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HomeMy WebLinkAbout23498-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 2-24885 Date FEBRUARY 5, 1997 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 1775 SMITH DRIVE NORTH SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 76 Block 3 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 15, 1996 pursuant to which Building Permit No. 23498-Z dated JUNE 13, 1996 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 ALTERATION, ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FLORENZIO & PATRICIA GOMEZ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-407834 - JANUARY 8, 1997 PLUMBERS CERTIFICATION DATED FEB. 3, 1997 - MIKE JACOBI PLUMBING uildi g Inspector Rev. 1/81 FORM NO. 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) N9 23498 Z Date .� 1.................... 19l.�? .......... .... Permission is hereby granted o: low ....... ........ . .:............... ......� . . l ...... Y - ,' at premises locate at ......� w .: ......... � ...`��. ............................................../7.:.7.-s'.. ....... . . . . ...�� �.�.............. ..................................................... ....... . .. ................................................................ County Tax Map No. 1000 Section ............3(�?.... Block .......�......... Lot No. ................ pursuant to application dated .1.1..., 19.. ;4 and approved by the Building Inspector. Fee s.....v�d.6ml/ ........ ........ .............. Building Inspector Rev. 6/30/80 70.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU W PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE © INSPECTOR 76S-1802 BUILDING DEPT. I INSPECTION,, FO ATION IST [ ] ROUGH PLBG. [ (FOUNDATION 2ND [ ] INSULATION [ ] !FRAMING [ ] FINAL [ ] ;FIREPLACE & CHIMNEY R KS: .� IV DATE7//z7/��< INSPECTOXR !:� M-1802 BUILDING DEPT. 1 NSPECTIO [ ] FOUNDATION IST [ ROUGH PLBG. ION 2ND [ ] FO AT [ ] INSULATION [ RAMING [ ] FINAL [ ]' FIREPLACk& CHIMNEY RE ARKS: 7v'' 1 DATE / INSPECTOR Albert J. Krupski, President 'Cawtl 11211 John Nalz2pfet, Vice president 53095 Mwfi knod Jim King P.O. Sok 1179 Martin 11. o2rrellSouthold, Now York 11971 Peter Wenzel meiephotle (316)765-1892 tot (316) 763-1823 MAO OV TOWN TROSTISM TOWN by 800THOLp February 28# 1996 Samuels & Steejmari Atchltects 25235 Main Road cutcboguet W 11935 RBa Gomez Resideodb SC" 16-3-2 and �q---- ttupp Residenoo St'mM 51.-1-21 near Samuels & skeuimt# Architdcth; hehove reisrstt}�and 4glidWd s st:d #utvey Va baeh reviewed h the ottice and at# ffiutld to 'tit #ide {i t9d Ttusteed urisdic ort as pat Outyegh trubmIdhd, it you have further quehtiohbl, please do trot hesitate to contact this office: Albert J. (Krupski 1 sir t President# Board of 'ft0tees AJK:Jmd cc: Bldg. Dept. BUILDING DE?AV, _Fjii �•4.9�OK 1�{7j TOWN HAIL 7b5-!902 FEB - 8 FT APPLICATION FOR CERTIFICZTE OF OCCMP SNCY A. This application must be filled in by tvpewrirar OR ink and submitted to the building spectar with the =OLlowing: Lor aew oui -ag Or new a52: ! . Final survey of .property with accurate_ location or ail buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of avatar supply and sewerage-disposal(S-9 form) 3. Aouroval of electrical installation from Board of Tire Underwriters. 