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HomeMy WebLinkAbout28337-ZFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspectom Tow~ Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30036 Date: 02/20/04 TtlIS CF~ITIFIES that the building NEW DWELLING Location of Property: 710 OLD MENHADEN RD CUTCHOGUE PIOUSE NO.) (STREET) (t{AMLET) County Tax Map No. 473889 S~ction 111 Block 4 Lot 19 Subdivision Filed Map No. Lot No. __ conforms substantially so the Application for Building Permit heretofore filed in this office dated MARCH 25, 2002 pursuant to which Building permit No. 28337-Z dated APRIL 30, 2002 was issued, and conforms 5o all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FA~4ILY DWELLING WITH COVERED FRONT POHCt{, SIDE PORCH WITH DECK AHOVE AND ATTACHED ONE CAR G3LRAGE AS APPLIED FOR. The certificate is issued to ANTHONY F & SHEILA B SEVERINO (O~SR) of the aforesaid building. SUFFOLK COOAITY DEPARTMENT OF HEALTH APPROVAL R10-00-0082 ELECTRICAL CERTIFICATE NO. pLLlb~BERS CERTIFICATION DATED 02/10/04 1072357 12/13 / 02 12/20/02 PECONIC PLLT~BING & HEAT Rev. 1 81 POP~M NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) FULL PERI~IT NO. 28337 Z Date APRIL 30, 2002 Permisszon ms hereby granted mo: ANTHONY F SEVERINO 10 HEATH AVENUE H~NTINGTON,N1 11743 for : 20NSTRUCTION OF A SINGLE FAMILY APPLIED FOR DWELLING WITH ATTATCHED GARAGE AS I at premises located at 710 County Tax Map No. 473889 Section 111 pursuant to application dated MARCH Building Inspecnor. Fee $ 1,532.70 OLD MENHADEN RD CUTCHOGUE 0004 Lot No. 019 and approved by the Block 25, 2002 ~~~iture ORIGINAL Form No. 6 TOWIil OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or knk and submitted to the Building Department with the follo;wng: 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 se;verage-disposal (S-9 form). 3, Approval of electrical installafion from Board of Fire Underwriters. 4. Sw0m statement from plumber certifying that the solder usedin system conta/ns less than 2/10 of 1% lead. 5. Connnercial building, industriai building,, muitiple residences and similar buildings and installations, a cer6ficate of Code Compliance from architect Or engineer responsible for the building. 6. Submkt Planning Board Approval of completed site plan requ/rements. Bj For existing buildings (prior to April 9, 1957) non-conforminguses, or buildings and "pre-existing" land uses: 1. Accurate snrvey ofproperty showing all property lines, streets, building and unusual natural or topograptdc features. 2. A prop,erly completed application and consent to inspect signed by the applicara. If a Certificate of Occupancy is de~ied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Allerarions 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 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 Owner or Owners of Property: Suffolk Coumy Tax Map No 1000. Section Subdivision Permit No. ~L ~_q~ Date of Permit. Health Dept. Approval: I~ ~ Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Date. *t0gi~-. 