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HomeMy WebLinkAbout28094-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30700 Date: 01/21/05 THIS CERTIFIES that the building ALTERATIONS Location of Property: 685 ORCHARD ST NEW SUFFOLK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 5 Lot 38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 19, 2002 pursuant to which Building Permit No. 28094-Z dated FEBRUARY 20, 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 ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GARY J BUCKNER & VALERIE MARVIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2036767 12/15/04 PLUMBERS CERTIFICATION DATED 11/01/04 BRIAN BLATT PLUMBING u oriz d Sig ture 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. 28094 Z Date FEBRUARY 20, 2002 Permission is hereby granted to: GARY J BUCKNER PO BOX 653 NEW SUFFOLK,NY 11956 for TO MAKE ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 685 ORCHARD ST NEW SUFFOLK County Tax Map No. 473889 Section 117 Block 0005 Lot No. 038 pursuant to application dated FEBRUARY 19, 2002 and approved by the Building Inspector. Fee $ 150 . 00 w., uthorized ORIGINAL Rev. 2/19/98 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL DEC I 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: 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 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, 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 2J lO 1 b New Construction: / Old or Pre-existing Building: (check or e) Location of Propert �1�� G House No. Street / Hamlet Owner or Owners of Property: :e-? 4 V '�J-��-���C �v c ✓7 Suffolk County Tax Map No 1000, Section Block CC)O Lot b �g Subdivision /I Filed Map. Lot: Permit No. DateofPermit. y�2v�°Z Applicant: TDZ, !et,- Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ✓/ check one) Fee Submitted: $ Z Applicant Signature �a 3 Doo aPLrIgApr SBY THIS CERTIFICATE OF COMPLIANCE THE 5 S NEW YORK BOARD OF FIRE UNDERWRITER 5 S S S SBUREAU OF ELECTRICITY S 5 40 FULTON STREET — NEW YORK, NY 10038 SCERTIFIES THAT 5 5 5 L5, Upon the application of upon premises owned by 5 5 SGARY BUCKNER GARY BUCKNER 5 PO OO BOX 653 SHELTER ISLAND HEIGHTS, NY 11965 NEW SUFFOLK, NY 11956 5 5 55 SLocated at 685 ORCHARD STREET SOUTHOLD, TN, NY 11956 S 5 5 5 Application Number: 2036767 Certificate Number: 2036767 Cj 5 5 5 Section: Block: Lot: Building Permit: BDC: nsl1 S 5 5 SDescribed as a occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: S SFirst Floor,kitchen reno,Outside, 5 5 5 rSU A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 Sherein, 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 5 authority having jurisdiction, and found to be in compliance therewith on the 15th Day of December,2004. S 5 Name QTY Rate Rating Circuity Type 5 Alarm and Emergency Equipment Sensor 1 0 Smoke 5 Appliances and Accessories 5 Dish Washer 1 0 1.2 KW 5 5 Wiring and Devices S r5Outlet 19 0 Fixture j Fixture 19 0 Incandescent 5 5 Outlet 20 0 General Purpose 5 5 Receptacle 12 0 General Purpose S Switch 8 0 General Purpose 5 5 Receptacle 1 0 20 amp Laundry 5 Receptacle 1 0 30 amp Dryer 5 Dimmers 4 0 5 5 Receptacle 3 0 GFCI S 5 5 S sea/ 5 5 5 5 1 of 1 5 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. o��bUFFO(,�c c � Town Rall, 5309S _ Maia Road P.O. Box 11.79 �� Fax(631) 765-9502 Southold, Nevv York 119"1-09 59 y��,( � ��� Telephone(63 1) 765-1802 BUILDING DEPARTMENT S TOWN OF SOUTHOLD CFRTIr, ICA 'TION Date:.