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HomeMy WebLinkAbout25977-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: 2-27217 Date: 07/26/00 THIS CERTIFIES that the building ADDITION Location of Property: 8045 GREAT PECONIC BAY BLVD LAUREL (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 126 Block 9 Lot 14.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 7, 1999 pursuant to which Building Permit No. 25977-Z dated AUGUST 25, 1999 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA #4737. The certificate is issued to ELYSE BORAX (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-529941 07/14/00 PLUMBERS CERTIFICATION DATED 07/21/00 PETER VICTORIA Auyhorized 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. 25977 Z Date AUGUST 25, 1999 Permission is hereby granted to: ELYSE BORAK 53-24 206TH ST BAYSIDE,NY 11364 for CONSTRUCTION OF AN ADDITION AS APPLIED FOR AND TO THE CONDITIONS OF THE ZBA #4737. at premises located at 8045 GREAT PECONIC BAY BLVD LAUREL County Tax Map No. 473889 Section 126 Block 0009 Lot No. 014 . 001 pursuant to application dated MAY 7 1999 and approved by the Building Inspector. Fee $ 75 . 00 r AuthoorriiizeedL ignature/' ORIGINAL Rev. 2/19/98 TOWN OF I7 LS u u �'{ '{ UILDINGND EPARTME ., ,r..._.. BUILDING DEPARTMENT 2;Aj HALL765-1802 3APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the buildin 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 buildi. 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 a "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 applican 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . ��.�.Q�. . . . . . . . . . . . . . . . . . . . New Construction. .. . . . . . . . . Old Or Pre-existing Building. . . GGGGGG p Location of Property. . . . o©W._�... . . . 2e � OhJ;t .. -b VU House No. { ^µms Street\ Hamlet Coweror Owners of Property. . . "_-►, :e:. . . . . - . . .p. .. .. . . . . . . . . .`. . . . . . . . .1. . . . County Tax Hap No 1000, Section. . . I.s?Z &?. . . . .Block. . . .Q.�D. 1. . . . .Lot.0.1.1 1:1._o. O� ` . Subdivision. .tt.��.��..�J'.. . . . . . . . . . . . . . . . . . . . . . . ... . . . .c.-. .Filed Map. . . . . . . . . . . .Lot _. . . . . . . . . . . . . . . . . . Permit No. .a, . 9 .�.�. . . .Date Of/f PermitI;c -t` . ( 3. . . . .Applicant. .��eu/.�...,. .L':i.�an$,2. . . Health Dept. Approval. . . . . . .&)/6 . . . . . . .(((. . . . . .Underwriters Approval. . . J.Jr!�. . . . . . . . . . Planning Board Approval. . . . . . . . . .. . . . . . . . . . . . . . \X/ Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . L.'. . . . . Fee Submitted: $. . . .aJ�:��. . . . . . . . . . . . . . . . . . .. . . .. .. . . . . . . . . . . . . . . . . . . . APPLICANT C7Zec. 5ssa3 SOFF01,t Town Hall,53095 Main Road o '� Fax(516) 765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 O BUILDING DEPARTMENT TOWN OF SOUTHOLD July 21, 2000 Fred Milner, Builder 870 Bray Ave. 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 $ 25977-Z (BORAK) Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. OG'�A Town Hall,53095 Main Road p :4 Fax(516) 765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 dol � Sao BUILDING DEPARTMENT TOWN OF SOUTHOLD July 21, 2000 Ms . Elyse Borak 53-24 206th Street Bayside, N.Y. 11364 Re:Premises @ 8045 Gt. Peconic Bay Blvd. Mattituck, NY Suffolk Co. Tax Map #1000-126-9-14 . 1 Dear Ms . Borak: As per our conversation, you are aware that a building permit is required for the new heating system that was installed in the above premises . Enclosed is a building permit application. Please submit it to this office along with energy calculations required from aN.Y. State Architect or Engineer. Please also sumbit a check for $75 . 