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HomeMy WebLinkAbout27099-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28488 Date: 06/06/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 4725 ORCHARD ST ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 27 Block 2 Lot 2 .6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 18, 2000 pursuant to which Building Permit No. 27099-Z dated MARCH 1, 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 AN ACCESSORY GARAGE WITH NON-HABITABLE SPACE AS APPLIED FOR. The certificate is issued to JAMES F JR HAAG (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 05/02/02 PLUMBERS CERTIFICATION DATED 04/19/02 KING PLUMBING Aut orized S' nature 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. 27099 Z Date MARCH 1, 2001 Permission is hereby granted to: JAMES F JR HAAG PO BOX 28 ORIENT,NY 11957 for . NEW CONSTRUCTION OF AN ACCESSORY BUILDING AS APPLIED FOR WITH FLOOD PERMIT. at premises located at 4725 ORCHARD ST ORIENT County Tax Map No. 473889 Section 027 Block 0002 Lot No. 002 . 006 pursuant to application dated SEPTEMBER 18, 2000 and approved by the Building Inspector. Fee $ 342 . 20 Author ed Signature ORIGINAL Rev. 2/19/98 CK c D ten ;J Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Q` �� ) 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPAN This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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. Photocopy of Certificate of Occupancy-$0.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00 Date. y/j4/ 2— New New Construction: / Old or Pre-existing Building: (check one) Location of Property: y 77s o,c c�,y,r O "PT-. O.G i fi✓ 7" House No. Street Hamlet Owner or Owners of Property: Ti/"l /HA AG T Ta OP _r,-R^1 sGx G Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. 2 7c9Y z Date of Permit. Applicant: MAcpo�n�✓� Ncoor+io.�.c��� Health Dept. Approval: /✓�/7 Underwriters Approval: _ Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 2 s-, 00 Applicant Signatu e ori eAj O Ir o W Town Hall;53095 Main Road - . Fax(631)765-1823 P.O. io Box 1179 A Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: �L O Z Building Permit No. r © ` Owner: _J✓fin sy►ra c (please pri t) Plumber:fC i v D�D,n (please nt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. �4_ l (Flambe ignature) Sworn to before me this day of 1 20 oo t Notary Publi County CLAIRE L GLEW Notary Public,state of New York Ission ed in s HalkC�eQr�� Commission Expires Dec.8 The New York Board of Fire Underwriters Bureau of Electricity is in the process of issuing a certificate of compliance for the electrical installation as provided for in the application for inspection # Ale-W i -r eq2cm-/ej 02l&-41!- New York Board of Fire Underwriters Bureau of Electricity Inspection activity pursuant to Application #_C4'��/-5 (O has been completed and a certificate of compliance setting forth the detail of the electricalsstem is being prepared. 5 Z , � Inspector Da e IV14� Jhl4tTuGT�4 Fom 00(Rev.06/00) c. 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET ~ NEW YORK, NY 10038 5 S 5 CERTIFIES THAT S5 Upon the application of upon premises owned by 5 5 JIM SAGE ELEC. INC. JIM HAAG 5 P.O. BOX 38 4725 ORCHARD ST GREENPORT, NY 11944-0038, ORIENT, NY 11957 5 5 5 Located at 4725 ORCHARD ST ORIENT, NY 11957 e� SApplication Number: 1054784 Certificate Number: 1054784 5 5 5 5 Section: Block: Lot: Building Permit: BDC: NS11 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 First Floor,Second Floor,Detached Garage,Outside, 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5 found to be in compliance therewith on the 28th Day of May,2002. 