-- Building Pen-nit No, _2-19 Q 9 Owner: Ir kr i c �'v►'-, (Please print) Plumber: &,10- PJ _ gLAIT bc- (Please print) lead. I certify that the solder used in the water supply system contairts less than 2;14 of I% (Plu"Signature) Sworn to before me this �5 day of— C,� --- 20 Notary Public., _,ZAIKCounty Paula D.Nocella Notary Public,State of New York No.01NO6051432 Qualified in Suffolk County Commission Expires 11/27/200�j. Thursday, April 11, 2002 2:17 PM Meryl Kramer 6314770826 p.01 M E R Y L K R A M E R a r c h i t e c t Mr.Gary Fish Southold Town Building Dept. Southold Town Hall PO Box 1.179 Southold,W 11971 April 11,2002 VIA FACSIMILE 765-9502 RE: Marvin Buckner Residence Tax Map#1000-117-5-38 Dear Gary, In response to your concerns regarding the above project I am certifying that the insulation in the sloped ceiling area of the kitchen will be adequate. Although the R value in this area is not R-19,the rest of the walls and ceilings do have adequate insulation. The Owner has been made aware of the situation and would prefer to leave the ceiling height in this area as it currently exists. I hope that this answers your concerns and that the contractor will now be able to schedule further inspections in order to complete the job in a timely manner. Should you have any�`ons or concerns,please do not hesitate to call me. I will be available by cell phone if not in my office,22`�� .1 Best ar 4. O� r t CC:Valeri a in, p OP 124 8ROAD STREET GREE N ' 0 RT. NY 11944 631 -477 - 0826 Wednesday, July 16, 200310,19 AM meryl kramsr 631-477-8936 p,01 M E R Y L K R A M E R a r c h I t e c t � 620C Mr.Gary Fish Southold Town Building Dept. Southold Town Hall PO Bout 1179 Southold, NY 11971 July 16,2003 RE: Marvin Suckner Residence Permit#2SO94Z Deer Gary, Attached please find a revised floor plan showing the installed stove pipe for the future installation of a wood stove. PIe9SO amend the permit accordingly. t egards aryl r r Cc:Yale arvin and Gary Buckner ED R. T% sF 124 6R0AD STREET 0REENP0RT. NY 11944 631 . 477 . 8736 631 -477 -8936 FAX Wednesday, July 16, 2003 10;19 AM meryl kramer 631-477-8936 p.02 • t SL-F,VAT 1a1•i LLS O-IWa� HJ cL 1 N t� w7 ; �Na�ows� LZ tvi macZo- , KALI -� 4,j . N I Wf►CI NSW ISr�•ND 3 -l'�a% �I 1/2 LVL I fRrrr MOVE11'57", ciltom'- �" a . ..... L) X PAN�J.►N�. 1J�6•► � r- a , c-a-lt3 vJAL1.6 71 HRO1J404aIT--` � AN 'DST 3'-0 W I DSI S�4 16T, _ CSD opg1 j I�& i G ` 2'*102 1 DI11 Thur3day, March 21,2002 9:54 AM Meryl Kramei 6314770826 _ p.01 �. a0U M E R Y L K R A M E R a r• c h i t v_ o f ova ., o � Mai►2� Mr.Bruno Semon y Southold Town Building Dept. Southold Town Hall PO Box 1179 Southold,NY 11971 March 19,2002 Revised March 21,2002 VIA FACSIMILE 765-9502 RE: Marvin Buckner Residence Tax Map#1000-117-5-38 Dear Bruno, In response to your concerns regarding the above project I am providing you with the height and area calculations for the Kitchen/Dining room. The space with the sloping ceiling is existing and the only structural modifications we are making to this area are replacing windows,adding new skylights and removing an interior wall. The entire renovation is certainly less than 50%of the value of the entire existing construction. Square Footage of Kitchen/Dining Room-396 sq.tt. Square footage of space under sloping roof more than 5 feet and less than 7'-6"- 113 sq.fL Percentage of total room area that is area under sloping roof -29% According to section 711.1(2)this space is acceptable under the NYS code. The height to the underside of the beams in this room will be 7'-0",allowable by section 711.1(3)of the NYS code. It is my understanding that the roof and other framing is not as indicated on the drawings due to existing conditions that were not visible to me whicle I did my field measurements. I have reviewed these conditions with the contractor and verified with my consulting engineer that the new framing will support the loads. In the areas