00 fee for building permit. Respectfully, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector GJF:gar encl. (Cert. Mail) TEL. 765-1802 oS�FFDU,CSG, TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR o '•' ;— P.O. BOX 728 TOWN HALL SOUTHOLD,N.Y. 11971 C E R T I F I C A T I O N Date 7 .2 0 Building+ Permit No. < 0(,please print Plu^bar C`C � (please print) I certify that the solder used in the water supply system contains less than 2/10 of 18 lead. (plumber' s signature) Sworn to before me this qday of ' �9�Du Noo tary ublic ME E ep�YtRE notary Public, Su �Pa County 7pubVAWeMMWyQ*mos 3 �ao1 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 r11351,0 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10038 Date SLILY 14,2000 Application No. on file 19091899/99 N 529941 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of ELYSE BORLtY, 5045 FECONIC BAY BLVD. , MATTITUCK-LAUREL, 14Y in the following location; ❑ Basement 0 Ise Fl. ❑ 2nd FI. Section Block Lot was examined on JULY 06 1 2WO and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS, INCAN OUTLETS DESCE FLUORESCENT I OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT, N.W. 7 "l 1 3 1 6 1 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMS. K.W. OIL H.P. GAS N.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 1 20 1 600 SERVICE DISCONNECT NO.OF S E R V I C E _ METER NO.Of CC CONK. A.W G. A.W.G. AMT. AMP. TYPE EQUIP. 1 SW 1 ]W 3 0 SW 3 0 4W PFR• OF CL.CONO. NO.Of MI-LEG OF HI NO.OF NEDrRALS OF NELHRAL 1 ieN� CE 1 X i 2 _ 2 OTHER APPARATUS: i i i i .::PWE^ 12tRRAY LIC. #3653 L L F.O.F)x 305 UUPIL. NY, 11946 GENERAL MANAGER 1,1_ I 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. ' REM COPY FOP BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERFO tN ANY MANNER. J . WA554N 14 (v1AP CF PG<j: rCG2TY SUt2VEYEO v 42 68.3 E Y `> LGR AK 16 A IL. 1 AT h1AT-rtTIJGK , N. Y. b pi to b � z = SCALE : to p N i 7J iyl to O % 1- Stv Sj hz. HO. � � 1 In N 96.0 - r ec cG8.G ' To ✓ $.hl ' fp 00" Y". '� M.ON, BC.AY AyE. . i� PEGoNIC 9 AY $OULEVAP-D CjUGTY[THt�ed to tke' SecuYi+� i+1e GlAava"A-L3 Cc, pe+d, to t ..._.y tiSoYtFt F=ot•1t C-3Pt-+�c J: TYNs'$ CO. orro W. VAN T-Wr t✓ LiGENBEiU C_F. t36 SU2\'Fv�G. _t FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y_ NOTICE OF DISAPPROVAL DATE: July 21, 1999 . . . . . . . . . . . . . . . . . . . . . . .. .. . To Elyse Borak . . . .. . . .. . .. . . . . . .. . . . . . . . . .. . . " ' - " " - 8045 Peconic Bay Blvd. .. . . . .. .. .. . . . . . .. . . . . . .. . . . . . . . . . . . . . . . Laurel,_ New York.. 11948. . . PLEASE TAKE NOTICE that your application dated . . , .Illy.?.. ... . . . . . . 19_99. . for permit toconstruct. an. . . . . . . . . . addition _ . . . . . . ... .. . . ... . . . .. . . . _ at .. . .. . . . - ' . . . . . . . ... Location of Property . .. .8045 Peconic Bay Blvd. Laurel ... . . ... . . .. .. . . .. . . . . . . _.. .. .. . . . House No. Street Hamlet County'Taa Map No. 1000 - Section _ _ . 126_ . . .. BLOCK . .. .9. . . . . . LOT . . 14:. .. .. .. . Subdivision Filed Map No. . . . . . . . . .Lot No. . . . .... is returned herewith and disapproved on the following grounds . ...... . .. .. . . . . .. .. . . . . . . . . . that the proposed addition encroaches on the combined side yard setback. Under Article ._ . . . . .. _ _ " -- ' - - '--- ' . . . .. . . . . . . . . .. . . . . .. .. .. . . .. . . . . .. .. . . . .. .. ... . . ... . . . . . . . . . . . . . . . . . %%IV, Section 100-244, nonconforming lots require thirty five (35') feet combined setback. .. .. . . . . . . . . . . . . . . ... .. . . .. . .. . .. . . . . . . . . ... . .. .. .. . . . . . . .. . . . .. . . . . . .. . . . . . . . . . . . . . . .. .... nonconforming in_an.R-40.Zone.) 35' required. . .. .. . . . . .. .. . . . .. .. . . . . ... .. . . . . . ... .. . .. . . .. . . . . . . ... .. .. . . .. . . . . . . . .. . .. . . .. . . . . . . . . . . .. +/- 7' encroachment ... .• •• ••• •• •-•.. .. ... . . .. ... . . ... .. .. . . . .. . . .. .. . . ... .. .. .. . . . .. .. . . .. . . . .. . . .. .. .. . . .. . . . ..... .. .. . .. .. ... .. .. . .. . . .. . .. .. ... .. . .. . . .. .. .. .. .. . . ... .. .. .. ... .. .. ... .. . . . . . . . . ...... . ... .. .. .. ... .. ... . . .. . . . .. . . ... . . ... . . ... .. .. .. . . .. .. . . .. . . .. . .. . . ... . . .. . . . . . . . .. . . . .. .. . . .. ... .. . . . .. .. . .. . . . . .. . . . . . . . . . . .. . .. . .. .. . . . . . . . . .. .. . . .. .. . .. . . . . . . . . . . . . . . . .. .. . . . . .. . - .. ... .. . . . .. . . . . . .. . . . . . . ... . . . . . . . .. . . . ... . . . . . . . . ' . . . . . .. .. ... .. . . . . . . _ . . . . . . . . . . . - -- .. _ 7��� . . . - ' - - BUILDING INSPECTOR RV 1/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: July 21, 1999 .. ... ... ... . . . . . . ... ... . . To - Elyse Borak . . . .. ... . . . .. . . .. . . . ... .. . . .. .. ... . . .. . . 8045. Peconic B!17. Blvd. Laurel? New York_ 11948 ...... ..... ... . PLEASE TARE NOTICE that your application dated . .. .May.?. ... ... ... . 19-99 .. for permit toconstruct an addition . . . . . . . . .. . . ... . .. . . ... ... .. .. .. .. . . . . . . .. . . .. . . . . .. ... ... .. . . . . . at Location of Property . .. .8045 Peconic Bay Blvd. Laurel . .. . ..... ... ... .. .. . . . . . ... .. . .. ... .. House No. Street Hamlet 6 41 County Tax Map No. 1000 - Section ... 12. ..... BLOCK . . . .9. . . ... LOT ..t ... .. ... .. Subdivision . . . . ... .. .. . .. ... .. . . . ... . . . . . . Filed Map No. . .. .. ... .Lot No. .. ... .. is returned herewith and disapproved on the following grounds . ... ... .. . ... .. ..... . . . . . . .. that the proposed addition encroaches on the combined side yard setback. Under Article ..... .. . . . . . . . .. . .... .. . . . ... . . ... . ... . .. . ....... .. ... .. . .... .. ... .. . . . .... .. .. ... . . .. .. . . %%IV, Section 100-244, nonconforming lots require thirty five (35') feet combined setback. .. ... . . . .. . . . ... . . ... .. ... ... . . . . . . . . .. . . . .. .... . . . . .. . . . . . .. . . ... . .. .. . . .. . . . . .. ... .... .. nonconforming, in.an.R-40. . . . ... .. . .. . .. ... .... . . . .. .. .. ... 35' required. .. ..... ... ... .. ... ... . . ... . . ... ... .. ... ... . . . . ..... .. ... .. .. ... . . ... ... ... .. ... . . . . . . .. ... +/- 28' j).ro.Posed ..... .. ........ . .. .. . ..... .. ..... . . .. ......... .. ........ . ....... . . .. .. .. . +/- 7' encroachment .. . .... ........ ... .. ... . . ... . .... ... .. . .. ... .. .. .. ... . . ..... . .... .. .. . ... ... . . .. ... .. .. .. . . ... ... .. ...... .. . . . . .... ... . .. . . ... . .. .. .. . .. . . . . ... . . ... .. . .... . . ... ... ... . . . ... ....... . ......... ...... ... . . ... .. ... .. . . . ... . .. .. ... .. .. . .... . . .. ..... ... .. ... ... ... . . . . ... . . . .. . . . ... ..... .. . ... .. . .. ..... .. . .. ... ... . . ... .. . .. .. . . ... .. . . ..... ..... ... ... ... .. . . . . . . . . .. .. . ... ... . .. . . . .. .. . .. . . ... .. . . .... .. . . . . .. ... . . . . . . ... . . .. ... . . ... .. ... ... ... . . . . . . .. . . . . .. 