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HomeMy WebLinkAbout22962-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24420 Date JUNE 11, 1996 THIS CERTIFIES that the building FOUNDATION Location of Property 145 MACDONALD ROAD LAUREL NY House No. Street Hamlet County Tax Map No. 1000 Section 128 Block 6 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 8, 1995 pursuant to which Building Permit No. 22962—Z dated AUGUST 22, 1995 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 A NEW FOUNDATION UNDER AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARILYN & ARTHUR L. SMITH JR. (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A v uil ing Inspector Rev. 1/81 i 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) Date .............(2,,69................. ............, 19..1....... N9 229621 Permission is hereby granted to: ...F��....................................................... to ................... ...... ' ....fir .... .... . - .. - ..^ ..... ..... .V .......... .. .... ...... ....,��...... ..... .......�-� ......... . . .... .................... ................................................ at premises located at........................ ter. © .... ....................... ..................................... ........................................ . ............ County Tax Map No. 1000 Section ...../e�.K.. Block.........�............ Lot No. .....1....?............. pursuant to application dated ................. rl........... 19....9.�...., and approved by the Building Inspector. Fee$.....1....��.... Y7, ................. .... � ................. ..... Building Inspector Rev. 6/30/80 _ Form No. 6 j m TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL, 765�1802,. APPLICATION FOR.CERTIFICATE-' 'OF-`OCCUPANCY A. This application must be filled in''by typewriter' OR ink -and submitted to the building inspector 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 2/1.0 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. 61. 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, 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 - $20.00 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�. . . . . ./I. . . . . . . Location of Property. . .�,VS . . . . . . . . . ./%YU)CAy4p. .�'? .��'�G� '`r'c?''t!. . . . . . . . ���r2EC . . . . . . . . . House No. � Street Hamlet Onwer or Owners of Property. .: .i:2.T�{ 2_. L . .'�: ./tZ�firz!�. 'N . . . �tt.��{ . .Z . . . . . . . . . County Tax Map No 1000, Section. . . . .Block. . . D . . . . . . . . . .Lot. ..©l . .... . . Subdivision. 1�G�.N�fc .�l9rz.rE. . . . . . . . . . . . . . •� �•.. . �f3. .1�CZ. . . . ..Filed Map. . .Lot. /° FCAL- Permit No. . . . . . . .Date Of Permit. r . . . . . .Applicant ,�. .% Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final. Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . ? . . . . . . . . . . . . . . . . . . . . . . . . nX-7 ry A1'PLI T ~ O.M.B.NO. 3067-0077 Expires M 31, 1996 ELEVATIONCERT��ICA�'E P °� FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revisionl(LOMA or LOMR). I Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER _Arthur__IL_.mAt h, Jr- STREET ADDRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER Mc Donald Road OTHER DESCRIPTION(Lot and Block Numbers,etc.) _S.C.T.M_. No. : 1000-128-6-17 CITY STATE ZIP CODE Laurel New York 11948 SECTION B FLOOD INSURANCE RATE MAP(FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION (in AO Zones,use depth) 36081.3 0118 C June 15, 1983 A4 8 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): NGVD'29 ❑Other(describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE:UAL_ J.0 feet NGVD (or other FIRM datum—see Section B,'Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 8 2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top,of the reference level floor from the selected diagram is at an elevation of __.. _._. _i9 J 7 J feet NGVD (or other FIRM datum—see Section B, Item 7). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I I .0 feet NGVD (or other FIRM datum—see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is 1_11.LJ feet above❑ or below I J (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selectedd diagram is U.U feet above❑ or below❑ (check one) the highest grade adjacent to the building. If no flood depth number is'available, is the building's lowest floor(reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:E NGVD'29 ❑ Other(describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 7), then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) ' I 1 4. Elevation reference mark used appears on FIRM: ❑ Yes 1 No (See Instructions on Page 4) 5. The reference level elevation is based on: 91 actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) ' 6. The elevation of the lowest grade immediately adjacent to the building is:�L �5�.fL�.feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations Specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's "lowest floor"as defined by the ordinance is: L I_1 1_U.0 feet NGVD (or other FIRM datum—see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31,MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATICNJ SECTION E CERTIFICATION I , This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones Al—A30,AE,AH,A (with BFE),V1—V30,VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A(without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use,wall openings,or unfinished area Feature(s),then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. 1 certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. i CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal) Kenneth F. Abruzzo 49999 TITLE COMPANY NAME Land Surveyor Young & Young ADDRESS CITY STATE ZIP 400 Ostrander Avenue Riverhead,, New York 11901 SIGNATURE I. *�:s DATE PHONE o -• n4/2q,Lg6 (516) 727-2303 Copies should be made of this Certificate for: 1)community official,2) insurance agent/company,and 3) building owner. COMMENTS: ON WITH ON PILES, SLAB BASEMENT PIERS,OR COLUMNS A VI A A V ZONES ZONES kZON!ES ZONES ZONES REFERENCE REFERENCE LEVEL BASE LEVEL RE LEVENCE FLOOD ELEVATION BASE .:::::':ii%'•: � .� BASE OD ADJACENT': "}` REFERENCE FLOOD ELEVOATTION GRADE 'LEVEL ELEVATION REFERENCE ADJACENT LEVEL GRADE .. ITl/F. `::.:: 'i.•:"�i:.:+:.':;;. ': GRADE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at tIhe bottom of the lowest horizontal structural member. I I I Page 2 I ' .'_. IF .. JUDITH T. TERRY i -. Town Hall. 53095 Main Road TOWN CLERK � ���.:�_� ,-;., , P.O. Box 1 179 REGISTRAR OF VITAL STATISTICS a� ; .�'' Southold, New York 11971Fax (5I6) 765-1823 MARRIAGE OFFICER y �� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER 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)] . I# TOWN OF SO:J7HOLD /�h T. Terry Southold Town Clerk August 25', 1993 APPLICATION.#/ 7g/= 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 sign): 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 reasonable 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 ACCURA E. (APPLICANT'S SIGNATURE) DATE ���` SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT /�.V ��✓Cp ri l� 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" the nearest intersecting road or well-known landmark. A sketch attached to this application showing the pr lect location would be helpful. FDP(93) APPLICATION # 78F PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑Addition ❑ Residential (More than 4 Family) .Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT $ 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. 7�/� . Dated � 5 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 4 V 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional ' tructions. SIGNED ✓ DATE ✓� �S APPLICATION # 72V PAGE 3 OF 4 SECTION 4:ADDITIONAL INFORMATION REOUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. evelopment plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement),types of water resistant materials used below the first floor,details of floodproofing of utilities located below the first floor and details of enclosures below the first floor. Also, ❑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>4s B. ❑ Is not in conformance with provisions of Local Law # 19 %- The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE yv If BOX A is 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 #/7 gle� PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision ---Approved? ❑ Yes . ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (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: Fr. NGVD (MSL). 2. - Actual (As-Built) Elevation of floodproofing 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 ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE ' BY DEFICIENCIES? ❑ YES ❑�Owo- DATE a L BY DEFICIENCIES? ❑ YES ❑ NO zz D BY DEFICIENCIES? ❑ YES ❑ NO ECTION 8: CERTIFICATE OF COMPLIANCE To be completed by LOCAL ADMINISTRATOR Certificate of Compliance issued: DATE: //h,6 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 (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: Q PERMIT NO. �70 � 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�J SIGNED• DATE .�� L6 B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) .L jF -A, . ©�V FIELD INSPECTION REPORT DATE COMMENTSVm Al�n —I� u ' -------------------------- y FOUNDATION ( IST) �� - --- FOUNDATION (2ND) -----____-- _________________________ ________I --------------------- _ -- - ------ ------------ iIf- ---��— -- 0 ROUGH FRAME & - PLUMBING II l INSULATION PER N. Y. I STATE ENERGY l CODE II I - -II - ---II !! H II II FINAL - -II � e ADDITIONAL COMMENTS: H° - O a r ro r� FORM No.4 TOWN OF SOUTHOLD PUG _ G 1QQr� BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . . 1050$.f . . . . Date . . . . . . . . May. 2.g . . . . . . . . . . . . . . . .. 1981 . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property , , 45 Edgemere Avenue ( Pvt . Rd . ) Laurel , New York 1&iso lVo. � Street . . � � � � � �Nll ei County Tax Map No. 1000 Section . . . .28 . . . . .Block . . . . . . .U . . . . . .Lot . . . . . . . 17. . . . . . . Subdivision . . .Edg.omerp— Park . . . . . . . . . . . .Filed Map No. 7.42. . . . .Lot No. . . .R/.0. 2. .& . 3Inc1 . conforms substantially to the Application for Building Permit heretofore filed in this office dated 19 .$Q pursuant to which Building Permit No. . . . . .10 9.7.1. .Z. . . , . . . dated . . NPXQOPr . 17. . . . . . . . . . . . . 19 8.Q ,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 . . . . . . . . . . . . . .Addi.tion, to ,Dwellin.g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . Ar.thur. .L. . A.nd''`Mar.ilyn. .S .-Smith.,: .Jr.. . . . . . . . . . . . (owner`/esseg or t S. of the aforesaid building. Suffolk County Department of Health Approval . . . . N R UNDERWRITERS CERTIFICATE NO. . . . .r15 2 0 0 o Q, . , , , , . . . .. . . . . . . . . Building Inspector Rev 4/79 �l�rZESS 1 S FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y: 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. S. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . . flay. 20, .1981. . . . . . . . . New Building . . . . . . . . . . . . . Old or Pre-existing Building . x . . . . . . . . . Vacant Land . . . . . . . . . . . . . Location of Property . 145.Edgemere .Auebuua, '• Aulrel • Nmi•Mork • • • . • • • . . • . . ' . . .Hamlet House No. preei Owner or Owners of PropertyArthulr. 1. . and -Marilyn. S. • Smithy. Jr s• • • • • • • • • County Tax Map No. 1000 Section .128 . . . . . . . . . . Block 06. . . . . . ... . . . . Lot -017. . . . . . . . . . . . Subdivision . .Edgemere Park . . . ; . . .Filed Map No.7AP . . . . . . .Lot No.Part4f jqt. 2 all of lot 3 Permit No. .10971 . . . Date of Permit . .11.r•1,2..Mpl1cant .George •Ah]er'e. builder; • Inc.- - Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . Underwriters Approval . .. . . . . . , . . , ,Planning Board Approval . . . . . . . . . . . . . . . . . . . . . . Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . X . . . . . . . . . . . . . . . . . . . . Fee Submitted $5'00. . . . . . . . . . . . . . . . . . . . . . . . . nn�► ( l}i Construction on above described building and permit meets all applicable codes and regulations. �� Applicant 4. I,,,, George Jere Builder, Inc. .� J 'I Rev.10-10-78 � George Ahhrg, Ares. ►. I AUG 8 T /)/Z cc't S-� -7 �vIt/ZSrc� KE f'-/C 1--0 S t '77,15� C/5127f C� 72�7 Inc c t-OHC-qlc�� rT; C, e /Z v 71e c 04 A Smith Jr Marilyn &Larry Smith Box 214 P.O. Box 494 Nw Canaan,CT.0684&0214 Laurel, NY 11948 1,7 76 �z ass-isoz BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE � INSPECTOR rrs-isoz BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: 1h4� � � 2�- wool 13 ` ztat 114"- DATEdN1 !!