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HomeMy WebLinkAbout26855-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28904 Date: 10/01/02 THIS c~u(TIFIES that the building ADDITION Location of Property: 1670 LEETON DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 58 Block 2 Lot 7 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 25, 2000 pursuant to which Building Permit No. 26855-Z dated OCTOBER 20, 2000 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 BEDROOM AND BATHROOM ADDITION TO AN EXISTING SEASONAL ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CHARLES A LUYSTER & ANO. AS TRUSTEES (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~RALTHAPPROVAL N/A ELECTRICAL CERTIFICATE NO. 2939 09/05/02 PLUMBERS CERTIFICATION DA'r~u Rev. 1/81  _URT' S RELIABLE ~' kuthorized Sig/ure 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. 26855 Z Date OCTOBER 20, 2000 Permission is hereby granted to: CHARLES A & ORS LUYSTER 11 AUSTIN LANE HUNTINGTON,NY 11743 for : NEW CONSTRUCTION OF BATHROOM AND BEDROOM ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR WITH TOWN TRUSTEES AND NYSDEC APPROVALS. at premises located at 1670 County Tax Map No. 473889 Section 058 pursuant to application dated AUGUST Building Inspector. LEETON DR SOUTHOLD Block 0002 Lot No. 007 25, 2000 and approved by the Fee $ 175.00 Authorized Signature Rev. 2/19/98 COPY TOWN OF SOUTHOLD . BUILDING DEPARTMENT3--~ . ' APPLICATION FOR CERTIFICATE 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 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. 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 New Construction: Location of Property: Old or Pre-existing Building: House No. Street Date. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Block Date of Permit. /0/~-~/o O Permit No. ~ (~ ~' ,5~g' Z Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ",et -oo 2. (check one) Hamlet Filed Map. Applicant: Underwriters Approval: Lot- ~ -- 7 Lot: Final Certificate: ~ (check one) Applicant Signature Town Hall,. 53095 Main Road P,O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-1823 Telephone (631) 765-1~ BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. _r~'.-~'~'~- Owner: (b~ease I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this dFf ~otaryeublic, &F~/~,~_ County ,'~'o , / L U T ~z O q z ~ Nassau Suffolk Electrical Inspections, Inc. 5A Canal Street * Center Moriches, New York 11934 * Tel: 631-878-3500 * Fax: 631-878-3764 Application No: 2939 Issued to: Luyster Address:. 1670 Leeton Dr Village: Southold Zip: 11971 Introduced By: Klein Electric Date:9/5/02 Township:Southold License#:4423-E was examined and found to be in compliance with the National Electrical Code ,~ic 1st RoorlT~'l Re~lendal I'ffi Pool Der. Gaaoe Switches Receptacles Fixtures G.F.I. Microwave Whirlpool 6 5 2 1 Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon Range/Amps Monoxide 1-Exhaust Bath Furn ace 0 il G as Circulators ,Sm oke Bell Detectors Transformers Other Equipment Meter Amps Phase Motors 1~Paddle fan I IOOAOH 1 Out,Res This certificate must not be altered in any manner JUDITH T. TEIC/~RY TOW~ CLERK I~J:~GI~ITL~R OF VTTA]. STAI~SqlCS MARRIAGE OFFICER ~CO~)S ~AGEME~ OFFICER FREE~M OF INFO~ON OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Hall, 530'o5 ~Xla,u P O Soulhold. New York I lqTI Tclcphonc THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 2q, 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)]. BL~,G. OEPT. ; Tow oF so.tm .o [ Southold Town Clerk August 25, 1993 APPLICATION PAGE I o[ 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start uno a permit is issued. 