1/ . . . . . . . BUILDING INSPECTOR RV 1/80 J . WASSQN ( � ^ _ MAF CF P<<�, �CF2ry N, kl ' Iol C. I \ 5UC2V YE[7 i'C S2. l 68.3 AN DL s_l i. Y S L J1�Gna. i AT i a'- MATT4Tl) CK N. Y. e 2 S SC.AL-H : w 0 V e mID i 0lz 3 n Q ii It 0 i 96.0 -- j ' r,ee 9o.0 % BRnAYCAve ✓ 5.41 ° 1000" l4.'. MON. 1.36 6. _ PECONIC SOU LIE\/A C.D Guur«r�+eee to tk n' C�< CI1Y;tL Title * Guuvar+ty CO. and to t: Novt1+ fork C3atylc s Truss Co. as suvvcst.sed OC+. S. 19 ui . Q or ro W. VAN T(jy, . 765-1802 BUILDING DEPT. INSPECTION [FOUNDATION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE S CHIMNEY REMARKS: ,. 4 DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FQNflDAT10N 2ND ( ] INSULATION [ ✓j/FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: {"✓Z�wj DATE INSPECTOR Qy---�� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION i ST ( OUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ^ 1-11-11 DATE INSPECTOR 765_1802 BUILDING DEPT. t NSPECT10 [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ® INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSILATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: - a -77;; DATE ol-�) INSPECTOR 'IL '_j is -*APPEALS BOARD MEMBERS p [��`Southold �FFO( {' 5 h��9 Town i{all Gerard P. Goehringer, Chairman tiy53095 Main Road James Dinizio, Jr. C= cLL ' P.O. Box 1179 CO zTOV „, ,_ . Lydia A. Tortora T ,. '—'--'-_--_Southold, New York 11971 O Lora S. Collins y �� ZBA Fax (516) 765-9064 George horning' ��l ��,�' Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION REGULAR MEETING OF AUGUST 18, 1999 Appl. No. 4737 - ELYSE BORAK 1000-126-9-14.1 STREET ADDRESS: 8045 Peconic Bay Boulevard, Laurel DATE OF PUBLIC HEARING: August 18, 1999 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The subject property consists of 21,220+- sq. ft. with 90 ft. frontage along the north side of Peconic Bay Boulevard in laurel (near Mattituck). The lot is located in an R-40 Low-Density Residential Zone District and consists of land formerly deeded at two lots (the lots were merged and combined according to the tax assessment records on May 29, 1985). The subject lot extends a depth of 263+- feet north to a private right-of-way. This lot is improved with two buildings: (a) an one-story, single-family dwelling situate at 42 feet from the southerly (front) property line and side yards at 8 ft. from the westerly line and 35 feet from the easterly line, and (b) accessory garage located 3+- feet from the easterly property line behind the dwelling. BASIS OF APPEAL: The Building Inspector's July 21, 1999 Notice of Disapproval, under Article XXIV, Section 100-244 for a proposed addition which will encroach into the combined side yard setback at less than the required 35 R. minimum. Applicant proposes total side yards of 28+- ft. total for a 15-ft. wide addition at the east side of the dwelling, leaving a setback of 20 feet. AREA VARIANCE RELIEF REQUESTED: Side yard total of 28+- feet (8+- feet exists at the west side and an east side of 20 feet) for a proposed 15-ft. one-story addition to applicant's dwelling. REASONS FOR BOARD ACTION. DESCRIBED BELOW: On the basis of testimony presented and personal inspection, the Board made the following findings: 1. Grant of the area variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The proposed addition will be partially screened from view of the adjoining property owner by a four-ft. high wooden fence that extends the full length of the applicant's property on the west side. The size of the addition is modest and will enhance the appearance of the house and be a benefit to the surrounding neighborhood. 