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HomeMy WebLinkAbout24709-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26366 Date: 04/12/99 THIS CERTIFIES that the building NEW DWELLING Location of Property: 655 KAYLEIGH'S CT EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 4 Lot 16.10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 9, 1998 pursuant to which Building Permit No. 24709-Z dated FEBRUARY 24, 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 ONE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE-FRONT & REAR PORCHES AS APPLIED FOR. The certificate is issued to BRUCE & SHIRLEY SIEVERMAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-97-0178 04/07/99 ELECTRICAL CERTIFICATE NO. N480719 02/23/99 PLUMBERS CERTIFICATION DATED 04/10/99 ROBERT VANETTEN Building Spector Rev. 1/81 1, 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. 24709 Z Date FEBRUARY 24 98 Permission is hereby granted to: B. SIEVERMAN A/C D.DUNNE 2175 PINE NECK RD SOUTHOLD,NY 11971 for CONSTRUCT NEW 2 STORY SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE & FRONT PORCH AS APPLIED FOR. at premises located at KAYLEIGH' S CT EAST MARION County Tax Map No. 473889 Section 031 Block 0004 Lot No. 016 . 010 pursuant to application dated FEBRUARY 9 98 and approved by the Building Inspector. Fee $ 990 . 00 Building Inspect ORIGINAL Rev. 2/19/98 I0R Q d E Form No. 6 ��yU� � Ua , ri1 TOWN OF SOUTHOLD � APR _ a BUILDING DEPARTMENT TOWN HALL SLOG-DEPT. 765-1802 TOWN OF SOUTH04D s 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings 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. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - .25¢. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 \,X Date . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . New Construction. .. . . . . . . . . Old Or Pre-existing Building. . . . . . . . . .. . . . . . . Location of Property. . . . . . .. .. . . . . . . . . .. . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Streets( Hamlet Onwer or Owners of Property(//., ..� �%: .. . . �!?? 7 /• . , , , . • • , , • , • , County Tax Map No 1000, Section. . . .3 1 . . . ...Block. .. ®. .. . . . . .Lot. . . W . . . . . . . . . . . . . Subdivision. I�� zl� . Y.:�.a s. . . . Filled Map. . . . . . . .L,oJt. . . . ./. . . . . . . . . . . . . . . . Permit No. . . /��! . . . .Date Orf P/ermit. :.: . l. . . .Applicants ' T /� Health Dept. Approval. . . ... . .. .. . . . . . . . .. . .. ..Underwriters Approval. . . v• • . . . . . . . . . . . . • • • • • i Planning Board Approval. . . . . . .. . ' .. . . .. . . . . .. .. Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. !. . . . . . . . Fee Submitted: $. . . 