1. Sworn statement from plumber certifying that the solder used in system contains Less than 2/10 of 1% Lead. 5. Commercial building, industrial building, mui tiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. o. Submit Planning Board Approval of completed site plan requirements. 3.,1 For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1 . Accurate survey of proper!77 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 aDDlicant. if a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. _es 1 . Certificate of Occupancy - New dwelling 525.00, Additions to dwelling 525.00, Alterations to dwelling 525.00, Swimming pool 325.00, Accessor- building 125.00, Additions to accessory building 525.00. Businesses 350.00. 2. Cartilicate or Occupancy on ?ra-existing 3ui?di32 - 5100.00 3. Copy of Certificate of Occupancy - - .25c. A. Updated Certificate of Occupanc;r - 550.00 5. Temporary Certificate of Occupancy - Residential/515/.0/0, Commercial $15.00 Date f.a/. . 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . .a�Old Or Pre-emistiag 3ui.lding. .K.. . . . . Location of Property. . . .nsDS. , .SCYJ1T6f ADZ „rVbJt:7... . . . . .5.C2i-?7-4q4,C) .. . . . . . . . . . .. . . . . House No. Street Hamlet Onwer or Owners of Propert7..)9(Z.-..+. X�e:5 . . . .0-.44d.ZA 'Y: ,�Q . . . . . . . . . . .. . . County Tac Nap No 1000, Section. ..F. ... . . ....Block. . �. . . . . . . . . .L�t. . . . . . . . . . . . . . . . . . .' Subd vision. . . . . . . .F;7ed wav. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Pe mit No. 3 Lf ?—. .Data Of ?emit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .. . .Underwri cars Approval. . . . . . . . . . . . . . . . . . . . . . . . . ?Tann'-ng Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary CCartificate. . . . . . . . . . . _final Ca_-T`--cct_. . . .(-- . . Submitted: 5 . . . . !,•'. �.� . . . . . . . . . . . . . . . . . ,. .✓. .C.'�Ci . . . . . . . . . . . . . . . . . . . . . . . . . AIM, IC cd�ay��s M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: (O'leV4 a DATE INSPECTO �t 11t; z THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGF 1 1000484 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 1 gate' JANUARY''08,1? 0�OfULA,CD/ TEL. 76S-1802 1, TOWN OF SOUTHOLD ,r 1 OFFICE OF BUILDING INSPECTOR o ': P.O. BOX 728 cry z7rd ^' TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date 3 Building Permit No. 231V 9 $ Z Owner Mt 'EMvs cj -(, M,z (p)lease print) Plumber _ !::' i/c e jkC,4 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumb s signature) Sworn to before me this �2, -qday ofc�e s , 19 �`7 h ,�/ Notary Public Notary Public , ' /t ale, unty Not NEIFNE D PIORNE rV Fu1,Nc,State of New York Quallfie do.495 t,3pA Comn�issinn n�ouffolk county A s flrlay 2, 19 � > .'r: ..—.I•.t.'..-. tiCrv� v ., n. .. 3. .. -�:: � ra;4. 