2. The benefit sought by applicant cannot be achieved by some method, feasible for appellant to pursue, other than an area variance because the lot size is nonconforming and there are no other exterior areas of the house on which an addition could be constructed without the applicant incurring major renovation costs to existing rooms. Page 2 -Appl. No. 4737 - Elyse Borak Regular Meeting-August 18, 1999 At, Southold Town Board of Appeals 3. The requested area variance is not substantial and represents a seven (7) foot reduction in the code-required 35 ft. combined side yard setback. 4. 3 he proposed variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because the addition is most and will be an improvement to the house and the community. 5. The alleged difficulty has not been self-created. In considering this application, the Board deems this action to be the minimum necessary and adequate to preserve and protect the character of the neighborhood, and the health, safety, welfare of the community, while enabling applicant the benefit of an addition. RESOLUTION/ACTION: On motion by Member Tortora, seconded by Member Dinizio, it was RESOLVED, to GRANT the variance, as applied for. Vote of the Board: Ayes: Goehringer, Dinizio, Tortora, Horning, Collins. This Resolution was duly ADOPTED (5-0). A GERARD P. GOEHRI GER, CHA AN Filing on or about 8/25/99 OF L F Li TZwN o� s EVE '. . . , -i •'J �y a CWAP� v 4,11 ms CIX,. A _ FIELD INSPECTION REPORT DATE COMMENTS =_== ----_===It --- 11 _ +wa ._'1� u It it FOUNDATION ( IST) Itt�i It it rr J I c FOUNDATION (2ND) II�I��� �I _______________ IIS'===-___ _____/.----- _-_______ --- it— ROUGH FRAME d n PLUMBING II n I � INSULATION PER N. Y. it — STATE ENERGY ti/pJ CODE it it u II p H II n II � FINAL N I it ADDITIONAL COMMENTS- ------- ----------------- --__�_-- ---____-----_ ---- ----- � 7 / " 71 H H N O x a r ro H BOARD OF HEALTH . .. . . . ...: ... . . PORN NO. 1 3 SETS OF PLANS ... . . .. . ... .. . . TOWN OF SOUTlIOLD SURVEY .. .. .. • • • • • • • . • . MAY 7 1999' L. BUILDING DZPARTHENT CIIECR ...... .• . • • • . • . TOWN IIALL SEPTIC FORH ... . . . . . . . . . . . . . . . . ' SOUTHOLD, N.Y. 1 1971 TEL.- '765-1802 NOTIFY. CALL .. . 6cl. .V.�:�/ . . r 192 �j HAIL TO: . . .. . . . . . . . . . . . . . lamcnined. . . . .�`:.., 19. Penuit No. �5 .:�• ••.Z�ApproveKI ......... . ................................... Disapproved a/c ..................................... .. .. .. (lksilding Ins• •tor) . APPLICATION FOR BUILDING PBIIHIT �. / QDate � . . .,.191. INSTRUCTIONS a. lois application must 'he campletely filled in by typewriter or in ink and autsmitted to the Building Inspector wi 3 sets of plans,.accurate plot plan to scale. Fee according to adhedule. Cana ices: Or lxhl'lic b. Plot plan showing location of lot and of buildings on premises, relatioaehip to adj nS Pte" streets or areas, mud giving a detailed deacriptiai of layout of property moat be drawn on the diagram W1'id' is part of this application. c. 'Ane work covered by this application bray not be cahmenced WOWissuahx:e of Building Permit. cl. Upon approval of this application, the building Inspector wilt issue a Building Permit to dle applicant. Sud' permit shall be•kept on dhe premises available for inspection th=410ut the work• h;�t'atever until a Certificate of e. No building sloll be occupied or used in Whole or in part for any purpose Occupancy shall Inave been granted by die Wilding Inspector. APPI.ICmw IS imPdiY MAIC to the Building Department for the issuance of a Ifuildlog, Permit pursuant to the Isuilding Zone Ordinance of ti'e Town of Southold, Suffolk County, New York, and other applicable Lsh.w. Ordinances or Regulations, for the construction of Wildinga, additions or alterations, or for remaoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinenoea, building code, housing code, and reg<hi ii t� � ,r un�I %J sorsa% c1StsLiVrii.2d ina;xctcrS ore ,-sr idea :.' ;n h3i'11ding F.