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HomeMy WebLinkAbout29831-Z FORM NO. 4 TONIN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30844 Date: 04/06/05 THIS CERTIFIES that the building ADDITION Location of Property: 400 TONIN CREEK LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Nap No. 473889 Section 64 Block 1 Lot 14.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23, 2003 pursuant to which Building Permit No. 29831-Z dated OCTOBER 23, 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 DECK ADDITION TO EXISTING COTTAGE AS APPLIED FOR. The certificate is issued to PHILIP STANTON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3503-A 01/16/04 PLUMBERS CERTIFICATION DATED N/A \ tho zed eignature Rev. 1/81 Form No.6 �l TOWN OF SOUTHOLD BUILDING DEPARTMENT I i JR 5 7005 I' TOWN HALL 765-1802 0 0, _CE — ,_Qvv_SF_ 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 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 I. Certificate of Occupancy-New dwelling$25.00, Additions to dwelling$25.00, Alterations to dwelling$25.00, Swimming pool $25.00, Accessory building$25.00, Additions to accessory building$25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. New Construction: t/�/ �T Old or Pre-existing Buildin�g:[� / (check one) Location of Property: ( CJy �9 co � C e Q � o ouse N Streqt Hamlett Owner or Owners of Property: h Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. ( 03 Applicant: l� Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ✓ (check one) 00 Fee Submitted: S � Applicant Signature C pc G `19 21 CO -E 309 V 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. 29831 Z Date OCTOBER 23 , 2003 Permission is hereby granted to : PHILIP STANTON 18 ORCHARD STREET APT 5 NEW YORK,NY 10022 for DECK ADDITION TO AN EXISTING COTTAGE AS APPLIED FOR at premises located at TOWN CREEK LA SOUTHOLD County Tax Map No. 473889 Section 064 Block 0001 Lot No. 014 . 006 pursuant to application dated SEPTEMBER 23 , 2003 and approved by the Building Inspector to expire on APRIL 23 , 2005 . Fee $ 150 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 Nassau Suffolk Electrical Inspections, Inc. 5A Canal Street • Center Moriches,New York 11934 • Tel: 631-878-3500 •Fax: 631-878-3764 Application: 3503-A Date: 1/16/04 Issued to: Stanton Address:. Town Creek Lane Village: Southold Introduced By: EECO Elctric Lic#:2781-E was examined and approved up to the above date and was in compliance with the NEC MC 1st Floor® Rmidertial® Fboi Det Garage BasmwtlZ1 2nd floor 91 Camendal Flat Td) PJAM Switches Receptacles Fixtures G.F.I. microwave Whirlpool 28 16 19 7 1 1 Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon Range/Amps Monoxide 4 1 1 1 2 Furnace Oil Water Healer Heal Zones Smoke Bell Detectors Transformers 2 1 5 Meter Amps Phase