5 Name OTY Rte Rating Circuit Type 5 5 Alarm and Emergency Equipment Sensor 2 0 Smoke 5 rj Appliances and Accessories Electric Heater Baseboard 2 0 .5 KW 5 5 Exhaust Fan 1 0 F.H.P. 5 5 Water Heater 1 0 4.5 KW 5 Panels 5 5 1 100 13 5 Wiring and Devices 5 Receptacle 18 0 General Purpose 5 Switch 14 0 General Purpose Fixture 10 0 Incandescent 5 5rj Paddle Fan 1 0 5 5 Receptacle 3 0 GFCI 5 5 seal 5 5 1 of 1 5 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. 5 LAWRENCE M. TUTHILL r� PROFESSIONAL ENGINEER Jf tli; 5 2WE1(t P.O. BOX 162 GREENPORT, N.Y. 11944 A (631) 477-1652 June 5 , 2002 To whom it may concern: Re: Auxiliary bathroom James Haag Residence, 4725 Orchard Street, Orient, NY Building Permit No. 270992 The addition of an auxiliary bathroom at the Haag Residence, 4725 Orchard Street , Orient will not exceed the Suffolk County Flealth .Department for the sanitory system as originally designed, Sincerely, /A Lawrence M. Tuthill f of HEVf YD' h Q`� yi • ♦ J 6 N w 032254-1 v �OFESS0 BUILDING PERMIT REVIEW CHECK LIST DATE REVIEWED: f/ l/7/0o APPLICANT NAME: U G — 2 2 7 DATE SUBMITTED: 9 l00 SCTM# --- DISTRICT: 1,000 SECTION:; BLOCK: 2- LOT: ,2. 6 PROJECT LOCATION STREET: ?'??_,!� © �� nrp� S-/ CITY: Cy7c_s4 SUBDIV. NAME: ARCHITECT/ENGINEER: FAST TRACK: YES OR NO SINGLE & SEPARATE CERTIFICATION-REQUIRED: YES OR NO NOTES: ZONING: PERMIT ESTIMATE AMO $ SD 4— .00 ZONING DISTRICT: R40 R80 AC CONFORMIN<4a NO REQUIRED LOT SIZE: SQFT. ERE ACTUAL LOT SIZE FRO TAX CARD g / ` mss ACTUAL LOT SIZE:396396 SQFT. so 1j REQUIRED QUIRED REQUIRED FRONT:' PROPOSED:—' SIDE YD: 30 'l 66 ' PROPOSED: '/ REAR:/c�d 'PROPOSED: LOT COVERAGE: ALLOWED: s % EXISTING: sf % NEW: sf % TOTAL: sf % CORNERYES NO WAT ER FRONT? YES NO DESCRIPTION: LOTS 40,000SF --100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger. (A nonconforming at anytime after July 1, 1983.) PROJECT DESCRIPTION: ADD.ALT Acc R N/D:� 1�� . r�r�s. AV,.«? h� dY�a,,,.�i�,�i4zini AGENCY PERMITS REQUIRED FOR REVIEW 0/ NEED TOWN SPETIC PERMIT:o _, ec•-) !�e, 744- 4+j7e,9"-,.y SUFFOLK COUNTY HEALTH DEPT: or (BED #�TE: / / PE71T#:RIO- NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or / SOUTHOLD TOWN TRUSTEES: YES or TOWN ZONING BOARD APPROVAL: YES o N TOWN PLAN. BOARD APPROVAL: YES or O� FLOOD COMPLIANCE ZONE: PRE-FIRM 3/18/80 PANEL #: FLOOD ZON ASE9 Arld- NYS ENERGY: YES OR NO EGRESS: ''� VENT: LIGHT: _ NOTES: c t*' c ..., FEE STRUCTURE: FOUNDATION: 764f SF FIRST FLOOR SF SECOND FLR >6s SF INIT OTHER TOTAL TOTAL: 153.6 SF FEE FEE FEE TOT( SF)- S( oQ SF)= ./63,G SF X $ - 7 =$ U2;4)+$ 5 +$ 16c) $ �� �lr , to,eJte-&-rrp Lv 04 cw •I a .•. `� low11 Hall 5VIQ aI IZoa i J7IDITH T. TERRY 1f P.O flax 117() TOWN CLERK Siwlhnld. Nc < U 11 rk 111171 REGISTRAR OF vITN.STATIS-II E (S CS �+' IC•b `�^ �- Fax (S 161 765-1911 MARRIAGE OFFICR _ ��" � Tcicphotic 16) 7(,.c,- IH(11 RECORF)S MANAGEMENT OFFICER 1 a 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 : - - Q 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) ] . 6: G. GEr. TOWN OF SOU7HOL9 / � udith T__ /Terry Southold Town Clerk August 25, 1993 03/19/::1 MON 14:31 FAX 212 489 6715 ,HARRY WINSTON INC 2002 FROM SOUTH= TOWN PLANNING BOARD FAX NO. : 631 765 3136 Mar. 19 2001 02:35PM P1 ^rrL1CAT1ON x PA(E 1 of a " TOWN Of-* SOUTHOLD r1,00DPLA N DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. 