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Home My WebLink About27137-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27954 Date: 09/18/01 THIS CERTIFIES that the building ADDITION Location of Property: 1025 NORTH SEA DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 4 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 25, 2001 pursuant to which Building Permit No. 27137-Z dated MARCH 13, 2001 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 INTERIOR ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ALAN & LORIN LITNER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 51005 08/31/01 PLUMBERS CERTIFICATION DATED 08/01/01 MIKE JACOBI Authorize Signature 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) PERMIT NO. 27137 Z Date MARCH 13 , 2001 Permission is hereby granted to: WILLIAM A CUFF 146 NW 100TH TERRACE CORAL SPRINGS FL, 33071 for INTERIOR ALTERATIONS AS APPLIED FOR ( LESS THAN SUBSTANTIAL IMPROVEMENT ) at premises located at 1025 NORTH SEA DR SOUTHOLD County Tax Map No. 473889 Section 054 Block 0004 Lot No. 012 pursuant to application dated JANUARY 25, 2001 and approved by the Building Inspector. Fee $ 175 . 00 /46/4 '-'X Authori d Signa re ORIGINAL Rev. 2/19/98 Form No. 6 �- --- j TOWN OF SOUTHOLD i BUILDING DEPARTMENT SFP. � $ r TOWN HALL t 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 withthe 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 ft•om 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 building, and installations, a certificate of Code Complianoe 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.conseut 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 dwellipg' $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 Buildiniz - $100.00 3. Copy of Certificate of Occupancy - L +2 4. Updated Certificate of Occupancy - $50.00 5: Temporary 'Certificate of Occupancy - Residential 0$15.00, Commercial $15.00 -Date 4444 .. . ... . . . ... .... . . .. .... . .. ... . . . New Construction.:. ...... .... old Or Pre-existing Building. ..'.. . . . . . .. . DaS jV r 6., A4 e-,�t 4Se Location of Property.... . ........ . .° ' House No. Street Hamlet Onwer or. Owners of Property l `/� . ' `� �8lr� � eoo- ... .. . . . ... . .. . . .. . ... ... .. ... . .. . . . . . . . . . . ... . . ... . . . . . . . . . . . County Tax Map No 1000, Section. . . .... . . . . .Block. . . . . . . . . . . . . . . .Lot.. .. . . . _.. . . . . . . . . . . . Subdivision. . ... 4.4* .. . . . . 4 e o . . . ... .. . . . . . . .. .Filed Map. . . . . . . . . .Lot. . .. . . . . . .. . . . . . . . . . . Permit No. :? . .?.. . .Date Of Permit. . .. . . .. . . .. 44 . .Applicant. . ... . .. . .... . . .. .. . . . . . . . . .. . Health Dept. Approval. . . . . .. .. ... . 4 . 4.4. . .. .. Underwriters Approval. . ... . . . . . .. ... . . . . . . . . . Planning Board Approval. .'. .. . .444 .. . . . .. .. .. 4 . . : . Request for: Temporary Certificate. .. .. . . . .. . Final Certicate.l- . . . . . . 5 � • Vee Sub. tted: $ • .`4/ .. . . 444444 . . . 1. .. . . . . .: O�Og11fF0��-coG o� s� CIO Town Hall,53095 Main Road 0 Fax(631)765-1823 P.O.Box 1179 1i �� Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD August 16, 2001 Alan & Lorin Litner 111 East 85th St, Apt 30D New York, NY 10028 RE: 1025 North Sea Dr, Southold TO WHOM THIS MAY CONCERN: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. xx The check is (not in 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 u 27137-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Electrical Inspection Certificate Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11772 (631)286.6642 Date: 8/31/01 Application No. : 51005 Issued to: Alan Litner Street: 1025 N. Sea Drive Village: Southhold Zip: 11971 Town:Southhold Section: -Block: Lot: Introduced by. Evergreen Electric (L) Lic.