Motors 1 1150A UG 1 1 Other Equipment: cottage ut,Res This certificate must not be altered in any manner 765-1802 BUILDING DEPT. NSPECTION /FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL � [ ] FIREPLACE & CHIMNEY [ ] FIRE FETY INSPECTION REMARKS: DATE e INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOU�IBATION 1 ST [ ] ROUGH PLBG. [� FOUNDATION 2ND [ ) INSULATION [ .J�iMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION 41; �PREMARKS! - DATE INSPECTO g (D:INS�ELTIOS�BEEORE DATE 0011 FOUNDATION(IST) m FOUNDATION OND) 1 'I O 5 � ROUGH F$AXMG.& �3 YLUN MQNG C 3N&ULATION FM N.Y. STAT&Bran&"CODE � FINAL ADDITIONAL CONIlIZE M s 0 m S p x 0 JWN OF SOUTHOLD r Yz n , BUILDING PERMIT APPLICATION CHECKLIST UILDING DEPARTMENT Do you have or need the following,before applying? OWN HALL 3 M Board of Health IOUTHOLD,NY 11971 3 sets of Building Plans fEL: (631) 765-1802 Planning Board approval FAX (631) 765-9502 �_---.- -, Survey www.. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined Jn Ga 3 ,2003 Contact: Approved /06t3 ,2003 Mail to: i Disapproved a/c Phone: ` Expiration :).3 ,20 0 n 179 -7 9 Building Inspector APPLICATION FOR BUILDING PERMIT Date —, 20— INSTRUCTIONS 20INSTRUCTIONS 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. �V The work covered by this application may not be commenced before issuance of Building Permit. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall bFtept 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 (�itllu ( L. (Signatt(uriof applicant or name,if a corporation) �QO(2rEatl.1' luau rllh Y (Mailing address&applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder l--, C il\ef6U Name of owner of premises (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. Loca//tiio�on of land on why proposed work wil be one: //00 / 7 ) X( feQ G �tt�Gf�oIGY House Number Street Hamlet ` County Tax Map No. 1000 Section („ 'Y Block_ Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises antended use bpd occupancy of proposed construction: a. Existing use and occupancy S Tff �ra. ,ti n^ VN( " ,.,4 b. Intended use and occupancy 5 r .. cl o - a AI' .1 l7C 2 3. Nature of work (check which applicable): New Building Addition ✓ Alteration Repair Removal Demolition Other Work mo (Description) 4. Estimated Cost `]COD 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. ' I 7. Dimensions of existing structures, if any: Front �K Rear 3 Depth 3 Height /X t Number of Stories Z Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 't 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 ✓ Will excess fill be removed froremises? YES_NO emR 14. Names of Owner of premi es .S Address k d Phone No. l0 Name of Architect Address ( Phone No Name of Contractor r Address Phone No.S(is 9-1 0 ?A'25- 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 ' "1 1e L C_ I W tt^�F t1 P I- s ( being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing co tract)above named, r (S)He is the `- . y� lV Gt CZ 1- (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 this ( A I ri1.3A! day of�t�20 0 3 1 �V�/ ` Notary Pfiblic §ignature of Applicant LINDA ST0e�NOW Y Notary Public. Sut{otk courZtV � No 74821563,Su.0 ��i$ Serra,t-xP 5UR\/EY OF LOT 4 --- - --- --- --- _ _- - - - - A5 SHOWN ON MAP OF LAND SHONINCG PROPOSED 5UBD 11/1 S 1 ON MADE FOR HELEN M. LATSON APPROVED BY 5OUTHOLD, TOWN PLANNING BOARD, MAY 13, 1 q-71 II 151TUATE: 50UT40LD jTOWN: 50UTHOLD SUFFOLK COUNTY, NY 5URVEYED 09-23-02 - - -- - � 15UFFOLK COUNTY TAX # (Port of 1000-64-1-14.4 r9 \0 C <.O s O�. I F ip� 'n r • v O` °3 601 — gpg',TA"8 3,3p^B 85 e � 3 t1'i�,�ap•, $ �g05 01 r r 1 e � r , ✓ r e apP n . , 9" — ac (n w000� Fevre e ✓ F III - r N860 42, 0 169.61 yi✓ Lance N ,. ^ b ^r N✓ P tante" e Jenn�Fer amberis Sta T a, nt�r� y, z� d� iW r ^J " .74' S8502552W r I !Z • Lot r r � � v O ro ;a ti = z E =.T - r r r, �T to R/ f-o Genoa .... ..... .... _ `0"Sto"-, C"rar„ 71, ab��24 0 �rcaF��. Tp ' A tDn �� C Adchty r1 ��FK of NowOF Nf Citibmk N A fC. Ey,w/' cq NOTES: a MONUMENT FOUND O PIPE FOUND nFI 02 A STAKE FOUND ,- ,,. sF0 LAND s AREA = 41,155 SF OR 0.96 ACRES JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 j GRAPHIG 56ALE 1"=IF--40' _ RWERHEAD,N.Y. 11901 „ 369-8288 Fax 369-8287 REF.\\IIp server\d\PROS\02-290.pro � �`� �� 51TUATE: 5OUTHOLD ®� 5U FOLK COUNTY Y TOM 5OUTHOLD W E SURVEYED 09-23-02 S SUFFOLK GOUNTY TAX u 1000-64-1-14.4 CERTOW TO: Mlennif e; B.smMtau St anm a. own Peconic AbWact,Inc. MddUy Natiaod r9le ban== Company of New Yock ® Ckfl mk N.A. tn W G "V) u v� Land GrIU U{ or>.e^'?e�,'v y o Form'vn iCr A � / o.. e y of 9 3 W0p00m / 0 uf 3 v 3 3 I / , ✓„ m, p F'Pi i I M 1 O' Q z1 O �a N86°42 oVil F�-E ' vw 1 .61• 'r �o- �'✓°dam •`L QVOVB N M� W�°�1'00"8 91.70' 2Av/06 o n ciQ 1 — 1 �\ L craw IIII Ban INo Iw , o Lo ® 3L jw REF L.Ipg BAK Lor _ SiqnCp Bp(, Of added 03-I9-03 CR \ ■ MONUMENT FOUND - D, O PIPE FOUND V/f >RGEL AL50 APPEARS AS LOTS 3, 4 b 5 ON A MAP - = PROPOSED SUBDIVISION FOR HELEN M. LATSON ' R. VANTUYL. APPROVED BY THE THE SOUTHOLD (3F NC , JINN PLANNING BOARD, MAY 13, 1971. G. Ey =ED REFERENCE L. 10528 c.p. 414 REA = 120,814 a.f- or 2.11 acres JOHN C. EHLERS LAND SURVEYOR t�uran.naea.o,..w.xq+v u,a ua n n •.� ��nM SURVEY OF LOT 4 A5 SHOWN ON MAP OF LAND SHOWING PROPOSED SUBDIVISION MADE FOR HELEN M. LATSON APPROVED BY SOUTHOLD, TOWN PLANNING BOARD, MAY 13, Ict-71 SITUATE: SOUTHOLD TOWN: SOUTHOLD N I SUFFOLK COUNTY, NY0 4 2003 J E I (SURVEYED OG-23-02 15UFFOLK GOUNTY TAX a I (port of 1000-64-1-14.4 S r 9 3L C Q N O 7 T �� Jy r nnLL � r Q apt 1�Dom• X� '�.�y �_ NO �0.1 V o� 41 � I 13 1-04 e � y r l G a "w69.61 o e 1 III r.