HomeMy WebLinkAbout30288-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31119 Date: 08/18/05
THIS CERTIFIES that the building ACCESSORY
Location of Property: 305 OLIVIA LA CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 83 Block 4 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 4, 2004 pursuant to which
Building Permit No. 30288-Z dated MAY 4, 2004
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 ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to THOMAS & CATHERINE ANDREJACK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1065137 11/18/02
PLUMBERS CERTIFICATION DATED N/A
Authorized 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. 30288 Z Date MAY 4 , 2004
Permission is hereby granted to:
THOMAS ANDREJACK
PO BOX 349
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF AN INGROUND SWIMMING POOL WITH FENCE TO CODE AS
APPLIED FOR. THIS PERMIT REPLACES BP#28354 .
at premises located at 305 OLIVIA LA CUTCHOGUE
County Tax Map No. 473889 Section 083 Block 0004 Lot No. 005
pursuant to application dated MAY 4 , 2004 and approved by the
Building Inspector to expire on NOVEMBER 4 , 2005 .
Fee $ 150 . 00
T Authorized Signature
ORIGINAL
Rev. 5/8/02
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
n�CAO^MPLETION OFc THE WORK AUTHORIZED)
PERMIT NO. 28354 Z Date MAY 3 , 2002
Permission is hereby granted to:
THOMAS ANDREJACK
PO BOX 349
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at 305 OLIVIA LA CUTCHOGUE
County Tax Map No. 473889 Section 083 Block 0004 Lot No. 005
pursuant to application dated MAY 3 , 2002 and approved by the
Building Inspector to expire on NOVEMBER 3 , 2003 .
Fee $ 150 . 00
thor' zed Signature
ORIGINAL
Rev. 5/8/02
Ll
Form No.6
1G 17 2005 TOWN OF SOUTHOLD
BUILDING DEPARTMENT
1 TOWN HALL 93�
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:
I. 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 Mo lead.
5. Cornnercial 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 Plarming Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and"pre-existiug" land uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic.
features.
2. A properl_; 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, Alterattous 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. "fennporaty Certificate of Occupancy - Residential $15.00, Commercial$15.00
Date. fS�/
New Construction: Old or Pre-existing Building: J�(check one)
Location of Property: i 3_65-- ._ L
House No. Street q inlet
Owner or Owners of Property: _�� fi C^-;(, , L- ftwAP,�/'SHC/C
Suffolk County Tax Map No 1000, Section Block �DOY Lot Qr 5
Subdivision_ Filed Map. Lot:
Permit No. 3O ',"M z Date of Pennit._ Applicant /(VS ,�f_ —
Health Dept. Approval: _._UndenNriters Appro�aL _
Planning Board Approval:
Request for: Temporary Certificate _ Final Certificate __ (check one)
Fee Submitted: $ 2.5--- 0z)
pplicant Sigtn t e
(Io _ �M
so
Town Hall,53095 Main Road Fax(631)765-9502
P.O. Box t 179 GO
Telephone(631)765-1802
Southold,New York 11971-0959
COU
BULLDING DEPARTMENT
TOWN OF SOUTHOLD
August 11, 2005
THOMAS ANDREJACK
P.O. BOX 349
CUTCHOGUE, N.Y. 11935
To Whom It May Concern:
We are unable to complete your Certificate of Occupancy because of the following
reasons:
An application for Certificate of Occupancy is not on file. (Enclosed)
No Electrical Certificate on file.
The Check is not on file. —$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file. (All permits involving plumbing being
issued after April 1, 1984.)
