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Home My WebLink About26264-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27413 Date: 11/17/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 1105 PARK VIEW LA ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 5 Lot 24.26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 9, 1999 pursuant to which Building Permit No. 26264-Z dated JANUARY 11, 2000 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 WITH FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to LAURENCE M. TROISI & MIRIAM BISSU (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 46342 08/29/00 PLUMBERS CERTIFICATION DATED N/A Authorized Sign ure Rev. 1/81 FORM NO. 3 Y 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. 26264 Z Date JANUARY 11, 2000 Permission is hereby granted to: RICHARD J CAPUTO 1105 PARKVIEW LANE ORIENT,NY 11957 for CONSTRUCTION OF AN INGROUND POOL WITH REQUIRED FENCE ENCLOSURE IN THE APPROVED REAR YARD AS APPLIED FOR. at premises located at 1105 PARK VIEW LA ORIENT County Tax Map No. 473889 Section 015 Block 0005 Lot No. 024 . 026 pursuant to application dated DECEMBER 9, 1999 and approved by the Building Inspector. Fee $ 150 .00 "Authorizedgature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUT+2T.OLD 71"7 BUILDING DEPARTMENT TOWN HALL 765-1802 �!,e ri OCT APPLICATION FOR CERTIFICATE OF OCCUPANCY ^ IT,in �h A. This application must be filled in by typewriter OR ink and submitted to the building , inspector with the following: for new building or new use: 1. Final survey of property with accurate location of 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 a 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, Swimming 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 - .2 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing �� Building. . J,l. . . . . . . . . . . Location of Property. ./)05. . . adc,. . V ev. . t,�L4e.. . . . . . . . . . . . . . .0r .e.a .). I�`.PC . . . . . . House No. Street �A Hamlet Onwer or Owners of Property.�� .� :'.�lSl ,(�V1 , , ,'°�,6� 1�MIAZ!i15.L4 . , , , , , . . . . County Tax Map No 1000, Section. . . J. . . . . . . . .Block. . . . . -S.. . . . . . . .Lot. . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . Lot. . . . . . . . ��77 �� wt m Permit Noo2.�.� &(i. . . .Date Of Permit.�f lli.0(2a . . . . .Applicant.11.r� a1) U15 �G �l`2/1CG'T�IS/ Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . , Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . / Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .V . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . APPLICANT Town Hall,53095 Main Road p Fax(516)765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD August 22, 2000 Laurence Troisi & Miriam Bissu 420 E. 55th St. , Apt. 16 New York, NY 10022 RE: 1105 Park View Lane, Orient. To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 26264-Z _ Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. -ift',;q `rr p'•.t� .r''• `.-�".-i.c<'.-,3fvj`%,,':r!••i;�•i,h„;''rS,/f✓",;3..�n`:Fils62`}ylr£f,Lr,iw."".sr't9rn{mc.2�.j1.7fMt'i i^,>:`S..;l.tIu.{i.lid'2,t,'•.t}t''1t,S'Lj},l.J{r,.i'.,'F..:..�:ra\„t,,,.y•,{itts.+t,.•..,.,HAx,1,tn.;+',,�;,Src.1f.ar,ff;:27.;��R.:F.