112�5.: . . . . . . . . .. . . . . . . . . QQ�.2c. rSY 09 rte. . . . . . . . . . . . . . L-o Z a 6 3�G PLICANT pi`s a 1 APR 121999 �cuFFO(k�oGy BLDG.DEPT o= TOWN OF SQId ni s�n�5 Main Road y Z Fax(516)765-1823 P. O. Box 1179 • Telephone(516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N / DATE: Building Permit No. 17 / 7 9 Owner,: S I ey e- O r) (please print) � 1 , Plumber: kO b e r� VOl r\E++ 1n (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day ofr( 1991 Notary Public, Ik L:� County MELANIE DOROSKI NOTARY PUBLIC,State Of New York 01.1)U 4624870•Suffolk P.numtty Commission Expires glia�wt�u APR 7 1999 �A yLG�/G.G/3 C4U.E'T Au1folk Co.Dept atH83 rvices Environmental Pro n `.So�ZD / •Q4� t� � ��" C�FeoC ��g> D lAIyDB x r � 41. LEk r o o p N � `_--- DR MEW YoP ak�r�y �ovai—il � L .m.........._ .a.. 9P �~ � ice. � 4i V l) Ll iJ [ry�, Cfi yy U a' *044 ; �, t3 ,.y p a: tj it N% fat TT J s.:; ,s c: V) 9TI N/ (/i1//aN CiL�EE ✓G%GL�!O��IT. ' Z a' �veY6y�oe•B.Q!/CEs�J�.t'/•L'GFy�/6�E.eMdi'rS/ ANT.yO1OV 41.Ze#V,4NZ7l0A ?�t''/' Gar• �/Ylg/>o.�'/�i�.s�,oaivr wc�oc5 LiONo,�J.6'i�BY+9� P.O.6fox�/�/B /Ocg�iay. �i�f7�&A'I,aV Tar✓_.YOva-4oa///aay, r....,_...)�/� VGE�JH/rk°L�`y✓/�✓E>L'L'�1rS'N,l'�L- 117 f,.,+11�F..�t�/L/i(/6 r'�/T.�J �fi�iio�rt .i7.u/) p.0 /�$/GM✓ ¢�VNN/hEVIJWGi.9C7H�A'rJV�%T[E Or4/flrJ.�.!!CE'CD 4Y45 ��F'i✓Dd��JE�e/��97�i/�l.+�T/J/9�� F.vr�Laernaufe�zuveYiz 1999 /Oaa-3/Gar//�)/a 1, �'iallry 08E0 lAhO �ic9P TKG � 8G LEWq 94 "_r 1 ti0 OL s N Ot vEw y * Q ti Vi N _ DR IV E W Y DPS b S—UF=COL&TPY DEPARTMENT OF HEALTH SERVICES N DooG - - PERrdrr FIDE APPROVAL OF UCTION FM A v a oSOMLE FAawn y wmmzmcz ONLY N'CtL )DA111 1 _tf/ - -0/7 APPROVfiD �.v. p FOR MANMUM OF B 0 N% PLEASE NOTE E anm THREE YEARS FROM DATE OF APPROVAL Minimum dista��e betWeen Well and cesspool I�`to be 150 feet. 25 Received Suffolk County IV16 -56,06W "g,0-:5 NOV 2 5 1997 N�`T!/N/GN /=SEE aChG O/aT. � Opt. Of Health Services lice of Wastewater Mot . I, }` �ueverr.�oe•B.eacF��hr.Q�.siEVF,e�.��y ,t An�rNorvyKi.L�'�•t'A.v�xJw.��t'i' Lor• /YJrf'/Ja�/�iG,yooivr Yf�G�o%.'S LA/VO." VeYAFI2.e .o0.6�ax��B �ocrrrav �:�er..�/.�,e�ot% Tvrriyo�.�ourvoaa./t/Y, .?�xiT.1/4t0 NY.//9�/ Lemorandum To: Southold Building Department From: Homeowners Date: 03/30/99 Re: Driveway and lawn Shirley and Bruce Sieverman owners of 655 kayleigh's 41, All Caurt, East Marion, do hereby release Dan Dunne as ia�r of the responsibility of putting in the driveway and �laivif,' , _sWe will be responsible for having the driveway and �layn done. �f,a,: t``j, `RMAO MOTWHIROACM NOTAIVY PUBLIC,$tate of Now Yore 5County WhmissionExp es, March 10, Z®� Lemorandum To: Southold Building Department From: Homeowners Date: 03/30/99 Re: Driveway and lawn Shirley and Bruce 5ieverman owners of 655 Kayleigh's Coo rt, East Marion, do hereby release Dan Dunne as ild r of the responsibility of putting in the driveway and lurrt. y�s,We will be responsible for having the driveway and ` thIr�vn done. 05 4" �SZ44941V t99 jA NQTA�PLUM OTSCHENRACN611 NO.52-4854401 . Naw Yom Suffolk County OMEN= a6mmissioo Expires. March 10,1Wjj- -C ( M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLAC A CHIMNEY REMA KS: 6) t �2 9427 G DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO GH PLOG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING ( ] FINAL [ ] FIREPLACE & CHIMNEY � REMARKS: DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1195099 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date FEBRUARY 23,1999 Application No. on file 16175798/98 N 480719 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 MR.