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HomeMy WebLinkAbout29662-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29892 Date: 11/30/04 THIS CERTIFIES that the building ALTERATION Location of Property: 450 TASKER LA GREENPORT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 33 Block 4 Lot 42 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 25, 2003 pursuant to which Building Permit No. 29662-Z dated AUGUST 22, 2003 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 CONVERT ATTACHED GARAGE TO BEDROOM & BATHROOM IN SINGLE FAMILY DWELLING AS APPLIED FOR"AS BUILT" & AS PER CERTIFICATION OF WARREN SAMBACH P.E. DATED 10/08/03 . The certificate is issued to KIMBERLY IRWIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2017431 08/13/04 PLUMBERS CERTIFICATION DATED 11/30/04 GREENPORT PLUMB.&HEATING uth rized Signature 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. 29662 Z Date AUGUST 22 , 2003 Permission is hereby granted to: KIMBERLY IRWIN 675 VANDERBILT AVE #3D BROOKLYN,NY 11238 for CONSTRUCTION OF AN AS BUILT GARAGE ALTERATION AS APPLIED FOR at premises located at 450 TASKER LA GREENPORT County Tax Map No. 473889 Section 033 Block 0004 Lot No. 042 pursuant to application dated JULY 25, 2003 and approved by the Building Inspector to expire on FEBRUARY 22 , 2005 . Fee $ 300 . 00 �w 4Ah ignature ORIGINAL Rev. 5/8/02 •v L ul PI V. U - .--. TOWN OF SOUTHOLD - BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY i..__ . A. This application must be filled in by typewriter OR ink and submi't"7i��d -to-the build3.zg inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, streets, and unusual natural or topographic features. 9 Property lines, 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 17 lead. 5. Commercial building, industrial building, multiple residences. and .similar buildingE and installations, a certificate of Code Compliance frotn::_architeet or. engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 19.57) n "pre-existing" land uses: on-conforming uses, or buildings and 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.009 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 - .25jp 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.009 Commercial $15.00 Date SEPTEMBER 30, 2003 New Construction. . XX. . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . • • • • • • • . . • . • . • . • . • . Location of Property.450 . .TASKER.LANE . . . . .. . . . . . . . . . . . . . . GREENPORT House No. Street Hamlet. . • . • • • . • . Onwer or Owners of Property. . . KIM, �R�WI1V. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section.��. . . . . . . . . . .Block. . . . A . . . . . . . . . .Lot. . .42, , , , , , , , , , , , , , , , Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map, . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . , .?96622, . .Date Of Permit. . . KIM IRW . . . . . . . . . . . . .Applicant. . IN . . . . . . N . . . . . . . . . . . . . . . . Health Dept. Approval. , . . . . . . . . . . . o . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board.Approval. . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final XXX Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . n ... . . . . . . . . . . . . . . . . . . . . . . . . . . APPLICANT %3F FO • h i Town Hall,53095 Main Road O Fax(631)765-9502 P.O..Box 1179 y�01 �aO� Telephone(631) 765-1802 Southold,New York 11971-0959 Vv BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date:--/f ,30 Building Permit No. `J 6 aZ Z_ Owner: A .Z-/2 1V (Please print) Plumber: ���c m h12o r 49/vim /Sf n� (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Si ature) Sworn to before me this day of QPA 20 Notary Public, U I IC County � 0 � 5 BY THIS CERTIFICATE OF COMPLIANCE THE S 5 RD OF FIRE UNDERWRITERS S S NEW YORK BOA 5 5 BUREAU OF ELECTRICITY S 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT S S 5 Upon the application of upon premises owned by CSS 5 5 5 BRIAN BROOKS ELEC. INC. KIM IRWIN BOX 1001,455 5 R. 450 TASKER LANE CUUTCHOGUE, NYE6D1935, GREENPORT NY 11944 S S 5 5 Located at 450 TASKER LANE GREENPORT, NY 11944 5 5 Application Number: 2017431 Certificate Number: 2017431 S 55 SSection. Block: Lot: Building Permit: BDC: NS 11 e 5 occupancy, wherein the premises electrical system consisting of 5 rj Described as a S C electrical devices and wiring, described below, located in/on the premises at: �, 5 First Floor,Outside, Cj 5S �j A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 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 13th Day of August,2004. 