1 SECTION I GEtMEA s PROVISIONS (APPLICANT to road aQd sign)- 3- No work may start until a pctmit is issued. ` 2. The permit may be revoked if any falsc statements are made. bcroin_ 3. If revoked, all work must cease until permit is re-issucd. A. Devclopment shall not be used or occupied until a CcrtiGeate of Compliance is issued- $. The pwmit will expire if iso Work is eommeneod within six months of 4ssu2nct. 6. Applicant is ht#by informed that other permits may be required to hzWW local, state and ruderal regulatory requirements. 7. Applicant hereby gives coaacet to the Local Administrator or his/her representative to make reasoeable inspections required to verify mmprance_ 8. I, THE APPLICANT,CERTIFY THAT ALL STATEMENTS HHRHIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO THE H OF MY/KNOWLEDGE,TRUE AND ACCURATE. (APPL1CANl'S SIGNATURE) < DATE ECT[ 2: PROPOSED hr,completed by APPLICANT S BUILDER ENGINEF-R • To avoid delay in processing the application please provide caough information to easily idcuti[y the project a location Provide the street address, lot number or legal description (attack) sad, Outside urban areas, the distance to the nearest intersecting road or Weil-known landmark. A sketch attached to this application showing the proje locations Would be helpful w igell�, — O / FDP(93) 03/19/01 MON 14:52 FAa 212 489 6715 HARRY WINSTON INC 2003 FROM SOUTHOLD TOWN PLANNING BOARD FAX NO. : 631 765 3136 Mar. 19 2001 02.35PM P2 APPLICATION Pm<.;E ? OF 4 DESCRIPTION OF WORK (Check all applicable boxcs); A. STRUCTURAL DEVELOPMENT' n IV'T'Y S T RUCi URE n?E ,Aa caw Structure ❑ Resideadal (1.4 Fasoily) � �b 0 Additioe ❑ Residential (More than 4 Family) C3 AJreratioo O Noo-residwtia! (floodproor[ng? O Yes) ❑ Relocation ❑ Combined Use (Residential At Commercial) 0 Domolitioo ❑ Manufactured (Mobile) Home (Io Manu- O Replaeemcao factumd, Home Park? 0 Yes) ESTIMATED COST OF PROJECTS 00 U V B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill O Mining O Drilling O Grading O Excavation (Fseept for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modil[ndons) O Drainage Improvements (Induding Culvert Work) O Road, Street or Bridge Consstruriioa O Subdivision (New or Expaosion) O Individual Water or Sewer System 0 Other (Please Specify) After rAmpleClag SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DKI MINATION (To be comnimcd bx LOCAL ADMITti RA R The proposed devdopme:nt is located on FIRM Panel No. . Dated The Proposed Dcvelopment: O Is N= locatod in a Special Flood hazard Area (Notify the applicnAt " the application review is ootaplete.and NO FLOODPLAIN DEVELOPMENT PF.RNCT IS REQUIRHD). ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is SAO-Year hood elovation at the site:is: Fl. NGVD (MSL) 0 Unavailable D The proposed development is located in a Roodway. FBFM Pancl No. Dated O See Section 4 for additional i [ructions. SIGNED DATA APPLICATION # PAGE 3OF4 SECTION 4 ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The apphcant 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 floodproofmg of utilities located below the fust floor and details of enclosures below the first floor. Also ❑ Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations 0�,'Iif they arc not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted_ ❑ Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A. ❑ Is B. O Is not in conformance with provisions of Local Law tR , 19_. The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION a _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg 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 commtmity's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8• CERTIFICATE OF COMPLIANCEffo be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: +r 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) FROM SOUTHOLD TOWN'-PLA 1`�- 0. 631 765 3136 Mar. 19 2001 02:35PM P1 .-� V 7 t t1t11S ( APR 26 innl I` APPI,ICA'(ION # f'nGF I of -� TOWN 01- SOOTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. 55,CTTQN,1: GENERAL PROViSLO S APPLICANT to read and siPnl: 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. A. Development shall not be used or or=picd until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six mon(bs of issuance. 6. Applicant is hdt*y informed (hat 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 compilaAce_ 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND 11`4 ATTACHMENTS TO THIS APPLICATION ARE, TO THE BT OF MY KNOWLL-DGE, TRUE AND ACCURATE. (APPLICANTS PPLICANS SIGNATURE) / DATE SECTION2: PROPOSED DEVELOP c con e d v A PLICAL\ NAME ADDRESS 1 EPH NF APPLICANT FS BUILDER ��✓ ��fgCi N Ii�LYZ�i�✓� ENGINEER !ij✓ ��fj/�/— ��-�'_�-�-�It�L.�T PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location Provide the street address, lot number or legal description (attach) and, outside urban areal, the distance to the nearest intersecting road or well-known landmark_ A sketch attached to this application showing the project loeauoa would be helpful- FOP(93) / i FROM SOUTHOLD TOWN PLANNING BOARD FAX NO. : 631 765 3136 Mar. 19 2001 02:35PM P2 /,,FPLIC-ATK.) xl PAGE 2 OF e — DESCRIPTION OF WORK (Cheek all applicable boxes): A. STRUCTUP-/�J-- DF_VELOPMFN'i ACTJyj]LYY STRUCTURE _TYPE cw Structure ❑ Residcutial (1-4 Family) ❑ Addition ❑ Residential (More than d Family) 0 AJtcratioo ❑ Non-residcaual (Floodproofmg7 ❑ Yes) ❑ Relocation ❑ Combined Use (Resideoual & Commercial) ❑ Dcmolitiou Q Manufactured (Mobile) Home (lo Manu- 0 Replacement factu:cd Home Park? ❑ Ycs) FSTIMATL-D COST OF PROJECT SZO_CJ'0I) 0 B. OTHER DEVELOPMENT ACTIVITIES: �. O Fill O Mining O Drilling ID Grading ❑ Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) 0 Road, Street or bridge Construction O Subdivision (New or Expansion) O Individual Water or Sewer System O Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by I.QCAL ADMINISTRATOR) The proposed development is located oo FIRM Pancl No, Dated The Proposed Development: O Ls NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT 15 REOUIRED). ❑ Is located in a Special Flood Hazard Area. FIRM zone dcsigoation is 100-Year flood elevation al the site is: Ft. NGVD (MSL) 0 Unavailable O The proposed development is located is a floodway. FBFM Panel No. Dated ❑ Sec Section 4 for additional i 7 tructicos. SIGNED DATE X, 1'A' 11 I \N/t 1-j.1 Y I\ __1 j zz 1 Applicant/ Date Owners Natnc:. __--_--_------ — Revie\�cd- ---_—__- -- Architect/ / Date Engineer-. �_ _ Submitted: - SCTM il: District 1 ,000 Section_ _ Block Lot Project Subdivision Location � � _ Name_ Sin(fle& separate Required cerliGcation Yes/ No) Rcq Rcq. /ovine Uatncl 11,01 slzc _ Acual_ l [Lol coverage Piopowd Rey Rcq. Req. [Prone Yard Proposed: ] [Side Yard Proposed J [Rear Yard Propo.,ed l Project Description: AGENC)tRERMITS 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: Not I TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET Ta��; VILLAGE DIST. SUB. LOT FORMER OWNER N E ACR. y. _2hO S(�I{r 41P 1A } SOS S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS AL e) - _< wrorf� d v ,eru -!5-3 O O 34 g - " P` oco TEV 4000 "�Ialql =Lll7 5� - �f lan "acv 5400 t0 �ocR' 11Z L a5 -� - Cn or q Zoo 9 I cx� I 30o i7 es e Zv6 Fs60 c) 1 00 e� Tillable 2. 