HomeMy WebLinkAbout25069-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27222
Date: 08/02/00
THIS CERTIFIES that the building ACCESSORYL
Location of Property: 4000 WUNNEWETA RD
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 111 Block 14
CUTCHOGUE
(HAMLET)
Lot 22.1
Subdivision Filed Map No. __ Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 29, 1998 pursuant to which
Building Permit No. 25069-Z dated JULY 29, 1998
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE IN THE REQUIRED
REAR YARD AREA AS ApI.I~D FOR.
The certificate is issued to DOMINICK SEGRETE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-470860
PLUMBERS CERTIFICATION DATED N/A
11/09/98
ut-o/rize~Slgnature
Rev. 1/81
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F
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. 25069 Z Date JULY 29, 1998
Permission is hereby granted to:
for :
CONSTRUCTION OF AN ACCY
DOMINIC,, SEGRETE
106 NEWMARKET ROAD
GARDEN CITY,NY 11530
IG POOL WITH FENCE TO CODE IN THE REQUIRED
YD AREA AS APPLIED FOR & PER TRUSTEE~ZBA & DEC. DECK TO BE AT NATURAL GRADE.
at premises located at
County Tax Map No. 473889 Section 111
pursuant to application dated JUNE
Building Inspector.
4000 WUNNEWETA RD
CUTCHOGUE
Block 0014 Lot No. 022.001
29 1998 and approved by the
Fee $ ].50.00
Building ~s~e~t~4~
ORIGINAL
Rev. 2/19/98
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~.' ~BLP~LIGATION FOR CERTIFICATE OF
This application must be filled in by typewriter OR ink
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~ Cem~ercial building, industrial building, multiple residences and similar buildir
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 Ap~il 9, 1957) non-conforming uses, or buildings an
"pre-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.
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 Qccupancy on Pre-existing Buildin~ - $100.00
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
Date. p..~.~.'. ~ ....... .i~i.I .......
New Construction ........... Old Or Pre-existing Buildmng....~..~.l..~..~.~
Location of Property ~ ~ .~~. ~ ~~ ·
House No. Street Ha~et
Onwer O~ers of Property ~e~/~ A ~.~. · ·
' .4
~ounty ~ ~ap ~o lO00, Section ........... Block ............. Lot ..........
Subdivision .. . Filed Map .. Lot ..................
Permit No....~.~.~.~J~.%~.Date Of Permit...~.%~.'.~ .... Applicant.~-~.~z~~..L~
Planning Board Approval.:~...~[..~.~.~..~ /~ ~ /~r~ /'~'~7~
Request for: Temporary Certificate ........... Final Certicate .... ~ .....
Fee Submitted: $ ..................... , ,
APPLICANT
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (5~6) 765-1823
Telephone (516) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
July 6, 2000
Dominick Segrete
440 Ninth Ave.
New York, NY 10001
~E~7085 ~ons Lan~outhold/'-~he chec~ou o~ginally
subm ted stal d. P submit ew eck.
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX
The check is (not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file,
(All permits involving plumbing being
issued after April 1, 1984).
Please contact our office on this matter, Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ~..~TION
[ ~']'*'FI NAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ,~
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ROUGH PLBG.
[ ,]/~ULATION
[ ~ FINAL
[ ] FIREPLACE & CHIMNEY
DATE ~~ INSPECT
765-1802
BUILDING DEPT.
INSPECTION
]FOUNDATION 1ST [ ] RO~G~J-PLBG.
] FOUNDATION 2ND [ ~ISULATION
] FRAMING [~/] FINAL
[ ] FIREPLACE & CHIMNEY
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1185077 BUREAU OF ELECTRICITY
.: ~- 40 FULTON ~TREET~ NEW YORK, NY 10038
Date NOVEHBER 09,1998 Application No. on file 16696898/98 l'l 470860
THIS CERTIFIES THAT
only the electrical equipment ~ desc~bed below and introduced by the applicant named on the above apRlica~on number is in the premises of
DOHINICK SEGRETE, 4000 WUNNEWETA ROAD, CUTCHOGUE, NY
in the following location; [] Basement [] 1st Fl. [] 2nd Fl. OUT Section Block
was examined on I~OVI~}~BRR 05,1998 and found to be in compliance with the National Electrical Code.
