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Home My WebLink About27194-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29122 Date: 12/16/02 T~IS CERTIFIES that the building ALTERATION & ADDITIONS Location of Property: 19375 SOUNDVIEW AVE SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 1 Lot 20.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 6, 2000 pursuant to which Building Permit No. 27194-Z dated MARCH 29, 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 ADDITIONS, ALTERATIONS, SECOND FLOOR DECK, FRONT AND REAR COVERED PORCH ADDITIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. %~ne certificate is issued to GERALD E RUPP of the aforesaid building. ( OWNER ) SUFFOLK COUNTY DEPARTMENT OF MRALTH APPROVAL ELEC"I~RICAL CERTIFICATE NO. PLUMBERS ~TIFICATION DAT~3 Rev. 1/81 N/A 1072520 08/21/02 12/10/02 MATTITUCK PLUMBING & HEAT ~~re 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. 27194 Z Date MARCH 29, 2001 Permission is hereby granted to: GERALD E & ANO RUPP 10 EAST 40TH ST NEW YORK,NY 10016 for : ALTERATION AND ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR WITH TOWN TRUSTEES 5244 AND NYDEC 1-4738-02235/00003 APPROVALS. at premises located at 19375 County Tax Map No. 473889 Section 051 pursuant to application dated DECEMBER Building Inspector. SOUNDVIEW AVE SOUTHOLD Block 0001 Lot No. 020.001 6, 2000 and approved by the Fee $ 686.00 A~ature Rev. 2/19/98 COPY Form No. 6 TOWN OF S~UTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of.property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-existing" land uses: i. Accurate survey of property showing ali 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. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Sw~ming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existinK Buildinm - $100.00 3. Copy of Certificate of Occupancy - = .25~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date L@. 1.)2. I.P..~.,'. ..................... ;ew Construction ........... Old Or Pre-existing Building ............... ,o~tio~ of Pr°party...I.9..553. ............. 5~w~ w~ ¢~... b ~.e.: ........ .s.e.~.~ ~ .~. ....... ~ouse No. Street Hamlet ,n~er or O~ers of ~roperty..~..~'~a '%' ~O~ :ounty Tax Map No 1000, Section....~.~ ........ Block .... .~.~ ......... Lot .... ;ubdivision .................................... Filed Map ............ Lot ...................... 'ermit No. ~..~.[ .~.~ .~ .... Date Of Permit..~./.~.~ l~.~..~. [ .Applicant.~ .~-.~..~..~....g. -~-~- ......... [ealth Dept. Approval.~.!0.:.~..~.~..~.~.~ ....... Underwriters Approval ......................... 'lanning Board Approval ........................ [equest for: Temporary Certificate ........... Final Certicate..~ ....... ~c ~3~ / ..... ~~ "~ ......... BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: SCTM#--- DISTRICT: 1,000 SECTION: .5'/ BLOCK: PROJECT LOCATION AND TYPE OF PROPOSED WORK: PROJECT DESCRIPTION: ADD ,ALT, ACC OR N/D: STREET: ~ q.32.5 .q o,,,.,~fft~,,,..I /4v,,,,,, DATE REVIEWED: DATE SUBMITTED: /,~ / CITY: SUBDW. NAME: ARCHITECT / ENGINEER: .>a,,-,ea, t.4 FAST TRACK: YES o}~/NO ZONING: ZONING DISTRIC : RT~ R80, AC, WHERE ACTUAL LOT SIZE FR0~Aim~') REQUIRED "~ KE'~UIRED FRONT:.570 ' PROPOSED: ,/g,~ ' SIDE YD:/__~ '/ ~.~ ' PROPOSED:/t LOT COVERAGE: jSJ.~LOWED:. % EXIS.~T~G: sf % CORNER? YES og.._~J WAT ER FRONT.'? ~oR NO DESCRIPTION: FLOOD COMPLIANCE ZONE: pRe-S~m4 3ns/80 PANEL #: J~cc' PERMIT ESTIMATE AMOUNT: $ ,~0 K .00 PERMIT USE: EXISTING: -~f~) INTENDED: -~/~ ~/~ CONFORMIN .' Y~_~R NO REQU~*,ED LOT SIZE: SQFT. ACTUAL LOT SIZE:.