HomeMy WebLinkAbout26354-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27567 Date: 02/28/01
THIS CERTIFIES that the building ACCESSORY
Location of Property: 2000 ALDRICH LA MATT/LAUREL
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 125 Block 1 Lot 2 .19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 10, 2000 pursuant to which
Building Permit No_ 26354-Z dated FEBRUARY 18, 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 TO CODE IN THE REQUIRED
REAR YARD AREA AS APPLIED FOR.
The certificate is issued to THOMAS G & THERESA KOBER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-547665 01/12/01
PLUMBERS CERTIFICATION DATED N/A
Auth rized ignature
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. 26354 Z Date FEBRUARY 18, 2000
Permission is hereby granted to:
THOMAS G KOBER
2000 ALDRICH LANE
LAUREL,NY 11948
for
CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO
CODE IN THE REQUIRED REAR YARD AREA AS APPLIED FOR.
at premises located at 2000 ALDRICH LA MATT/LAUREL
County Tax Map No. 473889 Section 125 Block 0001 Lot No. 002 . 019
pursuant to application dated FEBRUARY 10, 2000 and approved by the
Building Inspector.
Fee $ 150 . 00
Authori ed Sign ture
ORIGINAL
Rev. 2/19/98
s-.�a_ ocnn
`Z%flAdi / 111gr Form No. 6 iI 1
i ;ii•
' TOWN OF SOUTHOLD � F
BUILDING DEPARTMENT AJC
TOWN HALL -�
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 19 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
t 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 dwel Additions to dwelling $25.00,
Alterations to dwelling $25.00 Swimmingpool $25.00 Accessory building $25.00,
Additions to accessory building , 25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildiniz - $100.00
3. Copy of Certificate of Occupancy - ' -2510
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . .�4h. e6rugry. . vZ9A.� . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing JBuild�inng. . ./. . . . . . . ..�. . . . . /
dl-
Location of Property. . . . . 000 . . . . . . . ... . . .. Yl. . .!�a ✓le
. . . . . . . . . . .. C (/. . . . . . .
House No. �y Street / Hamlet
Onwer or Owners of Property. . . . . . . :. ::Y �?9 . . , Z . . . 1. . . ./74�JS� . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . . .Z. . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . /./0. . . . . . . . . . . . . . . .
Subdivision. . . . .. . . .. . . . . . . . . . . .. . . . . . . . . . .�4. . . .g Filed Map. . . . . . . . . . . L�ot. . . . . . . . . .`. . . . . . . . . . . .
Permit No.4�l0.0�s� T . .Date Of Permit.rla/vl�P. . . . . .Applicant. . ." !./
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. 14� . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . X �
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . ./ . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . .
�. . . . . ,�e .. . . . . . . . . . .
CO-"& a 75(p APPLICANT
7GS-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ATIAN
[ ] FRAMING FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: '
,DATE INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ NAL
[ ] FIREPLACE & CHIMNEY
REMARKS: � ��
,DATE �� INSPECTOR
ii ii
ii
%TTON ( IST)
n ° �
)ATION 2ND)
II it
II II
II II
II II
iT FRAME S n 41J
itu--- -- - --- -- ----- ------ ----- - -- -- Q5
PLUMBING ii —�i ------------- —..-- -- --------- 6
u n
n
ii
u
u
LATION PER N. Y.
