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HomeMy WebLinkAboutZ-44623 & 44624 'SUEFOIKcxr Town of Southold 10/2/2023 �ao� °yam 53095 Main Rd t�ia x Southold,New York 11971 ar PRE EXISTING CERTIFICATE OF OCCUPANCY No: 44623 Date: 9/30/2023 THIS CERTIFIES that the structure(s)located at: 12250 New Suffolk Ave SCTM#: 473889 Sec/Block/Lot: 116.-6-11 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 44623 dated 9/30/2023 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame with stucco single family dwelling, two enclosed porches and accessory wood frame and stucco shed.* The certificate is issued to Plimpton Family LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A thoriz Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 12250 New Suffolk Ave SUFF.CO.TAX MAP NO.: 116.-6-11 SUBDIVISION: NAME OF OWNER(S): Plimpton Family LLC OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Plimpton Family LLC DATE: 9/30/2023 DWELLING: #STORIES: 2 #EXITS: 4 FOUNDATION: brick CELLAR: partial CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM(S): 3 UTILITY ROOM(S): PORCH TYPE: 2 enclosed DECK TYPE: on grade PATIO TYPE: BREEZEWAY: FIREPLACE: 1 double side GARAGE: DOMESTIC HOTWATER: oil TYPE HEATER: AIR CONDITIONING: TYPE HEAT: floor grate WARM AIR: HOT WATER: #BEDROOMS: 5 #KITCHENS: 1 BASEMENT TYPE: OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood/stucco SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 7/10/2023 TIME START: 10:40am END: 11:20am 7"z%sem guFfOlK�a<r Town of Southold 9/30/2023 c°°y 53095 Main Rd C* a t Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 44624 Date: 9/30/2023 THIS CERTIFIES that the structure(s) located at: 12250 New Suffolk Ave SCTM#: 473889 Sec/Block/Lot: 116.-6-11 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 44624 dated 9/30/2023 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame with stucco accessory partment with second floor deck.* i The certificate is issued to Plimpton Family LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A tho ' d Signatubt BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 12250 New Suffolk Ave SUFF.CO.TAX MAP NO.: 116.-6-11 SUBDIVISION: NAME OF OWNER(S): Plimpton Family LLC OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Plimpton Family LLC DATE: 9/30/2023 DWELLING: #STORIES: 2 #EXITS: 2 FOUNDATION: stucco over brick CELLAR: none CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM(S): UTILITY ROOM(S): PORCH TYPE: DECK TYPE: wood PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: electric TYPE HEATER: AIR CONDITIONING: TYPE HEAT: electric WARM AIR: HOT WATER: #BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE: OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 7/10/2023 TIME START: 10:40am END: 11:20am �SufrniK�p TOWN OF SOUTHOLD—BUILDING DEPARTMENT �GQGyp ag Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny_gov APPLICATION FOR PRE-EXISTI1N.G'CE,RTIFICATEV17-OCCUPANCY OWNER(S)OF PROPERTY: Name: / h Date: Physical Address: r ,(Q SCTM#1000- V,9 pff1 116-6-fl Phone#: 02.0 S I- / Email: /?j t u(Gc_. ��.r� 77�� 1)\,jt(. c-0 7_ - Mailing n-- Address: � CONTACT PERSON: Name: KATE SAMUELS Mailing Address: 25235 MAIN ROAD, CUTCHOGUE Phone#: 631-734-6405 Email: KATE@SAMUELSANDSTEELMAN.COM To apply for a Pre C.O.for an existing building(prior to April 9, 1957) provide i fkF • Accurate Survey • Floor Plan JUN 2 7 203 • $100 Fee CONSENT TO INSPECTION LRI.)FIDL1,eG DEFT, That the undersigned does hereby give consent to the Building Inspector of the 1T50h of.SoutH61af et nter upon the above described property, including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws,ordinances, rules an egulations of the Town of Southold. rV l� 6, 2,0 23 Owner's Signature Date PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I,-Wit residing at the above address,do hereby authorize Sa A4 U v(S to apply on my behalf to the Town of Southold Building Department for approval as described herein. 1 2y 1 12-3 Owner's Signaure Date CU-63 14. THREATS TO BUILDING,: a.none known IN b.zoning❑ c. roads ❑ d. developers ❑ e. deterioration ❑ f. other: 15. RELATED OUTBUILDINGS AND PROPERTY: a. barn❑ b. carriage house ❑ c. garage ❑x (half-timber) d. privy ❑ c..shed ® f. greenhouse ❑ with simulated g. shop ❑ h. gardens ❑ thatched roof. i. landscape features: Gate posts of glacial stones j. other: 16. SURROUNDINGS OF THE BUILDING (check more than one if necessary): a.open land ❑ b. woodland.❑ c.scattered buildings d.densely built-up ❑ e. commercial ❑ f. industrial ❑ g. residential ❑ h.other: lawn, beachfront 17. INTERRELATIONSHIP OF BUILDING AND SURROUNDINGS: TIndicate if buildingor structure is in an historic district he house sands south of New Suffolk Ave. a sparsely tra- veled road that runs near the beachfront areas. The house itself dominates the beachfront and has an unobstructed view of Peconic Bay. IK. OTHER NOTABLE FEATURES OF BUILDING AND SITE (including intgrior features if known): 22-story,, irregular) jerkin-headed gable roof, English-style half-timber house. The garage is now the Plimpton winter residence. SIGNIFICANCE I,►. DATE OF INITIAL CONSTRUCTION: 1925* ARCHITECT; Beverly King BUILDER: ?Cl. HISTORICAL AND ARCHITECTURAL IMPORTANCE: * The house was built by Beverly King, the architect of Kimogenor Point. This is one of the fine summer homesthat were built on the shores of Peconic Bay in the early 20th century. 21. SOURCES:* Interview with J.Randolph Plimpton 2/22/86 Form prepared by Rosemary Skye Moritt, research assistant. (3 j FOR OFFICE USE ONLY BUILDING-STRUCTURE INVENTORY FORM CU-63 UNIQUE SITE NO. it-,3-ip- 0522K DIVISION FOR HISTORIC'PRESERVATION QUAD NEW YORK STATE PARKS AND RECREATION SERIES ALBANY,NEW YORK (5181474.0479 NEG. NO. YOUR NAML•: Tnwn of So»thnl d I/ SPT.TA DATE: Marrh 14.1- YOUR ADDRESS: Tnwn Hal l , Main Road_ TELEPHONE:K16Z765-1892 Southold L.I. , N.Y. 11971 ORGANIZATION (if any):Snuthol d Town Comm_uni tyDevelopment Office s • • • s • s • • • • s s s s • s • t • a s ♦ • s s s s • t s • s • • ♦ IDENTIFICATION I. BUILDING NAME(S): Hollenger 2. COUNTY: Suffolk TOWN/CITY _gQuthold VILLAGt . Cutcho�ue 3. STREET LOCATION New Suffolk Ave. : s side: of of Short Rd. 4. OWNERSHIP. a. public ❑ h ptivate 5 PRFSENT OWNER Plim tori____._ _ ADDRESS:New Suffolk Ave. f,. USE- original: Res].denee Present: Residence 7. ACCESSIBILITY TO PUBLIC Exterior visible from public road Yes T No ❑ Interior accessible: Explain DESCRIPTION K BUILDING a. clapboard ❑ b. stone ❑ c. brick ❑ d. board and batten ❑ MATERIAL e. cobblestone ❑ f. shingles ❑ g. stucco ® other. half-timber house 4). STRUCTURAL a. wood frame with interlocking joint% ❑ SYSTLNI h. wood frame with light member% !]d (if knovn) c. masonry load beating walls d. metal (explain) e. other lu CONINTION: a. excellent X h. good 1 c. fair ❑ d. deteriorated ❑ 1 1. IN"11 6RI'I Y a. original My X b. moved ❑ if so,when? c. list Major alterations and dates (if known): CU-rsm XI-8 1213110TO. West and north PlPvation 13 MAP, N.Y.S. DOT Southampton Quad From north west •i or or c Country Club m •• 1 �L r rth Fork `- ` t tit Club W f w � Z F OL - w 4 _ • imo@ener •�,. - 1� Pt ^� CU-63 la. THREATS TO [BUILDING: a.none known ® b.zoning❑ c. roads ❑ d. developers ❑ e. deterioration ❑ J. tither: IS. RELATED OUTBUILDINGS AND PROPERTY: a. barn❑ b. carriage house ❑ c. garage Ox (half—timber) d.privy ❑ e. shed ® f. greenhouse ❑ with simulated g. shop ❑ h. gardens ❑ thatched roof. i. landscape features: Gate posts of glacial stones j. other: IG. SURROUNDINGS OF THE BUILDING (check more than one if necessary): a.open land ❑ b. woodland.❑ c,scattered buildings Lel d.densely built-up ❑ e. commercial ❑ f. industrial ❑ g. residential ❑ it.other: lawn, beachfront 17. INTERRELATIONSHIP OF BUILDING AND SURROUNDINGS: �Indicate if buildin or structure is in an historic district) he house sands south of New Suffolk Ave. a sparsely tra- veled road that runs near the beachfront areas. The house itself dominates the beachfront and has an unobstructed view of Peconic Bay. 18. OTHER NOTABLE FEATURES OF BUILDING AND SITE (including interior features if known): 22-story,, irregular) jerkin-headed gable roof, English-style half-timber house. f The garage is now the 'Plimpton winter residence. SIGNIFICANCE lr). DATE OF INITIAL CONSTRUCTION: 192 5 � ARCHITECT: Beverly King BUILDER: 20. IIISTORIt'Al, AND ARCHITECTURAL IMPORTANCE: * The house was built by Beverly King, the architect of Kimogenor ,Point. This is one of the fine summer homes that were built on the shores of Peconic Bay in the early 20th century. 21. SOURCES:* Interview with J.Randolph Plimpton 2/22/86 Form prepared by 22. TI�LMF: Rosemary Skye Moritt, research assistant. 3s FOR OFFICE USE ONLY BUILDING-STRUCTURE INVENTORY FORM CU-63 UNIQUE SITE NO. ru05'45< DIVISION FOR HISTORIC PRESERVATION QUAD NLN' YORK S IA FE PARKS AND RE(REATION SERIES ALBANY,NEW YORK (518)474.0479 NEG. NO. YOUR NAME Tnwn nf_ Snuthnl d / SPT,TA DATE: Marnh 14, 1-986 YOUR ADDRESS Tnwn Hall , Main Road TELEPHONE:K16,L765-1892 Southold Z. I. , N.Y. 11971 ORGANIZATION (if any) Southold Town Community Development Off?ce • • t • • t t • • • • i • t t t • ► i t • t i t t t • • • t • t • i t i IDENTIFICATION 1. BUILDING NAME(S):_ ipilenger 2. COUNTY Suffolk TOWN/CITY--Sputhold VI1.LAGF _Cut chogue 3. S"IRI-.h:r