1 A 7-S-0SA s0-p o0 o FRONTAGE ON WATER X25 Woodlon18"4 ZA 5'0 1 OO FRONTAGE ON ROAD Q S DEPTH House Plot O BULKHEAD Total _ �LL .. tett rt ■■■■■■■■■■■■■■■■■■■■ - ■■■■■■■■■■■■■■■■■■■■ ■HUMM■■■■I!■!■■■■■■■■■ ■IPM!■■M■■PM>■■■■■■■■ ■ii1llii■■1!�!.q�■■■■■■■■■ • ���■ Interior ' ® r 7GS-1802 BUILDING DEPT. PZ4 �I le o NSPECTION NDATION IST [ ] ROUGH PLBG. ( FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLAC & CHIMNEY R MARKS: - DATE INSPECTO G 765.1802 BUILDING DEPT. 114SPECTION ooe [ ] FOUNDATION IST [6Y ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMA 5: 77fiI2 ,47 itol ,y DATE INSPECTO X70 765-1802 BUILDING DEPT. INSPECTION' [ ] FOUNDATION IST [ 14 OUGH PLBG. [ ] FOJJNDATION 2ND [ ] INSULATION [A' FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 7REM"RKS:n DATE jl INSPECTO -L70 'T 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ G• [ ] FO ATION 2ND [ INSULATION [ FRAMING ( ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE / � 7INSPECTO 70 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN TION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: rU DATE -� O L INSPECTOR FIELD INSPECTION REPORT DA COMMENTS _ lr - ---' _____ __ _______ _ _________ ________-_______- J c... H FOUNDATION OST) 1r— �I if b 7�1 � FOUNDATION (2ND) -------------- ------------------ IF - o . ROUGH FRAME & PLUMBING it II s., INSULATION PER N. Y. 00, y STATE ENERGY CODE u ii If If H II p 1f— II If � q FINAL II q x rx=s----=s=axx-=ll-------��-�-.-------ssxces=axx=esx=ssxxx=ssxp=seaxc=sso=ssx ADDITIONAL COMMENTS: 6 5 a H z � Z ro H � ILI ri + BOARD ' OF HEALTH . . . . . . . . .. FORM N0. 1 3 S&S OF PLANS TOWN OF SOUTHOLD SURVEY . . . . . _ _ . . . . . . . . . . . . i BUILDING DEPARTMENT CHECK • . _ . . . . . . . . . . - TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.. 765.1802 t:t)T i FY i CALL 375 . . . . .3� Examined . &4 , , , , , , , .,200.d MAIL TO: Approved . . . -� . . . . . . ., �. Permit No. pZ�f��� . . . . . . _ . . . . . . . . . . .: . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . SJc . , . . . a ,15 . 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 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 inspec ' s. (Signatu f applicant, or nary if orporation) Po: Sox a8 0��� t, ►�y a tqs-� . (Mailing address of applicant) State whether applicant is owner, Ibssee, 'agent, architect, engineer; general contractor, electrician, plumber or builder. Q Wh(e✓. . . . . . . . . . . . . . . . . "Tame of owner of premises . . . . ila , OUL Joe.. (as on the tax roll or latest deed) T applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. . . . . . . , , , , , Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . : . . . . . . . . . . . . . . . ,J`�, . . . ... . . . . . . . .{�rc wdl tYc Wit. . . . . . . . . . . . . . 1�`r. ..1�`iS . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section ... . . . . . . . . . . Block .QrZ. . . . , , . , , ; , , , Lot . . . . . . . . . . . . . 