4...x..:. -, ._ ._r+ x a v.e v., .. �4.3,.... PYAJD_A&PECPION_REPORT _ xDA T _y —_—_ — — _ -- COMM TS W ---=--- ------- --- -- --- — — --------A-- _____ _ _ FOUNDATION ( IST) II------_II - — -- _!-- _-- Ilzr FOUNDATION (2ND) II M ROUGH FRAMES _— PLUMBING II I II _______}__`___________________ INSULATION PER N. Y. STATE ENERGY — cooE �---- -II II `, it cdI II FINAL ADDITIONAL COMMENTS: 7y � LD tv y f t i i APPLICATION # l ¢r PAGE 1 of 4 ` TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. 1 SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): �AY 24 �99� 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. r 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO THE T OF KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE)—( DATE rV24/9l(p_ SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE ,tom ��/' a 1 JD /,GIAJ uui gD c' z -}D 5t)rretj In AA. 6uhu- A4 . 3108 BUILDER OVILhER5 790 CLoMr lahe. SotAbo, J--7� E+WANEEP. F�lI�T� lL1F� F—SAN 28235 HA/N ld? 734 . 6405 G5 Tc 0f NT 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. �zrZ � E1Y11Ja r , �JnUlro/a� �cTL''I 2 FDP(93) APPLICATION # _ PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure Residential (1-4 Family) gAddition ❑ Residential (More than 4 Family) V Alteration ❑ Nan-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) _ ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- C3 Replacement factured Home Park? ❑ Yes) o r� ESTIMATED COST OF PROJECT$ Cn N Gv7 B. OTHER DEVELOPMENT ACTIVITIES: oo A o~ ) ❑ Fill ❑ Mining ❑ Drilling ❑ Grading o ❑ Excavation (Except for Structural Development Checked Above) y.,. ❑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 i - 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: ❑A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust floor,details of floodproof ng of utilities located below the fust floor and details of enclosures below the first floor. Also, ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser,the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential. only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law #_, 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. r MAY 2. 41996 E . te.--BLDG pE4'T. OW [ WTF1m�L�, APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofrig protection is FP. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: rp I IV i, MAY Z q E. ..b- TOW p D(G, SourhOL " -- .--.i Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area E MAY BLD('sa[i rD - _ _,awry or o . - -�.. u7horn ' K 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. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED SIGNED_ DATED: MAY 2 4 1.9.96 fis TOWBLDG. UEP"I C/C(93) S A M U E L S & S T E E L M A N June 5, 1996 :F Mr. John Boufis Building Department 4 • J� .,,•' ` Town of Southold Main Road `• ,' Southold, NY I Re: Gomez Residence Dear Mr. Boufis, Enclosed, please find the following items to accompany the application for Building Permit for the Gomez Residence: 1. FEMA Certification by Van Tuyl Surveyors 2. DEC Permit Please note the FEMA