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Home My WebLink About28213-ZFORM NO. 4 TOBFN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29853 Date: 11/19/03 THIS CERTIFIES that the building Location of Property: 22540 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 18 Su]odivision Filed Map NO. -- ALTERATIONS ORIENT (STREET) (HAMLET) Block 5 Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 15, 2002 pursuant to which Building Permit No. 28213-Z dated ~RCH 19, 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 INTERIOR ALTERATIONS TO AN EXISTING TWO STORY SINGLE FAMILY DWELLING WITH NON-HABITABLE ATTIC. · ~ne certificate is issued to ROBERT EHRLICH of the aforesaid building. (OWNER) SUFFOLK COUNT"f DEPARTMENT OF H]~ALTH A~PROVAL ELR~-rKICAL CERTIFICATE NO. PLUMBERS CERTIFI~_ATION DAT~ 11/14/03 Rev. 1/81 N/A 1060490 10/20/03 ROBERT VAN ETTEN orlze atuie 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. 28213 Z Date MARCH 19, 2002 Permission is hereby granted to: ELIZABETH THOMPSON A/C ELRICH PO BOX 464 ORIENT,NY 11957 for : INTERIOR ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 22540 MAIN RD ORIENT County Tax Map No. 473889 Section 018 Block 0005 Lot No. 005 pursuant to application dated MARCH 15, 2002 and approved by the Building Inspector. Fee $ 285.30 COPY Rev. 2/19/98 Form No. 6 TO'~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled itt by typewriter or ink and submitted to the Building Department with the tbllowing: A. For new building or new use: 1. Final sup/ey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic fea'tu, res. : . 2. Final Approval fron't ~°¢.lth Dept. of water suiSply and sewerage-disposal (S-9 for,~.' 3. ,Ap, l~[0val of electrical mgLallation from Board of Fire Underwriters. 4. S:-/om statement from plumber certifying that the solder used in system comaius less than 2.,10 of 1% lead. 5. Conunercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible tbr 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 unnsual 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, Swinuning 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, Commemial $15.00 New Construction: Location of Property: Date. Old or Pre-existing Building: House No. Street Owner or Owriers of Property: ~O/"~' ~ Suffolk County Tax Map No 1000, Section t~ / _~' Block Subdivision Pernfit No. ~ ~:~"~,~ ,/.~ Healtt~ Dept. Approval: Platming Board Approval: Request for: Date of Pernfit. Temporary Certificate (check one) Hamlet Fee Submitted: $ Filed Map. Applicant: Underwriters Approval: Final Certificate: Lot: (check one) Apphcant Signature Town Hall 53095 Main Road P,O. Box 11'/9 8outhold, New York 119'71-0959 Fax (631) 765-18 Telephone (63l) 765 BUILDING DEPARTMENT TOWN OFSOUTHOLD CERTIFICATION I certify that the solder used in the water supply system con 'tains less than 2/10 of 1% load. (Plumbers'gignat~e) BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by C-CAT CO. ROB EHRLICH 9280 SOUND AVE. 22540 RT 25 MATTITUCK, NY 11952, ORIENT, NY 11957 Located at 22540 RT 25 ORIENT. NY 11957 Application Number: 1060490 Certificate Number: 1060490 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting electrical devices and wiring, described below, located in/on the premises at: Basemeut, First Floor, Secoud Floor, Outside, was inspected in accordance with the National Electrical Code and toe detail of the installation, as set forth below, was · . . 20th OctoUer, 2003. found to be ~n compliance therewith on the Day of Name QTY Rate Ratin~ Circuit Type Miscellaneous 2-30 amp compressers Alarm and Emergency Equipment Sensor 4 0 Smoke Sensor 2 0 Carbon IVlonoxide Appliances and Accessories Exhaust Fan 1 0 F.H.P. Wiring and Devices il 0 GeneralPurpose Receptacle Switch 18 0 General Purpose Fixture 22 0 Incandescent Fixture I 0 Fluorescent Dinmaers 6 0 Receptacle 2 0 30 amp Appliance Receptacle 1 0 40 amp Range Receptacle 3 0 20 amp Appliance Discmmect 2 0 30 amp Motor Control seal 6 0 GFCI Receptacle Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by C-CAT CO. 9280 SOUND AVE. MATTITUCK, NY 11952, ROB EHRLICH 22540 RT 25 ORIENT, NY 11957 Located at 22540 RT 25 ORIENT. NY 11957 Application Number: 1060490 Section: Block: Lot: Certificate Number: Building Permit: 1060490 BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Second Floor, Outside, was inspected in accordance with the NationakElectrical Code a~d the d~,~iJ of the installation, as set forth below, was found to be in compliance therewith on the Day of Name QTY Rate Rating Circuit Type Service 3 Phase 4W Service Rating 200 Amperes Sen, ice Discotmect: 1 200 cb Meters: I sea! 2 of 2 This ceRificatemay not be altered in anyway and is validated only bythe presence of a raised sealatthelocation indicated. Elizabeth Thompson, Architect 250 M~rcer Street, Suite B 806 New York. New York 10012 Tel/Fax 2t2.614-7180 ETArc~ec't~nyc. rr. com J~e29,2~3 Michael Verity South, old Town Hall Fax 631-765-9502 Dear Michael, I received word today about a stop work order on 22540 Main Rd, Orient. The owner has requested that I submit ~me revised drawings needed to comply with your request. This is to inform you that lwill be out of the country for the next 7 days, and ~o will be unable to respond to your request until the following week. At that time I will call you to make an appointment to review the requested information. Sincerely, ~-~ Eii~_a~th Thompson Cc: D. Finne, R. Erlich TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF REVOCATION DATE; July 11, 2003 TO Robert Ehrlich 100 Roslyn Avenue Sea CliffNY 11579 Please take notice that your pelmit #28213 For permit to renovate an existing one family dwelling Location of property 22540 Main Road Orient NY County Tax Map No. 1000 - Section 18 Block 5 Lot 5 Subdivision Filed Map # Lot # Is returned herewith and revoked on the following grounds pursuant to Chapter 45 Section 45-12A which statesi § 45-12. Revocation o fbuildin~ permit. The Building Inspector may revoke a buildin~ permit theretofore issued and approved in the follmving instances: A. Where he finds that there has been any false statement or misrepresentation as to a material fact in the application, plans or specifications on which the building permit was based. Pernfit issued for renovation to an existing one family dwelling:. Due to subsequent amendments to the plans submitted, actual construction observed, correspondeuce and conversation, it has been determined that the scope of the project has changed and represents a change to a commercial use of the property. Pursuant to Town Code a commercial project requires Pl,'mning Board Approval prior to the issuance of a Building Permit. No such approval has been granted nor applied for. cc: Cert Mail. Town Board Town Attorney Planning Board MEMORANDUM TO: FROM: DATE: RE: Mike Verity, Building Department Damon Rallis, Plans Examiner Ed Forrester, Code Enforcement June 24, 2003 Ehrlich Property, 22540 Main Rd. Orient, SCTM#1000-18-5-5 I was called to the above site on a complaint that C&D debris had been dumped on the lot as driveway material. An examination of the material reveals it is indeed C&D a non- permitted substance. While there, I approached the front door from the porch and observed the inside of the front room. It has been configured and appliances installed that are consistent with a commercial use. I examined the most recent amended plans submitted to your office, as well as a letter from the architect stating that the applicant is intending a commercial use. The plan no longer resembles a one family dwelling as originally approved. I request a review of the permit file by your office to determine if the proper approvals are in place for this type of use and for construction to continue. COUNTY OF SUFFOLK Robert J. Gaffney SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES UNDA MERMELSTEIN, M.D., M.P.H. Acting Commissioner June 12, 2003 Mr. Michael Mapes 163 Peninsula Path Riverhead, NY xxgo~ Subject: Variance/Waiver Request C1o-o2-oox6 ~ Orient Coffee Company, s/w/c Village Lane and Route 25, Orient - t/o Southold - SCTM: #[ooo-18-5-5 Dear Mr. Mapes: Your request to appear before the Board of Review of the Suffolk County Department of Health Services has been received. The rex4ew of this case has been scheduled for July lo, 2oo3 at ll:o0 a.m. in the Suffolk County Department of Health Services' Conference Room, County Center, Room S-238, Riverhead. You