/ INSPECTOR BUILDING DEPT. 1 PECTION [ ] UNDATION 1ST [ ] ROUGH PLBG. O�X ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL . REMARKS: "xZ Lo- I DATE � INBPECTO �y -- - VMIM MO. 1 J SET' S OF PLANS . . . . . . . . . TOWN 01: SOUT110L1.) SURVEY . . . . . . _ . . . . . . . . . . • 1IUIL0IN(3 1)E f'Afi (M[_N1 (:IIECI. . . . . . .. _ . . . . . . . . . . . . ,.� TOWN I I A L L SEPTIC 1`0 Ill I . . . . . . . . . . . . . SOUI'I IOI_f), N.Y. 111)71 - 'T(_"1_.: 765- 1B02 11OT 1 F'Y ; � �� C A 1.1. ) _HC-RoLi� I:xaniineclI r1n t (. To . zt313-so�f9. . . . . Approved �II91Permit ilo. . . %. . . I)is;11 proved IIJc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r . . . . . . . . ..3X41, (I1nilding Inspector) • �'PI_ICKHON 1'011 BUILDING PERMLT Data . . . . . .. 1195. INS'FRUM IONS a. 'I'llis application must he•con1111cle1y filled in by lypewriler of- in Ink and submitted to lite-lltilldinl; lnspeclor, willl sell of pllms, 'ImiliMp plot plan to scale. l`-cc according to schedule. b. Plot plall showhig Ipc(ltion of lot An(1 of buildings on premises, relationship to adjoining premises or puhlic slice or areas, and giving a detailed description of layout of properly iuust be drawn on the diagram which is part of (his appl cation. c. 'I'he work covered by this application play not be commenced before issuance of i3tliiding Permit. (I. Upon approval of Allis application, the 13iii1ding lnspeclor will issued a 111ilding Pellnit to the applicant. Such poll! shall he kept on the premises available for inspeclion Allrougholit (he work. e. No building shall be occupic(I or used in whole or in part for any purpose whatever until a Certificale of Occupiul( shall have been granted by the 1uilding Inspector. APPLIC'A'TION IS Ill lt(.;13Y MADE to the Building 1)eliflrinlcnl for lhe.issuiulce of A Ilutlding Permit ptirsualll to It IIuil(ling done Or(linance of the 'Town of Soulhol(I, Suffolk County, New York, and outer applicable Laws, Ordtnanccs F Rcgnllllions, for (he conslrtictlon of bilil(lings, a(mmons or alleratitms, or for removal ell demolition, as herein desclille. 'fhe applicant agrees to comply with all Applicable laws, ordinances, building code, housing code, and regulations, and I adillil authotizell inspeclols on premises Auld in bilild,ing for necessary.hispeclions, �J . . . .,►-.•`�1C.�c_�. ..•. . . .. . . . . . . . . . . . . . . . . . . . . . . . . (Signalure of applicant, or name, If a corporation) . .�a1c.�gY,. .cc? -tH p`f CAFl (Mailing address of applicant) SI,ile whelher applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde . . . . . . . . . . . . . . . . . . . . . . . . . . . . P>tZekl47�.�-7. . . . . . . ... . . . . . ... . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . Idanle. olo\vllel' ofpicilliseS . 1 2'7HUlZ. . . � . . ��ll_Y,�. S �inAIrkt 4R,, , , , , , , , , , , , , , , , , , , , , , , (as on the lax loll or lilies( deed) II' applicant is a colpolation, sit;llature of duly atltholiied officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and line of colporate officer) 1111ilder's license No. . . . . . . .55!4 .ICI. . . . . . . . . . . 1'lunlbel's License No. 151edliciaii's License No. Othcr 'I'rade's I:icense No. . . . . . . . . . . . . . . . . . . . . . I . i.aclllion of land on which proposed work will be clone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . 1.i/5. . . . . . . . . . . . . . . . . . . . C n r►1117 . . .�yC=.ti?u G. . . . . . . . . . . l RL. . . . . . ... . . . . . . . . . . . . . Ilouse Number Street hamlet Cotlnl y Tax Map No. 1000 Section . . . :�'?8. . . . . . . . . . Illock . . . .(7 ro . . . . . . . . . . . Lot . 0.171. . . . . ... . . . . . Subdivision ?-Pays . . . . . . . . . . ... 17iled h1ap No. .7.4f:z . . . . . Lot V/a z+.3.l.nl�.L. (Idanie) � . . :'.. Slllle existing use and occup(nlcy of premises and iniclided Ilse and occupancy of proposed c;onslrnclion: II. I:xisliliguse and occupancy C ICC. -tEOL h. lnlendcd use and occupancy . . S[aUGc..E.-. . f1?rW.tI�Y. B.