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HomeMy WebLinkAbout24017-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26059 Date: 10/23/98 THIS CERTIFIES that the building ADDITION Location of Property: 35 BAYVIEW AVE GREENPORT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 52 Block 5 Lot 31 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 23, 1996 pursuant to which Building Permit No. 24017-Z dated MARCH 31, 1997 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LAURA ANN & WOODGER LOEHR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 10/15/98 PLUMBERS CERTIFICATION DATED 09/09/98 HERB WOODER "'� Q" � //ki>4ng In pector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEFARTIBNT TOWN :i�Ll_ D7Po 1s02 � m'-z —7�1: P?Llc_ lON FOR cH.RT=FICATE of 0CCUP_NC': Nrt1c&V Q KY4FPnoD kc ©593 Thr Pap cation sus be filed by tyvewri_er OP, ink and submitted to the building nspector the f lowing: for new 'building or new use: operty with accurate location o'. all bu'_id:.ngs, Property lines, and unusual natural or topographic features. 2 zal approval from Health Dept. of water supply and sewerage-disposal(S-9 form) J. 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 build'L's and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan reaciraments. B. For existing buildings (prior to April 9, 1957) mon-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 `eatures. 2. A properly completed application and a consent to inspect signed by the applicant. -= a Ceram`icate of Occupancy is denied, the Building =inspector shall state the reasons therefor ia vn tiag to the applicant_ C. Fees 1 . Certificate of Occupancy - New dwelling 525.00, Additions to dwelling S25.00, Alterations to dwelling 525.00, Sw_Mmfng pool SZ5.00, accessory building $25.00, Additions to accessory budding 525.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3 . Copy of Certificate of Occupancy - .25C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residentiai $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . .. . Old Or Pre-existing Building. . . . . . . . . . . . . . Location or proper /�G✓ v House No. / Street Hamlet Onwer or Owners of Property. .. . . 4 ' �11�. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . `. . . . . .Block. . . . . . . . . . . . .Lot.. . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Han. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Pe mit No. . o�.y 4 � � Data Of Pe sit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Aporoval. . . .. . . . . . . . . . . . . . . .. . . . . .Under-criters ADUrovaI. . . . . . . . . . . . . . . . . . . . . . . . . ? anai.ng Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Recuest for: Temporary C[a�rt=._tate. . . . . . . . . . . .4 ail Cer==tate. . . . . . . . . . . J Subm_t_ed: 5 . . . . � J.. . . ... . . . . . . . . . . - l . . . . . . . . . . . ..cy�: . . . . . . . . . . co 2d� c1S G Town Hall, 53095 Main Ro oad y x Fax (516) 765.1823 R O. Box 1179 Telephone(516)765-1802 Southold, New York 11971 • Aol OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 10, 1997 George Wernikowski 8 Parkview Court. Riverhead, N.Y. 11901 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. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 24017-Z (LOEHR) Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. !O$M NO. a 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) q N° 24017 Z Date ....................3/j1........................., 19.1..,7 Permission is hereby granted to; . •!vlt ln1.... .. f .......... 4 ... ..1.1. 'x1. to ..... .... 4l .....,./��✓....t .................ir ......... ........... .tX/✓�'1ZIr .......... .. ...... J....� °11.... .,..... ........... .............................��................................................................................................................ .............................................................................. �..../............................................................ at premises located at ...... ....... . ....... ..............(+� es....... County Tax Map No. 1000 Section ......F .............. Block ..... �...... Lot No. .......`1......... pursuant to application dated ...04.Ct .....POU...... 1916 and approved by the Building Inspector. Fee S.•�l .................... —nsl:' J . ......................... -gild"g Inspector Rev. 6/30/80 David Lee Fulton Plumbing & Heating P. O. BOX 706 RIVERHEAD, NEW YORK 11901 PHONE 727-7854 Date : /�4kg�, OwpAer: '7 'e Premises : �,�r�n� Pi• IJ.f, j14Lly TO WHOM IT MAY CONCERN: ALL domestic water lines , at the above-referenced premises hav(e� beens ered with a lead-free type solder . ' " - - -' *id y s , -:c P. COSTS to ` Lary rubles, State of New York No.4758357 lton Qualified in Suffolk County Commission Expires May 31 _ o r� c� ead � SEP 2 2 1998 BLDG.DEPT, TOW Of SO LO Fi- LtVD°uSfGNEO TEMP,M pl(E cITV OR vaLAGE "- ZIPCODE j L/� f TOWNSHIP (^ couyry// _ STREET AND NOO -� .ROLE NUMBER . : 0ET4EEN WMN TN9 CROSS STREET;IS PREMISES Lq=ED' SECTION BLOCK LOT OCCURWSUPANi' NAM T� 9UILDING OGCURWCY /Dr •, 1��,'� � v wz -- ONNER'S NAME ADDRESS 5 �- _— HO TELEPHONEBFJi CURRENT SUPPLIED BY f FRUMTHEIR OFFICE MRK TELEPHONE NUMBER BUILDING ISJ ,y/ ,NEW❑ OLD I3U VWRK IS NEV, AOdTIONAL LJ DEFECTIS OV IJ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED LocaNUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH OFFICE USE tam Lamp Receptacles CIRCUITS ONLY bon —Side mmch't _ - -- HP -Much Cedln9 Wall C.—OPIle S-Wh Pendant Bracket No. Type Each No Each ND Gauge INSPEOTION OUT - SIDE . SUB BASE 845E MENT IC -- _- -- FL 2nd FL ad FL FL I REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. I THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED,BUT IF AT TIME OF INSPECTION,THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT,AS PROVIDED BY THE APPLICANT [SIZE OF MAINS FEEDERS ELECTRIC VGNSI-AMPS MAL WATTS I r.npRK,'IER OF hVRn U EXPoBED GA.TUBE iIGNiRIJvSFOFFIERS Cf \a ( CONCEALED _ WE WORK TO BE STARTED DATE COMPLETED SIZE 0-SIGN NUMBER) CAPACITY SERVICE ENTERS BUILDING ,{�// MANUFACTURER OF SIGN _ Imo' WERHEAD C UNDERGROUND DATE INSPECTION REQUESTED ONiOR AS NEAR ASPo�IBLE, - MUST ENTER APPLICANTS (f 'e IDENTIFICATION NUMBER, I \ I�!