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HomeMy WebLinkAbout20307-z ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23436 Date JANUARY 3, 1995 THIS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property 2305 BAY AVENUE MATTITUCR, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 144 Block 04 Lot 04 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 26, 1991 pursuant to which Building Permit No. 20307-Z dated DECEMBER 3, 1991 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 GARAGE ADDITION, AN ADDITION, FIREPLACE & ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM C. & LINDA E. MERCURIO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-244096-7/23/92 & N-286257-8/13/93 PLUMBERS CERTIFICATION DATED DEC. 3, 1994 - TANDY PLUMBING & HEATING ilding Inspector Rev. 1/81 mass xo. 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) 0 N_ 2 0 3 0 7 2 Date ..1..~,~~ ~4.. r~ Permission is hereby gmnte~~d//to~o: ~.30..'~ GZ~~„.• at premises located of ...r'~...s~Qy,~~y.'` . J .:..~~....7~...~4r.. y~~.~:.5~~~~-.d~„~~Z,~ do©/....-. a County Tox Map No. 1000 Section ~.lT.~.T...... Block .......~1. ~.~.....Q... Lot No......... ®..c..~...,... pursuant to application doted .....1.1~~:.~ 19!~., and approved by the Building Inspector. Fee 5...~:`..~i ~uildi Inspector Rev.6/30/80 " Form No. 6 TOWN OF SOUTHOLD s~~ IlA . ~ g~~ ~ ~ 0 BUILDING DEPARTMENT j, ~""°""'^~V t TOWN HALL 76s-laoz ~.z~g DEC 2 g 1994 APPLICATION FOR CERTIFICATE OF OCCUPANCY 70W~ pFS"°P~o' OU7HOL0 A. This application must be filled in by typewriter OR ink and submitted to the building M, 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. Z. Final Approval from Health Dept, of water supply and sewerage-disposal(S-9 form). 3,. Approval of electrical installation from Board of Fire Underwriters. ' ~i. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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 Co the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.0 ,Additions to dwelling 2~,f)0; Alterations to dwelling $25.00, Swimming pool ? sory uilding $25.00 Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.0~0~,,C/ommercial $15.00 Date ~.-~r<.:~~!..~~" ;ew Construction........ Old Or Pre-existin Building............ a3os .ocation of Property.. ..............!-~~l ~~t°r.............. /.v!!~T7./TL/Grl~ . House No. Street Hamlet i nwer or Owners of Property.... ,(GGi<fr/,.,~ c ~i^/a,¢ E ~4c~~JU~a/~ . . . . . ounty Tax Map No 1000, Section....~~~....Block.....~........Lot....` ubdivisian.. ..................................Filed Map.......... ~~L/ot.~J/~ ermit No, ,l~; O ~ ~ ,Date Of Permit.. ////~~~/p ..............Applicant.. ealth Dept. Approval ..........................Underwriters Approval.~l~'.4.~ ! D~Z19.Z-, Tanning Board Approval 'quest for: Temporary Ce`rtificate........... Final Certicate..~,,,,, '-e Submitted: Od 6~.,c. K $ 9 . . . eo~d3~f3G ...APP •IC~T 1 THE NEW YORK BOARD OF FIRE UNDERWRITERS! f'xr~, ~ 1Q'01"3.31 BUREAU OF ELEGTRlGITY 85 JOHN STREEET, NEW YORK, NEW YORK 10038 Date hfTil);i'll 1ZrL9tl,~ APPlicationNo.anfile $1('3,1§cJ1f~$ 2£in~,~i'F THIS CERTIFIES THAT only the electrical equipment as deacrihed 6e/om and introduced (+Y the opplicont Homed on the afwve opplicotion numher in the premiaea of 4f]:LLTAhi MERCU[2I0, 2J©!i f)AY RIIBNIfF;, 4'OhEIk9.~, tdA.TA'I'~UCK, Cd.l. in lhefallowinq lncationl ? Basement ~ Ist FL ? 