Certificate indicates the lowest level elevation which is currently the existing partial Basement. The Certificate also notes the existing first floor elevation at 9.2'. We hope this information will allow you to finalize the permit. If you have any additional questions, please do not hesitate to call. Sincere{ , S s & Steelm Architects A. 1 ancy to � i JUN - 61996 BILIDEPT ' TOWN OF SOUTHOLD ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (516)734-6405. FAX(5 16)734-6407 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE { 1-4738-01277/00001 May 29, 1996 FACILITY/PROGRAM NUMBER(S) PE IT EXPIRATION DATE(S) Under the Environmental May 31, 1999 Conservation Lau TYPE OF PERMIT 0 New ❑ Renewal 0 Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Arti�cte 15, Title 5: Protection ❑ 6HYCRR 608: Water Quality 0 Article 27, Title 7; 6NYCRR 360: of Waters Certification Solid Waste Management 0 Article 15, Title 15: Water n Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR 373: Supply Hazardous Waste Management 0 Article 19: Air Pollution 0 Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion Transport Management 0 Article 23, Title 27: Mined Land ❑ Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain Island Wells " Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers I Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 Other: PERMIT ISSUED TO TELEPHONE NUMBER Dr. and Mrs. Florenzio Gomez (516) 764-3408 ADDRESS OF PERMITTEE 40 Surrey Lane Rockville Centre NY 11570 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Nancy Steelman - Samuels & Steelman Architects 25235 Main Road, Cutchogue NY 11935 (516) 734-6405 NAME AND ADDRESS OF PROJECT/FACILITY Gomez Property 1775 Smith Drive North LOCATION OF PROJECT/FACILITY Southold SCTM #1000-76-3-2 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Goose Creek DMIPTICN of A JMI7M ACTIVITY Construct deck and modify existing single family dwelling as per approved NYSDEC plan dated 4/8/96.- Instatt new underground electric service. All work shall be in accordance with the attached NYSDEC approved plan. By acceptance of this permit, the periaittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADbRN55 George W. Hammarth Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE - May 29, 1996 Page t of 5 I1 U 1 BOARD OF HEALTH . . . . . . . . . 15 FORM NO. 1 3 SETS OF PLANS . . . . . . . G TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . TOWN UTHOLD SOUTHOLD, N.Y. 11971 " TEL.: 765-1802 NOTIFY CALL ./ �'- F�✓. . . . . . . . Examined . . . ( ., 191 9 PIA IL TO : t2l Approved �J ., 19PermitNo /. .� Disapprov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) AP ATION FOR BUILDING PERMIT e �� cc�� Dat � . . . . . . . . . . ., 19<lr• INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stieets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. " c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build' g code, hou rg code, and regulations, and to admit authorized inspectors on premises and in building for necessary,' s ctions. lr . . . . . . . . . . . . . -- Signature f applicant, or name, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, *agent, architect, engineer, general contractor, electrician, plumber or builder. .