~'/J=3~ SQFT. REQUIRED '/ 4 2 ' REAR:..~ ' PROPOSED:,b'~_/' NEW: sf % TOTAL:4£p?sf ~ % FLOOD ZONE: AGENCY PERMITS REQUIRED FOR REVIEW INCLUDF_,I~IN APPLICATION TOWN SPETIC PERMIT: ~or NO SUFFOLK COUNTY HEALTH DEPIC~_~ or NO, (BED #): ~ DTE: 2 /.~ /o! PERMIT#:R10-q?-/~.ff . NEW YORK STATE DEC: PRE-DECg/1/7~r NO 1-4'73,8-0.a.44'1/0000! ~-1-.2~) SOUTHOLD TOWN TRUSTEES: ~(...~,' r~ £24~ ///.277~0 TOWN ZONING BOARD APPROVAL: YES 'oQ..N~ _ TOWN PLAN. BOARD APPROVAL: 57.0 J NYS ENERG N0 : EGRESS: VENT: LIGHT: NOTES:· FEES~RUCTURE: F6UNDATION: /o,~--._~ SF FIRST FLOOR : /~o SF SECOND FLR : R'8'4/ SF INIT OTHER TOTAL TOTAL: .3 qO.~ SF FEE FEE FEE T(Sq0~ SF)-( ~0 SF)=?::,:,,r SFX$.2c =S.r//- +$ .)~'- +$ ~=$ G~-~.o~ Tr~wn H,~II, 5.'109~; Mai. rlogd P. O. P,~x 117g ~m,tl,uht. fJ~w Yol'k ! 1§71 I ny (~1~) r f,I. phone (51~) OFFICE OF 3'11E BUILDING INSPECTOR TOWN OF SOUI'I IOLD please ( ploAee print) I certify /hat the sol. der us,d in the wzxter ~u[.,p].y sy:;tem contains l'os~ than 2/10 of 1%, le~d. Sworn to befor~ me NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Upon the application of upon premises owned by JIM P.O. BOX 38 GREENPORT, NY 11944-0038, NEW YORK, NY 10016 Located at 19375 SOUNDViEW DRIVE SOUTHOLD, NY 11971 ~ I Application Number: 1072520 Certificate Number: 107250 2 Sect on: Block: Lot: Building Permit: BDC: NS1 electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Second Floor, Outside, Attic, Pool/Spa, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth b~16 found to be in compliance therewith on the 21st Day of August, 2002. i' i , Name QTY Rate Rating Circuit Type ~ Appliances and Accessories g_ Exhaust Fan 2 F.H.P. Furnace i F.H.P. A~r Condltaoner 1 3 , Air Conditioner 1 2.5 Air Cond~tioner I ~ , Tub, Residential 1 i Hydro Massage ~ Wiring and Devices Outlet 63 Fixture Receptacle 44 General Purpose ~- Switch 39 General Purpose i .~ Fixture 63 Incandescent . I ~ Receptacle 1 30 Special · ~Dimmers 18 600 ~ Receptacle 6 GFCI GFCI Circuit Breaker 1 50A seal ~ Continued on Next Page 1 of 2 ~ lh~s certificate may not be altered m any way anO ~s vahdated only by the presence of a rinsed seal at the location mchcated. NEW YORK BOARD OF FIRE UNDERWRITERS 40 FULTON STREET ~ NEW YORK~ NY 10038 I Upon the application of upon premises owned by , JIM SAGE ELEC. INC. GERALD RUPP P O BOX 38 10 E 40th STREET GREENPORT, NY 11944-0038, NEW YORK, NY 10016 ' Located at ! 9375 SOUNDVIEW DRIVE SOUTHOLD, NY 1 ! 971 i Application Number' 1072520 C~ificate Number: 1072520 i Described as a Residcmial occupancy, where,n the prem,ses electrical system con~,s: ng~ electrical devices and wiring, described below, located in/on the premises at: Basement First Flor Second ~loor Outside, Attic, P~Spa, was inspected in accordance with the National Electrical Code and the detail of the installation, as set fo~h below found to be in compliance therewith on the 2[st Dayof Ausust, 2~2. N~e OTY Rate Ratin~ Circuit ~ Phase 2W Service Ratin[ 300 Amperes ~ Se~ice DJsconn~t: 2 150 ~B Meters: 1 (Swiping Pool)' This ce~ificate covers compli~ce at ~e date of inspection on y Because of unusual environments it is adv sable to have ~equent test ~&Jr rep~rs made by a qualified person. ' 2 of 2 ~ lh~s ce~ff~cate may not be altemO m any way an~ ~s vahdated only by tho prosence o[ a ra~se~ seal at tho location indicated. New YoPk State Department of Environmental Conservation Division of Enviromnental Permits Building 40 - SUNY, Stony Beook, New Yoek :L~790-Z356 Telephone (6~1) ~.~.