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HomeMy WebLinkAbout26414-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. , CERTIFICATE OF OCCUPANCY NO: z-27082 Date: 05/15/00 THIS CERTIFIES that the building NEW DWELLING Location of Property: 3875 WICKHAM AVE MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 9 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 14, 1992 pursuant to which Building Permit No. 26414-Z dated MARCH 21, 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 ONE FAMILY DWELLING WITH ATTACHED WOOD DECK AS APPLIED FOR. The certificate is issued to KATHLEEN MILNE & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 91-SO-89 05/12/00 ELECTRICAL CERTIFICATE NO. H-067107 02/14/00 PLUMBERS CERTIFICATION DATED 09/13/94 K&K PLUMBING & HEATING C1.tiC� Au o ized Signature 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. 26414 Z Date MARCH 21, 2000 Permission is hereby granted to: KATHLEEN MILNE & ORS. PO BOX 1707 MATTITUCK,NY 11952 for CONSTRUCT A SINGLE FAMILY DWELLING AS APPLIED FOR (REPLACES BP #20843Z WHICH HAS EXPIRED) at premises located at 3875 WICKHAM AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0009 Lot No. 004 pursuant to application dated JULY 14, 1992 and approved by the Building Inspector. Fee $ 408 .50 v Author' z d Signature ORIGINAL Rev. 2/19/98 r'I "MQrY BUILDING DEPARTMENT TOWN HALL - 9 20 e 765-1802 GUW �t APPLICATION FOR CERTIFICATE OF OCCUPANCY PLC, GLF7 IS.iGr„OF sOu7h10LD A. This a-pp'Y]ca 0Tr-Must be filled in by typewriter OR ink and submitted to the buildinf, inspector with the following: for new building or new use: L . 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 buildii 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 ar "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 - .25v. 4. Updated Certificate of Occupancy - $50.00 1 5. Temporary Certificate of Occupancy - Residential $15.c00, Commercial $15.00 Date . . GU New Construction. . .r7 Old Or Pre-exist ifig Building. . . . p.. Location of Property. $/ `. . . . �G �Q�/1!1 Ave-0�Q . . . . . . V;tt�'�1;1!(t t`. . . . . . . . . . . . . . . . . . House No. Street Hamlet 'Onwer or Owners of Property.6L�!`l .��t V� i 1���:. .�. / ((�� . . . . . . . . . . . . . . . 4 . . . . . . . . . . . "J County Tax Map No 1000, Section. 1970 09. . . . . .Block. . . . . . . . . 9 . . . . .Lot. . .+60.0 Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . aQ/,3 64f4 ,. �� vv I� � �`l4f . . . . . . Permit No. . . . .SJ."J. . . . . . .Date Of Permit. . . . . . . . . .Applicant. :� . . . . . � . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . .. . . . Final Certicate. . . . . ../.. . . . . Fee Submitted: $. P.S"o . . . . . . . . . . . . . . . . . . . . . . L . (`:C.r.�. . . . . . . . . . . . . . . . . . k, APPLICANT .SVG e0-jz_ C2)082 •L�F 4� '��Y1� x. TOWN Or. SOUTHOLD , •f OMM Or BUILbtIQO INSPCCTo(t P.O. BOX 728 1 "� ". t!► TOWN HALL I •�d0 SOUTHOLD, N.y. 11971 f t C C n T i F I C A T I O N ' date ------------- Building Petmit ¢ ySS d Owners (le- 141, , 1 . ��p ossa pr nth j� 1 BL1�G•1JHPT. It PLuMber ' 1nra• Ip Daae print) &• t certiE that 9 ,j Y the so.tdnt used in the water supply systsm"' eo>titninn lend than, 2/10 of 14 lead. x (/j/yam/,"/� .} �j� ,%/��/ '/,///� ,n'.�i 'i:"„x • ?ii' i (plumber ' s signature) 1 . 'ti :Fsrjit ' `R= Swo��rcc��n to beforh me this of 19 !� Al otary Public. ' HotstY 1►ubil a, d► County � f�. JOYCE M.WiLKlNS > Notary Public,State of Now York j, No.4952246,Suffolk Cott Term Expires Juna 12,1 � G�x ' 'e� d}4P Tex• n, r x x s a y . TEL. 165 f Bog TOWN Or SOUTHOLD lr k t orrlcGOf BUILDING INSPECTOjt ^�y� P.O. BOX 728 �" t1 TOWN HALL i v SOUTHOLD N.Y. 11971MR -19 0 ' a ., �lpl !•� �d . r N TOWViUG, ft C E R T I F I C A T I O N r bate • Building \Permit No.