2. The permit may be revoked if any fal~e 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 ff no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Admlnktrator or his/her representative to make /easonable inspections required to verify compliance. S. I, THE APPLICANT, CERTIFY TI~IA, T ALL ST^TE~S HEREIN AND IN A'rTACHMEmS TO _ THIS APPLICATION ARE, TQ~'BEST OF MH[~OWLEDGE, TRUE AND AccuR4TE. {AP P LICANT'S S I GNATURI~//'~./-/./1~ [,~//,~---'-' DATE 1/2 / / SECTION 2: PROPOSED DEVELOPMENT {To be completed bv APPLICANT} APPLICA.NT NAN~E ADDRESS TELEPHONE ENGINEER 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 areas, the distance to the nearest intersecting road or weft-known landmark. A sketch attached to fhln application showing the project location would be helpful. FDP(93) APPLICATION PAGE 2 OF a DESCRIPTION OF WORK (Check all applicablc boxes): A. STRUCTUP,~d~ DEVELOPMENT ACTIVITY Aew Structm-e ddifion [] Alteration [] Relocation [] Demolition [] Replacement ~TRUCTURE TYPE [] Residential (1-4 F-mily) [] Residential (More than 4 Family) [] Non-residential (Floodprool-mg7 [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Paxk? [] Ye~) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACfiVITIES: [] Fill [] Mining [] Drilling El 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 Admlni~trator for review. SECTION 3: FLOODPLAIN DE-I/~RMINATION (To be completed bv LOCAL ADMINI~3~rRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] lm NOT located in a Spodal Flood H~Tard Area ('Nodfy the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT pERMrF IS REQUIRED). [] Is located in a Special Flood H.Tard Area. FIRM zone de.qignation is lO0-Year flood elevation at the site i~: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FBFM Pancl No. Dated FI See Section 4 for additional instructions. SIGNED DATE FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pa~les I - 7. O.MB. No. 3067-0077 Expires July 31, 2002 SECTION A - PROPERTY OWNER INFORMATION For Insurance C~npany Use: BUILDING OVVNER'S NAME Policy Number BOiLDIN-G S'I'REET ~,I~D-R~SS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number Leeton Drive CITY STATE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Des~=,;AJon, 1000-58-02-07 ZIP COOE 11971 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) ( ~ - f~ - f~.f#~' or HORIZONTAL DATUM: L_INAD1927 I INAD1983 SOURCE: I IGPS (Ty~e): I I USGS Quad Map I IOther: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION l B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER a2. COUNTY NAME B3. STATE Southold, Town of 360813 Suffolk NY B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REWSED DATE ZONE(S) (Zone AO, use depth of flooding) 36103C0154 G 05/04/98 AE El. 11 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I I FIS Profile IXI FIRM I I Community Determined I I Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: I ZI NGVD 1929 I I NAVD 1988 I I Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? [~ Yes I~ I No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. C2. C3. Building elevations are based on: LJConstruction Drawings* I__lBuildirxj Under Construction* ~2JFinished Construction *A new Elevation Cedificate will be required when construction of the building is complete. Building Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, APJA, APJAE, ARJA1-A30, AR/AH, APJAO Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? [~J Yes [X,I No ~ a) Top of bottom floor (including basement or enclosure)n~~)~ 118'60.