LOCATION New Suffolk Ave, .' s side: of of Short Rd. 4. OWNERSHIP a. public Cl h private 23 S PRFSLNT OWNI•R Plimpton ____ _ ADDREss New Suffolk Ave. e USI- Original Rgsld.e.nc.e Present: Residence 7 ACCLSSIBI1.11Y lO PIIBI I(' Exterior visible from public road Yes Nu Interior accessible: Explain _ DESCRIPTION X 81111 DIN(. a. clapboard n b. stone ❑ c. brick ❑ d. hoard and batten ❑ MAII RIAI e. cobblestone ❑ f. shingles C_1 g. stucco 12 other. half—timber house 9 S'I RIJC1 URAI a. wood baric with interlocking points L 1 SYS'1'I•.%I h. wood frame with light members !X7 (t( kniwn) c. masonry, load hearing walls Cl d. metal (explain) C. other___----- I0, CONDH ION r excellent X h, good f_1 c. lair U d. deteriorated 1 I. IN1 I GRH Y a original site 31 h. moved ❑ if so,when? c, list major alterations and dates (if known): CU-rsm XI-8 I'. PH(rro. West and north elevation 13. MAP: N.Y.S. DOT Southampton Quad From north west Of or n Country Club P1 •• fn - Z ` A _ rth Fork nt Club - o W � s 2� a f A h � • F OL _ y • {r imogener ••�,. :: .33x4 `�" f i' ♦ ,J 1 4 2 ?0 36 w { – I r- 1� 1 7x = - - 17XI I I M. Bldg. I .1 7 x3 G � vv ' . �7i IY�'yQ � 'J-0 � Foundation — � r.l �/� Bath Z� u Extension // � 1x f Basement - f�!� i� Floors Extension v/ �,rPQsl X l y ? `� y at. Walls__ C 0'r, Interior Finish Extension b poS IY I-V rl„� Rire Place Heat S J, _ Porch f. Attic I Y I 1 rj r 4 („ / Porch Rooms 1st Floor Breezeway I)(% t�, y Patio Rooms 2nd Floor v F.., Gauge � 1 3 0 % .l �f v '� 3 �0 Driveway v g Q Jt !11 t2 i �K� i Of SOUIyo� f TOWN OF SOUTHOLD BUILDING DEPT. °ycou631-765-1802 116-6-11 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ PRE C/O [ ] RENTAL REMARKS: use - ire G& oG,e fi a rl on e t A ham[lZaevAt . 4w C22 hon do-4ee-barr vvaK- D u�s��. hid�ovw• �Ao,es. DATE 7'l�"a3 INSPECTOR ARCHITEC S: SAA MUELS+ STEELMAN CONSULT, VTS: •� W EX. CL EX. CL EX. CL EX. CL EX. CL EXIST. BATH EX. CL OWNER: EXIST. HALL NICOLA PL 11✓IPTON AND RUSSELL MCCALL 12250 NEV `>UFFOLKAVE EXISTING DN EXISTING NEW SUFE )LK, NY 11957 OF BEDROOM #2 EXIST. HALL BEDROOM #1 %i R/F REVISION: EXISTING EXISTING O O LIVING/DINING ` KITCHEN0 AREA EXIST. BATH DN EXISTING DECKIE . . c . � - EXISTING DECK ( 7 EXISTING DECK BELOW e � _ LJ . 7 -j19 UP L W o - �- _ U EXISTING CONDITIONS EXISTING CONDITIONS I R zg""iT IF L A uo" Ok"Ro"x"' mrLAlw'mm So" E C (o)" N ru'% F L u" A uo" wr"Z" m rm"k L 'Am I'm' SCALE: 1/4" = l' -O" SCALE: 1/4" = V -0" PROJECT ,')DRESS: 12250 NEV! SUFFOLK AVE NEW SUFf ?LK, NY 11957 GROSS AREA: 547 SF PER FLOOR TOTAL: 1094 SF DRAWN B' KS DATE: 5.30.23 SCALE. 1/4"= 1'-0" DRAWING -,HEET NAME: ACCESSORY APT. EXISTING DRAWING SHEET NO: SURVEY OF PROPERTY N SITUATE : CUTCMOGUE e s TOWN : SOUTNOLD w A Ilk, SUFFOLK COUNTY, NY SURVEYED 02-2G-2019 S SUFFOLK COUNTY TAX # 1000 - 116 - G - I I CERTIFIED T0: FIS / PLIMTON FAMILY LLC �` V V 3 ' S U 9 haulntc r� FOb� 0O" Poad VE'n-U _ ff PIL, R .: ` PPOLE PILLgR / 131 7,g, L / E oz 1 "q��Fs°RY ,3, eLl/LDING Y OALC01V 00 DECK (y) o IurlL �O V ., w l�PoLi cir O o" O Q / IY � _.._ — _ - _ - -•-_-5p l4.1' 19.1' _ w �(US) . 