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HomeMy WebLinkAbout25579-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26751 Date: 10/21/99 THIS CERTIFIES that the building ADDITION & ALTERATIONS Location of Property: 1050 OAK AVE (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 77 Block 1 Subdivision Filed Map No. __ Lot No. __ SOUTHOLD Lot 7 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 14, 1998 pursuant to which Building Permit No. 25579-Z dated MARCH 4, 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 ENTRY ADDITION AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANCA BASILE of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A 28916 06/30/99 N/A 7i/din~I/ns~p~ tor 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. 25579 Z Date MARCH 4~ 1999 Permission is hereby granted to: FRANCA BASILE 188 NORTHFIELD RD HAUPPAUGE~NY 11787 for : CONSTRUCTION OF AN ENTRY ADDITION AND ALTERATIONS FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. FEE INCLUDES $100.00 FLOOD PERMIT. at premises located at 1050 County Tax Map No. 473889 Section 077 pursuant to application dated DECEMBER Building Inspector. OAK AVE SOUTHOLD Block 0001 Lot No. 007 14 1998 and approved by the Fee $ 175.00 ~Aut o~r~~ature ORIGINAL Rev. 2/19/98 A. Form No. 6 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 p£operty 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 I% lead. 5. 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and qpre-existing" land uses: i. 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. 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 Qccupancy on Pre-existing Buildinz - $i00.00 3. Copy of Certificate of Occupancy - .25~ 4. Updated Certificate of Occupancy - ~50.00 . 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ......... ,.. Old Or Pre-existi~. Building.., ...... Location of Property..¢¢~'.~....~..~.~... -.¥.~ ................................. House No. Street Hamlet Onwer Owners of P operty ~..~.~.l~ .~. .~ ~.~ ; t.~. ...... County Tax Map No 1000, Section..O.~..~. ...... Block.~.~..~./ ....... Lot.~..~..~. ........... Subdivision .................................... Filed Map ............ Lot .................... Permit No.. of Permit..O ..... ~..../../..Applicant, ........ ~l,..*¢.~¢. .. Health Dept. Approval .......................... Underwriters Approval ....................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................ - ~~ ................... ~ec~mcnc ~vse~c=o~v s~nc~ z:vc. 375 DUNTO~ AVENUE ' ~ __._______________________._~,~P~TCHOGUE,~EWYORKI1772 ' .: (510 28&6642 ' ,' 28916 DATE: 6/30/99 , ,: ~ ~PHCATIOH Ho. ON FI~ ~OE: Southold ~' ~: , ,. Southold ~D~SS: 1050 O& I~SU~ ~: Franca B~le NDATION NDATION (2nd) FRAME & .PLUMBING' SULATION PER N. Y. STATE ENERGY CODE 'FINAL Albert J. Krupski, President James King, Vice-President Henry Smith Ar%ie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 December 16, 1998 BO.ARDOF TOWN TRUSTEES TOWN OFSOUTHOLD Draftec Consultants Inc. Mr. Arcadius Kaszuba 99 Smithtown Blvd. Grnd. Fl. Smithtown NY 11787 RE: FRANCA BASILE SCTM ~77-t-7 Dear Mr. Kaszuba, The Southold Town Board of Trustees reviewed the survey dated and received in our office on December 15, 1998, and determined that your proposal to construct a 10' X 39' deck onto an existing dwelling to be out of the Trustee Wetland jurisdiction, under Chapter 97 of the Town Code. However, any activity within 75' of the Wetland line requires a permit from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. Aiber~ J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES [/.]