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HomeMy WebLinkAbout30276-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold., N.Y. CERTIFICATE OF OCCUPANCY No: Z-30190 Date: 05/12/04 THIS CERTIFIES that the building ACCESSORY Location of Property: 765 FAIRWAY DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 109 Block 5 Lot 14 .32 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 2004 pursuant to which Building Permit No_ 30276-Z dated MAY 3, 2004 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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to MATTHEW C & DENISE GILLIES (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2001204 05/11/04 PLUMBERS CERTIFICATION DATED N/A A / oriz "d Sig ature Rev. 1/81 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. 30276 Z Date MAY 3 , 2004 Permission is hereby granted to: MATTHEW C GILLIES PO BOX 1280 CUTCHOGUE,NY 11935 for CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#26161 . at premises located at 765 FAIRWAY DR CUTCHOGUE County Tax Map No. 473889 Section 109 Block 0005 Lot No. 014 . 032 pursuant to application dated MAY 3 , 2004 and approved by the Building Inspector to expire on NOVEMBER 3_,--2-0-Q5 Fee $ 150 . 00 7eq Si •nature ORIGINAL Rev. 5/8/02 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) Cl I PERMIT NO. 26161 Z Date NOVEMBER 17, 1999 Permission is hereby granted to: MATTHEW C & DENISE GILLIES PO BOX 1280 CUTCHOGUE,NY 11935 for m CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. at premises located at 765 FAIRWAY DR CUTCHOGUE County Tax Map No. 473889 Section 109 Block 0005 Lot No. 014 .032 pursuant to application dated OCTOBER 29 99 and approved by the Building Inspector. Fee $ 150. 00 Authorized ature COPY Rev. 2/19/96 Fom No.6 TOWN OF SOU OLD 3 BUILDING DEPARTMENT TOW'HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with tae following:, A. For new building or new use: � 1. Final survey of property with accurate location of all buildings,property lines, streets,and undsuail gat 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%Iead. 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 eases: 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. C. 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 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. (� �� New Construction: Old or Pre-existing Building: Fes)J(check one) Location of Property: 7& 5 5fElruja7cl Dv- House No. Street Hamlet Owner or Owners of Property: ( a 1 &It Suffolk County Tax Map No 1000, Section �� Block C Lot 032— Subdivision Filed Map. Lot: Permit No. Date of Permit. � bq Applicant: F,)Ck7 CSrt Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 1 4—� 1�� Applicant agnature e5/1212ee4 e9:26 2123853740 NY BOARD PAGE e2 13Y THiIS CERTIFICA rE OF COMPLIANCE THE UNDERWRITERSNEW YORK BOARD OF FIRE BUREAUL. CTRL 9 40 FUL,T®N STREET — NEW YORK, NY t®03 1 OERTI RES THAT Upon the application of upon premises owned by MATT&DENISE GILLIES MAlT& DENISE GILLIES 765 FAIRWAY DRIVE 765 FAIRWAY DRIVE CUTCHOGUE, NY 11935 CUTCHOGUE, NY 11935 Located at 755 FAIRWAY DRIVE CLITCHOGUE, NY 11935 Apipfleation Number. 