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HomeMy WebLinkAbout29051-Z FORM NO_ 4 _ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30269 Date: 06/38/04 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 755 ANCHOR LA SOUTHOLD (HOUSE NO_) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 3 Lot 6 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 2002 pursuant to which Building Permit No. 29051-Z dated DECEMBER 31, 2002 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 SECOND STORY DECK ADDITION ANTiJ AL`PERATION TO ACS EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN P & BARBARA C EBELING (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3582 06/23/03 PLUMBERS CERTIFICATION DATED N/A i o zec ignature Rev_ 1/el FORM NO. 3 TOWN OF SOUTHOLD BJJILDING DEPARTMENT Town. Hall Southold, N.Y. RUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29051 Z Date DECEMBER 31, 2002 Permission is hereby granted to : JOHN P EBELING 145 SCHOONER DRIVE SOUTHOLD,NY 11971 for : ALTERATION & ADDITION TO P24 EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 755 ANCHOR LA SOUTIOLD County Tax Map No. 473889 Section 079 Block 0003 ]Lot No. 005 pursuant to application dated NOVEMBER 1, 2002 and approved by the Building Inspector to expire on JUNE 31, 2004 . Fee $ 150 . 00 , G Authcrized Signature ORIGINAL Rev. 5/8/02 i I ` L �c � l Form No.6 TOWN OF SOUTHOLD BUILDING 1)EPARTNIENT TOWN 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 the following: A. For new building or new use-- L se_1_ Final survey of property H ith accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerdge-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 10,o lead. 5. Coumrercial building, industrial building,multiple residences and sitrular 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. R. For existing buildings(prior to April 9, 1957) non-conforming uses, or buildings and"pre-existing' laud 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, 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$15 00 Date. 612-2-110V I New Construction: // Old or Pre-existing Building: (check one) Location of Property: ( C S `J^C '� � � �Ie SC?L7 7-Alt La _ House No. Street Hamlet Owner or Owners of Property vZlk� A'. o 3FAi6R)2'P- e8EU r'1/C— Suffolk County Tax Map No 1000, Section cJ Block Lot Subdivision Filed Map. Lot: Permit No. c>'L 7�9J I t? Date of Permit. Applicant: `lZ&j I-' OOCLI1 Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted:$�rJ G Co(p �Applicant Signature S __II 1!E Lau J I,GTL - licilia IV!VK JUL ll- , INLW" 1 01 e: ,7J- - •I v,,-o, I _4-'�- �! Application:3582 Date: 6,133103; !! EE EE !� 1!! ---= - - - ------tri lI so Village: Southold introduced Ly. LLLV LLC—cml L14f G%tT I !! ®� was examined and approved nF to the above date and was in compliance with the NEC ! .6 �! !E ®� is nom iffSiM,swmu rani !l ME ME rip-- 1 1 EE - oven carbc1 E �� "r 318 inhw_ nr°� _ -__r.`v.T,0a , u�Ve� , . ... . . .. l Ftanf)eiTmps I eaonoride ! !! iBitNJ �p� y Furnace E oil ee.: ucc:Zcne� Smoke Bell E !! ! s { 0 f I ve`ELLe:3 { Ilan----a--- i I F f ! ! f f !! I I M.erer I mm�z E Ph.zt._ psere.s ! ! I �! btn--.ErufP.