HomeMy WebLinkAbout21616-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24125 Date JANUARY 22, 1996
THIS CERTIFIES that the building REPAIR
Location of Property 910 PARR AVENUE EXT. MATTITUCR NY
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 8 Lot 29
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 12, 1993 pursuant to which
Building Permit No. 21616-Z dated AUGUST 20, 1993
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 A PILE FOUNDATION UNDER AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to DEBORAH G. CELIC
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
/ `
4uil ing Inspector
Rev. 1/81
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)
6PI
Date
a...... 19...9
N® 21616 Z
Permission is hereby granted o:
to C-CJ C.7.T
....~x... Ufa.......... !!f...../~s C ! ~~r..J(~....../7~J......
. I
at premises located at......9
County Tax Map No. 1000 Section ....143.......... Block Lot No ~.719
pursuant to application dated uc 12-
19...../. and approved by the
Building Inspector,
Fee
'15~....
ildis ector
Rev. 6/30/80
y r
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1.802
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 - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Co er isall $15.00
411- /
Date ..s/~~G~
New Construction........'./.. µ0ld Or Pre-existing Building
Location of Property../. *K . ..lrU ~ftNSID•U. , , , , , , .
House No./Street Hamlet
Onwer or Owners of Property ..~~A4W. C~_ . .
County Tax Map No 1000, Section.../!L Block e....... Lot.......
Subdivision....///....................................... Filed Map............ LLot......................
~^Y•°t"
Permit No..~lfDate Of Permit..?.:'~9.: • Applicanti,G~? "
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary ~Certificate Final Certicate.. Y........
Fee Submitted: $....5 •
Lrtr 6qg .G'..
APPLICANT
4
~~SUFFO(~-~O
.o~~ Gyp
H ;
Town Hall, 53095 Main Road p Fax (516) 765-1623
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 16, 1996
Ms. Deborah Celic
New Suffolk Avenue
Mattituck, NY 11952
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)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21616-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
pppppM-1802
BUILDING DEPT.
1NSPECTION
[ ] FOUNDATION 1ST [ } ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS: 46
or ~r
adz-
DATE 71d Pl INSPECTOR
o~~s~fFO(~-cOG
N x
Town Hall, 53095 Main Road W -
Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 27, 1995
Ms. Deborah Celic
New Suffolk Avenue
Mattituck, NY 11952
Re: Building Permit #21616-Z
Premises: 910 Park Ave Ext., Mattituck
Suff. Co. Tax Map #1000-123-8-29
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
o~OgpFF01,f
Gym
o =
Town Hall, 53095 Main Road p ® Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
SoutholdNewYork 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 16, 1996
Ms. Deborah Celic
New Suffolk Avenue
Mattituck, NY 11952
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)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21616-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
N
OUTIDATION H
r ~
fi=OUUDATTO:l
(2nd) I _ m
2.
Q o •-O
DOUGH FRAME & fill Q
-PLUMBING II
C
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rn m
II
r1SULATION PER N. Y.
I
STATE Ei1ERGY II
CODE I * V
FINAL
ADDITIONAL COMMENTS:
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•1"RUS•rl:ES v$,a F01/( co SUPERVISOR
John M. Bredemeyer, III, President Gyp SCOTT G. HARRIS
Albert J. Krupski, Jr., Vice President q
Henry P. Smith 7bwn Hall
John 13. Tuthill A~ 53095 Main Road
William G. Albertson P.O. Box 1179
Southold, New York 11971
'filephonc (516) 765-1892
Fax (516) 765-1823 BOARD OF TOWN TRUS'T'EES
TOWN OF SOUTHOLD
June 1, 1993 1 d
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~4 141 ~
Diane Herold
P.O. Box 884
Westhampton Beach, NY 11978
Re: Robert Cel.ic SCTM # 1000-123-8-29
Dear Ms. Herold:
The following action was taken by the Board of Trustees at their
regular meeting of May 26, 1.993:
RESOLVED that the Southold Town Board of Trustees approved the
request for a waiver to raise house to the required tidal flood
plain elevation for V-4 zone. House and decks will be raised and
placed on pile foundation.
