HomeMy WebLinkAbout21389-Z FORK NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PEIUWT
R"rrl ov)e- Satin
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date . �...... .......................
NNO 21389 Z ...
Permission is hereby granted/to:
.Ly./.... . ... .. .... . ... .. . ......A-P.-.L................
. ...........
to ......... .....................
.......... . ...... .. ...... . ...... ..... ... ...... . . ................
at premises locat at ..... . ll.
..Ja.......R. . ... . . ........................................
............................................
............................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section ......3--(........... Block ......L.9........ Lot No. —13.............
pursuant to application dated ...... ....... �................... 1913, and approved by the
Building Inspector.
Fee $
a..046. .. .J
W.I.....
Building Inspector
Rev. 6/30/80
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5 BY THIS CERTIFICATE OF COMPLIANCE THE c
5 NEW. YORK BOARD -OF FIRE UNDERWRITERS 5
5 5
SBUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT 5
5 5
5 Upon the application of upon premises owned by
S JIM SAGE ELEC. INC. JEFF GRAY
5
5 PO BOX 38 600 RABBIT LA 5
5 GREENPORT, NY 11944-0038, EAST MARION, NY 11939 c5
5 Located at 600 RABBIT LA EAST MARION, NY 11939 c
5 5
5 Application Number: 3025724 Certificate Number: 3025724
55
Section: Block: Lot: Building Permit: BDC: ns11 S
5
5 5
5 Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: �5
5 Outside, 5
u
5
5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed c
5 herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5
5 5 authority having jurisdiction, and found to be in compliance therewith on the 19th Day of March,2007. 5
Name OTY Rate Rating Circuit Tyne 5
rj Service 5
5 1 Phase 3W Service Rating 150 Amperes e
5 Service Disconnect: 1 150 cb 5
C5� Meters: I C5�
5 5
5 S
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5 5
5 , 5
5 5
5 sea!
5 1 of 1 5
5 . , CS
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. C
5 5
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STATE ENERGY II
CODE I
FINAL
ADDITIONAL COMMENTS :
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Board Of Southold Town Trustees ►
SOUTHOLD, NEW.YORK
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PERMIT N0. .. ....3.1-18..-13... DATE: ....3/.11/93.........
ISSUED TO II
VIRGINIA M. GRAY
\ ,1 Pursuant to the provisions of Chapter 615 of the Laws of
i '..- �' the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en- !fin
titled "REGULATING AND
N THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and then
"I REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on ............2./..2.5./..9.3
.,: ..........., and in consideration of the sum of $ ....... paid by
,..:
A� 19 9 3
ti 4
lof ......................................................................................... N. Y. and subject to the `?.
Terms and Conditions listed on the reverse side hereof
of Southold Town Trustees authorizes and permits the following:
Repair bulkhead, located Rabbit Lane, East Marion. �F
ew.
all in accordance with the detailed specifications as presented in 'f4
the originating application. ` SF
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of 01 said Board as of this date..............
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G Ga'. .... ........
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s) ''. =,�;• `'' ac: MITI"r.
9 _1(10.901—=5C. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER AM EFFECTIVE DATE
1 L , Ac'r�c1 �Z \
FACILITY.PROGRAM NUMBER(s). ERMIT EXPIRATION DATE
UriderltHe;I:nvironmental Conservation Law (ECL)
TYPE PERMIT(CheckAil Applicable�Boxes)
.0Modification I "Permit to Can*strucf
❑Permu to Operate
Article 15, Title 5: �,---�'r-----
Article 17, Titles 7, 8: Article 27, Title 9; 6NYCRR 373:
Protection of Water SPOES Hazardous Waste Management
Article 15, Title 15: Article 19: Article 34:
Water Supply Air Pollution Control Coastal Erosion Management
Article 15, Title 15: Article 23, 'Title 27: Article 36:
Water Transport Mined Land.Reclamation. Floodplain Management
Article 15; Title 15: Article 24:- Articles 1, 3, 17, 19, 27, 37;
Long Island Wells Freshwater Wetlands 6NYCRR 380: Radiation Control
Article 15, Title 27: Article 25: Other:
Wild, Scenic and Recreational Tidal Wetlands
Rivers Article 27, Title 7; 6NYCRR 360:
6NYCRR 608: Solid Waste Management
Water Quality Certification
PERMIT ISSUED TO TELEPHONE NUMBER
ADDRESS OF PERMKTEE
i - 0 r1 \
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
':!:A I L
NAME AND ADDRIESS OF PROIECTIFACILITY
LOCATION OF PROIECT,FACILITY
LINTY ` 17�WMCITYNILLACE WATERCOURSEMETLAND NO. NYTM COORDINATES
� \ C E: N:3
DESCRIP ION OF AUTHORIZED ACTIVITY
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By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance
with the ECL,all applicable regulations, the General Conditions specified(See Reverse Side)and any Special
Conditions included as part of this permit.
PERMIT AIDMMINI TRATOR ADDRESS
AUTHORIZED SIGNATUREDATE
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Tow,y GF fcau>is�aca /1/,,Y 9�'�h'cbYr fSilY�9•sivo���
130,1FD OF HEALTH . . . . . . . . .