+.1`it.',:�b aiu,,.1o�.•,'tn•i4�„,r1'r,.1fp'$f..d..j,l.h.i,.ist).n.,1,}tia..,.?..r a.,55,,ay11h1,:ir,�£ifS,.9:.`i.'<y3.:S`�Sl.I;i,il,'fi',n%Al`,Qra.!,W'.)c'hJ..,'iA.R s�.,j.i,.•.�itv'`Y,`•,p d.'�i'i0An./9 m,,t :Ua�v,.a;•.A.v.,f,I.F.?a.�33iys"pp,rMild i l;:3i§nyrV`.R.•..,......ft1 ,17h:+d.t''iiS[n.<L`Y:t„y St)�•Pu.,'R;•1 tt2r:j.•f.Jt•npr,i:`.Vr�v'S.1,�L�aA,t..,I,�dWrlg,/n:..=F`.h..,L.;.!t,i i'��yx�yi'.,5i f;rr,r./j.,�R SL.<ii S„„�t1i sS' ' - . Electrical Inspection Certificate Electrical Inspection Service, Inc. s :• : = ... 375 Dunton Avenue r East Patchogue,New York 11772 (631)286.6642 gl'✓rd?. , u Date: 08/29/2000 Application No. : 46342 K. Issued to: Larry Troisi& Miriam Bissuf;r Street: 1105 Park View Lane rLF JiZ •...av�t a fcC(Ee, Village: Orient Point Zip: 11957 Town:Southold Section: 15 Block: 5 Lot: 24026 >; Introduced by. Hank's Electric Inc. L/c.# 2675-E - was examined and found to be in compliance with the National Electrical Codears, El Attic ❑1sfFloor ❑ O/S Residential OPool El Det. Garage ❑ Basement ❑2nd Floor ❑ O/S Commercial [I Hot Tub ❑ NV Defects tn, Switches Receptacles Fixtures GF/ Heaters A/C Fans 2 1 h Dishwashet Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal Furnace Oil Gas Circulator Smoke Detector Bell Transformer rs Meter Amps Phase Motors Telephone Television Carbon Monoxide w.: - ��r r r ,, SW” Other Equipment: timet%kJ20ampspecialJ2HPMotor - e':vs Hugo S. Surdi ' President ': • (Clijr BU//ding Permit NO. This certificate must not be altered in any manner Inspectors may be identified by their credentials t r r 3 r ,rS v•,� r , � v� afi p ae�:=3 �4�Sf, ] '. �i,f1S 1, .3\ 'vA x s`L ./., �• L1Lvif '.(,tt, �v21f \;t.b fp J\�•LL�uS t 3�Y.tf� to 2 fftl iS S,i`iv'21 CWt'•r3i•`N'i� 4t' 1.aYr'r„�0 �'f 'ems: e..-.<1 ,h i•T•, ::3v 'r7t,v.eMA1.e.,f:�1,c• „/•/n...iQ i...bf;,+1 ,.;�,..,1�i�l r-Jf+Y, ..L ✓rA � ,,.`i. �V`Njty�Z l,�y{( a £� t Nn.w i'�.. .s ,f ji'iSr3.rt` ;ts,�,ty;:% 11Y',•:,k'a;''i�f''•i YS :v,SU'+11!'iL`:`'t'�lff,.i\ II(� t.{:ti,:.;r '{`�`-'.`,�.�r74 •.t:i"n4".:Y,Rp�`l, y3+n k j1,76�i1v!d: ;A i''`�yji��I�W�f i'yU�Ry. .;lj;lr ,,fiii'�IP•2Ff'iir�%ti3S;:"s�J'i5Y �i+'Yyrt��}:• '{��,.�j�:Y ✓;Sfl��t; ..Ini"+V,�� 'f S,�r�V��: '<ii ri r Ir/,a •5 ��it r rilTi��{}I 'Itit30'� 6.5�. '� �6°r.l7;t ��,rM,Df• '. I} ''17Y. 765-1802 BUILDING DEPT. INSPECTION j ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ] INSULATION [ l FRAMING [ ] FINAL [ ] FIREPLACCE & CHIMNEY REMARKS: DAT INSPECTO AFIFLD INSPECTION REPORT DATE COMMENTS FOUNDATION OST) 11 __ t�-- II�_---�I FOUNDATIONOND) _ _ ______ ________________________ 770 4 Vl 0 ROUGH FRAME & ri------ii / � �®�� PLUMBING lj �j�G �e *AF� t ---- n Oslo( It INSULATION PER N. Y. STATE ENERGY CODE It II �I u� -- ------ -- ---------- - ____ TII�fI�� O �I II Ii II FINAL I .� fi ADDITIONAL COMMENTS: �t air uv� of a %sem' ��_� �► Fee e cl"3 ss re H 4 z � H RPR.17.2000 7.06AM SMITH BARNEY 40W57ST 2124688599 N0.529 P.2/2 FSR wavozv ,�'1 t'NIS,a7ECK� I ' �! s'yuar•. 8 d r�srso"W"r 6o p a d R q Q SpA ' � v ik1\ o /l JY .fXpM�7�r�AOP4/9�G{'l AU= VTAY LA SOJtMB a PA.0QX 312 PLyN M P.T. JiM m'u suav r m (90 P4 018)433-Mm w SIIRV�� eevrsrrir,ate+ ' QRS A�847 9(RENS CAMTO WAMOrrM U.S,sAVft saes r. 