If you have any questions, please call our office.
Vep /~truly yours,
64 -
John M. Bredemeye
President, Board of Trustees
JMB:djh
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1.4738-00810/00001.0 July 30, 1993
tXPIRAl
FACILITY/PkOGRAM NUMBER(S) PE T J
uly uly 3131,,0N 9Ar$(S)
199b
Under the environmental
conservotlan Law
tYPE OF PERMIT New tl Renewal tl Modification ? Permit to Construct ? Penait to Operate
0 Article 15, title 5: Protection tl 6WYCRR 6081 Water (lustily 0 Article 27, Title 7; 6NVCRR 360:
of Waters Certification Solid Waste Management
0 Article 15, Title 15: Water ? Article 17, titles 7, 8: SPOES ? Article 27, title 9; 6WYERR 373:
Supply Hazardous West* Management
? Artiele 19: Air Pollution
0 Article 15, Title 15: Water Control ? Article 34: Coastal Erosion
Transport Management
? Article 23, title 27: Mined Lard
0 Article 15, title 15: Long Reclamation tl Article 36: Floodplain
Island Wells Management
0 Article 24: Freshwater Wetlands
0 Article 15, Title 27: Wild, 0 Articles 1, 3, IT, 19, 27, 37;
Scenic and Recreational Rivers d Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control
0 Other:
PERMIT ISSUED TO TELEPHONE NUMBER
Deborah Celic ,
ADDRESS OF PERMITTEE
c/o Celic Estate Agents, Route 25, Hattituck, NY 11952
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Diem Herold, P.O. Box 884, Westhampton Beach, NY 11978
NAME AND ADDRESS OF PROJECT/FACILITY
Park Avenue Extension - East End
LOCATION OF PADJECT/FACILITY
MattitUck
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold
DMIMCN OF WJI OIZE1a ACPIVITY
Raise existing single famlly_dwellina and two decks to elevation 0 on i0' long piles as per NYSDEC approved plans dated
4/93 by Diane Herold.
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict eompltanee with the
ECL, all applicable regulations, the General Conditions specified (aea page 2) and Why Special Conditions included as part of
this permit.
DEPUtY REGIONAL PERMIT ADDRESS
ADMINIStRATOk:
David DORIdder Bldg. 40, SONY, kcom 219, Stony Brook, MY 11790.2356
AUTHORIZED SIGNATURE DATE
July 30, 1043
Page 1 of 5
!',1 A! j(; ! 2 899;
1 lkt
= iCYdUia": %,ii,r
t L O"ITICM
inspections
1 inspe tcion at easonableehoursyandnIntervalsrelevant authorecord, ized lep esentativeiof
the Department of Envltorrrental Ccinservatlon (the Departrrent) to determine With this
Such te ta~tivermay orders thelwark uspended pursuant to ML 7110301 and SAPA 40p(3).
copy of tilts permit, Including all referenced traps,. dr~vings and special
conditions, nest be available for Inspection by the Deparittertt at all times at
the project site. rallure to produce a copy of the permit upon request by a
Drparti representative Is a violation of this permit.
'
Pe mil t Changes and fl-MM Is
2. The Mpartrrent reserves the right to modify, suspend or revoke this permit W*n: of any
a) condition of the permit L or d provisions of the d13CL and pertl o inent egul
tions Is found;
b) the permit "s obtained by misrepresentation or failure to disclose
relevant facts;
c) nonrnaterial'inforration is discovered; or
d) regu a~nt hove materially changed relevant since technology, opermitrwaspIssuebd. larv or
3. eThe na`alnlaadificationlorttransfer rof this permit, SuchiapplicationntrrustTInclude fees
rtren
on the
rnl3t
res renem Ir and I f s cat ion oruptransfer' (granted by ithe Department rrust beegIniwr I t ing y
h. The permittee nust'subnit a renenel application at least:
a) 180 days before expiration of permits for State Pollutant Discharge
Elimination I"ton (SPM), hiazardous \Abate Nbnagai Facilities
(iW'p/F), major Air Pollution Cotrol (APC) and Sol Id ftste Nbnagamnt
racilities,(I; and
b) 30 days before expiration of all other permit types.