~".~-~.~. Draftec Consultants Inc. Mr. Arcadius Kaszuba ~__'~' 99 Smithtown Blvd. Grnd. Fl. Smithtown NY 11787 RE: FRANCA BASILE SCTM %77-1-7 Dear Mr. Kaszuba, The Southold Town Board of Trustees reviewed the survey dated and received in our office on December 15, 1998, and determined that your proposal to construct a 10' X 39' deck onto an existing dwelling to be out of the Trustee Wetland jurisdiction, under Chapter 97 of the Town Code. However, any activity within 75' of the Wetland line requires a permit from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. LOT. $04- .MAP'OF PROPERTY.::':, · SURVEYE, D. FOR" kl 0 R B F:: R:T ' R'~ D F: 1VI - ' '-: -AND I ,.' E D E LIIR A ~.D .,-R A DE M A C Li E R.:::i.:..'J 2-.: f h:.:-- .'.-.:, ::::: . -:-:' SITUATE ' AT . -- ,.. -..".:. z"'GUARAN. TEED TOTHE A,M~ZiC...&,N' T~,LE ' ' ' ..... ':': - ; ,"<' '.' ,': '-o ~VEVE~ - APR L ~i 972 . , TOWNOF 50UTNOLD~N.Y... ..... ..... ,: . . .~ ......... ,, ~ ~ ,, - ~ ~ - , ,. .'-;?,~,. :,', ., - ~ '..-," "., . '--'~ .... ~...~:A~d t.U~.L &-~,~,, APPLICATION PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I: GENERAL PROVISIONS_(APPLIC. A2,FI' to read and 1. No work may start un*,'i a permit is issued. ~. Thc pcmllt may b~ revoked if any false statementS are made herffm. 3, If revoked, aH vtork must ecsc until permit i~ re-issued. 4. Development shall not lac used or occupied until a Certificate of CompI;*-cc is issued. 5. Thc permit will expire if rio work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fnJfill local, i[ate luld federal regulatory requlr~ments. 7. Applicant herr. by giwas oansent to thc Local Administrator or his/h~r represr, ntadve tO make reasonable inspections required to verify compl!=,,, 8. I, THE APPLICANT, C~tTIFY TI-IA . THIS APPLICATION AP, E, TO THI (APPLICANT'S SIGNATUREI . ~ HEREIN AND IN A'I'rACI-,IMENTS TO -arm ACC? SECTION 2: PROPOSED DEVELOPMENT fro be comuletcd by APPLICANT) NAME ADD~ ~-qi TH2L.EPHONE ~LICANT Drafte~ Ccmsultants, Inc. 99 Smithtown Blvd. Smithtown, NY 11787 BUILDF. R C~l My Own Again Enterprises, Inc. 99 Smithtown Blvd. S~.thtown, NY 11787. ENGINEER Eryou Er~jineering, 9 Lady Jane's Way, Northport, NY 11768 To avoid delay ia ~ the application, please provide enough information to easily identify thc project location Provide the street address, lot number Or legal descfiptiun (attach) and, outside urban axe. as, the distance to the nearest intersecting road or well-known landmaxk. A sketch attached to this application showing the project location would be helpful. Residence of Dr. & Mrs. Franca Basile, 1050 Oak Ave. sour.hold, NY 11971 . '{see attacfied site p/an for property location.) SClt4 ~ 77.7t-7 FDP{93] = © MAC,ER '" ' ' ...... APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check ~JJ appGc~ble boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY ID Addltlou J~teratlon rn Relocation O l~molitloa ~Rc$idendal (14 Family) C] Residcntiat (More tha~ 4 ri Nou-r~d~fi~ ~pr~g? ~ M~a~ (M~fle) Home On M~u- fa~u~ Home P~k? ~ Y~) mM/t'l,l~l) COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIF_,S: [2 Fill [3 Mining Ct Drilling [] Grading [2 F.~cavatloo (Except for S~'uc~aral D~velopmcut Checked Above) · [] Watercourse Alteration (Includiag Dredging ~0d Charmed Modifications) CI Drsln~e Improvements ~aciuding C~lv~rt Work) ri Road~ Strut or Bridge Coostruction. f-I Subdivision (Ne~v or EXpansion) ~ Individual Water or $~r System ~Other (Please Spoci/y) mino~- b~rq~i.]'[i~'~ ~*-~,,,~ n~..~,~.-~ ,.~-~..