The URL can be used to link to this page

Home My WebLink About25501-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27424 Date: 11/28/00 THIS CERTIFIES that the building ADDITION Location of Property: 235 SOUND BEACH DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 99 Block 1 Lot 17 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 10, 1998 pursuant to which Building Permit No. 25501-Z dated JANUARY 28, 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 10 'X14 ' ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HELEN MAHARES (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 11/22/00 PLUMBERS CERTIFICATION DATED N/A tho 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. 25501 Z Date JANUARY 28, 1999 Permission is hereby granted to: HELEN MAHARES 43 RAVINE AVE GLEN COVE,NY 11542 for CONSTRUCTION OF A 10 ' X 14 ' ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR. (FEE INCLUDES $100.00 FLOOD PERMIT. ) at premises located at 235 SOUND BEACH DR MATTITUCK County Tax Map No. 473889 Section 099 Block 0001 Lot No. 017 pursuant to application dated DECEMBER 10 1998 and approved by the Building Inspector. Fee $ 175 . 00 Authorized Signature ORIGINAL Rev. 2/19/98 Form No. 6 .T UTHOLD BUWN OF ILDING DING DE UPARTMENT `-27 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 17 lead. ' S. Commercial building, industrial building, multiple residences and similar building: 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. y _. .S�p � . 2. A properly completed application and a consent to inspe s n �l_ - _—th`� applicant. If a Certificate of Occupancy is denied, the Building I mor shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to ,d �e Alterations to dwelling $25.00, Swimming pool $25.00, Ac, esu318in�g"r�$O2D5� .� 00, Additions to accessory building $25.00. Businesses $50:00. 2. Certificate of Occupancy on Pre-existing Buildin¢ - $100.00 3. Copy of Certificate of Occupancy - .251P 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .4 ..... . . . .?. ! . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existli)Jjg Buildin} _ q Location of Property.. . .) ., 5�? w1t . . 1 :ILCv z./!11V, , ,(. House No. Street �� Hamlet Onwer or Owners of Property. . . . ur_ . . [Y. . . S.t . . !!. .: J .n!�rf}. Jr. . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filled Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . Permit No. .S rd/. 2- . .Date Of Permit. .' . : g .! . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . �. . . . Fee Submitted: $.q� 5 O o \�C, sgFON APPLICANT e� � a �ya�f S10 F014, o Town Hall,53095 Main Road o Fax(516)765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 ty BUILDING DEPARTMENT TOWN OF SOUTHOLD November 14 , 2000 Helen Mahares 43 Ravine Avenue Glen Cove, NY 11542 RE : 235 Sound Beach Dr. , Mattituck 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 # 25501-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. &P �)5Q) 1cto THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1205030 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10038 Date DECEMBER 01,2000 Application No. ars file 21359800/00 N 543994 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 TOM MAHARES, 235 SOUND BEACH DRIVE, MATTITUCK, NY in the following location; ❑ Basement ® 1st Fl. ❑ 2nd Fl. OUT Section Block Lot was examined on NOVEMBER 27,2000 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SWITCHES OUTLETS INCANDESCENT FLUORESCENT I OTHER AMT. K.W. AMT. N.W. AMT. K.W. AMT. K.W. AMT. X.P. 4 11 1 7 1 4 S FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS M SYSTES !!7 K.W. OIL N.P. GAS X.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. X.P. NO.OF FEET AMT. WAFTS 1 F 1 30 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. 