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HomeMy WebLinkAbout29819-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30740 Date: 02/03/05 THIS CERTIFIES that the building ALTERATION Location of Property: 3600 PEQUASH AVE CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 103 Block 14 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 2003 pursuant to which Building Permit No. 29819-Z dated OCTOBER 16, 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 GARAGE CONVERSION & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT" . The certificate is issued to MATTHEW & ALEXANDRA NINFO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1195796 02/27/04 PLUMBERS CERTIFICATION DATED 11/10/03 DINIZIO PLUMBING&HEATING AutTiorized 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. 29819 Z Date OCTOBER 16, 2003 Permission is hereby granted to: MATTHEW & ALEXANDRA NINFO 3600 PEQUASH AVE CUTCHOGUE,NY 11935 for GARAGE CONVERSION & MINOR ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS BUILT PRIOR TO 2003 at premises located at 3600 PEQUASH AVE CUTCHOGUE County Tax Map No. 473889 Section 103 Block 0014 Lot No. 002 pursuant to application dated OCTOBER 14, 2003 and approved by the Building Inspector to expire on APRIL 16, 2005 . Fee $ 300 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No.6 ----- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL FEB 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. 1 173 1 J0 5� New Construction: Old or Pre-existing Building: (check one) Location of Property: :?60 d Pe 11 of S 4 I 1 U e vl o e— House No. Street Hamlet /�o. Owner or Owners of Property: !" ` or' t e w fi A 1e x q h d (,r al P ( LA 1'(� a Suffolk County Tax Map No 1000, Section 4 7 3 '9!K O3 Block O 0 t L Lot 002— Subdivision O2— Subdivision Filed Map. Lot: Permit No. 2 q 7 Date of Permit. 10 16 d Applicant: M o!ff e 4/ N tq -� y Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: V (check one) Fee Submitted: $ L .l Applicant Signature Com 3o� 10 oS$gOFFO�,��o Town Hall,53095 Main Road C'* Fax(631)765-9502 P.O.Box 1179 Oy Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: i /—��—C)3 Building Permit No. 029 9�J Owner: { y) C�A) N)-�6 (Please print) Plumber: ,� 1 -2 i C7 P ff (Please prin I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Pl ers ignature) Sworn to before me this day of 20 l - Notary Public, County BONNIE J.DDROSIQ Notary Public,Stets Of New Molle No.01DO6095328,Sutfor Term Expires J*7,20 a BY THIS CERTIFICATE OF COMPLiA.P.'CE-7 THE- -IFF R BOARD OF FIRE UNDERWRII -RS BUREAU OF ELECTRICITY IR 40 FULTON STREET — NEW YORK, NY 10038 & PL-- CERTIFIES THAT P-- 1-1pon the application of upon premise's owned by PE Q.C. ELECTRIC 1 %G. MATHEW NiNFO P.O. BOX 518 3et70i PEQUASH AVE LAUREL, NY 11948-0518, GUTCHOGUE, NY 11935 �5� G4 RE Located at 3600 PEQUAS01-1 AVE CUT CHOGUE, NY 11935 P- r-- CE Application Number: 1188002 Certificate Number: Ed Section- Block: Building Permit: BDC: nsl 1 ME Described as a &esidtntial occupancy, wherein the premises electrical system consisting of electrical devices and wiring,described below, located in/on the premises at: G! 5 , R, 134sellielit, 1-list Floo), R C� 5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was found to be in compliance therewith on the 22-d Day of Janua.--y'2004. Name OTY Rate Ratin Circuit Tvpc A moun UZ Miscellaneous K1'1'(.'l-J.EN RENOVATION $0.0c REPLACE MAIN PANEL $0,00 Appliances and Accessories RE Oven 1 0 7 KW $5.0 ELI, KW 41 1-1 6 1 V Z' T r Disposal I 0 F.H.P. $- Panels 1 150 42 $6,0(_1 Wirina and Devices 0. Receptacle Genei-a'Purposc Switch 2 0 General Purpose Fixture 5 0 Incandescent $i.oql-! Invoict,Toth S50,0(0 IR 51 0- 1-! seal a M 1 of I This certificate may not be altered in anv wav and is validated onlv by the presence of a raised seal at the location indicated. [I!