-~- AIter completing SECTION 2, APPLICANT should submi[ form to Local AdminL~rator for review. SECTION 3: FLOODPLAIN DETERMINATION ~T'o,be compl~c_d ~v LOCAL AD1WIHISTRATOR) The proposed development is Io~ted on ~ Pauol No, . Dated The Proposed E] Is ~OT loc~e~I bi a Special Ftood Hazard Are~ (Hot/fy the applicant that ~hc application review is complete and NO FLOODPLAIN DEVELOPMENT pF. IhM1T IS REQUIRED), [] Is located in a Special Flood Hazard Area. FIRM zone designation is l(X)-Ye~r flood eicvatlon at thc slit is: Ft. NGVD (MSL) [2 Unavailable The proposed development is located in a floodway. FBFM Panel No., , Dated [] Sec Scaion 4 for additional instructions, SIGNED , ,, DATE .... A~PLICATION # PAGE 3 OF 4 SECTION d: ADDITIONAL INFORMATION REOUIRED (To be comnleted bv LOCAL ADMINISTRATOR] The applicant must submit the documents checked below bdore the application can be processed: rn A site plan showing the location of all existing structures, water bodies, adj.aceet roads, lot dimeusious and proposed development. Development plans, drawn to scale, and spebifications, [ndudlng where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water re.~tant matoriah u,~xt beJow the f~rst floor, details of floodproo£mg of utilities located below the fu~t floor and details of ~desuces b~inw the f~rst flOOr. C! Subdivision or other d~velopment plans (If the subdivision or other dc~lopmcut exceeds 50 lots or 5 acres, whichever i~ the lesser, the applicant must provide lt}0-year flood etevatioixs if they sro not othe~dse available). showing the extent of watercourse relocation and/or l_a,edlorm alteratious. Top of uew f'dt elevation Ft. ~qGVD 121 Floodproo£mg protection loyal (non-residential only) ~Ft. NGVD (MSL). For floodptoofed structures, applicant must attach certification from registered engineer or archlt~:t. Certif'gation from a registered engineer that the proposed activity in a regulatory floodway will not result in any inerease ia the height of the lO0-year flood. A copy of all data and calculations supporting this finding must also be submitted. SECTION 5: PERMIT DETERMINATION Cl'o be completed by LOCAL ADMINISTRATOR) I have determined that the propused activity: A. D Is B. 0 15 not in coafonnance with provisions of Local Law ~ ..... ,19 . The p~rmit is issued subject to the conditions attached to and made part of this permit. , Dx'rE I~]t.~.&.,ia~r~, the Local Administrator may issue a Development Permit upon payment of di:signated fee. If~O~.[~, 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 tbe Board of Appeals, APPEALS: Appealed to Board of Appeals? 1'3 Yes 13 No Hearing. date: Appeals Board Decision ~- Approved.'/ E3 Yes Cou~tio~.s_ APPLICATION 8 ,,, PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS fro be submitted by APPLICANT ~efore Certi~cate of Comollance h issuod~ The follow~g b~forma6oo must be provided for projec~ struc~urer~ This r~ction must be completed b.y a registered professional cnglnr~r or a licensed land surveyor (or attach a certir~ation to this appliCation). Complete ! or 2 b~ow. 1. Actual (As. Built) Elevation of thc top of ~h¢ lowest floor, iltleludln~ basement i t Areas. bottom of lowesl structural member of thc low~st floor, eaalucling-pillag aad columas) is: so~ lnolc~, Fr. lqovD (MSL). (8.95*-8.58*)---0.37' b::rp of bas.licit: scratch coat: (~ att~tched cfsrt:ifJ.caF. J.on) 2. Actual (As-Built) Elevation of floodproofmg protectio~ is, FT. NGVD NOTE: An7 work performed prior to submittal of the above information ia at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be comoleted by LOCAL ADMINISTRATOR') The LOCAL ADMINIb-i'K~TOR w:dl complete ~ sectlo~ az applicable based on h~pecfion of