��j 7 ' } Owner. p ease printl Plutnbar ' . (please print) 1 certify that the aolder used in tilt_ water supply system �Ieontains less than 2/10 of 18 lead. '; A k zN (plumber ' s signature) 1 :Swo • to before a thi r , day of i l a � q ..L iilY Y' nt x .' Notary Public llokArf Vubliao 4 c unty CLAIRE LGLEW ' Notary Public,State of New York ' �S r•, , No.4879505 Oualified in Suffolk County 4,fie Commission Expires December 8,1 Q L ` y f. x THE NEW YORK BOARD OF FORE UNDERWRITERS PAGE 1 8078786 BUREAU OF ELECTRICIT-YF 40 FULTON STREET, NEW YORK,-NY-100385 Date FEBRUARY 14,2000 Application No. on file 1 £3aJ d.00l00 1i 067107 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant roamed on the above application number is in the premisesbf e KATHLEEN MILNE, 3875 WICI(iiAM AVENUE, MATT'ITUCK, NY in the following location; ® Basement ®'Yst F7 ® 2nd Fl. 1, OUT Section Block Lot 2000 �' ✓ was examined on FEBRUARY 07 fr)u�d to a in eompZianpe withU{e Natigttal Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT I OTHER I AMT. KW. I AMT, I K.W. I AMT I K.W. AMT. I K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL RECTT. TIME CLOCKS I BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT NO. A.W G. AML AMP, ^ANiT.,1 AMPS.;,TRANS/ AMT; H.P NO,OF FEET AMi. WAi1E SERVICE DISCONNECT- NO;of - - - -- - -S E - --- R `". s-V I C E - - - - - - - METER NO.OF CC GOND A.W.G. A.W G AM7. AMP. TYPE EQUIP. 10 2W I 0 SW 3 0 3W 3 0 4W PER 0 OF CC. OND` :'NO.,QF HI-LEG' OF HI-LEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: ELECTRICAL SURVEY AS PER 2/7/00-1 *NO VISUAL DEFECTS: "An electrical survey has been made of the exposed electrical equipment in the premises indicated. " "No obvious unsatisfactory condition was found. IdLr L L KATHLEEN MILNE P. 0. 80X1707 GENERAL MANAGER 11ATTITUCIC, NY, 11952 Pere 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. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE 'MUS`C,NOT :BE ALTERED IN ANY MANNER. �w i y ti at � LEWq 9� `>n p �EW YnN �r..,eY�ae:.��,P�.c'i9 k�i7"� /dt�rf�at/Y G(� ,CCs^.%�,/•'1.� JSk7 �a yrv �rntn �.Io!vr.� +iii � G��ur� oder Y' AM 13 NE BLDG.DEPT: Sca�7xarefb.j",�"illsf OV,74, TOWN OF SOMQLD� COO c� Gym y x Town Hall,53095 Main Road p Fax (516)765-1623 P. O. Box 1179 �'� �! Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 26, 1996 Mrs . Kathleen Milne P.O. Box 1707 Mattituck, NY 11952 Re: Building Permit #20843-Z - (new dwelling) Premises : 3875 Wickham Avenue, Mattituck Suff. Co. Tax Map #1000-107-9-4 File under Barbara Reiter. During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284, it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. O�1;�SOFF0(,t ti� oGy� Town Hall,53095 Main Road p 1 Fax(516)765-1523 P.O. Box 1179 COD Telephone(516)765-1802 Southold,New York 11971-0959 O BUILDING DEPARTMENT TOWN OF SOUTHOLD May 5, 2000 Kathleen Milne PO Box 1707 Mattituck, NY 11952 Re: SCTM# 107 . -9-4 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : x An application for Certificate of Occupancy is not on file. (Enclosed) + / No Underwriters Certificate on file x The check is (not on file. )$25.00 /x 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 # 26414Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. rola[ NO. s 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) NNOO 20843Z Date .............../ ..........................., 119.4.t- Permission is hereby grants P.., ftt/S ti` I�EEGI —�G................ r°Q... AW..... 4;P......! :..................... 4 � ......�..... �.. ro . .........A....... Sti✓�a.��. ... .... .�r..Ly�l............ se%..........;! ..G.......... at premises located at ....................✓.F....t�✓�r.............1!//14r /S`!fd .......... e4g,..................... 1 Z ............. .... .. .................. ............ . .............. ...... ..... ? /.. . J..../���T! ....d!`.q�.f!.e1 ....... ...................... County Tax Map C. 1000 Section .../...0.7....... Block ......©/........... Lot No. .....® ........ pursuant to application doted .................?.l. T ........................ 19✓-., and approved by the Building Inspector. Fee ;.. Of...