HomeMy WebLinkAbout28381-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28588 Date: 07/15/02
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 1370 LATHAM LA ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 15 Block 9 Lot 1.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 8, 2002 pursuant to which
Building Permit No. 28381-Z dated MAY 13, 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 ALTERATION AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ANDREW R MARTIN & LISA MARIE CASEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1052514 06/07/02
PLUMBERS CERTIFICATION DATED 07/10/02 KING PLUMBING & HEATING
�T
t orize 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. 28381 Z Date MAY 13 , 2002
Permission is hereby granted to:
ANDREW R MARTIN
200 HICKS STREET #6-S
BROOKLYN,NY 11201
for .
ALTERATION AND DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR FLOOD PMT. INCLUDED
at premises located at 1370 LATHAM LA ORIENT
County Tax Map No. 473889 Section 015 Block 0009 Lot No. 001 . 004
pursuant to application dated MAY 8 , 2002 and approved by the
Building Inspector.
Fee $ 250 . 00 CFJoc 1?...4.1. d)
Authorized Signature
COPY
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. Swom 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. 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 a 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$25.00,I
at3das ttr$welhng$25 00,
Swimming pool$25.00,Accessory building$25.00,Additions to accessory buil5.0QQ u$i-I SOHO.
2. Certificate of Occupancy on Pre-existing Building- $100.00 J� I 4g� -
3. Photocopy of Certificate of Occupancy-$0.25 t
1
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00 _ -
` n
� C-
Date.G -2'
New Construction: r7 Old or Pre-existing Building: ✓ (check once))
Location of Property: 3 / L IC44tlq,V-1" �rq�� a/Z l' /
House No. Street Hamlet
Owner or Owners of Property: 8 ►j l M -1,-7
Suffolk County Tax Map No 1000, Section Block_C�G10 Lot X/,00X
Subdivision l:�W t) Filed Map. D LJ Lot:
Permit No. ^Z Date of Permit. S/��1� 2- Applicant:L IJ✓l�2pWl►� ' i � 2
F01L 0 w
Health Dept. Approval: \A Underwriters Approval:
Planning Board Approval: '13`N2�1
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ d S
5 Ss
pplicant Signature
Nwom to uetore me tis t
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5
5
J 'BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
40 FULTON STREET — NEW YORK, NY 10038 C�
5 CERTIFIES THAT C5
5 Upon the application of upon premises owned byALAN HUBBARD ELEC. 5
5 5
5 1ANDREW
126 CLOVER R PURO.BOX 2241 11370LAT MAN ANE 5
5 AQUEBOGUE, NY 11931, ORIENT, NY 11957 5
7C 5 Located at 1370 ATHMAN ANE ORIENT, NY 11957
5 5
5 Application Number: 1052514 Certificate Number: 1052514 5
5 5 5
Section: Block: Lot: Building Permit: BDC: NS11 5
5 Described as a 5
C Residential occupancy, wherein the premises electrical system consisting of 5
electrical devices and wiring, described below, located in/on the premises at: 5
5 Basement,First Floor,Second Floor, Outside, 5
5 55
5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was S
found to be in compliance therewith on the 7th Day of June,2002. 5
5 Name QTY Rate Rating Circuit Type
5 Appliances and Accessories 5
5 Dish Washer 1 0 1.2 KW 5
5 Exhaust Fan 1 0 F.H.P.
5 Oven 1 0 4.7 KW 5
5 Wiring and Devices 5
5 Receptacle 8 0 General Purpose 5
5 Switch 14 0 General Purpose 5
5 Fixture 12 0 Incandescent 5
5 Receptacle 9 0 GFCI 5
5 Dimmers 3 0 5
5 Paddle Fan 2 0 5
5 5
5 5
5 seal 5
011
5
5 I of I 55�'
SThis certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 5
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WARREN A.SAMBACH,SR. h t '
111
CONSULTING ENGINEERS PLANNERS f �
a
U
i L , 2002 �I
7675 COX LANE - P.O.BOX 1033 •
CUTCHOGUE,NY 11935 L1!y,`e F C�"11 tTHOID
6 31— (�)734-7492
June 7 2002
Juhn Boufus
Building Department
Town of Southold
Town Hall
53095 Main Road
Southold NY 11971
Re: Casey/Martin Residence
1370 Latham Road
orient NY 11957
Permit #28381
SCTM 1000-01500009-004
Mr. Boufus :
This is to certify that the headers were installed as
per detail submitted.