-0365 'Facsimile (65:~) 444-0360 Januaw 20,2000 LETTER OF NON JURISDICTION--TIDAL WETLANDS Mr. Gerald Rupp 10 East 40th St New York, NY 10016 Dear Mr. Rupp: RE: 1-4738-02541100001 Rupp Property Sound View Ave, Southold SCTM #1000-51-01-20 Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the property landward of the topographic crest of the bluff greater than 40 ft. elevation as shown on the survey prepared by Joseph A. Ingegno, LS dated December 28, 1999 is beyond the jurisdiction of Article 25 Tidal Wetlands. 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, without 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 from 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 MMR cc: Lan se Ecological Services New York State Department of Environmental Conservation Bui!dDg 40 - SUNY, Stony Brook, New York 11790-2356 Telephone 1516] ~.~.~, 0365 Facsimile (516l ~.~,~, 0360 LETTER OF NON JURISDICTION -TIDAL WETLANDS Commi~oner Date: January 27, 2000 Mr. Gerald Rupp 10 East 40 Street New York,. New York 10016 1-4738-02235/00003 Rupp Property Soundview Avenue, Southold SCTM No~ 1000-51-01-19 Dear Mr. Rupp: Based on the information you have submitted, the New York State Depm'tment of Environmental Conservation has determined that the property landward of the top of the bluff, as shown on the survey prepared by Joseph A. Ingegno dated 2/1/99 and last revised 12/28/99, 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, without 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 from 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: Tanya Lachenmeyer, Land Use Ecological Services, Inc. Bureau of Marine Habitat Protection, NYSDEC File DMG Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 Mr. Charles W. Bowman Land Use Ecological Services, Inc. 2576 Sound Ave. Baiting Hollow, NY 11933 Re: GERALD RUPP SCTM#51-1-19&20 Dear Mr. Bowman: The following action was taken by the Board of Town Trustees during its regular meeting held on November 21, 2000 regarding the above matter: WHEREAS, Land Use Ecological Services, Inc. on behalf of GERALD RUPP applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated September 27, 2000, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on November 21, 2000 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approvethe application of GERALD RUPP to construct an addition to the existing single-family dwelling, as per survey dated February 1, 1999 and last revised November 8, 2000. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees: None Very truly yours, 9. Albert J. Krupski, Jr. President, Board of Trustees AJK/lms cc: DEC Building Dept. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK DATE: .N. ?..yembc~.....Z.7' ISSUED TO GERALD RUPP Authorization Pursuant to fha provisions of Chapter 615 of the I-~ws of the State of New York, 1893; and Chapter 404 of the Laws .of fha State of New York 1952; and the Southold ToWn Ordlnance en- titled ."REGULATING 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;!f. end in accordance with the Resolution of The Board adopted efa meeting held on .~l..°...Y..:..2..~.:. ....... .Z0.0~...., and in ¢onslderation eT the sum of $..~:.~.0.~..0..? ....... paid by .. Land...~.~.e ~c?!~!~al S~vi~es .f?~ G?~!..d......R...u..p...p.....: ..................... of ........... ~..a.!~!..n..~...~}!?~ N.Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct an addition to the existing single-family dwelling, as per survey dated February 1, 1999 and last revised November 8, 2000. all in accordance with the detailed specifications as presented in ~the ot;g;nating apPlication. · IN WITNESS WHEREOF, The sald Board of Trudees ~ere- by cau~seJ¥|fs Cbrporate Seal to-be affixed, and these-j~,resenfs .to' be sUbS~'~.bed bY ~'majorlfy of the said Board as of ~bts daf~.. Trustees TERMS ,,nd CONDITIONS The Permlttee Gerald I~upp · residing at 10 East 40th St., New York, NY N. Y, as pan of the consideration for the iss~,nce of the Permit does tmdetstand and presctlbe to the fol- lowing: 1. That the said Board of Trustees and the Town of 5outhold are released from any and aH damages, or da;m, for d,m*ges, of mits arising directly or indirectly ss · result of any opec- at/on performed Fu~uant to this permit, and the said Permit~e will, at his ot her o,u expense, defend any and rtl such mits'inlthted by third pattie~ and the ~tid Perlzt[t'~ ~ full _lhlgllt. y with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That thi~t Permit is' valid for a period of 24 mos. which Is considers! to be the estimated dine required to complete the work involved, but should cito,n~ances wan. ant, i~luest for an extension may be made to the Board at a later da~. 3. That this Fermlt should be retained indef/ni~ely, or as long ss the said Permict~e wishes to maintain the stmaute or project involved, to provide evidence to anyone concerned that auth- orization waS originally obtained. 4. That the work involved will be subject to the .inspection and approval of the Bosid or its agents, and non-compliance with the provisions of the originating appHcation, may be _~,,~e for revocation of this Permit by resolution of the said Board. 5. That there will be no -nreasonable interference with navigation as · result of the work herein a~d~orized. 6. That there shall be no interference with the right of the public to psis and repass along the beach between high and low water marks. 7. That if future operations of the Town of 5outhold azcluire the removal and/or alterations In the location of the work herein authorized, or if, in the opinion of ~ Boani of Tnutees, the. work shall cause unreasonable obstruction to free navigation, the said p,.rmltIee will be tequit~ upon due notice, to remove or alter this work or project herein stated without expenses to the of Southold. 8. That the said Board will be notified by the Permittee ot the completion of the work anth- or/zed. 9. That the Permittee will obtain all other permits and consent~ ~at nay be required sup. plementai to this permit which may be subject to revoke upon falluze to obtain same. SOUTHOLD NO, USTEES Issued To~ Date~ Address q ~'~' ' , THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 · A]ber~ J. Krupski, President James King, Vice-President Henry Smith Artie Foster /~Ken Poliwoda 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 COASTAL EROSION MANAGEMENT PERMIT Date: April 26, 2000 SCTM#51-1-20 Name of Applicant/Agent: Tanya Lachenmeyer/Land Use Name of Permittee: GERALD RUPP Address of Permittee: 10 East 40th St., New York NY 10016 Property Located: 19375 Soundview Ave., Southold DESCRIPTION OF ACTIVITY: Construct a one-story addition to an existing single-family dwelling within an existing brick patio area with drywells. SPECIAL CONDITIONS: (apply if marked) Bluff restoration through a re-vegetation plan is a necessary special condition of this permit. A relocation agreement is attached hereto and is a necessary special condition of this permit. A maintenance agreement as attached with application and is a necessary special condition of this permit. Albert J. Krupski, Jr. President, Board of Trustees AJK/lms STATE OF NEW YORK ) SS.: COUNTY OF SUFFOLK ) That deponent is over the age of 18 years, and resides at That on the .