2q; ~oo5 tcheck one) Hamlet 5"eq,,~ [ t~;o Block Oo, oq Lot 0lq. Filed Map. Lot: q[;olO~- Applicant: a.~h~ 5~:~Gd ~-a~ Underwriters Approval: q w ~ Final Certificate: check one) Apphc~nt S~n~l~tre Town HalL, 53095 Main Road P.O. Box 11.79 Southold, lxlew York 11971-0959 Fax (631) 765-9502 Tel?phone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTItOLD CERTIFICATION t ~fy that the solder used in the water supply system comains less than 2/10 of 1% lead. Sworn to before me this ~.~o F--rd day °f4~?~--, 200~ _ (Plumber's S~gnature) VICI(I L. LOPER Notary Public, State d New York No. 01L06070081 Oua~ed in Suffolk Count},~ j ,.. ,. Commission ~pires ~ ~ I 'cf/~(,.~ BY THIS C£RTIFICATE OF C0Mp[.IANC£ THE; NEW YORK BOARD 'OF FIRE UND£RWRITE. RS BUREAU OF ELECTRICITY 40 'FULTON 'STREIE'T - NEW, YORK, NY 1 0038 CERTIFIES THAT Upon the,application Df upon premises owned by ROSLAK ELECTRIC CUTCHoGuE; NY 11935-2453, Located at Application Number';' 107235~/ Section; Block: Described as a Resident/al ANTHONY SEVERINO 710 OED MENHADEN ROAD CUTCI-]OGUE;' N'~ ;l i935 710 OLD MENHADEN ROAD CUTCHOGUE. NY 11935 Certificate Numbec Lot: 1072357 Building Permit: BDC: N$1'1 occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Ba.~emcmr. First Floor. Seconal Floor, Attached Gara§e. Outside, Attic, was inspected in accordance with the National Electrical Cede and the cletaJ] of the installation, as set forth below, was found to be in compliance therewith on the Name Addltlou~l Charges rough by R.Richen Alarm and Emergency Equipment So.or Savor Appliances and Accessories F~a~ Rang~ D~h Wa~ W~n8 and D~s ~ecep~cle S~tch Fix~ Recep~cle D~era ~cEault C~it Int~pmr 13th Day of December, 2002. QTY' Rate Ratin~ Circuit Type 1 0 5 0 Carbon Monoxide Smoke 1 0 3 0 F,H.P. 1 0 11,6 KW i .0 1,2 KW 47 0 43 0 42 0 1 0 1 0 6 0 4 0 11 0 GFCI stml C o~,~nu~ o' nNal~tPls~aehdated.4 t~et3 .T~IJS cerJJflcate ma) nol; be altered i?~Jl~C*~y on ~by p~'esenca of a ra~$ad sea at th~ location indicated. $4.5C BY THIS ¢£RT~FICATE O~,COMPLIANC£ TH£ NEW YORK BOARD ,OF FIRE,UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON'$'rREET ~ N£1d~' YORK, NY 10038 CERTIFIES :THAT Upon the appiicaUon of upon premises owned by ROSLAK ELECTRIC P.O. BOX 164 CLITCHOGUE, NY 11935-2453. ANTHONY SEVERtNO 710 OLD MENHADEN ROAD CUTCHOGUE. NY 11935 Located at 710 OLD MENHADEN ROAD CUTCHOGUE. NY 11935 Application J~Juml~ ....... 10723-5-7 ............ ~eflificate Number: 1072357 Section: Block: Lot: Building Permit: BDC: N$11 Described as a ~.csideat~J. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Ba.