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Home My WebLink About15425-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17157 Date AUGUST 3~ 1988 THIS CERTIFIES that the building ONE' FAMILY DWELLING Location of Property 1325 NORTH SEA DRIVE House No. Street County Tax Map No. 1000 Section 54 Block 4 8OUTHOLD Hamlet Lot 15.3 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 17, 1986 pursuant to which Building Permit No. 15425Z dated OCTOBER 25~ 1986 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 ONE FAMILY DWELLING W/ATTACHED GARAGE & DECKS. The certificate is issued to STEPHEN VALI & WIFE (owner, 85-S0-215 6/27/88 N016840 of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2%LTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED INNOVATIONS PLUMBING INC. 3/18/88 Building Inspector Rev. 1/81 lF~mlw NO. I TOV/NI OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. IIUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15425 Z Date ....~. .......................................... Permission is hereby granted to: ........... ,o ~'t premises located at J..~,,~,.~ ......................... ~ ..................................... County Tax Map No, 1000 Section ...... .~..~,.~. .......Block ..... .,~..J .......... Lot No ..... ./...~.:...~. ........ pursuant to application dated ...... ~...~..~..-..!..~.. ................. , 197....(~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2.Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Eng neer responsible for the building. 5.Subm t Plann ng Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to p repute a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50. O0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .JtLne. 10,.1988 ............ NewC°nstz~ucti°n × Old or Pre-existing Building Vacant Land Location of Property 1325 North Sea Drive Southold House No. Street /-/am/et Stephen Vali & wife Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section 054 B~ock 04 Lot 15.3 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..I.5.4.2.5...Z.. Date of Permit 10/25/86 .Applicant Ron Morizzo Builder, Inc. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate X Fee Subm tted $ 25.00 .~.~.. c~,~. ~ .~. Construction on above described building an~per~t meets.e~l,a[~licable codes and regulations, Rev. 10-10-78 MOTORS: 1-1 275 TOWN flARBOR LANE SOUTfiOLD, NY, 11971 ..: - .... This ce~ificate m~t not ~ alter~ in any manner; return to the office of t~ Board if in~orre~. 'l~sp~to~s m~-be ~dent~fied by their credentials. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date /~/~, 19; I~ Building Permit No. Owner ~E¥~ (please print) Plumber /t~MOV~7'ION3 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this Notary Public., ~_l/~/~County - Notary Public - THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~' B5 JOHN STREET. NEW YORK, NEW YORK 10038 atlNE ]6,]985 46517287/87 N 016840 ~t~ ~pplle.~ion No. o. file THIS CE~IFIES THAT ~y ~ e~t~ ~u~nt ~ ~ ~ a~ int~ by t~ ~nt ~ on the ~ ~t~ numar ~ t~ ~ o~ ~ exami~d on and found ~o be in compliance with the r~uiremem~s of th~ ~. RXTURES RANGES COOKING DGCKS OVENS DiSH WASHERS EXHAUST FANS / ,.E~ ~o. SeT. ~U,~:. L?ME¢ ~t~ T"~S. IT"AT S~S~ ~t DRYERS I FUIU4AC! MOTORS A~ HANDLER- l 100 AMP TRANSFE~ SWITCH-1 ELEC. WATER HEATERS::2-4.5 '~ ~ ~CK LIG~T[NG:-56 PAUl, ~. BURNS 27h TOWN HA!~B()R I,Ai'~F. SOUTI'iO[,I), NY 119~1 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. ~ BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MAFINER. .... ELEVATION 'CERTIFICATE EXPIRES' JUNE 30 1990 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ,' This form Is t6 be used for: 1) POSt-F~RM construction only when the base flood intormabon Is available for the building site; and 2) Pre-FIRM buildings rated using Post-FIRM rules. . ~ Instructions for completing this form can be found on the reverse side. Mr. & Mrs. Stephen A. Yalt BUILDING OWNER'S NAME POLICY NUMBER 1325 North Sea Drive STnEET ADDRESS Apt.-AIUnit-U Sude-SIBIdg.