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SUflyk'Ykik .eueurrir,„aro /7��//�/,.IW/ QO ACT ` p 'O ' ttFA5�71FJifs WS SYNC1� sGJR l'. ,b' tlNi ABY WD W 1wm”mm fWWI T NR 10�R AT90CT3 �wi BAR 'RII lE tlUCtbCI{AK A N TIE WbID AQfNlg4 RAAICATIRR At IRI umvm IL 10 roam«ro�lcc a am�anyaur�r.Rs o+.r ana n�m aeaw.rotlu smcr wwn rm man a�prixTvaa�t ma ms aeu u� m m a v c� at a®s6v $ WIRD RGR IF fRR AMY 1qf MOt glniWn . C�IP�c7-d FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19451 Date OCTOBER 16 1990 TRIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1105 PARKVIEW LANE House No. ORIENT N.Y. Street Hamlet County Tax Map No. 1000 Section is Block_ 5 _-Lot242_ Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 26 1990 ursuant to which Building permit No. 18917-Z _ ______dated MARCH 29 1990 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 WITH ATTACHED GARAGE AS APPLIED FOR. The certificate is issued to RICHARD & IRENE CAPUTO (owners) Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-16- SEPT. 20 1990 UNDERWRITERS CERTIFICATE NO.- .N-153701 - OCTOBER 4 1990 PLUMBERS CERTIFICATION DATED OCT. 16 1990-pECONIC PLUMBING & FIEATING uilding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOhD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20843 Date JULY 9, 1992 THIS CERTIFIES that the building ADDIT10N I-OcatiOn of Property 1105 PARKVIEW LANE ORIENT N.Y. -louse No. Street Hamlet County Tax Map No. 1000 Section 15 Block 5 Lot 24.26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 22 1992 ursuant to which Building Permit No. 20576-Zdated --- —_ _ APRIL 23 1992 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to RICHARD J. & IRENE CAPUTO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL_ N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A k%-Ilding Inspector Rev. 1/81 .gym _ J1 ii m r7 R . Ra rF�°a • N U1J N , Y.4• a r 0 f�• * • . a s �' • o Z. o r l Y 11 V ••� :A s• v ` . IMP �•a• 1•.4• ! 44 . 14 r b ya84 �,.•'d(ii M:j' ,:.H: f,'�'' ',.^h!},i a�•�V. ..iirya(y ,,pkp,r N w' ,h Oda w ..... ,,. ... r.• .ry,�r,. rr 7 i� l µ 0 ► • r.N � ��,.,, .�"'*r.,797!l��":�W'i}ir.0 �PN'+7:.1924n. FPsj{•`s'b b�wuV n' .e... .. -„ y f 1 vi�.JZ'tl<�Y.Yfit �'f��,�J , '^'^^T'••. _9•T:�� r o = I of r; 9 r r , �112 y4 p b , N Ry b A O ^-_- •____ - __ - - - - A= �_. . �_ . 'O. � e'en • w a 7P $ Ctrs ift it • • 'O41• at Jt �F0.. .� O jp G• .� o .3 �O jT ... • t ., t too .� .•s • �y ti ) , N A ic 2 -� a M73 73 w : tU� i�Trt x min m BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . .. TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: / ym CALL �.7J.I. . . . . . . . . . . . . Encmimred.................. 19... MAIL TO:'5wntMlk.t� IOOIS Approved......`.7.1�....... ?P00 Permit No. .GX!�!??G Z YZ .. �C..��S/¢ .... Disapproveda/c .................................. Building Inspector) LIGATION FOR BUILDING PERMIT 9 ..• C 9 � . � i, ;f Date. / . . .r . . . . . . . . . , 19. . L..w_..._._....._.._... .._.... 