~emcnt~ First Floor, Second l~loor, Attached Garage, Outside, Attic, was Inspected in accordance with the National Electr ca Code and the deta of the installation, as set [orth below, was found to be ln compliance tberewiLtt on ~e 13th Dayof December, 2002. Name Se~ice 1 Ph~e 3W Se~ice ~g 200 S~ce Disco~cct: 1 200 cb Invoice Total seal ~ 2 This certificate may n~t be altered in any wa~y and is validated onl~'by ~ presence of a raised seal at the location Indicated. -~TELEpHoNE j/~ ~ [~/ D. w. MCOAHAN RESIDENT AL DES GN CONSTRU~:TI~N AND ~USTOM RENOV^TIO]~ P.O; BOX 602 CUTCHOGUE, NY 11935 TOWN OF'SOUTHOLD PROPERTy RECORD CARD OWNER STREET '7//0 VILLAGE DIST, SUB. v LOT "~yg ~ ' ' ' TYPE OF BUILDING :'~" LAND IMP: TOTAL DATE REMARKS AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Voodland ;wampl,and FRONTAGE ON WATER ;rushlond FRONTAGE ON ROAD ~ouse Plot ' DEPTH ~ / 'oral DOCK I~NERGY CODE CALCULATIONS Design Crikeria 6,U00 Degree'.Days O.A. £O°F r.A. 7U~F DESIGN I THI:", [IMEL . SUBSYSTEM AREA. "U" ' RATING REMAIIKS .... 4.,., Skylights . % ~oundatim~ Walls Slab Insulation ~ l]uilding ~nvelQps Sy's~sms to meet require,nent~ Qf 7815.2 I1VAC Equipemen% %o l~lee~ r~quirements Of, 7~15.11 HVA£ Systems [o mee~ r~quirements of 7S15.1'2 Duck Systems t~ m~e[ requiremehts ef 7g15.13 Ventitakions Syskmms ko meek requirements of 7815.14 Insulatiml ~f Piping Systems to meet requirements Qf 7~15.15 Service Wa~er I[~a~ing Systems & Equipment to meet requirements of '1815.21 Electrical & Li~ll~ing Systems & Equipmenk %Q roes% requirements of 7815.31 To the besk belief, & professiqnal judgement, ~hese plans are compliance wfki~ the code. :' ?I# DISTRICT: 1,000, SECTION: /// , BLOCK: BUILDING'PE~IT EXAMINER~CHECK LiST DATE ISSUED: "~/02 DATE REVIEWED: 15AT,SUBMITTED: S~D~SIO~ FAST TRACK7 /~l~{} CEPARATE CERTTF1CATION-REQUIRED? NOTES: ~.~ff~,~ ,OTS4~)~00OSF-10O-24. Lotrecognltlon.(CtUgA~DbeforeJune3( 198-', UNDERSIZED LOTS FROM JAN.199710~-2~.Merger. kA nonconforming ac an fim~afrer7/1/83 ? f~VATER FRONT2 5ONING DISTRICT: CONFORMING? ~ ~Q~ LOT SIZE: ~.~ACT. LOT SIZE:~REQ. LOT COV. ~ ACT. LOT COV. ~Q~ FRONT ~:~ PROP. FRON~' ~Q SDE ~O/~ ~' ACT. Sm~'~/~/~ ~% ~ ~ PROP. ~ ~t ~ ' DESC~TION: FLOOD ZO~:~ APPROVES ~Q~D ~FOLKCO~TY~HDEPT: ~S orNO,(BED~): DTE: / /~/~ D~ SEPTIC ~CE~T~ ~ N - ~W YO~ STATE DEC~-~c ~n/,s ~S or~ O~OLD TO~ TRUST~ ~S or~ ~ - ~ ZO~G BO~ ~PROVAL: ~S o~ _ )~ PL~. BO~ ~PROV~: ~S o~ v ~ (SPLm): 2So~ =so o: 18 H ~n.? 4 sq total) ~ (SQ. FT. CO'S: Y OR N BP PERMIT #:R10-d;O- tOo~'~5~.. x 4%). LIGHT (SQ. FT. x 8%) -Z / C/O Z- -Z / C/0 Z- . STRUCTURE: FOUNDATION: /,,b 3 fi' SF FIRST,FLOOR: ,,~a;tO~t SF SECOND FLOOR: ! ~ ~ SF OTHER: t , SF TOTAL: ;]qS ~ SF SF)-(~f0 SF): q;0~ SFX*.i5* SE)- ( _SE)= SFX $ INIT OTHER TOTAL FEE FEE FEE 15'o =$ +$ +$ = $ TITLE NO: 25936 Town of Southold Southold, ~ sDistrict: ect ion: New York 1000 111.00 04.00 019.000 Gentlemen: FTDELITY NATIONAL TITLE INSUR3LNCE COMPANY hereby certifies that it has searcAed