BUILDING PERMIT #30288-Z (ACCESSORY INGROUND SWIMMING POOL)
O rJcn� rPrnrJrJr;I ; 11n121 al rlrlrJ�rJ�rrrJ'rJ'rJ'rJpLpLr.rL3PL EJ drPrJ�rJ�rJ��nrJrJ�r>�r�rJcncnrJ�rJ�cP cncnrJr�rJ� o
f5, BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY C5
55 40 FULTON STREET — NEW YORK, NY 10038 5
5 CERTIFIES THAT S
SUpon the application of upon premises owned by S
5 ROSLAK ELECTRIC THOMAS ANDRE JACK 5
5 P.O. BOX 164 305 OLIVIA LANE �5
7C7C7C5 CUTCHOGUE, NY 11935-2453, CUTCHOGUE, NY 11935 5
Located at 305 OLIVIP LANE CUTCHOGUE, NY 11935 7c
5 Application Number: 1065137 Certificate Number: 1065137 �5
Section: Block: Lot: Building Permit: BDC: NS11 5
Described as a Residential occupancy, wherein the premises electrical system consisting of
e5 electrical devices and wiring, described below, located in/on the premises at: 5
Outside, Pool/Spa, 5
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 18th Day of November, 2002. c�
5 Name OTY Rate Rating Circuit Type 5
r57 Appliances and Accessories
5 Time Clock/Switch 1 0
5 Pool/Spa Bonding 1 0
Wiring and Devices
5 Fixture l 0 Pool/Spa 5
5 Receptacle l 0 20 amp Pool/Spa 5
5 Switch i 0 General PutT+ose
Receptacle 1 0 GFCI
5 GFCI Circuit Breaker l 0 20 amp Pool/Spa �5
C5'J (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have 5
5 frequent test and'or repairs made by a qualified person. 5
5 5
5 seal 5
5 of I
5
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 cPrJ�r�rJ�rJ��PrJ'rJ�rJ'rJ'rJ'�rJ'rJ�rJ'rJ�r�rJ'rJ�rJ�rJ'rJ�rJ�r�rJ�rJ�rJ�rJ�r�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�cPcPr�rJ�rJ�rJ�rJ�rJ@PrJ@PrJ'�.PrJ�r.P rJ'rJ�r1rJ�rJ� O
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL 41 t
[ ] FIREPLACE & CHIMNEY
] FIRE SAFETY INSPECTION
REMARKS: " �?�
i� D
DATE 7_ �� INSPECTOR ' v `
o'K
3 D � 937 Z 765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [FINAL 07 ,
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: A-
DATE 7��3 6S INSPECTOR ��
_4
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE -OSIST.1 SUB. LOT 1
orMt) 4 CCt Qr Yt L_
K ( �^. I ( ., . a4v
FORMER OVONfIR N E ACR.
Q. r
�U t
r� Fe11, nrj4 r- Ar S W TYPE OF BUILDING
Z10 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
ND IMP. TOTAL DATE REMARKS
( .'y) . Y -
( 5oo'?E-j -7 &'m 9' Z12- 1 °r 47-L ll 14 173U- ell,n -1hcp� E�f -Io Ander,�c� �w �:?� n
1500 6400 Do it IF 116 �lO�tj - 13P ,2 % ! /` n �f r l
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD C�
Meadowland DEPTH •'
v
House Plot I6-0 1 z BULKHEAD
Total ( ��
� I
F
— r
5 "
. ys
M. Bldg. Foundation Bath
Extension /I X 17 /1;5,5
35° G gy Basement �,� Floors
Extension .2x I 1b 3? Fxt. Walls1 Interior Finish
`lt�� �n R .
Extension 12 17 ;J0 Fire Place Heat
ao
Porch ll X (4 c 17(o Pool Attic
Deck Patio Rooms 1st Floor ;;K _t
Breezeway Driveway Rooms 2nd Floor
Garagez S $$
22 Kms=
0. B.
October 28, 2003
To: Southold Town Building Dept.
From: Tom Andrejack !V I
To whom it may concern,
Upon contacting Southold Town in regard to my pool building permit, I was advised
to write a letter requiring a 6 month extension since the current permit expires on
November 3, 2003. Please notify me if there is an additional cost, or if I am required to
provide more than this letter.
The property address is: 305 Olivia Lane, Cutchogue
Thank you for your attention to this matter.
C�(
Thomas Andrejack
�n,�
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
n COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28354 Z Date MAY 3 , 2002
Permission is hereby granted to :
THOMAS ANDREJACK
PO BOX 349
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at 305 OLIVIA LA CUTCHOGUE
County Tax Map No. 473889 Section 083 Block 0004 Lot No. 005
pursuant to application dated MAY 3 , 2002 and approved by the
Building Inspector to expire on NOVEMBER 3 , 2003 .