# 4536-E t< was examined and found to be in compliance with the National Electrical Code ❑ Commercial [INV Defects ❑ Pool ❑1st Floor ❑Indoor ❑Basement ❑ Hot Tub W Residential ❑ Det. Garage ❑Attic 0 2n Floor El Outdoor ❑ Addition ❑Survey Switches Receptacles Fixtures GFl Heaters A/C Fans 35 30 41 5 2 1 Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal 1 1 G Furnace Oil Gas Circulator Smoke Detector Bell Transformer 5 Meter Amps Phase UG/OH Telephone Television Carbon Monoxide 200 ®/ ❑ 1. Other Equipment. 1 plugh mold r H o S. Surdi President Building Permit No. This certificate must not be altered in any manner Inspectors may be identified by their credentials Final Inspection: 8/31/01 Rough Inspection: 4/24/01 Inspector: Quentin Reynolds FfO(/(ea, Town Hall,53095 Main Road y x Fax(516)765-1823 P. O. Box 1179 W- Telephone(516)765-1802 Southold, New York 11971 ti'flpl � dao I, r _ r OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD � r C E R T I F I C A T I O N —1 DATE: 1 Building Permit No.__ Owner: /� [CA( � i � Ne r (please print) Plumber: I l 1� JG�Gd r (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers gnature) Sworn two before me this ��---"day of Notary Public, County ELNE D.Notary Public,State of New York OualifieNdoin Suffolk County Commission Expires ApplicanU Date. Owners Name: t.2`� _ _ _ _ Reviewed: Architect / Date Engineer: - ____- _. Submitted: _ _t`r - SCTM #: District: 1,000 Section: ��41/131ock: Lot: Project /D�S, Subdivision Location: Name: Sin&le&separate Requir certification: Yes o Req Zoning District [Lo(size 00Actual [Lot coverage Proposed Req Req. Req ' (Front Yard Proposed J (Side Yard Proposed. I [Rear Yard Proposed J Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: e • c A DV FEDERAL 1EMERGENCr MANAGCMENT AGENCb NATIONAL FLOOD INSURANCE PROGRAM O M.8 Irto. 7 0077 Expinsa July 31,2002 ELEVATION CERTIFICATE --- : Read the InattrucUows on am 1 -1. SECTION A-PRO t:RTY O=: Fw Irasuaaoe I , 91NLWNp OWNER Lorin and T n B. Litner oImu a STII ADDRE"(Molud' j4- ApL,UM,9uAc.anNa BI0/,No.)OR Cin' A&Wlbn 1025 No h ea Drive CIry Southold, sTaTC NY ZIP COOP 11971 MOPIRTY DESC ION 1 M and &x PooW Number,I oe,c„plbn.ew.) •12 ttlmL use(eq„Rsl"Mml NOA.reslsma .Aaeasseg.sk. Us CommNA,sech"it naassAry) Residential LA 1rUMOLONOITUDE(OITtOttAL) IZONTAt 1 ad•-de•se or a M.NM+1 L NAD ts27 SOURCE: LJ tMa(TI); LI NAD 1 tea L_I t1SG6 tiv.d Map Ll 0l116r: SECTION 0-FLOOD NSURANCE RATE MAP(FIR INFORMATION B 1.NFIP COM UNITY NAM COMMU UIIMER .COUNTY ,STATE Town of Southold 360813 Suttoik New York L3610WP ANEL a 9UFf11l 110 Fapd INMEX IST ia111 PANEL in LOOM N.419E FLOOD ELtVATI N(3) 3CO154 NUAMER DATE TF—FFECTIVOnEvagin DATE 2ONE19) (Lone AD,use depth of no") Blo.Il eft sora 0f the este Flood FIO��(OFF dela or baa -- v);' El. 13 U FIS Prof! IJ FIRM a Aooa�anAwed rn 60_ - LI COIN" dty Defemrir�ed j_{Other(OescMay all-Int'I d*tW#Wn OMM Und IN 1M OFE In AA•1x,1 Nfrvn Ina L)Nave jqm L omv(Oeecnby: Bi 2.le Ilse building WcWAd In A CoWel fkmier Re6aress System(CORS)area or ovorwiss Proleded Ares jop p L j yes IX J No Oats. SECTION C-91.11ILta1NG ELEVATION INFORMATION IOURVEY P"Umto) C1.Buil&V elwslione as based on: LlConsuucfmr 01wvrh9s• LIBuilding under Con oWion- WFIn4hed Consmilck m •A new Elemom CerliAcale**be mqw and-Im eanW001im of M1e bWld ft is cornplep, C2 6vildtrg Diagram Nom6er..Ii._(Soled the bimMing 0moram III stnhllm Io lnd buildkq for which Ines eiv* cats K bairhp completed-see p09a•and 7. It no disprtm M=Uroely represents Mho bW W9.PMVNW•dtetch o►pholep eph) C3.Elcvatlsn■-Zone Al-ASO.AE.AN,A(wllh BFE),VE,VI-V30,V(with BFE),AR,AAM,ARAE,AR/A1-A30.AWAH,ARIAO Complete Meals Cas-i below spoor"to the bu§dkg disgi and spe A in hem f,? Slate the dakan used.M 1116 detwhh is diasmM irom the dsNm used for the BFE in Sdd"B,6onverf the dekon to thet wed Iw the OFF.Show field maasumnam and datum CWWWWOR Cakt"ion. Use the speq provided W the Conlrtrsnls arms of Staten 0 or See ion G.es sWopri616,to docwhent the dal conwrslon. Dal CorwerslOrwamin "s El.v-10 1 mlerenas"wIt used 0066 the ell reference"Wrk used appear on Ile FIRM? 1__J rte I— U No 0 s)lop d bottom%W(including btsemenl or w4caws) u R.