�r• *wemtina�n► Inspections. rat i c>,i) . (Signature of applicant, or naof, if a corps k-V................... (Hailing axklrsasi'of applicant) State wi►etlher applicant is owner, lessee, agent,,-ardhit'ect, engineer,*general contractor, electrician, plu ler or builde ............G�' ..?:'�:�a .... .k-fP:4-.�?J�.•.....................................................I.............. Name of owner of premises ..:�:. .�. -.......I . ....................................................... (as on the taut roll or latest deed) If sppliccanrt isa corporation, signature of duly authorized officer. .......!.V�A.........6......... . (Name and title of corporate officer) builders License 130. .l..l. ..1...J. PluTbers License No. ......................... \ Electricians License No. ..................... Other Trade's License No. .................... � 1. 1,ocation of land on wlhidh proposed work will be done...... ......................................... abuse Number Street ,�_ p / llaiolet County Tax Map No. 1000 Sectioci .......!a:�:... Block ......4......... Lot �{°.... I ..1• Subdivision ...................................... Filed Map No. .......... ...... Lot .... ........... (Name) 2. State existing use and occupancy ofpremises and intended use and occupancy of proposed Construction: a. !'wating use and occupancy .........� 6l'RIX ....... RM—.1......•.......�....................... OH(,8_M AONY,J b. Intended use sod occupancy ...........�:. :�r•+...••..••••.••••...• tt�*• .......... 3. Ksture of work (dw&tAilds appllcable): New Building .......... Ad dition . Helm Ir ....... Removal .. •• ... Alteration fleml{tion ............ Other Work (Description) r` 4. Lal in+ated Cost .. .� �................ fee • ... (to be paid cx► filing this appi,L'cation). i 5. if r1`4elling, txniwer of aviling units l�?�( �11,>tiber of cAmllin units cx► each flooral ��� g Q�} Ifgarage, rxnher of cars ...................................... 6. if 1x►siuess, cam►sreial or mixed'occupancy, specify nat:urey and extent of earl► type of use.......... ., 7. himenxla►a of existing structures, If any: irrcmt.... , '3 ;� •t• .••,. Rear Deptl► 3 O Might ..........F.�..........4. limber of Stories .. .11..• .. ......... . .. ........... himenalons of same stnscture With alterations�oi'additions: Front ..... Q..,,. Rear ,vF9..., Depth hei ►C .. • .................... gl .........�.4........ N�ntx:r of Stories ..... S. hitieensions of entire new eonstructiont Front .... I , .. Rear ........•Npth ..r ►�....... IM101t ............ ......s... Mober of Stories/ Z. ............ 9. Size of lot's FrOnt .........0.......... Rear ...:f:� �....... Depth ......1 o Q........ I(1, hate of hird►ase ......I.1... ...... t4rm of Ponner (Mer ......... ............................ 11. Zone or use district in uhidt premisea are situated ... �:7,i.f�.?✓Y�.�cr�..,...,... 12. floes pcoposecl construction violate any 2ming law, ordinance or regulation: .....to. 13. Will lot be regraded ....... .O.II......... H��il��t excess fill be removed tram premises: YES 14. Home of 0ueer'of premises ..E.1:���.....L:S�.��, Address ................ 