2nd F'L /~~II 3ertion Block Lot 11 U (i U S T 1.0 r 3 and ound to be in cam range with the National Elechical Code. outs examined are f Pi~ FIXTURE ECEPTACLES SWITCNES FIXTURES RANGES COOKING DECKS - OYEN$ DISH WASH R EXHAUST FANS OUTLETS INCANDESCENT FWOREECENT O7HEfl AMT K.W. AMT K W~ AMi K.W. AMT. AMT H.P 7 ~ ~ ~ / 1 ` l DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS 9ELl UNIT HE TERS MULThQUTLET DIMMERS SY--STEMS AMT. K. W. On H. P GAS H. P AMT. NO A. W.G. AMT AMP AMT AMPS. ~ TRANS. AMT." H P. ,~NO. OF FEET AMi WATTS I SERVICE DISCONNECT NO.OF S E R V j~ ~ C E METER NO, OF CC COND. A W. G. A W. G. A. W. G AMi. AMP. TTPE EONP. 1 A' YW t % SW 5 $ 9W l,e' rW PER % FCC COND. ' NO: Or NbtEG OF H4LEG NO. OF NEUTRALS OF NEUTRAL i sri~ O7NER APPARATUS: r~o~n~s:lr r,,e, PRN~LttQAphSv1-f; C~IIt. 10~) f G,F,Q,I:..r 3MOIiL 1)ETRG9'(}li c - L SRRr,[; L7GWTING:-12 ' JOKY t'UM1LG0 f,IC.zI^3@t~-L~ C~~~~ kA4' LRNF hIR9"S'I1'lit',[;, NP, 119'i'l GENERAL MANAGER it 1' 6 1 t.'~ k t ~aY ~ This certificate must nol be altered in any manner; return to Lhe office of the {Board if incorrect. Inspectors may be identified b.i their credentials. Cf3PY F®R 6UIL®91V~7 mEPA@i3'MEGEIY. Y~BI~ ~®e~~ ~E€3 a 6CBu~~ll E NVIU~~ dv®~ ~E e4LTERE® lil9 Aill~f 61/iAR4tli9E~. . - TEL. 765-1802 ~~c~~FFUl.A~~pG TOWN OF SOUTHOLD y°c OFFICE OF BUILDING INSPECTOR ~ 'zT P.O. BOX 728 ~ ® TOWN HALL ~ ~ ~ 4., m. O fit- SOUTHOLD, N.Y. 11971 1 ,v ~ Itn ; V ~~l 'Yp ~ ~f~ ~ 9.., . ~ ~ 1994 ~ 4.~ mw~ TU~aLD~ d? ~ m~ C E R T I F I C A T I O N ~ '"-~.,~?OFgp~~r~~ Date 3 ~ `f Building Permit No. ~030~ • Z Owner C?/GU~m !»~2c'y2>~n (please print) Plumber~jfJ,Vny „r-jJ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber's signature) Sworn to before me this 2I ~ day of D~C~C!!!,v"~..C~i , 19~. Notary Public Notary Public, ~j,r/=p~/cam County NANCY A. PESTER Notary public, State of New York No. 4940985-Suffolk County . Commission Expires Aug. 15, 2!~ =1i;LJ i::~'.`C:-~%:i ~~Jn;., j{ ~i;d~ti4kiNT.^, ~ e ~ q t . ~ ~ a' ~ ~ q FOUtIDATIO^! (1st) a ~ ~ ~ FOUtIDATI0t7 (2nyT ~ o - I ~ o~ P,OUGH FRAME & ~y ~PLUMHING • N ~3, ~ m cn IIISULATIO?I PER N. Y, -3 STATE EPtERGY II CODE ~ T /r` 2 ~ ~ ~ r 4 J . 4 `.f-` ~ ~ - _ L ADDITIONAL COMMEPITS: ~ t _ ~ ~ lP° ~s t eye x a ~J~ ~ ~ H ! M _ _ ~ \ r '9 T • O I ^o H - 4 7 INSPECTORS ~OSUFFO(,~-C (516) 765-1802 p O h`l` Gy SCOTT L. HARRIS, Supervisor VICTOR LESSARD, Principal ~ 1 CURTIS HORTON, Senior r°n Z Southold Town Ha11 VINCENT R. WIECZOREK, Ordinance p P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire ~ p~~ Southold, New York 11971 Building Inspectors ~t ~p Fax (516) 765-1823 'THOMAS FISHER Telephone (516) ?65-1800 GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD June 13, 1991 Mr. William C. Mercurio 2 Bay Path Court Huntington, N.X. 11743 Re: Premises at 2425 Bay Ave., Mattituck, N.Y. Suff. Co. Tax Map #1000-144-4-4 Dear Mr. Mercurio: We return herewith your building permit application, check #678 and building plans for the fallowing reasons: 1. Building Permit application needs to be notarized. 2. Please submit survey showing contour line. 3. DEC waiver or approval required. When you have the necessary paperwork complete, please resubmit your application. Thank you. SOIITHOLD/~TOWN ~BI3ILDTNG DEPT. Georgia Rudder, Secretary encls. New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 ' , , (516) 751-1389 ~ Thomas C. Jorling y p ,"~~E'";C~~~`?_~.~~~p~~ ..