& IIRS. SIEVERI4AN, 1r.AY LEIGHS COURT, EAST 14ARION, NY in the following location; ® Basement ® 1st Fl. ® 2nd Fl. GAR/ATTIC/OUT Section Block Lot was examined on FEBRUARY 18,1999 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENTI FLUORESCENT I OTHER AMT. I K.W. AMT. I K.W. AMT. I K.W. AMT. K.W. AMT. H.P. 46 63 74 42 4 4 1 F DRYERS FURNACE MOTORS FUTURk APPLIANCE FEEDERS I SPECIAL REC'PT. TIME CLOCKS I BELL I UNIT HEATERS MULTI.OUTLET DIMMERS SYSTES AMT. I K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP AMT. AMPS. TRANS. AMT. H.P. NO.OF MFEETAMT. WATTS 3 F 1 DW 12-. 2 20 1 SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC COND. A.W.G. A W.G. A.W.G. AMT. AMP. TYPE EQUIP. 1 0 2W i 0 3W 3 0 3W 3 0 4W PER 0 Of CC..G. NO.OF HIAEG OF HI-LEG NO OF NEUTRALS OF NEUTRAL 2 ISO CB 1 X 2 2 2 1 OTHER APPARATUS: WELL PU1fP-F-1 WHIRLPOOL BATH-'1 PADDLE FANS-9 2 1/2 TON AIR CONDITIONER-1 3 1/2 TON AIR CONDITIONER-1 GOA DISCONNECTS-2 L L lir Continued on Page 2 >» GENERAL MANAGER Mper_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. ss THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 1195099 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date FEBRUARY 23,1999 Application No. on file 16175798/98 N 480719 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 142.& MR-­ SIEVERMAN, KAY LEIGHS COURT, EAST MARION, NY in the following location; © Basement © 1st Fl. ® 2nd Fl. GAR/ATTIC/OUT Section Block Lot was examined on FEBRUARY 18,1999 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS , OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMi. K.W. AMi. HP t DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL REC'PT.1 TIME CLOCKS I BELL IUNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMi K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E -" R - V I C E METER NO.OF CC COND A,W.G. A.W.G. A.W.G. AMI. AMP. TYPE EQUIP. 1 0 2W 1 0 3W COND. NO.OF HIAEG OF IIILEGNO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: JI11 SAGE ELEC. INC. LIC.#3635 Ldp L rn >L PO BOX 38 GREENPORT, NY, 11944-0038 GENERAL MANAGER 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUS - NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ OUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: cy- 0a DATE INSPECTOR (201j��14 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY r REMARKS: � -- zz DATE INSPECTOR LA M-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1 ST j ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE I �s g INSPECTOR X76 765-1802 BUILDING DEPT. INSPECTION [Z TION 1ST [ ] ROUGH PLBG. TION 2ND [ ] INSULATION G [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE ! INSPECTOR Aeel_k2l A-�, q M-1802 BUILDING DEPT. INSPECTION [ ] F NDATION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,- DATE J' li O` INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ J FIREPLACE & CHIMNEY REMARKS: �, ,~ col DATE �� INSPECTOR �rL AM y / IMMUNE IN ,�„ i fit, t a IN ! f �_ ti t�s£D L4Iy0 1V 49. 