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Home My WebLink About27224-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28870 Date: 09/13/02 '£~iS CERTIFIES that the building Location of Property: 245 PINE PL (HOUSE NO. ) County Tax Map No. 473889 Section 37 ALTERATION EAST MARION (STREET) (HAMLET) Block 4 Lot 13 Subdivision Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 28, 2001 pursu~nt to which Building Permit No. 27224-Z dated APRIL 11, 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 ALTERATION TO A/q EXISTING INGROUlqD SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to DAVID M WIRTZ of the aforesaid building. (OWNER) SI/FFOLK COUNTY DEPARTMENT OF ~RALTH APPRO~L~L N/A ELEt-£~ICAL CERTIFICA'r~ NO. 2089 os/o~/ol PLUMBERS cmRTIFICATION Rev. 1/81 N/A Authorized ~nature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIT~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27224 Z Date APRIL 11, 2001 Permission is hereby granted to: DAVID M WIRTZ 60 SUTTON PLACE SOUTH NEW YORK,NY 10022 for : ALTER3tTION TO EXISTING INGROUND SWIMMING POOL AS APPLIED FOR WITH TOWN TRUSTEES AND NY DEC APPROVALS WITH FLOOD PERMIT at premises located at 245 County Tax Map No. 473889 Section 037 pursuant to application dated MARCH Building Inspector. PINE PL EAST MARION Block 0004 Lot No. 013 28, 2001 and approved by the Fee $ 250.00 /~uth6~Signature Rev. 2/19/98 ORIGINAL Form No. 6 TOWN OF SOUTHOLD TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANFY This application must be filled in by typewriter or ink and submitted to the Building DelJam~,~;L~?rd~the fo,l!s~ 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. Bo 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. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Co Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy - $25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-e~ting Building: /X (check one) House No. . Street ~ Ha~et Owner or O~ers of Prope.y '~~~ ~ffo 1kC*ant y T~~~~-7 _-~~ B~ ~. Lot~~ Subdivision FiRed Map. Lot: Pe~it No. ~ Date of Permit. Applicant:~ Health Dept. Approval: Undemriters Approval: Planning Board Approval: Request fbr: Tmnporary Ceaificate Final Ceaificate: ~ (check one) FeeSub~tted:$~ D ~ ~~ ~ '~ ~ ~ ~ ~ ~ pplicant Si~at 8u~ O1 O1 01:52p p. 1 Nassau Surtblk Electrical hlspections, hlc. 5A Canal Stre*t * Center Moriches. New York 11931 * Tel: 631-878-3500 * Fax: 631.875-3764 Date:6/4/0l Application No: 2089 Issued to: Wirtz Address: Pine Place Village: E.Marion Zip: 11939 Introduced By: Bethel Electrical Cent Township: Southold Licenseg 2880-E was examined and found to be in compliance with the National Electrical Code ~ floor Comn'e~ H~ TuB NV Cefects ~ Il'5°°w"t' ' I Oven Fens Dishwasher W asheriAmCs On/er/Amps Range,'Amps Fumece Other IEqulpment Oil G as Meter C ffculatofs Amps Smoke Oe~octors Phase Inground Pool 1-20A Timeclock iO ut, R es Carbon Monoxide Bell Transform ers Motors 1-11/2 Hp This certificate must not be altered in any manner Section: 037 Block: 4 Lot:13.t 04/11/2001 08:51 FAX 5157426851 RAINS & POGREBIN New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building '40 - SUNY, Stony Brook. New York 11790-2-356 Phone: (631) '444-0365 FAX: t631 John P. CahilJ Commissioner LE'I-FER OF NO JURISDICTION David Wirtz PO Box 35 l East Marion. N'¥ 11939-0351 March [2, 2001 Re: [ -4738-i.)2S 19,01)0~i l ~4_ Pine Place. East Marion SCT.'