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 . . . ... .YAc ?,� . 14' "" t . . . . . . . . b. Intended use and occupancy . . . . . .�?Ai . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . Nature of work (check which applicable): New Building X , Addition . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Alteration . . . . . . . . . Demolition Other Work . . . . . . . . . . . . . . . 4. Estimated Cost . . . J`-�r444� , (Description) Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) If garage, number of cars . . . ,s S. If dwelling,number of dwelling units . .. . . • , • , , Number of dwelling units on each floor . . : ? CAJLS 6. If business, commercial or mixed occupancy,specify nature and extent of each type of use 7�7. Pimensions of existing structures,if any: Front . ' Ieight . . . .a2.cl•.�.S . . . Number of Stories . . . -Z S/� . . . . • Rear. . . . . /.�:: . . . . . Depth . . .96,. . . . . hf�Dimensions of same structure with alterations or additions: Front • • • • . • • • • ' ' ' ' • ' ' Depth . . . . Height . . . . Rear . . . . . 8. Dimensions of entire new construction: Front . Numbel of Stories . . . . . . . . . . . Height . . . . 1 �4 N . . . . . . . . Rear . nZ�. . . . . . . . . . Depth c3o1-t. . . . . . . . . . Number of Stories 9. Size of lot: Front . . .454` �... . . f. . . . . . . . . . . . . . . a�. 10. Date of Purchase . . , , Jytl lS- '" Rear . . . , 7,$, , , , , , , , , , , • Depth ,$ 11. Zone or use district in which premises are situated , Name of Former Owner ?!44°t4. , , , , , • , , , _12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded `fC!�. • • • . Will excess fill be removed from premises: Yes 14. Name of Owner of prem} es � , /?`?171'0-, Address 10- No Name of Architect (f � � �' ` ` W#Vt?hone No. 3d.� ?� alb. R, ee f-1- 1-_X *Address M--tON! ftb:4fAL/.T Phone No. 3. 3. .S Name of Contractor . .�/S1� , / Address 15. Is this property within 300 feet of a tidal wetland? * e •Phone . .No.. . , , , , *If yes, Southold Town Trustees Permit may. .be required. . " No,�a, , , , , , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set back dimensions from interior or corner lot. property lines. Give street and block number or description according to deed, and show street names and indicate whether CATE OF NEW YORK, )UNTY OF . S.S being duly sworn, deposes and says that he is the applicant (Name of individual si nin ontract) we named. is the . ... . . . . . �4�1✓ �r . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor,agent, corporate 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 rk will be performed in the manner set forth in the application filed therewith. 3m to before me this . . day of ary Public, County ELIZABETH A STA S ARY PUBLIC,Stateof New Yak No.01 ST6008173,Suffolk Cou ty • • • • • • - TermExpiresJune8.20SL (Sig re of applicant) . J SCDHS Ref. # RIO-96-0026 The local/ons of wells and cesspools N shown hereon are from field observations and or Irom data obtained from others. y" �c 'a TEST BORING 0 BROWN LOAMY SURVEY OF �,, 30 or 6' - -- - -- O LOT 6 J F BROWN FINE n a5�' aro 7 \ OS To COARSE SETTLERS AT OYSTERPONDS h° SAND FILED MAY 4,1984 FIE NO. 7729 1\0 � 2s, h/>; Ili, A o �l �p � \ e\\\ ti 76 __e/ 3 0 AT OR/ENT WATER IN TOWN OF SOUTHOLD /P A IjQ oPo BROWN FINE SUFFOLK COUNTY, N. Y. C G� oM1 4 e\ TO VERY ah ,� n����'P °O o COARSE SANG 1000 - 27 - 02 - 26 L � s ,� o. �„ � ., � aj �, ,, \\ e I4- Scale: 1"-60' a �0 