� W✓ Lona`Naw cr Fcrm Philip 6 Stanton q Jenn,Fer Lornberts Stantor�� �a 95.74' S85e25'52"W - to Lot P I , eo RoUrt / s venue \^� LOn' f n✓J CaOn5tanra cn,t,e - � ti Ne i Philip B.Smnwn Fiddity NM=d IWC �EFK �F NEN, Cifibmt Nof New York .A 0. APs 9� NOTES: MONUMENT FOUND p PIPE FOUND O A STAKE FOUND T- sF0 LAND SJP AREA = 41,735 SF OR O.q6 PGRES Tr JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 6RAPHIG SCALE I '= 40' RIVERHEAD,N.Y. 11901 — -- — —--= 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\02-290.pro STANTON COTTAGE DECK 400 Town Creek Lane Southold , New York SCALE: %'=1' August 21, 2003 i 10 ' BRco Door �pF NEwYp Fisc q� LU • 0525 y 8" concrete pier ss�oNP Joseph Eischetti Professional Engineer 1725 Hobart Road Southold, NY 11971 18 (631)765-2954 IE as 10� 2"x8" girders y2" lag screws 4"x4" saddle bracket 1 ' - 9 " Grade FNEy, 3 P� 1scyF y0. r� r 9 ;. 8" d1a. son � tube O NO• s �o � O i aFES510NP� Joseph Fischetti STANTON COTTAGE DECK Professional Engineer 400 Town Creek Lane 1725 Hobart Road Southold, NY 11971 Southold , New York (631)765-2954 August 21, 2003 SCALES �"=1' 2 ?on9 TYPICAL DECK WIND UPLIFT REQUIREMENTS HEADER GIRDER CONNECTIONS: USE THE FOLLOWING USP BRAND OR APPROVED EQUAL GALVINIZEb DECK HEADER UPLIF METAL CONNECTORS WITH THE RECOMENDED FASTNERS AND SPAN SPAN Ibs, INSTALLATION BY MANUFACTURE. i 6' 11408 PRODUCT DESCRIPTION PLIF GALV, MINIMUM P' 1878 NUMBER lbs. FASTNER REQUIRED 20 10' 281 7 PBS44 4x4 1815 POST':, 41a) 1.601 M. NAIL ' 12' 2817 POST- CAP BEAM: (127 1601 'COM. NAIL ' 6' 1859 PBSE44 4x4 POST: (8) 16d C M. NAIL 28' 8' 2479 ENDPOST CAP 1430 BEAM: (8) 1601 COM. NAIL 1.0' 3098 ' REAM/GIRDER "(2) ' /8' B L'TS 12' 3718 KC44, 4x4 COLUMN CA 3265 POST/COLUMN, (2) 5/8' DIA. BOLTS 6' 2310 36' 8 3081 1 PAU44 4x4 2240 FOOTING/PIER 5/8'x7' ANCHOR 05LT 10' 385111 12' 4621 POST ANCHOR POST/GIRDER1 (12) 16d COMMON NAILS CBE44 4x4" 3585 WET POST ANCHOR COLUMN BASE POST/GIRIIER> (2) IIP' DIA, BOLTS UPLIFT CONNECTIONS FOR; KCB441 4x4 5650 WET POST ANCHOR JOISTS-TO-GIRDER / HEADER COLUMN BASE POST/.GIRDER: (2) 5/8' DIA, BOLTS DECK CONNECTION MIN., 801 NAIL 6x6 POST; (12) 1601 COM. NAIL ° SP^^I CAPACITY REQUIRED PBS66 1815 vp _ POST CTAP BEAM: (12) 1601 ,COM. NAIL I 12' 427 lbs. 4 PBSE6fi 6x6 1430 POST: <8) 1601 CUM. NAIL °. 16' 526 ,lbs. 5 END POST CAP (BEAM: (8)" 1601 COM. NAIL b 20' 626 lbs, 5 KCC66 6x6 5225 B A /G RDER+ ) 5/8 BOLTS o _ 241 726 lbs. 6 COLUMN CAP POST/COLUMN: (4) 5/8' DIA, BOLTS a IIIII� ft1111�1{�,1 �i , IN7111- =11 TIlsll�: 28' 826 'lbs. 7 TYPTQAL DECK 32' 92: lbs. 8PAU66 6x6 2350 FOCI INCMER: 5/8'x7' ANCHOR BOLT �^ 7 POST ANCHOR POST/GIRDERt ,(12) 1601 COMMON NAILS N.T.S. 36' 770bs, CBE66 6x6 3570 WET POS RNCHOR ', COLUMN ,BASE POST/GIRDER+ (2) 1/2` DIA. BOLTS APPROVED AS NOTED KCB66 6x6 