and interested parties are requested to appear, with or without counsel. On that occasion, you may produce any information or e~idence you wish to be considered concerning the above- referenced property. Should you have any questions, please call (631) 853.3o86. Very truly yours, ~,' ~ ~ ~_ Stephen A. Costa, P.E. Chairman - Board of Review $outholdTown Plannmx Board SAC/kn C: Martin Trent Donald VanDeWater James Bagg ~ Planning Department Bruce Williamson ~ SCDHS Valerie Scopaz ~ Town of Southold Robert Erlich John Fitzgerald ~ SCDHS · Board of Review · Suffolk County Deparlment of Health Services 220 Rabro Drive -Hauppauge, NY 11788 (631) 853.3086 ~ Fax: (631) 883.3075 I 5 '2903 August 4, 2003 Mr. Michael Mapes 163 Peninsula PAth Riverhead, NY 11901 COUNTY OFSUFFOLK ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE Subject: Board of Review Heating - July 10, 2003 C10-02-0016 - Orient Coffee Company, s/w/c Village Lane and Route 25, Orient - t/o Southold SCTM: 1000 01800 0500 005000 Dear Mr. Mapes: Enclosed is a copy of the Board of Review's (Board) findings, recommendations and determination concerning the subject application. It was the determination of the Board to deny the request for variance as detailed in the enclosed. The proposed variance is not in general conformity with the Suffolk County Sanitary Code. Ve;cy-truly yours, Stephe/i ~ Costa, P.E., Chief Engineer Chai~an, Board of Review Board of Review File - Riverhead Mr. John Fitzgerald - Reviewer Mr. James Bagg - Planning Department Mr. Robert Erlich Ms. Valerie Scopaz - Town of Southold AUG 1 4 2003 $outhold Town Board Mr. Bruce Williamson - Div. of Public Health William & Evelyn Hines Living Trust Mr. Jeffrey & Ms. Claudia King Ms. Allyson Constant SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES DIVISION OF ENVIRONMENTAL QUALITY BOARD OF REVIEW ARTICLE 2, SECTION 220, SUFFOLK COUNTY SANIT.~RY CODE to~ Linda Mermelstein, M.D., M.P.H., Acting Commissioner From: Stephen A. Costa, P.E.~ Chairman, Board of Review Subject: Findings and Recommendations of the Review Board Regarding: C 10-02-0016 - Orient Coffee Company, s/w/c Village Lane and Route 25, Orient - t/o Southold - SCTM: 1000 01800 0500 005000 Hearing Date: July 10, 2003 Statement of Problem Construction standards require that the distance between sanitary systems and shallow private wells be at least 150 feet. The applicant is proposing installing the sanitary system less than 150 feet from a private well. Water standards require a minimum of 40 feet of xvater in a well casing. The on-site well for this project has less than 40 feet of water in the casing. Findings and Facts 1. The applicant wishes to convert an existing single-family residence to a take-out coffee bar and restaurant. 2. The parcel size is 0.28 acre and is located in Groundwater Management Zone 4. Design flow for the project is 300 gallons per day (gpd), which includes 240 gpd of kitchen flow and 60 gpd of sanitary flow. Yield at density is 84 gpd. The project conforms to density requirements. 4. Soil conditions are good, with 3.5 ft. of loam and 3.5-9 ft. of coarse sand & gravel, and sand deeper. 5. Depth to groundxvater is 16 ft. 6. The variances requested are as follows: Proposed well i. 88 feet from proposed sewage disposal system ii. Shallow, less than 40 feet of water in the well Proposed sewage disposal system i. 88 feet from proposed on-site xvell ii. 93 feet from existing well on the lot to the southeast iii.101 feet from existing well on the lot to the south iv. 66 feet from existing well on the lot to the west. Linda Mermelstein, M.D., M.P.H., Commissioner Hearing Date: July 10, 2003 Subject: Findings and Recommendations of the Review Board Regarding: C10~02-0016 ~ Orient Coffee Company, s/w/c Village Lane and Route 25, Orient - t?o Southold - SCTM: 1000 01800 0500 005000 7. According to an engineering report submitted by the applicant, groundwater flow is toward the southwest. 8. The applicant is proposing to replace the existing single cesspool with a new sewage system consisting of a grease trap, septic tank and leaching pool. 9. The proposed well will be 50 feet total depth with 34 feet of xvater in the well. Standards require at least 40 feet of water in the well. The proposed well cannot be made deeper due to the presence of chlorides. 