2001204 Certificate Numben 2001204 Section, Slock: Lot: Building Permit. SDC: ns11 Described as a Residential 0-599 s oar's ft. occupancy,wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement;LDaatside,Pool/Spa, A visual inspection of the premises electrical system, limited t0 electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction,and found to be in compliance therewith on the 11th Day of May,2004 Name 07Y Rate Rabat's circuit Y�ie Appliances and Accessories Pool/Spa Bonding 1 0 Time Clock/Switch 1 Wiring and Devices Swatch 1 0 Greneral Purpose Faxtrare 1 0 pool Spa Receptacle 1 0 20 amp Rotel/Spa Receptacle 1 0 GaFC1 (Swimming Pool).This ceAificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have .frequent test and/or repairs made by:a qualified person. seal 1 of Y This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. O ---- THOLD -M- r`i is TOWN OF `I - ,=5 — // OWNER STREET > %�, VILLAGE DIST. SUB. LOT 5 N D v Chi"i ld U. ✓G2Cl_�c� .�. m_ FORMER OWNER N E A S W TYPE OF BUILDING RES. J f(� SEAS. VL. ( FARM COMM. CB. MICS. Mkt. Value LAND IMP, TOTAL DATE REMARKS 7727 1--747� v �� /�aoj fa eyie�e ✓ J li7 i S!Y. �JPcu �wW-/� i�. ✓OO� OP-p L''� Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD J"G;_ Meadowland DEPTH Al "j 9, House Plot BULKHEAD __........ .__..._ _, Total ., . - ^s v rzt,{rte, a'*,i mxj"r. aa .at ti!- .v,, .+�t?tr§* ..xi7•�` '},"3'�', } stir ° i, �'§ �s -� COLOR TRIM I- - - — _ — L2 4 x Z x r= - - - 1 _1qEia 5 — x ^x._.z r �ZY3'x' r� - M.-Bldg: z4x3 , tja� . � /Z Extension -- -- Extension Extension Foundation �, � Bath T Z Dinette Porch Basement - --- ----- Floors ��/��( K. Porch t A X �3 c 143 GNU / Ext. Walls � 'S '�< �'�' Interior Finish ?. LR. Breezeway Fire Place _. Heat DR. !I x } r_ Garage k / �� Type Roof �g jg� Rooms lst Floor BR. Patio K \q 2p . p Recreation Room Rooms 2nd floor FIN. B O. B. Dormer --- Driveway -- - - Total -- 7/® ? z f��, t �G o �c. s i y �I 765-1802 BUILDING DEPT. INSPECTION FOUNDATION I ST [ ] ROUGH PL [ yFOUNDATION 2ND ) N TN [ ' FRAMING [PI FINAL [ FIREPLACE CHIMNEY [ ] FIRE SAFETY S CTI REMARKS® - � _ a c s E I'i ATSINSPECTOR—=: �� 765-1802 BUILDING DEPT. INSPECTION [ l FOUNDAT30H IST [ JROUGH PLBQ. [ ] FOUNDATION 2hpD [ ] INSUtATIOK [ FRAMING FIS L [ FIREPLACE CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS- DATE a� m C INSPECTOR I 1 III it II I .. — fry — II I x J JI I y It � GS' rt' IR 3 TT®N ( IST) n u u it II �L11 TION (2NI4) If If ii II T---- I ii a FxArffK & ;} s PLUMBING a it ----- \ Ir— u n ----�' ------- — ----�i �'•` If If If It _ . ------------------ II If it TION PER H. Y. - vd ;N C+7 TE ENERGY II II u----i7 CODE I g un a u --------------------- 47 If / /ds'6✓ Vii..® w 9 I ;-71 II II INAL. if ADD NAL C0194ENTS- ------ ----------- 9 � O gsa b --------------------------------------- fl . 2 9 i g BOARD OF HEALTH . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . ctDG. DcFT. TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . 7`r - ^.+"-SOUS'F9Qtf3 - 1BUILDING DEPARTMENT CHECig TOWN HALL SEPTIC FORM . . . . . . . . . . . .. . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: Rxnm �a "ned.................. 19.... MAIL TO: . . . . . . . . . . . . . . . . . Approved (t'( .......... 19��. Permit No. �. Disapproveda/c .. ............................... ........................................ EN41 (Baalda Spector) APPLICATION FOR BUILDING PERMIT Date. .)/4Z. . . . . . . , B9'` `2. INSTRUCTIONS a. this application must be completely filled in by typewriter or in ink and si mnitted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee accordi .. Repair o.=pork (cheek which applicable) € Building Addition ,..... e Alteration ... Repair .........