�.!. k.l. . . . . . . . .—.}. .. . . . . . . . . . . . . . . .�. ._.]. .,.. . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises .►. .K� ©. . . .J.'t�J C.�G�a .IOYl'1C!'� —. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . I . , . . . . . . . . . I . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . y J j 1. Location of land on which proposed work will be done. . . 1771 _`,;'). .. 1­6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .amu. . . C31d, . N. '(•. . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . : . .7(a. . . . . . . . . Block . . . . . . . . . . . . .. . . . Lot . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) , 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ,5JY1�I . . ci�Y.Y11 . . b. Intended use and occupancy . . . .�,.xq Y.Yl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... : . .. . . . :... .. . . ... . . . . . . . . . 3. Nature of work check which applicable : New Bu'ildin ' S1 t ',1 ( ) g . . . . . . . . . . Addition . . .X. . . . . Alte'i"a[ttStt"""f Repair . . Remov al . . . . . , . Demolition Other Work . �/ e(I .c tion) . T, . . 4. Estimated Cost . . . . . . .I 0, poo Fee . , . . . . . . . . . S. If dwelling, number of dwelling u (to be paid on filing this, ton} !?` its . , , . . .� . . . . . . . .. Number of dwelling units on each floor . . . '':- . If garage, number of cars s 6, If business, commercial or mixed occupancy, specify np, re and extent of.each tvne of use . .- 7. Dimensions of stun structures if an Front . . `�, . n , , Rear . . �.'.17��, , ' u Height . , j y rr Depth . . . .cJ – G Pf'l.'.4? . . , . . �r of Stories . . .1.��. .SJ IL'S. . . . . . . . . . . . . . . . . . . . . . . . . . g . S t uct Numb alterations or "ditto s: Front . . . :- °, , , , , , Rear . �. . g �� n of same structure with Height 9 ._ Number of Stories , . . . . .�2 , 'rj^ Depth • 'ns of entire new construction: Front . . . . , , , , , , , ; Rear . . . . . . Depth imensio 8. Dimensions p Height . . . ... . . . . . . .. . . . . . . . Nump4r of Stories . . . . . . . . 7 p 9. Size of lot: Front . . . . . ./. . Q. . . . . . . . . '. . . Rear . . . . .�QF.-. . . . , . . . . . . . Depth . . . .-. . . . . . . . . . . , 10. Date of Purchase . , , , . , ,0, , , , ; , , , , , , ,,, , , , , , , , , NmeofFormer Owner . . . . . . . . . . . . . . . . . . 13. Doe lot be re ' es zoning la , . . . /'Cnce or, e u, o : . . . , • „ . 1 1. Zone or use distract in which reml Will 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . .I,7.o, , , , , , , , , graded . . . . , n.o , : , , , , , , , , , Will excess fill be removed fr^, /AA-Phone p9ra premises: Yes No 14. Name of Owner of premises . envzlD 3A(5; y zl. Address-9 .6vrrg .� No.76. .Name of Architect 9ftlU,e }C I Y), Address�5a?35. f» ophone .6 0 ;. . . . . . . . . If yes, Southold To Address . , . , , . , , . . . . )(. . . . Phone No. . . . . . . . . . . ... . . . ameofCpntrPctory feet of a tidal wetland? *yes„�(, , , , No. . . . . . . . . 