- 101 j AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. ION t NAME AND A:]Ok' - NAME OF APPLICANT ' J GATE OF APPLICATION/ -„ SIGN URE PLIGNT - g` STREET ADDRESS TELEPHONE NO � � - ; � CITY ? U-- OR PO FFI E ZIP CODE LICENSE NO WHEN APP`LICARLC _ v r < „t v 1"6; 85 Jo n Street 41 State reef 570 Delaware Avenue 17 Lake Avenue 202 Arterial Road NEW YORK,NY 10036 ” ALBANY,NY 12207 - BUFFALO,NY 14202 ROCHESTER,NY 14608 ( �-) SYRACUSE,NY 13206 (212)227-3700 (518)463-2122 (716)884-1155 (716)254.0141 (315)463-8552 THE NEW YORK BOARD OF FIRE UNDERWRITERS QG DEPT COPY OF APPLICATION FORV46-EL;NEW YORK-BOARD OF FIRE UNDERIMP TERS — - FILE THIS COPT WITH BUILDING DEPT.WHEN REQUIRED. SEP 2 2 1998 BLDG, DEPT, TOWN OF SOUTH LD ( Ir_LD_INSPECTION REPORT DATE ---------- I-- -��u I j—OUNDATION OST) it fl 11 II 17- 11 :.7 (F2UNDATION----(2ND)-----_I�--_ -------------------- ----- 11��a II -- � , � y� ��♦ p,� I n CJI n _ ROUGH FRAME & ii ,� •�' III PLUMBING 1 II It i i�II CA II II _ S I � II INSULATION PER N. Y. STATE ENERGY CODE II II . I II II II II ° II II � •461 I II II 04 IN n II FINALit o ADDITIONAL COMMENTS:A 9-7 ! z ilk ©3 q ,7 Le2 - �p 8199 Tq IV OF Sol { b Y ��a✓� l2/Y/��5/�r rt JUDITH T. TERRY - _ '� Town Hall, 53095 Main Road TOWN CLERK o �< r=-, P.O. Box 1179 tri " Southold. New York 11971 REGISTRAR OF VITAL STATISTICS �✓� {"_'� + DY Fax (516) 765.1823 MARRIAGE OFFICER Y�pp �+� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER Vl FREEDOM OF INFORMATION OFFICER 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) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)] . 13�� TOWN OF SO T'POLO Ajeu-dith T. Terry Southold Town Clerk August 25, 1993 t APPLICATION #_ PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to he filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 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. S. 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 seasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO BEST OF MY I GE, TRUE AND ACCUR�tTE. (APPLICANT'S SIGNATURE �— DATE f</1 SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT 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 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 2OF4 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 (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- 0 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: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special Flood Hazard Area. FIRM 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 be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: 0 A site plan showing the location of all existing structures, water bodies, adjacent roads,lot dimensions and proposed development. 0 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 fust floor,details of floodproofmg of utilities located below the fust floor and details of enclosures below the first floor. Also. 0 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). 0 Plans showing the extent of watercourse relocation and/or landform alterations. 0 Top of new fill elevation Ft. NGVD (MSL). 