Lot
FIXTURE R
OUTLETS
2~
DRYERS
SERV,CE D,SCONNECT
AMT, AMP. TYPE EQUIP.
OTHER APPARATUS:
· 2 24
FURNACE MO~ORSF I FUTURE APPLIANCE FEEDERS
S
SH/g~4ING POOL & YARD LIGHT-1
SPECIAL RECEPT. bYIP. 20-1
a(SWI}~4ING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
environments it is advisable to
1Yarc freoblent test/and or repairs
made by a qualified person.
<<< Continued on Page 2 >>>
RANGES
MT· K.W.
~PECIAL REC'PT.
AMT. AMP.
I 20
R
OF CC. COND.
TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET
AMT. AMPS. TRANS. H.P. NO. OF FEET
3 ~0
V I C
NO. OF HI-LEG OF HI-LEG
EXHAUST FANS
AMT. H.P.
DIMMERS
AM?, WATTS ,
NO. OF NEUI'RAL$ A. W, G.
OF NEUTRAL
GENERAL MANAGER
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·
THE NEW YORK BOARD OF FIRE UNDERWRITERS
11~5~77 BUREAU OF ELECTRICITY
V 40 FULTON STREET~ NEW YORK~ NY 10038
Date NOVEHB~R 09, i998 Application No. on file i6696S98/98 N 470860
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
DOMINICK SEGRETE, 40~O WUNNE~TA ROAD, CUTCHOGUE, NY
in the following location; [] Basement [] 1st FI. [] 2nd PI. OUT Section Block
was examined ott NO~E~ 05,1998 attd found to be in comp/lance with the National Electrical Code.
Lot
FIXTURE
OUTLETS
DRYERS
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
FLUORESCENT OTHER
IULTI-OUILET
SYSTEMS
NO. OF FEET
E R I C
NO. OF CC COND. A. W, G. A.W.O. NO. O{= NEOTRALS A.W. G,
OTHER APPARATUS:
ROSLAKELECTRIC
P.O.BOX 164
CUTCHOGUE, NY, 11935-2453
LIC.#3677E
GENERAL MANAGER
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.
:OUNDATION (1st)
FOUNDAT. ION
2.
(2nd)
ROUGH FRAME &
.PLUMBING'
INSULATION PER N.
STATE ENERGY
CODE
COMMgMT£
FINAL
AD]ITION~L COMMENTS:
_ TQXt, INt ,OIC SDUTblOLp,..I~M.'
!
I.
FORM NO. 3
TOWN OF SOOT~OLD
BUILDING DEPARTMENT
SOUTHOLD, N.Y.
HOTICE OF DISAPPROVAL
DATE: April 9, 1998
Dominick Segrete
.J06.~¢~.~rg~g.gg~ ............... .. ...
Garden City. New York 11530
PLEASE TAK~ NOTICE that your application dated .~t.7[h 97
for permit to ~pp~ll an inground pool and deck addition
Location of Property . ~000 ... Wunneweta Road ......... C~[chogue .....
House No. Street Hamlet
County T~x Map No. 1000 - Section Ill BLOCK 14 LOT 22.]
Subdivision .................. Filed Hap No .......... Lot No .....
is returned herewith and disapproved on the following grounds ..........................
~y. 3~Xi~..~.jA.199:~)y..~3.,' ~)~..b.~i)~.n~.jp.~. S~. ??. ~?~?~?~. P?~!.~ .........
similar structure exists ay~ y~.~ck are adjacent to tidal water bodies other
Action required by the Zoning Board of ~ppeal~..
RV 1/80
88:35 2i26293907 TSR CONSULTANTS INC PAGE 02
Town Hall, 53095 Mare Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
In order to issue a Building Permit for your proposed
construction for buildings located on lots adjacent to tidal
water bodies, fresh water wetlands, we will need a waiver of
jurisdiction or a permit from the DE~.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Building Inspector
Phone numbers:
DEC - 444-0360
DOMINICK L. SEGRETE, A,I,A., Al:ICI-lITE:CT
titiO NINTH AVENUE NEW YORK, NEW YORF, IOOOI 21~-(529-39OO
July 8, 1997
Board of Town Trustees
Town of Southold
53095 Main Road
Southold, NY 11971
Re: 4270 Wunneweta Rd.