Fee $ 150 . 00
thnQed Signature
ORIGINAL
Rev. 5/8/02
FIELD INSPECTION REPORT I DATE COMMENTS
FOUNDATION (1ST) — -- -- -- — o^
--------------------------------------
FOUNDATION (2ND) -- -- — — — -- — --_ -
O
- - _ - - U)
.A
ROUGH FRAMING& — - -- - -- r
PLUMBING �J
r
INSULATION PER N. F. -
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
- m
m —
- — --- — 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 ( t,J ,5oa,as 3 sets of Building Plans ✓
TEL: 765-1802 Survey
PERMIT NO. Zg?7s�F� Check ✓
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 3/ '20 2 Contact:
Approved_) /_�, 20?— Mail to:_
Disapproved ac
y_ 73y TUGS
Buil mg spe
s
APPLICATION FOR BUILDING PERMIT
Date �//��V 20 OZ
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 be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupancy
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 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.
Lrildl7UK ' L L5 LJ''a-
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
C,o&372 }e.-i z
Name of owner of premises 77/0M/V 5 4 jr,4;rA0ryAV- qAYpRL''YAPA(
(as on the tax roll or latest deed)
If applicant is a corporation, siggature of duly authorized officer
(Name and title of corporate officer)
Builders License No. b j�/,7 -/-/..T
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
eA-111,14 Z-464s ZJDOD'BIAJE MANv7- e��c
House umber Street Hamlet
N
County Tax Map No. 1000 Section 9-3 Block D/ Lot 6.5'
Subdivision�1 UDt¢�S/1[.yl Filed Map No. 4239 Lot :5—
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 7,
b. Intended use and occupanc ;—z /, Gy,�y iN 4,
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition er Wor
(Description) '
4. Estimated Cost `�/? 0,040,400 Fee �'iSG,00
(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 Z,, Rear Depth !�J<'
Height mooNumber of Stories t
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 /J Rear /yam L'/ / Depth ?70
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated �, >7i aL
12. Does proposed construction violate any zoning law, ordinance or regulation: A)o
13. Will lot be re-graded A�5 Will excess fill be removed from premises: ES NO
14. Names of Owner of premisesmW&u* s A&&0css4eeAddress 3crsd✓,ra 0.40-1!F Phone No. 73V- S232
Name of Architect Address 0Lr'A0'r'`4-- Phone No
Name of ContractorlswA r 'RAS tjII Address �r Phone No. X35/-JGG 5'
CSC/
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES 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)
COUNTY OP�!:),
�iuB C//i7ci� being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the CoN /{C7o2
(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 b fore me this
day of �20
c
Notary Public _ Signature of Applicant
CLAIRE L GLEW
Notary
Noblic State f No ork
Qualified in Suffolk Cou
Commission Expires Dec.8,
13 F Plain Pale]((080091
1J'Plain Pends(08014) I }III 1
14'Plain 90*(a er S((08-016) E f T 6 —+i M ^1 , Y N .i J ern
19o•Tane Set(o8-0to) p 4S NOTED
8 8' 8' 8' 12&aNww)•Braes(08 210) SIZE A ° C D E f 6 H J K E
1 Sled Iladrare U(08 204) 20'.4a Zr 4a re r4 1r4 1s 6 r r r r rr 0" S/S
1.2000 Sha' hi Coping 6'Radius 110 D031 nr1 Nn a .a.rale
q roa 1 m•en 50 4r 5'p r4' 1W 15'6• r 4' 6' r rr
5 190•Copeq(amr54t(10001) F^F• I r.
8 I Y�ryi Einer(see option below) I t i r ' :DEPARTMENT A
4 PM FOR-THE
$ 11 6'SIS•► Remove 1.(08 009)8'pane](and .n
A 1{08-016)1' ep p REQUIRED
8 and 2108-013)pondp n I IDL 006)6's1
tar
(j 8' 8-0161 aave&10sert1 0panels D02)8,d \ " F,,.. - CO,kSTRUCTION SM
q' I{08-01611'panel. linen 1 (01001)B's'p I
ad 2{08-011)6'poneh. FeAET BE CA:,AP,ETE FOR C.O.