I��N H
TATE ENERGY
CODE _
N
N
mil
_________________—___
I'II OV
l� H
u
t
I
h I
fl �1
FINAL n n
eW
—==n_ 3 __= C—==— — -- --- _-- __
-- —___
ADDITIONAL COMMENTS:
a
to
.z
--------- ------------------------------------------
I
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2
1000760 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date JANUARY 12+20181A licat. n No. on file 11,483600/00 N 547665
THIS CERTIFIES THAT f'WIT. NO. 163542
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
'POM KOBER, 2000 ALDRICH LANE, LAUREL, NY
in the fallowing location; ❑ Basement ❑ at Fl. C1 2nd FG OUT Section Block Lot '
was examined on JANUARY 05,200➢1 and found to be in compliance with the National Electrical Code.,
FIXTURERECEPTACLES SWITFIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
CHES
OUTLETS INCANDESCEN FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. X.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MU171-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL N.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMi. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC GOND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. I 0 RW 1 D JW 3 0 JW J 0 4W pER 0 OF CC.COND. NO.OF HI-LEG Of HI LEG NO.Of NEUTRALS OF NEUTRAL
OTHER APPARATUS:
ROLANDS ELECTRIC, INC. LIC4147 E dwt
307 SUBURBAN AVE.
DEER PARK, NY, 11725 GENERAL MANAGER
11 _......
Per
This certificate must not be altered In any manner; return to the office of the Board It Incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING- DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT 85 ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
F]�.'000'160 BUREAU OF ELECTRICITY
I 40 FULTON STREET, NEW YORK, NY 10038
Date JANUARY 12,2001 Application No. on file 114836+x0/00 N 547665
THIS CERTIFIES THAT PERE4IT NO. 263548
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
'POM KOBER, 2000 ALI)RICH LANE, LAUREL, NY
in the following location; ❑ Basement ❑ Ist Fl. ❑ 2nd FI. OUT Section Block Lot
was examined on JANUARY 05,2001 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. X.P.
4 2 2 4
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIALRECPT.1 TIME CLOCKS BELL UNIT HEATERS MUSYSTEMS ET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. I A.W.G. I AMT. I AMP. I AMT. I AMPS. I TRANS.I AMT. I H.P. NO.OF FEET AMT WATTS
1 P I I 1 1 20
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC COND. A.W.G. A.W.G. A.W G.
AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W PER 0 OF CC COND. NO.OF NI-lEG OF HI-LFG OF NEUSRALS Of NEUTRAL
OTHER APPARATUS:
SWI144ING POOL & POOL ROUSE-1
G.P.C,I:-2
"(S60I11MING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
environments it is advisable to
have frequent test/and or repairs
made by a qualified person. � L
a<K Continued on Page 2 >»
GENERAL
MANAGER
PCY t"
This certificate must not be altered In any manner;return to the office of the Board It Incorrect. Inspectors may be Identified by their credentials.
COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
o�osuFFoc�-oo
o� Gyp
Town Hall,53095 Main Road h Z Fax(631)765-1823
P.O.Box 1179 Oy ® �.F Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
FEB . 15, 2001
MR. THOMAS G. KOBER
2000 ALDRICH LA.
LAUREL, N.Y. 11948
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
XX An application for Certificate of Occupancy is
not on file . (Enclosed)
No Underwriters Certificate on file .
XX The check is (not on file . ) $25 . 00
No Health Department Approval on file .
No final inspection has been made .
No Plumber Solder Certificate on file .
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 26354-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
/Sp
BUILDING
PERMIT I
e:21 G3Swa
ISSUED TO 6bW, DATE l8
ADDRESS �-
This notice must be displayed during construction
and returned to Building Dept. to get a certificate
of occupancy upon completion of work.
` BUILZ)INGIISPECTOR'S OFFICE, TOWN OF SOUTHOLD
a �` ,+ "> �. +, t t mr r-w�F6�7�^.. � Mme, ;. i � r_ N�'�� b 4,xC"` �7 t `.0+, Y' ,'a^;rr`x vs ,FS x r y„, ,„ ,.•S
;�,„, N •�„; .� � � #bra � , ',� 4 ,��.�"�s � .ar 'ni ��. ''F � 2�tl- 9„�s� a�w4 a�`,���,'�` n. � s�� � '•� �:t �s`�'' "� ' w5i��' �t ��`'�r
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:
�Q 22 CALL . . . . . . . . . . . . . . . . . . p 1
Examined.. ... .. '../!. ,sFfVZ� MAIL TO: SA1trn It I;,% I to!V
Approved.. il`� Penni t No. p ? 7 N7 1 (?-
Disapproved
2
.., __...............................