-— Removal ............. Dcoolition ........ .Zar ild a✓rati!e{v .'��'a✓.�........... (Description) 4. Estimated Cost f.. o vU _A!'o"e.s✓a (to he paN on riling this application) 5. . If dwelling, ncmfor of dwelling units ............ Hater of dwelling omits on each floor Ifgarage, nurber of cars ................ ......... ........... fn. If business, commercial or mixed occupancy, specify nature and extent of each type of ,se...... 7. Dimensions ns of existing structures, if any: Ftoant.:zv 10P Might ............... famdor of Stories -1.......... .< BDruensions of same structure with alterations or additions: Front ... Pear ... Depth —44 ............. Height lir of Stories .....—....... S. Dimensions of entire new constr-,xtica: Front ................ Pear .............®. Depth .....:..:..... Might Nugher of Stories ..................... 9. Size of lot, Fant ...Z-9...._.._.._. Pear ....No........... Depth .010! ....:..,,. ITlite of Moose ..................... Nae of Former owner ............................... t[_ two or use district in which premises are sanaated ���T �u7/��oae.. .................... L ➢K 5?aes proposed construction violate any acnaeg lam, orr2aemanxe or reganlation, ..�.................. .�. §3. Will lot be regraded ............. Vill excess fill be removed from premises: '1c 14. Meet of Owner of premises � `y�:7TrL�.�/GL/t5.... _gess ���.r'/aio2�ry �?0�v✓ i ate. tifil'&;il2 Name of A mnitect ................:................... stress ....... ... ............<..... Phone leo. a.;..,.;.:... Mace of Contractor ��JjTV�.;� Ls..t ��.......... Address ^��a.�. 1� "��� Flats V0500:1150t 1150t F5. Is this property vithim 3M feet of a tidal wetlanoA? * YES ........., NO ,.�..... QF HES, 901MIXID lKsK TKMEES M51T 290 HE - PLOT MAGRAK Locate clearly rico➢ distinctly all buildings, whether existing or proposaQ and indicate all set-back dimensions firm property lines. Give street and blood number or description according to dam, and show street names and indicate wnetler interior or corner lot. �NCWSZQ0CLT0 COOS i TPR @ L�E�woRSA °° �A�S: � d B.Rfid�6 IEEE: Vie; N s1Fv BU@LDINNF DEIFY :aAEKT � ae o-sgs F �f n 1 765-1802 P ANP76 4 r, FOR, I'elE s pr 415kp 4; Atrarl �'� � u�6.0 t�u6�T9��i a � a �M v�8 r i P'�' � o ���blri.�E'� . . i e @ *�` _ FOR. FOURED CONICS U Z' 3, MSULKFOX 'npl FPAKMPY fig. EBNIAt - COMS7RUC-MM MUST ID q4 v u 4 Z d�y Cx6 BE COMPLETE E '=oPi ALL CONSTRUCTMN SMALL KlEro 7HE REQUIREMENTS OF 7ME MX �ft�J�pdUni7ERS C GB�sp� S7,AEE oo15S,RUCTOS' & ENERGYSPh'E 'ug' WEi NJdC{, CODE& n�NC RESia�"�U'SME FOR S WW RED Q fl9&°4Y fE° ..................:.... . . ���.70 : OR COK,,S7S9j .oK ERRORS iUY71................. ..being duly swurn, deposes and says chat he is the ap licant (Mame of individual signing contract) above waned, /d �j to is Lina ....flex!0 0so0/C . (Contractor, agent, corporate officer, etc. of said owner or covers, and is duly authorized to perform or have performs; the said mark end to mace ani file this application; diet all statements contained in this application are true to the hest of his knowledge and be_fef; ant that the work will be performed in the mater set forth in the application filed therewith. Sworn to before ra this ........day of Mary F�u,aaI.ae�.�-`''� y7, l!`:v''Z':l.. . r"�-C( �/�?-.8✓.e . �!/ f <�!