~~~`~i~ Commissioner ~ii~.dr`I, ; NOU 2 91991 G 4{~d „_f`~~/ November 22, 1991 William C. and Linda E. Mercurio 2305 Bay Ave. Mattituck, NY 11952 RE: PermiC /I1-4738-00357/00001-0 Dear Mr. & Mrs. Mercurio: In conformance with the requirements of the State Uniform Procedures Act (Article 70,ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permiC sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Cl. Joel ~~'G~ ~ .,P Laura Scovazzo Environmental Analyst LS/rw enclosure 95-206 (10/90)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ' DEC PERMIT NUMB 6ER EFFECTIVE DATE 1-4738-00357j00001-0 ~ Nov. 22, 1991 FACILITY)PROGRAM NUMBER(S) PERMIT EXPIRATION DATE Under the Environmental Conservation Law (ECL) Nov. 30, 1993 TYP~EIOF PERMIT !Check All Applicable Boxesl vJ New ?Renewal Modification ?Permit to Construct ?Permit to Operate Protect on of ItWate~r ~ SPDES 17, Titles 7, 8: ~ Hazardous Walste Management 3. Article 15, Title 15: ~ Article 19: ~ Article 34: Wafer Supply Air Pollution Control Coastal Erosion Managemen: Article 15, Title 15: Article 23, Title 27: Article 36: Water Transport ~ Mined Land Reclamation ~ Fioodplain Management Lotng Island IWellsS ~ Frelshwat r Wetlands ~ 6NYCRRI3 0: Rad agion Con~rol Article 15, Title 27: ~ Article 25: ~ Other: Wild, Scenic and Recreational R Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRA 608: ~ Solid Waste Management Water Quality Certification PE Rh11T ISSUED TO TELEPHONE NUM6ER William C. and Linda E. Mercurio ( ) ADDRk 55 Or PCRMITTEE 2305 Bay Ave., Mattituck, N.Y. 1]952 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMOtft ( ] NAME AND AUDRLSS OF PRO)FCT FACILITY LOCATION OF PROTECT/FACILITY 2305 Bay Ave., Mattituck COUNTY TOIVN/1x1~1~tFi.~G~'~ WATERCOURSEIWETLAND NO NYTM COORDINATES Suffolk Southold James Creek E. N4~ _ DESCRIPTION OF AUTHORIZED ACTIVITY Construct an addition and a garage appurtenant to an existing dwelling. All work shall be in accordance with the attached NYSDEC approved plan. 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. PE IT DMIN TRATOR ADDRE David DeRidder gesyan i~ESEC^- 19 SUNY AUTHORI2ED SIGNATURE l~ DATE l 1/22/91 Page 1 of GENERAL CONDIT4ONS Inspections 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at ail times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Renewals 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department for renewal, modifica- tion or transfer of this permit. Such application must include any forms, fees or supplemental infor- mation the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF): and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, con- ditions or requirements contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili- ty for ail damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impair- ment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights• of-way that may be required for this project. Page 2 of 95~266a (10/90)-25c ADDIt10NAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 688 ( ) 9. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the structure or work herein authorized, or project. if, in the opinion of the Department of Environmental Conservation 13 Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused }4. There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 15 If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be coin- authorized has not been completed, the applicant shall, without expense pieced, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require, remove all or Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration. the State of New York on account of any such removal or alteration. }6. If granted under Article 36, this permit does not signify in anY way 10 That the State of New York shall in no case be liable for any damage that the project will be free from flooding or injury to the structure or work herein authorized which may be caused 17. If granted under 6 NYCRR Part 608, the NYS Department of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project will not conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Ac[ of 1977 11 . Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met bility of obtaining any other permission, consent or approval from 18 All activities authorized by this permit must be in strict conformance the U S. Army Corps of Engineers, U.S Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part Office of General Services or local government which may be required. of the permit application, p 12 All necessary precautions shall be taken to preclude contamination Such approved plans/w04xn8tprepares by Paul T. Canaliz0 of any wetland or waterway by suspended solids, sediments, fuels, 7/ 1/91 solvents, lubricants, epoxy coatings, paints, concrete, leachate or any on SPECIAL CONDITIONS 1. 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. 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 is permitted in tidal wetlands. 3. The storage of construcj-j:on equipment and materials shall be confined to within the project work site and/or upland areas greater than 75 feet distant from the tida weCland boundary. 4. A row of staked hay bales shall be placed 15' southwest of the seaward edge of the proposed addition (generally parallel to the southwest house corner) and must remain in place until the project is completed and all disturbed areas are stabilized with vegetated. Trapped sediments shall be removed to a suiCable upland site before the bales themselves are removed. 5. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for immediate on-site recharge. 6. There will be no draining of swimming pool water directly or indirectly into tidal wetlands. 7. All excavated material shall be disposed of on an upland site and be suitably retained so as not to enter the waterway. 8. Excess material shall be removed from Che site to a landfill or other approved upland disposal location. 9. There shall be no disturbance to vegetated tidal wetlands as a result of the DEC PERMIT NUMBER permitted activity. 1- 7 PROGRAM/FACT LITV NUMBER Page 3 of 4 SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all per+nits: A. !f any UI" Lhe pe unit conditions aro unclea+,l he permitf ee .hall con- tact the Division of Regulatory Affairs at the address and telephone noted below. B. A copy of this permit with supplementary conditions and approved plans shall be available at the project site whenever authorized work is in progress. C. The permit sign enclosed wiCh the permit or a copy of lette[ of ~ approval shall be protected from the weather and posted in a con- , spicuous location at the work site until completion of authorized work. D. At least 98 hours prioc to commencement of the project, the permittee shall complete and return the top portion of the enclosed receipt form certifying that he is Eu11y aware of and understands all provisions and conditions of this permit. Within one week of completion of the permitted work, the bottom portion of that form shall also be