8 8 8 8' U I CORNERS ® ALL COr:STRUCTION SHALL MIRE
THE REQUIREMENTS OF THE N,x
Replace/.e'dminpp�a�eeh108009)rith: + .R,re STATE CONSTRUCTION A EnUff
1 finlet il-wo) 1j oA"E� CODES. NOT RESPONSIBLE RDA
1$ighl pone](18-012) DESIGN OR
- I T iplK pall IM-0121 N$TA{ICTpN WAM
8'Steel Step Isle)Remove
8• N3:(03-60S-(S),(03605.LS).103605 RS) 2{08-009)8'parols. Irnen UNDERWRITERS CERTIFICATE
1-9103.20561103-205.LS),103-205-RS) 1408.301)8'sled step, ETERS ED
S-14:(n305{S),(03.305.Sl,(03JO5-RS1 1408-013)7'parol,I-08 167)
6 6
45•c I'kAer pond and
NSPI TYPE 111 1-108168)4'fair panel.
. ,.
10 0-083)steel stop roping
„• x1 and 1-(l 0-085)roping ,
8 !Ot comer set required.See page I.
a 8 6 8'steel Step(4nd)Remo" OCCUPANCY OR
L10800918'panels and USE IS UNLAWFUL
I-(06-016)4'panel. Imen
6' ��
2408-167)45'x
WITHOUT CERTIFICATE
6 1(08-167)45°x lIa panels,
2-(08-0I5)S'ponekand OF OCCUPANCY
8 8 8 8 TOPAZ STERLING STONETITE 1{08110)stenemy slop coping
pin.
8 183605) 103201) ID3 305) and 2(10 085083) )oiling corner and 2�(10�085)coping caner
NON DIVING LINERS---- sets required. See page I. A,,,,,n,•,D„y r.�„mf.,.aa a,..b 6.a4y coh°r wad.+ rwr°
Ni(033431 1.81032431 S-14(03-3431 "—.d-,.d° -d a r"°0°Z"O"""°bpd,en v..-1•
Poll .,�,„•rN,6 . SnW r"�,�, FORT nAYINPOO"..t_+la9jwm.;m DO NOT PROCEED WITH
•Dioportok jinn to 90e point of(omm. a.. Fw. °"" '° '•^"" ' " "`"^" FRONT 1 =R rt UYK r 46M VM 171q QPU51
r h d-..,m•dF..6 a`b..0 so.e.d nsl -o.� w.,w.o.-,....,r,....,.�w•r,„°d. FRA
�^"w"4e�"^+"'--,edvd.b mA�°d we• b,tidd/.woe eM +'Rr"•'9 mr.eoaN POO IS ti.wwe w.w.
�..,� • • ed..,g6;--4.Jdr.»bbr wd..6++,.D°d,rJwr °nd.db Me.a►.bwb:e•.dw;m+e.v--0' ^. IRN-DOS FOUNDATi�
m ar . w.',++,+K1o�,oM 6,N.,.,d sro a nnl J,...,d,N•r�d .dwA+
7 ia1°,r d ] E-wv.m Jen('b T ba.6.d d swrd eurrrr'i..,wr.• ,w:e.d.a a q°.s vd°r.dna ih,
odn b»d v+J,ad e*o wA ib w boo V°d, A,1a MR�'�n.nu •vu �n°ak A.n e. pew ed sdr.+,r v.d , r
wndo,&.-,. rle,;.,d 6redlny,:'4111f�n.do.. aw".adnm, rti...w"bodd�ad�.mw,,.a/. MAT 20X4D
• .. u.d a..v. :z °..7031034 Ooez "�"" d"" "^�"° n 6i """" 1995 RERANGLE 6-RADIUS
IN-GROUND SWIMMING
L WILL BE
VINYL LINER THAT WILL HOLD APPROXIMA LY CONSTRUCTED 000 GALLONS OF WATER-
A "IMMEDIATELY"'NCLOPOOLCODE
ENCLOSE POOL TO CODE
FENCE WILL BE CHAIN LINK CONSTRUCTION,4' HIGH WITH SELF CLOSING GATES THAT UPON COMPLETION
WILL MEET TOWN CODES. BEFORE"WATER"
�("8
6 p i� --' 3915 z
SCQHS = RIO - 96 - 11
'9 \Raba 91 /� /p t`f,,
The water supply and sewagedisposal
systems for this residence w1/l conform
Op <1F h to the standards of The Suffolk County
0
Department of Health Services.
