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HomeMy WebLinkAbout30433-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31356 Date: 12/27/05 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 4550 STILLWATER AVE CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 137 Block 2 Lot 7 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 24, 2004 pursuant to which Building Permit No. 30433-Z dated JUNE 24, 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 ALTERATIONS & ADDITIONS WITH DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RAYMOND & ROSE ANNABEL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1071281 07/29/04 PLUMBERS CERTIFICATION DATED 12/23/05 CUTCHOGUE EAST PLUMBING Authorized Signature Rev. 1/81 ry r 035 r l Form No.6 TOWN OF SOUTHOLD DEC 2 7 2005 f BUILDING DEPARTMENT i TOWN HALL 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. S. 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. � New Construction: Old or Pre-existing Building: V (check one) Location of Property: 4 550 n w,4 T ,r- R U rti(-IO CZu 6 House No. Street Hamlet/C Owner or Owners of Property: RAYMOA)D f D se— A A141 t B Er Z-- Suffolk -Suffolk County Tax Map No 1000, Section 1.3 7 Block Lot Subdivision g Filed Map. Lot::} ---Applicant: - Vt9-yM--061-0 A}V_1V-Irtl Ole L- Health Dept, Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: N (check one) Fee Submitted: $ Z*4 .* O R ( CIw A c nN, 0 tit iT /Vo. 1s2 - Ap 'cant Signature�Wv 39357 JN� o 55 BY THIS CERTIFICATE OF COMPLIANCE THE N 5 EW YORK BOARD OF FIRE UNDERWRITERS 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 c� CERTIFIES THAT 5 Upon the application of upon premises owned by 5 5 5 B.J. ELEC. CO. ANABEL RAYMOND S5 BOX 16 4550 STILLWATER AVE 5 STILLWATER AVENUE CUTCHOGUE, NY 11935 C 5 CUTCHOGUE, NY 11935, Located at 4550 STILLWATER AVE CUTCHOGUE, NY 11935 rej Application Number: 1071281 Certificate Number: 1071281 rj Section: Block: Lot: Building Permit: BDC: NS11 e� Described as a Residential occupancy, wherein the premises electrical system consisting of 55' electrical devices and wiring, described below, located in/on the premises at: �5 Basement,First Floor,Attached Garage,Outside,Attic, 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5 authority having jurisdiction, and found to be in compliance therewith on the Day of 5 29th July,2004. rr++ 5 Name OTY Rate Ratine Circuit TyIN Alarm and Emergency Equipment Sensor 1 0 Carbon Monoxide r 5 Sensor 5 0 Smoke 5 Transfer Switch 1 0 200 amp �+ 5 Appliances and Accessories 5 Exhaust Fan 2 0 F.H.P. rrr+++ 5 Dish Washer 1 0 1.2 KW 5 Furnace 1 0 Gas 5 5 Wiring and Devices Outlet 39 0 Fixture Fixture 31 0 Incandescent 5 Fixture 8 0 Fluorescent Outlet 94 0 General Purpose NJ Receptacle 58 0 General Purpose 5 Switch 57 0 General Purpose Paddle Fan 5 0 Dimmers 1 0 Seel rl 5C Receptacle 2 0 20 amp Laundry J Continued on Next Page 1 of 2 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. 