1�1►oc�e No��1�. Mm of Ardnitect • ................... Address &rw of Contractor ................ Address �A.......�.'�.....::..�..,.... Pilon Ado. ............ .l:r::R-r..1'hone No.a R : !�A. 15. Is this property Within 300 feet,of a tidal wetland.? * YR.3 ........., Alp •�•,, *IF YL3, S(JI1• aD mm Z43USR2r.S 1'LwllkdfT MAY ISLE MAJIRM. M' PLOT DIAGRAM Imate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bac:k dimensions fromiw rty linea. Give street and block nu►ber or description according to deed, and allow street names aril irxiicate ►d►etl►e .Interior or corner lot. -� i k•- o � ahs . S 1' Il. M N Y(MtK, SS (ill IY t1U' � 1......... . .�. .. .•►••��•L RJ?...........................k-11111 duly sWc)rn, deix)ses avid Says that he la file appl.i c nwn ( tic of ivxdividual signing contract) at waned, Ile in the 4 .4............. (Contractor, agent;corporate offl•er.,.etc.) •• of Said a+vver or owners, and is duty authorized to perform or lsrtve perforneed the said work mxl to nuke arxd fIl.e this rllwpl leatioi►; that all. statements contained In this alwlniicattvr► are tn)e to file best of his kvx fledge ntvd IxilieH noxi that. tdve work will be performer) In the manner set forth in the application filed therewith. xsrn to - ,,�re tee tilts qq .clay f ...... :o......19.....1... Notary Public ... .��� .y...,:.... .... tYNDAM.BONN (Sittuntrre of Applicnnt) FLOW State of New York No.018020932 QL~In Mwah 8,220un ty I gIVW 0 4� ,J IU1U LI."I`I All V I ILjI.Y USE IS UNLAWFUL .� l 4 ROUT CERTIFICATE APPROVED AS NOTED DATE: S.-1522 2 B.P. VTN (C)CCUPANCY FEE: s BY:NOTIFY BUILDING DEP765-1802 9 AM TO 4 H copper tubing is used FOLLOWING INSPECTIONS: for water distributing PLUMBING 1 FOUNDATION - TWO REQUIRED system; piping shall be ALL PLUMBING WASTE FOR POURED CONCRETE &WATER LINES NEED 2. ROUGH - FRAMING & PLUMBING r.l� 4. Of types K or L only TESTING BEFORE COVERING 3' INSULATION W FINAL - CONSTRUCTION MUST CA UNDERWRITERS CERTIFICATE BE COMPLETE FOR C.O. �y"`� REQUIRED ALL CONSTRUCTION SHALL MEET i �/ 00 THE REQUIREMENTS OF THE N.Y. P STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR �� r PLU,44GER CERTIFICAT1r)1y a DESIGN OR CONSTRUCTION ERRORS- ON LEA® CONTENT BEFORE ' a ' CERTIFICATE OF OCCUPANCY C roZ 2 ce SOLDIrR USED IN WATER a 12!5 w "c SUPPLY SYSTEM CANNOT � E.YCL '" 2/l0 of 1% LEAD. a) 8 - U_ r 6 J PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS co i r REQUIRED BY PART. 714 OF N.Y. STATE BUILDING CODE. t bO� -.To I� y o y'' ^apv PROVIDE SMOKE-DETECTING �'�'k to - ��vla ' ►J! L_ ALARM DEVICES R'%� AS TO PART. 721.1 \ l'tJO(A Ir ' UagROVI¢E ANTI-SCALD AND/OR lir e t�H N.Y.S BUILDING CODE. THERMh1 SHOCK PREVENTING _5( _ Fp2 t-tv.d3 — vin�� Sd.� DE�If0 PAW._902__Kms( 1--_- --------- ----- --._ _ N.Y. STATE BUILDING CODE. Fred Milner Fred Milner Carpenter Carpenter 870 Bray Ave.,Laurel,New York 11948 870 Bray Ave., Laurel,New York 11948 (516)298-8821 (516) 298-8821 Licensed &Insured#HI 19597 r Licensed&Insured#11119597 1 Vj N � a 1 � J BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date ..2 l// Owners Name: Reviewed: Architect/ Date 4��F 4" Engineer: Submitted: �fcf� SCTM #: District: 1.000 Section: ��Block: /9 Lot: _/ Project ��. �n� Subdivision Location: !'� Name: Sin,le&separate Required certification: (Yes I No) �hr� Req. 2 / 9 Req. Zoning District:�O (Lot size: Actual: // V /• A[Lot coverage 12010 Proposed: Req. /� Req. —/ Req , O [Front Yard 70 Proposed:_ I (Side Yard Proposed: 1 (Rear Yard �b Proposed: O Project Description: ' AGENCY PERMITS Permit REQUIRED FOR REVIEW NA. lO 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??? �j Flood Zone: Notes: 3s