- HP Fax Series 1020 Last Transaction Report Name QC ELECTRIC INC. Fax Number : 621 298 5244 Lute&Time . Jan 24 2004 09:29am ------------------------------------------------------------------------------------------------- Last Fax Date Time Type Identification Duration Pages Result ------------------------------------------------------------------------------------------------- Jan 24 2004 09:2S:01am Sent 17708286272 00:01:22 00 No Answer ------------------------------------------------------------------------------------------------- a ��n�����n�n���n�r3� 'En�n������nrr�n�������Ln�CPC��Ln� Ma Lrr�n a 5 BY THIS CERTIFICATE OF COMPLIANCE THE S S NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 ERS 5 S . BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 0 5 CERTIFIES THAT 5 5 Upon the application of upon premises owned by 5 5 5 5 5 MATTHEW NINFO MATTHEW NINFO3600 PEQUASH e] 5 CUTCHOGUE NY 19935 3600 PEQUASH AVE c 5 CUTCHOGUE, NY 11935 cS 5 Located at 3600 PEQUASH AVE CUTCHOGUE, NY 11935 5 , 5 5 Application Number: 1195796 Certificate Number: 1195796 5 5 5 e5J Section: Block: Lot: Building Permit: BDC: ns11 5 5 5 5 Described as a Residential occupancy,wherein the premises electrical system consisting of S 5 electrical devices and wiring, described below, located in/on the premises at: 5 First Floor, 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5 5 found to be in compliance therewith on the 27th Day of February,2004. S 5 SName QTY Rate Rating Circuit Twe Alarm and Emergency Equipment 5 5 5 Sensor 1 0 Smoke 5 Appliances and Accessories 5 Exhaust Fan 1 0 F.H.P. 5 5 Dish Washer 1 0 1.2 KW S 5 Oven 1 0 4.3 KW C 5 Wiring and Devices 5 5 Receptacle 14 0 General Purpose 5 5 Switch 9 0 General Purpose 5 5 Fixture 6 0 Incandescent 1c 5 Paddle Fan 1 0 5 Dimmers 1 0 5 Receptacle 3 0 GFCI 5 5 5 5 S seal 5 5 5 1 of 1 S 5 55 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. C 5 5 o ����LP�C�L3Pr. ���������������������������������� ��� r-o © a Q _ n 3 _f _ TOWN OF SOUTHOLD PROPERTY RECORD CARD )WNER STREET i "'` VILLAGE DIST. SUB. LOT � e l.�xro�rl2- v a, �`` C� cr fc a v f f r= e a a lR ti ,E n�cirrc t�lF NZ , K. T©� EC�e ACR. v , •IF (� Kv m► leiS W � TYPE OF BUILDING S. 0 SEAS. VL. FARM COMM. CB. *MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS ,f U jlIt�+ a �,r ,Td CsetF�/r �'4 �'`o Z .,f"6 D 6JT7,'v?�'S, C'i t`el #4' 7 J`' y- �, y d ,s-a40 © y� T� r / 7/ So li', 3ooQ. �v ey 76 a v �,e .� o d � s11ra f/< e !o b a a S'f 7 4. oo ay BULLIJING CONDI ION .y2' 1,�1 /�.f //9?_ 7 C'os �, c2uvc x, ' 7r i �73' "� f JEW 00 N L/ W O -3 j 'p*/tP80- pPC C '�SDc� 'ARM Acre Value Per Value ag v cr � ,fig -�, 5q 53q- �o nn Ip;n - kendar,6 f8v,aur llabl i f liable 2Z0() 7-500 2pp 7 i Q 93 4—/NssrSS -��O 70o -3o o goov v i �Pa �` �-4a n�a t 1SZ �8 Qc o-� b ishland FRONTAGE ON ROAD 4� � ruse Plat DEPTH BULKHEAD 3 L Z3 -eent1rick !VI Ital DOCK COL.• ■■NE■■ �■■�■■����= iii=i ■n■��■�■■■�e■tee ` � =i��a� i�i�iiiiiiii�iiiiii MMMMMMMMUMMMINCIVEMEMMMM ■■t EMt■■ ■IMviNME■■■t■t■N MEMENCE ��13�i�a�� D■t■A!l71��■ ■■■■ - - " �N■nom �n������������vM TOWN CARD .. I v i OWNER � ,.:-, _.,. STREET �,c �. r., , ; VILLAGE DIST. SUB. LOT 0e 10 eq, ORMER�3E ACR. ln�.ccriciW NL �, ,� �� EI (<'o V"I p F✓1 A Wc S W TYPE OF BUILDING IES. Q SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS�"��Q/ 6 6 �-S`aZ S D 6 o J r r 3 r'7JG , ,,1!777,Y, S, C1i ea"e��G��, 0 !`I`a i-rey _ , 34od. t�J��Ha,-vcy ?•o ,�,�,/tarvey. 9191 .� . ..., CEJ UI �a� A Lt./y 4193, ,/ r 0 0 / + �j'��/ t`.>-C� �7U.o 047 1//11.1�c T., k")" Ic i>, � S r 7 GE 6 BUI DING CONDI ION 2! 11,2y lj. /v,/t' 1f9i�f NEW cats N L/ 5,W/W O 3,lf3� 3` �'���fp� - CbfiS oPCk 9-c 5� FARM Acre Value Per 'Value c� iCO m - �A P i n e n 0 ric *i 180 Qui Tillabi i �a5 90 -�Pol &' - ConS�`� !Tillable 2'700 -7500 �2�0 7 �.