(ah) pf IrFly a b)Top of next Noor floor "13 L it(r^) U e)BoMorhr of towel htMiorllal slRrelural rn6rtrbsr(1r sons only _......_. �' R.(m) S� �.► "'°rt,'r �¢ Q d)ANWAM 9mW(bp of Nab) __9.(m) `° �.•:::� �' 0 6)Loweg ekVMbn of mh 0ft"andlor 6gUpanent •- it ung Mie OlMbtrlp t 3 .1.-A.(m) O f)Lowest Od)am"grate(LAO) G 9)1fi0rlesl mgme t"de(HAG) z5zl 0 h No.d 6dgaosrht or*" ) pennan6nt spsrwrrOs(Good vemm)wW11rh 19.saws � ''�� •o x� o i)Tolet al Of aN peraleM01`11 eperdmps(hood Vent,)in C31, sq.in.(60,cm) � t A D 5� SICTNM D-SURV"OR,&4M#tiFR,OR ARCHITECT CERTMAT101111 This CWVAC Wn Is W be Mooned Ind meted by a lend surwyw,enpinMr,or arCN tM Authorliad by lew to AeAI(Ir elevtlldn Infanmetion. I o6Ady AN Nle kMwr dw M Secdone A.A,and C on ens ca WAM RPIN rs OW 06ot dff&b Ib kuerprW Me deft avMDM I trrmkvM W that my III shleehalt maybe pwml by Ahs or sorr"em unIll 1e U.S.Cods,Sch on IM ml ohn T. Metzger, L.S. L 49618 TITLE t;.o�iwti wwE i.IMEss esident Pecontc Suryg4aa= p C _ P.O. Box 909 Southold, STATWNY ZIPCooE 11971 — 910NAT T Jan. 25, 200 REPHOW 1 765-5020 FEMA Fon"91- N SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS Z/Z aSed `•WVIZ: ii 10-9Z-uef:55Zv 69L nz `•83NlIl 7 X03 1:131-10133 :A9 juag :TAT(_ OF NEW YORK ) __ 5S COUNTY OF SUFFOLK ) benng duly sworn, deposes and says That deponent is over the age of 18 years and resides a1 20 7¢ R c--" Av,� . //9�x- That on the," day of '� ,�� ,/2000 deponent architect/engineer, 7— licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building Code (9 NYCRR); said plans pertain to property located at SCTM# 1000- S,f ^6 – 00 1 street address� A% T�.O��v� Ar itect/Engrer SwQM to before me this ,U-Loy of, 200+. CAILD O 46 _. NeWyu lft,S►tft ofiNm%* �JWWWV.10.10,gj. ` H all. 53095 Nla,n Ilcia<1 JUDITH T. TERRY — �• , TOWN CLERK c _ p f'.O. R<,e 1179s. `' �% r So udlOId. Nc- York 11971 fZEGISfRAR OF VITAL.STATISIICS .✓mow cC�� Fax (5161 765-1973 MARRIAGE OFFICER _ J Tcicphonc (S 161 7(15. 1 X(I I RECOR!)S MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold : "Floodplain Development Permit Application" [FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area (C/C(93) ] . _ PDj4 TOWN OF SOS+OLD udit/h T. Terry Southold Town Clerk August 25, 1993 APPLICATION PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DENTLOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is h&*y 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 TH GE,TRUE AND ACCURATE. (APPLICANTS SIGNATUR DATE j SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME AD D R ESS TELEP HONE APPLICANT v` /5 " BUILDER ENGI R ZT � � 2a7 rti�-,,v•RD; L�-.cXc fit.. ¢g PROJECT LOCATION: To avoid delay is processing the application, please provide enough information to easily identify the project ` location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION r PAGE 2 OF d DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑ �*ddition ❑ Residential (More than 4 Family) Alteration ❑ Non-residential (Floodproofuag? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) If ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No.________, Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). O Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To he 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 first floor, details of floodproofcng of utilities located below the first 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 *Aif 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 no( result in an 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 fTo be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A ❑ Is B. ❑ Is not in conformance with provisions of Local Law At , 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 B03C B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION PAGE a OF a APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hca-ring 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 floodproofing protection is FT. 