com- pleted and returned. E. For projects involving activities to be accomplished over a period of more than one year, the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to the commencertie nt of resumption of work each year. F. If project design modifications take place of tee permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modi- fications. The permittee is advised that substantial inodif ication may require submission of a new application for permit. G. All necessary precautions shall be taken to preclude contamination of any wetlands or waterway by suspended solids, sed intent, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leaehate or any other environmentally deleterious materials associated with the project work, H. Any Failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. I. The permittee is advised to obtain any pe units or approvals that may be required from the U.S. Department of Army Corps of Engineers, NY District, 2G Federal Plaza, New York, NY 10278, (Attention: Regulatory Functions Branch), prior to com+nence+nent of work authorized herein. J. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242, which may be required for any encroachment upon State-owned lands underwater. Regional Permit Administrator NYS Dept. of Environmental Conservation Bldg. 40, 5UNY-Room 219 Stony Brook, NY 11790-2356 (516) 751-~~~y „ ul>c u /-`~735'Od 357JOd00/- G Page 4 of Y ' CHA12L~5 'L'. HAMI LTUN Chief, Marine Regulatory Section NYSDLC, Bureau of Marine Habitat Protection Bldg. A0, SUNY, Room 225 Stony Brook, NY 11790°1350 Re: Permit No. • Issued To: - Contractor's Name: Cun CracLOr's Address: Contractor's Phone No. Ueai Si ri Pursuant to Gene[a] Cundi Liun Number 1 uL the above rrferenced permit you are hereby noJ.itied Lhat the authorized activity shall ConnnenCe on _ 'Ibis notice is to be seal al. Jeasl. _ two days rn advance of commencement of the project. The permit sign will be pasted aL the site and cupy oP permit. will be available at site for inspection. SuLmil led B Uate: FA U.Ul2k; 'I'U NOTII'Y OR POST SIGN W[i,i. hHAV P: OWNIi12 AND/UR CUN'1'RAC'I'OI2 SUIlJ I:C'I' '('U APPLi CAlihk: P6NAL.'1'1 LS 1•'ON NON-OUMPL IANCk: Wl'fll P612M 1'1' COND 1'L' I UN . CIIARI.,LS T. I1AML1, 1'i)N Chief, Marine Regulatory Secliun NYSDEC, Bureau of Marine Habitat Prat eel luu Bldg. ~IU, SUNY, Room 22S Stony Brook, NY ll790--2356 Re: Permit No. Issued To: Cunlrackor's Name: Cunt racto['s Address: ' Cuntractor's Phone No. Ueae Sir: Pursuant Lo General Condition Number 1 of the above ['eferenced permit you are hereby notified thak the authori•red activity was completed on Submi tled 8y: _ Uale: '1'lliS NO'1`f Cts, Wl'Pll PIIU'1'OS OI'' COMPLL•''L'L:U WONK ANU/UN COMPLG'P[:D SURVGY,^LS '1'U UL SRNT 1'O ABOVI's ADURRSS PROMPTLY UPUN CUMPLL:'P IUN OE YRUJ C:CT. 1~`AI LURli T'O N01'I PY Wll.h Lf.AVG OWNGR ANU/OR CON1'RAC 1'OR SUHJGCT TO APPh1CABLG P[:NAL'1'1 LS i''OH NUN-COMP4CANCG W1'PH PL•'RM I'P CONUI'PIONS. y ~ 4 N O C ~ ~ ~ C NJ~~~~ .C ~ ~ V ~ ~ ~ p.~ Q to wc°n~o,~a E _ ~ ~ ~ O.~C O a - s~sox.~o ~ trS ~ ~ LL. 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[ ]FOUNDATION 2ND [)INSULATION [ ]FRAMING [ FINAL ~ REMARKS: DATE °~0~" ~ INSPECTOR ~ -A. 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T ( ) ROUEN PLBG. [)FOUNDATION 2ND INSULATION [ ]FRAMING [ FINAL REMARKS: L~~ ~ o~~~rt-~.