�.. ildin-1, ctor Rev. 6/30/80 4 New York State Department of Environmental Conservation Building 40—SUNY, Stony Brook, New York 11790-2356 15 16) 751-1389 Owe Thomas C. Jorling j Commissioner I I March 5, 1992 s I I Barbara Reiter Box 1707 Mattituck, NY 11952 RE: 1-4738-00378/00001-0 Dear Ms. Reiter: In conformance with the requirements of the State Uniform Procedures Act (Article 70,ECL) and its implementing regulations (6NYCRR, Part 621) i we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, �V&Aa W. Mark Carrara Sr. Environmental Analyst MCC/nw enclosure 9520-b(10)90)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ! 4 DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-00378/00001-0 MW March 5 , 1992 FACILITYWROGRAM NUMBFR(s) PERMIT EXPIRATION DATE Under the Environmental Conservation Law (ECL) March 5, 1995 TYPE OF PERMIT(Check All Applicable Boxes) VjNew ❑Renewal ❑Modification ❑Permit to Construct ❑Permit to OperateArt !I le 5: Article Prolcle 15,tection ofllWat r SPDES 17, Titles 7, 8: Article Hazardous Waste Title 9; 6NYCRR 3 ste Management Article 15, Title 15: Article 19: Article 34: Water Supply Air Pollution Control Coastal Erosion Management Article 15, Title 15: Article 23, Title 27: Article 36: Water Transport Mined Land Reclamation Floodplain Management otnge15,Island Title15: Frescle hwater: Articles I shwater Wetlands � 6NYCRR3 0: Radiation Control Article 15, Title 2Article l Other: Wild, Scenic and Recreational Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: Solid Waste Management Water Quality Certification PERMIT ISSUED TO TELEPHONE NUMBER Barbara Rieter (516 )298-9543 ADDRESS OF PI RMITTFE Box 1707 Mattituck, NY 11952 CONI ACT PERSON FOR PFRMITTFD WORK TELEPHONE NUMBER Tom Samuels , Architect (516 )734-6405 NAME AND ADDRESS OF PROJECT/FACILITY Reiter Property. 3875 Wickham Ave. LOCATION OF PROJECT/FACILITY Mattituck COUNTY TOWN)t1GX/Y9V&XX WATERCOURSE/WETLAND NO NYTM COORDINATES Suffolk Southold Long Creek E__ _ NA DESCRIPTION OF AUTHORIZED ACTIVITY Remove existing dwelling, construct new single family, dwelling, driveway, septic system, and decks. All work shall be done in accordance to plans prepared by Thomas C. Samuels dated 9/6/91 stamped VSDEC approved on 3/4/92, By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations,the General Conditions specified(See Reverse Side)and any Special Con iti s i cludded as part of this permit. caaz annm2s�y AA99mirs De u °I�e �onal o aumv, PERMIT ADMINISTRATOR ADDRESS FY4�9fy Brook, 24.V. 11190 IS34 Christine Costo oulos AUT HO IZED SIGNATURE DATE March 5, 1992 Page 1 of 5 95.20.6a(10/90)-25c ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 75 (Title 5), 24, 25,34, 36 and 6 NYCRR Part 608 ( ) 9 That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the stricture or work herein authorized,or project. if, in the opinion of the Department of Environmental Conservation 13 Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State,the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused 14 There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized revocation of this permit, the structure, fill, excavation, or other 15 If upon the expiration or revocation of this permit,the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed,the applicant shall,without expense pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require,remove all or Conservation may require,remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse No claim shall be made against New York on account of any such removal or alteration the State of New York on account of any such removal or alteration. 