5. Wiess expressly provided for by the Department, Issuance of this permit does
not rrodify, supersede or rescind any order or determinatloh praviously_Issued by
the Depatin-ent or any of the terms, conditions or requiramnts contained In such
ordet or determinatian.
Other Legs I Cb l i gat I ons of ill Pe mw ttee
6. The pernittee has accepted expressly, by the execution of the application, the
full legal responsibility -for all darroges, direct or Indirect, of Wintever
nature and by Wrrreyer suffered, arising out of the project described in this
permit and has agreed to Indaiiify Arid save harthidss the State from suits,
actions, dal-ages end costs of every name and description resulting fram this
project,
7. This permit does not convey to the perrnlttee any right to trespass upon the
lands or Interfere with the riparian rights of othetit In order to perform the
nterestt Inoreal~orr'pdoes It authorize arsonal property held or vestedt I'of y n a peerson hots at party to
the permit.
8. ease~an stand rights-of-vilayethat mayabe I eq ired fort tphls project~rovals, lands,
Pae2of5
o', 20 n,, (702)- 251
ADDITIONAL GLNERAI CONDITIONS LOP ARTICLES 15 (Title 5), 24, 25, 34 aril 6 NYCRR hart 609 9 rhat if fuhpe operations by the Stale of New York require an al- other environmentally deleterious materials associated with the
terhlion in the position of the structure or work herein authorized, or project
if, o the opinion of the Department of f ea romnetual Conservation 13 Any material dredged in the prosecution of the work herein permitted
it shall cause unreasonable ohsuuctlon to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across
waters or flood flows or endanger the healdi, safely or welfare of the bed of a waterway or floodplain or deep holes that may have a
the peoplo of the State, or <ause loss or deWuchou of the natural tendency to cause damage to navigable channels or to the banks of
u"oul, os of the Slate, Ibe owner may be ordered by the Depmmnent to a waterway
remove or ahar the shun tural work, obstructions, or hazards caused
ihereby without expense to it)(' State, and t, neon the expiration or Id 1 here shall be no unreasonable interference with navigation by the work
revocation of this permit the Structure, fill, ex,avation, or other herein authorized
modification of the watercourse hereby authorized shall not be coin- 15 If upon the expiration or revocation of this permit, the project hereby
pleled, the owne,s, Shall, without expense to file Slate, and to such authorized has not been completed, the applicant shall, without expense
extent and in such time and manner as file Department of Environmental to the State, and to such extent and In such time and manner as the
Conservation moy require, remove all or any portion of the un(olnpleted Department of Environmental COnServatlon may require, remove all or
structure or fill and woore to its former condition the navigable any portion Of the uncompleted structure or fill and restore the site
and flood capacity of the watercourse No Clain Shall be made against to its former condition. No claim shall be made against the State of
the Stale of New Yolk mil a( (count of any Su( h removal or alteration New York on account Of any such removal or alteration
10 1 hill the Stale of New York Shall In no case be liable for any damage 16 If granted under 6 NYCRR Part 608, the NYS Department of Environ,
or injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project will not
by or result ((nor future operations undertaken by the Stale (or the contravene effluent limitations or other limitations or standards under
conservation or improvement of navigation, or for other purposes, and Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977
no (lain, or right to (on,ponsatton shall acuoe from any Such damage fill- 95-217) provided that all of the conditions listed herein are met
I I Caanting of this pernhit does not relieve the applicant Of the responsi- 17 All activities authorized by this permit must be in stnet conformance
bdiey of oblzlning any other permission, consenl or approval from with the approved plans submitted by the applicant or his agent as part
the t S Army Corps of I ngincers, U S Coast Cuard, Now York Stale of the permit application
O(fkeofCehreial Services or local government which may be required Such approved plans were prepared by Diane Herold
17 All 11111essary precautions shall be taken to preclude con tan,ina Lion (3 pages) 493
of any wetland or walerwav by suspended solids, Sediments, fuels, on
solvents, lubri( ants, epoxy coalhtgs, patens, concrete, leachate or any
SPECIAL CONDITIONS
a-. During construction, no wet or fresh concrete or leachate
shall be allowed to escape or be discharged,.nor shall washings
from transit mix trucks, mixers, or other devices be allowed to
enter tidal wetlands.