0 Floodproofng protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. 0 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. 0 Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. 0 Is B. 0 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 Areasbottom 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 FI'. 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 comyleted 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 S• CERTIFICATE OF COMPLIAN (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. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑EXISTING BUILDING ❑ 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. COMPLIANCIE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: CIC(93) � 4 765-1802 BUILDING DEPT. NSPECTIO►N it,,4 FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO�JGH PLBG. [ ] FOUNDATION 2ND [vj INSULATION [ ?l r MING j ] FINAL [ FIREPLACE & CHIMNEY REMARKSI t OW. l DATE �� r/�`- INSPECTOR294 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] F�OUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: C DATE 7 INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE Z11liF:ZINSPECTOR l/�� M-1802 BUILDING DEPT. INSPECTION [ j FOUNDATION IST [ ] ROUGH PLBG. [ j FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ j FIREPLACE A CHIMNEY REMARKS: DATE _INSPECTOR 4- • '� �Tt- 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. j ) FOUNDATION 2ND [ J INS U TION [ ] FRAMING [ INAL [ ] FIREPLACE A CHIMNEY REMARKS: 7-5 DATE J1 I INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARKS: D,� C. D. DATE Z J INSPECTOR yo 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL �� [ ] FIREPLACE S CHIMNEY REMARKS: vo DATE h-/ D INSPECTOR L.� L P p° N ,pp•, °° iij 'o 0 4 0. N � �Op N , � 0,4 / shr a�• , V / °0 (�. �3i / 6 �gN / / T � Ile a � Zo .ft a�0cr Q� a� 5 5 Q N 010 G � \ 3 z� SURVEY FOR o LA URA AMM L OEHR & CAROL ELLIN WOODOER A T ARSHAMOMA OUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y VW - 52 - 05 - s1 AREA = 1A767 aq ft to tie km ScMe. 1"= 20' Mar. !061994 FARM ZONE A4 (EL. 8) COAD JANTY-PANEL NO. 3608/3 0076 E Ek, . S `o �,, A�11' OR IS A VIOLA nONAS OF 77E�1E� Ata S. LIC. NO. 49618 P.C.Aaormmw i v ra zvm" V lW7W AAAM IAN VAir INSU SAI ZpTMO MAl S . 3-ft I AAE MOT AM LAW. SOOT 11971 94 - 127 BOARD OF• ❑FALIH . . . . . . . . . . . . . . vol rt tui . 1 I NETS OF PLANS . . . . . . . . . . . . . . fOun OF aoufn0I.1) SURVEY . . . . . . . . . . . . . . . . . . . . . . BUILDING ING HEPAIIIHENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . DEC ^ 3 '10141f HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . UOUfuol.u, R .Y . 11971 TEL: 165- 11102 NOTIFY ;7- CALL t.x:.IIiIK;,I._. . . 3 .. ..., 19.7. MA 11. fO: . . . . . . . . . . ') Appurvcd. . .. . . . �31. ., I � I'ennil fkl. ,.�. .�/� . . . . . Ilis:,I+lu crvu,S n/.: . .. .. ... ... ... ... . ... .. . ... . .... . . .... . .. . .. . ... .. . ... . .. . .. .. . .. . . . . .. . . ...... ... .. ... . ..... ... . .. . .. . . .. . . . . .. ... . .. . (I I I Int ^In:llu:rl of ) Ar PLICAflun FOR BUILDING rF.lul rr INSTRUCTION:; u. 