Disapproved a/c .................................. lam!G k .. F:.. N y 11-17,?
L.... ... 0% ...
(Building Inspector
I 0 APPLICATION FOR BUILDING PERMIT
2000
Date. . � .! . . . . . . . . t9. . .
--- .__.,.j INSTRUCTIONS
a. 'chis application must be completely 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 work covered by this application my 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.
APPLICATION IS IMM MANE 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 reroval or demolition, as herein
described. The applicant agrees to cdmply with all applicable laws, ordinances, building code, housing code, and
regulations, and to admit authorized inspectors on premises and in building for necessary in , tions.
g ..
Scu t✓�. �� 1. ((bb�
..............
(Signature of applicant, r name, if a corporation)
... A (e.I r..
p I �$j (Mailing address of applicant)
.
.!r
} 4.. ?C C e r.d l .t✓ ......C n o o LS:...i ...........^.'..1 ..... .Q�+. /� r builder
St o r ..cant fent architect,r� �..... lra� �� S electrician,oflumber it......
Name of owner of premises f... T.� i
................. .........................................................................
(as on the tax roll or latest deed)
,If applicant is a corporation, signalise of duly authorized officer.
.....................� .......... ..................
(Name and title of corporate officer)
Builders License No. ....... ............
Plumbers License No. .........Nf ..........
Electricians License No. ...�.�?. /�.s.....
Other Trade's License No. .....1VA.......
I. Location of land on which proposed work will be done..............................................................
y O v1CAI �-CA
........... . ..................... .............................r.
.. .........................
House Number Street Hamlet
County Tax Map No. 1000 Section ....... Block ...... ...... Lot ....)-.-..'.r.�....
Subdivision ...................................... Filed Map No. .1............. lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....�.::.�.... ./'1-.M t L-3...�W L 1• -1E�1�! G�'t`�"itL�2.(J �]AKAA4
�nww��om�+e�rua G
b. Intended use and ocnxnparmcy ... ' ... `1 ,....�....v.. ... v;9. 3YttUtiO .............
A •'v:#�
Nature of work (check hahidh applicabje): New Building ........ ..
Addition ........ Alteration
..
irerr
pa' Removal ............. Demolition ............ Other Work ...... (°'o.0.4....................
'r 6 D D D (Description)
EstimatedCost ... .............. fee .......... .
�� (to be paid on filing this application)
If dwelling, number of dwelling units ............ Nud:er of dwelling units on each floor ...... ... ... . ...
Ifgarage, number of cars .................I....................
If business, commercial or ndxed occupancy, specify nature and extent of each type of use.......... ............
i i
Dimensions of existing structures, if any: Front..... (`.Q..(existing *
.... Rear ....F7.p...... Depth .. ?� d..........
..........
Dimensions of sae structure with al r of Stories ons,...............
erasions or additions: Front ............... Rear ........... ....
Depth .................... Height r of SCori sr ...............
�,
Dimensions of entire new construction: Front .......... x Rear ............. Depth .......... ....
Ileiglht ......................... 11u(her of Stories .................... .
Size of lot: Front ................'.... Rear .................... Depth ....................
Date of Purchase ...................!:. Name of Former Owner ....................................... .
Zone or use district in which premises are situated ................................................ ..............
Does proposed construction violate spy zoning law, ordinance or regulation: ........................
Will lot be regraded ......V......''.,... Will excess fill be removed from premises: = N0
Names of Owner of premises % *'rh+E2esq l�ogE resa .,, 000 �OC�RICN L.ANE (051-298-1"5 0
/ ............ �n �} Phone No.
T'ikomA
Hare of Architect .yeo( 'e wt<L 05 101
01 d,1 (F '1} j,il—�2$—f] 3'I
..... ../�5,.. Feal........ ......... Phore No. .............