~-2- fl.(m) ft.(m) ft.(m) ft'(m) ~ /~A~ ~m ~~"~E == ~ '~ ~ ~E' . · ff.(m) 7 '0 ft.(m) = sq. in. (sq. em) b) Top of next higher floor c) Bottom of lowest horizontal structural member (V zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery and/or equipment servicing the building f) Lowest adjacent grade (LAG) g) Highest adjacent grade (HAG) h) No. of permanent openings (flood vents) within I f. above adjacent grade i) Total area of all permanent openings (flood vents) in C3h SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represants my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imp6sonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER John T. Metzger. LS TITLE President ADDRESS P.O. Rc)w 909 FEMA Form 8~-~/1. AUG 99 ~ (.~ ,m 49filR COMPANY NAME (;IT?P~'r~' ..... ~ ~' -q~ve[~or~TAmp''~ E C ~o]3~-~o!~ ~ NY DATE TELEPHONE ZIP CODE 02 I1R./Dfl 11956 (62!) 765 5029 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITION,' Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ISSUED TO ................. ~.~.A~E~. L. UYS~ER ............................. Pursuant fo the provisions of Chapter 615 of the Laws of fha State .of New York, 1893= and Chapter 40~ of fha ,L~. ws of fha · State of New York 1952; and the Soufhold ToWn Ordmance en- titled · "i~EGULATINC= AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;~:. and in accordance with fha Resolution of The Board adopted afa meeting held on .....M_a.¥....2~ ..... :..Z0.0.q and Jn consideration of the sum of $ ........ !.5.0...00.... paid by ...... Ch.9.[]~S. Lu¥.s.~[ of ........ S.~u~hold., N.Y. and subiecf to the Terms and Conditions lisfed on fhe reverse side hereof, of Soufhold Town Trusfees aufhorizes and pern-dfs fhe.following: Wetland Permit to construct a 13'x13' addition to existing home, addition will be 1 bedroom and 1 bathroom. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees ~ere- by causes, ifs Corporate Seal fo be affixed, and these presents to be subscribed by a majority of the sa~d Board as of this date. - ' Trustees New York State Department of Environmental Conservation Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (516) 444-0365 Facsimile (516)444-0360 LETTER OF NON JURISDICTION -TIDAL WETLANDS John P. Cahill Commissioner Date: August 7, 2000 Mr. Charles Luyster 11 Austin Lane Huntington, New York 11743 1-4738-02645/00001 Luyster Property 1670 Leeton Drive, Southold Dear Mr. Luyster: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the property landward of the bulkhead in excess of 100 ft. in length and consla-ucted prior to 8/20/77, as shown on IR 714, is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required 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 jurisdictional boundary, as indicated above, withbut a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result t~om your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Permit Administrator cc: Bureau of Marine Habitat Protection, NYSDEC File DMG E. S. KALOGERAS,,. . CO ~.,-~ ~, fJ~/-}'Z~..~ Z~'Z,~ ~'~F__~ ~ ACEC Member Supporting Excellence In Engineering UNION SQUARE · 727 UNION AVENUE · RIVERHEAD, NY 11901 May 21, 2002 Town of Southold Building Department Main Road Southold, New York 11958 Re: Residence extension for Charles Luyster at 1670 Leeton Drive, Southold, N.Y., Residence I.D.