1 e 2W 1 D DW D D DW D e 4W PER 0 OF GC.GOND. NO.OF HIAEG OF W. NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: PADDLE FANS F-2 r.F.C.It-1 SMOKE DETECTORL-1 TRIN FORK ELECTRIC LIC.#L3488E L P.O. BO.K 48 JA1,1ESPORT, NY, 11947 GENERAL MANAGER 11 Per 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 MUST NOT BE ALTERED IN ANY MANNER. MATTITUGK IHOET TOWN0 �~� ,you=rWoLD -F- /K' oSJJFr OI.K a COOMY *1 } f Si. AP/ � z ;810` a., r,t x A iAJ al ° oe$K ,p�P l�r✓arON7e -A, 7` e Aj'' � DdTsyesd N///swirl/9,/5 .�JANN�o�'.,Ui�o//� 77 ti 4 a . Y lo�� LoN�t/il/ f� /1N1f�G� C�l�/fig iJefddlo 7vC ,v, i/le - ELEVATION CERTIFICATE CMU No 3067 1977 0 M B May 67 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR) Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER BUILDING OWNER'S NAME Helen S . Mahares STREET ADDRESS(Including Apt,Unit,Sude and/or Bldg Number)OR PO ROUIE AND BOX NUMBEn COMPANY NAIC NUMBER 235 Sound Beach Drive OTHER DESCRIPTION(Lot and Block Numbers,etc,) 1000-99-01 -17 CITY STAIE ZIP CODE M t+i tuck NY 11957 SECTION B FLOOD INSURANCE RATE MAP(FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions) I COMMIINI IY NUMBER C PANPI NUMRFR 9 SUFI-IX 4 [AIF 01"FIRM INDEX 6 FIRM 70NE 6 F ASSES Ft OOD Et FVAIION _ 360813 0143 AE 12 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE). 1 NGVD'29 I Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: - I feet NGVD (or other FIRM datum—see Section B, Item 7) SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 8 . 2(a). FIRM Zones At-A30, AE, AH, and A (with BFE) The top of the reference level floor from the selected diagram is at an elevation of I- I 1 11 10 1.12 1 feel NGVD (or other FIRM daturn—see Section B, Item 7). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I I I I I ,1 I feet NGVD (or other FIRM daturn—see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is 1 111 191 feet above Ix l or below I I (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is feet above or below' I (check one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? I I Yes I ] No I -I Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:lxl NGVD '29 1 1 Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: Yes �x No (See Instructions on Page 4) 5.The reference level elevation is based on: 61 actual construction I I construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6.The elevation of the lowest grade immediately adjacent to the building is: 1 18 1,141 feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's "lowest floor"as defined by the ordinance is: I I I I 1 1.1 1 feet NGVD (or other FIRM datum—see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31r MAY 90 REPLACES AI-1-PRI'VIOUS I DI I IONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification Is to be signed by A land surveyor,engineer,or architect who is authorized by state or local law to certify elevation Information when the elevation information for Zones Al—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE) Is required. Community officials who are authorized by local law or ordinance to provide floodplain management information,may also sign the certification. In the case of Zones ASO and A(without a FEMA or community Issued BFE),a building official,a property owner,or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and - Distinguishing Features—If the certifier Is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing�equipment, area use,wall openings,or unfinished area Feature(s),then list the Feature(s)not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal) John T. Metzger 49618 TITLE COMPANY NAME President_.