10. Department and state health standards require that this site operate a noncommunity public water supply in order to serve the public. 11. A memorandum is on file from Robert Farmer, P.E., supervisor of the Drinking Water Unit, which states that the project is not recommended for approval as a noncommunity public water supply. This is based on the distance from the proposed on-site sewage disposal system to the well and the shallow depth of the well. The memorandum also notes that recent water analyses from nearby private wells show a general trend of elevated nitrates with some traces of ammonia, indicating possible sewage impacts to the groundwater. The memo also notes that there is a plume of contamination from MTBE south of this project. 12. A water analysis from a test well on the site showed the water met drinking water standards, although there was a trace of ammonia found. 13. A letter is on file from the Town of Southold Planning Office that states that the town did not have a site plan application pending and that in their opinion the site and location of the proposed use ,,vas insufficient to support the intensity of the change of use. Mr. Bruno Semon, senior site planner reviewer for the Southold Town Planning Board also appeared at the hearing to reinforce that position and to request a coordinated SEQRA review. 14. Two neighboring property owners appeared at the hearing and another forwarded a letter to the board. All expressed concerns over the impact a business operation on the site would have on their wells. Determination It was a 3 to 0 determination of the Board to deny the request for the variance. The Board deliberated the facts presented, in accordance with Article 6, Section 760-609 of the Suffolk County Sanitary Code requirements and concluded the application does not warrant a variance. The requested variance is from a construction standard that requires a 150' separation distance between a proposed sanitary system and drinking water wells located on adjacent property and for a shallow well on the subject property that is within 150 feet of the sewage disposal system and must be approved as a noncommunity public Linda Mermelstein, M.D., M.P.H., Commissioner Hearing Date: July 10, 2003 Subject: Findings and Recommendations of the Review Board Regarding: C10-02-0016 - Orient Coffee Company, s/~v/c Village Lane and Route 25, Orient - t/o Southold - SCTM: 1000 01800 0500 005000 water supply. The application is being denied based on our review of the criteria in Suffolk County Sanitary Code (Sanitary Code), Section 760-609(A) and the potential public health impacts of your application. Specifically, the Board of Review finds that: There are shallow wells downgradient from the proposed sewage disposal system. In accordance with §760-609A. l.b, granting of the variance would result in the uses of groundwater as a drinking water supply being impaired, taking into account the direction of groundwater flow. The proposed well is not acceptable as a noncommunity public water supply because of the proximity to a sewage disposal system and the shallow depth. Traces of ammonia were found in the test well. In accordance with §760- 609A. l.e, granting of the variance would adversely affect the design of an adequate on-site water supply, taking into account depth to groundwater, direction of groundwater flow and shallow well conditions. As per §760-609 of the Sanitary Code, the approval of the variance would not be in harmony with the general purpose and intent of the Sanitary Code to protect groundwater and drinking water supplies, surface water and other natural resources, and public health, safety and xvelfare. August 4, 2003 Stephe~A. Costa, P.E. .j Chairman - Board of Review FROM : Tlm Smultan PHONE NO. : 021856506? Edwin J. Blasch Jr. P.O. Box 430, 46 Youngs Road OHant, N.Y. 11957-0430 Tel/Fax: 631-323-3858 Ms. Elizabeth A. Neville Town Clerk Southold Town Hall 53095 Main Road, P.O, Box 1179 Southold, NY 11971 By FAX: 091-631.765-6145 August 11,2003 AUG. 11 2003 02:06PM P1 RECEIVED AUG 11 %uthold Town Cled Dear Ms. Neville; Re. Ehrlich Property, Orient