#47388958-2-7 Gentlemen: This is to certify that we have monitored the construction at the above residence, for which Building Permit No. 26855Z was issued by your department, since inception of the project and that the construction is in conformance with the New York State Uniform Building Code. Our last recommendation regarding installation of metal clips to tie the roof rafters to each other, has been achieved by the homeowner and we find the building structurally sound and in compliance with codes and regulations. If you have any questions concerning this matter, feel free to call me at your convenience. Very truly yours, E.S. Kalogeras, P.E. Consulting Engineer Encl. ESK:wpwin 10.0 cc: Mr. Charles Luyster TEL: (631) 722-4040 · FAX: (631) 722-4004 · E-mail: Lkalogeras@msn.com JUL - 2 ~0!'2 11 Austin Lane Huntington, NY 11743 July 1, 2002 Southold Town Building Dept. Town Hall, 53095 Main Road Southold, NY 11971-0959 Southold Town Building Dept.: Please extend building permit #26855Z at 1670 Leeton Drive, Southold, NY for 6 months. Charles A. Luyster BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: DATE REVIEWED: /~/1.2_ DATE SUBMITTED: PROJECT LOCATION STREET: ARCHITECT / ENGINEER: SCTM#--- DISTRICT: 1,000 SECTION: CITY: BLOCK: ,9.-- LOT: ZONING: ZONING DISTRIcT:~ RS0, AC, WHERE ACTUAL LOT SIZE FROM? REQ. FRONT: ~ ' PROPOSED:~.~- ' SIDE YD: /O '/~ ' PROPOSED:~'/ LOT COVERAGE: ALLOWED: ;20 % EXISTING:/~',~' sf2 % SUBDIV. NAME: FAST TRACK:(Y~oR NO CONFORMING: YES OR NO REQUn~,~ED LOT SIZE: .'/~O~' SQFT. ACTUAL LOT SIZE: .2.252! SQFT. REQ. '/ 9 ! ' REAR:~ ' PROPOSED;~" -- N~-~: ?~4' sf,~; % TOTAL: ~2.t~' PROJECT DESCRIPTION A~,ALT, ACC OR N/D: AGENCY PERMITS REQUIRED FOR REVIEW NEEDED CORNER? YESoRG WATERFRONT?~oRNO. DESCRIPTION: SINGLE & SEP~TE CERT~ICATION-~QU~D: YES o~OTES: LOTS 40,000SF --100-24. Lot recognition. (C~ATED before J~e 30, 1983), ~ERS2ED LOTS FROM JAN. 1997 100-25. Merger. (A nonconfo~ing at any time after July 1, 1983.) TOWN SPETIC PERMIT: ,..y~ or N_O~_ C~-,/,3t"~ S~FOLK CO~TY HE~TH DEPT: ~r NO, (BED ~): DTE:' ' / ~/ PE~IT ~:R10- ~W YO~ STATE DEC: ~or NO SOUTHOLD TO~ TRUSTEES: ~r~ TO~ ZO~G BO~ ~PROVAL: ~S o~ TO~ PL~. B0~ ~PROVAL: YES o~) - FLOOD COMPL~NCE ZOO: PAN~ WNT:L, HT: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : ? ~; .2- SF SECOND FLR : TOTAL: SF INIT OTHER TOTAL SF FEE FEE FEE OT( SF)- ( SF)= SF X $ STATE OF NEW YORK ) COUNTY OF SUFFOLK ) ~~~~~t~, being duly sworn, deposes and says: TI;at deponent.is ovc, r the age~f.. ~,8/years and resides at ' That on the 2-~ay of ~ / , 2000 deponent architecVengineer, licensed by the State of New York, hereby states that s/he ac~pts 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- /~,.~? o ¢0~, 07, street address /~' Sworn to befo~'~~2000. cc: Applicant UNION SQUARE · 727 UNION AVENUE · RIVERHEAD, NY 11901 September 5, 2000 Town of Southold Building Department Town Hall Main Road Southold, New York 11971 Re: Building application submitted by Chuck Luyster on August 25, 2000 for property at 1670 Leeton Drive, Southold, N.Y., SCTM# 1000-058-02-07 Gentlemen: Please be advised that we have determined that the cesspool system at the above referenced property is sufficient to accommodate the small bedroom addition for the subject application. Thank you for your consideration in this matter. Very truly yours, E.S. Kalogeras, P.E. Consulting Engineer 'as S. Kalogeras, t~.E. ESK:wpwin90 ' TEL: (516) 722-4040 · FAX: (516) 722-4004 · E-mail: Lkalogeras@msn.com 765-1802 BUILDING DEPT. 