__. veyors, P.C. _ ADDRESS CITY STATE ZIP P.O. Box 909 NY 1 1 971 SIGNATURE DATE PHONE 08/25/98 ( 516 ) 765-5020 Copies Id be made f WdCal rtificate for: 1)community official,2)Insurance agent/company,and 3)building owner. COMMENTS: ON ail WITH ON PILES, SLAB BASEMENT PIERS,OR COLUMNS A v A A V ZONES ZONES ZONES ZONES ZONES REFERENCE REFERENCE 0�9E LEVEL REFERENCE LEVEL FLOOD LEVEL ELEVATION \. BASE BASEAOACENT $.1 REFERENCE FLOOD FLOOD GRADE "'V LEVEL ELEVATION ELEVATION REFERENCED p..ACENT LEVEL GRADE ) I lwall r'f 1.11.ri` I 111 ii•ijj.; ::';.:::.:::g'xu;3:�i.;:p ;viipwpcENr;; The diagrams above Illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones ahoy Id be measured at the top of the reference level floor. Elevations for all V Zones shop Id be measured at the bottom of the lowest horizontal structural member. ' r Page 2 Town Hall. 53095 Matti Road I JUDITH T. TERRY p O. fine I I79 Tot N CLERK A —' Southold, New fork 11971 �� .,� Fax (5161765-1923 RECISTI2A(t OF VITAL STATISTICS roQ� Telephone (5,16) 765-1901 MARRIAGE OFFICER .. RECORDS MANAGEMENT' ANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER 1 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)J , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)) . Ni. _ J I 6vu. LcP'T. ' TOWN OF SOUVHQLb ��h�T�l�� Southold Town Clerk August 25, 1993 APPLICATION #_ PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL PROVISIONS (APPLICANT to read and sian): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO lTHE BEST OF MY KKNO%VLLEDGE, TRUE AND ACCURATE. X(APPLICANT'S SIGNATURE) <yr DATE SECTION x• PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS 1� T`ELEPHONE `APPLICANT' /� J ' ✓ V �(? ` (o 1 >4 Zi BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the r distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) Addition ❑ Residential (More than 4 Family) ❑Alteration ❑ Non-residential (Floodproo£mg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- 13 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. . Dated The Proposed Development: ❑ IsI+L I located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). As located in a Special Flood Hazard Area. RM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4 ADDITIONAL INFORMATION REOUiRED (To he completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures, proposed elevation of lowest floor ('including basement), types of water resistant materials used below the first floor,details of floodproo£mg of utilities located below the fust Boor and details of enclosures below the first floor. Also ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5 PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law #_, 19_ The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6• AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding-piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8• CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT. PERMIT NO. 23 S SQ�� ^ �� PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: LAJIs• /V!A 14 11-RE 5 ❑ NEW BUILDING Zhu A V I ✓V 4-:: A V ,13EXISTING BUILDING 0 VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] �FOAATION 2ND [ ] INSULATION [ FRAMING [ } FINAL [ ] FIREPLACE & CHIMNEY REMARKS:C � � DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ ' FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,DATE �� INSPECTOR I 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] F UNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY REMARKS: s DATE ' INSPECTOR " 1 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ( RO GH PLBG. [ ] UNDATION 2ND [ INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR s M-1802 'BUILDING DEPT. 1 Ili PECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ j FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ j FIREPLACE & CHIMNEY REMARKS: Y l � DATE INSPECTOR ✓ a FIELD INSPECTION REPORT DATE COMMENTS saasasaasxxaxxx==a=saxsxs�/s/=xx xxxcxxsxs�sssxssxs;—�x=sssxsx=essxx=ssaa=xx=xssx=xx=xaxx=xx N! D ~\ H H FOUNDATION ( IST) rr— - I p— �li � FOUNDATION (2ND) n N c QJ ROUGH FRAME & jj W PLUMBING I N ✓� [f n _ q � a :aasxaaa=a--a--xexasxxaa ( x==� — x — aes— x xsaaxs--.