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Home My WebLink About28723-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28881 Date: 09/24/02 THIS c~TIFIES that the building ALTERATION Location of Property: 8665 MAIN RD (HOUSE NO.) County T~x Map No. 473889 Section 31 EAST MARION (STREET) (HAMLET) Block 3 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, 2002 pursuant to which Building Permit No. 28723-Z dated SEPTEMBER 5, 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 INSTALLATION OF A HEATING & AIR CONDITIONING SYSTEM AS APPLIED FOR "AS BUILT" & AS PER CERTIFICATION OF JOSEPH FORCINA, P.E. DATED 9/14/02. The certificate is issued to ANNE PAGE BRITTON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~KALTH APPROVAL ELECTRICAL c~TIFICATE NO. PLUMBERS CERTIFICATION DA'r~o Rev. 1/81 N/A PENDING 09/21/02. N/A ~' A~t hori z;d S/at're FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIT~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28723 Z Date SEPTEMBER 5, 2002 Permission is hereby granted to: ANNE PAGE BRITTON 490 PENN AVE WILLISTON PARK,NY 11596 for : INSTALLATION OF A HEATING AND AIR CONDITIONING SYSTEM AS APPLIED FOR "AS BUILT". at premises located at 8665 County Tax Map No. 473889 Section 031 pursuant to application dated AUGUST Building Inspector to expire on MARCH MAIN RD EAST MARION Block 0003 Lot No. 014 26, 2002 and approved by the 5, 2004. Fee $ 300.00 Rev. 5/8/02 ORIGINAL ~i. DG. DE?T. '7"~\',~,~ QF SOUT~OLD 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: 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 fi.om architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. Ao 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. Fees 1. Certificate of Occupancy - New ~lwelling $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 - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. ~ ~i~ [~ ~ New Construction: Old or Pre-existing Building: Location of Property: ~ [ 1~ ~ House No. Street Owner or Owners of Property: {~ Y'I~I~ [5:~o~-~a,~ ~c-~¥¥'~r~ Suffolk County Tax Map No 1000, Section '"~[ Block (check one), Hamlet Lot | q Subdivision Permit No. '7_ %'-I -'L-'"~ - '2- Date of Permit. Health Dept. Approval: Filed Map. Applicant: ~ V4 Underwriters Approval: Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ri. ~ , 0 0 Final Certificate: G,,.tc_, 6, (check one) A pplican~ Signature RE ~ E HOI'IE IDISPEETIOI~' EO£P Heating System Inspection Ann Britton 8665 Main Road East Marion, NY 11939 09/14/2002 HEATING/AIR CONDITIONING SYSTEM TYPE: Two furnaces provide heating for the house. One furnace is located in the basement and provides heat to the first floor of the house. The second furnace is located in the attic and provides heat to the second floor of the house. The furnaces are identical and the heating/air conditioning system is configured as follows: · Manufacturer-Goodman Manufacturing Company, 100,000 BTUs, gas fired forced hot air/air conditioning system, with one zone per furnace. · Approximate Age- New (less than a year old) SUMMARY: On 14 September 2002, AC&E Home Inspection Corporation performed a visual inspection of the accessible heating/air conditioning system components (i.e., furnace, piping, registers, ducting, emergency shut-off switches, exhaust stacks, thermostats, etc.). The heating system/air conditioning was turned on, and a functional check was performed. On day of inspection the heating/air conditioning system was working properly with no observed leaks or safety hazards. As a result of this inspection, AC&E concludes that the heating/air conditioning system has been installed properly and in accordance with applicable State and local building codes. Thank you._, Joseph Forcina, P.E. LIC # 077433 A C & E Corp. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD Of FIRE UNDERWRITERS BUREAU OF ELECTRICITY STREET ~ NEW YORK, NY 10038 40 FULTON CERTIFIES THAT Upon the application of upon premises owned by MARY MCTIGUE CIO ANN BRITTON COOK PHONY FARMS REAL ESTATE 8665 MAIN ROAD 57125 MAIN RD EAST MARION, NY 11939 SOUTHOLD N.Y 11971 Located at 8665 MAIN ROAD EAST MARION, NY 11939 Application Number: 1080935 Certificate Number: 1080935 1000.31 Block: 3 Lot: 14 Building Permit: BDC: NS11 Section: Described as a Residential occupancy, wherein the premises electrical system consisting electrical devices and wiring, described below, located in/on the premises at: Basement, Outside, Attic, was inspected in accordance with the National £1ectrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 23rd Day of September, 2002. .Name QTY Rate Rating Circuit Type Additional Charges Survey of 2 gas furnaces and2-3 ton air con No visual defects: an elctrical survey has been made of the exposed electrical equpment in the premises indicated. No obvious unsatisfactory condition was found. seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. THENEWYORKBOARD OF FIRE UNDE "?:'P"~" BUREAU OF ELEr'TRIGITY :' 40 PULTON ~TREET, NEW YORK, NY 10030 I~ ...... : ' ' Ap~fi~mn , 'o. on ~ I~ CERTIFIES THAT ly ~e e~ct~cai e~ment ns de.~c~ he~ ~ intr~u~e~ ~y the applimnt aa,n~d on the abo~e ~pl~'~ion number ...: .... ~ ...... ! ............ L ................... : ........................... DRYERS ~ FURNACE MOTO~ ~ F~E APPUANCE ;EEOERS ISKC~ EEC'~,; RME ~KS T IELL I ' "~--'-~' ....... ~ ........ ! .................. · m · , I m : , - - T L .._~ ..........; ......... =. .......... ~ ............. .~'-~ '~i::' =~W--' FF~;i'~"~)~F;, ......... -~..~ .'... ::: : .: -.. :.:~' GENERAL MANAGER i) ThN 4~fllf~qt~ mum ~ IM oltl~KI bt any Maimer; TltUm IO. ttllb QffJ~l of~! I~ R IhGOnUG~. Ir41~lOt,. moy be Ic~entlfiod I=y Iholr CreCI41n!l~m. NTCGO75FB NTC6075HF NTC6100GF NTC6100KF NTC6100KJ ~TC6126KJ, NTC6160KJ Model Number NATURAL~II~ i IITC6OSOFB INPUT (btuh) 50,000 75,000 75,000 100,000 100,000 100,000--' J ~5,000 150,000 HTG. CAP. (btuh) 40,000 59,000 60,000 79,000 80,000 79,000 99,000 120,000 AF'UE % (lC, S) 80.0% 60.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% CSE 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% TEMP. RISE (dm:j. F) 35 - 65 35 - 65 25 - 55 45 - 75 40 - 70 35 - 65 40 - 70 45 - 75 VOLTS/PR/HZ 115/6011 11516011 115/6011 115/60/1 115/60/1 115/6011 115/60/1 115/60/1 F. LA. 9 9 12 7 12 12 15 15 TRANSFORMER (V~..) 40 40 40 40 40 40 40 40 GAS PIPE SIZE (IN.) 1/2 1/2 1/2 1/2 1/2 1/2 1/2 1/2 CATEGORY ! VENT SIZE 3" 4" 4" 4" .~-4=-~---T~ 4' 5" 5" COOLING CAP. 3.0 TON 3.0 TON 4.0 TON 3.5 TON ( 5 TON ,~/ 5.0 TON 5.0 TON 5.0 TON FILTERSlZE(IN.) 14x25x1 14x25x1 16x25x1 16x25x1 '"lEX'25x1 16x25x1 {2) 16x25xl (2) 16x25x1 (2) SHIPPING WEIGHT (LBS.) 127 129 157 159 159 175 177 179 DIMENSIONS (in.) HEIGHT 40 40 40 40 40 40 40 40 W1DTH X DEPTH 151/2 x 281/2 151/2x28~/2 19~/8 x 281/2 191/a x 28~/2 191/e x 28~/2 22~/4 x 281/2 223/4 x 281/2 22~/4 x 281/2 Model Number NATUP.