May 25, 1995 a% d� aS¢ e` FEB. 14 1996 (SCDHS. INFO) 6'/ie ' ' /i ��� ��� APRIL 19, 1996 (SCDHS REVISIONS) Aug. 27, 1996 (foundalion) Aug. 15, 1997(final) 3� 1� �s-a 4rh b QL Aeq a NOV. 29, 2000 ( Topa. 1 'pi Feb (P'.P yar ) hB, 200 10 0� U / VO e�A k �� ,/ eper V �p 9ge SF. 3 i O 9 � PLO0 ZONE 4/'V� O moo � P �o • J I am familiar with the STANDARDS FOR APPROVAL ° AND CONSTRUCTION OF SUBSURFACE SEWAGE Al DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the permit to construct. ) _ N/ �O Q ,Q 5 P,0 F �0 i�sE- �• el/o-.3 czc fin f/r e/ /2.5 '90 01 IE LE /000 a/ jE 0 J G Y p rz5 seP�k u, oa Omi tb, = /' S•5 1P ioil lJ \ e/ — CERTIFIED TO, JAMES F HAAG, JR. - MERRILL LYNCH CREDIT CORP. SANITARY SECTION CONGRESSIONAL ABSTRACT CO. e1 ��qF �EYYJl7 A$ 4A �. uerro 'P•i S and Ep ANY ALTERATION OR ADDITION TO THIS SURVEY /5 A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW g EXCEPT AS PER SECTION 7209-SURDIVISION 2. ALL CERTIFICATIONS ; LIC, NO. 996/8 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F Y SAID MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 2 = PROPOSED CONTOUR I PE k US P.C. WHOSE SIGNATURE APPEARS HEREON. 9 �' (63/ X (63/) 765 - 1797 ADDIELEVATIONS AND CONTOUR LINES - _ L MUST/BE USE TO COMPLY WITH SAO LAW THE TERM UTILIZING TCOP BY' ARE REFERENCED TO N.G.V.D. P. O. MUST OT USES R ANY AND ALL ERMSSURVEYORSSUCH ASVtSPA COPY _ 1230 TRA VE ER STREET 'B ANOTHER SURVEYOR'S MAP. TERMS SUCH AS ' THE LAW. AND p L JUJ ZONES FROM FIRM 360813 0098E AREA = 9. 1049 Acres 'BROUGHT-TO-DATE'ARE NOT W COMPLIANCE WITH THE LAW. - ,. SOUTHOLD, N.Y. 1197/, 95-179 170 L l ; DHS flglf #RIO-96-0026 The locallons Of wells and cesspools shown hereon ore from field observations and or,/rpm data obtained from others. " ul�t CFr 7 1 2001 '� e� �,y "a c�oc' Derr. rstiulrtorn / z r�Q , " i S TEST BORING 40 O BROWN LOAMY SURVEY OF _ r 6 — - -- LOT 6 �ro°ND SETTLER$ AT 0 �pS P15 ACEDMAY4,=4 W P 772$ 3a AT ORIENT 7.6 -,TE WATER TOWN OF SOUTHOLD x y M y Z aw To VERY SUFFOLK COL#Vrr N. Y. brt 0 ° A. O '4�. a coARSE.,SAtm a1000 - 27– 02- 2.B a v // Scale: 11'=60' g� f �� tl,� ° flay 25, 1995 t o4t p it FEB. 1 4, 1996. (SCDHS. INFOI APRIL /9, /996 (SCDHS REVISIONS), E• d .y _ �S�bdc Aug. 27, 1996 (foundation) Aug. 4% 1997(fkW NOV. 29, 2000 ( Topo. !tSa �• Z'. ,/ �� Y Feb. 6 200' ferepp ggw.r.� Sept 15, 2001 -Illnal'gar.! eo O / / I o I am famMar w/lh the STANDARDS FOR APPROVAL \\ _ AND CONSTRUCTION OF SUBSURFACE SEWAGEQ " DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and wU/ abide by the condUions set forth therein andndonon the \ / permit to construct �� - _ \ rA 1B\5 \ 0 - {fsl e,M.3 csc {n. flr, el 12.5 @2� V� a ° LE LE /000 .a1F rs2D P 0� Yank P.� Oti/ LP 511)(7 0' . 5= - - PR aCERTIFIED TO, coo '�4 a �r e�/ ' � •�" - - JAMES F. HAAG, JR. SANITARY SECTION MERRILL LYNCH CREDIT CORP. � PZEDF .NEW CONGRESSIONAL ABSTRACT CO, )• o�H 1.reria Oyu r , . 1 p.¢ , A Y ALTERATION OR AOD ITmN TO SfNVEY!S p VIOLATION SECTmN 7209 OF THE NEW YORX TATE fiDUCAn N LAW EXCEPT AS PFR SECTION 7P09-SAA 2. ALL L'EHTFICASWW rrEDN ARE v um Purr rws MAP A GUMS'THMOF ox Y IF S. L/C. NO, q 6{6 SAM/ NAP OR CGWIES BEAR Tri SEAL OF RAE SLRVEYOR S.SPo'NATURF APPEARS HEWM —I = PROPOSED CONTOUR AVMTVNALLY To COAWLY WITH SAm W 7W TE21r ALTERED BY' ELEVATIONS AND CONTOUR LINES PEC ORS, P.C. MUST BE L/SEO BY ANY Arm A!L AN/�pEYOW LIMO 6 A COPY ARE REFERENCED To NG V.p, • (63(1 76 2D FAX (631) 765 - ,(797 OF ANOTHER SLprVEYORS MAP. TERNS SUCH AS '1KSPECTEO'AMD P� O. BOX 909 I I-TO-0ATE•ARE NOT MI CpgpMCE W/TH ryg LAW. FLOOD ZONES FROM FIRM "'36Q813 0048E AREA = 9, 1049 Acres 1230 TRAVELER STREET SOUTHOLD, N.Y. 11971 j 95-179 x� I�sU� wsu i ��I 6FbN ROODZOn A9 Q ° ToK�Vcv oN yc x, ,.