� Q I 9 5f14—/4 S5e5S - '700 3o ti g000 z Z Pi o? a Mo ►-rbc n 8 �8 acc'�i shJpc) ed iwa , �rushlancl FRONTAGE ON ROAD 4® ^ -louse Plot DEPTH BULKHEAD 'otal DOCK s ' APPEALS BOARD MEMBERS oS�FFoJ/.40 OG Southold Town Hall Ruth D. Oliva, Chairwoman y 53095 Main Road Gerard P. Goehringer•. = y P.O. Box 1179 Lydia A. Tortora 5 ' Southold,NY 11971-0959 Vincent Orlando Tel. (631) 765-1809 James Dinizio, Jr. lt `1►a Fax(631) 765-9064 ,y http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF DECEMBER 2, 2004 ZB Ref. 5606—Special Exception for Accessory Apartment Applicants/Owners: Matthew and Alexandra Ninfo Property Location: 3600 Pequash Avenue, Cutchogue; CTM: 103-14-2 Date of Public Hearing: November 18, 2004 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type 11 category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned. The Zoning Board of Appeals held a public hearing on these applications on November 18, 2004, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: APPLICANTS' REQUEST: The Applicants are the owners and residents of their home at 3600 Pequash Avenue in Cutchogue, and request a Special Exception as provided under Article III, Section 100-31B, sub-section 13 of the Zoning Code, to establish an Accessory Apartment within the existing principal building in conjunction with the ownership and residence therein. A certificate of. Occupancy was issued for the existing dwelling on August 21, 1973 under No. Z5397. PROPERTY FACTS/DESCRIPTION: This property contains 15,000 sq. ft. in area with 100 feet along Pequash Avenue in Cutchogue. The property is improved with the applicants' one-story, single-family dwelling and two accessory storage buildings located in the rear yard, as shown on the January 6, 2003 survey prepared by John C. Ehlers. The existing dwelling contains a living area of 2019 sq. ft., of which 731+-sq. ft. is for the Accessory Apartment FINDINGS OF FACT In considering this application, the Board has reviewed the code requirements set forth pursuant to Article III, Section 100-31B(13) to establish an Accessory Apartment and finds that the application complies with the requirements for the reasons noted below: 1. The Accessory Apartment will have a livable area of 731+- sq. ft. within the existing single- story home. The Apartment unit will be in conformity with the 40% size limitation of the zoning code, based on the size of the 2019 sq. ft. of the principal building footprint . 2. Matthew and Alexandra Ninfo acquired the property on February 12, 2003. Mr. and Mrs. Ninfo will continue to occupy the dwelling as a principal residence while the accessory Page 2—December 2, 2004 ` SE #5606—M. and A. Ninfo CTM 103-14-2 apartment is occupied as a single-family unit. 3. The applicants' plans comply with the on-site parking requirements and provide for a total of four (4) parking spaces, two for the principal use and two for the Accessory Apartment, and assure that parking will be maintained at all times on site. 4. The applicant complies with the requirements of a dwelling unit as defined in Section 100-13 of the Zoning Code. The existing livable first floor is 2019 square feet. The applicants confirm the floor area of the apartment at 1181 sq. ft. 5. The plans indicate that exterior entry to the Accessory Apartment of the existing one-family dwelling will retain the existing appearance of a one-family dwelling. REASONS FOR BOARD ACTION DESCRIBED BELOW: Based on the testimony, documentation, and other evidence, the Zoning Board determined the following Findings of Fact to be true and relevant: SPECIAL EXCEPTION 1) The Accessory Apartment, as applied for, is reasonable in relation to the District in which is located, adjacent use districts, and nearby and adjacent residential uses. 2) The Special Exception use is accessory to the principal use and will not prevent the orderly and reasonable use of adjacent properties. 3) This accessory use will not prevent orderly and reasonable uses proposed or existing in adjacent use districts. 4) No evidence has been submitted to show that the safety, health, welfare, comfort, convenience, order of the Town would be adversely affected. 5) This zoning use is authorized by the Zoning Code through the Board of Appeals, as noted herein, and a Certificate for Occupancy from the Building Inspector is a code requirement before an Accessory Apartment may be occupied. 