-B NO. ROUTE. County Tax Map No, 1000 Section 054, BloCk 04, LOt No, 15.3 BOX NUMBER OTHER DESCRIPTION (Block and lot numbers.. ~c.) H Southold NeW York 11971 CITY - STATE ZIP CODE This form is to be completed by a lend surveyor, engineer, or architect who is authofized by state law to certify elevation information when the elevation information for zones Al.A30, AE, AH, A(with BFE), Vl-V30, VE, and V(with BFE) is required. In the case of zone AO, the building official the property owner, or the owner's representative should complete the information in Section I and may also complete the certification. Community officials who are ~authorized by local law or ordinance to provide floodplain managemeq~'informatioi~ may also complete this form. ;, SECTION I BUILEING ELEVATION INFORMATION 1~UsingtheF~d~h1%urance`Manua~r~theNF~PF~d~nsuranceAppicati~h-Part2~W~rksheet ndcate~theproperdagram number 2. FIRM Zones A1-.~), AE, AH, and A (with BFi~). The top of tSe r~fer~,nce level flo~;~ from the!select~ dia~lram is, at an ' ' ' elevation of : feet NGVD. (or other datum-see #5) 3.FIRM Zones vI-V30, VE, and V (with BFE). The bottom of the lowest'horizontal structural member of the reference level floor from the selected diagram is at an elevation of/~/;~feet NGVD (or other' datum-see//5). 4. FIRM Zone AG. The floor used as the reference level from the selected diagram is I r Ifeet ~bove highest natural grade next to the building (also enter in line 8). This value must be equal to or greater than the AG Zone flood depth number listed below. If no flood depth number is available, is the building's lowest floor (or reference level) elevated in accordance with the community's floodpfain management ordinances? [~Yes J--lNG r-]unknown 5.Indicate theelevation datum system used in determining the above reference level elevations: E~]NGVD []Other (describe on.back) 6.Indicate the elevation datum system used on the FIRM for base flood elevations: 'F-~NGVD [~]Other (describe on back) (ATTENTION: If the elevaflor[ datum used in measurieg the,elevatiOns is~different than~that used on the FIRM, then the elevations provided must be converted to the datum system used on the FIRM~.) '. 7. Is the reference level based on actual construction? [] Yes [] No* ~ * A "No" answer is only valid if the building does not have the reference level floor in place. Fill in the elevation based on Construc- tion drawings and do not complete question #8. If "No" is checked, this certification Will be valid only for buildings in the course of construction. After construction of the reference level floor is completed, a post~Construction elevation certificate will be required for continued flood insurance coverage. ' 8. Provide the following measurements using the natural grade next to the building (round to the nearest foot). a. The reference level is: b. The garage floor (if applicable) is: . I I I feet [] above [] below (check one) the highest grade. I I [feet [] above [] below (check one) the highest grade. I I Ifeet []above J~below (check one) the lowest grade. [ I Ifeet []abOve []below (check one) the Iowe~ grade. SECTION II FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions on back-Date of FIRM) and accompanying insurance application: Elevation reference mark used appears on FIRM ["-~Yes []No (See reverse side for details) SECTION III CERTIFICATION This certification is to be signed by a land su~eyor, engineer, elevation information for zones Al-A30, AE, AH, A(with BFE), Vl-V30, VE, and V(with BFE) property owner, or the owner's representative can sign the certifica Officials floodplain management information, may also sign the certification. the data available. I unders and that an}/'false statement ma TITLE COMPANY NAME SIGNA~,4~E~"~'~--~,~ ~4~' I~ .... . ~ PHONE The h-~,&.