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 communitys 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: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) tdo 4� 9w,�- �K 71 3;;�� 76s-1902 BUILDING DEPT. Gvdto� r-�✓� INSPECTIO [ ] FOUN TION 73T [ ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ro�-A-26' tv�dxe al(qovr� eo-t, l/.� � .�„ ,Pam, ��aa S� �j aGs•-�� ,DATE INBPECTO tion . BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] GH PLBG. [ ] F UNDATION 2ND [ INSULATION FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY R RKS• X�/,� CX� ,DATE � � INSPECTO BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ( ] ROUGH PLBG. [ j FOUNDATION 2ND [ ] IlAdLATION [ ] FRAMING FINAL [ ] FIREPLE CHIMNEY 7 REMARKS: i DATE & INSPECTO FIELD INSPECTION REPORTDATE COMMENTS FOUNDATION f /, ► FOUNDATION O1 1 � AA ROUGHI•PLUMBING i / II r INSULATION PER N. Y. STATE ENERGY CODE NA e jj�<2 4 / / i FINAL ADDITIONAL COMMENTS: I: I v w tv yr OV u i rnvi-A) ' is UiLI)i NU YbXIV11 I A??LA_A i 1UN C hl✓C;KL1S BUILDING DEPARTMENT Do you have or need the following,before applying TOWN HALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: 765-1802 r� Survey Check Septic Form N.Y.S.D.E.C. f Trustees Examined / , 20� Contact: Approved , 20 Mail to: Disapproved a/c GC <�'` )q Phone: Building Wector r�11_ APPLICATION FOR BUILDING PERMIT Date 2 S , 20 o I 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 areas, and waterways. 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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupan is issued 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 applicant or name, if a corporation) LO¢- ,tG• ,9' ' (Ma ,ng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises L�2�4•� / O �}L : /.�. Gi�'ivgcc. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 0KJRA9 AMA House Number Street Ham . aS•fit �urucb:tuiigx�no�aNnmoO ni County Tax Map No. 1000 Section ¢ Block O Lot /2 Subdivision Filed Map No. Lot (Name) '_. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy /1lzs,.D,r.�.17,-e >. Nature of work (check which applicable): New Building Addition Repair Alteration P Removal Demolition Other Work 9/ I. Estimated Cost .l�f o, o Fee (Description) e pa ng to If dwelling, number of dwelling units / Number of dwelling(units onteach floto this application) If garage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Rear ?3 Depth 2 8' Height 2Z Number of Stories_ 2 Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories Size of lot: Front Rear Depth 0. Date of Purchase 2 4y2-'-01�ame of Former Owner /V 14 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: /l/v 3. Will lot be re-graded Will excess fill be removed from premises: YES (�OD 4. Names owner of premises L,r,��-,c. Address i'' c 21 Z — 95%6 Name ofo.�s� /�oB'`'c� a' �,�, Address es ,�,Q Phone No. - _ r�� `"'�"" Phone No�9� Name of Contractor Address Phone No. 5. Is this property within 100 feet of a tidal wetland? *YES v NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: 'OUNTY OF ) loe aQ/.-# T d ` ��B.c/ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, �)Iie is the - �,v{��,� �►�„� (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 application; iat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be -rformed in the manner set forth in the application filed therewith. worn to before me this day of 20 0 Notary Public Signature of Applicant Ofty Public,8ta�Nm% No. 01CAW18740 s C n 0 K T TT r r I rr x'. C' s SURVEY OF PROPERTY AT SOUTHOLD =� TOWN OF SOUMOLD m ' SUFFOLK C OU�NTY,, NY - 12 4p DEC. 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