9' __- Uo m PSC NA C� (L LCLI U, 4.a- NlT P'YIME II(j SE N O O O� V m; 7, 3 NC R 7 O OAICR�E w 5 2�'3 011l tiGREAT � \ PECO /V/C BA Y� NOTES: .y*y. "Unauthorized alteration or addition to a survey map bearing a licensed land surveyors seal is a JOHN C. E h LE RS LAND SURVEYOR ,� vlolatian of section *York subte Edu6 2, a(the w." `r1- New'York State Education Law." "Only copies from the original n this survey —o—�— STOCKADE FENCE �lS���'O `�±r�•�1 4,j, marked with of original of the land surveyor's }� stamped seal shall be considered to be valid true —X—X—� WIRE FENCE ,{t coDles s °. a 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 .=;, "Certifications indicated hereon signify that this —o---o— SPLIT RAIL FENCE g y survey was prepared in accordance with the ex— Area = 47,938 S Ft. RIVERHEAD N.Y. 1 1 901 G3 I -3G9-8288 S F fisting Code a(Practice for Land Surveys adopted e �' c' by the New York Stale Associatlon of Professional t 1./ �c.— :-. VV Area = !.I Acres T S �_ �}�'; ' Land Surveyors. Said certifications curs shall run only jesurvey@optonllne.net +;a.•'^ �• I n the person rot whom me wavey Is prepared, �� ' and on his behalf to the title company, GRAPHIC SCALE 40 p y, governmen- - tcl agency and lending institution listed hereon, and '`• .�n`ry to the assignees of the lending institution. Certifico- 19-112 tions are not transferable to additional institutions February 20, 2020 To whom it may concern: I was able to go to the Plimpton's apartment over the garage from about 1964 or so. It was a wonderful place for all of us to be. It has sleeping spaces, a kitchen and bathroom. We went there to enjoy time together and have fun I I I I It was a living space for as long as I can remember. It held several bedrooms and lots of places to socialize. If you have any questions, please feel free to contact me at 720-987-1038. Cindy Harrison 729 Maple Street Edmonds WA 98020 February 21, 2020 To whom it may concern: I went to the Plimpton's apartment over the garage from about 1964 or so. It was a great gathering place with bedrooms,bathroom and a kitchen. It was a living space from the time I was about 10 thru my teens and to the present day. If you have any,questions,please feel free to contact me at 949-233-3352. Beverly Bigelow 63 Bennington Irvine, CA 92620 Dear Nicola, I have fond memories of your carriage house garage on New Suffolk Avenue. The upstairs was a great place to listen to records and dance. I know there was a small kitchen and two bedrooms and a bathroom as well as the living room at the far west end . .In 1965 1 turned 16 and we had a birthday party at the carriage house. It might have included Betsy Brautigam, who had the same July 16 birthday. Next summer I would like to visit and have a look at the property that we enjoyed so much as kids. Fred Endemann - Stuart FL— February 22, 2020 8/28/23 Town of Southold Building Depart. Town Hall Annex Building 54375 Route 25 PO Box 1179 Southold,NY 11971 Subject:Affidavit for 12250 New Suffolk Ave Dear Building department Official, Regarding the previous use of the"cottage" at 12250 New Suffolk Ave. I have personal knowledge of