� r ,a J �`� / APPROVED AS NOTED COMpLYW1TH CHAPTER r 46 �,� /`y , ,7k rYsec DATE: o/ B.Pp��� �— FL=DAMAOEPRE\!ENIIGNI s�JJ++�'' �� BOUTHOLD TOWN CODE ee�n�ti� . G1:I�IF1 C{ t ,r 6 FEE: �•� BY: _ O / J -� .A yrs I / I� o / _ '��� •I .-� I 'tr,(C-K1 NOTIFY BUILDING D4 PM FE9 ,E )i ,J`Jorer ,ne.ia-/- be rt ql �il'\I GYM 766.7802 8 AM TO 4 PM FOCI .,E /� FOLLOWING INSPECTIONS � i B i. FOUNDATION - TWO RFS a e C n0 Co _' � ✓-" i = FOR POURED CONCRETE 0 � CT=- ,'' L" (�Y w,51-AT �( U! ( ______- _-_- _ - MING & P._ G r� � �� � � 2. ROUGH FRA � � O f1 I , Kl `bl T: - — / 1 CO / 3. INSULATION I� - �/ U _ _ — _ _ _- 4. FINAL - CONSTRUCT 7N _ iT _ — .__. _ .. —��I�CL� �I�af' _ — _ _ q as Fr (S.�•<cy SECOMPLEFEFOR , J ALL CONSTRUCTION' =,'I^ -T T ' THE REQUIREMENT' 15T$�-� �19 ,� T`. _ _—__ _ -- _ �^ STATE CONSTRU;r„ L q N� CODES. NOT FI ' v �u�� 'J z _ rt i ,.£ LY 'ss DESIGN OR CONST..'„':;1IV., ..,5 s — - pr,, 7CY OR C N ai i I o A Q � f i o sa, U = ( 1 ' / ��I U NI °` " �" d [.�'.. 9 bl ILAWFUL r� W 516 ' xs� �a r I I.II�1 a �;��p CERTIFICATE G - - U DCPd1';^T -^ EGTIFICgTE o^I ro � � /4-" nu ,; m = I v W Y wAU6 1� @ I I O 6d RP Lm p� �. ✓' I I I Clfol�lNll I I��JI \ I �I �Y /N� � SP4NOEN[p,yO9'- 8 23i, a�- 3r 28z-� l0�- O n lo'-o,•_ 8,. - �• `�. �90FkSSjo /00 r � � - �1 y' kr r 3GXh6 X3G 0 5 Q ! - — - i` I� HPG -- _ r- rr—r_r_ FG�-rIh � � I I � I s1.661-T 5T N } n I 1_ —T - — ! i i I I � 1 II ILII II II I 11 I 1�11�I I I -- 5°l`G5HA AI5 W. VASJNK? EllE— I Mr54171a�11ot1�" L1 I T T I � I I, I I I I I I Sr—) k_F-4WJ�_5T r (D I --- L - - - - - - 1 I- - - - r - - - - - - - - ' Proposed Garage Haalg/ Samberg Residence Floor Plans & Elevations �( NI� �T-� I - %ATI Q N b(. °I Z'%Irf Date• Prepared for: PnepazeDrawn Folio k Jim Haag- Todd Sambcrg Art Dire ctions, Hu. A F-v 1 I Scale: l/4'=1'-0 Orchard SL P.O.Box 310 bY,.,��b Al Appr val: Orient N.Y. 11957 Orient N.Y. 11957 07�"J .z 8 1 w.� /-xg _ LX6 IXEZ DPS -f�i LA 19 �� yxloH� �tZOK �QIdIY / VIINIbW Fr-&IAE �,S5Z81t7 RfiSTx'II� �7" 2X�srU� 6° �Lrp cowN IXH KAKI _ t X5 �l �- �� vi [3rd 0 / vXIO OF NEW r� CE t � w 032254-1 p90fES510NP� W /iE.° WAND � r 7" FKOM ' YW2L5191^dC� b'I$G�rh w 6"SANy3 � h i 2x14 1<I�y INS �.nnaN - - 6 C v ( .1 a/' I�Ci l✓ T i' li T ---�.—_--_ f t N ,doe Od D _—. - T'—�—T —I )CO[\l5-rf�LAG-FIO N-- D�TAI I- ST I F�, 2�" Al L I WI N t�OV! ti PWf\ 3C4{F-17�f�o C� N A1�NOTES - �- r - - -- --- ----- --------- ------- pr-)Cir\if�FQN WA QT1, MANC** AF-CMF4 r,•o, 14CAT ORI �0\M5 o�aN:J3uY4 r-FD FWo4 � h o ?Fl-4A lzez i6-mryco r,:-OG�lo" �x<�us� +� - NI IY• 50LIT. -AST LCur 1 vN_ I~XT,rAA�gP�R. t 7- akn�i�nymn,( 6 r� 7XT tkwi- GAr c� 56E mol- = ru v}(T. f-N-M4 7)k>f G I � N1KY _ -4- -W?( '2" 6N r _ _ NZ ItyC ON PWC�ONFiI 1� 2 _ 'rBD - ?;•z'X�'-Ic" ��� tkN — G ��J7 .. % y `X o� Proposed Garage . Southeast Elev., construct. coc�ck.q� a Smh�cr� 11 y Haag/Bamber Residence g details, W/D schedule ate: 61 Prepared for: Prepared by: Drawn Polio # h�dNlni r(XGT T Z ?I-I-A +7+7 2b W5TrM "Ir"X'''11" i �im� JE� N�TE n Fv, ° 17:'- Cn 11 a ToddSambe ArtDiredions,Inc. b'/�/ A ---- —_--- - I Seale: Various Orchard St P.O.Box 310 2 ---- — - -- Approval: Orient N.Y. 11957 Orient N.Y. 11937