~L~II~ NTC6OSOFB NTC~iTSFB NTC6075RF NTC6100GF NTC6100KF NTC6100KJ NTC6125KJ NTC6150KJ BLOWER TYPE AND SlZ~ 10x8 10x8 10x10 10x10 11x10 11x10 11x10 11x12 MOTOR H.P. (TYPE) 1/3 1/3 1/2 1/2 3/4 3/4 3/4 3/4 MOTOR SPEEDS 4 4 3 4 4 4 4 4 LOW 575 675 1503 815 1278 1210 1264 1357 .10 ESP IN. W.C. MEDIUMII.~ 859 859 1043 1546 1441 1520 1542 M E DIl,~ll 1722 MEDIUM ~IMGH 1015 1015 1324 1822 1773 1841 1709 HIGIfl 1306 1306 1887 1649 2302 2104 2161 2073 LOW 662 662 1460 783 1264 1201 1251 1325 .20 ESP IN. W.C. MEDIUM ~ 846 846 1030 1543 1430 1506 1525 MEDIEIM 1660 MEDIUM IIllG~ 999 999 1302 1784 1740 1803 1750 HIGI,t 1268 1268 1810 1616 2231 2078 2132 2040 LOW 651 651 1420 755 1244 1197 1249 1290 MEDIUM ~ 819 819 1021 1499 1453 1486 1503 .30 ESP IN. W.C. MEDIUFiI 1608 MEDIUM I1~ 1230 1230 1280 1737 1740 1772 1761 HIGF! 1324 1324 1752 1592 2171 2061 2079 2014 LOW 636 636 1370 735 1212 1191 1219 1270 MEDIUM [l~ 795 796 ~ 989 1471 1441 1456 1480 .40 ESP IN. W.C. MEDI~IB 1540 MEDIUM ~ 952 952 1255 1683 1718 1736 1740 HI(~I 1193 1193 ' ''1670 1546 2098 2020 2042 1975 LOW 608 608 1318 704 1185 1167 1168 1243 MEDIUM LOW 765 765 968 1417 1425 1427 1464 .50 ESP IN. W.C. MEDtUlg 1484 MEDIUM i!611 914 914 1218 1641 1707 1702 1710 HIGH 1133 1133 1599 1502 2012 2005 1991 1953 LOW 564 564 1250 668 1178 1160 1178 1225 .60 ESP IN. W.C. MEDIUM LOIN 735 735 941 1367 1390 1415 1430 MEDIIJM 1400 MEDIUM IIGI4 870 870 1171 1574 1676 1672 1650 HIGH 1056 1056 1520 1425 1921 1953 1914 1885 LOW 514 514 1182 646 1119 1130 1143 1195 MEDIUM LOW 685 685 881 1304 1365 1358 1401 .70 ESP IN. W.C. MF_D1UII - 1322 MEDIUM HIGH 818 818 1100 1495 1654 1614 1602 HIGH 980 980 1425 1353 1826 1917 1838 1827 NOTE: Application of NTC61OOKF, NTC61OOKJ, NTC6125KJ, & NTC615OKJ above 1650 CFM requires two side returns or bottom return or use accessory stand-off fleer rtl lot single side return. To achieve 2000 CFM vVilh Ihe stand-off filter kit you will still need a bottom return or 2 side filters. · ~[ClFICATIONS SUBJECT TO ClI~IIGE WTTHOeT NO'rlCE aa~lNumber ~ ~ NTCGO75FB NTCGO76HF ~ NTC6100KJ NTC6125KJ NTC615OKJ INPUT (btuh) 50,000 75,000 75,000 100,000 100,000 100,000 125,000 150,000 HTG. CAP. ('otuh 40,000 59,000 60,000 79,000 80,000 79,000 99,000 120,000 AFUE % (ICS) 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% CSE 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% 73.0% TEMP. RISE (deg. F) 35 - 65 35 - 65 25 - 55 45 - 75 40 - 70 35 - 65 40 - 70 45 - 75 VOLTS/PH/HZ 115/60/1 115/6011 115/60/1 115/60/1 115/60/1 115/60/1 115/60/1 115160/1 El_A. 9 9 12 7 12 12 15 15 TRANSFORMER (VA.) 40 40 40 40 40 40 40 40 GAS PIPE SIZE (IN.) 1/2 1/2 1/2 1/2 1/2 1/2 1/2 1/2 CATEGORY ! VENT SIZE 3" 4" 4" 4" ,,.~--4'~-~ 4" 5" 5" COOMNG CAP. 3.0 TON 3.0 TON 4.0 TON 3.5 TON ( 5 TON ~/ 5.0 TON 5.0 TON 5.0 TON FILTERSlZE(IN.) 14x25xl 14x25xl 16x25x1 16x25xl "T63C25x1 16x25x1(2) 16x25xl(2) 16x25xl(2) SHIPPING WEIGHT (LBS.) 127 129 157 159 159 175 177 179 DIMENSIONS (in.) HEIGHT 40 40 40 40 40 40 40 40 WIDTH X DEPTH 15~12 x 28~/2 15~12 x 26~12 191/s x 28~/2 19~/s x 28~/2 19~/e x 28~/2 22~/4 x 28~/2 22~/4 x 28~/2 223/4 x 28~/2 Model Number NATURAT.