~- day of ~N~ , ~9, deponent, being the architecdengineer, licensed by the State of New York, hereby states that s/he accepts full responsibilily for the accompanying plans compliance with the New York State Fire Prevention and Building Co~(9 NYCRR).~ Architec~Engineer S2.~y. prn to before me this day of PATRICIA RICHARDS Notary Public, State of New York No. 01RI6042467 Qualified in Suffolk County Commis~lon Explrea May $0, 2002 cc: applicant 83/22/208i 83:12 5167346487 SA~UELSSTEELHAN PAGE 01/0i S A M U E L S & S T E E L M A N March 22, 2001 Ed Forrester Building Department Southold Town $outhold, NY 11971 FAX 765 1823 Re: ADDITION & RENOVATION TO THE RUPP RESIDENCE SCTM #1000-51-1-19,20 Dear Ed, In response to your question to Mark Boeckman, the general contractor for the project, the existing brick terraces shown on the SITE PLAN are built on sand at grade, which allows them to be located in the setbacks and over the remaining property line. I hope this clears up the matter, but if you have further questions about the application, please let me know. If all is in order, please expedite the issuance of a building permit for this project. ARCHITECTS 25235 MAIN ROAD CUTCHC~UF, NEWYORK 11935 (6~J) 734-6405 FAX (631) 734-6407 7G5.'1802 DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REM~ARKS: /~//~c~~ ~/~ jDATE~ INSP I/NSPECTION [ ]//~UNDATIOH 1ST [ ] ROUGH PLBG. [~]' FOUNDATION 2ND [ ] INSULATION [ ] FRAMIN,~._.~ [ ] FINAL [ I FIREPCACE,~ CHIMNEY REMA~ 765-1802 BUILDING DEPT. INSPECTIO [ ] FOUNDATION 1ST [ ~OUGH PLBG. [ ] F/OUNDATION2ND [ ]INSULATION / [ /.,]/FRAMING [ ] FINAL []FIREPLACE&CHIMNEY DATE ~ I NSPECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ~ ] R~ PLBG. [ ] FOUNDATION 2ND [ '"] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY/~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ -~ FRAMING [ ] ROUGH PLBG. [ ~J~ INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECTOR [ ] FOUNDATION I ST [ ,~"OUG ~ [ ] F~TION 2ND [ ] INSULATION i i F/RAMIN~ [ ]FINAL /~..,,_..~ i i ~CE & CHIMNEY ~~~~ DATE ~INSPE~OR ~ 765-1802 BUILDING DEPT. [ ] F~I3NDATION 1ST [ ]ROUGH PLBG. [,]//FOUNDATION 2ND [ ]INSULATION [[~' i ~iRRAE~I;;cE & CHIMNEY[]FINAL REM~KS: ~*~ ~/~/,~- ~ INSPECTION 765-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO~IGflPLBG. [ ] FOUNDATION 2ND [//~] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS.,- ~ ~~'-~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ ] IN~TION [/~INAL [ ] FIREPLACE & CHIMNEY REMARKS: 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROU/~PLBG. [ ] FOUNDATION 2ND [ ],~LATION [ ] FRAMING /~ [ ~ FINAL [ ] FIREPLAC~'~IIMNE~'~ · \ /-..~:~. /~ ~ INSPE DATE ~OUNI)ATION ( IST)' FOUNI)ATION (2ND) ROUGH FP, AHE & PLUlqI~ING II~Sui. ATION PER N. Y o STA~I~ ENER6'~ CODE FII~L RgPORT - DAtrg : ............ :,- COI.~41~NT S q FORH NO. I TOWN O17 SOUTIIOI,I) IHJ I 1.I} [ HG I)EPhR'FHE~IT 'I'OI4N Ilhl.l. SOUTIIOLD, N.Y. 11971 TEl,.' 765-1802 ^PPl. ICA;J'iol~ FOR IIUII.I)ING PERNI'r l NSTRIIC'r 10NS 3 SETS OF PLANS · .............. SIlRVIr,¥ .......... ............. ; CIIECK ......................... SEPTIC FORH ................... a. 