where the framing is inadequate,the contractor has been instructed to add additional framing so that it is structurally sound. The additional framing is being completed today. I am therefore certifying the framing. I hope that this answers your concerns and that the contractor will now be able to schedule further inspections in order to complete the job in a timely manner. I Should you have any further questions or concerns,please do not hesitate to call me. I will be available by cell phone if not in my office,220-6588. Regards, ', ra CC:Valerie Marvin,Rich Reinhart 124 BROAD 9TREET GREEN PORT. NY 11944 631 . 477 . 0826 Tuesda�,March 19, 2002 8:45 PM Meryl Kramer 6314770826 p.02 • M E R Y L K R A M E R b. Mr. Bruno Semon Southold Town Building Dept. Southold Town Hall PO Box 1179 Southold,NY 11971 March 19,2002 RE: Marvin Buckner Residence Tax Map#1000-117-5-38 Dear Bruno, In response to your concerns regarding the above project 1 am providing you with the height and area calculations for the Kitchen/Dining room. The space with the sloping ceiling is existing and the only structural modifications we are snaking to this area are replacing windows,adding new skylights and removing an interior wall. The entire renovation is certainly less than 50%of the value of the entire existing construction. Square Footage of Kitchen/Dining Room-396 sq.fL Square footage of space under sloping roof more than 5 feet and less than 7'-6" - 113 sq.ft. Percentage of total room area that is area under sloping roof -29% According to section 711.1(2)this space is acceptable under the NYS code. The height to the underside of the beams in this room will be 7'-0",allowable by section 711.1(3)of the NYS code. The contractor has been advised to add an LVL to the new girder so that it conforms to the drawings. I hope that this answers your concerns and that the contractor will now be able to schedule further inspections in order to complete the job in a timely manner. Should you have any further questions or concerns, please do not hesitate to call me. I will be available by cell phone if not in my office,220-6588. st a ards, Mery Kram r 1 2 4 B R O A D S T R E E T G R E E N P 0 R T , N Y 1 1 9 4 4 6 3 1 - 4 7 7 . 0 8 2 6 M E R Y L K R A M E R y 2002 a r c h i t e c t U sic ,J�l1,0 0 Mr.Gary Fish Southold Town Building Dept. Southold Town Hall PO Box 1179 Southold,NY 11971 April 11, 2002 VIA FACSIMILE 765-9502 RE: Marvin Buckner Residence Tax Map#1000-117-5-38 Dear Gary, In response to your concerns regarding the above project I am certifying that the insulation in the sloped ceiling area of the kitchen will be adequate. Although the R value in this area is not R-19,the rest of the walls and ceilings do have adequate insulation. The Owner has been made aware of the situation and would prefer to leave the ceiling height in this area as it currently exists. I hope that this answers your concerns and that the contractor will now be able to schedule further inspections in order to complete the job in a timely manner. Should you have any_Luabexcluestions or concerns,please do not hesitate to call me. I will be available by cell phone if not in my office,22 �ED A ,Best ar r CC:Valeri a in, O� N E 1 2 4 B R 0 A D S T R E E T G R E E N P 0 R T , N Y 1 1 9 4 4 6 3 1 . 4 7 7 . 