—�..:�...., (Signature of Applscast3' NOTARY PUBLIC.State ofNwVb .GIST SINSuffn urs T ExpussJu5�S, FAIRWAY DRIVE TIE= r6 .3o' N 01® 00' 40" E 150.00 s FD Rz 2.3, CM c� Lae 38.51 2 Ll cn ^ cn ASPH ..2 `o DRIVE BELGIUM � ZlE BLOCK CURBING 5.5 2 RAIL KLdCE 4' SLATE WALK 2x.2' 22.2' e.r' r1.T 6'6' 19' GARAGE 27.5° 6.4° . .7' 1 STORY WOOD 3os' r5.3 FRAME RES. J.7' LOT 31 12. 35.9' 6.r' 5'e ^� 24.3' SLATE PATIO FENCE ENCLOSED CR- LOT ,33 — SELF CLvSin� Z ? ` Tc gn , y/NE vJs 71-1 Sr=LF LhA)5"�L'7 Y`a�7L'S Guarantees indicated Iwe on shall yL. only to the person whom theyo s, as `YFt'1>YG.n- °` Ci d®5E17 title company, G ermantal AgeaecL7xyo ii49- 2Ltru :eW.':ng inslZrO;M, if °sted herew, an .�a97r-v-t�uy `dtLc; to tls assignees of the ending institut° C�aarcntees are not trans able to g add°u¢icncal institutions or sub cent ow I � A_tnauther+zed alteration ®r addition t9 t5i's survey o; a violation of Section 7409 *1 the Now York State 'Education Lama. � 70 ' ro TElqz a�E2TY Lb-�r FD FDCk C® coo m 39' 09' E ® r �e s 114,44 S 06 S 01 55 10 �5WOOD FENCE .36,0.3 NIF HICKS N F HORTON SURVEYED /0 SEPT. 1998 SURVEY OF SCALE TM 1000-109-0 -014.052 LOT 32 AREA= 42,112 SF IN 0.9667 ACRES MAP OF FAIRWAY FARMS FR®lly 6066 SITUATE SURVEYED RY FILED FEB. 15, 974 CUTCHOGUE, TOWN OF SOUTHOLD STANLEr �aKsEN.JR. SUFFOLK COUNTY, N. Y. P.O. R,`�\ � GUARANTEED TO NEW E�E�Ld� - y - 1/ 5MA 6 DENISE G1I IES SURVEYED FOR MATTHEW G/LLIES 596 _ =•� NORTH FORK s DENISE GILLIES _ FIDEL r FORK BANK ies Of this snap not taring - - TOWN Y NAT! NAL T/TLE INS. CO. the Land Svrveyors embossed seal shall LIGENS 4V TO bBIN OF SO THOLO =iii E not be considered to be a valid true NYS Ll O;..'492X3 9 8737 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30190 Date: 05/12/04 THIS CERTIFIES that the building ACCESSORY Location of Property: 765 FAIRWAY DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 109 Block 5 Lot 14.32 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 2004 pursuant to which Building Permit No. 30276-Z dated MAY 3, 2004 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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to MATTHEW C & DENISE GILLIES (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2001204 05/11/04 PLUMBERS CERTIFICATION DATED N/A Y/Oriz/d Sig ature Rev. 1/81 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. 30276 Z Date MAY 3 , 2004 Permission is hereby granted to: MATTHEW C GILLIES PO BOX 1280 CUTCHOGUE,NY 11935 for CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#26161 . at premises located at 765 FAIRWAY DR CUTCHOGUE County Tax Map No. 473889 Section 109 Block 0005 Lot No. 014 . 032 pursuant to application dated MAY 3 , 2004 and approved by the Building Inspector to expire on NOVEMBER 3,L_2Q05 . Fee $ 150 . 00 P'- ori e Si ature ORIGINAL Rev. 5/8/02 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 OFTHE WORK AUTHORIZED) 30�-.rl�0 Qc"'O' , r6� PERMIT NO. 26161 Z Date NOVEMBER 17 , 1999 Permission is hereby granted to: MATTHEW C & DENISE GILLIES PO BOX 1280 CUTCHOGUE,NY 11935 for CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. at premises located at 765 FAIRWAY DR CUTCHOGUE County Tax Map No. 473889 Section 109 Block 0005 Lot No. 014 .032 pursuant to application dated OCTOBER 29 99 and approved by the Building Inspector. Fee $ 150 .00 Authorized ature COPY Rev. 2/19/98 Form No.6 7�'�. TOWN OF SOUTHOLD /3 �- BUILDING DEPARTMENT TOWN HALL l 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY t1 J This application must be filled in by