~Ii~ NTC6OSOFB NTC6075FB NTCGO75HF NTC61OOGF NTC61OOKF NTC6100KJ NTC6125KJ NTC6150KJ BLOWER TYPE AND S~ZE 10x8 ' 10x8 10x10 10x10 11x10 11x10 11x10 11x12 MOTOR H.P. (TYPE) 1/3 1/3 1/2 1/2 3/4 3/4 3/4 3/4 MOTOR SPEEDS 4 4 3 4 4 · 4 4 4 :LOW 675 675 1503 815 1278 1210 1264 1357 .10 ESP IN.W.C. MEDIUM ILOTT 859 859 1043 1546 1441 1520 1542 MEDII~flJ 1722 MEDIUM IIM614 1015 1015 1324 1822 1773 1841 1709 HIGItl 1306 1306 1887 1649 2302 2104 2161 2073 LOW 662 662 1460 783 1264 1201 1251 1325 .20 ESP IN. W.C. MEDIUM [OW 846 846 1030 1543 1430 1506 1525 MEDIglJ 1660 MEDIUM HIGH 999 999 1302 1784 1740 1803 1750 HIGt~ 1268 1268 1810 1616 2231 2078 2132 2040 LOW 651 651 1420 755 1244 1197 1249 1290 MEDIUMILOW 819 819 1021 1499 1453 1486 1503 .30 ESP IN. W.C. M EDI!JqJ 1608 MEDIUM ~l~! 1230 1230 1280 1737 1740 1772 1761 HIGht 1324 1324 1752 1592 2171 2061 2079 2014 LOW 636 636 1370 735 1212 1191 1219 1270 MEDIUM U~N 795 795 ~ - 989 1471 1441 1456 1480 .40 ESP IN. W.C. MEDIUM 1540 MEDIUM ~ 952 952 1255 1683 1718 1736 1740 HIGH 1193 1193 ' '"1670 1546 2098 2020 2042 1975 LOW 608 608 1318 704 1185 1167 1168 1243 MEDIUM ILOW 765 765 968 1417 1425 1427 1464 .50 ESP IN. W.C. MEDIUM 1484 MEDIUM iNS1} 914 914 1218 1641 1707 1702 1710 HIGH 1133 1133 1599 1502 2012 2005 1991 1953 LOW 564 564 1250 668 1178 1160 1178 1225 .60 ESP IN. W.C. MEDIUM LOW 735 735 941 1367 1390 1415 1430 MEDII,QJ 1400 MEDIUM t41GH 870 870 1171 1574 1676 1672 1650 HIGH 1056 1056 1520 1425 1921 1953 1914 1885 LOW 514 514 1182 646 1119 1130 1143 1195 MEDIUM LOW 685 685 881 1304 1365 1358 1401 .70 ESP IN. W.C. MEDllJ 1322 MEDIUM HIGH 818 818 1100 1495 1654 1614 1602 HIGH 980 980 1425 1353 1826 1917 1838 1827 NOTE: Application of NTC61OOKF, NTC61OOKJ, NTC6125KJ, & NTC6150KJ above 1650 CFM requires two side returns or bottom return or use accessory stand-off filter kit Jot single side retum. To achieve 2000 CFM w~h ~ stand-off filter kit you will still need a bottom return or 2 side filters. S~EC1FlCATIONS SUBJECT TO (:~l~g~l~E WT'FHOUT NOTICE BUILDING PERMIT EXAMINER CHECK LIST SCTM# DISTRiCI': 1,000, SECTION: 3t/ , BLOCK: ~, LOT: STILEET ADDRESS: ~:~'-~ ~ CITT: ~~ DATE REVIEWED: DATE SUBMITTED: / PROJECT DESCRIPTION' SUBDIVISION: ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: FAST TRACK? SINGLE & SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF -I 00-24. Lot recognition (CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN. 1997 100-25 Merger (A nonconforming at any time afte ZONING DISTRICT: REQ. LOT SIZE: REQ. FRONT REQ. CONFORMING ? ACT. LOT SIZE: REQ. LOT COV. PROP. FRONT REQ SDE PROP. REAR REQ. HEIGHT ACT. LOT COV. ACT. SIDE PROP. HEIGHT WATER FRONT? PANEL #: FLOOD ZONE: DESCRIPTION: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #):_ TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PR~4)~:C 9n/?s YES or NO SOUTHOLD TOWN TRUSTEES: YES or NO TOWN ZONING BOARD APPROVAL: YES or NO TOWN PLAN. BOARD APPROVAL: YES or NO TOWN HISTORICAL PRE (SPLIA): YES or NO DTE: / / PERMIT #:Ri0- NYS ENERGY: YES OR NO : 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 BP -Z / C/0 Z- , NOTES: ~ -, FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SECOND FLOOR: OTHER: TOTAL: 1. ( SF)- ( SF)= SF X $__ 2. ( SF)- ( SF)= SF X $__ SE SF SF SF [iNIT FEE OTHER FEE =$ +$ +$ = $ =$ +$ +$ = $ TOTAL FEE TOWN OF SOUTHOLD PROPERTY REC:ORD CARD OWNER STREET <~>/ze(,~ ~'''~ VILLAGE DIST.. SUB. S W ~ ~PE OF BUILDING ~ES~_0 S~S. VL FA~ COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS ~'' / ~ ~ '1 AGE BUILDING CONDITION N ~ NO~L BELOW ABOVE FA~ Acre Value Per Value ~re Tillable 1 Tillable 2 Fill~ble 3 ~oodlond 5w~mplond FRONTAGE O~ WATfiR ~ t 3rushlond ~ouse Plot DEPTH BULKH~D fatal , DOCK COLOR .. Bldg. :tension :tension <tension )rch )rch reezeway arage 'aria Dtal Foundation ~asement IExt. Wa,,s Fire Place Bath Floors Interior Finish Heat / ~,~. Type Roof Rooms 1st Floor /~F Recreation Room Rooms 2nd Floor Dormer Driveway (~ oo TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN, HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examinecl_ r)~' ~ Approved~ . '~. ~"' Disapproved a/c Expiration~ PERMIT NO. ,~t~' ~o2 .