~[ 1000-37-4o13 Dear Mr Wirtz. Based on the inlbrrnation you have submitted, the New York State Department of Environmental Conservamm has determined that: The portion of the parcel located land~vard of the bulkhead ( as shown on the survey by Roderick Van Tuyl. dated .March 2, 1992) is not within NYSDEC jurisdiction as shown of the NYSDEC Tidal ~..-5~4 and infra-red photographs, t Wetland Map # ""~' ' Tl~erefore. in accordance with. the current Tidal Wetlands Land Use Regulations (6N'YCILR. Part 661) no permit is requtred under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands junsdi~fional bounda~', as indicated above, without a permit. It is your responsibility to ensure that all necessary precauuons are taken to prevent any sedimentation or other alteration or disturbm~ce to the ~ound surface or vegetauon v~'ithm Tidal Wetlands ~ unsdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary, and your project (i.e. a ti' to 20' ~ttde constructt,m area) or crecung a temporary, tence, hamer, or t'tay bale berm. Please bc further advised that th~s letter does not relieve you or'the rcsponsibtliD' of obtaining any necessary penmts or approvals ~?om other agencies, cc: (ilo 5'~,',~' Wry trul~¥ours. Ro~er Evans De~u~' Reoional Permit Admimstrator 65128.54895 KP~DIN PO0~S & SPRS 458 PO1 ~PR 05 '01 i6:03 · la{~ HiRhwe/, ~' ~: :': RE: 'WZRT'Z': ~ AfaR.OVAL x~ x~o~xx0~ ~am!~o wm~z vox~ows. ams cov~ smmz ,,2, YACKS TRANS~.~..~ON IS NOT ~ PI,BA~ CALL "E~fabli~he~l '/972" 6312834893 KAZDIN POOLS & SPAS .: '= =New'York State. Department of Environmental ' :~ ":=.'= ': Division of Environmental.. Permits, Region One .,..~, Buiichng g0 - SUNV, S~,onv Sroov,. New Yor~ ' ~ 790-2355 LETTER OF NO J't'RISDICTION David Win:, PO Box 3.~ 1 Dear Mr Wu'tm. \[-',rch 12. 200t 'Based on the m. form. a:zon .you h~v¢ submm~g, :he New York '; 'i Consc,~'a~ion hc6 detem;med that: ! T.ha pt~iou of [he parcel located lam:lw'~rd of the bulkhead ( as sbo ' TuyL dared M~rch 2. 1992) is not within NYSDEC jur~dicdor · %'etland M~p ~ 722-554 and i~l'ra, reR pho~graph~. '... :: ~ Theretbr~. ia ac~or~c~ w!~h [k~ c~ent Ti~i Wetlands L~d Use pe~tt ts requ;re~ ~:Zer th~ Tt~l Wetlands Ac[ . P'.~ase be =dvi ,: sedtmentatmn, or disturbance ot any hnd ~)' t~e plac~ seaward .. precauuons arc taken to prevent ~), sedimen~uon or other alterattoB. or vegetanon w~flam Tidal Wetlands jurisdiction ~t'hich may result/rum include mammmmg a~cquate ~ ork area between :he tidal weQandj~ : (i.e. a 15' to 20' ~v~de co~tst~ctmn area~ or erect:nj a ~mporaw t~nce. '~ Please be fu~hcr a~vt~ed rhar tins le~r does no~ r~hex'e you of the rc~ pem~ts or appr,*x al~ I'rorv~ other agencies.. 45~ P02 APR 05 '01 16:03 Conservation Joht~ P. Canill :~ rte Department o£ En,,-tronrnenml · n on the survey by Roderick Van as shown of the NYSDEC Tidal :¢,..,ulanons (ONYCRR Part 66 i ) ao ed. however, that no construction. at the u~l wetl~d$ jUnsdi~ional ibihw to ensure that all neceasa~ }r d~smrbanc~ to the ~o~d $~Ihce your project. Such precautions may die:tonal ~unda~ and your project ba~icr, or hay bale bern. ~nstb:h~' ot'obmming any necessary ,\dmlnlSlralor APPLICATION # PAGE I o[ 4 -- TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and 1. No work may start until a permit ia issued. 2. Thc permit may be revoked if any fal~e statemen~ axe made hcrci~. 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 ia issued. 5. Thc permit will expire if no work is commenced within S~ months of issuance. 6. AppLicant is hereby informed that other permits may be required to fulFdd local, state and federal regulatory requirements. 