5 Name QTY Rate Rating Circuit I)Te 5 5 Alarm and Emergency Equipment S Sensor 1 0 Carbon Monoxide SAppliances and Accessories S Exhaust Fan 1 0 F.H.P. C 5 Electric Heater Unit 1 0 1 KW 5 5 Panels S 1 40 8 C 5 Wiring and Devices S Cj Outlet 9 0 Fixture 5 Fixture 7 0 Incandescent S SFixture 2 0 Flourescent 5 5 Outlet 14 0 General Purpose Cj Receptacle 7 0 General Purpose C5� Switch 6 0 General Purpose 5 Paddle Fan 1 0 Cj 5 Receptacle 3 0 GFCI 5 5 An as built visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the tens allation is 5 believed to be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. S 5 1 of 1 5S 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 o � File No: 6403 WARREN A.SAMBACH,SR. CONSULTING ENGINEERS•PLANNERS 7675 COX LANE • P.O.BOX 1033 s CLITCHOGLIE,NY 11935 6 3 1— ")734-7492 September 30 2003 Building Department Town of Southold Town Hall 53095 Main Road Southold NY 11971 Re: Kim Irwin 450 Tasker Lane Greenport NY 11944 Permit #296622 SCTM: 1000-33-4-42 To Whom it May COncern: The alteration-construction of a one car garage into a bedroom conforms to the New York State Residential Code, 2003 . Sincerely, daUX44' 4►2_ Warren A. ambach Sr. P.E. gra s:s File No: 6403 WARREN A.SAMBACH,SR. CONSULTING ENGINEERS•PLANNERS 7675 COX LANE • P.O.BOX 1033 CUTCHOGUE,NY 11935 631 i5&734"7492 December 4 2003 Building Department - Town of Southold Town Hall 53095 Main Road Southold NY 11971 Re: Kim Irwin 450 Tasker Lane Greenport NY 11944 SCTM: 1000-33-4-42 Permit #296627 To Whom it May Concern: Site observation reveals that a Smoke Detector and a Carbon Monoxide Detector, battery operated have been installed, Sincerely, Warren A. Sambach Sr. P.E. was: s cc: Irwin FES �4 A. -' x ' o t� File No: 6403 WARREN A.SAMBACH,SR. CONSULTING ENGINEERS•PLANNERS 7675 COX LANE • P.O.BOX 1033 CUTCHOGUE,NY 11935 63 Jk5,,44 ase October 8 2003 Building Department Town of Southold Town Hall 53095 Main Road Southold NY 11971 Re: Kim Irwin 450 Tasker Lane Greenport NY 11944 SCTM: 1000-33-4-42 Permit #296622 To Whom it May Concern: Site observation of alteration-construction of a one car garage for framing, plumbing, insulation and ventilation conforms to the New York State Residential Code, 2003 and B uilding Code of New York State. Sincerely, "��)V - Warren A. Sambach Sr. P.E. was:s cc: Irwin N� 99 a Permit Number 4 REScheck Compliance Certificate Checked B /Date P By/Date New York State Energy Conservation Construction Code REScheckSoftware Version 3.5 Release la Data filename:\\Craig\shared\MECcheck\KIM IRWIN.rck TITLE: KIM IRWIN COUNTY: Suffolk STATE:New York HDD: 5750 CONSTRUCTION TYPE:Detached 1 or 2 Family HEATING TYPE:Non-Electric DATE:08/08/03 DATE OF PLANS:07-21-03 PROJECT INFORMATION: KIM IRWIN 450 TASKER LANE GREENPORT,NY. 11944 COMPANY INFORMATION: WARREN A. SAMBACH SR. CONSULTING ENGINEERS AND PLANNERS P.O. BOX 1033 7675 COX LANE CUTCHOGUE,NY. 11935 NOTES: ALL WINDOWS TO BE ANDERSEN HP GLASS OR EQUAL COMPLIANCE: Passes Maximum UA=85 Your Home UA=84 1.2%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Cathedral Ceiling(no attic) 375 23.4 0.0 16 Wall 1: Wood Frame, 16"o.c. 454 13.0 0.0 33 Window 1: Wood Frame:Double Pane with Low-E 24 0.330 8 Window 2: Wood Frame:Double Pane with Low-E 12 0.330 4 Door 1:Glass 20 0.400 8 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 322 19.0 0.0 15 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans, specifications,and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Registered Design Professional has stamped and signed this page,they are attesting that to the best of his/her knowledge,belief and professional judgment, such plans or specifications are in pliance with this Code. Builder/Designer DateQ-03 J C � X Y'3 n No.237lo yo 71"cTR�•E y REScheck Inspection Checklist New York State Energy Conservation Construction Code RES checkSoftware Version 3.5 Release la DATE:08/08/03 TITLE:KIM IRWIN Bldg. I Dept. Use I I Ceilings: [ ] I 1. Ceiling 1:Cathedral Ceiling(no attic),R-23.4 cavity insulation I Comments: I Above-Grade Walls: [ ] I 1. Wall 1: Wood Frame, 16"o.c.,R-13.0 cavity insulation Comments: I Windows: [ ] I 1. Window 