— — -- p INSULATION PER N. Y. H STATE ENERGY I� CODE p N a ssxaa aa�=saaxssxxss=I�aa— a ='a. Nxsxsxa— xxax�aaaaaa�asss�- 1, a u l/' to n u H II N l�I----- n II N N q FINAL u aasaa:asaassxaxxsssxa �xx----�—� saassxaaa=a—:—s*� sssasss=a��aa=sa:aaaaasaemss O ADDITIONAL COMMENTS: 166 M 95siDep — Id x5 ATIyef- N A H N O x ra ro H BOARD OF HEALTH . .. . . . . . . . . . . . . € FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . tt �+ TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . DEC ( 0 1 12) BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . } TOWN HALL SEPTIC FORM . . . . . . . . . . . . .. . . . . . TOWN SOUTHOLD, N.Y. 11971 TEL. 765-1802 NOTIFY: �'. I�.�.n: Examined.....I Ill...... 19.,ft C y MAIL T0: .t/T�1'6. . Approved........(.Z.�..., 19.�.I Permit No. .�J....1Qj.. �.�?.K/tn_yL�e.J .......... Disapproved a/c .................................. ...I .GT�t ..l�.y ....................................... ....... ... .. ..... . ....... .... (Building Inspector) APPLICATION FOR BUILDING PERMIT 0 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector w 3 sets of plans, accurate plot plan to scale. Pee according to schedule. b. Plot plan slowing location of lot and of buildings on premises, relationship to adjoining premises or public sheets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. 'Hee 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 throug}iout 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 BRIEW 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. (Signature of applicant, or name, if a corporation) 14 Ud_, Gee NCoVF ................................................... (Mailing address of applicant) IV/ / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .... ..................Y... . ........... .................................................................. Nameof owner of premises .... -.......................................................................... (as on the tax roll or latest deed) .r" If applicant is a corporation, signature of duly authorized officer. .................................................4....... (Name and title of corporate officer) G1 Builders License No. / l M A 1 C /f N Ic X T / c--2 S PlumbersLicense No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. Location of land on which proposed work will be done... s.... . .. ....................................................................................................................... House Umber ,� 3 5� Stree So UAL)) P,< Hamlet M }) 7- T/ County Tax Map No. 1000 Section .....�.�....... Block ..../........... Lot ...9Y�:..��.. Subdivision e. 4 p .. /UY... r/tT `.. Filed Map No., 7 ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intend use and occupancy of proposed construction: .. a. Existing use and occupancy .... !?:?!' tri'.. ... '. ................................................ b. Intended use and occupancy ...... C�""� 4 �(M ............................................................................. 3. Nature of work (check which applicable): .. . Wew Building .......... Addition ..� Alteration .tl. . Repair ........... Removal ............. Demolition ............ Other Work Estimated .l..Atl#9lli ',.rtyyi;. / _._. 4. Estited Cost ...6 /,�. :v........... fee ............................................. (to be paid on filing this application) 5. If rkielling' n}t coer of dwelli n g units Nusber of &jelling units on each floor .: ..... If garage, number of cars .....,�.`-- 6, If business comercial or mi occupancy, specify nate extent of each type of use......................... ' is �s, if any: Front........ ..... Rear ....,. ........ Depth ...9 i7........ 7 Dimensions of sanetatxuchrre r... Nodter of Stories .......6?. '4 r...... }let t .................. h alterations or additions: Front ....