^ment: I 1-60A Sub Panel a �! I�® ELL134.CLLLLlL.6L6 LLLLIJL ILVL VG 11LGLGL£ KK®® in any manner Q Yermiv"�: 29051-L. RQ i� ®E !! �E i r > ENERGY CODE CALCULATIONS CHAPTER 5 SECTION 501 Detached One and Two Family „_ Design Criteria 5750 Degree Days (For Non-Electric Heat) _ Zone I1//13 For: Eje,- /Ins Per: Briny lY S 0,1Y. So „ Dated: We- 12 1,,6Ai _> Soh 0-00'”0-00'" 7 SUBSYSTEM AREA DESIGN CODE DESIGN CODE "U" "U" UA UA I Exterior Walls /,�(9 r/ p, 1401 0.14 .414- 94 I e5-. Ceiling Roof 0.031 Floor Over Unheated Space y 110, 0, 05' 0.05 20 .96 26 - 5,0 I Heated Slab On Grade 65 i Unheated Slab On Grade 4.5 ? I Basement Wall 0.1 - Crawl Space Wall 0.06 I NOTES: 9 s y o 9 B ,9 o Construction shall comply with 502-1.1 moisture control and 502.1.4 air leakage Building Envelope Systems to meet requirements of Section 501 The mechanical systems and equipment including: HVAC Equipment,HVAC Systems,Duct Systems, Ventilation Systems and Insulation of Piping Systems to meet requirements of Section 503 Senice Water Heating Systems&Equipment to meet requirements of Section 504 Electrical&Lighting Systems&Equipment to meet requirements of Section 505 To the best of my knowledge, r< belief, &professional judgement, these plans are in compliance 57 .1 ��I with the code. �or ��;r , L , s�ot J FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL_FLOOD INSURANCE PROGRAM ._Rn s:n`N usxrP br'tl Bost-FIRIA rwswcnon tn,what.the base nail is avazlsble tai the h ffl w sPa:and ZI P-IF FM huildmiis mi it uelnq Pest-FIRM rules - IrshuKions for comPiecmy Fhis Pmm tan be ii, MPA Ire.2 en,Y sial= John Ebeling BUILDING OWNER'S NAME POLICY NUMBER 145 Schooner Drive STREET ADDRESS App.-AiUnn-U Surto- Brag.B NO. P.OL:TE ROx NUMBER 1000-79-03-06 OTHER DESCRIPTION,Block and hal numbers..eic.) Southold, 2:Y 11971 OTY STATE LF CODE This.`arm is to be cumptered by a and SLTvayar,ergnecr,or arrhlect who is authorized by state Paw:o:erary elevation information when rhe elevation informatiar for mases At-A30,AE,AH.A(.0h SFEJ. VI—V3. VE. and V(w m,BF-E)is required.In?he Fse of zone AO. ire hurlding offrcral, the property owner,or the owners representative should complete the infor ,msman in,Section I and may also camplere the zertrficafon. Commuriky ofriafs who are authorized by Iuc`I iaw w orG;na,.ce tc provide floodptain man gemant rrio;ma an.PBV also cc^,.E7e?e this Iain. SECTION I OUILDING ELEVATION INFORMATION 1.Using the Flood Insurance Manu--I or the NFIP Food Insurance Appt:catior.—Par;2 Worksheet,indicate the proper diagram number_ 2. FIRM Zones Ai-A30,AE, Ah, and A(with CFE).The lop of the raierenue Revel flow from the Selected diagram is al an elevation of 20.6 feet NGVD. Car other datum 45) 3- FIRM Zones Vt-V30- VE, and V (with EFF)- The bottom of the lowest horizontal structural member of the reference level floor from the selected diagram is at an elevation of feet NGVD (or other datum-see K5). 