1:Wood Frame:Double Pane with Low-E,U-factor: 0.330 I For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: [ ] I 2. Window 2: Wood Frame:Double Pane with Low-E,U-factor: 0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: I Doors: [ ] I 1. Door 1:Glass,U-factor: 0.400 Comments: I Floors: [ ] I 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation Comments: I Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials. If non-IC rated,the fixture must be installed with a 3"clearance from insulation. I Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. I Materials Identification: [ ] I Materials and equipment must be installed in accordance with the manufacturer's installation instructions. [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R values and glazing U-factors must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Supply ducts in unconditioned attics or outside the building must be insulated to R-8. [ ] I Return ducts in unconditioned attics or outside the building must be insulated to R-4. [ ] Supply ducts in unconditioned spaces must be insulated to R-8. [ ] Return ducts in unconditioned spaces(except basements)must be insulated to R-2. Insulation is not required on return ducts in basements. Duct Construction: [ ] I All joints,seams,and connections must be securely fastened with welds,gaskets,mastics (adhesives),mastic-plus-embedded-fabric,or tapes. Duct tape is not permitted. Exception:Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). [ ] Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions. [ ] Cooling ducts with exterior insulation must be covered with a vapor retarder. [ ] Air filters are required in the return air system. [ ] The 14VAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: [ ] Separate electric meters are required for each dwelling unit. Fireplaces: [ ] Fireplaces must be installed with tight fitting non-combustible fireplace doors. [ ] Fireplaces must be provided with a source of combustion air,as required by the Fireplace construction provisions of the Building Code of New York State,the Residential Code of New York State or the New York City Building Code,as applicable. Service Water Heating: [ ] Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. [ ] Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 105 T or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pipits: y_s Ani Types Range F 2"Runouts l"and Less 1.25"to 2" 2.5"to 4" Heajtint Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: 05/03 APPLICANT: -Tawio DATE SUBMITTED: /0101/03 SCTM#DISTRICT: 1,000, SECTION: BLOCK: 4 , LOT: q—SUBDIVISION:Z�,,,- (r, jhae- ADDRESS: q f-ga LA, CITY: pot ZONING DISTRICT: CONFORMING? �( S BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP -Z/C/0 Z- , INFO —/BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconfomung at any time after 7/1/8 REQ. LOT SIZE: �h Y- ACT. LOT SIZE: 1 REQ. LOT COV.Q,�' G ACT. LOT COV. REQ. FRONT PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT PROJECT DESCRIPTION: ESTIMATED PROJECT COST:qP914— ARCHITEC WATER FRONT? , tC� DESCRIPTION: PANEL # FLOOD ZONE: C� APPROVALS REQUIRED SUFFOLK COUNTY HEALTH rT: YES or��T , (BED #): DTE: / / PERMIT#: TOWN SEPTIC RECEIPT: Yor NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or DTE: PERMIT#: SOUTHOLD TOWN TRUSTEES: YES )(U DTE__/ / PERMIT#: TOWN ZONING BOARD APPROVAL: YES o DTE: /_/_ PERMIT#: TOWN PLAN. BOARD APPROVAL: YES o DTE /_/ PERMIT#: TOWN HISTORICAL PRE (SPLIA): YES or NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2)(96 or NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1SF)- ( SF)= SF X $ =$ +$ /-)U +$ / U= $ 2. ( SF)- ( SF)= SF X $ =$ +$ +$ = $ 3. ( _SF)- ( SF)= SF X $ =$ +$ +$ =$ FINAL TOTAL: $ �OG NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: Ground Snow Load:45 Wind Speed: 120MPH Seismic Design Category:B Weathering: Severe Frost Depth: 36" Termite:M-H Decay: S-M Design Temp: 11 Ice Shield Underlay:YES Flood Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: Y/N HEADERS: Y/N WALL STUDS:Y/N GIRDERS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/N ROOF RAFTERS: Y/N LUMBER SPECIES AND GRADE: Y/N DESIGN LOAD CALCULATIONS: Y/N LIVE: Y/N DEAD:Y/N SNOW: Y/N SEISMIC:Y/N WIND:Y/N WINDOW AND DOOR SCHEDULE: MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N VENT 4%: Y/N NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGRESS: Y/N PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) M.