Sincerely,
Warren A. Sambach Sr. P.E.
was:s
encl.
t
WARREN A.SAMBACH,SR.
CONSULTING ENGINEERS- PLANNERS `y _
r.... _ ' 9
7675 COX LANE - P.O.BOX 1033
CUTCHOGUE,NY 11935
631-I=)734-7492
June 5 2002
John Boufus
Building Department
Town of Southold
Town Hall
53095 Main Road
Southold NY 11971
Re: Casey/Martin Residence
1370 Latham Road
Orient NY 11957
Permit #28381
SCTM 1000-015-0009-1 .004
Mr. Boufus :
Enclosed is a header detail installed for the Awning windows
in the kitchen and it conforms to the New York State Uniform
Fire Prevention and Building Code.
Sincerely,
Warren A. Sambach Sr. P.E.
was: s
encs .
WARREN A.SAMBACH,SR. I j
CONSULTING ENGINEERS• PLANNERS
T 2�yVy� I!�
7675 COX LANE • P.O.BOX 1033 �.__.----.--- -
CUTCHOGUE,NY 11935
631- 0734-7492
June 6 2002
John Boufus
Building Department
Town of Southold
Town Hall
53095 Main Road
Southold NY 11971
Re: Casey/Martin Residence
1370 Latham Road
Orient NY 11957
Permit #28381
SCTM 1000-015-0009-004
Mr. Boufus:
The installation of the headers for the awning windows
in the kitchen for the above residence are more that adequate
to support the load imposed on them, and conforms to the
New York State Uniform Fire Prevention and Building COda.
Detail of the header installation is submitted herewith.
Sincerely,
1 Q � ,d
Warren A. Sambach Sr. P.E.
was:s
encl.
STMRA
�a
�f John Q Ehlers Land Surveyor
6 East Main Street, Riverhead, NY 11901
(631)369-8288 Phone
r (631)369-8287 Fax
May 202 J !
Judy McAfee
Environment East, Inc
2885 Indian Neck Lane
PO Box 197
Peconic, NY 11958-0197
RE: Martin Property(Lisa&Andrew)SCTM#1000-15-9-1.4
Dear Judy,
Pursuant to your request on behalf of the above homeowners, we determined the elevations of several
items at the property. We found the deck elevation to be 17.1'and the finished floor to be 17.8'. These
elevations are referenced to NGVD'29.
Please call if you have any questions or require further assistance.
Sincerely,
61'John C. Ehlers
Land Surveyor -
G. �o
r .,�P
,]� H : _.
• • d�" T. TERRY r_ 1 na'ri .IIIS 1OuS
) nlJlll ILOad
TOWN CLERK ZZ, i•. C P O R(,\ 117()
S(IUllluld NC11 lurk 11(171
REGISTRAR OF VITAL STATISTICS l �✓� iC� � Fez 010)
MARRIAGE OFrICI.R
RECORDS MANAGEMENT OFFICER _ .1 O• T
-'IQl y� cicPh<,nc (S 1(,) 7(,S. I HU 1
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 :
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of the Code of the Town of Southold: ((Floodplain Development Permit
Application" [FDP(93) ] , and "Certificate of Compliance for Development in
Special Flood Hazard Area (C/C(93) ] .
t I1
Bi iv. C1-..
TOWN OF SOiM( !OLD
Audith T. Terry
Southold Town Clerk
August 25, 1993
APPLICATION
PAGE 1 of 4
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION 1: GENERAL PROVISIONS (APPLICANT to read and si6):
1. No work may start until a permit is issued.
2 The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make ieasonable
inspections required to verify compliance.
8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
THIS APPLICATION ARE,TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE.