2. All necessary precautions shall be takOh.to prevent
contamination of the tidal wetlands and/or waters of New Mork by
silt, sediment, fuels, solvent] lubrioanta, epoxy coatings,
concrete leachate and any other pollutant associated with project
work.
3. Any debris or excess material from construction of this
project shall be completely removed from the adjacent area
(upland) and removed to an approved upland area for disposal. No
debris 1.9 permitted in tidal wetlands,
4. The storage of construction equipment and materials shall be
confined to within the project work site and/or upland areas
greater than 50 linear feet distant from the tidal wetland
boundary.
5. Any disturbance to existing beach grass shall be replanted
with beach grams on 12" centers the next growing season following
construction,
I ~.o..
Or c 114511A NUMBI -00810/0000 1-0
PRO(,RAWI At 111 rY NUMIII l2
+ Page 3 of 5
55-2'0b1` tI2/85)-25C NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 9b
SPECIAL CONDITIONS
For Article__ 25 (_`Tidal Wetlands
6. No decks, accessory structures, or additions will be
permitted without further approval of th6 Department.
7. Project must comply with all local and federal floodplain
regulations.
8. There shall be no disturbance to vegetated tidal wetlands as
a result of the permitted activity.
9. Equipment operation below mean high water is strictly
prohibited.
lo. 711 repairs to existing structures shall be confined to
replacement of existing structural elements.with no change in
design, dimension, or materials, unless specifically authorized
herein.
1.1. No fill is authorized.
12. Movement of the single family dwelling must be directly to
the south and shall not rest on any vegetated tidal wetlands.
Supplementary Special Conditions (A) thru (F) attached.
V:11 i
DEC PERMIT NUMBER } 3)..-"9""~1•-
1-4738-00810/00001-0 .,l
PROGRAMIFACIUTY NUMBER f"S
Page 4 of 5
5:.'??L~`CN':'ARl s?°C'.Al. COND_71ONS
he follawiag coeditions apply to all permits:
c,:-=v c' this permit, iacludinc all conditions and approved
pia-is, shall be available at the project site whenever authorized
work is in progress. T::e permit sign enc'_csed with the permit
shall_ to _ .,tected frpm the weather and posted a conspicuous
location at the work sate u:iti'_ all au-ho_'_zed work has been
completed.
i. The pe_mittee shall require that any contractor, project engineer,
or other nersan responsible for the overall supervision of this
project reads, understands, and complies with this permit and all
its general, special, and supplementary special conditions. Any
fallure to comply precisely with all of the terms and conditions
of ..is permit, unless authorised in writing, shall be treated as
a v4 - olar.ion cr he environmental Conservation Law. 15 any of the
permit ccadit"_ens are unclear, the permlttee must contact the
Division of Reguiatcry Affairs at the address on page one or
telephone (515) 751-1385.
if reject design modifications become necessary after permit
issuance, the ner:n'_`_:ee shall submit the appropriate plar,changes
for approval by the Regional Permit Administrator prior to
under`_.akLng arv such mcdif_cations. The term-Attee is advised that
substantial mcdif'_cat_ca,r.ay require submission of a new
app'_'_dation for permit: .
A. leas= two days prior 4 commencement of the project, the
pe.^a'_ttee and ccrtractcrsha11 sign and return the top poricn of
tae enclosed nctjdcaticn form certifying that they are fully
aware of and understand all terms and conditions of this permit.
Withir 20 days of ccmpietion of the authorized work, the bottom
portion of that fora shall also be signed and retained, along with
photographa of the completed work and, if required, a survey.
or protects 'involving activities to be undertaker. in phases over
apericd o, more than cne year, the permit-tee shall notify the
Regional Permit Administrator in writing At least 48 hours prior
to recommencing work in subsequent years. ,
The craning of t:^. is pehit does not relieve the per-~ittee of the
raspcrsiaility of ebtal.ning a grant, easement, or other necessary
approval from the Division of Land Utilization, Office of General
Services, 'cower 31-111-ding, ?mpire State Plaza, Albany, Ny 12242
(313) 474-2155, which may be required for any encroachment upon
State-owned lands underwater.