'Ih i:: ul)pl it:d illi uunl In: oufglcl cly tilled in Ly lyln,at it c, of in ink mut nulanilleJ W Ih<: Iklildiul, Im;IKwI< I m,•1m of plana, nccurnle plot: Vim to ncale. Fee mcoi ling to utlwdule. a If. Plot (,]fill e:buwiry, ImalAexl of lot wKl ol- Ixtildini it oil premtisen, u:lat ioumhip In ndiolyd"m pfunkeu of IK,blit lit IVet 6 ra arwa,, wul Rivlilt, a flet ll led dencl ipl ion of laytxd of pt opel t ooal. Ile: duan ou lite diagl on Off(11 is Jim l lid" nlylicnl iun. 1•, '11 to ,alk covered by 061$1 nlyI kcal inn racy Ilot IK] fU1llkiwe,I Ilei ore Iuno:a we of I k I I Idiif, Pe,nlil . d. Ill.., aP1,,Irval of Ihis app] 1cat ion, the Ill li ]dint, Inspect of oil] iasue a Ho 11 di ng PermiI to Ilse app] icanl . Sl Ixnu,il a1m1I be. kept no the promises nvailoble for incgreol itxt IhrlmglumC the rank. e. Do Inti ld ing IJtalI Ix: mcupied of used in %A,ole or in pati for any lul Pose IAud ever until n ce,tl flcmle of tk',epalxy shall have IXMII ),rant Ilii by Ie Ikli l diet, Ion]Ilei or. AI'I'L11'AfICO IS HI?IIISIIY MAIN: to llue Uoilrliut, leluulua:nt fur the imm"Ke of a Poildlug 10mit Ixut;uud to the Ikl'lidiol) CAxx' Oldil ncc of the Ttx+ll of Huoiluld, SAtlfo]it Coonly, IJmt York, a;Kl olhef applicable lima, (Adhl;1IwA of KePu]al lens, fur the: conatitwLilxt of bolldioga, ;xklit limit; of alteu,tiona, or for remrrval or doual it inn, fie Weill desaliled. 'file applicant agfeea to cotply with all nlryd lalbie Iran, urdioancen, buildhag ctxte, hlxtaioi, tsxle, mml legolal.ions, wKI to axL,ifi authorized limpeaUFS in pluuireu 010 in lxllldinl for t uennitry 14sle rut pp. . .!{! , .... . . . . . . . . . . . (fiiRnal lu a of a�ld tennl , of n:+a:, I f a ,:ul pot al io 3� N�. . ll..jU'..�Ph. rww. G7. awl �xF (I4ri I iol, midleaa of 411,111 icanl ) /'q, jiq i State tAm:l Llet applicant ill owner, leaner., a)nntl , anoh11ec1 , engineer , Rene,al diol rlw1ur, elect.I What, p]udxn or Ix . . .. . .. . . .... .. . ... ..�T. ��"EI�.Y? . . . . F.(VIfid;... . ... .. . .. . . . . . . . . . .. . . .. . .. it;... of ,nater of nuulse$1 . . . . fl-IC t3mo.(1t're. . . . . . . .. . f3.V.1.�. . .l .lf!1 D. !�QFI/.� .l llV�-?.•. . . . (fill tx, the tan toil of ]ulenl deed) 11 nIT1 icald in it cullK)Irai inn, ❑'I,l]Hina of duly uo.hol ivied ufl icer. 01.ni ;uul ]true 141crnfol fit e office" ) ho Ideal Li eeosC til. . . .,.! JA -.0 . I'ludxv$1 license No. .... .. . . . . . .. ..•.... .... . Elect, icings License No. ..... ...... . .. ... .... O1lict 'Vx;mle's Licenne fit, . . .. .. . . . . . . .. ... ... 1. IAx'al jon of 1taxt cxt ,.Ati eh pt ofKmod axuk will IK: dote. . . . . . . . . .. ., .... . .. . ... . .... . ..... .... . . .. . . ... . . . ... .. . . �. . . . . . . . . .se)4.171VI d... .. . . . .. ... ..... ....... . . . ... . . . . Ikewe Ifnie, !it reel IL.111(m (ixlnl y 'fox till) Ilk). IM) ;;<!t:t it.t . . .':Jr. . .. . .. Rlol It . .:. . . .. . .. . .. Iot �./. . .. .. .. . . !ktlx]ivinion . . . . . .. .. ........... .. . . ... ... ... . .. . . Filed M.ip Do. . . .. . . .. . . ... .. Int .. .. . .. .. . . . . . . (Iii Yll(:) 2. til ale exiat ing nae anal occulvax:y of Pcratiaes 111xI Botta Kkd ua:e mal excopulKy of Irtoplaw(I cunt Io( l lull: u. I AkI iog use will ekfeU1,al K'y .. .., /�h //1T�// V'C. . . . . . . . . . . .. . .. . ... . ... . .. ... .. . ... . . . .. . . .. ... . . . .. .. 