~ ' ~ ~ , e DATE ~~[~~INSPECTOR ~'©7-~ rss-zso2 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL REMARKS: ( ~ t ~ t. DATE /t v~ I~INSPECTOR r 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING ~ ~ ~ (]FINAL REMARKS: ~-r,~-~~ DATE ~ ~ ~2___~ INSPECTOR 11 " " ~ i 765-1802 BUILDING DEPT. INSPECTI®N [ ]FOUNDATION 1ST (~i~' ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: .Y.~~.., v~'" ~'t-~s~? i r - c~Q cx ~ ,f DATE ~ INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: ~ v~, DATE o~ /a2y-~ INSPECTOR rss-isoz BUILDING DEPT. 1 NSPECTION [ ] FO DATION 1ST [)ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: L~~~ ~ ~n ~d~ ~ `~sar°/ ~T ' DATE / ~ 9~'' INSPECTO ~ rsS-iso2 BUILDING DEPT. INSPECTION OUNDATION 1ST ( ) ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION ` [ ]FRAMING [ ]FINAL f o l'~~ -s- ~c~.,.- ~ REMARKS: 4 l `r DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST f ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: -e~~ r ~ r Gyy P, ~ ~ DATE T Q"~- INSPECTO ~ ' i ~ 1'~ BOARD OF HEALTH . ~ ; ~ w FORM NO. 1 ~ SETS OF~pL.IYS ~ • ,1 NOV2~9l99I ~!C` TOWN OFSOUTHOLD $uRVeY 'j ~ I~ CI1CCt: • . ` ~ EiUtLDING DEPARTMENT • 1~.~~~,~. -_-.~~m--,.~ Tow serr>:c r•ohrt ~ti2.f9~, l'ot'"4';P. SOUTHQ N HALL ~ • • • .•.~y, , '4'~ti'itC~i f%r ,,;~t5'@°.{~3E.E5 l.II„ C~1.Y_ 11r171 t ~ ~ SJ TEL.; 7G5• l II02 a` ~ ` Exarttincd .~%~~c~ , 19 CALL .~Q~, . MAIL T0: Approved 19 ~Pc . . rmit No. Disapproved a/c . Build o Inspector i~ ) APPLICATION FOR BUILDING PERMIT - / 4 ~ Date . ~ ~l% I.riln~ • INSTRUCTIONS a, Tlris application must be completely filled in b sets of plans, accurate plot plan to scale. Fee accon}in yto c hedufe or in ink and submitted to the Building Iits ti b. Plot plan showing location of lot and of building Peccor' %riL or areas, and giving a detailed description of la ~s on premises, relationshi to ad'oining cation. Yout of property must be drawn on the diagram which qss or public size: c. The work covered by this application ma Part of this apF 'd. Upon approval of this application, the Buildin~be commenced before issuance of Building permit. shall be kept on the premises available for inspection throu_}tou~rfhe work d a Building Petmit to the a e. No building shalt be occupied or used in whole or in part for an PPbcartt. Such petr. shall have been granted by the Building Inspector. Y purpose whatever until a Certificate of Occupant Build'nPLZone Ordinan eEofEhe Towne of Southoldl Suffolk Count t for the issuance of a Building The a licant ag Y, New York, and other applicable Laws, Ordinances c Re_ulations, for the construction of buildings, additions or alterations, or for removal or demolitione•as he °irt describe_ s PP reel to comply, with all applicable laas~ ~r~],,,n~c:-L--•;; .iBmi[ authonzed inspectors on premises and in building - dir.--~u~ t~u~i ~-ode, ana i'e - - - - for necessary insp ton gulationS, and t - _ Signature of applicant r nsrne, if a corporaaon) a`~~D~ - State whether applicant is owner, lessee (1llailin~ address of applicant) agent, architect, engineer, ^enera! contractor, electrician, plumber or builder .......1~.~?ti~=,e o Name of owner of re / ./G Li ,y ~ • - " • • . P miles , ,~~/-,/!V(7;¢ . ~ ;~E . ~C~C/,P/D (as on the tax roll or latest deed} • if applicant is a corporation, signature otduly authorized officer. ~ ~ • ~ • ~ • • ~ • • • • • • • • . (Name and title of corporate officer Builder's Liccnsc Na_ \ • Plurnbcr's Liccnsc No. Q ~~~Q~ Eleclrician's License No. . Other Trade's Liccnsc No. Location of land on which p~~r//o~~p~~osed wor _w_ill be dorc; Ifouse Nu~~s ~,0¢~/77i'~' ~ ~lT/TG/C~ . . StrccL t• " County Tax.