'NS PECTIN [ ] FOUNDATION I ST [ UGH PLBG.~ ,/~? [ ]FO~DATION 2ND [ ] INSULATION / [/.,1/FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY _~~ REMARKS: DATE "~-~INSPECTOR~ 765-1802 BUILDING DEPT. [ ] FOUNDATION I ST [ ,~ROUGHPLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE~ CHIMNEY REMARKS: ~/// DATE 765-1802 ~ING DEPT. PECTION [ tUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ]FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: /~~//~,~ /~/~/ //~*~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ /]/~N~ULATION [ ] FRAMING [/-~ FINAL [ ] FIREPLA M Y R£MARKS:~ .FORI~ NO. I TOt4N OF SOUTHOLD BUILDING DEPARTldENT TOIv-N HALL SOUTItOLD, N.Y. 1197 I 'I'EI.: 165- 1§02 Disap~ oved a/c .................................. L'~ ~J? !. (Building Inspector) jfJ ~ ~] APPLICATION FOR BUILDrNG Pe~T [ T~+~7~ O~ ~O~';~O~D J INSTRUCTIONS BOARD OF nEALTt{ ............... s ss?s o~ B~NS . ,< ...... . ...... SURVEY .......... .~. ............ CHECK ......................... SEPTIC FORH ................... NOTIFY: a. This application m~st be ca~pletely filled in by type~iter or in ink and suhnitted to the I~filding Insr~ctor 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan dx~ring location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lwyc~Jt of property must be drmm on the diagrsm ~hich is Imrt of this application. c. The ~ork covered by Chis application v~y not be cmr~enced before issuance of Building Permit. d. ~ app~,~al of this a~lication, the Building Inspector will issue a Building Pemit to the applicant. Such permit shall be kept on the premises available for inspection throughout the ~rk. e. No building shall be occupied or used in ~4mle or in part for any purpose ~ahatever until a Certificate of Oc~ shall have been grsnted by the Building Inspector. APPLICATI~{ IS ~ ~ to the Building Depa~tn~nt for the issuance of a Building Pemit puran~t to the Buildlng Zone Ordinance of the To~n of Sonthold, Suffolk County, Ne~ York, and other applicable Lmvs, Ordlnances or Rc~,lsrion% Fro- ~t,~ cnn.~r,~-tio, ~ t,,ild4 .ng~, ,~{t_i~ or a]Cerution% or For remu,:al or d~!ition, ~a .hereLn described. The applic_~t agrees to o,,;,ly ~ith ~ ' 1 ~,O.h~ble.l.~.. o~.~, building ~. ~o~ing cod~, ~.Iations. ~d to ad~t antheri~d i~to~sp~.ses ~ ,. ..... Uu'/-/,u~ 7'o,u . AZ ---.--.- ........................ (I"h~.D. ng a~__ress of appli¢,mt) State ~hether applicant is c~mer, lessee, sgent, architect, englneer, generaJ contractor, electrician, pl~her or bul]der ..... ~.~. ~..~ ................................... ~ ................................................................. (as on the tax roll or latest deed) If applicant is a corporation, si~ature of duly anthorized officer. (N~ne and title of corporate officer) Phnbers License It).. ~.. ~-.. ~-.-.-.-.-.-.-.-.-.~/~g~//L//---D Zloctricians License No.~. ~.~-..~. ~--J~..~-9~..//~//I/t--D Other Tr~l~'s License No ...... ~ ...... - ...... I. Location of land c~ ~d~ich proposed ~ork ~ill be done ....... ltouse 1~ ~her Street H~let Subdivision ...................................... Filed l~p No ................ I~t ............... 2. State existing use and occup~cy of premises and intended use and occupancy of proposed construction: a. ~,cisting u~e and oca.x~ .. ~/y'. ~ I~..