6) No adverse conditions were found after considering items listed under Section 100-263 and 100-264 of the Zoning Code. 7) A Certificate of Compliance or similar document will be necessary for issuance by the Building Inspector certifying that the premises conforms to Ch. 100 of Zoning for an Accessory Apartment use. RESOLUTION: On motion by Member Goehringer, seconded by Member Dinizio, it was Page 2 of 3 'Page 3—December 2, 2004 SE#5606—M. and A. Ninfo CTM 103-14-2 RESOLVED, to GRANT the Special Exception application for an Accessory Apartment, to be used only in conjunction with applicant-owner's occupancy as his/her residence, as applied for, SUBJECT TO THE FOLLOWING CONDITIONS: 1. Owner(s) shall occupy the dwelling as their own principal residence. 2. There shall be no backing out of vehicles onto the street. 3. A Certificate of Occupancy or written compliance document shall be obtained from the Building Department before occupancy of the Accessory Apartment. Vote of the Board: Ayes: Members Oliva (Chairwoman), Goehringer, Tortora, and Dinizio. (Absent was: Member Orlando). This ResolutiQrLwas duly adopted (4-0). � L C%L RUTH D. OLIVA, CHAIRWOMAN 12/7/04 Page 3 of 3 • �ROBERT O'BRIEN P.E. CONSULTING ENGINEERING SERVICES 0 N 3 2074 MAIN ROAD, P.O. BOX 456, LAUREL, NY 11948 631-298-5252 October 13, 2003 Town of Southold Building Department Town Hall Southold, New York 11971 Ninfo Residence 3600 Pequash Avenue, Cutchogue, New York Gentlemen: Please find below the proposed scope of work for the above-captioned residence: Scope of Work (1) Replacement of existing 2'8" x 6'8" exterior door at south side of the house with a new Anderson C13 casement window unit 2'4-3/8" x 2'11-5/16". (Use existing header, reduce opening with wall studs each side.) Provide 1/2" plywood hurricane shutter with hardware. (2) Demo existing kitchen cabinets and serving bar. Install new cabinets, approxi- mately same layout, plus center island (copy of drawing attached). (3) Electrical: (a) install new G. F. I. outlets at counter. (b) relocate lighting fixtures. (c) upgrade electrical service. (4) Plumbing: (a) alter plumbing water supply and waste lines for new kitchen sink. All of the above work is to be performed in accordance with all State and local Codes. A lead and electrical underwriters certification will be filed when the work is com- pleted. - 2 - Also 2 -Also applied for as-builts, as shownn drawin �92 �- 6e a pantry conversion to a kitchenette and garage conversion to a den/bedroom. This work was performed prior to the Ninfos ownership of the property. Sincerely, PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE ATE OF OCCUPANCY Robert O'Brien P. E. SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 OF 1% LEAD. UNDERWRITERS CERTIFICATE REQUIRED OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY gL, APPROVED AS NOTED DATE: 3 B.P.# a 8'/ FEE: .3'V BY: NOTIFY BUILDING DEPARTMENT AT 765.1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REWRED FOR POURED CONCRETE 2. ROUGH - FRAMING & K M SING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REWREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. • t f�"�n��;�.,�• Sheet 1 €` Residential Trade-Off Worksheet Envelope 2002 New York State Energy Conservation Construction Code —Bailder Name: Date: J9� A-404AAdef-Address: c .v Building Address: re5o Ar te.'Aff A; AL.,& el Project Description G « C�y�.t.r�,,,� ,Oie,� Zone#/— // Submitted By: /�,rA� Phone#: 2y¢ --Szs2 PROPOSED REQUIRED U-factors and F-factors can be found in Tables 1.10 Ceilings,Skylights,and Floors Over Outside Air Description Insulation U-factor x Area =UA Required x Area =UA R•value Uyfactor Ceiling r •a ft2 . 0, ft2 4- Floor Over Outside Air ft2 Skyfight ft2 ft2 ft2 Ceilings: Total Area ft2 Walls,Windows,and Doors Description Insulation U-factor x Area = UA Requtred>U- x Area = UA .R We- factir: Wall - ft7 ft2 Window ft2 Door .' Q ftr Sliding Glass Door V-; ft2 ft2 Walls: Total Area ft� Floors and:foundations Description Insul- Insulation U•factor x Area = UA Regjuired U- x Area = UA Depth R-value fit r'' Floor Over unconditioned ft2 ft2 Basement Wall ft2 ft2 Unheated in Slab <.