Cutchogue, NY
To: Board of Town Trustees
My family and I respectfully request a waiver for the installation of an 18~x 36' pool as indicated
on the enclosed survey. Please note, that the bulkhead is maintained and in go/Sd condition. The
pool will be situated as far from the bulkhead as is practical to our site condition.
We also understand that a permit from the Town is required and it is our intent to comply with all
Town laws and regulations regarding this type of application.
truly yours,
Dommlck L. Segrete', A.~.A v
Tuccl, Segrete & Rosen Conspltants, Inc.
440 NINTH AVENUE
NEWYOSK, N,Y, 10001
AMOUNT
1-148/2t0
1999
PAY
AMOUNT
OF
6PENNPLAZA NEWYORK, N.Y. 10001
"'O 1, qqq i,,' ~10 2 l, OO I, h.q E~:
07/22/1998
08:35
2126293987
UCCI
TSR CONSULTANTS INC
..... ~. ~., ~ ~,t...~;,~ ~ .......... ,
PAGE
SEGRETE & ROSEN
Town of Southold
Town Hall
8outhold, NY
Dear Board Membem:.i~
The attached partial Site Plan/Survey should ~tl,fy the queMlofl of lot
The method of calc~etlon ~ cootdtnate~ ~ld seot to bit. Oary Fish, see attached
I hope this will put a~ide the lot cover issue and allow my application for a pool varlence
go befoi~ the Board June 11, 1998.
~Vm-? truly yours,
DLS:ve
07/28/1998 10:42 2126293907 TSR CONSULTANTS INC PAGE 01
TUCCI SEGRETE & ROSEN
July 28, 1998
Mr. Mike Verity
Town of Southold
Building DepsrUncnt
Office o£thc BuiMing Inspector
Town Hall
Southold, NY 11971
Re; 4270 Wunneweta Koad- Pool Application
Dear Mike:
Thank you for spend time with me last Friday. Our pool application has been long in thc
making, hopefully we are in the home strctch.
Just a reminder, as mentioned during our meeting, I would bo willing to set thc new 480
Sq.Ft. deck on grade and construct it in masomy. Doing this would reduce thc total lot
area coverage to 3353 SF. well within the allowable of 3854 SF.
Again thanks for your help.
President
Albert $. Krupski, President
1ohn Holzapfel, Vice President
;Jim King
Martin H. Garrell
Peter Wenczel
Town Hall
5~095 Main Roafl
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
July 31, 1997 ,.
Dominick Segrete
106 New Market Road
Garden City NY 11530
RE: SCTM 9111-14-22.1
'Dear Mr. Segrete,
The following action was taken by the So~thold Tow~ Trustees on
Wednesday, July 30, 1997, at their Re~lar Meeting:
RESOLVED, that the Southold Town Board of Trustees grant a
Waiver to construct an 18' X 36' pool as indicated on survey,
and place dr~well and backwas~ landward of pool.
This approval does not constitute approvals from a~y other
agency.
If you have any questions, please feel free to contact our
office at 765-1892.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. Bldg. Dept.
~ 0~/22/1998 89.' 19 51624841~3 SEGRETE PAGE
~ 07/22/1998 89:19 5162484123 SEGRETE PAGE 03
New YOrk .State Department of Environmental Conservation
Division of,Environmental Permits
Building ~0 -,SUN¥, Stony Brook, NY 11790-2356
Phon~ . (616~ x.x.~.-e366
Fax # (516) 444-0360
Comm/~sioner
March 26, ~998
Mr. Dominick L. Segrate
106 New Market Road
Garden City, NY 11530
1-4738-00951/00002
De~r'Permittee;
In conformance with the requirements of the State uniform
Procedures Act (Article ?0, ECL) and its implementin~ regulations
(6NYCR~, Part.621) we are enclosing your permit, please read all
Conditions carefully. If you are unable to comply with any
conditions, please contact us ak the above address.
' ' Also enclosed is a permit sign which is to be conspicuously
,pOsted at the project site and protected from the weather.