15. Is this property within 30Q Town Trustees Permit may be required. PLOT DIAGRAM 1 Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , ;TATE OF NEW YORK, AUN T Y OF . . . . . . . . . . . . . . . . . S.S t rG �� . • • . • • • • . . . . . . . . . being duly sworn, deposes and says that he is the applicant (lame of individual signing Contract) Bove named. j /�I [e is the . . . . . . . / ce,J . �/ l . : . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to, the best of his knowledge and belief;and that the ork will be performed in the manner setl forth in the application filed therewith. worn to before me this da of. , . 1 ' C /. y � . . , . . . . 1�9.� otaryPubli <e. . County LINA FOROSICH • g�,-�. . . . . . . . . . . Notary PuMle,State of New York (Signature of applicant) No.49M,Suffolk County Tams EVkss Seq,3,19f.7 S% t � UT H OLD s J • MpPlrr.n •• SITE DATA S (� L°ndrng SOUTHOLD SCTM # 1000 - 76 - 3 - 2 PROPERTY: 1775 Smith Drive North B A Y ADDRESS Southold, N Y , 11971 .. o• wry _;' o ' °�:••� ° OWNER: Florenzio & Patricia Gomez : • ,• •� .'i 40 Surrey Lane ' D Rockville Center N Y , 11570 eaenr xoc, riecic Tel # 516 - 764-3408 .E SITE: 0 78 Acres (33,976 8 s f.) r�° n•r ' r. AREA �' i w _ ZONING: R - 40 � Y SURVEYOR: Roderick Van Tuyl U 0 SITE N ° � ,/,J„ Greenport, N Y. 11944 v LfMf 'Cr xoc NECK J) roe fM� License # LS 25626 A,'�L/pRJI r� Dated: December 17, 1980 Z Z Z BAY (�j _ W I J �PcWn�edeA / ij)T (/V M�EIMYIIRNIS CER1iICAiE ~ NORM � l W Q / APPROVED AS NOTED G / Z 0 Cq©09E G(LE�.I< GATE: B.P.# �o Z ° FEE: 60 _0 NOTIFY BUILDING D qR T765-1802 9 AM TO yOv �i� OP.OiMIf F2Y FHE jFOLLOWIG INSPECTION : N 1FOO - TWOREQUIRED FOR POURED CONCRETE ZOCCUPANCY OR FRAMING & PLUMBING W3. INSULATION FJIjJSE C IS UNLAWFUL 4. FINAL - CONSTRUCTION MUST Y C O ' y\��l �1�T'EFa_ n.1,nRI•� ALL CONSTRUCTION SHALL MEET BREQUIREMENTS COMPLETE FOR C.O. O = 6TFSOUT CERTEF9CA � TE THE QUIREMENTS OF THE N.Y. ��1STATE OCCUPANCY / CODES.0 NNOT RESPONSIBLE ENERGY � U �J,�N' O �� •� DESIGN OR CONSTRUCTION ERRORS PLUMBER CERTIFICATION�✓ ��� ON LEAD CONTENT BEFORE faRr�W.ala�f `� 1 ,hl� CO" ,�� �CERTIFICATE OF OCCUPANCY � Z F Cq406E IJ GCIL N Q � NI Cq 1-a \ I pI20Pt,IZ'Ir`r C>WtJEJ itP •,� SOLDER USED /N WATER r 4 2 . ` \ SUPPLY SYSTEM CANNOT x % EXCEED 2/10 of 1% LEAD. W J W r I \ � � W y szg _ J Y ,O a W Cl � " 5 n 0e PLUMBING s ALL PLUMBING WASTE 2 F- • u Lx IST N &WATER LINES NEED 3- F.?(ISI. rFMFJ�IT �-T FtE,✓✓c, TESTING BEFORE COVERING �°CGP35, w �w bl�co•.eR oa e><IaTING � E,iJC LASED H?Rc•N t`, �C. To rbF, QF Hover) ,�. Rr_CoI�S rfr'1.IG1- •o•. PI'so Pi's Ep H eepper tubing la used for water distributing , system, piping shall be + of types Kor L ord P�4 OF HfQy rl/r P. 