the records of the Suffolk County Clerk and/or the Suffolk County Registrar for deeds affecting the captioned proper~y and properties i~mediately adjoining and finds: SEE ATTACHED And the records of the Suffolk County Clerk and/or Suffolk County Registrar disclose no other further conveyance of any of the foregoing lots other than as set forth. FIDELITY NATIONAL TITLE INSURANCE COMPANY certifies that the above- captioned property has been in single and separate ownership Richard T. Stauffer, 25% interest & Doris Weston Stauffer, 75% interest and his/her predecessors in title since prior no 4/1/57 except as follows: (see annached chains of title). The liability of the Company is Dated: 3/22/00  ~_~__~LITY NATIONAL TITLE INSURANCE COMPANY MARIE PA~E Sworn to before me this 22th day of March, 2000 Notar~ Public TITLE NO. 25936 STATE OF NEW YORK) COUNTY OF SUFFOLK) MARGARET VOLLMOELLER Notary Public. State of New York No. 01VO5032469 Qualified i~n S uffoik Coun~; ~v~ Commission Exsir~s August 29.~-~ ~.x~, SS: MARIE PAGE, being duly sworn deposes and says: That he/she has had a search made of the records of the County Clerk of Suffolk County with reference to an application for a variance affecting the following premises: SCTM 1000-111.00-04.00-019.000 That the said re~ords indicate the following chains of title as to premises a~d adjoining lots since prior no 4/1./57. SUBJECT PREMISES: ~0-111.00-04.00-019.000 Nassau Point Club Dated: Properties, Inc. Rec'd: to / Liber L~don @. Tuthill and R~th C. Tuthill 9/14/36 10/5/36 1885 cp 437 *NOTE: Lyndon G. Tuthill died 3/13/37, #80 A 1937 leaving premises to Vera E. Tuthill, Howard ~, Tuthill and Jennie G. Tuthill. Vera E. Tuthill ¢/ Dated: 4/15/38 to / Rec'd: 4/19/38 Ruth C. Tuthill J Liber 1977 cp 270 Jennie Conktin Tuthill ~/ Dated: 3/16/59 tO / Rec'd: 4/20,/59 Ruth T. Houston f/k/a/ Liber 4614 cp 66 Ruth C. Tuthill / FIDELITY NATIONAL TITLE INSURANCE COMPANY B MARIE PAGE ~ Sworn to before me this 22th day of March, 2000 Notaryt Public MARGARET VOLLN'~OELLER Notary Public. State of New York No 0! VO5032469 Qualified in Suffoik Commission Expires August 29, ,-~ Ruth T. Houston a/k/a Ruth Tuthill Houston f/k/a Ruth C. Tuthill, individually and Ruth Tuthill Houston, as Executor under Last Will and Testament of Howard G. Tuthill, deceased 9/23/50, #574 P 950 ~uglas O.H. WesSon and Gertrude P. WesSon, his wife NoTE~: Douglas O.H. WesSon died 3/~7/88, to. Doris WesSon Stauffer. ! Doris Wes / to Stauffer > WestJ / Sheila B.