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CRIMNEY REMARKS: DATE � INSPECTOR FIELD INSPECTION REPORT DATE coho E n � FOUNDATION(1ST) 6' y . FOUNDATION2ND ( ) c t� z y 7t I ROUGH FRAMING& PLUMBING ►� IN6ULA1I0N PER N.Y. STATE ENERGY CODE ►� S a FINAL ADDITIONAL COMMTLNTS O x N r TOVyN OF 5OUTHOLD BUILDING PERMIT APPLICATION-CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. T`�G Check Septic Form N.Y.S.D.E.C. 3 Trustees Examined � ZZ' ,20 Contact: Approved 7.. ,20 — Mail to: Disapproved a/c -- Phone: 0 5P I Expiration 2. 2"Z 20 Build' g I p APPLICATION FOR BUILDING PERMIT f�. 5 V3 s Date QUI �J� ,200 - INSTRUCTIONS a Siris d'pplicafion MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 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 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.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 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. Oigrnat?ure�fappl* or e,if a corporation) �a L7' 19W— *3b G3/�-ooK c.Y�v !vY 1/23?- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises l rn/3 eK C- //4,7 /1/ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) 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: Z/5-0 --Task G=ame e i°o�-r— House Number Street Hamlet County Tax Map No. 1000 Section 3 3 Block 7 Lot 7 cK Subdivision_ Filed Map No. ZjV Z-f Lot 3 d (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost a 0 O--0 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 5-01 Rear 50 Depth �2 7 Height &/ Number of Stories Dimensions of same structure with alterations or additions: Front So 1 Rear So Depth 7 1 Height Number of Stories / 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front /0-0 / Rear /yy Depth /S0 10. Date of Purchase ©oZ Name of Former Owner ale A.Ik y /Y U1-S� 11. Zone or use district in which premises are situated 41 r,�-l 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NOV" 13. Will lot be re-graded?YES NO V Will excess fill be removed from premises?YES NO G,,r- npo<-i 14. Diaries of Owner of premises K/fyJ 94X A<wi w/Address 9 y IWylec,�e- e-v4 Phone No.-7/9 F5`7 O$'SU Name of Architect Address Phone No Name of Contractor Address Phone No. 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 OF ) � - Wl,Oo being duly sworn, deposes and says that(s)he is the applicant (Name of individuil signing contract)above named, (S)He is the G�v" K-- (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 performed in the manner set forth in the application filed therewith. Sworn to before me t s day f 20 0 Notary Public - Signature on i n JOYCE M.WILKINS Notary Public,State of Now York No.4952248,Suffolk County Term Expires June 12, a 00 I SURVEY OF LOT 30 N "MAS' OF EASTERN SHORES at GREENRORT" � w FILED APRIL 27, 1x64 MAP No. 4 021 SITUATE: &REENPORT °z TOM SOUTHOLD Sound Ddve 9 0 SUFFOLK GOUNTY, NY Lot rn 211 3 SURVEYED 06-I1-02 150.00' O N 0 SUFFOLK COUNTY TAX # o 1000-33-4-42 14 403 LA 19 50"]B 4 s O CmR17FIED TO: , IMMERLY IILWIN ata KIM IRWIN N _ SANDY HULSE AS EXECUTOR OF THE ESTATE OF HENRY F.HULSE ►� �F JP MORGAN CHASE BANK FIDELITY NATIONAL TME INSURANCE 00 COMPANY OF NEW YORK 1p � � O oituminov5 driveway `f --- o O o� dz ii, I Story Lot o g 2 1 g', Frame 16 30 ° n O House \✓ --- I� Cy- 11 I C o I n7 N I 0 ao V • O Fa O S _ -- wood fence ,e 150.00, S64°31'50 �,�� of NES, Lot ,nwuu�ee aiterouoa w aewtiaa m o w�.ey nap f»o-iy a ire.eee iaw>;.�eycr i>eo;i>o NOTES: Nen Ycrk State EO✓cotion Low' Si •racy�wie>rrom tro orig:b;or tn;>>,r.-ey �kee..at,o.t aryiroi ar Nte iate>�r.eyar> MONUMENT FOUND Q > e e�>Nali a�ee ee to�e ore e N � rertamauwo i,te<otee nereaa s;grty✓toe tn;s w�ey.+os p.epn-ee:,accoramce nrtn ute e.- O � +s[kg coee of Practice/cr Lace Surveys amptee SVP Gl"Nen York Stote Aswciotlon of Proressionol �ANU 7 LaM 5✓vcycrs Saie certiriwtion>shit rin cny to t,b persoc ror t�the>vrvey is proporee. ,� mo ac nis berrolt co me Utie compay gove.+»ren- to;oger<y ae;eaeatg.t>tit�to�;;stee nereoa,aae tc LM o»;c�tees cf ttte IenO•nn kstiWtkn. Gertir;co- [;cre are ric[tror>fxatle!c oeeit;crol institutions AREA = 15,036 5F OR 0.35 AGRE5 sulm®lm Place JOHN C. EHLERS LAND SURVEYOR GRAPHIC, 5GALE 1"- 20' 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.-\\Hp server\d\PROS\02-21 Lpro