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Sheet Title: \0 _ _ SITE a�� = Ics•o PLAN f�P-ISE N o rtT rl \ Sheet No: SITE PLAN 1 _ SCALE : I" = 20'- 0" I / n 1 �2 2 11 --- 24' 2'Ia FIELD �[FJ2IFy / 6i1_X1-711 21-4 I'$ 31_011 lal � � -- r - 1 4' 211 71 -9° _4"� I'- II" 7/(f]' Eat rsi � 17 2- p0 2442 S - RI (l Y III IIIm -axGcbSr �Gt1ET Coos Q �o ���S�P� G�O�. �� / -- W •� 5702. a I(o , = fHANGE IN— t �' �� A -,Ve g I�� p PN., Z _ I I '` a�l " 1 3�='— - - ' P� a�) N r Ae7Ef� 41 I �`� s� o o (P� - - _ T + � II v ' -zj F- {z{.� oaTDF� � �N II � Li y) Q 0 I- �f �' I • t " E.NIST WP FL 3 N N Q Ln T3 N o r/ - - - -- _ _--- - G4?PET 13YQhl Q Q �� - �� o L - KITG-E7J 4- F- REMPJE EX. ; /Q - —� 4,0' (L �0 T II caL�IP.T'&GJNK r>w.11cs INSTALLPD 6Y OWNER. 0 L.f°C.AS �'7 GaJ31NETR ( SUPFLIF_D&. 7Co 1- 15 P N _ i a' _' ,I III - '/1° TT INSl1L CLYJI2DINATi= A1JMfBINGG ELB:'f. uj W EX.`; O cP�2PEVII'm +� •Zk Q '� REPI �. - - - — - - - {� TLEWDFL, b - 6. ? 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REIPIPFuCrEl= T�J NT�Y G2a��' Jx,IpVC) O NSJL.0 UNIT C !vG � EXI67 wO � NORTH ELEVATION �;rt�� �o. ��DF WEST ELEVATION U NEVJ VINYL TIzIM �- c.FILa'Nc� SCALE : 1/4" = 1'- 0" No-; - ✓IGr- " FdlGir� �� :* SCALE : 1/4" = 1"- 0" gra �CI6'TNU ln�P N�uLs�rlcN FxlSr WfuL� C. �F�r' �• _`�tXJTH FIFVAT�ONS, o �- NEIJ f�pv>Lr Sl+ll�u>=5 N ON NF.y� 2Q'JF FR°{"VNG -- - - -- -- - NEvJ ASPHAJT _- - - - - -- - ----- - -- - - - — 5HINGLF= RAF ON _ _ -- -- - _.TOP-OF NF_W FF. -- - - ' - - Z _ _ EFS-j�� �- - � - r ISI' a OF VFh' 'F8- • NUJ f+SPH{aLT SHINGLE.. - -- - �.7F I 12 �ql Z • � _. � - -_ -- __ F2�F.ZE 3.7A:`dv — -- _ _- _ - EFR=F_'c t'�'.ic.^ > ____ _ � LL' • x .', J1 < -- - - - - - - - - - - - - -- - - -- -- _ - -- _ Ksr :-L OFT •n V'1 FF( Pg z -�M�=N E' F1C:ST SHC'J L WCY'D GFrs:kCSE PLAN �S nli-C1O- Dk p, i s FXY-'UT � LF.Nk'NF FX 5- C!�5F1 T 0 ' • __ INS ;L GL. 'JNI' ,, -CFS Pro ct SOUTH ELEVATION EAST ELEVATION Drawn awn SCALE : 1/4" = T- 0" SCALE : 1/4" = 1% 0" By: N5 Checked By: NIS Y� Date: 4 eL+/yG Scale: Sheet Title: BUILDING ELEVATIONS Sheet No: 4 . I _ 11;7n1 �17GH IZGZ'�P GOI�I_. �:. ✓:-,F, 'JF-tel` ASPI-IINuLF_ ,P60F 2x o P-"F�Ex"S�IG' ,J/a 30 P-�ATT NSJL L-2x10 ;?^FTEf5 C-- ,J/ 3 J/ 2 30 5A77 INSUL DI-FITe- -IreINI -- 2x4 57LD5 :? DbL HUNG �IND'JW 2" N G RGJ.F 7OF AP1'NF - �Q,yF - - � ASpHAI-T SHINC�LF� ��/ .Y / Z ;ZL PON 5/B EXT, W i LINE. JF 20 Jr >ND - / IST 2GYJF FaA 1N� 3 - r� HALL PLUW) SHFATGNG 0 o c: ENTRY Fb�N To 7�+I T s Y II H3 Iry 'N FFyT U y111N . 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N NE.hI--� I�6 1--VEL 'TOP OF �J6FL V 0 r - N '� PL riJ SUr'.�F l� _ - _ N CA PF f3ti ObvN EX F, F f-w �"r , 7 � r1!"� � _ _ � iY,tl , ir[' l"x'1 7 - ' �i r,v}� , , r i. t� ,- i Its- stir - iv , 'I�, i �> - Top O� GL13F{; r Y T 1�: 0 7 l " (�' ` i _ _ I r. T F.XIST DIL.C,L�GC+-7R 15T, ',''O.G wD ��xF'ts�GF HN •�.�ERCiYP.) �L I'iF-'-j '�� FaCF"r F1.., - - E N � Nenl 3- 2x l �� JOI T I- DIST; 2xf� F.T, � I RA - rTOP OF Fes(. +� IN'E. "2-1`91 5ATT N`_l L (,INF OF v.ALL. PF(,N/IVF' NF, 2x FT. i IL PLI, . F. IL< rt �,I. ,y3� - - GYP. I%D( VE�.0 - vFtl'i"r� rs�FAlr i nl t,FL, ,�. NEIrJ hIC� �L. I _ I i E EXIS.. ADR/a;Af�Le. 1x4 TRIM W, O°cLK.,"r1ND 1 ' E - FKFF2E -37-- -OL TO IZFNVvN NEb-I R- 1�1 ? T'r 'N'SLJL �'I _ III p( rJTN� I 'I11 1 VP-21FY HEADEf2 SIF I j I II �S�1NIF-'NT ex. Fx1sT error --EXISTING FOLJN�ihTIC�N A�.,UMPD F�;;C i, RD'?PNGS --T -j ' A' 1�. Fr �T a z -�.