\lapNo.l000Se ,~~/f DD••. ~ Hamlet coon Block , 0 »~D Subdivision • . • • . • • Lot . ~D~QQ~. . ..(N:ttttcj F.ilcd Alap No, Stzte ccisting use and occupancy of premises and in tended use and Deco • • • ~ ~ ' ' Lot • , ' pancY of proposed construction: • A. 1:xisting use and occupancy......~s~,~C~ B. Intended use and occupancy.:..?5~~(l~(~ Ie4i.. i I~ r . 3. Nature oCwork (check which applicable): New puilJing AJJiticn . Nteration Re air' F ~ Demolition , 4~. ;Swimming 001. • . Tennis Court,,, R•moval p Accessory IIuilding..........Fence .Other Work:. 4. Estimated Cost ....~S~.E ° Fee l.~~r~...................... . 5. If dtvclling, number of Jwclll• • • ~ 4tn he paid °n filing this application) ryl nits ' ~'n u • • • • • • • • Number of dwelling units on each (lour . Ifgaracc,numbcrofcars .g7ct~, 6. If business, commercial or mixeJi occupancy, specify nature and extent of each type of use • • / ~ • • 7. Dimensions oC existing strucfurc$, if any: iron[ , , Rcar . ~ Depth ...~,cp, ; ~ ~ ~ • Hci_Itt Num~cr of Stories . • . Dimensions of s me structurF wi h alterations or additions• Front • ,~?4~. Rca~ .•~.~..--r. r,, • Depth ..,5'~r.~- .Height . 8, Dirncnsions of entire new coPstn' • • ~ ' ' ' • • • • • Number oC Stories , , , , , • Hci_Itt . , fiction: Front . Rcar Depth , , , , , , " N~y,~n~er of Stories 9. Size of let: Front .....~!~~S ~i Rca:.....~4%t?.......... Dc....... •~/~L~.~... . 10. Date of Purchase . .Name of Former Owner .~~1L7>.~T/ 1 Zone or use district in which premises arc situated . , , , ; , 12. Does proposed construction ~i~i5~l~tc any zoning law, ordinance or regulation: l3, 1Vi11 lot 6e regraded ,l1' lY~ y... . l4. Name of Owner °f premises • • IVill exec fll be removed rom prcmiscs~~Yc- •'~~-~4~,p C~ Address .Phone No. • Name of Architect ~t . f~~I~~, ~ ~ ~ ,phone No'.'~ -"F ..Address ~~~7~1C~ , Name of Contractor#~.~t~~l9rU, ~'Q~/~/: • , , ,Address 7T/7~lCf,<, Phone N P:. . LS_2s this property ltica~ed within 300 feet of a tidal wetland? ^Y);S .•.NO.... *If yes, Southold TQwn'Trustees Permit may be required. • PLOT DIAGRAh1 'Locate clearly and distinctly] all (buildings, whether existing or proposed, and, indicate all set-back dime^:ior:' t: property Lines. Give street and bl¢ck number or description according to deed, and show street names and indicate wr.x:. interior or comer lot. II ' C / i i i i i , I . i I • STATE OP \EN $.S CO UNTIY' O l1/ ..111! I. 2~~ v: i, of ( , } • ' • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applir_r (Name of individual signi contract) about named. I Lie isthc (Contractor, agent, corporate officer, etc.) • ~ • • ~ • • ~ ~ ~ ~ • ~ ~ • ' • " " °f said owner or owners, and is duly, authorized to perform or have performed the said work and to make and file ti: application; That all statements contained in this application arc true to slit best of his knowleJge and belief; and that tt: work will be pcrl'orntcd in slit manncr',sct forth in the application filed thcrcwith. Sworn to bciorc me this i , r Notary Public. ll3ENE FFE• County Nptary Public, Stale of New York No. 496t59~2 . Qualilied in Nassau County ($i~nacure'of applicar+' Iarlll Expires Apirjl 30, 1992 i / ' ~ e c~f3M~'s ee,~~K ~ ~ , t r,~ ~ 0 4 ~o \'o :,r ~ ~ ~ Q ~ 4 ~ Q" ~ ~ V M 4 ~ ,C /+cgoaW k S23°// 45~E ME.naow w' O ? `k O._ - EACH pdG ? 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