the project to en~uto compli~ce with the commuaitT's local law for flood damag~ prevention. INSPECTIONS: DATE BY DF,.r"'tC~CIES? fq YES C] NO DATE ~ BY ,, DF_J~ILu.PA~a~,,$? iD YES ~] NO DATE , , BY DF_,FICI~NCIF. S7 C] YES C] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be com~leo~4 by LOCAL ADMINISTRATOR') C~rtiflc~¢ of Compihncr k~ued: DATE: BY: . ' 195 Alexander Avet~Je t~;..,.' conset, New York ~11767 Phone (516} 724-4832 Fa× (516) 724-5455 ~'?. Feb. 22,1999 Town of $outhold Building Department Southold, New York Reference: Subject pm'cci h~cated in the Towa of Southotd, Suffolk County NY L, ). / 000-77-01-.07 S.C.T.M, ~: Gentlemen, This letter is to confirm the elevation of the existing residence located on the above cited parcel of land. The finished flo~;r elev~.~tion of the existing residence on the subject parcel is 8.95 USGS datttm. S/ncerely, John L tnd Su 'l ey#n t95 Alexander Avenue Nesconset, New York fY767 Phone (516) 724-4832 Fax (516) 724-5455 Feb. 22,1999 Town of Southold Building Department Southold, New York Reference: Subject parcel located in the Town of Southold, Suffolk County NY S.C.T.M. NO. 1000-77-01-07 Gentlemen, This letter is to confirm the elevation of the existing residence located on the above cited parcel of land. The finished floor elevation of the existing residence on the subject parcel is 8. 95 USGS datum. Sincerely, THE STATE INSURANCE FUND 199 CHURCH STREET NEW YORK, N.Y. 10007 (212) 312-7276 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ON ~ OWN AGAIN ENTERPRISES INC 99 SMITHTOWN BLVD SMITHTOWN NY 11787 POLICY NUMBER 1224 014-9 DATE 1/22/1999 CERTIFICATE NUMBER 230-494 PERIOD COVEREDBYTHISCERTIFICATE 1/09/1998 TO 1/09/2000 POLICYHOLDER ON MY OWN AGAIN ENTERPRISES INC 99 SMITHTOWN BLVD SMITHTOWN NY 11787 CERTIFICATEHOLDER TOWN OF SOUTHOLD 53095 MAIN ROAD SOUTHOLD NY 11971 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAilED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY NO. 1224 014-9 UNTIL 1/09/2000 , COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AB INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/09/2000 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. U-26.3 s'r .ACORD, CERTIFICATE OF LIABILITY INSURANCE 01/ 3/99BATEI 'BO' V PRODUCER NORTHEAST AGENCIES INC. 2495 MAIN STREET SUITE 209 BUFFALO, N.Y. 14214 INSURED ON MY OWN AGAIN ENTERPRISES INC. 99 SMITHTOWN~ BLVD. SMITHTOWN, N.Y. 11787 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI~ CERTIFICATE DOE~ NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA BLUE RIDGE INSURANCE COMPANY INSDEERB: ZURICH INSURANCE COMPANY INSURER C INSURER D INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY~XPIRATION GENERAL LIASILITV EACH OCCURRENCE $ 1 , 000 , 000 A X) COMMERCIALGENERALLIABILITY FIR~EDAMAGE(AnyoneEre) $ 50, 000 -- --] CLAIMS MAOE ~OCCUR CC 000299 12/02/98 12/02/99 _MEDEXP(Anyoneperson) $ '5,000 ....... P~-RSONAL&ADVIN~IUR~'-- $ 1,0Q0,000 GENERALAGGREGATR $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: P~RODUCTS - COMP/OP AGG $ 2 ,~0. 00 , 000 -- (Per accident) $ EXCESS LIABILITY EACH OCCURRENCE $ ~ OCCUR [] CLAIMS MADE AGGREGATE $ $ .... E L DISEASE - POLICY LIMIT $ B DISABILITY 1777571-001 01/01/99 12/31/99 STATUTORY BENEFITS LAW CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETrER: __ CANCELLATION BASILE FRANCA 1050 OAK AVENUE SOUTHOLD, N.Y. ACORD 25-S (7~97) 11971 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE TH E EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL i 5 DAyS WRI~rEN NOTICE TO THE CERTIFICATE HOLDER NAMED O THE LEFT. BDT FAILURE TO DO SO SHALL