�2I. e Heated Slab in ft2 ft Crawl Wall in ft2 ft2 Total Pro posed Total Required UA . d Total Proposed UA must be less than or equal to the Total Required A Statement of Compliance: The pr building design represented in these documents is consistent with the building plans,specifications,and other calculations submitted with the permit application 0 g has bee esigned to meet the requirements of the 2DO2 New York State Energy Conservation Construction Code. igner Company Name Da New York State Department of State Code Enforcement Applicant/ Date, Owners Name: _>X 4 Reviewed: Architect/ Date Engineer: Submitted: 'o SCTM #: District: 1.000 Section: /03 13lock: -- Lot: ooh Project UZ7 Subdivision Location: Name: I Sin&le & separate RequirrdL certification: (Yes/No)e-?/A� Req• 7 Req. — Zoniog bisvicl: (I,ol size: _ Actual: v 3 I Ii coverage I roposcd� Rcq. q, / A Req` (I'ron(Yard Proposed : �x Proposed: J (Rear Yard Proposed Project Description: AGENCWERMITS _Permit REQUIRED 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: X � � ► 'All 7-11 �.C�OSS .20A0 r Ice.2 N ` M N M \ 4 W � fJ.vllG C iNG m I m \hy`* v JA5 Q d 0 s.y• ar.e ' F�gUG �c%vii/E moi!�EN�.•4.C�/ct/ - . 167 ( I Z 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING KFINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION lz �`'"'"� - REMARKS: - DATE / '-/ l � �� INSPECTOR ' � - pb FIELD INSPECTION B$POR'E DATE OONIlVIENTS „. FOUNDATION OSID rA FOUNDATION(2ND) �Y rn •ROUGH FxAMWG& y PLUMBING INSULATION PER N.Y. STAT]ENERGY COD] Le FUSUL ADDITIONAL CONMnDm O, O z TOWN OF SOUTHOLD 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. ��I�/�' Check Septic Form N.Y.S.D.E.C. _ Trustees Examined /O�IS 20 d 3 Contact: n Approved %v//6 120 63 Mail to: / AAitr-2,gAj1^w *X Disapproved a/c ^O QaX ¢.t'e- A/r'• AriitO Phone: ♦ - Expiration /Cv ,20.9j, — ,� 9�► S s Z ��-iC.f✓.=. —�Building Inspector z APPLICATION FOR BUILDING PERMIT Date Gkc.f /3 ,20 03 INSTRUCTIONS a. This application 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 Oe 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. 0 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 Buildiapg 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'Southola, 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. ignature of applicant or name,if a corporation) (Mailing address of applicant) W* • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumbef or builder etias ,,,w ArO — Name of owner of premises /1; A–.0 AZjrx.e...D.ta A,00 0,)OW (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: House Number Street Hamlet OYJFM A" *own"to etatd,Dkwq VNW OMO N16A to .0" County Tax Map No. 1000 Section �lfc� Block / ""XXL btt bedilsu0 Subdivision Filed Map No. • (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,X,gz�ao,.,or• b. Intended use and occupancy �f.a�t�Ds�.cr, 3. Nature of work(check which applicable):New Building Additi n Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 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'j Rear ,:rf Depth ¢a Height l¢ Number of Stories Dimensions of same structure with alterations or additions: Front Sof' Rear :rT Depth 4AI Height 14 Number of Stories / 8. Dimensions of entire new construction: Front &'r —Rear--A7—Depth 4E L Height /or Number of Stories /' 9. Size of lot: Front A" Rear /o• Depth �Sa 10. Date of Purchase /l oS Name of Former Owner /04-cot— fo�,�-�•� Aft 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO t 13. Will lot be re-graded?YES NO Will excess fill be removed from premises? YES NO 14.Names ofW)47remisesti -&,Aa Address��r4~ A, PhoneNo.Name of /C o ' ei!'i*.✓ Address?a 2¢ �-.....e�Phone No, •-"S2A2 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 R> UIRED. 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) pp SS. COUNTY OF A4J4, GQiT,r,r :�2 1 A&4.,", /-1•0; being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing 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 work will be performed in the manner set forth in the application filed therewith. 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