4. FIRM Zone AO.The floor used as the reference level from the selected diaoram is I I Ifeet above highest natural grade next to the building (also enter in line 6). This value must be equal to or greater than the AO Zone flood depth number listed below- If no flood depth number is available, is The building's lowest floor(a.reference levet]elevated in aocUrdance with the community's floodplain management ordinances? DYes 0N OUnknown 5.Indicate the elevation datum system used in determining the above reference level efevations:l]NGVD ❑Other (describe on back) 6-Indicate the elevation datum system, used an the FIRM for base flood elevations:WNGVO /Other(d ----^-�--- ATTE:'yT/ON:ft the elevation datum used in measuring he alevafiwis is different char.that used on the FIFY.1, men. bii I� f g l tile,elEvatians p:svin must be znvaded to the daR•m system used an the FIRM-) [• :' •-'--"'- 7. Is the reference leve(based un actual construction? FXYss OND- A "No" answer is only valid it the builalrg does not nave the reference level floor in place.Fill in the eteEratfen bz_ d Dn'eoris[rtic- -_ tion drawings and do not complete question 98. If"No" is checked, this certification will be valid only jar buildings in the course of ) �' construction- After construction of the reference level Floor is completed, a post-construchon elevation cert,ficale-willl be-Tequirc�-;cc continued flood insurance coverage- _LD 8.Provide the following measurements using the natural grade next to the building (round to the nearest foaq:"�"`-- - -- a.The reference level is: b-Thegarage floor(if applicable)is: [091feet Elabove O below(check one) the highest grade- I;°J feet Elabove ❑below(check ane)the highest grade. Mfeet Vabove ©below(check one)the lowest grade- [feet Dabove ©below(check one)the lowest grade- SECTION H FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions an back-Date of FIRM) and accompanying insurance application: COMMUNITY NO PANEL NO- I SLaelx OATS OF VIFIM FIRM c MMU ESTIMATED BASE FLOOD M RD 7.arra.ux dip" �yAOR ZONE V tF HED FOR ZONE A 360813 0079 0 ` 06/15/83 c ` _ I Elevation reference clerk used appears On FIRM ❑Yes ONO(See reverse side for details) SECTION III CERTIFICATION TAs carlificarian is to be signed by a land surveyor,engineer, or arch;tect who is authonzed by state - wormahon when the elevation mfwrnation for zones AT-A3o,AE,AH,Arvrth HFE7, V?-V30, VE, and V(wrlh aF:)is roque _ the building of oal,the property owrrer,or me awnars represen alive ion sign me carvffaat=— Co ..:,•rtiry amdats who byY dfnance to provide floodplain management inforrnefian,may aLw sign the oertirrcahon-I mertify that the ialorma ion W - re altars m in[erp2r the data available.1 understand that any false statement ma be punishable by fuse w i TOoT. AKI John T. Metzger 49 ; , CERTIFIERS NAME LICENSE (air ea. :PresidentPeconic Surve 'f'® s �Q TITLE COMPANY NAME UF NEVY P.O . Box 0109 / Main Acari Southold HY 11971 ADDRESS f 7� CITY STATE ZIP ATc 03 11i E (516) 7E5-5020 SIGNATURE 7 /I /DPHONE The i.rkrce agent ehoala attach Me origural appy Pt rhe completes term m the flood,moron.paltry appecaaon-Tire second ropy Yt..M 1>,,s,ppileel io the palieyhaMa sed the third copy r Wivid by Me syara:-The taunh capy L Ni W e iceai e¢ .alt/ iwreX W.-If rx3®tad. TH Or t MAF 5E FIEFRODUCEIt. FOR OPTIONAL COMMUNITY USE Is the reference levet also the lowest floor under the community's tloodpain management ordinances. I TOWN OF SOUTHOLD p OPERTY' RECORD CARD OWNER STREET 7,5,fiVILLAGE DISTRICT SUB. LOT z A,?