(APPLICANT'S SIGNATURE) DATE
SECTION 2: PROPOSED DEVELOPMENT(To be completed by APPLiCANTI
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER
PROJECT LOCATION:
• To avoid delay in processing the application, please provide enough information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing
the project location would be helpful.
FDP(93)
APPLICATION
PAGE 2 OF e
DESCRIPTION OF WORK (Check all applicable boxes)
A. STRUCTURAL DEVELOPMENT
ACTIVITI' STRUCTURE TYPE
O New Structure Wkesidential (1-4 Family)
W-Addition ❑ Residential (More than 4 Family)
W,i6 Jtcration ❑ Non-residential (Flood proofing? ❑ Yes)
❑ Relocation ❑ Combined Use- (Residential & Commercial)
❑ Demolition ❑ Manufactured (Mobile) Home (In Manu-
❑ Replacement factured Home Park? ❑ Yes)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES_
❑ Fill ❑ Mining ❑ Drilling ❑ Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
❑ Drainage Improvements (Including Culvert Work)
❑ Road, Street or Bridge Construction
❑ Subdivision (New or Expansion)
❑ Individual Water or Sewer System
❑ Other (Please Specify)
After completing SECTION 2, APPLICANT should submit form to Local Administrator for review.
SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
The proposed development is located on FIRM Panel No. . Dated
The Proposed Development:
❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
❑ Is located in a Special Flood Hazard Area.
FIRM zone designation is
100-Year flood elevation at the site is: Ft. NGVD (MSL)
❑ Unavailable
❑ The proposed development is located in a floodway.
FBFM Panel No. Dated
❑,$� ion 4 for additional instructions.
SIGNED )Fid- DATE Z
L./
APPLICATION N
PAGE 3 OF 4
SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATORI
The applicant must submit the documents checked below before the appbcaUon can be processed:
O A site plan showing the location of all casting structures, water bodies, adjacent roads, lot
dimensions and proposed development.
❑ Development plans, drawn to scale, and spccificatipns,including where appGcablc:details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water
resistant materials used below the fust floor,details of floodproofmg of utilities located below
the first floor and details of enclosures below the first floor.
Also
O Subdivision or other development plans (If the subdivision or other development exceeds 50
lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations
if they are not otherwise available).
❑ Plans showing the extent of watercourse relocation and/or landform alterations.
❑ Top of new fill elevation Ft. NGVD (MSL).
❑ Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For
floodproofed structures, applicant must attach certification from registered engineer or
- architect.
❑ Certification from a registered engineer that the proposed activity in a regulatory floodway
will not result in any increase in the height of the 100-year flood. A copy of all data and
calculations supporting this finding must also be submitted.
❑ Other.
SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
I have determined that the proposed activity. A O Is
B. O Is not
in conformance with provisions of Local Law 19 . The permit is issued subject to the conditions
attached !qAa&1nade part of this permit.
SIG D DATE ` q /d Z
If B checked, the Local Administrator may issue a Development Permit upon payment of designated
fee.
If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a hearing from the Board of
Appeals.
APPLICATION k _
PAGE a OF a
APPEALS: Appealed to Board of Appeals? ❑ Yes O No
Hearing date:
Appeals Board Decision --- Approved? O Yes ❑ No
Condilious
SECTION G: AS-BUILT ELEVATION (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered professional engineer or a licensed land surveyor (or attach a certification to this application).
Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard
Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FT. NGVD (MSL).
2. Actual (As-Built) Elevation of floodprooCmg protection is FT. NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant.
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINLSTRATOR will complete this section as applicable based on inspection of the project to
ensure compliance with the communitYs local law for flood damage prevention.
INSPI✓CTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
SECTION 8: CERTIF1CaTE OF COMPLIAN FITn a completed by LO wi ADhiiNI RATOR)
Certificate of Compliance issued: DATE: BY.
Attachment B
SAMPLE
CERTIFICATE OF COMPLIANCE
for Development in a Special Flood Hazard Area
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(ONA ER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
❑ EXISTING BUILDING
❑ VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19
SIGNED: DATED:
B• COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_7 AS MODIFIED BY VARIANCE #
DATED
SIGNED: DATED:
C/C(93)
BUILDING PERMIT REVIEW CHECK LIST
Applicant/ Date
Owners Name: C�.d[.� Reviewed:
Architect/ Date .