~ ~ 20 Av , 2 6 ';r 9 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: ~t l lo APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ~"-,~ - _, 200? 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 &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 decnolition as ~.~in described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous~:~ojfle, and~g'gu{atio'~s, and to admit ~-a)l~rized in;pectors on. premises and in buildin, g for necessary insp. getl'b"fi~.~.ff \]~~,,~ ~----~~ ~e~ ¢~/~. t%I t~.~ o~ . rp tion)//?67 , CUPANCY OR State whether applicant is owner, lesse~l~_~,~ec~. ~!~contra~~~' -- OF OCCUPANCY--- Name of owner of premises 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. ~LOr~J ~6~.ieo~ ~ Ai tO 4 Phl fOR ~ ~/ !_ FOUNDATION - ~n ae~IlIlI~ (As on ~e tax roll or latest dee~ POURED ~N~E .......... 2 ROUGH - FRAMING & PLUMBINI iNSU~TION FINAL . CONSTRUCTION MUI~ BE COMPL~ FOR C.~ ALL CONSTRUCTION IHA~ II~ THE REQUIREMEN~ OF ~I 1. Loc_atior~ of Jand on which proposeC,w~ork will be done: STATE CONSTRUCTION CODES. NOT RESPONSIBLI DESIGN OR CONSTRU~ON House Number Street County Tax Map No. 1000 Section Subdivision (Name) Hamlet Block rD dO Filed Map No. Lot 2. State existing use and occupancy of pr,~mises an/d ~tended/use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~ ~1 ~tr[2> °/~9 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition .-~ Alteration Other Work~;4~-r L.~-~./-~. ~,,,~,v/q~f ~Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth _ Dimensions of same structure with alterations or additions: Front Depth. Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner l 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES __ NO 13. Will lot be re-graded? YES 14. Names of Owner of premises/~dto~ ~.,'rT-o,J Address ~'~6,~ tqa-,-~ 12/5 Name of Architect Address Name of Contractor ~0~-~-,,,/~ ,~-, &, ,q e3 Address fi,0 ~3o,~e,-ffg't ~,,'~,~ ~r.' ,~/ //7ol 1 $ a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * 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. NO Will excess fill be removed from premises? YES NO Phone No. ff 7 7- ~' ~- o ~7 Phone No Phone No. ~'~ -~'-~ 7-0 a ~ 9" ~ ert¥ 16. Provide survey, to scale, with accurate foundation ~!~,~0 - lines. 17. If ele~,,~.~_ml? .poi~t,o~ property is at 10 fe~ $¢t~~$ g~aphical data on su~ey. ~L~ ? ~ ~ being duly sworn, d~oses and says that (s)he is the applicant g~[o~.~iff4~ual si~ng contract) above named, TS~,I~i ~Ol?:;[-,'r . ~ . (Contractor, Agent, Corporate Officer, etc.) of~~W~ ~g is du~ mthodzed to perfo~ or have peffomed the said work and to m~e ~d file this applicmion: th~ ~~d in t~s applicmion ~e tree to the best of his ~owledge and belief; and that the work will be pe~~ ~ fo~ in the application filed therewith. day,of ~ 20 O ~. ~6iau Public ~ JOYCE M. WILKINS N~a~ Public, State of New Y~ No. 4952246, Suffolk CounW T~rm [xpires Jr, ne 12. ~OO~ , ~..._.~ature of Applica'fm-.~ ~-~