DEC per=_t ac. ~'~73 & 'OCJ~IU~dPC7U/- C Page Sof S
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130'XRU OF, HEALTH.........
FoBrN No, 1 3 SETS OF PL.INS, . .
TOWN OF.SOUTHOLD SURVEY
.
1 21993 BUILDING DEPARTMENT CIIC.Ct _ . ~ .
.~z.` TOWN HALL SECT.IC~ rottti
SOUTHOLD, N.Y. 11977
TEL.. 765-1802, NOT1 FY .
p [ 01~~C1. 0...
19 CAL
//////pa ~j HA I L T O
Approved 7-2-~7 .10, Permit Na~~~o~~P'i?~ r . _ .
Disapproved a/c
eooii,
• rr•: . , .i . 1
U uiNdfrtg nspecto,)
APPLICATION FOR'BUILDING PERMIT
Date 19..
INSTRUCTIONS
a. 't'his application must be conililetely filled in by typewriter or in ink gnd submitted to the Building Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location,of lot anri of buildings on premises, relationship to adjoining premises or public'streetr
or areas, and giving a detailed description of layout of,ptoperty must be drawn on the diagram which is part of this appli
cation.
c. The work covered by this application may not be. eomnienced before issuance of huilding Permit.
d. Upon approval of this application, the,Building hispeetor will issued a Building penult to the applicant. Such permis
shall be kept on the premises available for inspeclion'lhroughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
=hell have been granted by the Building Inspector.
APPLICATION IS IIFIZEBY MADE to the Building Doartment forthe issuance of a Building Permit pursuant to the
luilding 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 altcrations,,or for removal or demolition, as herein described.
I lie 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 applicant, or name, if a corporation)
clue„ YY.vROV?G'+ ...MAT777004-.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil&
...........:.........ca
Name of owner of premises A.E f?>t?T.L.A•1(• , • C'ti „ , ,r,6.0.0,• , , • , , .
(as on the tax roll or latest deed)
Ir applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .
1'Inmber's License No .
P,Icctiician's Licmisr, No. H h-1~93o 'toe 70 092
PtCiNG CttiN-itL.w~e''toR- 11'sNt~5 ~
~ t{
Other Tradc's License No. ..vxgV!,VG. Clz»utQ taCYori- '-aFkvts 2i2OS E;iG ow" 8SV TAI
I, Location of land on which proposed work will be done.
. .
..T'PNRI( . .tVAN. E a1c.14A) Oj ..MPA-III.1 CA
Ilouse Nuniber Street (iannlet,
County Tax Map No. 1000 Section , . Black Lot'. , , .4'~ .
Subdixision, • Filed Map No. Lot' .
(N.nnc) ,
State ex Sling u,se anal occupancy Of,i reprises and:intende(lruse and'occurrancy;of`proposed'consttirctiont-
a; Existinguscandoccupancy,,. ;,.5)I)Okk:-.FA1•NI1W.1>W.FEL4(PG.. 4u,k'(R T~ CIC$:.......
b. Intended use and oepppall cy 9lJtr ; ~AmW41; , W441-41 Wll$~ #iaY ~ lS•
y~ntwrU1Na41ka".+tlb+ma -
3. Nature or work (check which 11)Plicable): New Building........... Addition l~ctloon X. :
Repair ...X Removal . . Demolition Other N~YY'ork ..lO
(Description)
4. Estimated Cost rJi0.'J4'? Fee .
5. Ifchvcllin; (to be paid on filing this application)
f , number of dwellIng units .....0N fr, Number of dwelling units on each floor . •
If garage, number of cars ..j.......... MIP.E
6. If bUSilless, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ...~?..Sr.ra...... Rear Depth .S3-ltp, , , , , ,
I [eight Number of Stories V1%.. .
Dimensions of same sttocture with alterations or additions: Front SArA4.. • , • , . Rear . .