.. Very truly yours,
... '.. Margaret M. Rorke
EnvironmentalAnalyst
anti, sure
icj 5162484123 SEGRETe PAGE 84
0~/22/1998 5162484123 SEGRETE PAGE
09:19
85
~ '0~/22/1998 09:19 5162484123 SEGRETE PAGE
r'~C PERHLT NUME£R
I 1 -~T~$-OOg51/QOOOZ
IFAC[LITy/PROERAH NUHB£RCS)
I iTYPE DF PERHIT · Ney
Article 15, T~tle 5: Protection
of Waters
~ Article 15, Title 15: Long
[] krtia[o 15, Title ZT: Wild,
Gcenic and Retreat(oriEL Rivers
~DRE$S OF PE~ZTTEE
_Garden City~ NY 11530
C~TACT PEESON me PER~ZTTED ~K
NEW YORK STATE DEPARTMENT OF E#VIRONMENTAL CONSERVATION
Same ss abovq.
NAHG AND ADDRESS OF pROJECT/FACiLITY
Segrete Property
LOCAT[~ OF'pROJECT/FACZLLTY
Cutchosue~ NY 11935
COUNTY .
Suffolk
Pi IT
Under the Environmental
C~setvatio~ LaW
rq Modification 13 Permlt to Censtruct
6NYCRR 60&; Water auaLity
Certificstian
Article t9: A{r Poilu[lee
Centre[
~ Article 2], Title ZT: ~tn~
~ Article ~= Freshuater getLa~s
Article 25: Tidal Wetlands
iEFFECTIVE DATE
March 26, 1996
EXPIRATION DATE(S)
flarch 31, 2001
ITOWN 'l gAT£RCOURSE
Sou[hold gunneweta .Pond
DEgCRIPTION OF AUTHORZZED ACTZVIT~
~3 Article 27, Title 7~ 6NyCRR
~60: Solid ~aste ~snsge~ent
O Article ~7, Ticte 9; 6NYCRR
Hazardous Waste Na~ase~ent
Articles 1, 3, 1T, 19, gT, ~7;
6~YCRR 380= Red{alien Con[ret
ITELEPHO~E NUMBER
(212) 699-$900
ITELEPHO~G ~UMBER
INYTN COOEDINATES
Construct in:ground suiming pool.. ALl work to be done according to NYSDEC staatped approved plan.
By a~ce~tance of this pemit, the perm([ten agrees that the permit is contingent upon strict compLian;e with the
ECL, alt applicable regu[ntlons, the ~anerat Conditions specified (ecs page 2) and any Special cendttionB included es part of
this permit.
I
George W. Ha,n~arth ~HR aids. &o, SUNY, Room Z19, Stony Brook, NY 11790-2356
Maroh 26, 19~ Page 1 of ~
)b'
'/
87/22/1998 88:35 212629398?'
TSR CONSULTANTS INC
87/22/1998 88:35 2126293987
TSR CONSULTANTS INC PAGE 85
APPEALS BOARD MEMBERS
Gerard P. Goehringer, Chairman
James Dinizio, Jr.
Lydia A. Tortora
Lora S. Collins
rge Homing
Southold Town Hall
53095 Main Road
~BA F~ (516) 765-9064
Telephone (516) 765-1809
BOARD OF APPEALS
TOWN OF SOUTHOLD
FINDINGS, DELIBERATIONS AND DETERMINATION
MEETING OF JUNE 23, 1998
Appl. No. 4568 - DOMINICK SEGRETE PARCEL 1000-111-14-22.1
(formerly 21 + 22)
STREET & LOCALITY: 4000 Wunneweta Road, Nassau Point Club
properties, Cutehogue
DATE OF PUBLIC HEARING: June 11, 1998
FINDINGS OF FACT
PROPERTY FACTS/DESCRIPTION:
The subject property is located along the westerly side of Wunneweta
Road, at Nassau Point Club Properties, Cutchogue. The parcel
consists of a total lot area of 19,274 sq. ft. to tie lines along
high water. The September 29, 1989 survey submitted by applicant
shows an existing single-family dwelling located at 15 feet from the
front property line and 15+- feet from the southerly side property
line, at the closest points. To the west is the highwater area,
bulkheaded in part. Timber walls and blacktop areas exist at the
promises in an approximate northwest location.
