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HomeMy WebLinkAbout30728-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31562 Date: 05/09/06 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 275 APPLE CT SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 1 Lot 6.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 26, 2004 pursuant to which Building Permit No. 30728-Z dated OCTOBER 26, 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 SECOND STORY ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROY & JANICE ANN MACOMBER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 2646-H 12/05/05 PLUMBERS CERTIFICATION DATED 05/05/06 WALTER H. BERRY l A hoz' ed S'gnature Rev. 1/81 FormNo.6 TOWN OF SOUTHOLD 5 BUILDING DEPARTMENT 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. 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. Por 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: (check one) Location of Property: (;t-75 ACPL,5 CT. _ 5M,117440 Lb House No. pp Street Hamlet Owner or Owners of Property: Pb7 -i-2_A0IC6 NUC.OM89& Suffolk County Tax Map No 1000, Section 01O Block C)[)Q Lot Subdivision Filed Map. Lot: Permit No. 50'1-�-Qj Date of Pennit. lD ab 0 Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ Applic nt Signature Co it 3150 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. 30728 Z Date OCTOBER 26 , 2004 Permission is hereby granted to: ROY & JANICE ANN MACOMBER 275 APPLE CT SOUTHOLD,NY 11971 for CONSTRUCTION OF A SECOND STORY ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. Replaces BP/128916 . at premises located at 275 APPLE CT SOUTHOLD County Tax Map No. 473889 Section 070 Block 0001 Lot No. 006 . 004 pursuant to application dated OCTOBER 26, 2004 and approved by the Building Inspector to expire on APRIL 26 , 2006 . Fee $ 150 . 00 1 t orize 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: 2646-H Date:12/5/05 Issued to:MACOMBER Address:275 Apple Ct Village: Southold Introduced By::H/O License#:N/A was examined and approved up to the above date and was in compliance with the NEC Attic 1st Floor Residential El Pool Det Garage Basement 2nd floor❑x Camerad Hot Tub Addition Switches Receptacles Fixtures G.F.I. Range Hood Smoke Detectors 11 28 9 1 4 Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon Range/Amps Monoxide 3-Paddle 1 Furnace Oil Gas Heat Zones Whirlpool Bell Transformers Meter Amps Phase Motors Other Equipment: 2nd Floor Addition Out,Res Nwmeao Ja�n//a 6 t rcaL T�b nc(y This certificate must not be altered in any manner FF04�OG C* y� vw _ Town Hall,53095 Main Road OCL Fax(631)765-9502 P.O Box 11 971-0959 y-70,( Ot` Telephone(631)765-1802 Southold BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: s�o G Building Permit No. 30-7--'6 Owner: �D +; IAmu E t- W COM ec< (please print) Plumber: /N0. t'k4— 0 (Ger(Y�� (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signabre-) Sworn to before me this da of 05 6 Notary Public, 01 County VICKI L.LOPER Nctlry tate at New York No.OIL08010081 CeivadOWFm " I �y� ✓D / (J o�aOF SOpT�O h �O TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: C c� DATE �alr INSPECTOR \ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO H PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ] FRAMING [ ] FINAL [ ] FIREP CE CHIMNEY [ ] FIRE SAFETY INSPECTION REMAR DATE INSPECT 307D.� M-1802 BUILDING DEPT. INSPECTIO [ ] FOUNDATION IST [ yROUGH PLBG. [ ] FOU TION 2ND [ ] INSULATION [ RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REM S: -77 j6deo� DATE �� INSPECTOR FIELD INSPECTION REPORT DATE CONIlVIENIS ro FOUNDATION(1ST) ] -------------------------------- y FOUNDATION(2ND) 773) x - J O ROUGH FRAMING& �3 PLUMBING S INSULATION PER N.Y. STATE ENERGY CODE CIO FINAL ADDITIONAL COMMENTS • �-a �0 M 8Y� �- O z m A .yi 1 CC C7 M ro E6700 - -1d_� __(0-A TOWN OF SOUTHOLD PROPERTY RECORD CARD ---'-- 1 OWNER - ...----- STREET 275 VILLAGE DIST. SUB. LOT rC� n qC�m fie_ C`o u Irt U e l 'bs, ACR. REMARKS a 0 3 _ a TYPE OF BLD. ? 9 #a 80U -Cp f )C4 lbq GIGO CZrA a a-L /) 2o 8;}3- fv �1 :y �ioal ILAND LOYI\C- rov, fPS PROP. C SS IMP. TOTAL DATE 7- IV2(J ------ -- 50© EXPiR65 (5cy' bo-, •- E Vit; i1P_UG(�- Arse sstAciJT 34,SS 6 5r00= �J%lD6152 4- Z70 Pnkr2 3� Z FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND I boo BULKHEAD HOUSE/LOT TOTAL M101P70 4 SDI• a E,SSE4FV1 rroN S'3j?OOY' rol/ \ �\ Nr y ® afi s X06' s �`� PLEASE �, b. Sanitary system!s not tao lx D,� " Piaoed under driveway m ` / •:it L.. ct Z7,t 4�<3��`29 55355 I RV PQ I G �k �z Ib MTSW W°LS Wlte"�� s 'apo I3 < MME LANE SINGLE FAMILY'OWELUN6 pN Y JAS EXPIRES 3 Y do-O d-^+ 11 Y3 EARS FROM GATE OFA&ROYAL C /# //�3s--- SURVEY OF ARE1 a#000agft LOT 11 "MAP OF SOUTHOLD VLLASrr FLED MAP AfO. Prepared M accordance with IM mrnrmum slanders. for lRie surveys as .s,obn:n.d AT SOUTHOLD by the a by The w°York state adopted TOWN OF SOUTHOLD 77114 Association. SUFFOLK COUNTY, NY. The water sup�pply and sewage dlaposol 1100-70-Of-P/O 06 systems for thk ,..lean,. wX conform to the standards of The Suffolk Counly Scale; I"= .30r Imenl of Neagh Servlc.S. March 11,, 1992 OLIG(_',�2.N The locations of weds and cesspools shown hereon . from field observations and or from data obtained from others. T/S'NS aOO. 0 //jll �.,.�r �O SAMe, SUFFOLK COUNTY OEPMTNENT OF IIE.LLTH SERVICE. G"�LlX`,a�f.'..n' '':.fir `C FOR MPROVAL OF CONST UCT OH.Y N.Y.S. LIC. NO. 99618 VA .REF.No. O+ NAY 28 1992ORS, P.C. z SC ufp O MPRovE° 9fRCT1l STR!CR SOUTH D, N.Y. 11971 87-670 / ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ • �?`` Interior Finish Woodstove -_ RoomslstFloor __ ENERGY CODE CALCULATIONS CHAPTER 5 SECTION 501 Detached One and Two Family Design Criteria 5750 Degree Days (For Non-Electric Heat) / Zone I lB For: a H CC o rn b e Per: ?en b y �1y 42 te COul-/ Dated: 12 e v !o a'v SUBSYSTEM AREA DESIGN CODE DESIGN CODE 'CUff [[U)) UA UA Exterior Walls `f 2 O, )2 L 0.14 So 69 a i,.6(,° Ceiling Roof ? ZZ '(25 0.031 3 6, /ti 12,36' Floor Over Unheated Space 0.05 Heated Slab On Grade 6.5 Unheated Slab On Grade 4.5 Basement Wall 0.1 Crawl Space Wall 0.06 NOTES: 86,7 f% Construction shall comply with 502.1.1 moisture control and 502.1.4 air leakage Building Envelope Systems to meet requirements of Section 501 The mechanical systems and equipment including: HVAC Equipmeat,HVAC Systems,Duct Systems,Ventilation Systems and Insulation of Piping Systems to meet requirements of Section 503 Service Water Heating System&Equipment to meet requirements of Section 504 Electrical&Lighting Systems&Equipment to meet requirements of Section 505 0, To the best of my knowledge, belief; &professional judgement, = r w these plans are in compliance s - At with the code. ®A slo 9�F , ESSIONP�, D fOWN OF SOUCHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING, DEPARTMENT Do you have or need the following,before applying? TOWN HAIL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. ✓ Trustees Examined / 20 Contact: Approved 20 !i Mail to: Disapproved a/c Phone: Expiration J 20 Building Inspector -- APPLICATION FOR BUILDING PERMIT Date' 0 o 20 6-P- 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 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 apps�.nt 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. (Signature of applicant or name,if a corporation) lb 36X 5� PE��r_ n1s//i4SrY (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Q//Y!?AQ � COnfiz2t�-e�L> Name of owner of premises Qo" (As on the tax roll or latest deed) If plicant co oration ignature of duly authorized officer ame and title of co orate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which/proposed work will be done:ac House Number Set / Hamlet County Tax Map No. 1000 Section 70 Block ( Lot CO Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructions a. Existing use and occupancy 5 P b. Intended-use and occupancy elf V- 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 6.0 000 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 n 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures,if any: Front 30 Rear 0 Depth Height Q Number of Stone Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front acv Rear Depth / 5 Height Number of Stories 9. Size of lot: Front Rear Depth �e 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate ��any��zoning law, ordinance or regulation? YES 13. Will lot be re-graded?YES /NU / Will excess fill be removed from premises? YES �NO_L -0— r fWV9 Comm-je(Z- �� 14. Names of Owner of premises/?v A.✓b 4 e Address&,g/l Clt �rl D" Phone No. 7(P S-� /0a 7 Name of Architect No 7&S-- /// �( Name of Contractor Ar-A AJAW Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland ora&eshwatdr wetly- --rm __ - - * 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) Y F COM being duly sworn, deposes and says that (s)he is the applicant ane of in ' tial s4amg contract)above named, (S)He is the Cx r.� (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 _meq day of 20 20a—I � Nofary Public' attire of Applicant Nft"Public&MoofBNmY.* TNo.4822563 Suffolk Ceti �E�stres December 31, p �— ENERGY CODE CALCULATIONS CHAPTER 5 SECTION 501 Detached One and Two Family Design Criteria 5750 Degree Days (For Non-Electric Heat) Zone 11B // For: P 4 7 /I',ccoM i e Per: G our/ Dated:_&e e !o v ti SUBSYSTEM AREA DESIGN CODE DESIGN CODE "U" "U" UA UA Exterior Walls q4 ? o, r 2 Z 0.14 S p , 6 S` 6 6vo Ceiling Roof ? y 2 195 0.031 3 y. /a z 2. Floor Over Unheated Space 0.05 Heated Slab On Grade 6.5 Unheated Slab On Grade 4.5 Basement Wall 0.1 Crawl Space Wall 0.06 NOTES: B7. 06 BG. 79 ConstmWon shall comply with 502.1.1 moisture control and 502.1.4 air leakage Building Envelope Systems to meet requirements of Section 501 The mechanical systems and equipment including: HVAC Equipment,HVAC Systems,Duct Systems,Ventilation Systems and Insulation of Piping Systems to meet requirements of Section 503 Service Water Heating Systems&Equipment to meet requirements of Section 504 Electrical&Lighting Systems&Equipment to meet requirements of Section 505 SEC, N To the best of my knowledge, belief, & professional judgement, ' r w these plans are in compliance2254-1 Z o with the code. A \ESSIONP�' / 0 y5- N/per -o 70Z. Q440V 1 jI c 0 9g O1 �OqN a f4NfE.RV4 ;,/0*'oN 7S 00. 7 35 -5 f ♦r n q \ A .4• CERTIFIED TOr QROY MACOMBER JANICE P OR VO 8 THE LONG ISLAND SAVINGS BANK FSB SUPERIOR ABSTRACT CORPORATION TRW-S-543938-11 "MOO' L-IOW S' W446WS 10.E 4.k LANE SURVEY OF AREA = 15,000 a¢ k. LOT " "MAP OF SOUTHOLD VILLAS" . Prepared Iaccordance with the minimum S A T SOUTHOLD FILED JUNE 25, 1992MAP NO9237 f standards for ./tie surveys as established dop TOWN OF SOUTHOLD by the L.I.A.L. and approved and adopted for such use by The New York Stole Land T/lle Assoclollon. SUFFOLK COUNTY, N. Y The water sup�ply and sewage disposal 1000 - 70 - 01- P/O 08 systems for !his residence will conform to The standards of The Suffolk County Scale 1"= 30" Department of Health Services. March 11, 1992 JULY 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from field Oct. 23,1992 (final) observations and or from data obtained from others. Ptd 4F NE*4, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY � * Y.S. LIC. N0. 496/8 92 SO 48 _ DATE HS. REF. N0. CO RV RS, F.C. JNe -e5 •ev APPROVED SO N.Y. 1197/ .o y ?� yG Sp 'I OCCUPANCYOR 3 USC IS UNLAWFUL WITHOUT CER'jF,ICATF , �A - . . . DATE '✓�'�ls/�, 1 NO1I1-Y'SUILDINC7 DIPATITMENT,A , 7997902 9A TO l4 PM FOR THE - - FOLLOWING INSPECTIONS . 7 FOUNDATION TWO REOUIREI) - - - - FOR POURED CONCRETE a NOSH F �+;' � a IN_' TIONR��N{�4APLyMBIjJ(} 0., FINAL'.-COhf6TRUCTIt)-N"UUST, 141 BE OOMPLETE'PORC.0.- - ALL.CONSTRUCTION-SH LL,MEET - THE .RE CUIREMENTS OF THE"fl,y ' + _ STATECzONSTRUCTIOfi E 6NEli4T a, ? x "'a- a49 - CQDES '.NOT NESPCNSIELg -FOR 1 DESIGN OR CONSTRICTION F,gH0�1 , y PROVIDE OPENINGS FOR 1 °, EMERGENCY ESCAPE.AS REQUIRED;By PART. 714 OF TATE ' SBUILDING CODE. PLUMBER CERT/F/CAT/ON ffi ' ON LEAD CONTENT BEFOREi CER7/F/GATE OF OCCUPANCY i SOLDER USED 1N 141A TER' . —+ M CANNOT i of 1 LEAD. 1f cPPPor tubing is UseiL'.. } _ter for WatOr distnbUtmg, sVstem'.giping shall b0 /;;�. {___ - _ - of types_K or L only -' �x T ~ I _ UNDERWRITERS CERTIFICATE iF3 Ch^a� ;uc . Y�ukvl�rtt - E i IREQUIRED `+ i ,�- / PS6VIDE T14C, All—JiRs � .le , � F _ THERMAL$ADO PREVENTING'' DEVICES AS'TO PART 90t'6(K) ' N:Y STATEBU!LDINGCO DE ,".+, UNDER4YRITERSCERfIflCATE ;4 REQUIRED � T � ALLPLUMBIPLUMNG c n '::� WALE G WASTE R LINES NEED TESTING BEFORE COVERING PROVIDE SMOKE-DETECTING ALARM DEVICES r,.._...__.-.�,...,.--.-- .r_--__._.--. '✓ ,_._. ._.:.. _�_ .._., AS TO PART. 721:1 r (- i .pr NEW,y0 s T� � W . - 1 0322541 p'7pFEss100 .�%1 _ , n ,, - "r, i - - O IA i AAMM i i i r y , b � 1 op�OF ESS\ONPY .. - a . o , I ad LL , f / w t - - - _ SEOF NEW y09 P - WY2641 g� - - q FESS\Q FO F / , / n; . a I a 6 � O t f^S Qo rwT RroF ! New l ------------ ^ .--^ � �J 1..�.Ll �i _�'... ! _.-_._ .__..,..__•___�"'K� ate`('/`\ - - - -_ .. `�__..�-�___�__.r_.�_.___-���.._.:.._�__�._._._.______-,____��._.___- _, � `� 'Y � . i ,_ �... ...-.-.T da r r W I- CC 111 _ :., \ I'Y k'� '''I- rj +` I { I' c.gr - (I �. �,•,:��5 i�.}S,c" "L,�ort� YL}v�.. � � � � �'� ' � � � i id ,41, ir I� i r' I �f 5 �Yp�� _ {' -F;.+r.--In _'-'rv_ -w .Jarn. .„-h� n-.h'•...r'^w' n.-+!L-!^lr.i'+W-+ rw. �.y�- •t y+���:p�� k 2 ' � �a.h:�� 'i,' .�.. .., T L�_"_ �,�-4.. ��+w r 4 +PM1� ^.x.+s...4---•+ � 4nOp 032 it ir - . ti^ei ,.3�r.,�:.1'u "^�.'"`Y-•fit-�ik+ ;'� I'W ,.', .. =.�” rn+; .. / u-)V V s µ, D BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: i /x/02 APPLICANT: DATE SUBMITTED: II / 6 /02 SCTM#DISTRICT: 1,000, SECTION: �go , BLOCK: , LOT: C,4 STREET ADDRESS: 1S C60 _ CITY: SUBDIVISION: PROJECT DESCRIPTION: �L 2 -v kh ESTIMATED PROJECT COST: ARCHITECT/� GIN RzTLL:t _ FAST TRACK? /,) SINGLE & SEPARATE CERTIFICATION-REQUIRED? /w NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83 ZONING DISTRICT: A h0h CONFORMING? -yam REQ. LOT SIZE: 00,000 ACT. LOT SIZE 4d D0 Q. LOT COV. ACT. LOT COV. REQ. FRONT 3r PROP. FRONT SIDE /� ACT. SIDE REQ. REAR 3 PROP. REAR REQ. HEIGHT PROP. HEIGHT WATER FRONT? led DESCRIPTION: PANEL #: FLOOD ZONE: , APPROVALS REQUIRED SUFFOLK COUNTY HEALTH T: YES orO, ED #): DTE:_/ / PERMIT#:R10- TOWN SEPTIC RECEIPT: Y VTN 00 NEW YORK STATE DEC: r C 9/1/75 YES041D SOUTHOLD TOWN TRUSTEES: YES or TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES or NYS ENERGY: IDOR NO �. EGRESS (18 H min.? 4 sq total) EVENT (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 BP -Z/C/o Z- , NOTES: t3�0/2a7V�'IS SDl/ ' No�. ►y f� S Off. /3aiy� FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INTr OTHER TOTAL TOTAL: �` SF FEE FEE FEE 1. ( _ � SF)-(SF)= SFX$ =$ +$ +$ _$ -"�_ 2. ( SF)-( _SF)= SF X $ =$ +$ +$ =$