FORM NO. 1 --13 SETS OF PLANS . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT �,,CIIECK . . . . . . _ . . . . . . . . . ... . .
TOWN HALL SEPTIC FORK _ . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 r:o<< F•f
Examined . : . . 19 CALL . . . . . _ . . . . . . . . . . . . .
MAIL TO :
Approved !l!r/t/!!�. . . . . . 19 9Permit No. .1 �
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ .. _ . . . .
i}
01
(Building Inspector) t-A` ' ` =s� 4_J@ 'FI
APPLICATION FOR BUILDING PERMIT
Date . . . . . j Z. . . . ., 19 13
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 streets
or,*eas, 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
�.. .�. . . . . . . . . . . . . . . . . . . . . . . .
(Signature of�licant, or name, if a corporation)
_ (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.�c�e� . ick. . . ✓. -. . �rey 4. .Cox, 77�-a-r��►? . . ���/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises . .V4 4 q t . . .ni. !4 v?: • /L 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax oll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. • . . . . . (Name and title of corporate officer)
.l
Builder's License No. . . ,l,l,G , , S�,YG�'
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . ... . . . . . . . . . . . . . . }.
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . , , , , , , , , - .
House NumberStreet . . . . . . Hamlet . . . . . . . .
County Tax Map No. 1000 Section . . . . . . . Block , . . , , , ; , , , , Lot . . . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . Lot . . . .
. . . . . . . . . . . .
State existing use and occupancy of premises and intended use and,occupancy of proposed construction:
a. Existing use and occupancy . , a AR �, ,. �yrso�%�,L, , -V., c�;/c.?. . . . . . . . . . . . ... .
b. Intended use and occupancy . :�(�.�?.'. .��.�+;S: !a� , ,��,'�,s i;�,�;✓c . . . . . - . .
3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration
Repair . . . • . . . . . . . Removal . . . . . . . . . . . . . .. Demolition . . . . . . . . Other Work . . . . . . . . . . . . . . .
$`(� 4 l90 i u �z (Description)
4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . .,7 '.��.�. . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling,number of dwelling units . . . . 1-• , Number of dwelling units on each floor.
If garage, number of cars . . . . . . . z. . . . . . . . , . , , " " '
6. If business, commercial or mixed occupancy, specify nature and extent of each tye•of use • • . .
7. Dimensions of existing structures,if any: Front . 20•�(�ft 6 . . . . • • • ' ' '� �' ' ' ' '
Height . . . . . . . Rear .�?: . . . . . . . . Depth . . . .3. . . . . . . .
. Number of Stories •T,,,;a •( �
Dimensions of same structure with alterations or additions: Front . . . . .aQ;(" •1 • • • • '
Depth . . . . . . . .3/ . . . . . . . . . . . . . : . . Rear . . :�. f. . . . . . . . .
. Height . Number of Stories . ?:
8. Dimensions of entire new construction: Front . . Rear . Depth . • . • -
Height • Number of Stories
9. Size of lot: Front . .S3. !/.tr.`. . . . . . . . . . . . Rear . .Ave .C2 .7. �. . . • . . . . . . •Depth . 1?a ;. . . . . ... . . . . .
10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . • • . . • •
11. Zone or use district in which premises are situated . • • • • • • • ' ' ' ' • ' ' ' ' ' -
12. Does proposed construction violate any zoning law, ordinance or.regulation: .I Q. . . . .
13. Will lot be regraded . Will exce s f 11 be re •oved from premises: • • • • Yes
14. Name of Owner of premises .U•,* ;,.y•yYl •�ic • • • • ��� s• f KS
Name of Architect ' 7. . . Address sl �•�vu. ,A•�vc4Q+Phone No. . . . . . . . . . . . . . . .
Name of Ke,,e�. �. . . . . . . . . . Address . . . . Phone No: . . . . . . . . .
Contractor • • , • • . . • Address fix.!'?4 �•1` .phone No. 7.�/y;3/S'/
15. Is this property within 300 feet of a tidal wetland? * • • ii.� " ' -
*If yes, Southold Town Trustees Permit may be required. No. . . . . . . . .
PLOT DIAGRAM
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 Iot.
,
TATE OF NE OR_� .
:OUNTY OF �. . S.S
rv47n a • •l• { • • • �• �(•� being duly sworn e
r •�• N.• g y , deposes and says that he is the applicant
(Dame of individual.signing cont act)
hove named.
eisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contract .r, agent, orporate officer, etc.)• . . . . . . . . . . . . . . . • . • . . . "
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; 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 set forth in the,application filed therewith.
vorn to before me this
. . . . . . . . . . ay of. . . '. . . . 19f
'tary Publi . .� . .�. :. :. . . . . Co��nt
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Natsry Public,.;c!;'';ce df New York ,
No.4 ..9505 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . .
Qualified in Suffolk County (Signature of applicant)
Commission Expires Decemb 8.19�.
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APPROVED AS NOTED
DATE: B.P.#J--/
FEE: BY. a
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 ARA TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUSS'
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGV
CODES. NOT RESPONSIBLE FOO
DESIGN OR CONSTRUCTION ERROW
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