0 8 2 6 M E R Y L K R A M E R a r c h i t e c t f .. Mr.Bruno Semon Southold Town Building Dept. Southold Town Hall PO Box 1179 Southold,NY 11971 March 19,2002 Revised March 21,2002 VIA FACSIMILE 765-9502 RE. Marvin Buckner Residence Tax Map#1000-117-5-38 Dear Bruno, In response to your concerns regarding the above project I am providing you with the height and area calculations for the Kitchen/Dining room. The space with the sloping ceiling is existing and the only structural modifications we are making to this area are replacing windows,adding new skylights and removing an interior wall. The entire renovation is certainly less than 50%of the value of the entire existing construction. Square Footage of Kitchen/Dining Room-396 sq.ft. Square footage of space under sloping roof more than 5 feet and less than 7'-6"- 113 sq.ft. Percentage of total room area that is area under sloping roof -29% According to section 711.1(2)this space is acceptable under the NYS code. The height to the underside of the beams in this room will be 7'-0",allowable by section 711.1(3)of the NYS code. It is my understanding that the roof and other framing is not as indicated on the drawings due to existing conditions that were not visible to me whicle I did my field measurements. I have reviewed these conditions with the contractor and verified with my consulting engineer that the new framing will support the loads. In the areas where the framing is inadequate,the contractor has been instructed to add additional framing so that it is structurally sound. The additional framing is being completed today. I am therefore certifying the framing. I hope that this answers your concerns and that the contractor will now be able to schedule further inspections in order to complete the job in a timely manner. Should urther questions or concerns,please do not hesitate to call me. 1 will be available by cell phone if not in 4 ,' . .� R. 0 r � ale i ch ein rt 4- 1 2 4 B R O A D S T R E E T G R E E N P 0 R T , N Y 1 1 9 4 4 6 3 1 . 4 7 7 . 0 8 2 6 b pros 0 fes• AID. -•urild /Or �.Y�, j � •�f Aair Newk 1"�Ott M ' 44 b Mis survey lea vtoletlert e/ sadmn 7106 a ft NOW Vb*err fid"iOn Lm Copies o,the survey map not boa" the hand surveyors IrYted seal Or embossed seal OW rxK J Z t valid MA copy. be eonaderrd to (� .� � L� �• Q O\ �/•4,��Q x r 9uaarrtess irtdieated hereon shall r.,s 40 p � � i edy to the person for whom the su,%W k prepared and on his b[:hatf:o the tyle company,governmental agerev ens # ! i lending instiiu!ion I s:ed hereon and /r L •.0 E to the s et the lending mstt j ' p y ft "; fullon.Gua anIces are not transferable — ._ 1 to additional institutions or subsequent 7 $t? - -"s 31t.�3 Gua rQ tam d f�t ' t �ftv; , <• : 4 t !K t1 r'gtf IC49 C 10sIn�a►rt� d r?tt� �'' r toyt - , ya lier i'I �`e.nL'::=x�..`''A°.'<niesi•ia . ,. ._ �, :.�.....,._ .._ .r.°. ..,.:,' _._ � _.. `x x'` �•s�� ��s�� � �• �sF.•c' �1��i� w_. _...Y..MCIP S�1•...+�qC!-"�ir �24., �'',�3'w'� • M __�+�.�wr*G�SSF �Y -t�. •�! 1 ._.433 '°` ',.�e@_„��,• ^.�.Sw''� su.�'% ,!!f �1-ATI= OF NEW YORK ) ss COUNTY OF SUFFOLK ) I�ItieYyl �-rm JV being duly sworn, deposes and says That deponent is ver the age of 18 years and resides at .tcfi PPV+, NY That on the V day of 200�Aeponent architecUengineer, licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building Code (9 NYCRR); said plans pertain to property located at SCTM# 1000- street address— Ll ddress Architect/ ineer j8j, n to before me this @y.of.. , 200 VALERIE MARVIN' Notary Public,State of Newyork _ No.4 C7 Z AIA 'Sb 8 D 2-9 Qualified in suitolk county Commission Expires Febwwy 4 / BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: 7/01 L .DATE SUBMITTED: /01 APPLICANT NAME: V CK IaE1Z+ Qty SCTM# DISTRICT: 1,000 SECTION: rte_BLOCK: 5' LOT:-5 STREET:45�S dem-mAeo CITY: LIE- S-F�o uc- SUBDIV.NAME: ~/ PROJECT DESCRIPTION: ARCHITECT/ENGINEER: FAST TRACK? SINGLE&SEPARATE CERTIFICATION-REQUIRED? NOTES: — LOTS 40,000SF-100-24.Lot meognition.