Nate of Contractor ANDy,�r,�q ec�Len'`i ,,,,r,Nndar as �W I.(2'lE7-S ky.f .t.�q,Plwne No. 4.71:.J,fy-bIoe
... ............. ....... .... .
Is this property within 300 feet of a tidal wetland? * YES .......... NO ..........
*rF YFS, SO1I111OLD MM TRUSIMS; PMJIT MAY M MQOIM.
PLOT DTAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set—back dimensions
n property lines. Give street and block number or description according to deed, and show street nares and indicate
ther interior or corner lot.
l
ITh OF NU Y(NiK,
VIYOF ho � �C SS
...... . ... II
..•• d l...1 ... .. ..`... . �c ...being duly sworn, deposes and says that he is the applicant contracta P ... .... .
re of individual signing )
is emthe ....... .. .... .." ' t .� ... ........................................................... ....
(Contractor, agent corpoFate officer, etc.)
said owner or owners, and is duly auChotized to perform or have performed the said work and to make and file this
licatioh; that all statements contained in this application are true to the best of his knowledge and belief; and
t the work will be perfonned in the we"MI r set forth in the application filed therewith.
rn to before me this
..,day of
story Public
MYAWM=4ArMMarmxro� (Signature o Appli t)
�o
VINYL LI IER SKIMMER
8`1R - RETU
= 3-31W, BARS RN
IR
Lill
FORM TIES
24 9 $ _
i \ , 'a TO FILTER
�`. - B 8'R I!D'R 1 RO
3SKIMMERS
4.- LE FOAM O
FROM
' B � _. LINER: FILTERond PUMP
UPTImw STEPS �� __ _ 4R
i C CRETE
FROM FILTER
S•R 2'R - 8'R :', 35001b TO RETURNS
POURED CONCRETE TO WASTE
VIN, I``` INER `;.�.j..:wd
A;: PIPING ARRANGEMENT
'•
PLAN
.... ., {c�i,A wig ,"'� 9' "
I -�a� - 66• 16-GONG
TOC. PYE63
2= 4* sA SECTION I IxI
SEE TYPICAL T L"- —'
WALL SECTION ,
FORM TIE FIBERGLASS
coMOULDED
I t°� co ^ PIECE
24" MAX
3/g.— , .
n EARS
Z".- 4"SAND BOTTOM~ .r
Y
SECTION B- B PLaN OPTIONAL STEP
GRADETYPE I.
O B=o•T- .a G _ T C A L WALL
S E C T :O N A- A u�.�F NOTES: PROPOSED POOL FOR: CONTRACTOR:
%, WALKS TO MOOTH, NON-SKID TYPE
'� SLOPED AW E20M POOL.
' 1 RANDY T. RODECKER, INC.
151% r i .: t x WATER DIST' l SHALL BE LIMITED TO SWIM KING POOLS
OWNERS PFS RfiY TO SUIT LOCAL REGULATIONS.
2 4 4 4 do �ssi 6i�c ROUTE 25A,
ROCKY POINT, NY 11778
NppII` �CFESSiOi�a'`" -
Iltl
n
APPROVED AS NOTED \�
DATE: ' B.P. N
d! FEE: BY: .��_ —
NOTIFY BUILDING DEPAgTMENT /{7
765-1802 9 AM TO 4 PM FOR THE ap
FOLLOWING INSPECTIONS: 44 46
1 FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING rt PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE NY.