Depth Height . . Number of Stories .
8. Dimensions of entire new construction: Front , , . , Rear Depth epth .
Height Dumber of Stories . . . .
9. Size of lot: Front l (t(LAG, U, { Q¢~........ Rear Depth • • .
10. Date of Purchase Name of Former Owner
11. Zone or use district in whiclzlrprenlises are situated , ..R'`: • .
12. Does proposed corrstruction violate any zoning law, ordinance or regulation: ...ala
13. Will lot be regraded -,1 :......Mr)............ Will excess fill be removed from premises: Yes (91
14. Name of Owner of premises p64ap1¢ { . 0944e , . , . Address ~C-l e aCr~4,Y, AcMrAA4 Phone No. Z4 000D
Name of Architect :mil QrUE{ .110IW&-'X;>...... Address AqX.4eV .1VA6 (Q7.6Phone No.4.6MONY. ; . .
Name of Contractor 'QA UlS T3(tp5 gyp. COR.P . Address . F° 4V£...90I.OT Phone No. 3;A A- 0.Z a . .
15. rs this property wi.thil} 300 feet of a tidal wetland? *Yes... X... No.........
If yes, Southolfi Town Trustees Perinit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions `uron
properly lines. Give street and block number or description according to deed, and show street names and indicate whethe
interior or corner lot.
SE6 A-ri"AtAft SUILV"
I
fA"f F. OF NF Y( 1: S.S
Of JN IN OF
.-•'"4rr • ' ~;G~~.• c:....... ; bcrin ilnly'sworri; fleioses and says that he 3s the applicant
~i(Nariic dr'individhal si~nincontrlc(~ ,
hove named.
C. is the .....Q. .IV«Z...... .
1 Contract . , . , .
( or;:agetttt ,CortioratebfficEtr ~ t s s~~s i . . . ;
• c. . f
a t d
)
l
f said owner or owners, hill is cluly authorized to perform or have performed the said work and to make and file this
yrlicatiml; that all statements contained in this, application are, true to the best of his knowledge and belief; and that them
oik will he perforpied in the manirerset forth in the application died thbrcAitlt.
a•onr to before mA this
2 day 7V ',Jt~ 1993
.otary Public, Vim, County_
INSWd , l ' r .
N"PAk $Wd0kWYak,
No ~~1J101t y (Signature of applicant_
CamE w~b.2A. ti_
09
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2vCns ICe u•c E. G= Joi57a I O UNTIL 2nd SURVEY OF
112111) It I ~ ~ III ' --WM~ FOUNDATION LOCATION
HAS SEEN APPROVED
APP 0 ED AS NOTED
I to-o' r I O'~ DATE B.P. A 642 1 L x 8 s @I Ce o . c'. n9J 1JZ .T;_ 4WWU
x I I I I NOTIFY WELDING BONAFRIVIEN7 AT_
xlRat 16' or, F. so%st~ S? 765-1802 9 AM TO 4 PM FOR THc
_ - I FOLLOWING INSPECTIONS:
lo'oFVSE~ l ~ ,s I.' FOUNDATION - TWO REQUIRED Gr' FOR POURED CONCRETE '
, 2. ROUGH'- FRAMING & PLUMBING
t 3. INSULATION
` . 4. FINAL - CONSTRUCTION MUST F
(V` BE COMPLETE FOR C.O. J
4YG, ~lac~rN~~ ALL CONSTRUCTION' SHALLMEET Q
.ccu Ht+-vN CtL-vAYro6 r THE REQUIREMENTS, OF THE N.Y. STATE CONSTRUCTION';& ENERGY ,11
aF czE CAGG~R-bClt-,-a ( CODES. NOT RESPONSIBLE FOR _ e2+
I I ~ DESIGN OR CONSTRUCTION ERRORS
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Oft OCCUPANCY OR o USE IS UNLAWFUL z
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7 llbo770M oF.,G16.P-C~t?.. CcA-72L-A7CSa n ' p1LE, za' Lo". I i WITHOUT CERTIFICATE > {
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UNDERWRITERS CERTIFICATE J- ~O'
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