-4 baga` i Y..�3V�1 � 7 . 't ..J fir'- F �tMER OWNE R�IrleQ�) `` N E j ACREAGE ��' 1e oncile rly t�ke el u)-F S ; J/¢ W TYPE OF BUILDING ` . . , s .. ew RES. �/0 SEAS. VL, FARM COMM. IND, CB. MISC. I Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS a� C, � iP Ci Ua b ��. , �9� si,� I BUILDING CONDITION � ? /� � '� '�� � �`' "� Z'`�'�i%' V ln� � `E/ 7 AGE L l IQ� � i - a' r NEW NORMAL BELOW ABOVE FRONTAL ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD5�� Tillable 1 BULKHEAD Tillable 2 DOCK Tillable, 3 Woodland Swampland Brushland ../ House Plot Total ✓/.9 war H IF " — 6-r � a M. Bldg. 3Z q {��= �7L y� �'° Foundation �� Bath - z^ Extension Basement /m Floors O H k Extension Ext. Walls Interior Finish - -- Extension Fire Place Heat - 0// iF1 �diQ Porch Roof Type 2 0 .. L/D'a a.J Porch Rooms 1 qt Floor Breezeway Patio Rooms 2nd Floor garage Z6 z�. 7Z P -- r�3 9/� Driveway Dormer fe NR.rN i/ D. B. Applicant/ � , Date Owners Name: lt� Reviewed: / Architect/ lu Date Engineer: Submitted: J IA bya- SCTM b: r Dis(ricl: 1000. Semon: 131oc6.: Lac 1� Project �y _ �+ /,� j� (� Subdivision Location: lJ �'GLCwl..2„__ IJL• �Q[/�.�_ Name: f— Sin�le& separam Requiredz f g certification: (Yes/No) /'/�F•1— Rcq_ Kcq. _— Lonine Disinn:Od IInl size. _ Aeloal' /' ti I (IAI mvcmgc I'ropmd Req_ �` Req :` , Req. mar ffm Vd Proposed: I [Sidle YYardd /Jr/tel S 1'ropased. J [Rra, yxrd, propo5ea f Project Description: x4cz tom/ AGENCWERNIITS Permit REOUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept New York State D. E. C. Town Trustees / Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: I? r`ii —FI /910 Notes: l - - V 181 4 6\V. W{Ji 1JVd 1 NAT[ONALPLOWWWRANCEPMI3RANI Expires July 31,2002 " -' ELEVATION CERTIFICATE LM45EC Read Ste irmirucbons on pagesill-7. _ – 4FCTIONA-PROPERTY OWNER INFORMATION Fe YsrareCanparyLLse: BUILDING OWNS S NAME Po5W Nmdia Barbara C. &John P. Ebeling BUILDING STREET ADDRESS(Indudng Apr,ULA Sale,a xft Bbg.Na)OR P.O.ROUTE AND BOX NO. Corrpww NAIL Nmrdrer 145 Schower Drove CITY STATE 21P CODE Smalold NY 11971 PROPERTY DESCRIPTION(Lot and Block Numbers,TaxPaoJ Number,Legal Description,etc.) 1000-79-03.08 BURRING USE(eq..Raidetd,NartaaderfeC Additiuh.Massay.do Ikea Camrerds err®,d rergsay:) Real Tal LATrrUDFAONGITUDE(OPTIONAL) HORIZONTAL DATLRk SOURCE: GPS(Type) RJR (W- -mAr or n#.3~0w) ❑NAD 192+7 [3 MAD 19a3 ❑LLSGS(Wad Map ❑Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.IFIPCOMMlN"MAW&COMWJWIYNL%%R BZCOIR71Y RMIE Ba.STATE TmnofSaddd 3W3 an* j NY MAP AND PANG B5.SUFFDC 87_FRA PANE. B9 a4BE ROOD MEVATION(S) NUIa�l M.FWX INDD(DATE EFFECTIVEIREVISM DATE HB.ROOD ZONE(b) (SAO,—dep affinu g) 361M165 C owm x 810.Indicale the source ofthe Bass Flood Elevation(BFE)da(aar liese flood depth enlind in B9. . ❑FIS Profile ❑FIRM ❑(otmtuaYOelermied ❑Otbwpaaner- 811.Irdirabe tine dendron dabsn usedhort he BFE n B4®NGVD 1929 ❑NAVD 1980 ❑Otner(Descrbe):— BIZ Isthe builiftiocaledilaCoasfalBatr'aRaaerns91senga%jamorOthemisePt Anse(OPA)'.)