~ a~nt ~hould attach the original copy of t~e completed form to the flood insurance:po cy appllcstioh. The second copy ~hould be supplied to the FOR OPTIONAL COMMUNITY USE: Is the reference~evel also the lowest floor under the community's floodplain manage~ ordinances? [] YES [] NO If NO the e~evatJon of the lowest floor is feet NGVD. :; ..... . ; 593-117 (6/87) INSTRUCTIONS FOR COMPLETING THE ELE~/ATION CERT FICA?E ' - ' /' ' ~ * r ' 3:he Flood Insurance Manual and ~he'Flood Insurance ~Applicatidn-~P~art 2 Worksheet Contains'a sar es 0f ~iagr~ms that are to be used to determine the reference level for the specific structure in question; T~e diagrams a~e a~ailable through oca n~ur~nce agents 0r the Nat ~a F cod nsurance Program ~ ~ ~ ~ , A reference leve~ is shown in,each of 4he worksheet diagrams of the various building ~pes. For prope~y locations in zQnes Al-A30; AE, AH, and,A (with BFE), Line 2of the EleVati0n Ce~ifiCate' indica{esthat,the elevati0n'should be .'- ~r measured' from the top Of the refdrence,l~ve floor. For prope~y ocat[ops, n zones V1 V30,..VE, and' V {with' BFE) Line' 3 , df' the Elevation' ~ificate indicat~ that th~ elevation should' be ~easurerd fro~ the bottom* of.the.'lowest her zonta 'structura~ member of the ~eferencp level,'floor.* ~ ,~ ", * . . .., ,~' ' ~ · The,insurpd will determine the measurements ~slng the top ~fl~r from the Flogd Insurancp-Pa~ 2 Worksheet diagrams. ~ diagram, right, demonstrates ~ A, 'A differences baleen the ~tnt ~. ~A ' ' " , V ' ' ' ' ~ONES ' elevations should be,measure~* ', ', ZON~' , , ZONes ~ ~ from In A zones ahd V zohes ~' ' ' Elevations for afl A k~nes'shoul~~ ~, ~be ~ea~u~ed from {he top~ of the" {elegance level floor. ,. ~ EIb~atio~s for all V zones ~hou~d ~LOOO ,be measured from the~b~ttom of E~EVAT ON · REFERENCE the lowest'horizontal structural ~ ' , member of the reference level floor. ' ' The reference level elpvation maybe reposed to the same level of precisio~ used to repo.,base, flood elevat on on the (e.g., if the, base'fl0od ele~t'ion is shown t0 th~ nearest half foot, the reference leveJ may be reposed {o the* nearest half foot). ' ~ , ~ .... : Base flood elevations are shown pn the community's FIoodlnsurance,Rate Map (FIRM) for zones Al-A30, AH, AE, V1.V~, and VE. Base flood elevations m~y also be on file with the community for:zones A and V for all subdivisions aod,~other new developments greater then 50 ets 0r 5~acres wh chever s the esser f ~he sta~ of constr~ct on was after December 31, 1974. Base flood depth numbers are shown oh the community's Flood I~sutance Rate Map (FIRM) for zone AOJ These dept~ m ~1 dd be used to 6b~pare with the height of the reference level floor above highest natural grade in Li~e 8 of reference marks other:than those shown 'on the FIRM may be u~ed for reference ~el elevation~ :. determinations, In areas experiencing ground subs dents, the most recent y ad usted reference mark e ovations ava ab e must be used. for elevabon deter~mations. If a reference mark not shown on the FIRM ~s used ~dentify the re~erenc~ mark. used in ,the comment section. ~ , D~te of FIRM used in Section,II ~f the~Eleyation Ce~ifieate csn be, ~ithe~ the ~daCe'o~ the F~RM in e~fect when the - 'ce~ificatloa is being provided or Ihs. date:of the FIRM that was i~ effec{ ~t the time the building Was constructed. NOTE TO INSURANCE AGENTS AND {: reference level is the bottom of the sh ~MMUNITY OFFICIALS: In all A zones, the reference level is the top of the lowest floor and in V zones the bll~o[izon~a support~ ,Agent8 should [sfer to the'flood !neurpnce manual for Instruction1 an lowest floor definition. * ~ ' .... ~ ....... "~ ' §9~1"/'-'2 (618~'~ ~INGLE FAMILY DWELLING ONLY 0R1~~.