I am writing to add to what must already be a large folder on the above-cited property. Since March 2002 when Mr. Ehrlich's plans were first revealed to the ~ommunity via an article in The Suffolk T/mas, not through a correct legal notice, which would have been more appropriate, there has been overwhelming opposition in Orient to his proposal(s), We realize that the Ehrllch property, through some quirk or mistake, is zoned commercial, though the property has always been used residentially. Under the previous owners, I understand that it was a legal twa- or three- family house. In a time when rental properties are scarce and the Town is twing to find solutions to lack cd'affordable housing, It is counterproductive to change a structure which could house three families into an unwanted and intrusive business. Most of us would accept an unobtrusive business there. We emphatically do not want anything Ilks what Mr. lEhflich has quietly prepared his property for. Many of us have already adequately documented our reasons for our opposition, so I will not here reconstruct them yet again, I understand that a stap-work order has been issued, perhaps a bit late since it seems the work is done, reedy for an opening. I am now In Cape Town, South Africa. I cannot monitor proceedings from acmes the road, as I usually do, both for Josh Horton and Ed Forrester. If you would like to contact me before I return in mid-September, my telephoneJFAX here from the US is 011-27-21-85e-5067. I can also be reached by e- mall: ementused~telkomsa.net I do want to take this opportunity to let you know that I appreciate your careful oversight. Thank you. I would urge you and all those departments in Town Hall that are Involved In this proposal to keep vigilant: I would also ask you to eopy this to Josh and Ed for me. Yours truly, cc. Josh H~on ~'-"~'~'-'~"~'- Ed Formater Town Hall, 53095 Main Road P.O. Box 1179 Southokl, New York 11971-0959 Fax (63 l) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 24, 2003 Robert Erlich 100 Roslyn Avenue Sea Cliff, NY 11579 To Whom It May Concern: We respectfully request that you immediately stop all work affiliated with building permit #28213, at 22540 Main Road, Orient, NY, SCTM# 18-5-5. Following a recent inspection of your property and further review of your file, it has come to our attention that you have gone beyond the scope of what is permitted by the above referenced permit. As you will recall, the permit was issued for alterations to an existing single family dxvelling, the only use for which you have a certificate of occupancy in place. It is apparent that you have changed the scope of work. As a result, you are required to gain the proper approvals before work can continue. This includes approval from the Southold Town Planning Board and, depending on the proposed use, possible approval from the Southold Town Zoning Board of Appeals. Also, we respectfully request that you clean up the construction debris that has been observed on the above referenced property. If you do not address these issues in a timely manner, further action will be taken which may result in the revocation of your permit. If you have any questions, please feel free to contact this office at (631) 765-1802, between the hours of 8:00 a.m. and 4:0(} p.m. CC: File; Ed Forrester, Director of Code Enforcement; Elizabeth Thompson, Architect Elizabeth Thompson, Architect 250 Memer Street, Suite B 806 Ne~ York, New York 10012 Tet/Fax 2t2-61'4-7180 ET.~.tr.com June 29, 2003 Michael Verity Southold Town Hall Fax 631-765-9502 ~ Michael, I received word today about a stop work order on 22540 Main Rd, Orient. The owner has requested that I submit some revised drawings needed to comply with your r~quest. This is to inform you thru I will be out of the country for the next 7 days, and so will be unable to respond to your request until the following week. At that time I will call you to make an appointmerlt to review the requested information. Elizabeth Thompson Cc: D. Finne, R. Erlich Elizabeth Thompson, Architect 250 Mercer Street, Suite B 806 New York, New York 10012 March 14, 2002 Tel/Fax 212~14-7180 ETArchitect@nyc.rr.com. Building Inspector Building Dept. Southold Town