16 If granted under Article 36, this permit does not signify in any way 10 That the State of New York shall in no case be liable for any damage that the project will be free from flooding. or injury to the structure orwork herein authorized which may be caused 17 If granted under 6 NYCRR Part 608, the NYS Department of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project will not conservation or improvement of navigation,or for other purposes,and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 11 Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met. bility of obtaining any other permission, consent or approval from 18 All activities authorized by this permit must be in strict conformance the U.S Army Corps of Engineers, U.S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part Office of General Services or local government which may be required of the permit application. 12 All necessary precautions shall be taken to preclude contaminationDrOVed b of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were d(pL* approved y solvents, lubricants,epoxy coatings, paints,concrete, leachate or any NYSDEC on 31402 /Q/�_. SPECIAL CONDITIONS 1. To protect the values of the tidal wetland, .a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topo- graphy within an area extending linear fleet landward of the tidal wetland boundary, 2. A row staked hay bales or approvable erosion control ,devices shall be placed 501 landward of the tidal wetland boundary at commencement of regulated activities and remain in place until project is completed and ,all disturbed areas stabilized with vegetation. 3. During construction, no wet or fresh concrete,or leachate shall be allowed to escape or be discharged, nor shall washings form transit mix trucks , MKers , or other de- vices be allowed to enter tidal wetlands. 4. All necessary precautions shall be taken to prevent contamination of the tidal wet- lands and or waters of New York by silt, sediment, fuels, solvent, lubricants , epoxy coatings, concrete leachate and any other pollutant associated with project work. 5. Any debris or excess material from construction of this project,sha,ll be completely removed from the adjacent area (upland) and ,removed,.to an approved upland area for disposal . No debris is permitted in tidal wetlands, 6. The storage of construction equipment and materials shall be confined to within the project work site and/or upland areas greater than linear feet distant from the tidal wetland boundary. DEC PERMIT NUMBER 1-4738-00378/00001-0 PROGRAM/FACILITY NUMBER Page 3 of 5 95-20-6f(7)87)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article 25 Tidal Wetlands 7. Prior to the ultimate expiration of this permit the permittee will cause all fill and exposed faces to be vegetated to prevent erosion. 8. No fill shall be placed seaward of the 10' elevation contour. 9. There shall be no disturbance to vegetated tidal wetlands as a result of the per- mitted activity. 10. All repairs to existing structures shall be.confined to replacement of existing structural elements with in change in design, dimension, or materials, unless specif scally authorized herein. Supplementary Special Conditions (A) thru (d) 'attached. DEC PERMIT NUMBER 1-4738- FACILITY ID NUMBER PROGRAM NUMBER Page 4 of 5 INSPECTORS �pgOFFOJA, (516) 765-1802 p VICTOR LESSARD, Principal =� Gy< SCOTT L.HARRIS,Supervisor CURTIS HORTON, Senior cm Town Hall p VINCENT R.WIECZOREK, Ordinance ^2+ P.O.Box 1179,53095 Main Road ROBERT FISHER, Assistant Fire Southold, New York 11971 Building Inspectors Fax (516) 765-1823 THOMAS FISHER Telephone (516) 765-1800 GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD TO: Judith Terry, Town Clerk FROM: Victor Lessard, Principal Building Inspector SUBJECT: Request for refund (Reiter) DATE: December 22, 1992 The first set of construction plans for Barabar Reiter & ors, approved April 29, 1992, B.P. #20601Z was submitted by Samuels & Steelman; and paid for by the architects check in the amount of $528. 35. The second set of plans was submitted by Kathleen Reiter Milne (daughter) on July 20, 1992, B.P.#208432 and was handled as a new and completely different application. The amount of the fee $408. 