1W �o� °o o nQ- Q DirvewY_ * Q = 9 � 9 �Q698 Q New VOO 'n Ala Y a �en�v rer s 1X COUNTY DEPARTMENT OF HEALTH SERVICES N A06- FOR AMOVAL OF CCMMUCTWN FM A �,farv,e-o SWG=F°AMAX WAMANCZ ONLY w Wm,Z. ' DATEDEC 01 1997 � ;. R/a- 617 APPROVED a Icessspool FORMAJIA4�I7Pri%OF,&_B R Ms ELMSSE. NOTE n Minitance between Well EXPI nTHRM YEARS FROM DATE OF APPROVAL and is o be 15( ieet Received Suffolk County �✓�om3B'zo /sem /y9,a3' NOV 2 5 1997 Dept. Of Health Services �;iice df Wastewater Mgmt. Doer r.woe-B.eac�t�Shre y�iEVE,e�.��y ,�_ o4Nr1101MV41Zet4A1A0` t%ej' ,a0•.5�ox�r�8 LgG.rTiav- 47 of �ioaaNato�/y, .?�uir•�,�� N.Y.//97/ r.Ale e,4,W`g_--,e1.5'1 g */04,0•0/DW-/6,/a I ,CSAxzZ16,4, S /� G�Og£D lAryoeG �OUN(�i9T/LNJ �F New Y Q� , Q\ n � 3 Nio�3B'zo� /-5903' 1V/r`l/rurov �v_y�y�oe•B.Q!/CFs�.�.t'/,2GcGY.��EdE•e�1.9:f/ ANryoivYKi.LEw�bva7wa�E'i GoT ����a�/�iG.s�.oai�✓r�oo,� 6ANO.�r��vEl�.e .o0•d�X�.iB �oc�riay �:�er.�rJ9R�o ,/ Tv .t�o� �iooss'aGo n/.y 'JT'�'� D ,�rido/�T•r�.u�oc..�l.9�'�/998 �� . ��•/%�jp / n 1 BLDG, DEPT WN FS UTHOLD _ I COUNTY OF SUFFOLK I ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE - - DEPARTMENT OF HEALTH SERVICES MARY E. HIBBERD, M,D., M.P.H. COMMISSIONER PERMIT I JL _ THE ATTACHED PLAN," WHEN_ DULY SIGNED BY A REPRESENTATIVE OF THE DEPARTMENT,' CONSTITUTES ' APERMIT "TO CONSTRUCT A WATER SUPPLY AND/OR A SEWAGE DISPOSAL„SYSTEM FOR THE PROPERTY AS. DEPICTED. CONSTRUCTION MUST CONFORM ,WITH>APPLICABLE STANDARDS INCLUDING THE STANDARDS FOR CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND STANDARDS AND PROCEDURES FOR PRIVATE WATER SYSTEMS. THE:PERMIT (PLAN) EXPIRES THREE (3),YEARS "AFTER THE APPROVAL ,DATE. " ANY MODIFICATIONS WHICH MAY AFFECT THE:PROPOSED SEWAGE DISPOSAL- f SYSTEM OR WATERSUPPLY REQUIRE SUBMISSION OF A REVISED PLAN AND ANY ADDITIONAL FEES,.'PRIOR TO CONSTRUCTION.._ NO INSPECTIONS WILL BE PERFORMED BY THE'DEPARTMENT ONEXPIRED, PERMITS. PERMITS MAY - BE REISSUED UPON = THE " SUBMISSION OF NECESSARY APPLICATIONS, PLANS AND FEES, AND; WILL BE REQUIRED TO MEET THE STANDARDS INEFFECT AT THE TIME OF REISSUANCE. A PERMIT MAY BE TRANSFERRED INTO ANOTHER PARTY'S NAME UPON RECEIPT. OF WRITTEN PERMISSION FROM THE,ORIGINAL APPLICANT AND THE RECEIPT OF ANY""REQUIRED"TRANSFER -FEES. IN THIS CASE, THE PARTY_PAYING THE " ORIGINAL APPLICATION FEEWILLBE CONSIDERED TO BE THE ORIGINAL APPLICANT. VVWM PAGE 1 OF 2 DIVISION OF ENVIRONMENTAL QUALITY COUNTY CENTER RIVERHEAD, N.Y. 11901-3397 - 852.2100 - - - 18-380:.12/92' - x „ ,, , �.>���.A.rs,., n„_t's.A.- ?:�a..c;xrs.�?-._..,..,�s.�..r .sems•.:�. .g- � `ea '»�Z�`�u�`' . a�'�` "t .,'a`d' ..