❑Yes NNo rIPSi ±22Dats SECTION C-13URDFNG ELEVATION INFORMATION(SURVEY REQUIRED) Cl-Building elevatimha am based on:❑Cazndon Dvav W ❑Building lbder Cxmtn tion' N Fwdslhed Construction Anew Elevation CerhTic vdbemgimdwhen=EnrCtiandarek&wgis CLBuilding DagramMarherg(Seledthebuilding degammost sialamthe luiforwNchthis r is being mnplated-see pages 6ad7. Rrroduan accurately reveserds the building punk a sketch ordhGograph.) C3.Elwdfio s–Zmres A1-A30,AE,AH,A 6&BFE),VE,V1-V30,V W BFE),AR,ARIA,ARIAE,ARlA7,43Q ARIAH,AWAO Complete Items W.,,m belay acco ding to the building deg am specified in Rem C2.Stye the dawn used.8the dAm is difiVent from de datum used For the BFE in Section B,convert ft dawn to Mused fur8he BFE.Shaw field measurearads and dahmh coma-ion dadatm Use the spameVo ded atthe Com xnts area of Section D orSecbm G.as appmp i le,b damrmadthe dahim axNas n Dabsn— CarvesoNCamnen5— EJev hon neferenrc mak used_Does the elevation mtmnoe nark used appear on the FllM ❑Yes NNo o a Top ofbmromtwer 6asanadaerhdrsue 12. 2ftm = - - - 1. t..c. • , o b)TapdtherdFdgherfioar .(itt(m) as p"' s0— o d Bottom of hnei hm mrdal mcbmal marnber(Vzones only) ._R(m) W Ire, ... • quad ad Cf" ga�e(top ) 17. 7ft(m) EE n a e Lows(eiaratiahof ardra - w m �'`� ' Y .3 r. servicing the bu2fg(DacrbeiraCamnattsa* 12.21L(m) E e F,� o 4Lawesta*wd gade(LAG) 17.8ft(m) i m o 1B. ULM o h)No.ofpennanerdoperdngs(Roodvents)wftiftabove a*DantBade o )Tod a!oadaipmmo)erdopedwq&Wvats)nC3.h__sq.in.(%cm) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a lad surveyor,eximeer.or achited authorized by law to cm*el daft irdmmation. 1 certify that the in mala n in Sediom A,B,and C on ffts certificate represents my bat efforts to interpret Bre date avaBeNe. I mderstand ff d any lake slataded may be punishable by fine orirnpdso mw#oder 18 U.S Cade Section 1001- CERTIFIERS NAME John T.Me-bW LICENSE NUMBER 49818 TDLEPreselert COMPANY NAME PecoricSurveyors,P-C. ADDRESS CITY STATE ZIP CODE P.O.BOX 909 Sw ftm NY 11971 SIGNATURE / DATE TELEPHONE I o 11rigm (831)7855020 SO-YARE FOOTAGE ABOVF T-6' 235.9431 SF 57-260/. BELOW 7'-6' 176.0943 SF 42-740A TOTAL 412.0374 SF 100.00% 2 4 3-2 elk - - UNHEATED ATTIC SPACE 6 POST i/,,�/. /' ?�!i//.i„%:' , SUNROOM --_---_--__-CATHEDRAL CEILING _--- _ ` Q R-21 INSULATION w S I+ POST/ . 7'-6”CEILING HEIGHT / \ _ , EXT'G CL :6 POST/ 5-8ti2' f S-4" - f 1 0, 14 -1 i / I (3) 13/V x 1 %"LVL HEADER (3)2X6 POST (2)2X6 POST i �(3)2X6 POST n RII NE 25, 15 2LA� A \L !W7 71-1 2X fi — R-311 INSULATION i HE TED 50 SUN OOMi- r `1 2X -16"O/C WITH R-211NSULATI N n /�'/a" SUBIFLOCIR GLUED AND NAILED x/ �X��xR 3 I(NSULATIIO(N/ ) � / X xx 36' 1/l�X �`.— Y� k ��(�,�X�(�'CX_X_Y�N� 2X10 FJ- 16"O/C 4„ - TR 3)2X12 GIRDER NE \ NE NE NE AGE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ZIN A7ION 2ND [ ] INSULATION G [ ] FINAL [ ] FIREPLACE & HIMNEY 7 _ REMA KS: DATE INSPE II II 765-1802 6 02 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: d DATE 1? � INSPECTOR —J ! FIELD INSPECTTON REPORT DATE COMnmgT J ro t� FOUNDATION(1ST) � C m FOUNDATION(2ND) w Zee - C ROUGH FRAMING& PLUMING z _ rn INSULATTON PER N-Y. STATE ENERGY CODE r all FINAL rl ADDITIONAL COMMENTS O Z X _ y O x t x d TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDPYG D,c.PARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of]Budding Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey vvww. northfork.net/Southold/ PERMIT NO. a2/Oso Check Septic Form N.Y.S D_E.C. Trrutccs Examined 12019,Z Contact: Approved t 3 l ,2019-4 Mail w: Disapproved a,c Phone: Expiration ,3/ 12004_ Building Inspector APPLICATION FOR BUILDING PERNIIT Date /U� J 200E INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plants, 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 waterways. 