7. Applicant hereby gives consent to thc Local Administrator or his[her representative to make reasonable inspections rcqulred to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN A'I~ACHMENTS TO _ THIS APPLICATION ARE., TO ~EST OF MY K_NOWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPOSED DEVELOPMENT ('Ti) bc comp~cd bv APPLICANT) ' NAME APPLICANT 0.a, r 'VZ' BUILDER E. NGINEER ADDRESS TELEPHONE piROSECT LOCATION: TO avoid delay in processing thc application, please provide enou~a information to ¢~s~ly identify the project location. Provide thc street ad&,'-ss, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known [alldma. t'k. A sketch attached to th;~ application showing the project location would be helpful. FDP(931 APPLICATION PAGE 2 OF a DESCRIPTION OF WORK (Check all applJcablc boxes): A. STRUCTURAL DEVELOPMENT A~TIVITY ~TRUCTURE [] New Structure [] Addition Fl Ahcration [] Relocation [] Demolition [] Replacement [] Residential (1~ Family) [] Residential (More than 4 Family) [] Non-residential (Floodproofmg7 [] Yes) [3 Combined Use (Residential & Commercial [] Manufactured (Mobile) Home (In Manu- factured Home Park? g] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACt'IVITIES: [] Fill [3 Mining F1 Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) - [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage lmpro~ve~.menta (Including Culvert Work) I~ Road, Street or Budge Comstrucaon [] Subdivision (New or F_.xpa~ion) Fl Individual Water or Se,~r System [] Other (Please Specify)~ After completing SECTION 2, APPLI~ should submit form to Loe. zd AdminEtrator for res4ew. ~ECTION 3: FLOODPLAIN DETERMINATION ('Fo be completed bv LOCAL ADMINI~iTRATOR) The proposed development is located ou FIRM Panel No. , Dated The Proposed Development: [] la NOT located in a Spexial Flood Hu~'urd Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVEI. X)PMENT pERMrr IS REQUIRED). [3 La located ia a Special Flood H~~'ard 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. FBF'M Panel No. Dated [] Sale S""~e tion 4 for additional instructions. APPLICATION # PAGE 3 OF 4 SECTION ,~: ADDITIONAL INFOF6MATION REOUIRED (To bc completed by LOCAL ADMINISTRATOR) Thc appticant must submit thc documents checked below before the application can be processed: [] A site plan showing thc location of ail cx~sting structm-cs, water bodies, adjacent roads, lot dLmensions and proposed development. [] Development plans, drawn to scale, a_nd specifications, including where appticablc: details for anchoring structures, proposed elevation of lowest floor (induding basement), types of water resistant materials used below thc f'trst floor, details of floodproo£mg of utilities located below thc first floor and details of cndnsures below thc 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 appLic~nf must provide tOO-year flood elevations if they are not otherwise available). Pla~s showing the extent of watercourse relocation and/or landform alterations. Top of new t-dl elevation Ft. NGVD (MSL). Floodproo£mg protection level (non-residential only) Ft.'NGVD (MSL). For fioodproofed 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 comoleted by LOCAL ADMINISTRATOR} I have determined that the proposed aclivity: A. 1-1 Is B. 0 Is not in conformance with provisions of Local Law $ , 19 attached to and made part of this permit. · The permit is issued subject to the conditions SIGNED , D~.TE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated If BOX B is checked, thc Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit ~n application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4 OF ~l APPEALS: Appealed to Board of Appeals? [] Yes [] No Hearing date: Appeals