIN CODE. -DETECTING PROVIDE SMOKE S 06VIDE AWTI-SCALD AN D/Ok ALARM DEVICE j"EjMAL SHOCK;PREVENTINA AS To PART.721.1 7! w 0. 1 . t1l. IF :IP2:11 ;Y;S BUILDING COOL OCCUPANCY OR J, FW4Dr.lA*j.*:jIjjWlTLH UTICkRTIFILCINT" 'WES SEP ARAlloll `FARr.717.3 (f)(Ij oo'�" MiV, pm�!, iv ffimtwl P71 _ q L� : bJ" n( _ 1 , �INJ - . 'Y.P Y. 3 . •{".A . b� Y Y , F -r.t L' -F ENERGY CODE CALCULA'T'IONS (For Non-Electric heat) Design Criteria G, 000 Degree' Days O.A. lU°F I .A. 7U°F Doti: � OU9 �4 .$ � 8/lo /hO PER• Pehh' lo&6e- p202 7 `F . �eW +c 56046 DA'1'EU: 2e+ AREA DESIGN '1'HERMGL REMARKS SUBSYSTEM "U" RA'Z'ING L•'x LCr'1.01: Walls (Opaque) 6011 , 03 31aziny /-7 2 / 80 . 3y Sep ,,. ey-G/ )cors yp 1cil.iuy/Roof (Opaque) / 21S, Ds, p 3lcyliyllCs 4 Floor e2 Foundation Walls ' Slab Insulation TOTAL ` "lc Les Iluildluy Envelope Systems to meet requirements of 7815 . 2 HVAC Equipement to meeL requirements of, 7815- 11 IIVAC Systems to meeL requirements of 7815 . r2 Duct Sys Items to meeL requiremeil Ls of 7815 . 13 Velltila Lions Systems Lo meet requiremen Ls of 7815 . 14 1,1s Ula Liou of Pipiny Sys Cams to meet requirements of 7U15 . 15 Service Water Ilea Ling Systems 5 Equipment. to meeL requiremen Cs of 7015 . 21 I;.Lectri.cal S Lighting Systems 6 Equipnien L- to meeL requiremen Its or 7UJ5 . 31 ,,OF NEWY '1'o the best of my knowledge, ytiP�Ncs . 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