- .,Y INC Z . IL EbJ rJP.X. HUf�'l L.Ilhl `� 1 III li ' III 1 X11 II N R. W I � I III I I 2 1 _ c it BUILDING SECTION SCALE : 3/8" _ V_ 0" � w . N Vl . NEJ,�I /16pHALT SHINGLE - 12i'-2'_�F _ EXIST, 7�'r E5CIS 7 2x RAr 24� — -- __ _-- .ASPHALT N DPCL7RATIVF WD / I / _ zcz.�� ✓EAMS4 kD GEIUNG �\ -- — - = - ec'LE - TY��=,moi. �c1sr. aT �,LL, �MOV5 FXI5T "ASDF"sro ON /�I� 5 e� '� q�CP� NES CbnIN To SHrATHINIG. P12CTIICF _ _ -_ 2x -3,T NE:J PAPEe - X p c= 2" 01796 1 EXIST Z<4 57LJD5 FXISL WD F''-ODRNIG y NEIn z-;S P.A'T TO _ el -OP FL TO Pte. ZeF'N�HEv NEW =aLJ'I TER• _ > �.NTR`� 6EYOND - c _ 1177 _ � 'L` 3 '_✓L Pojec[ o: 925 F _ _ - / W6x28 OPELJ 10 �TC}-{FN rt�ur=12 T IDP OF KIS SJf =t/ FIN. FL - - - -- .— Draw B CASED IN I x ^Q PINE Checked B TI LIUI �� v.N`' t Ix CLI? PINE F u_ Da e: d/8/1� I- 51T1 iNG I1Ck.71 POOR Scale:0 Scale: Y c EXIST" 2x0 11 G'' I6," .. k" .MO�/E. EX'.S(- L, AS .�`10WN Y Ohj/ N� P-- 'PA6PHALT5H'NG'LZ- �J/ �AU7.SHVS, � T CST INS L _ N P7 2x Sheet Title: EX I ST e ,,2^,'DF- D F _ 1.J�F PPNFi Ca AXIS I. ��SP��NT eeF N�IL 2x -FDC�72 VIII j1 _ — 'XJLrTUFlSTI BUILDING & 6CI5T 2x4 5TLD5 WHIM o sTku Tum Top AFL W hDPANFLNGCINT -1 l � l .l' nrr '�n - '. + t > i r •n- nr i , f �- r 1r� i� . --_ v Ton OF D- WALE � I Fexlsr 1sT c.�z,°`WLSPx� I d: SECTIONS -I r - o� I . o I ' I I I I I I I 1 I m III � WALL SECTION Sheet No: SCALE V _ V_ 0., T VIII 1 1 1 �', I II ' ' — Note: ? hrlbe rz.. ,a1 I : I to A53JY1QD -X15T GATT NSUL, 1 ,Gf2AWL —k12 2x r 8 c"O.G, 1\�UMr_U XIST. W� a °T T IN6UL Ft�OTING ' POFQ11ATe Fol INST/>UJ'T1C F TNCU - - -- _ 2-11 I 1 BUILDING SECTION LONGz)N6 F Dx -INF 5 . r7G. SCALE : 1/4" = V- 0" 3 K FDN A e z 1 � RECEPTACLE _ HALF HOT :k HIGH HAT LOM \,t�LTPCE ' SURFACE MOUNTED CEYLING ' SURFACE MOUNTED WALL WP WATER PROOF SWITCH TELEPHONE t — r I 'I ', __ - - - i TJ TELEVISION f l LO SMOKE DETECTOR �/ } I {�,� + QUADRAPLEX RECEPTACLIMMER SWITCH E 4 .L. LST Z Z D Gp 'U I vrr I W III I � \ — >�Ti-f a I— I � GFS GROUND FAULT INTERRUPTOR Q `� a / d / " -s I Pu a y C, 70 r4-,t A/ H REMa.IN e_EscT walls Q �,. r.FZ I / "n i 0 I 1 r i,. Iv UNDERCA61NE_T z W LIG F.°�s�e I a CC I C � tcit • .. . � Gr=z".a � Fr I 4 I T � I I � I �I ' I I / I� it I I _ � I ugµ z '� _ 1 a. -- - KI �� `� �� �' F \' r4T ,.r^ �• - � FLAT CmLG - rl UAW PI i L r � — - H J m may;} 7 r i \ iP I II I I i Z . I { I Lv peNC>gNTc. TRx� Ke x ➢ K —�_J — Cc]LL✓`V< �B � � �LLAR T� I/S�— ��FL Ou1't�T k / fi I 1 II ' II I � I � I - _ 5 To �C15T DUTL�T � III it I �- / I i - - - II I — - - 1r 5 PE c III I I i Ip D / I I , —� db l ��OF NEdy STF� 'LTgn SECOND FLOOR PLAN FIRST FLOOR PLAN I. SCALE : 1/4" = 1'_ 0.. -I ' SCALE : 1/4" = 1'- 0" I sr Pr 'ect No: 2 t 5 5 T Drawn B Y I NS /7��p,>n T- Checked By: �S MIJ Scale; Sheet T'tle: OIL I ELECTRICAL. I _-- -' J I FIRST ' , IF II I -III SECOND -- - -- - FLOOR - i - - - PLANS I Ll ---__ � _— � I- - 11 - ' J. I_ ,J L' �IF . { � Sheet No: i I