`_ 3 ��si,"�� INSTRUCTIONS k'OR FINAL APPROVAL OF CONSTRUCTED SYSTEMS It is the applicant's responsibility to (call the Department to arrange inspections of the sewage disposal system and water supply facilities prior to backfilling. These include inspections of the soil excavation for the sewage disposal system and inspections of the water supply well, well lateral,public water supply line, disposal system, piping and filial grading. Other inspections may be required, Following satisfactory construction and inspections: 1. The applicant must submit 4 prn�nts of an as-built plan (up to and including 11"x17"), by a licensed design professional, of the subject property showing the following: I a. the lot location and dimensions; b. the lot number(s) and the nam e of the subdivision, if applicable; c. permanent structures (i.e., buildings, driveways,walkways, swimming pools, decks, etc.); d. the exact location of the priv'te well, if applicable (give at least 2 dimensions measured from the comers of the building); e. the exact location of the public water line, if applicable; f. the exact location of the septi tank and leaching pool(s), if applicable. Give 2 dimensions from the building corners to the covers of the septI is tank and each leaching pool; g. the exact location of the seweY line from the dwelling to the street; if applicable; and h. have a clear area at least 311 e5" for the Department's approval stamp. 2. The applicant must submit a cerltificate from the sewage disposal installer attesting that the system has been installed according to the criteri n of the Suffolk County Department of Health Services,when applicable. 3. If a well has been installed as the potable water supply, the applicant must submit a current well water analysis (within one year) and a well dr.�ler's certificate. If the well or water quality does not conform to standards,proof of corrective measures will be r�quired. Refer to "Standards and Procedures for Private Water Systems." 4. In those cases where public sew rs are utilized for the dwelling,the applicant is also to submit one (1) copy of the sewer line inspection approval f�om the public sewer district. In districts operated by Suffolk County, two (2) copies of Form S-9, duly executed by the Suffolk County Department of Public Works, are required. 5. In those cases in which the installation and connection of the public water service line has not been inspected by the Department of Health Services , a tap letter from the appropriate water company is required. HEALTH DEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL NECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 �!, 18380..12/92 Y"".e...a......_,.,e.0.__ BOARD OF IWAL'I'II � M A 199�y FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . 1 CD a O TOWN OF SOU HOLD SURVEY ISU11A1NO DEPARTMENT (AIECR . . . . . . . . . . . . . • . . . . . . T tiLGG.GEPI: ONN I1AIJ. SEPTIC FORM . . . . —TOWNOF$011'fl;pLO SOUTIIOL ), N.Y. 11971 TEL: 765-11102 NOTIFY: / CAI.f. �/. .. . . . . . . . . . . . . . . . Exani ned..... ... 191---y,/ Q .. MAI1. TO: . . . . . . . . . . . . . . . . . . . . Approved....... 19-f4 Permit NO. -RC.�f..!.°.G. .:............................... ... Disapproved a/c .................................. .............................. ...... ........ .................................'- .. ..... .. .... ....... .... . . (Nei ldiag ]list ed or) All .KATION FOR IilII1.Df NC PIIRNI`l, INSTRUCTIONS a. 