~S wife Dated: 5/2/59 Rec'd: 5/7/59 Liber 4622 cp 31~6 $871 P 88, leaving premises Dated: 4/29/96 Rec~d: 5/2/96 Liber 11772 cp 318 Dated: 7/21/2000 Rec'd: 8/4/2000 Liber 12060 cp 855 PREMISES NORTH: 1000-111.00-04.00-~,~p00 Jennie C. Tuthill / Dated: 3/31/55 ~o / Rec'd: 4/4/55 George W. Matthews, Jr. and / Liber 3863 cp 337 Florence A. Matthews, his wife George W. Matthews, Jr. and Florence A. Matthews, his wife ~hn C. Scanlan and Carol A. Scanlan, his wife Dated: 4/10/69 Rec'd: 5/1/69 Liber 6543 cp 259 FIDELITY NATIONAL TITLE INSI/R3ANCE COMPANY MARIE PAG~ Sworn no before me this 22th day of March, 2000 Notary~ Public MARGARET VOLLMOELLER Notary ?ubtic, State of New York No 0~V05032469 Qualified in Suffolk Commissio~ Expires August 2~, John C. Scanlan and Carol A. Scanlan, his wi to Carol A.~ Carol A. Scanlan to Charles W. November and Ruth November, his wife Dated: 9/12/96 Rec'd: 11/19/96 Liber 11802 cp 360 Dated: 1/13/00 Rea'd: 2/10/00 Liber 12020 cp 199 Charles W. November and Ruth November ~ ~iber 12049 cp 733 9r~es W. November & Ruth November /L Mnxr~m~ees or their successors in i~est under the November Li~ing Trust dated 5/8/2000. / LAST DEED OF RECORD ~/ Dated: 5/8/2000 Rea'd: 6/19/2000 PREMISES SOUTH: Old Menhaden Road PREMISES EAST: 1000-111.00-04.00~000 Nassau Point Club Dated: 9/14/36 Properties, Inc. Rec'd: 10/5/36 to Liber 1885 cp 437 Lyi%~don G. Tuthill and Ruth C. Tuthill *NOTE: Lyndon G. Tuthill died 3/13/37, #80 A 1937 leaving premises to Vera E. Tuthill, Howard G. Tuthitl and Jennie G. Tuthill. Vera E. Tuthill to Ruth C. Tuthill Dated: 4/15/38 Rec'd: 4/19/38 Liber 1977 cp 270 Jennie Conklin Tuthill to Ruth T. Houston f/k/a Ruth C. Tuthil/ Dated: 3/16/59 Rec'd: 4/20/59 Liber 4614 cp 66 FIDELITY NATIONAL TITLE INSURANCE COMPANY Sworn to before me this 22th day of March, 2000 Notar~ublic ' MARIE PAGE ~%*,A R GAFf ET VOLLMOELLER Notary Public. State of New York No 01VO5032~¢69 Quaiified in,Suffolk ,~ountV Corn mission'Expires August 29, Ruth T. Houston a/k/a Ruth Tuthill Houston f/k/a Ruth C. Tuthill, individually and Ruth Tuthill Houston, as Executor under Last Will and Testament of Howard G. Tu~hill, deceased 9/23/50, #5~4 P 1950 to Douglas O.H. WesEon and Gertrude P. Weston, his wife Dated: 5/2/59 Rec'd: 5/7/59 Liber 4622 cp 316 ~871 P 88, leaving premises ~REMISES WEST: 1000-111.0,0-04.00q~0~0 Philip Huse~a Dated: to Rec'd: Grace L. Wilson Liber 12/7/39 4/5/4o 2093 cp 466 Grace L. Wilson Dated: to Rec'd: Fred Alander and Liber Frances Alander, his wife 10/30/62 1/7/63 5288 cp 337 Frances Alander, as surviving Dated: tenann by the entirety Rec'd: to Liber Walter W. Auer and Dorothy S. Auer, his wife 9/I9/85 10/11/8s 9892 cp 268 Walter W. Auer and DorOthy S~ Auer, his wife to DorOthy $'~:>~D LAST DEED Dated: 2/3/95 Rec'd: 3/13/95 Liber 11717 cp 990 FIDELITY NATIONAL TITLE INSIIR_A_NCE COMPANY Sworn no before me this 22th day of March, 2000 Notate'Public BY: .