use going back to the early 1950's.As I have lived summers just west of the Stine/Plimpton property, my grandmother Helen Walker Munkenbeck was best friends with Tove Stine.At age 10(1953) 1 began cutting the lawn at Aunt Tove's house.This proceeded for a few years. I regularly witnessed family members living in the guest cottage.This was not unusual,and can be verified by Gilbert Plimpton,who is close to my age(79.).To verify the years of lawn cutting, I recall Lisa Plimpton (the child)watching carefully one day as I nearly cut my toe off in the blades of a lawnmower.She lives in Hull, MA and can verify this.The guest cottage was used for family and guests as,a residence. I am available anytime for further details. Rmccall@gfifoods.com 404-274-2809 Russ McCall PRE,.0 O INSPECTION`SU,RVEY" So e e5. LOCATION: as 5-&l AjtW �j o �„ �� SCTM#:1000- SUBDIVISION: MAP#: LOT(S): NAME OF OWNER(S): l/M OCCUPANCY TYPE: ADMITTED BY: v�•ls ACCOMPANIED BY: KEY AVAILABLE: SOURCE OF REQUEST:$w"4,r4 DATE: 7/,o--y- r UCTURE.. STR ... .. .. :. .. . .. . :.:. . : .wed .S�v . . .:.: ... .. . .. . .,. . . .. . . TYPE OF CONSTRUCTIOfiY: t� GG p #STORIES: a # EXITS: FOUNDATION`:v rj f,1Gl, ? s�UGG o BASEMENT: li en4L- CRAWL SPACE: i # OF BEDROOMS", ! 1ST FLOOR: 2ND FLOOR: 3RD FLOOR: BATHROOM(S): TOILET ROOM(S): UTILITY ROOM: PORCH, TYPE:' 1 AVL' ��G� DECK, TYPE?- m/0-07C PATIO, TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOT WATERTYPE TYPE HEATER: A/C: TYPE HEAi�.Nv CialC, WARM AIR: HOT WATER: #OF KITCHENS FINISHED BASEMENT: r OTHER: R t.: CES SO Y TU :ACR S RUCT GARAGE,TYPE OF CONST: STORAGE, TYPE OF CONST: SWIMMING POOL: GUEST, TYPE OF CONST: OTHER: VIOLATIONS: AAP.TER:144':&:N s;04!F.ORM CODE: ` ... ., . LOCATION: DESCRIPTION: ARTICLE/SECTION: oss h � o�G�•� �� �� ,L V- RWV! d-t vl�i 6" ©C- �u 2 v REMARKS: INSPECTORS: DATE: '.��• TIME START: TIME END: `�: 1' : - >PREsC`,0-1NSP:ECTION SURVEY'; , r : a s LOCATION: apsv n,(, u SaAlolk- 14ye, , CtI&Ao ve, SCTM#:1000- SUBDIVISION: MAP#: LOT(S): NAME OF OWNER(S): ' /,�v n OCCUPANCY TYPE: �• G ,�� � �wG�l, ADMITTED BY: LA'k �p,�5 ACC MPANIED BY: KEY AVAILABLE: SOURCE OF REQUEST: ojVjt,4ejt 4Rdt, DATE: 7,10• ,3 -STRUCTURE �'�' TYPE OF CONSTRUCTION:W �7r �TORI ESS-. # EXITSN/ f FOUNDATIONS BASEMEN CRAWL SPACE: #OF BEDROO11�fS� IST FLOOR: v f 2ND FLOOR: 3RD FLOOR: BATHROOM(5) I TOILET ROOM(S):d ' ( ( UTILITY ROOM: PORCH, TYP?:w/,p6 - DECK, TYPE: PATIO, TYPE: BREEZEWAY: FIREPLAC& ✓ al o✓`! G S% GARAGE-'5e 5 DOMESTIC HOT WATER,, D/ TYPE HEATER: A/C: TYPE HEA T�''�/OOX Qin-- S Alx onl WARM AIR: HOT WATER: # OF KITCHENS,, t FINISHED BASEMENT: OTHER: ACCESSORY::STRUCTURE'.,', '• GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:,SAA� w�a( ��vcc"D SWIMMING POOL: GUEST,TYPE OF CONST: SAe S /2 off OTHER: VIOLATIONS: CHAPTER;14'4&;NY5'UNIFO.RM?.CODE`:?,; V LOCATION: DESCRIPTION: ARTICLE/SECTION: �1ltiR �'h.,n o1e-I I �a �Snc v ,22_. ?i pig 60VA011 s &>O�CC Qiha�i /A 5,0XtaitY- A4 G At.% c? A-4d •R.CCCSSIs - oeoU ev Aa /nsa/ ion.. wo /n cy;& S owl, e�le'lukl . dtote cs on pvsA REMARKS: I / INSPECTORS: DATE: TIME START: �� TIME END: ��: -