5640 WET POST ANCHOR DATE: o y1 3 B.P's COLUMN RASE POST/GIRDER:' (2) 5/8' DIA, BOLTS • *' FEE: BY: L NOTIFY BUILDING DEPARTMENT AT Q� RT10 TY-DOWN 585 JOIST: (6)801 COMMON NAILS ass-1eo2 8AM TO 4PM FOR THE ANCHOR HEADER/GIRDER (6) 8d COMMON'NAILS FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ALT. RT20 TY-DOWN 1105 JOIST+ (9) 10x1-1/2 NAIL,> FOR POURED CONCRETE ANCHOR HEADER/GIRDER: (4)' 10d COMMON NAILS Z• ROUGH - FRAMING a PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST ALL CONSTRUCTION SHALLBE COMPLETE FOR C.O. ALL SHALLMEET THE REQUIREMENTS OFTH! EQUIREMENTSTION S OFTHECOD E THE INSTALLATION iJOTES: ET OF NEW 1). ALL POSTS TOI BE ANCHORED TO FpOTIN6 OR PIER WITH POST ANCHOR CODES OF NEW YORK STAfC YORK STATE. NOT RESPONSIBLE FOR ' DESIGN OR CONSTRUCTION ERRORS. 2). HEADER & GIR'DER :CONNECTIONS TO BE ATTACHED TO EACH POST WITH POST CABrOODZONE 3), EACH JOIST TO BE ANCHORED TO GIRDER OR HEADER WITH ' TY-DOWN STRAPS, COMPLY WITH C A. 'Fq 46 UW AGFF���dE.N '�,N pf NEgr JOIST HANGERS TI❑ BE ATTACHED TOA PT LEDGER BOARD THAT IS TO BE BOLTEDIlf Y ' TOl^rN OCCUPANCY OR USE IS UNLAWFUL °. 06 TI,nl IT CERTIFivn t E l 1 SURVEY OF PROPERTY N �L®XD SITUATE: SOUTHOLD TOM OUTHOLD SUFFOLK COUNTY, �NY W E SURVEYED D9-23-02 s SUFFOLK COUNTY TAX u 1000-64-1-14.4 CERTMD TO: FniHp E.stantem Dennffer LamberIs St me m Pecome Abmracv Inc. EideUty Natlom"d dd¢Ve dnemtamce Cnmpeny ofPlew Yomk ® Utlbnnly N.A. SUP Q got .cam 2 115 re o$ rt ✓pe _ gat u 9 60 o 3 .w $ 11 e( s xl m m W042100"W169.61' '1, o v A a N14"21'00 !� g 20.06 S86o3 -E 91.70' 1 rzt,lslONs 4�`�2r "►{r`- - �r� � - topo added 03-19-03 704/ \_ /v 36 0 9 NATES C8 MONUMENT FOUND o FIFE FOUND n_ PARCEL AL50 APPEARS AS LOTS 3, 4 6 M. A A MAP \ OF PROPOSED SUBDIVISION FOR HELEN M. UTSON TO IN FLANNIVANTUYL APPROVED BY THE THE SOUTNOLD TOWN PLANNING BOARD, MAY 13, 1991. "r HI�J, G0 DEED REFERENCE L 10525 c.p. 474 T ,>� AREA = 120,874 s F or 2l9 acres ..... JOHN Co �EBLERS LAND SURVEYOR s Ly� L. _ �,;�Fa;,;gg;, 6 EAST MAINSTREET N.Y.S.LIC.NO 50202 6RAPHIG SGALE I"=40' ��' ;!�' - RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REFA\Hp smerkAPR0S{02-290a.pm 1 iak.' 11y V 7—� —11174,1U. - Applicant/ Date. IY3 Owners Name: _ Reviewed: Architect Date Engineer: ftIW Submitted: SCTM #: 49 District: 00 Section: Wock: Lot: Proaject Subdivision I,.ocation: Name: Single g separate Required certification: (Yes/No l Jf `r_ Req. Req, %oning Oiurim L0 (Lot size: OOi_d'Q'9 Actual: I (Lo coverage I rup<se� Req. , ' Req. �f iReq. (I`? —%Lpo onl Yard _Prosed:�^ I [Side Yard 3 Proposed.3 �0 i (Rcar Yard ,,/�. Proposed Project Description: i.C.� AGE_NCYJERHITS Permit REOUTRED FOR REVIEW N.A. NO VES Numbr Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Plaming Board approval: Flood Plane Elevation??? Flood Zone: Notes,