~_~__~ MARIE PAGE MARGARE¥ ¢OLLMOELLER Notary ~ubiic, State of New York No 01 VO5032489 Corem ss on E~i~es August 29, Town Of Southold P.O Box 1179 Southoid, NY 11971 * * * RECEIPT * * * Date: 03/21/02 Transaction(s): Septic Permit - Construct - Resid. Receipt~: 0 Subtotal $10.00 Total Paid: $10.00 Name: Clerk ID: Severino, Anthony F. 10 Meath Ave Huntington, NY 11743 LINDAC In[ernal ID: 51507 765-1802 BUILDING DEPT. NSPECTION [WI FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. ISPECTION [ ] F~.NDATION 1ST [ ] ROUGH PLBG. [~/FOUNDATION 2ND [ ] INSULATION [ ] [ ] [ ] IMNEY DATE 765J,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ -~ROUGH PLBG. [ ] FOUND/AT[ON 2ND [ ~ING [ ~/F~REPLACE & CHIMNEY REMARKS: ] INSULATION ] FINAL 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] FOUNDATION 2ND [/~NSULATION [ ] FRAMING [~ ] FINAL [ ] FIREPLACE & CHIMNEY DATE 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INS~ON FRAMING [ ~"~FINAL FIREp~I~E & CHIMNEY ROUGH INSIYLATION PER N, Y. STATE ENERGY CODE TOWN OF SOUTHOED BUILDING DEPARTS~E~r TOWN HALL SOUTHOLD, NY 11971: TEL: (631) 765-1802 FAX: (631) 765-9502 PEamT NO. BUtLDINGPERMIT APPEICATION ~HECKLIST Do 31on have or need ~e follow/ag, before applying? Board of l~eakh 3 sets o~Build~ng Plaus. Plann~ Board approval Survey Check Septic Form N.Y.S.D.E.C. Trastees Examiaed .-~ ~ 20 Contact: ' :.~,:?~ , ~. ,. ~ --. sets ofpi~s, acc~am plot pl~ to sc~e. Fee accor~g to s~e. b. Ptot pl~ shoWiag locgtion of lot ~d of bffil&ngs on pr~ses, relafiom~p to adjoining pre~ses or public struts or c. The work covered by tbs application ~y not be comenc~ before iss~ ofBMt&g Pe~t. d. Upon ap~oval offs applicafiom ~e Bu~ng ~pedor will issue a BMI~g P~t to ~e apphc~t. Such a p~t shall be ke~ on the pre~ses av~able for ~pemien t~on~out ~¢ work e. No bMl~g sba5 be occupied or used in whole or ~ p~ for ~y p~ose w~t so ever ~ffi ~e B~g h~spe~or issues a Ce~ificate of Occup~cy. f. Evew bMldmg pe~r shM1 e~ke if the work au~ofized h~ not comm~c~ wi~ 12 mon~ a~ ~e &re of cssu~ce or ~s not b~n comple,ed w~fl~ t 8 mon;~ ~om such ~te. ff no zomg men&~B or o~er relations affect~g the prope=y ~ve been enacted ~ ~e ~te~, &e BMI&g ~specmr my auto,e, ~ ~ ad&fion s~ mon~. ~ereaker, a new prat shM1 be req~d. ~PLICATtON IS ~Y ~E to ~e Buil&ng D~mem for ~e [ss~ce of a B~g Pe~t p~su~ ~o the BMi~g Zone Ordi~ce of the To~ of So,old, S~ok Co~, New York, ~d o~ app~mble Laws. ~ces or Re~atiom, for the com~cfion of b~gs, ad&tiom, or Mtmtiom or for r~ovM or d~ohtion ~ herein desc~bed. The applicam a~ees to comply with aH apphcable laws, offices, b~&g code, ho~ing code, ~e~om, ~d to a~t authored i~pecto~ on.pr~ses ~d ~ b~l~g for necess~ ~pectio~. (Si~e 6f app~cmt of ~, ff a co~orafion) (M&g a&ess of apphc~t) State wheth~ apphc~t is owns, lessee, agent, ~cMtect, ~e~, gen~M con~a~or, elec~ci~, plmb~ or b~lder t (As on the tax roll or latest deed) If applicant is. a corporation, signature of duly authorized officer YName and title of corporate'officer) Builders License No. Plumbers License No. Electricians License No. Other Tr. ade's License No. Location oflmad on which propose~d work will be done: -Fo~-,~, O~~-~ Hou~ ~umb~ - S~eet .... H~ ' Connty Tax Map No. 1000 Section } [l, ~0 Block ,0~. - (9~3 ' Lot O[q ,O~)O Subdivision Filed Map No. Lot (Name) ¢. State exlstzng ~.s,.e. and occupancy of premises and intended use and occupancy ofpropose~ co~stmdt'ion:. · a. Existingt/~e ~mSbcLqapancy ~ '~rv~4,y.3~' Lo'T- '~ -~ b. Intended use and occupancy ~') 120 o~_(_ 16d ~/ 3. Natureofwork(checkwhichapplicable):NewBuitding X., Addition Alteration Repmr Removal Demoliffon Other Work Estimated Cost ~ 079 ~ _t~OO ~ ox9 Fee 4 [f dwelling, number of dwelling un/ts If garage, number of cars If business, commercial or m/xed occupancy, specify nature and extent of each type of use. (Description) (To be paid on filing this application) Number of dwelling units on each floor D/raensions of exi~sting structures, if any: Front -- Height .... Number of Stories-..-..__ Rear Depth. 9. ~0. Date o£Purchase Dimensions of same structure with alterations or additions: Front Depth ~ Height - -~-- ...... Dimensions of entire new construction: Front ¢~O / Height Number of Stories Size oflot: Front //~ ,~-<~ ' Rear .~-~-*.15-' ...... Rear Number of Stories' ~: ' - Name of Former Owner Rear 36'"0 r Depth _.5'-0" 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoinng law, ordinance or regul¢on? YES NO ~ 13. Will lot be r~aded? YES NO __ Will excess fill be removed from premiseS? YES NO ~(~ 14. Names ofOwner ofprem/ses ~4./C2~,~1/xI~ Address [O IU~'H~t~}V5' ih[oAJi'~-- v~ t[9¢'3 Name of Architect Address Phone No Name of Conu:actor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ~ IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this properry within 300 feet ofa tidal wetland? ~ YES__ NO ~ ~ IF YES, D.E.C. PERMITS MAYBE P,_EQLSIRED. t 6. Provide smwey, to scale, with accurate foundation plan and distances to property lines. .17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 35rATE OF lxTEW YORK) SS: SOLLNTY OF ) < N~/~e~Jo f .~m~7~l /~ ' ' 3 ~F~n~,~[c/~ be/n g dulY sw°nT~'-dep°ses and saT~s.~dmt (s)he is the aPPlicant ' ' ' s'~gco a t) above named. S)He is the (Contractor, Agem, Corporate Officer. etc.) £ smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application: mt ail statements, conta/ned in this application are true to the best oflfis kaowledge and belief; and that the work will be erformed/n the manner set forth in the application filed therewith. , worn to before me this c~ [ day of_ %)0 ~.~ 20_O~.,~ ~m~'~bf~¢, Sram of N~ Yo~ , GUARANTYS INDICATED HERE ON SHALL RUN ONLY TO 1~1£ PERSON FOR ~101~ rile SURVEY (S PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNI~ENTAL AGENCY, LENDING INSTITUITON, IF LISTED HEREO~ AND TO THE ASSIGNEES OF THE LEND/ND INSTITHTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEDUENT O~VERS. UNAUTHORIZED ALTERATION OR ADDllTON TO THIS SURVEY IS ~ V~OLAT(ON OF SECllON 7209 OF THE NEW YORK STATE EDUCA770N LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EkIBOSSED SEAL SHALL NOT BE CONSIDERED TO BE / VAUD TRUE COP~< LOT 348 RESIDENCE LOT ,340 VACANT RESIDENCE CESSPOOL SEP~E J SEDRooM HO TE: TEST HOLE DA TA PERFORMED BY tvlcDONALD GEOSCIENCE f,.