RELIEF REQUESTED:
Applicant is requesting a variance from the bulkhead setback
provisions for a proposed 20' x 37' inground pool with an extended
deck area at the rear of the dwelling. The Landscape Design Plan
and survey sketch shows the setback proposed at 33 feet at its
closest point from the b~lkhoad and at 48 feet from the most
southerly point (highwater mark) along Wenneweta Pond.
BASIS OF APPEAL: Zoning Code, Article XXII, Section 100-239.4B,
based upon the Building Inspector's April 9, 1998 Notice of
Disapproval, disapproving a building permit application for an
inground pool and deck addition due to its proposed location within
75 feet from the b/~lkhead, concrete wall, rip rap or s~r.~lar
structure.
REASONS FOR BOARD ACTION:
In considering this application, the Board finds that a variance to
allow construction of the proposed pool and deck with a minimum
setback from the bulkhead of 38 feet is the minimum necessary and
adequate and at the same time will preserve and protect the
Page 2 - June 23, 11998 Meeting
ZBA Appl. #4568 - DOMINICK SEGRETE
Parcel 1000-111-14-2,2.1
character of the neighborhood, and the health, safety and welfare of
the community. ~
1. Grant of an ar~a variance will not produce an undesirable change
in the character pf the neighborhood or a detriment to nearby
properties. The applicant has provided a landscape plan to address
neighbor's concern~ that should provide suitable buffering. No
other impacts are a~ticipated.
2. The benefit sot~ght by the applicant cannot be achieved by some
method, feasible fqr the applicant to pursue, other than an area
variance because the property is triangular-shaped and no other
sites are available that are conforming.
3. The variance granted is substantial and represents a
reduction in the co~e required 75 ft. minimum setback.
4. The difficulty has been self-created and relates to the
applicant's desire t~ build a pool and deck.
5. The proposed ~arianoe will not have an adverse effect or impact
on t.he physical or envlr, onmental condltlOn~, in the neighborhood or
dis%r~ct because t%e nmghborhood properties are wooded and the
applicant has agregd to condition approval upon a landscaping plan
that will help buffe{ the pool from adjacent .properties.
RESOLUTION/ACTI~)N:
On motion by Member Collins, seconded by Member Dinizio, it was
RESOLVED, to DENY the 33-ft. setback as requested, and TO
GRANT THE FOLLOWING ALTERNATIVE SETBACK RELIEF:
1. Pool at its closest point to be a minimum of 38 feet from the
bulkhead and a ml~mum of 48 feet to the highwater line.
2. The deck shali be cut back to be 'in line with the existing deck
and approximately ~5 feet from highwater line.
3. Applicant sha~l provide landscaping pursuant to a landscaping
plan, similar to th~ plan submitted June 17, 1998.
VOTE OF THE BCARD: AYES: MEMBERS GOEHRINGER, DINIZIO,
TORTORA, COLLINS, and ~OR~ This Resolution was duly
adopted (5-0). ~~
~ERARD P. GOEHRING ,
******************~ ***/' Approved for Filing
11114-22.1/111-14-; 2.1
FORH NO.
TORN OF SOUTIIOLD
BUll.DING DEPAE'FNI~NT
TONH IIAI,I,
S011TIIOI,D, N,¥. 11971
TEl.: 765-- 1802
BOAIU) OF III,;AI,TII
3 SETS ()F I~LANS ...............
SURVEY ........................
CIIECK .........................
SEPTIC TORN ........ ; ..........
NOT 1 FY:
API'I,1CATION FOIl BUTI.I)IH(; PF. IIHIT
I NSTIIUCT 1 OHS
si. 'lhi,'; aFI)/icatlo~s ~r~mt De coal~letely filled in hy tyl~a,n-iter or in ink taxi ~M~nil:t~l lo the l~ihlini1 hml~C~or wiH~
3 ~ts of plans, acca~rate plot plan Io scale. Fee occordi~ to schednle.