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 will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work- e. orke.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit ptusuaut 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. Sie ture of applicaa r name,if a rporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises -MF/Nt�EL//IJ(r �1q� C a367&//J� (As A the tax roll or latest deed) If applicant is a corporation, signarme of duly authorized officer (Name and title of corporate officer) I Builders License No. Plumbers License No. Electricians License No. Other Trade's License No- 1. Location of land on which proposed work will be done: ( q s- scNoO nl�� a2c db Shu �r) House Number Street Hamlet County Tax Map No- 1000 Section 79 Block 3 -Lot Subdivision Filed Map No._ Lot (Name) 1. I State existing use and occupancy of premises and intended use and occupancy of proposed construction: a- Existing use and occupancy SINGGC— Fft 11 Y ee31D,cNCE � b. Intended use and occupancy SUAJ ,-0001 /"/yI, 3. Nature of work(check which applicable): New Building Addition Alteration 6/ Repair Removal Demolition Other Work (Description) 4. Estimated Cost OOUQ Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number 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 497 Rear (1ut' Depth J a Height e22 ` Number of Stories a Dimensions of same structure with alterations or additions: Front Cad Rear Aodl Depth Height_ 07' ' Number of Stories 8- Dimensions of entire new construction: Front c�/ r % Rear Depth 67 y� Height 0 _ Number of Stories C�_ i 9- Size of lot- Front 306 z Rear 2-& Depth 10. Date of Purchase 7 /Of o Name of Former Owner 09n/N6�_ FFyLL 11. Zone or use district in which premises are situated 12- Does proposed construction violate any zoning law, ordinance or regulation? YES_NO 13.Will lot be re-graded? YES_NO x Will excess fill be removed from premises? YES,NO_ 14. Names of Owner of premises it e E96-LIAlGAddress soU7tfaL- Phone No. 63( 766_6r)61 Name of Architect aljyY Ua/I9 ?L <CA#?Ft 1 Address M Phone No 6.31 (07 61�d Name of Contractor ,R--Z�d- Address I`Is MW_,0 Phone No. 6 a I )6T&o61 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__ NO ✓ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED- b. Is this property within 300 feet of a tidal wetland! * YES NO ✓ * IF YES, D-E.C. PERMITS MAY BE REQUIRED. 16. Provide survey,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- STATE OF NEW YORK) SS: COUNTY OFdI ) J0H1t1 P McLtAk— /dJV6R-V'q- 48 C d`/ $ lu y sworn, deposes and says that(s)he is the applicant (Name of individual gigning contract)above named, (S)He is the (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 wort:will be performed in the manner set forth in the application filed therewith. 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