$. RELNO. _~ The ~ew~e disposal and w~r supply f~iti~ for ~ ~Uon ~e ~ insured by this Depart ~/~ _ ~ ~.,,,~ ~' 'OUNDATION ( ls t) 'OUNDATION (2nd) ',OUGH FRAME / PLUMBING/ iNSULATION PER N. Y. STATE ENERGY CODE FINAL )DITION~L S: FORM NO. 11 TOWN OF SOb"~HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY DEVELOPMB~T PERMIT lU uu County Tax Map No. 1000 Section ~)$___~_~ Block cog Lob ) ,.,~', =~ by ,the Building Inspectop. Building Perml$ No. Building Inspoctop i ested, ield ssoclates Contractors & Engineers P.O. Box 1229, Westhampton Beach, N.Y. 11978 PILING FOUNDATION CERTIFICATION This ts to certify that Chesterfield Associates, Inc. has installed the below referenced piling foundation in complete accordance with regulations set forth by the New York State Building Code and the Federal Flood Plains Standards, as well as the criteria established by thQ Town of Southampton, Town of 8rookhaven, or the Town of Islip. All piling are CCA Boliden Pressure Treated, and extend to at least ~ mimimum tip elevation ef six feet below mean sea level. (MSL) Chesterfield Associates, Inc. Signed: -~'~'~"~-~'~ - '£.Oavies Allan, President Rate: 3/4/87 Reference: Terry Latham Re: Yali Residence,. Main Road, Box 72 Orient, N.Y., 11957 Office & Yard -- 5 Country Road, Westhampton Beach Phone 516-288-5100' - .h_ested. ield Rssocmtes Contractors & Engineers P,O. Box 1229, Westhampton Beach N.Y. 11978 PILING FOUNDATION CERTIFICATION This is to certify that Chesterfield Associates, Inc. has installed the below referenced piling foundation in complete accordance with regulations set forth by the New York State Building Code and the Federal Flood Plains Standards, as well as the criteria established by thQ Town of Southampton, Town of Brookhaven, or the Town of Islip. All piling are CCA Uoltden Pressure' Treated, anJ extend to at least ~ minimum tip elevation of six feet below mean sea level. (MSL) Chesterfield Associates, Inc. Sl,.ed: LLL ? ' E.Davies Al lan, President Date: 3/4/87 Reference: Terry Latham Re: Yali Residence~ Main:Road, Box 72 Orient, N.Y., 11957 Office & Yard ~ 5 Country [:load, Weathampton Beach Phone 616-288.8100 ,' .",The wa~er ,supply a, nd sewaSe po~a.1 . ld~n6~ 'wi:il conform;~o the sta, nd~rds of. ~he '.'Su~ol~Oou~,' '~ ,Ompa~me~t~ .... SUFFO/~'~UN~ D~ARTUENT OF HEALTH SERVIGES FOR A ROVAL OF CONSTRUCT ON Single Family Re~idenc~ Only Rd~ 'Hopizzo Sou~hold, N.Y. t~971. PLEASE NOTE ..' to supp y ,:~ o .sew,~e New York State Depa~ment of Environmental Consewation Regulatory Affairs Unit Bldg. 40, SUN-T, Rm. 219 Stony Brook, N. Y. 11794 (516) 751-7900 Henry G. Williams Commissioner April' 30, 1986 Mr. Rom Morizzo P.O. Box 789 Southold, N. Y. 11971 TIDAL'WETLANDS NOTIFICATION LETTER Re: Stephen A. Vali residence Suffolk Co. Tax Map ~o.1000.54.04.15.003 (1325 NOrth Sea Drive, Southold) Dear Mr. Morizzo: We have reviewed your proposal to construct a residence on pilings as shown on a survey prepared by Anthony W. Lewandowski, L. S. and dated October 12, 1985 (last revision April 19, 1986). It is understood that the septic system may be located seaward of the residence, but in no case closer than 100 feet from mean hig~ water, and that no fill will be used on the site other than that required to construct the drive- way. It is further recognized that the house will be located far beyond the 75 foot setback requirement of 6NYCRR Section 661.6(a)(1), or 40 feet from the North Sea Road Right of Way. Therefore, the NYSDEC has found this project to be in conformance with the Development Restrictions and no permit under Article 25 (Tidal Wetlands}of the Environmental Conservation Law is required. However, any additional work or modifications to the project may. require a permit. It is your responsibility to notify this office, in writing, if such additional work or modifications are contemplated. Very truly yours, Robert A. Greene Regional Permit Administrator Region 1 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I/NSULATION FRAMING ['~] FINAL 76S-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ZND FRAMING [ ROUGH PLBG. INSULATION FINAL DATE~,~ '~/? INSPEC~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ .] FOUNDATION 2ND [~'/INSULATION FRAMING REMARKS: FINAL DATE :/~:/~7 INSPECTOR ~_~ ,~ ?,~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS; [~/FI'NAL IApplication Received Disapproval Issued 19 Permit ~ 19 FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD i. Type of Development Proposed: Addition and/or Alteration New Structure (including storage tanks~ Flood