Board Decixiou --- Approved7 [] Yes Conditions [] No SECTION 6: A.5-BUILT ELEVATIONS ('To bc submitted bv APPLICANT before Certkqcatc 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 c~rtification to this application)_ Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hiu;h 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 floodproo£mg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. ~ECTION 7: COMPLIANCE ACTION {'To be completed Ipv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complet~'~ tkis section as apl~licable based on inspection of the project to ensure complian~ with the communitys local law for flood damage prevention. INS P]EC'FIO NS: DATE BY DEFICIENCIES7 [] TT.S V1 NO DATE BY DEFICIENCIES? 0 YF.S [] NO DA'I 1= BY DEFICIF_.NCIES? n ~rES [] NO SECTION 8: ~ERTIFICATE OF (~QMPLIAN(~E(T9 lpc completed ~¥ LO(~AL 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 ~ AREA (O~rNER MUST RET,kIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING' BUILDING [] VACA. N~r LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED VVITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: [~/'~ r~.z. ~ ~ z J SCTM#-- DISTRICT: 1,000 SECTION: 37 BLOCK: ~ LOT: DATE REVIEWED: 2 /~lal DATE SUBMITTED: /~-/ PROJECT LOCATION AND TYPE OF PROPOSED WORK: PROJECT DESCRIPTION: ADDER N/D: STREET: 2 /9/,,,., ARCHITECT / ENGINEER: '3/,4 CITY: ~r~54Jb/a~a SUBDIV. NAME: FAST TRACK: YES o~) SEPARATE CERTIFICATION-REQUIRED: YES o~"~'")NOTES: SINGLE & LOTS 40,000SF -100-24. Lot recognition.(CREATED before June 30, 1983), UNDERSIZED LDTS'-I~OM JAN.1997 100-25. Merger.(A nonconforming at any time after 7/1/83 ZONING: PERMIT ESTIMATE AMOUNT:_$ 3~),,~.00 PERMITUSE: EXISTING: /~.~ INTENDED: ,~(~-~_C ZONING DISTRICT~__.vx~80, AC, CONFORMING: YES OR ~ REQUIRED LOT SIZE: 4'or' SQFT. WHERE ACTUAL LOT SIZE FRO .TI~7~7~ REQUIRED -'--REQUIRED FRONT: ' PROPOSED: ' SIDE YD: '/ ' PROPOSED: LOT COVERAGE: ALLOWED: % EXISTING: sf CORNER? YES oR NO WAT ER FRONT? YES OR NO ACTUAL LOT SIZE',2//eOD SQFT. REQUIRED '/ ' REAR: ' PROPOSED: ' % NEW: sf % TOTAL: ~o~ sf/~ % DESCRIPTION: FLOOD COMPLIANCE ZONE: PRE-FIRM 3/18/80 PANEL #: /) 2 FLOOD ZONE: AGENCY PERMITS REQUI]LED FOR REVIEW I~CLUDED IN APPJ,.~ATION TOWN SPETIC PERMiT: YES or~' SUFFOLK COUNTY HEALTH DEPT: YES or ~QJ (BED #):__ NEW YORK STATE DEC: PRE-DEC 9/,/~0r NO SOUTHOLD TOWN TRUSTEES:~ orN,.~,O //,/2.,,/,~ - TOWN ZONING BOARD APPROVAL: YES o Nff..~[ TOWN PLAN. BOARD APPROVAL: YES DTE: / NYS ENERGY: YES OR NO: 4~ old, SS: ~V~NT: . LIGHT: / PERMIT #:R10- FEE STRUCTURE: FOUNDATION: FIRST FLOOR: SECOND FLR: TOTAL: T( /~'0 SF)- ( SF)= SF ~T OTHER TOT~ SF FEE FEE FEE SFX$ =$ +$ /~O +$ /oo =$ ~- ,,\pplicant/ Architect/ t-5~gineer: _ 5; ("I'M I1 c~ Single & scpanuc Required ccrfificmion (Yes / No) Rcq Rcq Rcq IFronl Y~d ~ Pro~sed ~1 [Side Yard Name Date Reviewed Dale ,qubnlillcd Rcq Actual ] [I.ot coverage Req Proposed I [Rear Yard Project Description: I'~oposcd --J AGENCS*~ERMITS REQUIRED FOR REVIEW 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: N.A. NO YES Permit Number Notes: Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda ~f Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 27, 2000 Kazdin Pools, Inc. 835 North Highway Southampton, NY 11968 RE: DAVID WIRTZ 245 PINE PLACE EAST MARION, NY SCTM#37-4-13 Dear Mr. Kazdin: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Tuesday, November 21, 2000 RESOLVED, that the Southold Town Board of Trustees grant the request for a Waiver to DAVID WIRTZ to renovate existing swimming pool and replace patio. New coping, new tile, new