' b. PIoL plan ~J~ing l~ati~ of lot arxl of IxHldi.ga on pronises, relationship to mljolning prenises or ixfl~llc
si r~ts or areas, ar~l givlr~ a ~l:ail~l descrlpt
this appl icati~.
c. 'lhe ~rk e¢~r~l by this al~lication v~zy ~x~l. I~ c¢mne~:ed Ira, fore issuance of IhHldln8 Permit.
d. UlXm al~n~al of this a~lical:ion, the l~il¢lin~l lnsl~etor will issue a IkJilding Permit to lhe applica,I. ~ch
l~rmit ~all I~ kept ¢m I1~ pr~i~s available For inSl~CkJCm tl.¢x~¢~l: the x~rk.
e. ~) ladldi~ ~tmll I~ ~ca~pi~l or u~l in ~ole or in l~rt For nny [Xll'lg)~ ~mtever until a (~rtiflcate o~
(k'¢~tll~n~'y ~amll have I~n Rrant~l hy tim I~Hlding h~sl~Cl. Or.
/~.APIq. ICATI~ IS IEI~I~ ~!~ to (he Ih,ihllng l~l~rtnenl] For the iss.n~:e of a ~]ihling Pennlt i~Jrmmnt to the
~lk~ildlng 7~e Ordi~qrx:e of tl~ 'l'a~t oF ?~ttl~ld, ~ffolk (xamty, ~ York, mxt olher aR~lleable l~s, (hdlnm~es or
~l~gulal:iems, for tie cemstn~tia~ of laHIdi~s, mklltiex~s or alterations, or For ~al or ekaolitlon, as herein
¢~Nilxx1. '11~ applicant agrees to
rel~daEi;ona, a~l to ~lult autl~rlz~l insl~etors ¢~t ln-~nises asxl in I~Hlding for ~cessa~ insl~cl lotto.
(Silp~tt,e of applicalll, or ~.ne, if a corl×)ral ion)
(Hai li~ ~Mre,q.s oF appllcant)
"IMMEDIATELY"
ENCLOSE POOl. TO CODE
UPON COMPLEflON
BEFORE "WATER"
StaLe ~d~ether applicant ia (~.~er, i le.~s~, egent, architect, enp, ineer, genera! contractor, elecl, r|cim~, ph~dxar of laHIder.
............................. .....................................................................
(aa (~'~ Ihe Lox roll or latest de¢~l)
1f appliennt is a eorl:orati(~l, sj, Rnature of duly autl~izx~l officer.
(l~ne and title of corlx>rnt'e officer)
OI ]PANCY OR
,~, i l,,ers l.icens~ 1%.. ,/o~.././~ Z~..C/.//..-~.~"~. .... I ISIIIlLAWFU L
,'~,.,~.~. ~.i,.e,,.~ .,, .......................... IRTHOUT CERTIFICATE
Fleet riel;. ; 1.1cen.qe I% ht I~l/S/MliSjilU~/ SECOMPLETE FOR C.O.
.......................... Vr ~r~] ALL CONST~TION .~HALL MEET
Other 'l'r;Kk~'s l,iceu~ ~) ..................... THE REQUIR~ENT~];~F THE N.Y.
r ~ ,~ ~ ,c~ x,~ ,~ <. ~ ~ <,,~ STATE C~:~CTION & ENERGY
~ ~ CODES.,~'Y, ~ESPeNS~LE FOR
.... ....... ...................... ..................
Ikx]~ ~.li~r ,,)treet'
c~,,,~y 'r,~ ~,p ~. ,~ ~,.i,,, ../fi/ ......... ,,~ ...Z~. ....... ,,~ .~X~ ....
(~m)
State exisl lng t]~ asxl ~:cul~]~:y of pr¢~nises m~] inte~lc~l use a,xl ~x:tl~lr~:y of pro~d c(amtn~ckion:
~. ~;~i~, i,,g ,,~, ,,,~ ,~,~,~.,~.y . .~..g~ ..........................................................
UNDERWRITERS C~IRCA~
REQUIRED
5.
I0.
)2.
Iix:ill(~. clem-I? mvl di~l:i~r:t'ly n!l Ixd.hli~t*. ~he. llsor e×ial:ing ()r propom~d, m~l |itdlcme nil ~et-lmck dhl*~n, inn,~
'i
'()rlx)r.¢o, ()llli('(:l , ri::.) "
l~,uyor rieL I{~rlh in Iht.. nppl Jcnl ion l i led thmc-~ith,
(',H{,I,H lJi e :)I ^ppi l( lJlll )
,I
OlOH.LfIO$ :JO NN~OI
POINT.