Proof Below Base Flood Elevation Other (specify) 2. Elevation Data in relation to above mean sea level of: (a) Lowest floor elevation, including basement / ~ feet (b) In a V Zone, bottom of lowest structural member /_~_ ~'e~t __ 3. FIRM--Flood Insurance Rate Map, 4. Owner of Premises 5. Location of Property: inches ~ inches Zone designations House # Street County Tax Map No., Dist. 1000, Subdivision Permission to be granted: __~ Owner as above Hamlet Section O$~ Block ~ Lot(s) Filed Map~ Lot(s) New Owner Name if not given above Mailing address Under Contract Lessee Contractor Phone Approval from other(s) before Permit is issued: DEC J.~)'~F~ ,~ a0~-t~,~-~) Wetlands (Town Board) Health Services ~-So-~;~ SBA Building Permit Planning Board I, , the applicant, am the Owner__, Co-Owner New Owner Under Contract Lessee , Agent __, Contractor __, and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises authorized to perform or have performed ~he said work and to make and file this application, that all statements contained in this application are true to the best of my knowledge and belief and that the work will be performed in the manner set forth in the application filed therewith. STATE OF NEWmYORK COUNTY OF ~ SWORN TO THIS Notary Public SS DAY OF Applicant's mailing address and phone # if not given above 11/85 FORM NO. 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. Box 728 ~ Town Hall Southold, N.Y. 119711 Main Road i Southold,N.Y. AP,PLICATT~5~ F~R D~VFLOPMENT PERMIT Instructions: The app!lication to the Building Inspector includes (each ~n duplicate) 1. Form No. 10 filled out in ink or typewritten, 2. Sur- vey of premises with .elevations above mean sea level, 3. Drawings of pro- posed work. The appl!ieation must give complete information to show that the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the Code of the Town of Southold known as "Flood Damage Prevention Law" of the Town of Southold. Tk'e applicant must submit approvals that any other agency requires. General Standards as irequired in Section 46-17 of the law to minimize flood damage: ' A. Anchoring of !structures, including tanks and mobile homes B. Use of construction material and methods C. Design and 1Qcation of utilities D. Subdivision proposal with drainage, public utilities design and base flood e~evations Specific Standards as required in Section 46-18: A. Reszdentlal constructIon B. Non-residential construction C. Mobile homesi The applicant must submit plans and specifications as well as any other information requeste~ by the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated abo~e the base flood elevation or;' if permitted by the Federal Regulation, fihat: 1. such structure is flood proofed in such manner that below the base flood level the structure is water tight with walls substantially ~nd impermeable to the passage of war. er, 2. that structural components "are capable to resisting hydrostatlc and hydrodynamic loads and effects of ibuoyancy, 3. applicant must submit certification by a registered professional engineer or architect that the standards set forth in Section 46-~8B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard. iarea (V Zone) 46-19. Applicant shall, submit plans, ~pecifications includinq the required certifications and such ct.her in- formation as the Building Inspector may require in that the provmsions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation!'with all space below open except breakaway walls. Sand Dunes. If sand!dunes exist on the premises and the applicant pro- poses to alter same, !plans and specification must be shown in detailed nature of any alteration submitted. Building Permit. A Building Permit is also required for any structure. Both a Development and a Building Permit must be issued before any work can start in a special flood hazard zone. A written disapproval or a ]permit must be issue~ within ten (10) working days. . During constructlon,!the inspector shall be notified in time so he may make the required ingpeetions. Upon completion, thel required certification of the final elevations and work must be submitted before the approval to use or occupy can be approved. (Fill 6ut the form on the back of this sheet) 11/85 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined C>.