(CREATED before June 30,1983),UNDERSIZED LATS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/ ZONING DISTRICT: CONFORMING? N& /0/0/0 REQ.LOT SIZE: y°'°oo ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ.FRONT ,:�S PROP. FRONT REQ SIDE %.f ACT. SIDE REQ.REAR 31r PROP. REAR WATERFRONT? DESCRIPTION: PANEL #: o► FLOOD ZONE:_, AGENCY PERMITS REQUIRED FOR REVIEW APPR VALS REQUIRED: SUFFOLK COUNTY HEALTH DEPT: YES oto)(BED#): !. .a DTE:—/—/ PERMIT#:R10- NEW YORK STATE DEC: PRE-DEC 9/1/75 YES o O SOUTHOLD TOWN TRUSTEES: YES o .TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES or O NYS ENERGY: YES 006 . EGRESS (18 H min.?4 sq total) .�-,�VENT(SQ. FT. x 4%) L 4 LIGHT(SQ. FT.x 8%) BUILDING PERMITS OPEN/EXP D: BP -Z/C/0 Z-_jqU 0/6 HAVE PRE CO'S : Y OR N BP/2y90 -Z/C/0 Z-�a�p e�� ,��y g cb� NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : 9.i SF SECOND FLR : SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 'OT( /9r SF)- ( =_SF)= SFX$ i =$ / +$ +$ �ss•i8o2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLB6. [ ] FOUNDATION 2ND [ ] 1 TION j [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 6401�100'� iop� DATE l � � d� INSPEC M-1802 � pp94� BUILDING DEPT. f-� INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [� FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE43 /8 6 - IN8PECT0 rss-iso2 suauiNa DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: T DATE 7 �a �� INSPECTOR -, M-iso2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RBG. [ ] FOUNDATION 2ND [ 'INSULATION [ ] FRAMING [ ] FINAL ( ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR ft�A-4 )-F-©y56 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ;7N [ ] FRAMING [ ZWLA FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ,,� 16416L � �� �� DATE INSPECTOR ' I ti � f FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) y xt ------------------------------------ FOUNDATION(2ND) z y ROUGH FRAMING& PLUMBING Y x r INSULATION PER N.Y. STATE ENERGY CODE c. 100, 1 L r�- FINAL s-av vLe t7 QcI44d�J 4-JAi5X— &41".r 4 ,, . ADDITIONAL COMMENTS ?�S oZ-- ac 5 0 Z m le l�— 03 r — b . y � z x lr y x d b H TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,NY 11971 TEL: 765-1802 BUILDING PERMIT APPLICATION CHECKLIST: Do you have or need the following,before applying?: Board of Health? 3 sets of Building Plans Survey Check Septic Form N.Y.S.D.E.C. Examined It20 Z Trustees ��„ \ Approved �/i� ,20 z' PERMIT NO. Disapproved a/c r Building Inspector APPLICATION FOR BUILDING PERMIT r 920 20 DateV { 67i _ INSTRUCTIONS a.This application MUST be completely filled in by typewriter or iii ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to sale. 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 of 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector . APPLICATION IS HEREBY MADE to the Building Department for the issuance a Build' g Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and of applicable Laws,Ordinances or Regulations, for the construction of buildings,additions,or alterations or for removal r demolition s herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,=gcode, d re lations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) 09&kJkM (Mailing address of applican SIi State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder IV OwNex Name of owner of premises C,,a� kj4,KNi5*,, I MAKVIN (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: & 8 5 OIC tZ.lp SV?V_0LA< . House Number Street Hamlet County Tax Map No. 1000 Section ` j Block 15 Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .e,"IbJ6LSAM i t& fZ�S I eAlGF_ 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 -504500 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 e }''ling structures, if any: Front Rear /2-V Depth 46 � Height i"1 Number of Stories 11 Dimensions of same structure with