-......... Rear ....... Depth ..........�0...... Belot .........,/.5......., Nlnber of Stories ...�L� .. 8. Dimensions of entire new construction: Front .... . ..... Rear X /o Depth D }leight ..............(.........� Amber of Stories ....®�...... J 9. Size of lot: Front ....... ?.�q........ pear ...... 5. ..........cDepth .AA,//f`S.............. 10. Date of Purchase Now of Former Owner .... ............ 11. Zane or use district in which premises are situated ....J,J..................................................... 12. Does proposed construction viol any zoning law, ordinance or regulation: ...d.:................ 13. Will lot be regraded ......... te( ..... Will excess fill be removed from premises: YRS / NO 14. Nares of Over of premises .1 91. i�JV.MAHW.SAddress i�AAVtY ,,VC-....... Mone No. k.-2 r'f r- C OO'd- t 1'S`t1 Nate of Architect ..... `� Address .............................. Phone No. Nape of Contractor�� i qJ. XT RJ 0145. Address .......T� '•�: ..Phone No. Qe��.......... 15. Is this property within 300 feet of a tidal wetland? * US .......... (J�)--Al..R„ *IF YES, S=J" IM 114M1MS M, TT MAY ll8 W4HRR. PLOT DIAGRAM locate clearly and distinctly all buildings, whaber 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 nares aril indicate whether interior or corner lot. SUM (% MV YORK ' •••-•`:!:�•��••••••�... �:. ...lteinp, duly sworn, deposes artrl says that he is L}te appl.icartC (Name, of individual signing contract) above rimed, lieis 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 applAcatiah are true to the best of his knowledge and txil.ief; and Lhat the work will be performed in the manner set forth in Che application filed therewith. Sworn to before me this (��J ........�Q.�...day NOSA0.Y flT1 S o etor' 19.r L... No.3U•4916m¢�Yed; Not Public rnmm � ai !!! .i .2. ..... � S Notary II (Signature of Applicant) 9e' I 6 -71- Mrs,Helen S.Mahares C 143 flavine Ave. .5 Glen Cove,NY 11542-2719 BLDG.DEP , TUwN OF SUUTHOto 14-'0" 200E WWI- _ - I _ '- v � - _� :ti,:.`_ - • - - 'I 5'21 � '1 �'e('I� RIGGI` 2�Cv MOOT' l�y°R('f�21h � f (o°O,L. ucaeE�i(r"aar 2xu coVtdiz rlr�iCagf' "o.t 1 , LL �, I �' I. , ,�. aR�I,,a_ y ^�,,µl.�.. %� '' r✓r� ('''L.YWae� T�'`� FIs. • " J ' 'G'r s W1P> > � 01?6w4 0 2'' Paf11�c� ` q t' HuIfeiiC' �p GE1'IaUG CAFr �J�IIaG1LMh`�D I �c l �I) GLI 1�'1 CSI V u1G Ivpj^ CJ 4• LaLI 4� ti L)4`I'1F a�J,{[."o, C„ n. iI rz- Iq Iot)u �pCIJl ° w L # fwep_ R'y[. O' J rvgH I r� � Grb _ 6"-10 COTe +gnl 1o141'vl� 'aP ' 311 laK ,' K�2 I% ILlJI 1[�� C RU. CQUSTRut,T o -fb COIT v vl �IYI_ 51171 D 0 U FIPiW acal ( lo* I� ` t F1 .00r HU. ISE MInI. 22" yy/ CI�APS 'tI,' to uCo�e Ado ;, ' ' 12-Iglu� Lv71eN ''/2"GYPyuH r�aer� � , P l c &f 1rF,D Pe Yhb,.a. R UL" — — �- + � 4� t��V&7l,4 1 vt L Air EvP57 G HO'..SE FLoo1z 1r Ih p- 0'r" uarm C" �CYJ1Z�r> i �{L-� I t JcjY e L. . .--t-fj ..r /lp �2136i'7 , C/'yST la'�'Ii V, I " r I4.0 01kr� �4*r 0 S o 1 1 I - 6� 0 14rhTdLL- � 13Ca�'r rEc4c '� 0 " l� ' Wrwtx ; Y 4' I I p o ' t'111OYIDEAl11F><CALDANO/OR � PLumalNG C rl # THERMAL SHOCK PREVENTING ALL PLUMBING WASTE _ �Q alp u. P G i - DEVICESASTOPAREl02.6(K) WATER-LINESNEEp N.1 -STATE BUILDING CODE. ING BEFORE COVERING _ y ---------- ti- It CERTIFICATION FI BER li copper tubing is used M for waterdistribu•'ng Ohl LFADCONTENT BEFORE pj�� . ,t1 i� system;piping shall be CER TII�/GA TE OFOCCUPANC PROVIDE%HR. FIRE Of types K or L onty SOL ER USED IN WATER RATED SEPARATION TO SUP ILY SYSTEM CANN07<" r_ _ - p—>r i�I PART.717.3(6(la OF EXCE€D 2110 OF 1%LEAD.' , I N,�STATE BUILDING CODE. PROVIDE SMOKE-DETECTING ECTING ALARM DEVICES E1 C GwC'L AS TO PART.721.1 - - ---------- ----- -- --- N.Y.S BUILDING CODE J L •� y ` a DY lGe, I PROVIDE OPENINGS FOR u y EMERGENCY ESCAPE AS APPROVED AS NOTED REQUIRED BY PART.714 0 - - ' - N.Y.STATE BUILDING COD DATE: '7'7� g.RA S-�l _ _ I FEE: em _ __ NOTIFY BUILDING DEMIRMEM AT I I. - - - --- --- _—._ --- -----.