5 e eQ BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 rj 40 FULTON STREET — NEW YORK, NY 10038 5 5 CERTIFIES THAT S Upon the application of upon premises owned by S SB.J. ELEC. CO. ANABEL RAYMOND 5 5 BOX 16 4550 STILLWATER AVE C STILLWATER AVENUE CUTCHOGUE, NY 11935 CUTCHOGUE, NY 11935, 5 Located at 4550 STILLWATER AVE CUTCHOGUE, NY 11935 5 Application Number: 1071281 Certificate Number: 1071281 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting of c5 electrical devices and wiring, described below, located in/on the premises at: 555 Basement,First Floor,Attached Garage,Outside,Attic, c� A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on theDay of 5 29th July,2004. Name OTY Rate Ratin¢ Circuit Type 5 Receptacle 10 0 GFCI 5 Service 5 1 Phase 3W Service Rating 200 Amperes 5 5 Service Disconnect: 1 200 cb S 5 Meters: 1 •� 5 5 5 5 S seal c7 5 5 5 2 of 2 5 y This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 0 g11ff04C N� Town Hall, 53095 Main Road Fax(516)765-1823 P. O. Box 1179 ,+a , p� Telephone(516)765-1802 Southold, New York 11971 1 41 �a0� OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O Nt DATE: I a o Building P t No �/ Owner, j- filoq' 6C/ (p ease print) —f Cartr ('69vC �_ �H 1Kc Plumb r: �tC �� ( 56 ( ease print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ftibers Signature) SuOAN J.NAGY Notarryy Publlo State of New Yo:k No.46735 QualMled In Suffolk County Sworn to before me this Commission Expires May 20917 r?3 Aol day of �� Notary Public, County 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. 30433 Z Date JUNE 24, 2004 Permission is hereby granted to: RAYMOND & ROSE ANNABEL 4550 STILLWATER AVE CUTCHOGUE,NY 11935 for ADDITIONS AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#28392 . at premises located at 4550 STILLWATER AVE CUTCHOGUE County Tax Map No. 473889 Section 137 Block 0002 Lot No. 007 pursuant to application dated JUNE 24, 2004 and approved by the Building Inspector to expire on DECEMBER 24 , 2005 . Fee $ 180 . 60 ! ' Au prized Signature - - ORIGINAL Rev. 5/8/02 �o�,,OF sou, , #�.� TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [/'FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: }' DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]v FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE 3 © G INSPECTOR " 765-1802 BUILDING DEPT. INSPECTION [ ] FOU ATION 1ST [ 1R H PLBG UNDATION 2ND NSULATION . [ ] [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: A16e- DA-M 6 (o Z/ INS 1 M-1"2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ y FOUNDATION 2ND [ ] INSULATION [ ✓/] FRAMING [ ] FINAL [ ] FIREE & CHIMNEY REMARKS: i .c.vtiJ G DATE © INSPECTOR I�r�o�z �'r 30 '33 M-1802 BUILDING DEPT. PECTION ] FOUNDATISN 1 ST [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE S'�CHIM��NEY RE"AR DATE ��� INSPE 1F�j M-1902 BUILDING DEPT. INSPECTION [ /IFNDATION NDATION IST [ ] ROUGH PLBG. [ 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE �� INSPECTOR "� Zoo c _ /37_ a _ 7 TOWN OF SOUTHOLD PROPERTY RECORD CARD _ y OWNER STREET VILLAGE DIST. �1 SUB. LOT FO MER OWNER N E ACR. `J9 s D. ' a S Yy TYPE OF BUILDING AV E 2 U SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS S/ b b 3 S o a 3& 300 j� o o S oa / _ 6 7 5�0o r 3 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 a i Tillable 2 t • 0 S7 Tillable 3 Is„ 7 v Woodland Swampland e 2 , Brushlond FRONTAGE ON ROAD s f f House Plot DEPTH "� f ..r• v v BULKHEAD Total DOCK ■■■■■■■■!