'illis applicatian Trust be camletely filled in Ly Lypac✓riter or in ink and mrinuitted to the Wilding Tospeclor will 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan slrawinyg location of lot and of lxrildings on premises, relationship to adjoining preainen or public sUeets or areas, axl giving a detnilecl description of: layout: of properly neat Ire drawn cxn the diagram which in part of this application. c. 71ke work covered by this apgdicatiou say not ITR canmerTced before issuance of Ikrilding Permit. d. Ulxxn approval of this application, the Ikuilding Inspector will ismre a Ikrilding Permit to the applicant'. Igich permit shell lie kept: on the premises available for inspection throughout the %circ. e- No Imildiryg 1,111311 Ire occupied or used in "wile or in part for any pupae 01i'Lever unlit a Cerl.ificnln of Occupancy alkall have been granted by line Wilding Inspector. APIM(WI'I(N IS ILt?MlY lWl; to the Ikrilding Depurtncat for the Issuance of a Building Permit pursuant to the Ikrilding 7"ke Ordinance of like 7Yarn of bio Llwld, Suffolk County, Nei✓ York, and other applicable Taws, Ordinances or ItegulaLions, for like construction of Ixrildings, aeklitions or alterations, or for rerroval or denolition, as luerelu described. 1be applicant agrees to comply with all applicable laws, ordinances, Ixuilding Cale, lawsing code, axe regulations, and to adn(t authorized inspectors al lrenises not in Ixr'I for necessa nsped:Ciaks. (Signature n ppb lcmnt, OC rlarke, lE a CUrTIUi"FIt IUs) (Malliag address of applicant) State cdueUv r agppHemnt Is Miller, lessee, agent, archil.ect, engineer, general contractor, electrician, plumber or builder. .....---(- "e-�?¢.t•a- / .(F?!�f!t ;°'.t1.°."............................................................................ .... Nine of a✓ner of prenlses RJc... D.. .f'..�..�(.1.�:U-C-C�..SIG'l!{��,m,!Y:/7........... ................................ (as al Like Lax toll or IaLest deed) If spplicaot is a corporation, signature of duly mrtlrori7cd officer. ' ...................................... ................... Mille. mid title of corporate off/icer) Ikrilders Mcenae No. Plmi>ers license No. Electricians license NO. ..................... Other Trade's License No. .................... I. location of laml on which proposed work will be (kxue.............................................................. ....................................................................................................................... Ikxrse Nrdper Street / Ik-mlet Ulont.y Tax Will R). 1000 Sectict. ...... .�.........Illock ...d.7,........ Int ..��.:.(.� . SulxlivisiaT .l`7,!9f ��P�Y/ L1/.�QF{J............ Filed Milk No. ............... Int ... ........... (lr:nue) 2. Stale existing use a1x1 ocr<gpnTxy of jH0111SC4 arxi Jinterxled use aunt occuparwy of proposed coualnkclion: a. Existing line and o:copeocy ....e ,.l............./...............-............... ........ b. bnterl&d Awe arxi occupancy ...—?1.'.'l�.�Q.. i; -''!�lll.( -. . .tN. :g,/!1',l- (................................ 