~.~...°'~.....~,.~.., 19 Approved O.e~...~.....&..~.., 19~.~. Permit No. /..~c~.~,..~."'..-~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received Date .0..c.~9.b.~.r.. 3.7. ..... ,19.~.~. INSTRUCTIONS a. This application must be completely tilled 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 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 building for necessary inspections. ·..~p.q .N..o.r.i.z.z. 9..s.u.i .~ .d.~.c, . .~.n.q, .............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor- Name of owner of premises ...... ~,tARh..ep..V.a..1 .i..qO .d..w.~F. ~ ........................................... (as on the tax roll or latest deed) If a~plicant is a corporation, signa, ture of duly, authorized officer. (Name and title df c~)rporate officer) Builder's License No .......................... Plumber's License No.~..O.~. Electrician's License No...J~......~.../...L~...~.(.~.~. 7~/e ~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. 13~5 Nor'th Sea Drive Southold House Number Street Hamlet County Tax Map No. 1000 Section 54 Block 4 Lot.. 3.5... 3. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occfipancy of proposed construction: a. Existing use and occupancy vacant i and b I d d d i1¥ ~}i~g .... ""; One fram dwe ,' ,', ~, , ' · nten e use an occupancy .............................. '., .... ,,: ......., c .......... 10. 11. 12. 13. 14. h appli · Nature of work (check whic cable): New Building .. ~<..' ..... Addition .......... Alteration .......... Repair ~.~ .[ '~!' ' ' Ren~oval ............ Demolition .............. Other Work ............... i 4~ ~/~ ~ ~.O, (Description) Estimated Cost . .$ .?.~ .900 ..................... Fee ........ . ............................. : ~' (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or m~xod occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nu~nber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front Rear Depth ..~... Height Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .................................................. .... Size of lot: Front .......... I ............ Rear ...................... Depth ...................... Date of Purchase .......... j ................... Name of Former Owner ............................. Zone or use district in which premises are situated.... .................................................. Does proposed construction violate any zoning law, ordinance or regulation: Will lot be regraded ........ i .................... Will excess fill be removed from premises: Yes No Name of Contractor . B. qn.. ~19. .~ gg.o. ,l~-J..clq¢.. Address .~oU.~hql, 0.,..H ,¥.... Phone No. 7~.~77.~ ..... PLOT DIAGRAM Locate clearly and distinctly a~l 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. STATE OF NEW YORK, COUNTY OF .... ' S.S ............................ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) abow~ named. He is the (Contractor, agent, 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 and belief; and that the work will be performed in the mann!er set forth in the application filed therewith. Sworn to before me this county ~ 4~lttlC, ~ of New Yetk (Signature of applicant) --I ¸ir t ' hfO'rlFY BUIL~ING OEP~T~ENT A? 7~5-150~ 9 A~ TO ~ PM FOR THE FOI.LOW~NG INSPECTIONS: FOUNDATION TWO REQUIRED If ea~tublng II ulld fro' ~ distributing ._ M ~ K or L only. EXCEED 2/10 M 1~ LEAD. USE IS UNLAWFUL ~.. PLUMBER CERTIFICATION WITHOUT CERTIRCATE C~.~nF/C.4r.~ O¢ OCCUP,4NCY OF OCCUPANCY I,I I,I hi I,I I PIL~- AND DP_~tKPF, AI'dll',~ PLaN .1 T -I '1 /I I0"~ ~c* ('¢'r~) (~Te~ woot.~) --'1 (¢) '"Y~ * I$I ~'¢,gC, Y.. , I PILE HP_-AL) fCOUT L,::;:~ATION¢ To GF-,.AE:r¢.: ¢EAhfl r~D'f'AIL STACK ¥ b"~T_ 'THP. U f~ ¢,tP1~ TuI5 J LAVATOkCf] GENP--RAL. NOTP-~: E-I