50. Section 45-11 (B) state in part, if application is denied 500 of fee would be retained by locale. If work commenced than the town would keep the whole fee. My recommendation would be that since Mrs. Reiter went thru the architects and used their money, that she should request a refund from them and not us. VGL:gar ,y M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING FINAL [ ] FIREPLACE A CHIMNEY REMARKS: 4 oe ON C - DATE INSPECTOR-.-I `�`"`� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY MARKS: � �✓ DATE INSPECTOR 3 7 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ , R¢UGH PLBG. [ ] FOUNDATION 2ND [�f/INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE l 0INSPECTOR r l � r M-1802 BUILDING DEPT. INSPECTION [; I FOUNDATION 1ST [ROUGH PLBG. [ - j FOUNDATION 2ND [ I INSULATION r, ] RAMING [ I FINAL C ,`RE RKS: DATE INSPECTOR f�5�- M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION t ] FRAMING [ ] FINAL ,s REMARKS: DATE ( _INSPECTOR /�"YV r x M-1802 BUILDING DEPT. INSPECTION [FOUNDATION 1ST I ) ROUGH PLBG. [ I FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [�-] FINAL REMARKS: e9 \ O \ ATE © Z- INSPECTOR ?� • I� Y� I � I �'• /Y y �/ / / / f / r X11 • • � \ i� t 1 � BOARD OF HEALTH . . . . . i FORM NO. 1 3 SETS OF PLANS . . . . . . ,,t�` TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . ,JUL 4 �''"� BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . d°' V TOWN HALL SErTIC FORM . . . . . . . . . . . L_ ,..._,.,_.. SOUTHOLD, N.Y. 11971 )20P> TO'ddiv ts� ay1;r'twt-K� TEL.. 765-1802 NOT, FY CALL ` . �7.-Z-!:?4$ . . . . . . Examined . . // v . . . . . . . . .. 19 MAIL/y�3� MAIL TO : Approved . . . .�?��, . . . . . . .. 19/-Permit No. t�! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` di/.- hispec tor) APPLICATION FOR BUILDING PERMIT Date .. . . . . .. 19�.?r INSTRUCTIONS v 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 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 bd 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. c� f 20 ✓� 1N.� 5t. S' £��{. . /N C.. . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) J State whether applicant is owner, //lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. �r .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . (as on the tax roll or latest deed) If licant is a corporation, signature of duly authorized officer. . ..`. ,d-Fes . (Name and title of corpo{ate officer) Builder's License No. . . .l2F q. �?.�. .I . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 1�� rcu.�l4,. ./.V <<f52 - Ilouse Number Street r Hamlet County Tax Map No. 1000 Section . . . . ./(�.7. . . . . . . . . Block . . . . . (• . . . . . . . . . . . Lot . . . .. Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . b, Intended use and occupancy . . �1 /N(1 �'. . e�t 1.4.x/. . !451 , , , , ; , ,•, , If work (check which applicable): New Building . . . k . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . r6lf . . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) matedCost . . .� aoo. . . . . . . . . . . . . . . . . . . . . . . . Fee , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) re e, number of cars , , units . . . . . / , . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . welling,number of dwelling Susiness, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . , . , , , . , . , Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure ith alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . 8. Dimensions of enure new const ' Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . , . . . .,. . . . . . . . �uction: Front . . . .! 4�. Rear . .4A .`. . . . . . Depth . . .30.r Height . . . .?�v . . . . . . . . Number of Stories . . . . . )�v. 9. Size of lot: Front .. . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . .2 . . . . . . . . . . . . . . . . . . . . . . . 10. l. Zone or use district in which pl . . ' ' ' ' ' ' • • • Name of Former Owner 1premises premises are situated , ,/�,GS�pEhtr(? .. , , , , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate-any zoning law, ordinance or regulation: . , II. . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Name of Owner of rases q i ' ' • • • • Will excess fill be removed from premises: Yes No 13. Will lot be regraded P eA024L�'trPL44�<'L�Address3M. . . . . . . . . . . . . . . . . Phone No. Name of Architect .. . . . . . . . . . . . . . . . . .Address , . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . BtNS .,l f' r./, , , . , , . , Address 6P.A4.47e,A*V+4P*gMone No. r , , , ,`, 15. Is this property within X00 feet of a tidal wetland? *yes. . . . . . . . No. . . . . . . . . *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alll 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, S S COUNTY OF . . . . . . . . . . . . . . . . . • • • • • • • • • •'• • • • • • • • • • • • • • • • • • • . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above 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 manner set forth in the application filed therewith. Sworn to before me this 7. . . . . . .day of. l . . �'`� ' . . . . . . .. 19 �1 Notary Public, :. County a M.WILKINS //��-�`�`!. . potary Public,State of New York . . . . . to.4952246,Suffolk Coupty (Signature of applicant) erm Expires June 12,19 1 _ _ J � 1 Q 0 1 / / �� -^C► 4 xa/fy P uj --v I 4•/ _z;s-,tic- / / S7 Z>al --7.07; // mac"vv •// / G W..� I � FJCI 1t.I Cfi .���_� • //� c U L 14 1992 r - Or • / 10 IN lt�10 y _ LLf / / / N i f I ' r f �c rD Jw 9 IF NE � S ,10 CON �-: ,` It2�rJ^cl,i vn✓� CS Zr��l•,�\� '� j ".cam nii4 I ./ E u 16 i FE'NGE j� c { -ir FSE_ . . . D.Mot, UMEK A elv I�d MAP nf� Yrs �{ { r•. -rt'`.I L':!'�r �.i� ' �L'+.,..%_ 4C}'7� �..r�� - �z.v. .,y ,^q::ar•n� j J{,r=;'-.'V• L _..y. l LFJEZ m¢; n•4,_r,.,..,:-s: „i ¢m'•1o.+'�.eG se51 5^,at',1.�6 C�+nsifiared , \ 3Jalvd 11uGi iiearantees ind+cztaC hereon shalt run i0 f' "'""^"`"s i - r nmun R the surVal ,7 only M tna�fe`eon i 5 preozreol and cn his bslslt to the bY,e wmcaml.gpvernmental:.gaRry 8"16 lendmi manta*um listed hereon�o,d 1'�r`. JUL ' �i c .:� 1 t0 the'a£Vdnass of the lendin^.insb_ ' �'� '-'!(L 1f w�.�E:/ tutwn.Gec-ar,.aas.re ttot ttcns4urat+ta RODERICK VAN TUYL, .C. Maddi;ional irwitunotis or _ owmes. LICENSED LAND SURVEYORS GREENPORT NEW YORK t i SURVEY OF PROPERTY � - CREEK z 4r; SITUATE 4Ji1 GI=.�O s WOOD N $544'11 " E MATTITUCK F 39'08, TOWN OF SOUTHOLD N 89`27'42" E ,�o�p, ' \ _ _ — _ — - SUFFOLK COUNTY, NEW YORK 46.11 ' F �.S�g j � � -__- �IE S.C. TAX No. 1. 000- 107-09-04 _TIE LINEALONG APPARENT WATER sl . MARK SCALE 1 "=30' ' ,MARCH 72000 7 te=a O++i _ t AREA = 36,188.40 sq. ft. "— � (TO TIE LINE) 0.831 ac. mX tip07. SF00,,, S 9�aJ CERTIFIED TO: S3, `�F�S $gam KATHLEEN MILNE SUFFOLK COUNTY NATIONAL BANK " "Fss, 1s NOTE: s 4i`� ✓�i n ��N S.C.D.H.S. REFERENCE No. 91 -SO-89 S7• ,,�0 k� pONT•" -� F 43.46, s' I �y a 9g1nyF �. .KIyV` I� OF � S` PREPARED=O�i f + •. '4 M1s. nv K k0. / \1 1 ✓, a ••< S,tOR�( �% �� 0. STANDARDS FOR ACCORDANCE TITLE SURVEYS AS ESTABLISHED BY THE H� • + • •o,• FOR SUCH USE.BYNTHE NEWVED YORKNSTATE LAND OPTED M ko._ E O�gE � rmE AssocwnoN. DcPAR �nEN$T8usO,$.Ff9zF"D2dF.iAuiY�T.e1 ScE1�Ram V�I'CE$t2s ITSAP'b \ y O su"my, coliy App80VALOYCONSTZiC .!h. $II�1Tr1L�°.T°AI' 's.V ,Cy� FOUND MAY. 20%H.s.Per N0. t o-89 5�0, :2k;�.< �yZn °'�°L \\ W GANG-M RE i}tee n PtflVT 7££tl m POLE fi• •,nsz1 and watet sapplY faciliti£s at this toca.I a wqF ?ry/' N \ > y £T a end's Dn totiad to ck. r a MR a31 thIsDepatuaw. Oto T 5 S \ `- 1ed gEDi$00�4 r. �n OF be satt>,aD a i Pd N.Y.S. Lic. No. 49668 Costa Y.E„Chicf P ' U d wastewatermwagement 5 8 r Joseph A. Ingiwgno ZED AL DITIONJ�`x•' •' "^�' \1 E1 V Land Surveyor IRVEY IS A VIOLATION OF V 1209 OF THE NEW YORK STATE 2�?' •+ LAW. :_" �- o�o%>' V THIS SURVEY NOT BEARING O B .? SURVEYOR'S INKED SEAL OR SEAL SHALL NOT BE CONSIDERED _"� QOJ� �M1D � Title Surveys — Subdivisions — Site Plans — Construction Layout ALID TRUE COPY. 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