'I. N (IfL of ex)lk (deck witidt ap> licable): Nrar Ik+ilding ..V .... Mklittcxr .......... Alteration ........ .. Itelxlir ............ IlentiNal '........... DenolitIou ... ......... Other Wotk ......................... .... . ..... . r . I' ....... fee ................. 1 teat lllxlla/l (:(19t (to lx: plid oil filhgg thiit appllcntlrx)) :g. If AfulIhill, rxolier of. AIell hlfg units . ........... I►nlxer of (),ailing unl I em enrh floor ..... .... ... . ... ]f garage, Clamber of earn ....'z ........................ ..... 6. If Ixsirleas, (:(mllerc)al or ailliel occol+alx:y, sled fy nalorp e+txl extent of each type of use.................... .. 7. Dlnxlnnlats of existing acroctu'rea, If, ally.. llr(xtC.. ..... ......... gear ............... Depth ......,.......... IloIg11C UA'IMr of Stories .. ...'................. Dintensiotia of stile aCrveture With alleratieoa or IxkMCions: Front .......... ..... Rear ............... Doplh ................ IItlic ................ .... Rmuler of Stories .......... / 9z Rr:u . Dtnsi(xis of entire new cnaLnlx 'locl ion: Frn_ ... z.. (Lear ...+flz... ..... Dep(h .............. 41 Ik•i 11. (�!f `l/fiJ.... .. . Mrdwr Lna:or ... .z...... ......... ✓� of Slies qqbb y 9. it2C of lot : 1 Fr(xIC /... .. .... Ir ...�7.,1:.�.`a�..... .. Ikeplh .2!4.L ..... . I0. Hine of Hu"chfu 'l.��.p.J.1 -7 ..... Matte of Foriwr 0juer/,�R'W1,2O .�f)A77. �Sax1?i<o$.......... ... It. Yxxe or nae diatrict In wltldr preninea are situaled ...................................................... ......... 12. tkx•u Irli quad uxu+I:nx:U ro) vkll IT. Will lolalie regrtildl ..Y hale fifty uxlinig Low, ordhaax:e or reltulatirxt: ....All?................ .f 5..1,,,,,...... Will excess frill lie ratavecl frac premNDises: YES 14. limes of Omier of Profit son 9141 .�P`�..� :et ^ e?rnµyi klresal4c.{C�7vIhF1W.f.,)r J-.1fiNUf` PI Me NO-Afll 030.1.... I K,, of ArdlllecC 1,�.?!l�/.FJ,G ✓1��2 �............. Arklress /.i/flir'tF l ..t7F4k:?/P°(3.f... "lone .490 .. Nrnr; of Clot.ractor !f??.l�y !'.n.�'.................. Aekiresaz(�. nn„ �,t�•„ a,�.; w ale Pb. '.ylJ,✓�fq. . Li. In (his property within :IOW ft of a tidal wetlarxi? * YK8 .......... ND ..,�.... IF YES, M111k)(1) 'I1XM Ti4)I IMS PCIMI1' MAY IME IU?tjilltUiU. , PIAT DTAGRAM locate clearly aril distinalyllall loildings, whether exial.ing or proposed, soil lixlieste all set-back dimensions frau property limes. Give street ar1c1 block nni,er or desrripLioo according to deed, prxl show street refines alxl Irxlicate Idlalher inler)or or corner lot. III MME , All; IMS NLlJ YINtK, (XIIINIY (N+ ...... ................. . ... .. . .... .... .. .. ..Ixeing duly fMIT11, dcp+emn alxl "nye dint be in the. appllemil. (Niiiii! of blilividlial nignhlg ronlrad!) IIIx IVa 114111lxi, tkein the .. ...... ...... ...... ... ...... ......... .1 .. ............... ...... ...... .... npallf ," corporace officer, etc.) of said (moer or owtlern, nix] in du1)f authorized to perform or have pe.iJorimil Ilse unlit work mil to nmke aril file this fgipl icnC ion; that all eL"LercenCs antLaited in Ihis applleafion nre (toe to the Beal: of his krxlwledge a+xl NiUef, nail that. (lie rink will lie gerl`ori"I III tlhe nramler sel, forth in the npplicnCion filed herewith. (lily �/d. . 