~..A4~' u, ~'../m:' ', "?,,~,-I '~ ............... ~t¢-~,' ~,t:' ~;' ..... ,' ? ','~' ':,'. ?,.:,~F~i ...... b. ~,,~,,~ ,,,,, ,,,.~ ,.',~,r,,,,~ ...~F---~.S~.:~./.~.4 .... ..~'.C~<./?....~:~...~.~....,'. ..... ~ ' "+' "~ of ~ork (d~'~ck ~dch applicable): ~ &dlding .......... /S~klition .......... Mteration .......... ~r Ren~val l)emol it ion ............ Other ~ ................................... ......................... (~ripti~) ~st i.mt~l C~st ~ ~ ~0 ~ ....... f~ .............................................. ................. ~to ~ ~id m filing this ~li~ti~) tf ~lli~. ~r of ~lli~ ~mits [ t~d~r of ~lltng traits ~ ead~ flmr ..... ~.'~. ..... If ~rage. i~t~r of cars .......... -~-'-~ ....................... ~ ~i~, ~,.,~i~ or ~ ~, ~i~ ~ ~ ~t~t o~ ~, ~ o~ ~.*. ........ i)i~nsi~s of ~isti~ statures, if ~: ~t .... ~.t ~ ~ f ~pth ..... ~,~.. ...... l.~' ~ o~ ~om~ .... z ............. ~, ~.~ ' I)i~l~ of ~m strt~t~re with alterati~s or ~lil:ions: ~t ...~t .......... ~ar ........... l)iuensi~m of entire t~ c~mt~ti~: l~t .... /.~ I ~r ~ .............. I ,~i~ ...... /~,~ ............ ~ o~o~i~ .................. /~ , ~i,~ o~ ~o~: ~,,,,~ ............ ~ ...... z ~..(... ~p~, ....... ' ..... ~9~. . ............... ~ ............. ~ or ~ district in ~id~ p~i~s a~ si~t~ ......................... ~.~.~ .......................... ~s pro~ ~t~:ti~s violate any zx~i~ 1~, ordlt~e or ~latt~: ........ ' ................ ~,~ ~~ ~ress tt~q~ ........... ~t ..... ~ ' ~,,~s of ~r o~ ~i~~--~-y~-~; ............... ~ress .............. , ................ ~ ~ .......... ~ of ~tr~tor ................................... ls Ods p~rty within ~ f~t of a till ~tla,~l? ~ YI~ ...~.-. ~ .......... ~ ~, ~ 3~ 'll~l~q t~Fr ~Y ~ IB~i~JI~. PI.OT DIAGRAH [~cate clearly and distinctly all Iraildings, ~l~tl~r existing or proposed, and indicate all set-back dimensions in-olmrty lines. Give street and block mtfl0er or description according to deed, and show street n~ms and indicate I~r interior or comer lot. /.-1~'-~I~AJZ) ;IE OF I',l~ Y(]~, SS INP/ OF ....................... ~ 3t, t -to euuc~q ~ (q~tm w,~r~e) 165o t V .Ix.i.l,, d. ly n~}rn, ckelx~va?n ~nd v,~yn that he is the sppl. icm}t · m of i,dividtu~l 8igni.g c(~t:ract) (C~tractor, agent, cor~rate officer, etc.) ' ~id ~mr or ~rs, a~ is &~ly ~thori~ to ~rfom or h~ ~rfora~ ~m ~id ~ m~ to m~ ~ file this ~)l. icat}~; flint all stat~mnts c~a~ta[m~ in this nl~*l icnthm are tm~ to ~e ~st of hi8 ~1~ ~ ~lief~ a~ mt ¢~e ~rk will I~ {mrfon~l in the ~mm~r ~t forth in ¢~e a~li~ti~ fil~ the~O~. ....... ~ ...... d~v o~~ ..... ~/---~-. ~ta~ ~1~~. ~.~~ NOTARY PUBLI~, smto o{ N~ Yo No 01ST6008173, S~olk ~un~ Te~ Expires June 8. ~ AREA = 22,871 sq. ft. to tie line COASTAL F'RO$10N HAZAtRC ..INE COASTAL EROSION HAZARD ARFA MAP PHOTO NC. FLOOD ZONE' AE' ,c. !I1 FROM FIRM 36103C0154 G SURVEY OF PROPERTY A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-.58-02-07 SC,~.~.: 1" =30' OCTOBER 22, 1998 FEB. 17, '2000 (ADDITIONS~ OF SE :. EXCE~ HEREct, SAiD M~ WHOSE F_*P ADD, T/OU TO THIS SIjRVE' S A OF THE NEF~ ~OPK STATE EDuC~T, ON LaW 5£CrlON 7209-SUBDIVISION 2 ALL ~E,eTIFIC~TiONS ~-OP THIS MAP AND COPIES THEPE©F ONL ~,'£S BEAP THE IMPRESSEP ~EAL OF THE APPEARS ~EREON P 0 80X ~ 1230 TRA VELE,R'"""~;q-REET $OuTHOLD, N Y, 11971 NO. 49618 98-31 %,/ AREA - 22,871 Iq. ft. to tie line COASTAL FRO,~ON HAZARD LINE: ffF~OM COASTA£ EROSION HAZARD A~tEA MAP P~TO NO. ~6-566-8~ FLO~ Z~ AE (el. tll FROM FIRM EX. PT ~S ~ '~CT~ ~0~~ 2. ALL CER~tCATI~S ~ ~ ~ ~ ~ ~ ~ES~D ~AL ~ THE SURVEY~