alteration or additions: FrontyV Rear Depth kl o ' Height Number of Stories 2' 1h Wll1 '112& WDZJ a- 8. Dimensions of enti Depth Height Number of Stories 9. Size of lot: Front IT Rear 11 1 Depth 10. Date of Purchase -`1\1 I A& Name of Former Owner NOL,AN) 11. Zone or use district in which premises are situated t`'�40 12. Does proposed construction violate any zoning law, ordinance or regulation: 0 13. Will lot be re-graded NO Will excess fill be removed from premises: YES NO MLKo 14. Names of Owner of premises �ADOKVINI 41b�JLk� ress CoV D�.Gt D one No:sfIN � sort O Name of Architect NI ML, KRIh16M Address 124 I" Si'. Phone No 4"-061-& Name of Contractor V41,* f-VN10*Vq* Address Phone No. 114 - 14 Z4 govt (10-6 LAN-6LXY 15. Is this property within 300 feet of a tidal wetland? *YES. NO • IF YES, SOUTHOLD TOWN TRUSTEES PE ITS MAY BE REQUIRED 16. Provide survey, indicate scope of project, to scale,with 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 OFF L4 V�Z L-a/6 P/ eyl being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the C)Lk) q�- (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 knowled belief; d that the work will be performed in the manner set forth in the application filed therewith. Swor►)t9 a me thi / 7 —day of 00t- Notary Public Q,tary public. State ofNewyork Signature of Applicant J . No.4951364 tlualified in Suffolk County -icon Expires May 22, p �j G Y Os ror V t-- Ale w 6 U ffo k- w qb L3 v Is ft survey ic a Vlow6n of 45ca/e 1*1 LU Se ion 720e of the Now York 8181- JL rxk=iion Law Copies 0,*his survey map not bearim the tand surveyof'S in.Wd seal or U, onbossed seal shall not be considered to be a valid true copy. e..-,.meas indicated horecn shag n-ifi G arty to the person for whom 1 -- SY kV.opnred,and onh' bchaff The to t, title rompany,00verilinmLILger-cVqft lending inst u::.,n <d hcrr.>n and to the ctsig6zcS ct%,,I&kndung insti- "on.Guaran;"a are rat transfsmb#o to additional insiku',ions or subsequent Owners. 63 6U a r a ti;teed J!O /M 5 Ci ra III CC e 7" ai5 �,eawvoe qd "z )Zoder;ck. van -ru; F. c. rz , v rz ".5 e d 1.&n d 154/rVe�YO/-.S Se c 0 rld +G, .. ;fit_ w.R 4N S PG q -}a...n ��e.. — po•"__�+... EC7 OCCUPANCY OR a w�'�,v. R• k�ti�>,A� USE IS UNLAWFUL PLUMBING WITOUT,.C.,ERTI'F,I, IN E AMPLUMBING NNBM r� R WATER LINES NEED •O�" �! +!N ? 1 TESTING BEFORE COVERING '' I' DATE: it : O� W rhe it sr. PLUMBERCERT/F/CATION NOTIFY BUILDING DE ENT AT ON LEAD CONTENT BEFORE 70!•1602 fAM TO • PM'M'1B'THR FOLLOWING INSPEcnON& CERTIFICATE OF OCCUPANCY f. FOUNDATION • Tw0 REQUIRED SOLDER USED IN WATER FORPOUREDCONCRETE IL ROUGH . FRAMING A VOWING SUPPLY SYSTEM CANNOT U IDERWRITERS CERTIRCAIIE' 4 FINAL - CONSTRUCTION MUST EXCEED 2/10 Of I%LEAD. REQUIRED NECOMPLETEFORC.O. , ALL CONSTRUCTION SNAK MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION S ENERGY If copper tublilg Is used CODES. NOT RESPONSIBLE FOR for water distributing ,1 DESIGN OR CONSTRUCTION ERRORS OW8M, Piping shell be l u of types K or L only ` UNDERWRITERS CERTIFICATE L4 REQUIRED ilk al 11 - -GFII ( -- NEW WINGbW� -- - — - Nrh4 _- _. _._ !✓JINiW -- -- NEW DOOR j --_ ----- --- ---- NEW WD5TaP6 --- - �--- - ----- - __" -- — 4 RAI LI K& -. _ - - -- --- ---- � I PARTIAL F-Ar=T r-- NE5T_t-_L.E_L �A Ip� 'til 2- 2'" * H /G 111 1x4LL5TWE2N cp S II C EWOVEa7bR�,, �� V b ' 22" sru�w` a~�TS�N/ d . NamI �I I W('N - - — x15 GNtavE G41N1N� 117 _ L_� L _� ;J��_ _J ,w pt lti b - '1/4. '/Z LVL- - IMpVE% \ �' V N=nl SKYLIGWTS — -I - _— PWATG-I:F'e�FR..'W•-�"IR �` `� VESP� EX 'NEKJ [xbM1 N 5{104 �- � N _ I w C' 7 -- - '� _-_— � � per, I �o m a I q a `� �2 I_V L k -111 GATT IJ�aUL, LHJJ� — ' pT �, )N RMBv� LsxlsT. 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