19...09.?. ?.nnn/lto lefure m. Ihtn fkx.ary L'tlblic . rv{!. ?.�U...(%(P-Irf-)IIe.�•......... 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IU ,C' I _n. 7U�C • f'LtI BFR-CEWIFICATIO QN LEAD C4� - say ES� 5: , / C� TIFfC�4T -OF.OGCUPA � ��U ��rY � �� U�� ll11'1'L U: x t• �/�p�J(b - F � U FD CONCRETE SOLDER USE'?IN WATER --- 2• ROS IGH - FR ING PWMBI . p a SLY SYST A �r T . �ANSU TIO w [' SUP o t - ® ST�Uc BUST - F . ` {* jj / D I;S Z G tJ 'i'f I L ItM CL E��EE ��1 Q Q1 'l� � �l �FSB x.43. SUI3SYS'1'CM I�R�11 � RCMI�RKS = o tt U tt It11'i'I N G w j.; '3 t __.3 (f, - ALL CONSTRUCTI N SHALL MEQ' . _: , -—erio Walls �� - PROVIDE ANTI-Sato��fl�o � � ' �� � - 2 .5 I� , v 77 �- /���f _ :z - z F flE�: TMERf�AL SH4CIC PREIiIENT►pG Pi.UMBiNG FS. -- .— EEPT h., SPU�iStBt.E- F Z ,� r s P �r w �,,.,- 4EYIDES AS TO PART.902.E — � FJ A13.Pi.UR6ING.V'I(��EEF �° tdST�J�T#t) i E€ � l y I q 7 3 2 8 e t�.r.StaTE svrcotN & R LINES I oY e p vg - - -- G CODE. eg=o �` Doors . YrQ�i - v 4 u , q0 _ � . !#comer!cam 19 est# ior � Ceil.i ng/hoof (U,paque) / U LL a > . 4 . SkyliyIt�s % i Sties# be sys�en�: . ,1! Ew y ZYP�K of t vn . , M �. 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N NEER OAAWINGL ,,P I r?4,,S or, R MAIN ROAD ORtENPO Ll 4 pmt '11944" N� YOAK 77 F F 16�-477�04 X,61'0477,0 8 00 FA a N O \ v I I J��` s� c°m6;Iti slV Roar- i 28310-2 283 0- � 293+ 0 2�3ID p H W4 9 OPENINGS FOR /z f '2 N At. 1 a o -- SHow FR 'm -� - - -- --- — +'1 7 $oK ne PROVIDE PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS \ EMERGENCY ESCAPE AS T{ „pry REQUIRED BY PART.714 OF f 1 o REQUIRED BY PART. 714 OF `$ ^ \ N.Y. STATE BUILDING CODE. 2a^ N.Y. STATE BUILDING CODE. *� _ ; U 1� MASTER Eko I"I 'L smigc- Isom cVEIs RQoM 2 BED rpnNi 3 EE flo I _ j i -t' 2 "9 \ 20' S11Z i Sb w CL m _ rn t3 of il PROVIDE OPENINGS FOR ° \ ry 3 ti m W o 'N m EMERGENCY ESCAPE AS o sp f N REQUIRED BY PART. 714 OF W Y z A,5 STMRSi ` rJG .._.. _._ „I All N.Y. STATE BUILDING CODE. r, HALL ,_ 41,vo — I h ,�'-'`+�!'Tf,'IwR?e �' " S lZi§.S_ „ 4 "f 1�1 �I IW 5H 2.2%ao _ I r �1�F° �'f•— P;. __ �b � � N �� I 4, C� 4 �.0 nIDto I. PROVIDE OPENING J� 81aK. u 00 j ��„ - E,MERGENCY, ESCA E 1 Std fry — — -- Cn 3 0 2' REQUIRED BY PART.714 OF L.Au uae / - .. ,Y. STATE BUI'LDING.CODE. E 6� ? Tug py $I`O RCJ[?Mi a �X wis-4 uRr P��L7 �Cd7h9 �f m v ti p PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS 01 BAT N ;,I o \YCf{ p�z REQUIRED BY PART. 714 OF \3xy a , ; {�• or N.Y. STATE BUILDING 4CODE. ( - ' -T 0 R CJ d f .254 aHpFI:SS101�p'� 4 w r' Nnrk Q a � � V' VfR/f`r �?INAIS fOMs !Y." .7R i 9 . = I, t.° r •a ,• ,` t _ r i i(t+ �y ',tt �•�y ,3: .. A A 9 F ff tJI�L� � 3 4T 7.1 L 4 l 'P I„> f 7Y rtAOM4' I a' , • - $ , '!' - r :C. 'lMIA1114YW 511hAMDillf111i1f�';•, t• •. ,,..,. .. !'' _ x` , "f+ iM�'f!ii' tlir , f tti vd -4 - ' u r ,. - • �S.i't i5,,. .Yom' <.';i. , .- , ,. a,. 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