Engineer: tti►.wK Submitted: 2q
SCTM M
District:JW Section: Block: _ Lot:
Project13 70 Subdivision
Location: Name:
Single&separate Required go
certification: SI'es/Nol
,(� R� ! / R�
Zoning District: C� (Lot size: Actual: ,`13�'d" 1 [Lot coverage a'd d Proposed:_ � 1
Req. ,�,�r/ Req. �'� Req. f
(Front Yard Jt/ Proposed] (Side Yard Proposedr (Rear Yard �� Propose
Project Description:
AGENCY PERMITS Permit
REQUIRED FDR REVIEWice. 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: (�wr ;2 '" / 3 A" ^
Notes-,
IWY
I V4
1114 8fy. 4
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ l FRAMING FINAL
[ j FIREPLACE & CHIMNEY
REMARKS: - _ f',
All
Zor
140
ATE INSPECTO
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLB .
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING INAL
[ ] FIREPL & CHIMNEY
RE RKS:
DATE INSPECTO -
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING �[ INAL
[ ]
FIR EPLA CHIMNEY
REMARKS:
DATE 'INSPECTO
FIELD INSPECTION REPORT DATE CObID'II'om
�c
FOUNDATION (1ST) _ui .
op H
-------------------------------------
FOUNDATION(2ND)
7s".
z
' O
D a— p
cn
ROUGH FRAMING&
PLUMBING y
x
INSULATION PER N.Y.
y
STATE ENERGY CODE
FINAL
ADDITIONAL CO.'
O
5 z
m
z
b
y
O
Z
x
d
b
y
TOWN OF SOUTH l' BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPAR NTe� -n Do you have or need the following,before applying
TOWN HALL ,- G 9 2C�2 Y g> PP Ymg
SOUTHOLD,NY 171 Board of Health
�— 3 sets of Building Plans
TEL: 765-1802
Survey
PERMIT-14 �? $ $ �-� Check
Septic Form
N.Y.S.D.E.C.
ExaminedTrustees
1 ,200a— Contact:
Approved_ 200a a
' Mail to:
Disapproved a/c
��I3 O: Phone:
Bu11d111gJJ
APPLICATION FOR BUILDING PERMIT
Date //3d/�Z , 20
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.
CAl01QG-TJrnE51 L"-r-$t is
(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
G�e &j-e q_4 CC) )-� rAC,4A---,
Name of owner of premises }')�
(as on the tax roll or latest deed)
If.. n signature of duly authon*7.qd officer
ame d 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�e done:
House Number Street Hamlet
County Tax Map No. 1000 Section I5 Block q . Lot
Subdivision (-z7-,,
(Name) �QFiled Map No. , Q Lot
2. State existing use and occupancy of premises and intended use and occupancy OT Proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy I FPxh-�r cut
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost 1-5,
p oo Fee (Description)
(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 1' ( h - Rear Depth
Height Number of Stories
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 Rear Depth
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:
13. Will lot be re-graded Will excess fill be removed from premises: YES NO
A.n. pan 1-i /fSv �7.t;tJb r3rr Z / 6�/4
14. Names of Owner of premises`�''�'��°�- Address N''t IJP to —Z L Phone Not*
Name of Architect Address Phone No
Name of ContractorPrQu�ncvh, w� tr i7_ Address 0 Wit° /9-) Phone No. 6 31 7 3 q?Y?2
wl 5v d'e(0
15. Is this property within 100 feet of a tidal wetland? *YES NO L/
• 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)
SS:
COUNTY OF ) p
�A /( being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,Aent, 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 wilt be
performed in the manner set forth in the application filed therewith.
Sworn to before me s
Myda2002-
t
/0
NOtaFTELENE D.HORNE Signature of?,ppl ant
Notary Public,State of New York
No.4951364
Qualified in Suffolk County
Commission Expires May 22, Oo`�
Friday, February 08, 2002 10:03 AM John C. Ehlers 631 369 8287
p.02
.n
SURVEY OF LOT , 4 N �.