'Ibis application fa:st be cca~q~letely filled in by typcq~riter or in ink alii mdnitt~ to the Ikdlding lnsimctor 3 ~ts of plaas, no,rate plot plan to ~nle. F~ nccordi~ to I). Plot plan ~i~ I~nti~ of lot ~1 of Ixdidii~s ~ ~i~s, relationMdp to ~ljoini~ praises or struts or areas, taxi Rivi~ a ~bl:ail~! ~b~ription of layout of pro~rty ~mt I~ dr~ m the dla~ ~ich is l~art of this al~)l icati(~. ....... c. '11~ ~rk c~r~l b~ Ods al~)lication ~ r~)t I~ c~<~l I~fore is~a~e of ~fildi~ Pe~dt; d. -U[~ n~r~al of this a~lication, tim lk~ildit~ !ns~ctor will is~ a ~ilding Pemit to the applicant. ~<h ' e. K) I~ildi~ r~mll Im ~oq)i~l or u~l in M~le or in ~rt for a~ ~)~ Mmt~er ~tll a 6~rtiflcate of &~H.1cA'rl~ lS I~ ~ to tl~ i~dldi~ ~ar~nt for O~e is~a~e of a ~dlding Pe~it ~rmmnt to the I~dldln8 7x~ ~di~a~e of tt~ 1~ of ~tl~ld, ~ffolk Oxmty, ~ Yo~, a~ other a~licnble I~n, ~di~es or ~lati~s, for tl~ const~ti~ of bdldi~s, ~Miti~a or atterati~s, or for r~al or ~lition, ns herein ~bscril~. ~I~ a~licant a~a to c~ly ~ith all a~licable 1~, ordi~ea, I~ildi~ ~, l~sing c~le, a~i rei~dati~)s, a~l to ~tnit ~t.l~ri~ ins~tors on l~ims a~ in I~dlding for ~ces~r~ ins~ti~s. ....... ........... (Sigmture o[ a~llcant, or m~, ii a eo~ratim) ......... (~ailing ~lres~ o[ a~l Stal:e Mmttmr applicant is {~mer, lessee, agent, architect, engioeer, §eoeral contractor, electrician, plud~er or I~!{hler ................................... : ...........____ ................................ i ..................... (as on the tax roll or latest deed) If applicant is a corporatit~n, signature of duly rn~tl~rized officer. (l~ne as~l title of corporate officer) l'h~bers l.icen.qe blo .......................... Electricians l.icen.qe ~} ...................... ~l~livisil~ ....................................... Fil~ ~p ~ ................ l~t ............... (~) 2. SLate existis~ UR al~ <Ol~<y at ~Ii~S ar~llinte;~ use n~l F~Hme o1: ~k (Hmck ,~hich alff~licable): 1~ IkHhlin~ Nhlitim~ All:eration I~i~H r ............ l~a I ............. 1~1 i t i~x~ ............ Other I~nk .................................. Esl i,,~tol (~ml: .... f~ .............................................. (Io I~ fffid ~m fil i~l~ this alff)l Jcal;i~) I1' i~n~;~l~(% ~dmr of cn~ ...................................... I f I~,~i,m~s. c~,,,,~,'clnl or ,,iml t~t~lmtmy, SlmCi fy ~l~re m~l exlenl: t~f each lylm of ~se ...................... .~.~..~: ,~i~,,.. ..... ....... ~,,,~ o~ ~,~,,~ ...... ~ ........... I~q,lh .... ~ ......... l~ip~l; ...... ~ ...... ~,dm~ of Slories ...~.~ .... I)ili~,isi~m of"enti~o ~ ct~mi'~:l:J~: Fr~lt ' .. I~ar ............... I~l~lll .............. I~it~l ......................... ~imr of Slories ..................... h~ or ~rm dist:rlcL in ~[d~. p~*ni~8 are ~i~m~l ................. ~..J ....................... ~.. ............. I01: Im regr~ ..... ~ ........... gill e~:es9 fill Im ro~l Eton ~'oni~s: Y~q ~ill ~.,~ o~ ,~ o~ ,,~.___~ ~ __'~a~ ................. ~,~..~y~. ~.~.. ...... .~. ~ ............... ~_~ ~,,~ o~ ~,:1,,~ ~~.~.~~~ .... ~u,~,, .~~.~. ........... ,, ,:,. ................. , ........... "T~:ate dearly md distit~tly nil l~{ld}ngs. ~tl~r ~{sthsg or propel, m~{ ilxlicnte ~,, prolv~ly li~s. Oi~ st~t n,~! I)l~k emJ,l~r or i~script{~ ~ccotdinB t:o ,~l, 8~ ~l~ street iv~ms m~{ {~lic~te ~llr~r' {i~lerJor or co~r lot. ' 1'^'11~. (ir hq',M Yi]~K, ,,,,,~ ,,~ ...~ ~.~ ....... ........... .. ..... ~~ ~...~~ . ...... ,~., .... ,,,,,, ~,~,,. ,,,~,~,~ .,., ~,,,~ ,,,.~ ,,~ ~ ,,~ ~,,,,,~,:.,,~ ,, ,,~ ,,,~, ............................................. ~.C~<.~ ................................... h;~L Ihe ~.k ~ill 1~ I~rfor.~l J. Ihe .~..~r ~oL [orLh b~ the nl~licnl:io, fil~l I:lmr~Jth. ...... ~ ..... ,,~ ~,~.~.~..~ ~,.~ PATRICIA RICHARDS Notary Public, State of New York No. 01RI6042467 Qualified in Suffolk Count,