---- ,-- 785-1802 9 AM TO 4 FAA FON TilE — - - -- - ----' -- 1�.ryy FOLLOWING INSPECTION& UNDERWRITERS CERTIFICATE 1 FOUNDATION - Two N1=111IED REQUIRED FOR POURED CONCRETE - '~ 2. ROUGH - FRAMING N RUkOM 3. INSULATION OCCUPANCY O —. _-_-_.,._-,..__ . ._ __-_ ____- __ _. ...___ -__. g 4. FINAL . CONSTRUCTION MUST ;— - i BE COMPLETE FOR C.O. R ALL CONSTRUCTION SHALL MEET USE IS UNLAWFUL THE REQUIREMENTS OF THE N.Y. I cl STATE CONSTRUCTION At ENERGY WITHOUT CERTIFICATE, - CODES. NOT RESPONSIBLE FOR I DESIGN OR CONSTRUCTION ERRORS OF OCCUPANCY s. eLln . r� at stir ' 7XIC 21rX4 et jrnplFenan I r"a.c, J W7j 54 COL laF- jl O gf ''D.c • S�II S � �I I -, � , � \ � , - ., %7 '� Grp �'L-YWoO� �I•{E��•I G , a �� Q � Ccite �f+o 1 'Z'GGM .- r-rs, d a+o mw+J l ' ® W (1 I 2' Pou2erl ' q 1� v 4. f /amu kF 1 r n F k 4 rack g�r� l uf7�Y14 Lj Jd� �GJ I( a < , � e � J � �- 2r� c�I u ff �F',INp•. t['$UULP�I OirIS I� " /�j i�" u b I Ile / L,IRAP ��-? - _ -(UP c V ,, 'SCS low 1U1 d7I/vO.C. � yrl� ' (" .' �'Qi �nnr� r�L�ra� i7• I�l I kk�XJl Ir,•F'I M)oTr Ig(ilhvio o11 E.�EsI.J b>x�l lay-I`� n e- YII�I�i- �JID117F-JG I" 1 i Li��3.bJL �,�Ge >2-191u�ail.,o.TIeN '/2" GY�,uM fa�cer� Mla F�_oolz raU� rye n}. ZZ 1 -- --- --- -�- � -- : � G�hoe Y�ez�-!C�• oI� { AtoVr- EIUSr'O HOUSE F GDR, --;—'- - — ly�[E�✓/ lwr Io60j4zer—� GIZDe� - rV4•'X2'-4-' X PC' PGL �o �e� C'Of� 7 �e o 12" U.(i. 11w , 2" 2 T7 CST ! � 4 1-4" L - Fi 2•D" SYS u x 114- c y ' P U c uc, I C,c1-�iZt,' F�?UC" �1 Cf En I 1U � � r __.�..�-ter 'r----� , ,II , .I a - iD F1P 7 { kYT tWO KL — Uo 1' a , rl --. — _.__._--• - - -- i t, , • -��'`� . -..., A1,4.slut-I I - � "�� If �•�()!'t"s i�11�i,;Cdi Fl� � _._- N - 1 �a Ci C p �.ss�•r ! �� 1 Pte(' ? „ 9/ ° F�AH l!<7�j , ---- ---- -----------'--- -- — euc cµ C'1, �. ifiG_ x H (.\I(,fa — - - - - - ION LAY I?rl ' f - of NEw yo9 j t 1 3P S I T- - -Lou(� R ob" IS l'7 15 U l5 11129 n " Ida IN Wal-L �j{7? ,a• C7 I y cp r r wl ' K m 0 n � N ^ Q Z W � r fc a Y LL O O C o erne CL I Hvo-r PIF h � L rr1r � �J z G/SP F all CIQ 1l �1i� . J� t Kwf� cOf ' 1'" 3 u� I i°O.G, o ` \ ml I �yT T�[no'LL " ,IUI �, - . .p r'• - I i� ,. !. ., _ 4 GF) - A!A'1�4�+k W C #P2' Y r Z 5I> ��-¢� '�lf-�lnl, •G fo 1 , "'1 �''(�� I �� ---- �y\ J 1 'PF1P7r;ppk'Si6' a. �•1� - �-= , � G rcak - ` 21e� C01PiJ4' JtjttrQt(n 'Gr< , / r 15 fc IR 11 �' ?kXadlJ I C695,Y9uc-fruu. Tp � 1r PLY "'� TI4 PTL? DUY (� ,m I? HOLD IOmu L;obb�° EDW ,.dcCl{'Iror �� ". '' 'f!''' F4"� 1 2' '- " .A 'e 4dp IG�G3L: - "�•. L1r1 .?. d+ FLOca�- 11V �E&Wj- `p( 4 P' - , t 1 'f2°G fP5UM 17baery # 31P17 C Taal G, #kQ979 F - �' Gf �Pd�Flkl�fil. nT { X — M7 slL Pla PROVIOE SN4KE-DETECTING to a ��z2fl ALARM DEVICES 1�1tco° " DT7 r L10 As TY m;72L3 "' .r� G%�ac12 N.Y.$BUILDINGCOl1G ' I` ' • ',_ PRDYIDE.liIIR i1RE''" RATED SEP.ARAT101F T0L� N.CSTAT717.3 00E: < PANL E 6911,41116 CDDEU P40VIDE.DPENIIMrS.FON EMERGENCY r#h1t — 1 .REQUIRED�BY,PART:�514-0E-.'.>, �U• '. N Y STATE,BUILDING 004E I ' S _ m T .. ' l t _ ° i . .' , 1 u�Irl r APPROVED AS NOTED,. 4- ..DATE: �f'Z'4 B.P.p�, FEE: LJr® DE '�LGMENT,AT NOTIFY 'BUILDING'DEPARTMENT AT---.-"165-1802 '9 AM TO 4 PM FOR THF." - _` - - - - � '-�"�' 1 - - -i• FOLLOWING INSPECTIONS". 1 FOUNDATION ^ TWO REQUIRER u �Q A I k � 1 , , FOR POURED CONCRETE7777 I r "' - '^ B 2. ROUGH - FRAMING QI PLUMBING \ ., - -I ' cF.. _ - YTT S. INSULATION )^IR' �L.007� --.�--,—=.--«- OCCUPAPdCY OR �� : , 4. FINAL CONSTRUCTION MUST �+ If ilpl! , , . 8E COMPLETE FOR C.O. USE IS UNLAWFUL `4`'. - �.,:�.� --------- ALL _-.::r CONSTflUCT10N SHALL MEET' 1^/ '7u * r T /� T THE REQUIREMENTS OF THE N.Y.; . -L11.ITHOUT C�ERI�IFICAI ESTATE , C6 !: GQ Es.NOT RUCTION RERG SPONSIBLE EFOROF,UVCUI'AIYCY_ DESIGN OR-CON5TRUCTIOW €RAOR$ _; ,1 nIt - - - - -