STATE CONSTRUCTION & ENkRGY / y
CODES. NOT RESPONSIB,� FOR
DESIGN OR CONS7RUCT10%b`ERRORS / ' -•' r \ti
bo, 'r CA
14
\ } A• JA L�O 0606
air♦ ♦. �� 4
yb Ctf ro
- S ��r.- • .rte'- •�.�... q � ��-
`S>� s \X f��o
.,I
* F Frani TIO-
0 9F
r
Opp
\\w �
SURVEY i
WK061( =N� ' THOMAS KOM 81 THERESA KOREA wLr .i. ,sBB
It"1E1 MFF,A°°W Ck+1L" "y LOT 10, I LAUREL ESTATES EAST, MZT I " !EE as, 192a
Myi�._,..._�p7 H.S. Rf3>•tiU. t'f�"�Q'� AT IAUEIEL - Ga% Nov. 10, e
.he 9TPItge dlcpmld W4 flaw w or tz'bw& ter VA 14VN OF SOUTNOLD SCALE iI= DO
kK.0ti0R 1W been 41140W'aa by*DWAell sat OWAIW SOFOL.� Cow" NEw v'Oft 110. � I T9g
I d%AUTIPDR1190 A060161"m 60 ALart'D0 m ry110 4LIARANTE0 TO
�W fUMCT a$ 1106A6160 to %a(rlf1l tt(rA cr 1)0( FI$WT AMERI �_.
1 Ota 86FM pI ftt>o0 lft!!C wcw TOA►tnr! L"Atlat LAB i 40 OF It Y.
4 �N� y
y!
�. a d i ACOPItt 0 1116 "Vir 001 ft•AAK rift uwf SOUTVOL.D vi
7:IAr[gA•5 *K&O SEAL OR lw%OSKtt It A, ]M/:L µ,(, of +
ND1 N CON S'BI IILD to A( C VAL,O IIlk)C CO"
00WA&MYRLt tom"RO taOtAA *MALL A4µOKI to O Ip
�t:ALrYt GCM1aTM£!(r 'q,A4R FOA L/'pPIQ�a1L TD[CKSTRfJCi na PeAetw PO0 VIIBO tA! wAJrt .0 ~AO(t
Awo ab twf tf1Y(I YO telt ntL( cl.I.r1, covuA- .� j..A = 4
A f1101jft W�RA *MIM Ar - IfoNGi d SAN*, Iwt9►It ►yA l ... "ZnI a .MO to Of
t lrOA �,-v-4 d �
% WPf 60 TAf s 66 KION 0 Pl Eq u a,1—A*t� RTfl TU O" /e R- alt4aObt D1 IP at tN % t
ATtRsI A!K MPC�illai +{Tryµ rOe Ills K TMIl 0P00RATt AI!tI t({t rpl AI}AMawtltf Y( Ipt tOaw/Il AA Ni I
OTMtB to" 1M%( %ADW 0a0tOK 10 ADOITIOR&L IMATlt UliOOaf OA %µAft Oµllt e
I TAR 061110 6W0/LT AM U faAt InAPdAL 11,STM POI Twit haltrIgm DIw al
ID•11tamext MOWN MCARDO IAOA M{.l9IPTT C wC}
WILL CtOIPDAa W f1l,iTAMONiO OF TWA 0eP7O1 tOr,1AK9 AtPOwrAtMT fm cA PS101i 11tOµt TAM!% A" pee A PT
w wu tw 11a11�1. MIAIOIt 406 Aft POt TD ft IStD 110 ft1)AI ItM I' I0,
ROA Ta! LaittlBa Q PCtAtRf V-AAM AytIF
b0'd ZL2h j'Lc' 9bS _ ,i�.
6T :6T 000c-eO-93=i
1 �1Z) 1
Applicant/ _ /�
<)wners Nam �o(�t/� � ` � ! �"'�� �/� Reviewed
Architect/ Date
Engineer: _- Subrrtitted
SCTM It:
District I ,000 Section 1 as Block Lot
Project � I� �� Subdivision
t_ocationoOO_ ld �h �,q _ Name
Sin&le& sepai ate Required
cemfication Yes/No __ -- -- — -- -
Rcq -- - -- /moi► _ Itcy .4
770
/,onmg Oistlrct [l )(S7, �" Actual (I�x o,-r raltc Piolxwd
—
-- - /
Rcq Rcq Rcq
[Front Yard Pioposcd __. J (Srdc Yard ProrxOSCd _ _ (Rear Yaid Proposcd
Project Description: j5lov�g
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- i 14.
Notes--.-
0