■■■■■■!■!■qNONE ■ t ■■■■■■!■■■■■■■■!■■■■■■■■■■ ° ■■■tiirmars mm ME��■■■■■■■■■■ ■■!1I■■!!■■i■■■■■ii■■■■■■■■■■ p ■ ■■R I■■■■■■■■!■■!f I!■■■■!■■■ 1 ■■■■II■■■■!■■■■■■!III ■■■■■!■■ ■■■N I■■NE!■■■■■■ ■!■■■■■■■ q■■iiE©©NE■■!■■ ■■■■■■!!■ ` ■q■■■■ eg_©■■!■!i!■■■■■■!■■ ■■■■■�ltl`•i■■■■a ■■■■■■■ ■■■■■ !■■■■!■■ ■■MEMO®®'Basement ��® FIELD INSPECTION REPORT DATE COMMENTS b FOUNDATION(1ST) c ol FOUNDATION(2ND) t4 1 z ol r ` H ROUGH FRAMING& �i y PLUMBINGJPU m// y+X INSULATION PER N.Y. s `3 STATE ENERGY CODE r o FINAL ADDITIONAL COMMENTS O of IV Z m z o-- I � e TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL1 Board of Health SOUTHOLD,NY 11971 )� _/S 3 sets of Building Plans TEL: (631) 765-1802 t `� Jv 33 Planning Board approval FAX: (631) 765-9502 Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. J/ Trustees Examined � '20 Z Contact: Approved 20 L Mail to: Disapproved a/c Phone: Expiration �� 1Y 2ez 3 APPLICATION FOR BUILDING PERMIT 1— ', 1 H Y 14 2002 tri Date 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 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 enackd 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,hoes' code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. (Siof applicant or name,if a corporation) � 4Wn- Rt-sr /AYE por2T Ti-FFC2S01✓, NY, 1177 -7 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,general contractor, electrician, plumber or builder o wNC-- 2 //�� Name of owner of premises RA YMOA)o A /✓1✓A 8,6 �— (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. (e 8 1 ) I Plumbers License No. Electricians License No. (0 70 Other Trade's License No. 1. Location of land on which proposed work will be done: 4-S6-o A116 C07-CffOQ () House Number Street Hamlet County Tax Map No. 1000 Section 137 Block 02- Lot 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 1 n1/ Y i?f 91 o E N e tr b. Intended use and occupancy F A W1 1 1- Y 9F-6 1 D 6WC-E 3. Nature of work(check which applicable):New Building Addition V/ Alteration Repair Removal Demolition Other Work 46, 660 1 Q D D p (Description) 4. Estimated Cost `t � 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 2 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. r (c" f6 " 7. Dimensions of existing structures,if any: Front Rear :1 Depth 2 ,9 --r— Height Height 8 ` (,C I L of(L—Number of Stories 1 Dimensions of same structure with alterations or additions: Front .SZ 1 t Rear 6 z G Depth 10 ':1-- Height 8 'CEjunMr Number of Stories 1 QQ 8. Dimensions of entire new construction: Front / (9 J- Rear I Depth CJ Height R ' CF-14-W4 Number of Stories 1 9. Size of lot: Front 14 1. � 7 � Rear 7/ � Depth 149, 731 10. Date of Purchase r 5 8 Name of Former Owner k1 e eK`l H /��✓i✓�1 B EG 11. Zone or use district in which premises are situated !1 f C' /1)ESV 7-I4 Z- 12. 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 from premises? YES_NO v J+ y hack&sr AVC 14. Names of Owner of premises RAYmofi p ANAs-Address P0A-- 3-4 PFX A S-Ov A'JPhone No. eo 3 v 4 73 - G 2�O 9 NameofArchitect WARREN A. SAM$AON Joe. Address '7eJ '' ` P,}�oneNo -'310 754 - -fq 2 Name of Contractor L7 & ✓.r/f}BE L Addtess u�C AT,a o1 N.4 one No.(Gs 1 734 - G 36 l 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO V/� * 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 t/ * 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) S ( S: COUNTY OKi, /� 1 \�Yl�©N D h L' being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the 4hL o—✓►-2 L-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 fore me this day o 20 6,,0 140taryFOJjc Signature of Applicant NONG RI D.MAHM Y c,eto W Naw Yak NO.01 MASOM48 QYr n In au; Cqu �+wwaagn E7,pbp Fayryyy�.20D SURMY OF PROMRTY AT CUTCHOGUF TOWN OF SOUTHOLD � 1' s SUFFOLK COUN77, NEW FORK 1 0 °� tis s 1000-137-02-07 SCALE: 1"=30' _ S�Gf �ZP APRIL 19, 2002 436 OleIts *t \ x ' VO t , ir E� i f 1 O lei (J 1 b, � 'L 02 s 42 ' Z ,�, v c3� NEW L4 N �0 LIC. NO, 49618 o �-^ EC ANY ALTERATION OR AORITION TO THIS SURVEY IS A VIOLATION AREA=26,86C� S,I" , 1631) D FAX;(631) 765-1797 OF SECTION 7209 OT TME NEW YOM STATE EXCATION LAV R D. BDX 909 EXCEPT AS PER SECTION 7209-StARIVISEW 2. ALL CERT)FICATIONS NERCO+ ARE VAus nr TNIS Mfr AND COPIES TNEREOT akty it E=MONUMENT 123fl TRAVELER STREET . sAu Par a c4rtzs THt POMFSEO SEAL OT THE U*vETOR •=PIPE SDUTHOLD, N.Y. 11971Eo 2: wow s70Mtt�t MK NrRF$d b S+Jlt/."a4e-t AVE, ` npfty Due C: G concrele ( a4"o--TT a InS •Gec I l x2+� r LlVwf+C T h 'l12r �► Il _r... J XrcErS Ie C ), �' ; i� <4eckinl4bs� concre4e ■ �` x { nca �osf an Leve S. olxg oirs ( to �,b k 8eckfi+ 51q x v Corotrib s i-e J'W��trti4 -Aumin iyr t r t i FTG. ,. ems - Ma nuv c�ara�e 41_ O Ft i J 3, 0 7 Fri pr �a Cry t6 u�w g DNDEkWaG�0,D PROVIDE OPENINGS FOR4" In EMERGENCY ESCAPE AS acc N 117�4,1�11�11 REQUIRED .,Y PART. 714 OF N.Y. STATE BUILDING CODE. N�UrCERT PRDVED AS NOTED 0 P' DATE,,Sy/;L- FEE all, X� • NOTIFY' MIL201NQmoa� NQ ARTILENT AT Ztl r -- 1 - 71 765-1802 10 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: A, 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE I ROUGH - FRAMING A PLUMBING a INSULATION 4 FINAL - CONSTRUCTIOR MUST BECOMPLETEFORCO ALL CONSTRUCTION ikl. MEET THE REQUIREMENTS OF THE N.% STATE CONSTRUCTION & ENERGY PROVIDIA 71-SCAIDA CODES. NOT RESPONSIBLE FOR THER ",4 A"t DESIGN Oil CONSTRUCTION Al.SHOCK P E ERRORS DE :T N, VICES AS To PART. V STATE BUIIDINC co ?z ok" PL UMBER CERTIFICATION Of/LEAD CO/vrc/V;re'r, CEI?;rIFICATF OF FORE OCCUPANCY SOLDER USED IN W A ------ size If I SUAOLY SYS7-FA4.1 CANIVTER 07- ,ar Ali c padAz, 1)(CEED 2110 of 1% LEADT 41" ALL PLUMBING PLUMBING WASTE & If copper tubing WATER LINES NEED IS USed A TESTING BEFORE COVERING for Water distributing /9 0,A "larn;Piping$hall be of types K or L ON I UNDERWRITERS CERTIFICATE REQUIRED Z_ -A C) C, Aeig-T L- �v A L z wase e L[ 71 9K A1110 19 ---------- 'A I-N LIMMMMOPPROMMOJAL LIAML &ACCEPTANCE AND USEOFIIHESE PLANS AGE'TAGREESTOLIMTH THE OW&NEMAMgM N F� EVAOL"OFWMRSEN /-F' -.r COP , !11 10 ENGINEERAND HIS El"10YEES WE TO NESI-ECT,ACTS OF' PSUCH7JAT THETA�R.REN 17 1 NBC I BILINOF IN z A'. "HEN,CONSULTING ��.E`FEANNTDEHT EMPLOYEES LL 0 A, E -D THE TOTAL TEE FDA SWVICESFUENDSEDONTHJ3 'R0jLCr 4 C) TT A �y OIL ow"L"6i tAl I _ I p,�T ^ EL.t�V �oU7N LI�.� lNorizrl annr.) Y ZYm Rrx�F- ; j{{jj � 2J4G L4G. m5T ''Irj'Pc�-• _ .. - __.._. _. __ 1 i 2,2AM M"D&t 2T�P,4� 2X4 " i-i -•1 2'Yc /h� aOX r LA 1011 / _SroL ':fl1r- �� j E/.•• .ar YLY- 5 Pkapa3B�6 'ExTc.MS�AtJ _ _ - T I - � . �+ -J=.d R� l�dt ,�111X, ,`, lQ,�yMb/�ipP FIHNAB►1�LL g aoralloo.� r 'lJ4 -- - � I She,_ A k J '. � ____ ___ _ ___ _......____ _. L.•.rren.blFr'e-yaw- YT..1: .. - + _ 4, r. • H ' f I t > r _ f .D. 11' �ouMpk4N�nc Pct I Siaa c + — - A &;c apart OW, r I r x 2-ax• isY - I� 1 PAA-1i AAP, 1 I� I ..nl I REN. axdT i u A ID A« Wo co r* C,Pmraam T"I SYa-c fita6 Cn�a� t' f VA AJ 06 w5 r, OK AN Ci 64�E.14' CASEAS EYT : a SEP E102 _ r. ! BLOC nEr eNn F t,umoro 1 IL I ' i , � New iNr.M- Saws w/ z•a�'t.;�a• taea;,x� �a.,. L Wp'v+ Fantntr34 pv� . I' K94MT&RA:*Ioojb AA.N! t4- - A56d .�rFs»a+�arrkr� ,�yMAwxr[b. ` - - �--- r 2f/N y� tl wN, r uA?" AY✓Yl1. .� ' :, � _ 'S�ca c�, r�i•0'J"•4'y�(._t+►d ,". ^R+ of*:,, •� _ t, y.i .�. '�.�.r�a.�+, �• . . ,.z - _ 4,.. ?M^ai r:�',»i.. .�x _. _.� :.i....s_ . .e v..::.ws..WLs�__,r,..,i'�,.?c..l�rir:>-.w,.a,_;�.''w . ..a. ;e�;-.;wp.-k.Ew:t.Sc:.::.P+�i�-y.1cn+� '3oqc� BUILDING PERMIT EXAMINER CHECK LIST DATE ISSUED: / /02 DATE REVIEWED: ,T //S/02 APPLICANT:'Rkvrr,o,1D Nl%IA-r-te - DATI SUBMITTED: SCTM# DISTRICT: 1,000, SECTION: , BLOCK: _�, LOT: _ STREET ADDRESS: ''Jsso CITY: SUBDIVISION: N .y PROJECT DESCRIPTION: Iz-) `moo+-� ESTIMATED PROJECT COST: ARCHITECT FAST TRACK? Nd SINGLE & SEPARATE CERTIFICATION-REQUIRED? 1!o NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at anytime after 7/1/5 ZONING DISTRICT: p_L10 CONFORMING? Na REQ. LOT SIZE: o 000 ACT. LOT SIZEQ. LOT COV. 202'ACT. LOT COV. 1 Z3 e-6 REQ. FRONT s(Q PROP. FRONT REQ SIDE_ 573 ) ACT. SIDE REQ. REAR PROP. REAR WATER FRONT? lec DESCRIPTION: PANEL #: � FLOOD ZONE:_ 1( , APPROVALS REQUIRED SUFFOLK COUNTY HEALTHD PT: YES or61 , (BED #): DTE:_/_/_ PERMIT#:R10- TOWN SEPTIC RECEIPT: Y of NEW YORK STATE DEC: P"-DEC 9/1/75 YES o SOUTHOLD TOWN TRUSTEES: YES o TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES o O NYS ENERGY: YES OR EGRESS (18 H min.? 4 sq total) VENT(SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- , HAVE PRE CO'S : Y OR N B -Z/C/0 Z- , NOTES: w FEE STRUCTURE: FOUNDATION: 500 SF FIRST FLOOR: 6q SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: qS� SF FEE FEE FEE 1. ( �-f� SF)- ( te�5U SF)= /o L SFX $ =$ j,60 +$ 1 JPO +$ = $ 60 2. ( SF)- ( SF)= SFX$ =$ +$ +$ =$