REPRESENTATIVEs.IMPOSE NO OBLIGATION OR LIABILITY OE~Y KIND· UPO77~NSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE IMPORTANT If the certificate holder ~s an ADDITIONAL iNSURED, the policy(ies) must be endorsed. A statement on th~s cerhficate does nc ~ confer r ghts to the cert f cate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such end?sement(s). DISCLAIMER The Certificate of tnsur~nce on the reverse side of this form does not constitute a contract between the issuing insurer(s), ~uthorized representative or producer, and the certificate holder, nor does it affirmatively or negative!y amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7/97) INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~JLATION [ ] FRAMING [ '/] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHP/LBG, [ ] FOUNDATION 2ND [ ~] IN~I~ATION~ [ ] FRAMING [ ~ FINAL [ ] FIREPLACE & CHIMNEY DATE 765-1802 BUILDING DEPT. ON 1ST [ ] ROUGH PLBG. [ ~"OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE~~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ],~JNI~ATION 2ND [ ] INSULATION FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~-~ ~.-~, 7G5-1,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ~]~AL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] ~.ATION [ ~"'rFINAL [ ] FIREPLACE & CHIMNEY REMARKS: INSPECTOR~~~ FORH HO. 1 TOWN OF $OUTUOLD TOWN IIALI0 SOHTIIOLP,, N.Y. I 197 I TEl.: 765-1802 APPLICATION FOR BUILDING PERHI'F BOARD OF BEALTII ......... : ..... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FOP. H ................... NOTIFY: CALL M. $.c.h.~. Kqb$~tein Draftec HAIl. TO ..................... 99 SmithtRwn ,B. lvd, Smitht~wn~ NY 1178 (516) 979-4018 INSTRUCTIONS a. 'Ibis application nust be conpletely filled in by typcn~riter or in ink and red,mitred to the l~dldlng Tnapector wi 2 sets st plarm, accurate plot plan to scale. Fee according to achedule. b. Plot plan sho~ing location of lot and of buildings on premises, relationship to adjoining premises or ix~blic ~treets or areas, and giving a detailed deacriptico of laycn~t of property ~mt be dravm o~ the diners, ddch la Imrt of ~hls appl icatioo. c. 'lhe v~rk covered Irj this applicatio~ ray oat be ccmnenced before issuance of l~fllding Pennlt. d. Upon .approval of this appl. lcatlo~b the l~ilding ~nspector will[ issue a lkdldtng Permit to the applicant. permit droll be,kep~ e~ the preadses available [or inspecti~ thro~ghout tl~ work. e. l~b building droll be occupied or used in r,/~ole or in part for any l~rpose ~hatever until a Certificate o[ Occupancy shall have bee. granted by tbe I~dlding Inspector. APPLICATIC~I IS tlg~lr/ M6~E to tbe lhsilding Department for tl~q, isanance of a 1/utldtng Pemit pursuant to the I~ildlng Zone ordinance of the To~ of Fx~thold, Suffolk County, 'lk~ York, and other applicable l.a~a, Ordinaries or Regulations, for the construction of hflldinga, additic~a or alterations, or for removal or d~olition, es herein deacril~l, lbe applicant agrees to ccmply ~ith all applicable l~e, ordinances, building code, housing code, and · (StBr~ture of eppiicunt, or name, if a corpo ati ) , " X! 79.7. (Hailing aalre~, of applicant) State d~etlmr applicant is ~ ~, >gg~% ~ ~S~c, gtn~eral contractor, General Contractor. Nome of o~ner of premises .B.a.s.~_.l.~...F.r..aQ.c.a. .................. : ......................................................... (as or, the tax roll or latest deed) If applicant is a corgoration, .ignaCure of duly antl~)rized officer. (Iq~e and title of corporate officer) ~ q050 ~k ~venue, Sou~old. ~ q~97~ . MAH~ ~A ~J~HOIM (Lo ~ lmid ~m flllug thla al~licatj~) If garage, ~t~timr of cara .... , ........ g. ...... ~.) ............. ,) 8 60*, Julv 29 1976 ~9r~rt.~d ~eltraud d er 14. ~ms of ~.r of pml~a ~i~ ~r~ca ~, ~ 4018 ·IF ~, ~ 1~ 1~ ~[~[l' ~Y ~ ~Jl~. PI.OT DIAGRAM. I~ate clearly a~' dlsti~rly pll ~[ldl~a, ~m~lmr ~lsring or pro~, m~ imllcara alt ~r-I~ dl~naiona See ak~ch~ p~s (lJ~l~ (J~ ...................... · Il ~ntractor I~ ia the ......................... .. ...................... ,.l ................................................. (C~ tractor, a~eut ~ cor~)rate~ off lee',., eke. ) oF amd (~r or ~mra, e[xl 1. &a[~ mLImrl~ to I~rfo~,, or I.~e lerfor,,~l Lhe ~1~1 ~k a,xl to .~ke taxi file this that th9 ~rk will la ~rfon~l tn t'lm .urn, mr ~t forth in Lite appl. lcattou ft]~l ' MIOHELE A. KE~NAN ,..19.~ .o1~i~o ' COI~ISULT YOUR LAWY~:R SEFOEE $ GNIN~, THIS ~S~UMENT~THI5 INSTRUMENT both uow ~e~id~E at No.1 Do. las Terrace,Woodcliff i~ Be~g~ Oo~ty ~ Etat~ oF New F~OA BASILE, now residing at 188 ~o~h~ie~d ~oad, Eauppa~e, ~folE Co~ ~d Etate of New ~o~k of thc part~ of ~ ~ond part lorevet, A~ the ~y of ~c fi~t pa~, M ~mplianoo with ~tlon 13 of the Lion ~w, ~ven~ that ~ pa~y of apply ~¢ same first to the paymenl of tb~ cost of the improvement b~fo~rt of th~ ~tal of th~ party o! tlao second part, WITNESSETI~ thee the par;y of the f/~st part, in consideration of T~n Doll. at/: and Other valuable ~idomfion paid by ~c pray of ~e socond part, does hereby g~t and relo~¢ ~a~ th~ p~ty of the ~nd p~* ~ho he~s or suco~oa aaa ~igns o o par~ of ~ ~n..~ . an orevet, ALL ~at ~t~ia plot, pi~o Or p~cl of land, wi~ ~e buildlags sad intpro~m~m~ ~ereon erectS,' $1t~- , ate, ly~g and being i~ at Southold~To~ of $onthold~Oo~ of B~fo~ ~d ., Bt~te of New York,~o~ ~d desi~ated as ~d by Plo~$ No~. ~0!,' 302 ~' ~O~ om a certain map e~itled, "~p of Goos~ Ba~ Esta~em" in' the ~o~ of ~tkold, Suffolk ~o~ty, New york; a~id map ~e~ ~de by~ Le~s N.Waters, L.~. of ~ster Bay, LOng Island, New Tork, dated sepmember lB,~ 1~ ~d fil~ ~ the Office of ~he Ole~k of the of 8~folk o~ th~ 1Bth day of Novembe~,iOB~, as a~d ~ the Map No. Ii~. Being and in~ended to be ~e s~e pr~ses w~eh were eo~ve~d to the~ pa~t2 of th~ first p~t ~y Deed fr~m ~ch~d H.Bedd~ ~d Ethel O.Red d~, his ~fe~da~ed May 12, I~2 ~d ~ee,~ded ~ .Liber ~1~1 0p ~?0 ~ May t7~1972. · ' "" ' ' ' ,'~ " 8~ECT to. a certain mor~g~a m~ae ~ tDe..partZ o~ 'tbs fir~% par~ ~o ' THIR~ ~0~' ($BO;00O~00) DOL~8, no~ re~qed t9 T~ 8~ ~OOS~ ~X~~ ~0 ~ ~ ~a' ~7/~. (~k~,¢V) ~L~S.,~ ~.. inte~e~t ~t t~e ~ate of s~vm ~d ~e~ (7~) per C~' pe~ ~- n~; dat~ Hay 13',1972 ~ rgcorded~ the ~ty Olerk~S 0ffiee, 8~folk OO~, ~ LiberJ~$~mp ~ ~ ~ /~ 19~2, ~ the p~ty of the second p~t here~ ~ree$ mo a~s~e ~a pay the $~e aa p~ of the consideration of ~ convey~ce. STATE OF NliW ¥OlLK, COUNTY OF O~ th~ day nE 19 ,betore; me ~rsonatly came to me known, who, bei~g by me duly sworn, did depose and say that he resides at ti~ he is ttg , the co~por~tion described in and which e.x,~-uted kuowa ~c ~t ol ~id cat.ration, t~t thc ~at amx~u ,o maid instrument is such co~r~tC seal; th~tijtc~s lion, and that he ai~ed h Off t~e a~y at {9., , te{~e to mc ~OWn tO ~ ~c ~vid~ ~ribcd ia and w~ ~uKd th~ fo~g~ng ~ ~A ~q~wlc~c~ that ~mo~]ly came to me known, who, ~ing by mc duly SWOrn, diB d~ ~ say that he re.idem at ~o. th~ h~ is tk~ o[ , the ca~mfi~ ~gn~ knows thg s~[ of sald ~r~rat~; t~t t~ ~t ~glx~ to ~id instrument is auch ~oratc sc~; t~t. R ~s t on, ~d th~t hc 5tg~u~ h . ~c ~0 ~Y ~c o~. FRANCA BASILE YORK BOARD OF TIS'LE 6UARANTIEED TITLE DIVISION i Town of Bouthold · 1~00 Main Street ' port ~efferaon~New York LA N N JOINS PANEL 0167 ' I