1 INSTRUCTIONS >ylttjs applicatitscii6uat be letely filled in by typewriter or in ink and submitted to the Building Inspector wit 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 application. c. The cork 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 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. AP11LIC97CN IS HEREBY MIE 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 td cdmply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in bui't ing'for / awry inspections. lf� :................................. Signa a of applicant, or name, if a corporation) .as 120 P�. ( (Mailing address of applicant) ��m ?V State whether applicant is owner, le see, agent architect, engineer, general contractor, electrician, plcuber or builder ............................. ! C.....I /tu-G................................................................ Nacre of owner of premises ..... ..�6 i.4.t.................................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Nae and title of corporate officer) Builders License No. .. .... 1f�t...... Plumbers License No. ... Electricians License No. .o) 6 C� ........ Other Trade's License No. ...N� ............ 1. Location of land on which proposed work will be done.. r ......�a.... .............................................. ........................................................Dr1�t� .... ..!1�....«R.s� .................. ............................ House Number Street Hamlet County Tax Map No. 1000 Section ....r.�......... Block ................ Lot ....� Subdivision ...................................... Filed Map No. ............... I.ot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .....................r ............................................... b. Intended use and occupancy .�f 0 .. .. �� ' �� ' / /1,G1 f o(ti vL�,.?,W u Mr dtry �D o L a !i ............... Nature of work (check wind: aPPcliabIs)-. New g k., Alteration ......... ro Repair ............ Removal Demolition .......... Other Work .`?. lw}Md S P4.��-........ (Description) Estimated Cost ..... .........ii..... fee .............................................. (to be paid on filing this application) If dwelling, number of dwelling .nuts ............ tkmnber of dwelling units on each floor ......... ....... Ifgarage, rxnber of cars ............ ...I...................... If business, commercial or mixed occupancy, specify nature and extent of each type of use...................... Dimensions of existing structures, if any: Front................ hear ............... Depth ................. Height r of Stories ...................... Dimensions of same structure with Iterations or additions: Front ............... Rear ............... Depth .................... Deight :................... Nuniher of Stories ............... Dimensions of entire new constructon: Front ................ Rear ............... Depth .............. Ileihiht ......................... "r of Stories ..................... Size of lot: Front ..............J..... Rear .................... Depth .................... 1. Date of Purchase ................. ... Nae of Former Owner ...............I........................ I. Zone or use district in %which prem�sea are situated .......................................6lwrl, ..........,.... ?. Does proposed construction violate�arry zoning law, ordinance or regulation: ........................ I. Will lot be regraded .. Y�...... Will excess fill be removed from premises. 'YES ND regi ... .] . i p p. m. Naims of Owner of premises ..Nt.'