MAP OF
FILED MAY 5, Iq?3 ® W E
AS MAP * 5409 Fra —1120 _ �!
SITUATE. ORIENT g
TOY`W- SOUTHOLDI
SUFFOLK COUNTY,INY
SURVEYED O8-I9-99 ^ �:/LD
PIPP. deck, a FEMA 02-Ob-02 1
SUFPOLK GOVNTY TAT N
1000 - IS - 9 -
CERTIFIED 70:
ANDREW R. MARTIN
L15A MARIE GA5EY
FIDELITY NATIONAL TITLE
INSURANCE COMPANY OF NY
FLAT13USH FEDERAL SAVING5 i 8`q
AND LOAN ASSOCIATION 9
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FIRM MAP N3610300086 G ...'.. .....".'..-...........:
SURVEY NOT UPDATED IN FIELD JOHN C. EM—ERS LAND SURVEYOR
REDUCED FOR FAX 6EAST MAIN pD•N.Y.11901
N.Y.S.LIC.NO.50202
j GRAPHIG 5GALE 1"= BO'
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MAP OF "LANDS END" ' W E
FILED MAY 5 I
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SITUATE: ORIENT S
TOWN: 5OLrrHOLD
5UFFOLK COUNTY, NY
SURVEYED 08-19-99 sS! 4.j�i
SUFFOLK COUNTY TAX #
1000'- 15 - 9 - 1.4
CERTIFIED TO: e�Ehi I�
ANDREW R MARTIN
LISA MARIE CASEY 4�
FOBAY NATIONAL TITLE e.
INSURANCE COMPANY OF NYFLA6
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MONUMENT
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AREA = 1.13 ACRE-5 .... JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
SRAPHIG SCALE I"= 30' RIVBRHEAD,N.Y. 11901
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HEADER DETAIL
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APP WW PECK TO E4511NG F{d�FEE Bv.
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FOLLOWING INSPECTIONS:
EXI511N6 PECK ANP 5SP5 1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
Kl
OUGH - FRAMING & PLUMBING
' &JE
SULATION
EXISTING PECK EXIENP E4511N6 RAID 4INAL - CONSTRUCTION MUST
E COMPLETE FOR C.O.
ACONSTRUCTION SHALL MEET
T REQUIREMENTS OF THE N.Y.
S TE CONSTRUCTION & ENERGY
C DES. NOT RESPONSIBLE FOR
D9 SIGN OR CONSTRUCTION ERRORS
NEW 1'6" 5LIPIN�WWOW W6'0" 5LIPIN6 6LA55 P
NEW POOZ5& F1919 PANEL TO WFLACE EXISTING -Ma EXI511NG I�At�ER, (51LL a h5" A130VE FLOOR) W/ 5WCL051NG PE
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6'0" %1121NG 6LA55 POOR rnv 60" 5LIPIN6 61,A55 POOR �
W/5ELF 0L051N6 PEVICI; W/SELF CL051NG PEVICE ( - . REPLACE EXI5i1WG
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2 WW WINVOW5
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1 ,28,02 '1 PLUMBING
SING WASTE
LINES NEED
MRONM f �A51' INC, EFORE COVERING
P ERQ�oF
C TENT BEFORE �y , +A.
PROVIDE A SCALD A /TIER CA OF OCCUPANCY If Copper tubing is ,
THERMALS K PREVEI ING for water distributin
DEVICES A ER USED IN WATER system;piping shall
N.Y. STATE BUILDING CODE. LY SYSTEM CANNOT of types K or L only
LXCEED 2/10 of 1% LEAD. UNDERWRITERS CERTIFICATE
REQUIRED -
3"
C65W MARM 115IM-Na
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4.18,02
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2X4 Q 18'D.C.TYP.
HEADER DETAIL HEADER DET41L
CASEY/MARTIN RESIDENCEs ,r �
DOOR / WINDOW HEADER DETAIL
1 .29.02