typewriter or ink and submitted to the Building Department With; le follwujng � A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual Zt 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. C. Fees 1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,;f 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 Date. (L� New Construction: Old or Pre-existing Building: POO( (check one) Location of Property: 76:P !5 fRi r Oaq 'D�- O V Tic pc House No. Street //�-- Hamlet � 6 Owner or Owners of Property: n-� °- T 1 1 ( e S Suffolk County Tax Map No 1000, Section Block Lot 0l Te ®3Z Subdivision // Filed Map. Lot: Permit No. © � l lc7 _K Date of Permit. JC (p d y Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ G�; 5- 9 o �-� Applicant ignature I j 5 BY THIS CERTIFICATE OF COMPLIANCE THE /I S NEW YORK BOARD OF FIRE UNDERWRITERS Is � S � II S BUREAU OF ELECTRICITY 5 40 FULTON STREET — NEW YORK, NY 10038 5 c 5 CERTIFIES THAT S ; li 5 Upon the application of upon premises owned by 5 5 5 . 5 MATT&DENISE GILLIES MATT& DENISE GILLIES 5 4 Sc 765 FAIRWAY DRIVE 765 FAIRWAY DRIVE cj j CUTCHOGUE, NY 11935 CUTCHOGUE, NY 11935 S ,I cS s II 5 Located at 765 FAIRWAY DRIVE CUTCHOGUE, NY 11935 ,-- s 5 , 2001204 2001204 I; Application Number: Certificate Number: 5 Section: Block: Lot: Building Permit: BDC: nsl1 , 5 Residential 0-599 square rj ft.Described as a occupancy, wherein the premises electrical!system consisting of li electrical devices and wiring, described below, located in/on the premises at: SBasement,Outside,Pool/Spa, 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed rj Sherein, was conducted in accordance with the requirements of the applicable code and/or standard 5 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the lld' Day of May,2004. Name QTY Rate R tin¢ Circuit Type Appliances and Accessories c� , Pool/Spa Bonding 1 0 5 5 Time Clock/Switch 1 0 ' 7 Wiring and Devices Switch 1 0 General Purpose j II � s Fixture 1 0 Pool/Spa i c S Receptacle 1 0 20 amp Pool/Spa 5 Receptacle 1 0 GFCI 5 i 5 (Swimming Pool):This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. I s 15 5 S X15 5 S CSJ. seal X55 S , s 1 of 1 5 This certificate may not be altered in anyway and is validated only by the presence of a raised seal at the location indicated. "I Y o i 3 a4,-7 f 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL G. [ ] FOUNDATION 2ND [ ] IN ATION [ ) FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION (v REM RKS: d2z ` c�Ei� � Z4S DATE fl INSPECTOR 7(2 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE INSPECTOR �"'� I I QN Kr,1-UK I ult i r, Ir J IAT ION ( IST) i< 11 t+7 )ATION OND) il u IT FRAME & n-------�i------ -------------- ------- -- — — U� PLUMBING u e — it CATION PER N. Y. u-- 1n TATE ENERGY u n CODE lil-- il II p II p (1 II j1 tl 11 � c ! - II II ` FINAL y - it �— ADD ONAL COMMENTS: r, iq H H b k nf i 2 91999 BOARD OF HEALTH . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS .. . . . . . . . . . . . . . BLDG.DEPT. TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . TOWN OF:SOUTHOLD BUILDING DEPARTMENT CHECK . .. . . . . . . . . . . . . . .. . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . .. . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: c/ Examined..... ........... 19. -�3o��� MAIL T0: Approved...1!'�.1..... 19 Q�. Permit No. . . . . . . . . . . . . . . . . . . .... .... . . . . ... ................................ Disapproved a/c .................................. ................................ ...................................A(Buildi .t.^.n.... n.g.. ...... . . ................ tor) APPLICATION FOR BUILDING PERMIT � Da t e. .��/��. .7. . . . . . . . 191c1. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part o this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector trill issue a Building Permit to the applicant. Sir Permit shall be.kept co the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occnpanxy shall have been granted by the Building Inspector. APPLICATION IS BMW MATE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ... ci....r...........-uK..fes..`...... (Signature of applicant, or name, if a corporation) . ....... ............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil_ ...................C�?:�-?���.yvZ................................................................................. Name of owner of premises .!:�!�T.rf:� ?..:�..�:-✓�.�.! ..Y�f,L1lS.................. ........ .......... .. (as on the tax roll or latest deed) ... If applicant is a corporation, signature of duly authorized officer. . ' _ _ ....`mss,.•��'............... (Name and title of corporate.officer) Builders License No. ,,(��/,1i.7.;/�.......... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Location of land on which proposed work will be done.................. ............................................ ......21#vt .'. ................... ���?.� y �� ........G.uT� �....... ................................ ..... House Number Street .......... LuHamlet County Tax Map No. 1000 Section ..l0........ Block ...Q ........ Lot ..fs.v - .. Subdivision /� +''r�;,, i !y�. ........ Filed Map No. .,1444 ..... Lot ..1.:1. ........ (Name) 2. State existing use and occupancy of premises and intended use and %W&T f.QST "' 1 1 ► ,2st ,lup�j�'on: a. Existing use and occupancy J. �... .............. b. Intended use and occmpaney .�. U•Zy.W� ... ' �,. /.� ...LJl Tfi�..' v/�;7./iUcc !:��/`-��� �roL 44in e a work (check udhidh applicable): New Building ........... Add .... Repair ............ Removal ...... Alteration .......... Demolition .... her Wo .�c'lIM.i':ll:V�.P4tl,4-........... (Description) 4. Estimated Cost .!::UU•v V............ fee .... . (to be paid on filing this application) 5. If (k elling, number of dwelling units ............ Naber of dwelling units on each floor ................ Ifgarage, nurber of cars ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front..Ad ......... Rear ..V......... Depth .,3.&............. Height ..J4.'***'*'*'*'*"'**. Number of Stories ....I................ , Dimensions of rssame structure with alterations or additions: Front ... ...... Rear ... ..... Depth ..44F ........... Height .................... Number of Stories ............... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth .............. Height ......................... Number of Stories ..................... 9. Size of lot: Front ...�.��..� .......... Rear .... Depth .. .>>�....:..... 10. Date of Purchase ..................... Name of Former Owner ........................................ 11. Zone or use district in which premises are situated .�Ci r/ -nn?f/ .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. v................ 13. Will lot be regraded .. �:�............ Will excess fill be removed from premises: --,M J!P 14. Names of Owner of premises �.... Address 7Gs.:�/�i.2G�Yf5' 'v............ Phone No. 7. Y.:d'; A Name of Architect .................................... Address .............................. Phone No. ............. Name of ContractorG.hNIIf�K..��.! -5..L .......... AddressOf.`..�..4�. '�?,,�;:<....Phone 15. is this property within 300 feet of a tidal wetland? * YES .......... ND .. ..... *rF YES, SO[TI M 10M MMME.S PM41T MAY BE RFi(XJIRED. PLOT DIAGRAM r locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and intricate whether interior or corner lot. MEDIATELY" ENCLOSE p001,TO CODE APPROVED AS NOTED UPON COMPLETION BEFORE"WATER" DATE:L t l? B.P.# tO` FEE:1 dZ BY (°{' @� (' NOTIFY BUILDING PA ENT AT ��°'°'UPAIV"Y OR FOLLOWING INSPECTIONS: 765-1802 9 AM TO 4 PM FOR THE S UNLAWFUL 1 FOUNDATION - TWO REQUIRED ED CONCRETE Al f ROUT CERTIFICATE 2. ROUFOR GH"- FRAMING & PLUMBING 3.OF OCCUPANCY 4. FINAL4TION- CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. sr/VIE Or Naa Yo w, UNDERWRITERS CERTIFICATE STATE CONSTRUCTION & ENERGY S,S REQUIRED CODES. NOT RESPONSIBLE FOR Q> ly or ....................... r DESIGN OR CONSTRUCTION ERRORS ..�44� '��=......e-1-1 U'�•....................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, lieis Lite .... ��Y ��.':...................................... ................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfonred in the manner set forth in the application filed therewith. Sworn to ore me this ....... ..........day of O.�TI.4 �..19 el Notary Publi len. . .� ....... ................ ... ...... NOTARY ELIZABETHASTATHI$ (Signature of Applicant) No.01 PUBLIC0007`3.SuffoStaw�tic Y Tenn Expires June 8, FAIRWAY DRIVE TIE= 160.30' N O 1' 00' 40" E 150.00' FD cm R= 23.74' Fo y L= 38.51 cM I 2 y ^ , 00 aD �V '►., Qo `< to ASPH 42 DRIVEWAY O � O BELGIUM nl BLOCK s s' CURBING 2 RAIL FENCE --K t' SLATE WALK 22.2' 2�.2' 8.1' 27.3' 11.7' 6.6 29. - GARAGE 6.4- .7' 30.5' 1 STORY WOOD 15.3' FRAME RES. 3.7' 1• LOT 31 12.j, 35.9 6.C 5.81 FENCE 24.3' SLATE PATIO ENCLOSEDJ LOT 33 IrIv — — _ .41/' 70 2t A2 eF 140LAe jFl-F Ct-05�� Cr.•t->G TC SIS` `'I 0eT7" WtTFI yrLF CL C'S1"�c� 447G'S Guarantees indicated he an shall only to the person whom the yo i ' title company, G ermental Agene .,2t1Xy0 /N la2cr%y en:';ng Inst' tion, if 'sled hereon, )11r1M Nt"j 'rwv to Wit cssignees of the ending instIM C varcntees are not trans able to pp additional institutions or sub cent ow A �o N Unauthorized alteration Ar addition 10 sunray i> a violation of Section 7209 of the New York State Education law. 70 ' To t �a'►�EkTy L/�:E I FO FD FD CM CAI , O» E S O 10 55' )O'EwooO FENCE 114.44' S 06' , 39 36.03 N/F HICKS N/F HORTON SURVEYED f0 SEPT. 1998 SURVEY OF SCALE 1"-30' TM 1000-109-05-014.032 LOT 32 AREA= 42,112 Sr OR IN 0.9667 ACRES MAP OF FAIRWAY FARMS FM 6066 SURVEYED BY �' slruaTE FILED FEB. 15, 1974 CUTCHOGUE, TOWN OF SOUTHOLD STANLEY'I A;AKSE1/,^JR. SUFFOLK COUNTY, N. Y. P.O. B �x= ,B4 _ GUARANTEED TO NEW fel K. . Y l 56 MATTHEW GILLIES SURVEYED FOR MATTHEW GILLIES 516 DENISE GILLIES DENISE G/LLIF NORTH FORK BANK f this ast'vey map not bS Copies oeartng FID£LTY NATIONAL TITLE INS. CO. the land Svrveyors embossed seal shall L/CENS = .QVE TOWN OF SOUTHOLD NYS Ll O:'.'�1- 2VR net be considered to be a valid true R737 `r A7-10 aFr ?FAQ C0A.S -ZtC7jq�> of S?�Z CJ/k4,-,5 e t ra2T-1A-o ► 1 14 UiA-YL tf ,r2 7W,047 4�yu .dcfLls ,CyC: �li c c!!L �t C ,lr liSTjY 'jet 4-7 _ tf 7 :76 '