Hall Southold, NY 11971 Dear Inspector, Enclosed are 3 sets of stamped plans, a construction permit application, and a check for a minor renovation in Orient. The owner has some future plans to convert to a business use. But it is expected that planning approvals will take some time, so he wants to make some minor modifications to the building to make it more suitable for his personal use in the meantime. As always, please call with any questions. Sincerely, Elizabeth Thompson Fax (5161 765-1823 TelepBone (5161 765 - 1800 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTHOLD TOWN LANDMARK PRESERVATION eOM [!sstol' z 2 TO: FROM: DATE: RE: Southold Town Building Department Southold Town Landmark Preservation Comm. - John Greene Mamh 21, 2002 22540 Main Road, Orient SPLIA #: OR-67 Tax Map #: 18-5-5 The Landmark Preservation Commission has revie~ved the building pem~it application along with the plans for the renovation of the above mentioned property. The Commission approves the application. Thank you. 765-1802 BUILDING DEPT. INSPECTIO/N ~ ROUGH PLBG. FOUNDATION 1ST [ ]/J~OUNDATION 2ND [ ] INSULATION FRAMING I ] FINAL [ ] FIREPLACE & CHIMNEY REM.A, RKS: ~ ~',,/~ DATE 2//~/~.//~ .~.., N SPECTO.,I~~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ..] F~NDATION/2ND [ ] INSULATION FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY ~.. REMARKS:,~/~/'~,~ ~:~T~/~ ~ DATE ~1NSPECTO~~~' 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHPLBG. [ ] FO/~DATION END [ ] INSULATION [ ~//FRAMING [ ] FINAL [ ] FIREPLACE &.CHIMNEY DATE ~~~NSPE~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND I ] INSULATION [ ] FRAMING [ ] FINAL ~R~:] FIREPLACE & CHIMNEY DATE /¢~/~ INSPE~O~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [_ ] INS~JLATION [ ] FRAMING [-- ] FINAL []FIREPLACE&CHIMNEY INSPE~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING ] ROUGH PLBG. [[ ]~ULATION [///l FINAL [ ] FIREPLACE & CHIMNEY / · 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO~)Lr~G. [ ] FOUNDATION 2ND [ ] I~ULATION [ ] FRAMING ~ [~/FINAL [ ] FIREPLA~~..HIMN~'~/h/~.~: ~ f.,~ ~~- / -. ~ 7 ~ DATE INSPECT~ ~.~ I FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) PLUMBING ~2 [ STATE ENERGY CODE /~~-- ~OlTION~ COMMENT~ ~ nl"O~Wl,~ OF BUIL DING 'DE P,~RTMENT TOWN SOUTI~OLD, NY 11971 TEL: 765-1802 Examined "~; ,20 ' :' Approved ,, ' ~. ~_, ,20 c~ Disapproved sc ~UILI.)I.NO I-'~,_KMII A.t't'LILA I'ION CHECK.LIS Do you have or need the follovAng, bc£orc applyin~ Board of Health 3 sets of Building Plans Survey Check Septic Form N.Y.$.D.EC. Trustees Contact: Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Mail to: Phone: a. Thts 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 shalI be kept on the premises available for inspection througho~ct'the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupa~ is issued by the Building Inspector. 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?ounty, New York, and other applicable Laws, Ordinances or Regulations, for the cbnstruction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to coinply with all applicable laws, ordinanc.es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~7~.~~ (Signature of app¥~cant or hame, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner ofpi'emises ~o&~l~ ~8'e-.-~,iC~ '~ (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 Location of land on which proposed work will be done: gZ~4o ~.o i'o~ ~ .... House Number Street County Tax Map No. 1000 Section Subdivision Hamlet Block ~ 5 Lot Lot Filed Map No. (Name) !. State existing use and occupancy of premises and intended use and occupancy of proposed construction,: a. Existing use and occupancy ~ p~.~ ~ ~ .~' b. Intended use and occupancy Nature of work (check which applicable): New Building_ Addition Alteration. Repair Removal Demolition Other Work i. Estimated Cost ~lo-a,-~ Fee h'dwelhng, number of dv,'elling units If garage, number of cars (Description) (to be paid on filing this application) Number of dwelling units on each floor J. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ,]o I Rear ~'7 t Hei~tht g ~5' Number of Stories Z. °&. Dimensions of same structure with alterations or additions: Front ~o ' Depth ~'~, ' Height Z~ .Depth Rear l '7 Number of Stories Dimensions of entire new construction: Front ~ Height Number of Stories Size of lot: Front ~.