plumbing and add drywell also include pool discharge basin. This approval does not constitute approvals from any other agency. If you have any questions, please call our office at 765-1892. S~cerely, Albert J. k~upski, Jr. President, Board of Trustees AJK: cjc cc: ,DEC i/Building Department 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATIONlST [ ]ROUGHPLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ]FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY , DATE ~ i NSpE~-CT~)~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~, ]~JLATION [ ] FRAMING [~"~ FINAL [ ] FIREPLACE & CHIMNEY DATE FIELD INSPECTION REPORT ' DATE COMME~S FOUNDATION ( ! ST) II II II II I! II FOUNDATION (2ND) ' II II PLUMBING fi INSULATION PER N. Y. STAIR ENERGY CODE FINAL II II II II I! I| I! I! II II I! II "' II II II II I| II II II II # II II II II II II- II II If fl H FORM NO. I TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOI~I NALL SOUT~OLD, N.Y. 11971 TEL: 765- 1802 ~ Yl ..... Pemit ................. Aw, o,,ed ...... //. ........, .,.oo , ~o I)i~-,d a/c .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEAI.TU ............... 3 SETS OF PLANS ......... ...... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... DEC ........................... 'IqtUSTEES ...................... NOTIH: CALL .................. MAIL TO: .................... INSTRUCTIONS a. t_~his'applicatien n~tqt be cuepletely filled in by typ~iter or in ink and sui~itted to the l~dlding Inspector ~ 3 sets ol"l~T~, ac~_rrate plOt plan to scale. Fee according to schedule. b. Plot plan daowing location of lot and of buildings on premises, relationship to adjoining premises or public s~reets or areas, and giving a detailed description of layout of p~-operty mast be dra~n on the diagram ~hich is part of this application. c. The ~ covered by this applici~tion my not be ca~enced before issuance of Building Permit. d. Upon ~pp. oval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit stroll be.kept on tim p~,=~ises available for inspection thro~aont the ~ork. e. No building simll be occupied or used in ~hole or in part for any purpose daatever until a Certificate of Occupm~y slmll have been granted by tim Building Inspector. APPLICATI(It IS ~ ~ to the l~ilding Dep~_~,t for ~ issuance of a Building Pemit pursuant to the Boilding Zone OrOlnnr~e of the To~n of Southold, Suffolk Court,jr, l~a York, and other applicable l-~s, Ordinances'or Regulations, for the construction of buildings, additions or alterations, or for r~al or d~lition, as herein described. ~he ~pplicant ~e~s to o,?ly ~rith all applicable l~as, ordinances, building c~de, housing code, and regulations, ~a to afl. it auti~.~ized inspector~ ~. premises a in lmildiag for r. aae3sa.--y inspectic~.~Z, (Signature of at~licant, or na~, if a corporation) (Mailing address of am, licant) ~ o~ ~ o~ ~.~ ..~s.~..o...~..(.~..~. .................................................................... {~ on the t~x roll or latest deed) If ,~llcant i~ a eorpm'~tion, ~iglrmt-ure of duly anthorised offle~r. ................... .... (R:~e and titl~ of corporate officer) I ~ ~ Pl~r'~ L~o~.n-qo ~ .......................... Eleetri¢i~n~ Licen.~ No ...................... -~" Other 'l'ra~ License l~ ..................... ~. ~_~, o~ l~ o~,~ ~ ~o~ ~ll be ~,...Y..~c~..~..~c~ ..................................... .... ....................................................................................... ltmse l~,,her Street Rmmlet Coanty Tax l~p No. 1(~0 Section ................ Block ................ Lot ................ Subdivision ...................................... Filed ~ No ................ l~t ............... (I~',*) 2. State existing use and occupancy of ~.~a,,ises amd intended use and occupancy of proposed construction: a. ~,.ng ~ ~_ ~ ...... ~ \~~'~'~t"; '- ........................... , 3. F, atnre of york (check ~hidl applicable): Ne~ Building .......... /~ldition ....... ,i" Alt~rlltion .......... Repair ............ l~val ............. Demolition ............ Other ~ork .... [L_o .s~.Xl.C~ 4. Estimated Cost '~O erc~ ,(Description) (to be paid on filing this application) 5. If d~elling, number of ds~elling mits ............ timber off d~elling traits on each floor ................ If garage, r~t)er of cars 6. If business, cumereial or mi~=d occupant, specify nature and extent of ead~ type of use ...................... 7. Dimensions of existing structures, if any: Froot ................ Rear ............... Depth ................. lleight ......................... limber of Stories ...................... Dimensions of same structure sdth alterations or .-~laitions: Front ............... Rear ............... Depth .................... Delght .................... Nmber of Stories ............... 8. Dimensions of entire ne~ construction: Front ................ Rear ............... Depth .............. Deight ........................ < Numl~r of Stories ..................... 9. Size of lot: Fro~t .................... Rear .................... Depth .................... I0. rlate of Purdmse ..................... llane of Former O~mer I I. Zone or use district in ~t~ich premises are situated 12. noes proposed constrnetion violate any zoning la~, ordinance or regulation: ........................ 13. Nill lot be regraded .................... Nill excess fill be i~,sved fr~n m-cruises: of of .......... ~-~t ~.-4 l o~hXi ............ nx~ No..8~R_______~. ....... ~ of ArdHtact .................................... Address .............................. Phone NO. ~ of Contractor .-~.."~)3"~t.?~. ............... Address~.~.~'.~.~..~ ..... t'none No. 15. Is this property within 300 feet of ~ tidal ~etland? ~ YES ..~ ..... fl) .......... PLOT DIAGRAH ~cate clearly a~d distic,:tly all buildings, ~hether existing or proposed, and indicate all set-back d~sio~s f,'uu property lines. Gi~e street and block r~m~er or description according to d~d, and ~ street n~es and indicate ~taether interior or corner lot. 'IMMEDIATELY' ,~r^'iE O~ ta,.~ Yolk, ENCLOSE POOL TO CODE car~¥ ~ ....................... ss UPON COMPLETION ........................................... being duly sworn, deposes and .says that he is tl~ applicant (Name of individual signing contract) lie is tile ........ ~ ......................................................................... ( tractor, agent, corporate officer, etc.) of .maid ,~mer or c~v~rs, a~v.i is thdy autherizcfl to Ferfom or have per£orn~J tlm said ~eork and to make and file this appl. icati~; Lhat all statmnts contained in this application are true to the best of his knowledge and b~liefl and that tile ~rk s, ill be perfon~l in tl~ runner set forth in the application filed tberesrith. .9~m to ~[~ me this_ . .... ..... dny No, 'i ;i ............. HELENE O. HORNE Nota~ Public, State of ~ Yo~ No. 4951364 Qualified in Suffolk Couflt~ Commission Expires May 22. ~'/.~:~0/ ,.¥ (~) ' .%. 9171 UNDERWRITERS CERTIFICATE REQUIRED .IMMEDIATELY' ENCLOSE POOL TO CODE UPON COMPLETION BEFORE "WATER' APPROVED AS NOTED FEE: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMIt;G & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS