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HomeMy WebLinkAbout38367-Z f ~ Town of Southold Annex 10/9/2013 P.O. Box 1179 54375 Main Road B IF p' Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36559 Date: 10/9/2013 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 20 SEAWOOD DRIVE SOUTHOLD, SCTM 473889 Sec/Block/Lot: 88.-2-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 8/31/2009 pursuant to which Building Permit No. 38367 dated 9/30/2013 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: addition (on existing foundation) to an existing one family dwelling as applied for. The certificate is issued to CARMEN BATTISTA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38367 10/7/2013 PLUMBERS CERTIFICATION DATED /ZZ Signature TOWN OF SOUTHOLD + Q BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY ,9Oj ' t jTT~~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit 38367 Date: 9/30/2013 Permission is hereby granted to: CARMEN BATTISTA 20 SEAWOOD DRIVE SOUTHOLD, NY 11971 To: CONSTRUCTION OF AN ADDITION OF AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FOR.REPLACES EXPIRED BP #34967 At premises located at: 20 SEAWOOD DRIVE SOUTHOLD SCTM # 473889 Sec/Block/Lot # 88.-2-10 Pursuant to application dated 8/31/2009 and approved by the Building Inspector. To expire on 3/30/2015. Fees: PERMIT RENEWAL $100.00 CO - ADDITION TO DWELLING $50.00 Total: $150.00 Xildinghnspector 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. 34967 Z Date AUGUST 31, 2009 Permission is hereby granted to: CARMEN BATTISTA 20 SEAWOOD DRIVE SOUTHOLD,NY 11971 for CONSTRUCTION OF AN ADDITION OF AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FOR.REPLACES EXPIRED BP # 26274 at premises located at 20 SEAWOOD DR SOUTHOLD County Tax Map No. 473889 Section 088 Block 0002 Lot No. 010 pursuant to application dated AUGUST 31, 2009 and approved by the Building Inspector to expire on FEBRUARY 31, 2011. Fee $ 100.00 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 COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26274 Z Date JANUARY 14, 2000 Permission is hereby granted to: CARMEN BATTISTA 20 SEAWOOD DRIVE SOUTHOLD,NY 11971 for CONSTRUCTION OF AN ADDITION ON AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FOR. at premises located at 20 SEAWOOD DR SOUTHOLD County Tax Map No. 473889 Section 088 Block 0002 Lot No. 010 pursuant to application dated DECEMBER 20, 1999 and approved by the Building Inspector. Fee $ 75.00 Author d Signature ORIGINAL Rev. 2/19/98 Form No.6 TOWN OF SOUTHOLD 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" hitect or engineer responsible for the building. arc 6. Submit'Planning Board Approval-of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00. Accessory building $50.00, Additions to accessory building $50.00; 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 4 Date. New Construction: - Old or Pre-existing Building: (check one) Location of Property: o ~E~OG+GIry liC X1.//7 House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section ey t `Block Q L' ' Lot r~/O Subdivision Filed Map. Lot: Permit No. Date of Permit q 30-/r Applicant: Health Dept Approvgl: Underwriters Approval: Planning Board-Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ J~ BU/ pplicant Signature ~¢o~ p S0~ U 0 Town Hall Annex 9y Telephone (631) 765-1802 54375 Main Road Fax (631) 765-9502 P.O. Box 1179 ~ o roger. riche rt(atown.southoId.ny.us Southold. NY 11971-0959 ;16 ~1~00UNTl ~u BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Carmen Batasta Address: 20 Seaweed or City: Southold St: NY Zip: 11971 Building Permit#: 38367 Section: $8 Block: 2 Lot: 10 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor X Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 4 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures 8 CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 5 Twist Lock Exit Fixtures TVSS Other Equipment: 2-paddle fans, GFCI protected disconnect for self contained hot tub Notes: Inspector Signature: ` LL- 12z; ~1'11o, Date: Oct 7 2013 81-Cert Electrical Compliance Form.xls 62 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FO DATION 2ND [ INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: fi LIZ DATE o INSPECTOR ~o~~ ov sours TOWN OF S O DING DEPT. 765.1802 IN ION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE O 11-3 INSPECTOR 7 O~NOf S0I/Gl d t TOWN OF SOUTHOLD BUILDING DEPT. ' 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) k] ELECTRICAL (FINAL) REMARKS: DATE 6 ~-5 INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS 11 II y FOUNDATION (MST) II II II -~I--°----------__ ax II II Ir-___ I - - FOUNDATION (2ND) II II S Ij 11 V/i~ Z----------- - - rt-------ji" o ROUGH FRAME b II-------~I ~q./r-`-- - ¢J ~t C PLUMBING II II ---II II II---~ It 11 H INSULATION PER N. Y. " STATE ENERGY " CODE II ii u-------il - 1 11 I u n u II II H I II IppI_ _ (f YO~ " - ql - FINAL u q }k~-`~" P X 2~ ADDITIONAL COMMENTS: S 07 N H o. 0 Z d ca ro - H BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CHECK TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL ..76s Sb'7. Examined . 19.... MAIL T0:0-2- ~ .N9/20 ApProved.... .1........,a4 D.o Permit No. Disapproved /c 7 1 (Buildi. •I.• tor) 20 APPLICATION FOR BUILDING PERMIT / qp Date/V101111J ...,19(.(. ' 4 j INSTRUCTIONS a. This application mist be completely filled in by typewriter or in ink and submitted to the Building Inspector vii 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan stowing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATICH 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 Imply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building fed ~ssa inspections. (Signatur applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant i owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Hare of owner of premises _ , , ; ,!A /!/i~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builders License No . Plumbers License No . Electricians License No . Other Trade's License No . 1. location of land on which proposed work will be done C=2 '00 - 9. .oJ.... 7R.~.................. .~.l ~l. House Nu ber Street Qp Hamlet Canty Tat Map No. 1000 Section Q.GQ Block , . k...... Lot . ~o . Subdivision E'. e.'.4E 5.......... Filed Map No. Lot (Name) 2. State existing use and occupancy pL4Wemises intended use and occupancy of proposed construct\ion: a. Existing use and occupancy 5.~.' CE......... ~Nb~E `/9.!.. . ./1 6 b. Intended use and occupancy 4 Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work /A C# a (Description) Estimated Cos[ W............ fee . (to be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, rnnber of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions of existing structures, if any: Front... Rear............... Depth leiglht ..Q...... Ndnber of Stories ......11 ~Q r , Dimensions of same structure with alterations or additions: Front ......36.... Rear Depth / . 8 Height .......~1..O. ~ Number of Stories .r;:.;( / n / Dimensions of entire new construction: Front Rear C C? : IG........ lei64ut .......L......... Number of Stories Z E)~ GJ Rear 1.V. O.......... Depth Size of lo[: Front 8j Date of Purchase Name of Fon er Owner I. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: 1. Will lot be regraded .....Ae~ © Will excess fill be reamed from premises: o YES 'd. Names of Owner of premises .mi~l1 ~./..f.!1l!9 Address ~BrJlr¢W U~~..t! 5 Blom KV.- Nam of Architect .........7. Address Phone No. Name of Contractor ........:5~ ~!!G Address Alone No. 5. Is this property within 300 feet of a tidal wetland? * YES NO *17 YES, SOLMM 'IUldl TRUSTEES PM41T NAY BE RE(VIRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions rum property lines. Give street and block number or description according to deed, and show street names and indicate Nether interior or comer lot. SEE fJ~~,~~~ )All; Or N~]-nj~.ac / . )UNIT OF ..........being duly sworn, deposes and says that he is the applicant vare of individual signing contract) )ove named, ss,^^ ~pp is the ...................~5 J~!.~ 4~l'\ (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and Ihat the work will be performed in the mecnner set forth in the application filed therewith. worn to before me this Agll ,day of199q... Notary Public rc../J:..a.4,4.- - ( //v// CAfll9111 &UrA0N (Si of Applicant) Na01 Inble,lfyNdNwY t! ' aft ~~2021 r3f S 0 Town Hall Annex 54375 Main Road 411 Telephone (631) 765-1802 P.O. Box 1179 C"I el* roger. richertAox w(MI)s7o6digooid. ny. us Southold, NY 11971-0959 NAts &UNT'll BUILDING DEPARTmENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: Name: License No.: Address: .Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: e---( ~&~(6 Zq *Address: 2<D ~6EA4_voo~c~ --~>Cz~ *Cross Street: A'V'1S '1::bK y *Phone No.: cs---iz-_" r3 Permit No.: 1~r Tax Map District: 1000 Section: Block: Lot:. *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: YES / NO Rough In Final *Do you need a Temp Certificate: YES / NO Temp Information (if needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form OF SOpryoloy Town Hall; 53095 Main Road T T Fax (631) 765-9502 P.O. Box 1179 G Q Telephone (631) 765-1802 Southold, New York 11971-0959 A. MON, BUILDING DEPARTMENT TOWN OF SOUTHOLD June 20th 2006 Carmen Battista 20 Seawood Drive. Southold, N.Y. 11971 RE: 20 Seawood Dr. SCTM# 088 0002 010 Dear Ms. Battista, Please be advised that your Building Permit #26274 issued January 14`h 2000 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of $150.00 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. pF SOUlyolo Town Hall, 53095 Main Road 4 Fax (631) 765-9502 P.O. Box 1179 v' Telephone (631) 765-1802 Southold, New York 1 1 971-0959 ~1y00Urf1'I BUILDING DEPARTMENT TOWN OF SOUTHOLD September 19th, 2007 Carmen Battista 20 Seawood Drive Southold, N.Y. 11971 RE: 20 Seawood Dr. (Addition) FINAL NOTICE SCTM # 88 2 10 Dear Ms. Battista, Please be advised that your Building Permit # 26274 issued January 14th, 2000 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of 75.00; at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. ' OF SOUTyOIo Town Hall, 53095 Main Road Fax (631) 765-9502 P.O. Box 1179 N Telephone (631) 765-1802 Southold, New York 11971-0959 ~~y000NfV N BUILDING DEPARTMENT TOWN OF SOUTHOLD FINAL NOTICE April 21't 2008 Carmen 4/-Teresa Battista 20 Seawood Drive k«-' 0i '~c Southold, N.Y. 11971 i RE: 20 Seawood Dr. (Addition) SCTM # 88.-2-10 Dear Mr. & Mrs. Battista, Please be advised that your Building Permit # 26274 issued January 14th. 2000 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of 75.00; at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. rra==.- Southold Town Building Department P.O. Box 1179 Permit 34967 54375 Main Road Southold, New York 11971 Permit Date: 8/31/2009 (631) 765-1802 Expiration Date: 2/28/2011 Parcel ID: 88.-2-10 BUILDING PERMIT RENEWAL LETTER Dated: 4/10/2012 Applicant: CARMEN BATTISTA Location: 20 SEAWOOD DRIVE SOUTHOLD Work Description: FOUNDATION CONSTRUCTION OF AN ADDITION OF AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FOR.REPLACES EXPIRED BP # 26274 A FEE OF $50.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: CARMEN BATTISTA Address: 20 SEAWOOD DRIVE SOUTHOLD, NY 11971 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. No work is permitted or authorized beyond the expiration date. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. Southold Town Building Department g,r9~if0(~° P.O. Box 1179 Permit 34967 54375 Main Road Southold, New York 11971 Permit Date: 8/31/2009 g (631) 765-1802 Parcel ID: 88.-2-10 Expiration Date: 2/28/2011 BUILDING PERMIT RENEWAL LETTER FINAL NOTICE Dated: 8/15/2012 Applicant: CARMEN BATTISTA Location: 20 SEAWOOD DRIVE SOUTHOLD Work Description: FOUNDATION CONSTRUCTION OF AN ADDITION OF AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FORAEPLACES EXPIRED BP # 26274 A FEE OF $50.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: CARMEN BATTISTA Address: 20 SEAWOOD DRIVE SOUTHOLD, NY 11971 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. 7011 1570 0001 8894 9296 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. s=- Southold Town Building Department 4 `'t P.O. Box 1179 Permit 34967 54375 Main Road Permit Date: 8/31/2009 Southold, New York 11971 Ada (631) 765-1802 Expiration Date: 2/28/2011 1 p, Parcel ID: 88.2-10 Dated: 11/9/2012 Applicant: CARMEN BATTISTA Location: 20 SEAWOOD DRIVE SOUTHOLD Work Description: FOUNDATION CONSTRUCTION OF AN ADDITION OF AN EXISTING FOUNDATION (BP#20014-Z) AS APPLIED FOR.REPLACES EXPIRED BP # 26274 Owner: CARMEN BATTISTA Address: 20 SEAWOOD DRIVE SOUTHOLD, NY 11971 Your BUILDING PERMIT #34967 has been referred to me because you have not responded to requests to obtain your Certificate of Occupancy as required by Southold Town code. Pursuant to 144-15A, of the Southold Town Code, "No building hereafter erected shall be used or occupied in whole or in part until a certificate of occupancy shall have been issued by the Building Inspector." e) L) Therefore, you have ten day rom the receipt fo this letter to submit a check made out to the Town of Southold in the amount of 00.00 to renew the building permit, or legal action will be taken against you. Should you have any questions, call the building department between the hours of 8:00 a.m. and 4:00 p.m. Respectfully Yours, Michael Verity: Chief Building Inspector Southold Building Department cc: Damon Rallis Zoning Inspector so Tb Town I lull Annex Telephone (631) 765-1802 54375 Main Road Fax (631) 765-9502 P.O. Box 1179 T Q Southold, NY 11971-0959 com N ~ BUILDING DEPARTMENT TOWN OF SOUTHOLD October 4, 2013 Carmen Battista 20 Seawood Dr Southold, NY 11971 TO WHOM IT MAY CONCERN: The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: OA~ Application for Certificate of Occupancy. (Enclosed) I? Electrical Underwriters Certificate. (contact your electrician)? A fee of $50.00. ~~5f> ~ohl~ Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1(84) Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept BUILDING PERMIT: 38367 - Addition Applicant/ Date Owners Name lam,( Reviewed- Architect/ Date Engineer Submitted SCTM i!: District: l 000 Section: Block Lot: Project l~ - - Subdivision Location ~ ~ - ~ lb-O7 C~ ~ ~ (h"~'w ' Name-_ _ Single & separate Required /YI cernfication: (Yes / No) w2114r-4' nning Uls111C1...7~ [Lot siu _y~~ 00U. AaunI I~__~t'/Iq coverage ~~Piatxitied __~1 Req / Rey. RN SO / tFronl Yard -itb-Proposed (Side Yard Proposed _ 1 IRear Yard Proposed J oT0 Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. ? Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation Flood Zone: Notes: C o . ~~~r~~ /3 o,~ D arw Building Permit/C.O. Checklist Procedure Approved by Signature D-te C C Application Received / Complete ? l:~ ~O Plan Review / OK for Permit ( enclose worksheet ) Permit Issued - Plan Amendment ( if applicable) Final Inspection Complete / OK for C.O. 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NOT RESPONSIBLE FOR D°~ f; I _ rr DESIGN OR CONSTRUCTION ERRORS ?xb It I ~ I ? f^ wA LL a x 80 Y zxb t FTE,2 S ~C ~ O f-FEa~R 2 ~C(, 1~ialE Jo i N ~ O 8 UJP, LL .fir S~~ING~oCrZ i • J , I'i it i___~_. - , ~ - - ~ I I ~ 10 J Its l~ ! I i i I i I ~ C I I I I'I v I i t it Z I , ' I I Ai ! i I ' ' ! w ~ ii I ~ s I I ¦ Complete Items 1, 2, and 3. Also complete A- Signet re I. Item 4 if Restricted Delivery is desired. X Agent ¦ Print your name and address on the reverse ? Addressee so that we can return the card to you. B. R by 9ed C. D to of Del ¦ Attach this card to the back of the mailpiece, 4?~ - or on the front if space permits. . Is Nary address different 0om Item f?f ? y 1. Article Addressed to: p?~~ 7y It YES, enter del ivory address below: ? No Can.nw~v, Bc~.~t~ 10 3. Service type 1 n A I P CeMged Mail ? Express Mall s~ aL.LC / / ~~q ? Registered Ill Receipt for Merchandise ? Insured Mail ? C.O.D. q6 n yy 4. Restricted Delivery? abdrs Fes) 13 Yes 2. Arable Number (llsns/erfrom born -70 Sp p( ~J ~V o[ g p / /yV _ service PS Form 3811, February 2004 Domestic Return Receipt 102595-02rs-1540 UNITED STATES POSTAL SERVICE I II II I Fimt-Class I D Paid P6 9N& GFees -10 • Sender: Please print your name, address, and ZIP+4 in this box TOWN OF S=HOW MUNNO DEPARTL ENT P.0. loot 117Y ftwili ld, Ky.11911