~e~ ~ Rear 14t.~ Refir Depth Depth 1~o.I;4. ~ 0. Date of Purchase Name of Former Owner 1. Zone or use district in which premises are situated. 3. Will lot be re-graded 4. Names of Owner of premises Name of Architect J~ Name of Contractor 2. Does proposed construction violate any zoning law, ordinance or regulation: Will excess fill be removed from premises: YES Address ~ g~v,o At~. ~ 'i Phone No. Address ~o ~m~.,z~ '~r ~.~t, Phone No Address ' to c¢,o~e -,.a'- Phone No. 5. Is this property within I00 feet of a tidal wetland? *YES NOR~Q~('UIRE · 1~ YES, SOUTHOLD TO%q',T TRUSTEES PERIvlITS MAY BE D gtz- 6. Provide su~'ey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at an)' point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEx, YORK~ SS: OLrNTY OF~c._' /~/~ ,~. ,~ ~.qZ~/ //~ ~.~vjO .,C ~),1 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signinbd contract) above named, ¢)He is the (Contractor, Agent, Corporate Officer, etc.) f sad owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file this application; ~at ali statements contained m this application are true to the best of his knowledge and belief; and that the work will be :rformed in the manner set forth in the application filed therewith. T UND£t~WRITER5 CERTIFICATE OCCUPANCY OR ,~QU~R~D USE IS UNLAWFUL ~PROVED AS NOE~ WITHOUT CERTIFICATE OF OCCUPANCY '-C , - s.,.,, ":' ~66.1eo2 s AM TO 4 PM FO~ THE PROVIDE SMOgE-OL~ I~OLI,OWINGINSPECTION6: ALARM DEVIC~ AS TO PART. 721j N,Y,S SUlLO]N~ ~ · FOUNDATION - TWO RS~UIRED FOR POURED CONCRETE dl ROUGH - FRAMING & III.UJIING · INSULATION & FINAJ,, - CONSTRUCTIOJ lUST I~ COMPLETE FOR C.G. ~ CONSTRUCTION SHAklEE? ~'HE REQUIREMENTS OF P~OVIDE OPENINGS FO~' ,~ITATE CONSTRUCTION · IN~RGY :' /m~llOE~. NOT ,ESPONS,,. ,ON E~E,GENc¥ ESCAPE AS~. ~TRU~ BY PART. 714, STATE ~ILDI~G CODE. PLUMBING s AII PLUMBING & WATER UNES TESTING BEFORE COV~DNG ,~'UMBER CERTIFICATION OI~_AD CONTENT BEFORE CERI~/CATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of I% LEAD. ) AND/OR )lNG CODE. If copper tubing is used for water d~stribeting system; pipin~ shall be of types K al L onl'~ UND£RWRIT[R~ · qFICATE Job Date Elizabeth Thompson. Architect 250 Mercer St. Suite B 806 Title Scale New York, NY 212-614-7180 lOOt2 ETAI chltect@nyc.rr .cam ~')Jl'~ F;'L~ ~J j II~d2 I~o 1 L plVl144 / ! Job Date Elizabeth Thompson. Architect ~o H,,~H I~voa~:Hf ~/r,//o~ 250 Mercer St. Suite B 806 Title Scale New York, NY 212-614-7180 ~1[~1' ~b~¢~ ~'b~,h.I l/~"~,l'~:~ 10012 ETArchitecl@nyc.rr.com ~1~1~ N~ ~/~7~HObl'rjok~ Job Date Elizabeth Thompson. Architect ¢~Jo H,,qlq ~ ¢~/l~r/,CZ.. ~, 250 Mercer St. Suite B 806 Title Scale /~ New York, NY 212-614-7180,~ · i0012 ETArchitect@nyc.rr,com ~lf~'~ ~r~.. J;:~[~ j/,~l!.~l'.¢l) ~' ~1 r~kl iM ge. Hov¢, Job Date Elizabeth fhompson. Architect .¢¢Z¢,40 HZ, ILl P-,p,o~;I4~' .~,4,f/0~, 250 Mercer SI. Suile B 806 Title Scale New York, NY 212-6i4-7180 ,¢ i~..ol~ lo0~2 ET^,ch~*~ot~nvc.,r.~om ~¢.COk4~ ¢L.,::O¢.- ?1~ I/'i'. -:4 - I ~- 1'¥4" × I ~." C' gg Hox Ill r..) Job Da~ ~----~,~ 250 Mercer St. Suite B 806 Title Scale New York, NY 212-614-7180 10012 ETA,chitect@nyc.mcom ~K-~gNP Fb::z)f~ FL.~ J/d'.'~l~-O I Job Date Elizabeth Thompson. Architect ¢~4c~ HAlt4 ~ 4/t~[oz. / 250 Mercer SI. Suite B 806 Tille Scale ~1~ New York, NY 212-614-7180 10012 ETAtchilecl@nyc.rr.com FII'~ FI,~P- F~kt I/4'!*'1 I , 't t ,I Job Dote Elizabeth Thompson. Architect 250 Mercer SI. Suite B 806 Title Scale New York, NY 212-614-7180 10012 ETArchitect@nyc.rr.com ~_.~OJ.4~ ~'LoDj?... PL.~ J/~i'~jl"~II · Z 0 Job Date Elizabeth Thompson Architect 250 Mercer New York, NY 212.614-7180 ]0012 ETA, chitect@nyc.rr .com F =~-~ r ...... ,~J Ill Nov -CC~aOU Job Date Elizabeth Thompson. Architect JZ~4O Ifl~ld P4P, oe4~kl'f' ,~,/14/o~ 250 Mercer SI. SuiJe B 806 Title Scale New York, NY 212-614-7180 100~2 ETA/chitect@nyc.rr,oom ~r_6~ktP FL~t~ ?lAid 1/41'~lLo u~ Job Date Elizabeth Thompson. Architect ~0 H,&lt4 lZ.~, o~JCk~' ~/?/oZ, · ~ 250 Mercer St. SuJJe B 806 Title Scale ~ '~ JJ New York, NY 212-614-7180 /Lfl'16 ~Ot r~LkM I/4'~j'-OI' '' 10012 ETArchiJeet@nyc.mcom