--__EXt..~TIN~ GR.4DE PALE WROI4C/~NETOMEDIU~ SAND SP 17' FOR S.C,D.H.S. USE ONLY SURVEY OF LOT MAP OF SECT/ON D NASSAU POINT CLUB °t?OPERT/ES, /NC. SI TUA TE NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: ANTHONY F. SEVER/NO SHELIA B. SEVER/NO TM 1000-Ili-04-19 FM # 806 FILED MARCH 24, 1926 SURVEYED 7 MARCH, 2000 SCALE 1~=40' AREA= 19.524.,~24 SF OR 0.444 ACRES OUARAI~ TEED TO ANTHONY F. SEVER/NO ' SHEL/A B~ SEVERINO F/OEUTY NATIONAL 17TLE /NS. CO. TOWN OF SOU~HOLD NOTE,' SURVEYED AS UONUMENTED ELEVATIONS TAKEN FROM EAST END TOPOGRAPHIC MAPS ON FILE W/7H THE SUFFOLK COUNTY DEPT, OF PUBLIC WORKS ZONED R-40 1. 5 UUL T 2000 CORRECT LOT AREA. 2, 12 utUL ~ 2000 ADD WM IN STREE- J. 18 OCTOBER, 2001 MOVE SANITARY SHOW WA TER SVC. PROP. SURVEYED BY STANLEY J, /SAKSEN, JR. P, O, .B,O,X 294 .,~ NEW,. SUFFOLt<, NY 11956/ WA TER SVC. ~ LOT 34-8 RESIDENCE LOT ,34-5 RESIDENCE ,v Ib NOTE: L< MAR OF SECTION D NASSAU POINT CL'US-PROPERTIES, INC SITdA TE NASSAU POINT TOWN' OF SOUTHOLD SUFFOLK COUNTY, N. SURVEYED FOR: ~NTHONY F. SEVERINO SHELIA B, SEVERtNO UNAUTH©RIZED ALTERATION OR ABDI770N TO THIS SURVEY $ A -IIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. \ / / 1. 5 JUL r. 2000 CORRECT LOT AREA. 2. 12 JULY, 2000 ADD WM IN STREET 18 OC'TOBEtE, 2001 MOVE SANITARY, SHOW WATER SVC. ~ PROP. 4. 18 MARC/% 2002 REVISE ~OP, STR. ~ LOCATION. O~ JUNE, 2002 LOCATE POURED CONCRETE FOUNDATtON WA TER SVC. ~UARANTEED TO ANTHONY F, SEVERINO SHELIA B. SEVER/NO FIDELITY NATIONAL TTTLE INS. CO. TOWN OF SOUTHOLD NOTE: SURVEYED AS MONUMENTES ELEVATIONS TAKEN FROM EAST END TOPOGRA. PHIC MAPS ON FILE W/TH THE SUFFOLK COUNTY OEPT. OF PUBUC WORKS ZONED R-40 SURVEYED BY STANLEY J. 'ISAKSEN, dR. P.O. BO~ 29~ ' NEW S~-FOLK. NY 11956 /7 00C88J OLD 5 FEB 04 CHANGE TIES AND LOCATION OF SEPtiC TANK. FINAL SURVEY-lC JUNE 200J ~926 UMENTED GUaraNTEED TO: ANTHONY ?. SEVERINO SHEL~ 8. SEVER/NC FIDELITY' NA~ONAL NTLE NS. SURVEYED: 7 ~ARON 2000 SCALE "- 40' ARE~,-= 1~ 324,924 S,F, 1444 ACRES 56 00C883 / / / / OLD SURV£ OF LOT 545 MAP OF SECTION D NASSAU POINT CLUB PROPERTIES, SITUATE CUTCHOGUE, TOWN' OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: ANTHONY F. SEVERINO SHELIA B. SEVERINO L:'M~ 806 DATE FILED ~A~CH 24, 1926 TMf 1000--~ ~ 1--0~---f9 NOTE: SURVEYED AS MON6 ~ENTED C~UARANTEED ]~0: ANTHONY F. SEVERINO SHELIA ~. S~/ERINO F(DEL/T~ NAT/O~,~ TILLS NS. CO. SURVEYE£ 7 MAR 3~- 2000 ~DAL E ?"~ 4-0 AREA = 19,J24.924 S.F OR 2.44~ ACRES FEB 04 CHAVOE TIES AND LOCATION OF SEPTIC TANK F/NAL SURVEY fO JUNE 2003 SURVEYED B~ STA,~,.EY d. /SAXSEN. JR. P.O, BOX 294 NEW ~FFOLK. N.Y. /.i4~56