11. hllolKkvl nae al K1 ,K:cIlpal K:y . . . . . . . . 1✓� 1T 19Y. . . . . . 4�.+<a lf'. . . . . . . . . . . ...... . . . .... . . . .. . .. . . .. .. . 1. MII M! 0f IAIII( (rheell thit11 ilryd icnbl!e): ltnj Illd filing . . . . . . .. . . MMlllloo . . !!.. . .. . M(emotion . . . . . . . . . , IMgxdr . . . . . . . . . ... ILnurvsl . . . . . . .. . . . . . Ikvirrl 11 ion . . . . . . . . . .. . 011iea 4)111 . . . . . . .. . . . ... . . .. . . . . . . . . . . . . . . . . I /J (14:ucr 1pl.ioo)Fit iicd cd Owl �f. .G.>.o�. . . . . . . . . rel: . . . . . .. . . . .. ... . . . . .. . . .. . . . . . . . . ... .... . . . . . . (Io Iwl paid on I'Iliofl Ibis nppllr.nt loll) i. II IAmil int 1. t.til w, of IAn!I.111'13 nulls . . . . . .. . . . . . Il II rel nl' rM n!II lni; u1'11n nn each fluor . . . . . .. . . . .. . . . . 1I gnn47r:, uvd w1' of coni . . . . . . . . .. . . . . . . .. . . . . .. . . . . . . . .. . . . . . i. Ir Incl Iwmi cr ooe,c lsl or mixed 1w:cup+nw:y, nix!cl Cy nal till 1.1.1 (!alenl, of enrh lyiwi or title... . . . .. . . . . .. .. . . . . . . �rI/ 1 tm ' Iliu.!nni,wm til' ex{at roll til ttwauten, IV n1'y: Pt oI 1 . . _X,.Y: . . . .. . Itr . . . .. ... Ik!plh . . . . . 1 IM!iIJ1 . .. . . . . . . . . tAntxu oC fltit ica . . . . . . . . .J If in.. �• .. . . ... . . . . .. . . . .. . onioww of nnv! 1'l nu•Im ur r. uII h 1'11 et 1'1 Innw or to Mlll Innn: Irl not . , . . . . .l. . . . . . . . . . . .. . . . .. . r "!pl It . . . . . . . . . .�. . . . . . . . . Ill!110 it . . . . . . . . . .. . . . . . . . . . 144/nhor or fil or len . . . . . . . . . . I. Ili!moll loon of rnl irn�I.." ctoill nua tool: Pt toll. . . .. . .. .;?. . . .. Rpm . . . . . . . . . . . . ... Ikpt11 . .13- . . . . Ile{1d II .�.f ll. . . .11.k 1/ lA nlu!r of Mur len . . . . . . . . . . . . . . . . . . . . it r �7 t 1 !i i'H! of til : 1'1 tw ll .. . . . i�w. . . . . . IW . . . . . .�;�. . . . . . . • . IL!pf It . . .�.( Iq. ILnr. 1'1 hod,l w! Ilp.w or 1'tn 1'.!I (l.,ner . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . .. . . . . . ll . 7.uu! 1'I Iia di nit I c I In IAI IIx 1,t,•wl of I! me I I,,I tial ed . . . . . . . . .. .. . ... . . . . . . . . . .. . .. . . .... . .. .. . .. .. . . . . . . .. . . . . . . . . 1). IAwn pngxan!d c<mnl ttwa.It") vfill file filly ztnlfnil IIIb, ill'I inatw,x 1't teirll III ion: . . . . . .. ... ... ... .... .... I I. 11111 Illi Ixe trllt,w M!11 . .. . . .. . . .. . ... .. . . . i7i 11 exrr!u!I fill Iw! trTrweJ (run ptrsl{!1141': YES 111 14. IMvw'n of (Arrv!t ar In,onl nen . . . . . . . .. . ... ... . .. . ... . ... Md,ens . .... ... . 1'hlnw! Ib. .. . .. . . tMnn or M(:b{ler.l . .. .. . ... .. . . . . .. . . . . . . . .. .. . . . . . . .. MMb enn Moots Ili. . . . . . . . . . If;".. or lirnlrnclor . . . .. . .. . . . . .. ... . .. .... . . .. . . .. .. . NMI non ... .... .. . ..15uwu! IkI. . . . . . . . . . Ill. In Ibis ptolotly oillliu Of feelof it Iidnl Ie.011107 A YI'a . . . . .. . . . . 