{n�� ... QT.S?... Address AtA05 Plc (7'�/✓J;e.h . •Phare Nave of Architect � 0(�Q y'h1(Y (105 Address .�DI / �yu�1� �16N� :�3(�Phore No.6�3171Y-F'?31 Nam of.Contractor �.. I�r ... .1......9K... Address f.�.� .: ?!? .° rJ4r(.�:.Phone No. i. Is this property within 300 feet of a tidal wetland? * YRS .......... NO .X..... *IF YES, SODIUM TOIrN "I PMWT MAY BE RTi(XI RIZ. (PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set—back dimensions rum property lines. Give street and block number or description according to deed, and show street nares and indicate )ether interior or corner lot. S ��,.p��t�y1 I� �DLcsT►wG�l I� r,�sn, rr7�rLL.I1I d- I Vr S l 6l�- I VIS f III )UNIY W. ... ...... � .. ......... .. .. ..I =ng 1,1m:ly sworn, dzposes and rays thea he is the applicant `tFnme of individual signing contract) xrve named, is the Q.V. . . ........ ........ .................................................................... (Contracto , agent, cororate officer, etc.) f: said owner or owners, and is duly outorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and hat the work will be performed in the mm1nner set forth in the application filed therewith. worn to before me this qq . ......day of �Q2celhl bOlr.l9..� .1.. Notary public ..... r ,ocln.?iNP976i3Cn9PA79 nl{NF.R"'c',^ , .. ..... .. ... ..... (LtA61FIIlSUFFOLK QI I'! (Slure o A li.cant) 4 4 101 ooh s ,��er �► "a IMAMMAFxmzZ �� 72VCf�A • M i lag, OX - ca sl Z �.� • Qfi14 X0z0«='°C O wi' zpspo p O V CO\ =�m�O 'ri mx Cm s 110 up 1 .01 Ryon. w �C ..•� � . �4r°R''Or?.(EHTBYT/dSE.O � � R/i+ SEC'rx'w Tisy➢EE .. Vz R9/EiYT, 77J1f'NG3�'.Sb(/TiSYh'D C.j F,CEO.G�'10BEB/Q' 9 y -� - V. y'!'� - - - - Fig yti Y ams s+uvvuu�av ti `� b ` O srr. acn/ rvr i ALBERT W: TAY = sm'VffOR ^� .0 P.O. BOX 312 PWNMEW, N.Y. 11803 0 FML SURVEY •TEL (516) 433•-3725 FAX (516) 433-M i 0 I • SURyE.YE7): ALGL6l/7, /9,Sb ^ �O CE WED ONLY TO: p RICHARD CAPU70 8 /RENS E. CAPU70 � 14 0 fi4PERS ABSTRACT V b 1/ =RBOTS U.SS STANDARD SCARE 1' N CER11iCAU0ltS StlAI1 RM MLY 70 PERSON T(R M151 1FIE 9At147 TRjmm=ALOATO R1t ADO[DCtR TD A SUi1(Y XAp C£Al A R PRiPARID Alm CM Its DCI WF 1011E ATfE CCN kff 001t%GE7(UL LXeW RAND SURVEIURS SE l K A YAx ARCH CF SEC1Ktt TSA A�tY AHD tFinPlc MSrtRnlut ta1E0!tR>Rt Arm l0 i1!A== SR1W=4 CF 11E tV 1Ct0C STATE TTJGGtj= RAX ff TIE RE10DC Pn><illl�CR1FlCA1K1R AtrF NC1f A=WK NSAN1 o CR S11=w"mm 7AA47ETiAOtE TO O0.Y CUM tRf7!11E CLOWN .ff TTts SL1df1 XAMO WM AX NO ATt9CAt,[ASDOfiS CH PAOPFXIY UMts7 M010�QED DAZ C{O "CF DE LM)SI.RYEYORS i7�Os5fD CR Ho Sm swl 1f0(r CR 1i41i CF ttAY16 Ai(Y JiOT SttxJR NE NOi CERRLFD PC CKWC TO DE YAW TAE C = BUILDING PERMIT' REVIEW CHECK LIST Last r ein c q- (Yl Fk 'S i Applicant/ ^n Date o Owners Name: + R-t 0./Y i SSI,I_ Reviewed: Architect/ Date Engineer: _ Submitted: SCTM #: District: 1.000 Section: block: 5 Lot: Project /� � Subdivision Location: OSy t �^� ' �"'�' V2 �Name: Sin&le&separate Require kik (STIP I,t� certification: Yes/ o Zoning District: [Lot siu: Actual: Q7 IF ] (Lot coverage Proposed J Req Req. Req (Front Yard Proposed: ] (Side Yard ff Proposed: 1 �[RRear Yard Proposed ] Project Description: Arc e5 Say 0DoL I ti iD e A!- ( 6 l-JQ AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Notes: ee