C1A
o S �,� �,�� �, �V �-p SURVEY OF
00.
�� �' �r`` LOT 5
4, s°� "MAP OF WOODBINE MANOR"
FLED DEC 141888 AS MAP/Y0. 8299
o i A T CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 83 - 04 -05
AREA = 40,857 sq.ft. '
scale : 1"' = 40'
0�0P0 0o July 26, 1993
i ro e X00' Feb. 25,1997 (Foundolion Location)
OCT. 7, 1997 Final /
CERTIFIED TO+
THOMAS ANDREJACK
CATHERINE L. ANDREJACK
FIDELITY NATIONAL TITLE 9�0
INSURANCE CO. 5.
201 8194
00. 1P
0
ELEVATIONS ARE REFERENCED a�
-�_
TO AN ASSUMED DATUM. �1 OO\Y/
N.Y.S. LIC. NO. 49618
Prepared in dance with the minimum Q
standards for Mlle surveys as established v OV �'�
�-e� CQN � ORS, P.C.
by the LJ.A.L.S. and approved and adopted e7 � 9
for such use by The New York Stale Land The locations of wells and cesspools
Title Association. a shown hereon are from Meld observallons MA
yo-° and or from data oblalned from others. SOUTHOLD, N.Y. 11971
ADD CERTIFICATION 0//03/97
Q'-1 n d n
BUILDING PERMIT EXAMINER CHECK LIST
DATE ISSUED: / /02
DATE REVIEWED: j;-/—,3 /02
APPLICANT: s�Cmmue 44<wL_ DATE•SUBMITTED: 5 /1 /02
SCTM# DISTRICT: 1,000, SECTION: , BLOCK: 4 , LOT:
1�/�Dn�1aE
STREET ADDRESS:3o QLIV 16k LA• CITY: CurrcHa SUBDIVISION:
PROJECT DESCRIPTION:
ESTIMATED PROJECT COST: ZK ARCHITECT/ENGINEER: /\11'4 FAST TRACK? Jac
SINGLE & SEPARATE CERTIFICATION-REQUIRED? A/0 NOTES:
LOTS 40,000SF-100-24.Lot recogn i tion.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83
ZONING DISTRICT: Ac CONFORMING? N'
REQ. LOT SIZE:&46w ACT. LOT SIZE:'0•$S:�REQ. LOT COV. ACT. LOT COV.
REQ. FRONT /p' PROP. FRONT r REQ SIDE jo/�o/ ACT. SIDE ✓
REQ. REAR /p .PROP. REAR T
WATER FRONT? M DESCRIPTION:
PANEL #: 117- FLOOD ZONE:_,
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or Ita(BED#): DTE:_/_/_ PERMIT#:R10-
TOWN SEPTIC RECEIPT: Y orfD
NEW YORK STATE DEC: P"-DEC 9/1/75 YES ori
SOUTHOLD TOWN TRUSTEES: YES or4S50
TOWN ZONING BOARD APPROVAL: YES
o
TOWN PLAN. BOARD APPROVAL: YES 01%
TOWN HISTORICAL PRE (SPLI/A): YES or
NYS ENERGY: YES OR NO :
EGRESS (18 H min.? 4 sq total) "�i�° "ENT (SQ. FT. x 4%) —LIGHT (SQ. FT. x 8%)
BUILDING PERMITS OPEN/EXPIRED: BP 23°►1 'S_ -Z/C/0 Z-01�SR 0 D
HAVE PRE CO'S : Y OR N BPZ`�-Z/C/0 Z-�q3" Slee
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF 1NIT OTHER TOTAL ,
TOTAL: SF FEE FEE
1. ( SF)- ( SF)= SFX $ =$ +$ +$ = $ ) so
2. ( SF)- ( SF)= SFX$ =$ +$ +$ _