11) . . . . . . . . .. All; YI!fi, fXXlllr111) 'ItAX4 'lltll!i 6191!1 11CIn41l' !NY IVs I(lilrlliti!I I. 1'LOV 111 t\OlW I,wFole clearly Elliot 411011!u:l ly fill In!f ldlnl,n, Ihpiller n.nlnl.loll or pt oln>ned, ilxl hulirnle IliI Re L-bnck dlnv!ui luno I rt In lit"IA!I t 1ilwen. Ci ve not ICel. nlwl if ml% Ix Noher or de Rer{pl loll serol dlntl to deed, mw1 ulnar nl reel. nm .it of of ILMI I Coin 'Awl Lcl iol to fol ar cof Twr Int:. .'ilAll'. IN` IA(ll YIHfIC !� . . . . . .� 1. . 1„ti, .(r� ". .. .� �f.K1.Q. . . .. . . .(. . . . . . lwio1l dilly ntnu n, det,ollmt will nrtyn Ihnr IIe fit Ihn nppl it:!nn (ILra• of ilxlivid, d Ili to lull rool twa ) filo rve oo,wil, IM! I!t 11!1• . . . . . 1�`. . . .. .. . . . . . . . . . .. .. . . . .. . . . . . .. . ... . . . . . . . . . . .. . . . . .. . .. ..... ... ... ... ... .. . . . . . .(lbnU ma 1'r, 1'111'1'1 , u!!lxn file ur Ciccl , atc.} of nnid 1M11I1oJ1 1'1 4111MI n, Mill In July nulhal In!d In 1x!r how ur 1MV(! ixti Pooled the rndd Wlk 111141 lu nrdte PINI rile Ihin nppl it til lull, 111111. ill slnl uleol11 rural;111RO in till it rrppl icoll 1011 file IIIc! to 111e I1enf of bin Yuxnaledfle nlxl Iw±l ir!1 { 111.1 Ihin Ihn wilt trill IK! 1w'tfuoled ilk Ilm icai!er net lot lit it, the nppl Icol.ioo filed Illeirmll.h. !Anna in Iw!fuli 1'r! lhi!i /� . . . . . . . .� .�. . .Jay or .... . . . .. 19G�yy. .(.6 / p ' CLAIRE L.GLEW `.(Lril;nnl!�ie u �' ppl Xilot) Notary Public.State of New York No.48795O5 Qualified in Suffolk County Commission Expires December 8,19; QFC 2 3 P11 .... ............ 7_1 T 711 A Cl - --- ---- -- W*T�F -r Loli" -7 --------- 1 . 717--' _71 WEST E�LFV,�-PON 101v SC^4t )'01' 1 3�4'otm . .. _ .. .. ... . _. .'mm.. . ._ J^. .,.._.r_._�.. ' " 04 , E&Er F1 IF VA 11p 115 0111Z _�77�7 _7 q 4 kcn*WA t 'tile 44 X V5 I�, uy Pclt wwrof 1pjl�_ TyvrA aov w"41 vo Y�o CAN 0" wp (#P- rLc 0,-jR, cAK Oky T_ 1II aoNco Od -Z ot FT0,7mg-4,�c. , - 1 11 wf� i mfl-rIfIN; H0Le_i*c IiiImo 44 " ; -, � " , L, K�;4$�y clu A I 11 - ,-- -- -�4_ =J P GONIA &,w w 3 V IV J� 4 7 1, " 1..40,AV j 777 ---- - - ter t 0`51? - G BEGA -rop, 166 Cott%% Ito" sAojp", ftA k I' J* 7 PR EN or 5EAVAXP- A fo)-t�_ift f#901/q A ori (4 Y 'Vp c �11, rTy 1;prp 6t/ I ` ;7 0 0 2. 1 UNDERWRITERS CERTIFICATE REQUIRED REi)"C, Tq I 1�� 7c ArP�r wm4 -0 RO OCCUPANCY OR pi,P, y i f " Cji It f� FOR I PROVIDE OPENINGS PoacH USE IS UNLAWFUL -7�vg jxrll� FAW, EMERGENCY ESCAPE AS f WITHOUT CERTIFICATE I REQUIRED BY PART. 714 OF 55, N.Y. STATE BUILDING CODE. IOF OCCUPANCY r k �1 1 . . 41 BEA (•icJPM RA,t}} ,/ t,, - ! , 4 P7-rt-w FEE:KITCHEN AP ROVED AS NOTED 15co Room DATE: 2ZA I 00'. 4�v I Ely: N NOTIFY BUILDING DEPA MEN AT DIV 766-1802 9 AM TO 4 PM FOR THE FOLLOWING T FOR POURED CONCRETE IL 1, FOUNDATION TWO REQUIRED 2, ROUGH � FRAMING & PLUMBING __j -kyf 3. INSULATION 41 FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. 777 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS i LIvIwcj Ii L3151) ROOM 1 _�.� ' I i f � h��p VAFIEP old A sww&y mkpe my ;bmq T.- Mpr4oa 0, PIFCmc 5,�Rvsvvo -7 N07L-5 _Of Pli T-7171 A t k FfLoog P, - 5CA,LC J' )Z' 4�_ ill WX 4� opt "p RINI 4Z 77