�SL�C�-?tJ4 � . . . . . . . . . . . . . . . 1 •.11..,: . �. ... �..,...11• ..1,1• .11 ;�111 �11111: Inc ,all /. t lulu I,uuuull; . . . • . . . . . . Allllll(ull . . 1 )tcntuval . . . . . . . . i1llcI;k ion l��'PctoktnaYA-t6. '3g". wf'tH uC d 3r Ucntulilic"t Oflier Walk lz coutt$Es 7a 'EKtS'fl1JG ' FDooR`7/O!J'tr2lalS.IS H0L? E I. lislintalcd'(:'uslLL (Desct il,licall) . � .�rr�z? . : . . . . . . . . . . . . . . . . . . . . . . . . lee , . . � . . . . S. If(lwcllin (lo ac I}�iicl cling {Iris apl,licalion)(„ utlntbel of dwellirt1l urti(s . . . .1 i '4 •. I'funtbcr of dwelling units on each floor I (> , number of cars Alppi • busittc:ss, c 1 . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . onuncrci;ll or mixed occlipancy, specify ualtIN an(I exlelll of.each type cif use . .•vA. . . 7. Dimensions ctl r.xisling slInC111res, if ally: Flotl( .4/O ' Ilciglil Z.I. . . . . . . . . Number Rcar . . .:Z.t� . . . . . . . . Deplll . :2)s ofS{cries . 7LiJ,o , , , • • • • • • • • Dimensions of sirlue structure Willi aller;tlions or I(I(liTwx! ! rout , . . . . . . ... . . . . . . . . . I)c:I,Ilt 3 -S 1lcigltl . . . . .yv . . . . . . . . . Rear . .� . . . . . . . . . . . . . ZY . . :. . . . . . . . : . : IJunlber of Stolies . . .-fA)0, , , • ; 8. Dir,tensions of en(ire new consltrtclion: I,mill Ieighl . . 1•Itl lte;tl . . . . . . . . . . . . . . . I)c tilt (� Writer of Stories . . . . . . . . . . . . . . : . I . . . . . . . . . . . Sire of IoI: l_'Iulnt . . . ,77P . . . . . . . . . . 10. Dale of Purchase PVLy?�. `rQ l4 a L . . . .. . . Rear . . . . . . . . . . . . Deptb j. . . . . . . . . . . . . . . . . I I. Zone of use dis(ticl in which Itemises ale silua(c(1 N;une of I'orlucr Owner . . . �- �v . . . . . . . . . . . . . . . . . . . . . . . . . 11. Does pinposcd conslluclion viola(e ally zoning law, otdilmll e or rcl;ulalfon: Will lot be tegradecl S.O. . . . . .VO.. . . . . . . . . . . . . . . . . . . I . {I;uuc of Owner of premises P�t7Hc.1(L�. M � 1Yill excess fill Ire removed front tremiscs: Yes ��r�-Yt.7 SM(-fIt!AcIcIress emZ.I.t., eti.gAYA tJ.�'� rlantc of Arc:biti:cl�I(q�[_ K�..�j Iola( K0 Zp - Q(6--�$?�� Idanl(: of (:onlraclor . ,r 1 S , P�(Lp c',/� (('������pp Addlcss�t3 p.8$q. L0 0. lnn���'?.�,8_. 'llultc Nu.C.Z�f�'$4�(q.:. . Sul . �. �?4. IZO . . A(I(IICss B , ?C-Aut1V i G. � tf`ils w s prc,perLy w.ttbin :3UO I:eel: of a L.fdal. weCland� tune Jo. 3G��.G,�.Y.o. .1.1 yes, soul.bold 'fowl( 'fr.urtLeea Permit Inay be ref{Y(red. No. . . i . . . . . PLOT DIAGRAn1 Locale clearly and disliltclly all buildings, wltelber existing cr proposed, nnd. fndicale nil set back dimensions front illteielry lines. e;ivc street and block nuntl,er or descriplion according; to deed, rul(1 show sfreef names and inclic lie wltclbcr i,ticlic,r or corner lot. • 11, r• . FA,I 1; 01 HI \v?'OIZK .fP-l.IU'.c. . . . . -(�E✓i�. . . . . , being duly sworn, deposes and says that Ire is lire applicant (hdantc of'Individual signing c:cnlracl) above named. Ileis (bc . ... . �7! . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . ... . . . . . . . . f(.on(raclor, agent, corporate officer, (Ac.) ul said owner or owners, and is (filly a(Illlorized to perfoll I or have performed Ibe said work and (o make and file Il,is applicalinn; Ibal all slalc,llellls contained in (bis-applicalion are (rue (0 Iltc best of his knowledge and belief; and Ib;,l Il,e wu,I; will be petforntrd in Ilse manner set for Ill in (be application filed (I* rewi(I1. Swoln to befole Inc ibis Ic . . . . . . . . . . :`/ : . . . . . . . . . .dayof . . . '.�. us.f, , . . . �., 19 � rlulaly PI11)1ic, �/� . . . . . . . . A A 'LJ . . . . . . . . . . . . . . L`� . . . . . . . . . (Signalure of applicartl) 0 0 1gaung �aun� Planning Engineering �ururying 01 V \ 8 ON�G PSG U, N1 l No CID o C o DR\vEwP6g•29 Cp °°v�Rs rn \ ��e• �+ O St \ 'Q'l56\6� •�O. O K •o g. 0 N� / 1 0• O�c �°° •e �i9. 7. 2 0 . J °� StOR(USA i O `0�fRP Eo 6 q5 �i(P. !b Ao 129 O r,\A y 2 / w0p0 ✓ / / NOTE: / 1. LOT NUMBERS REFER TO MAP OF "EDGEMERE PARK" / FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY /. ON JULY 2, 1931 AS FILE NO. 742 / 2. TOTAL AREA = 8540 S.F. / 3. ■ MONUMENT FOUND / 4, SUBJECT PARCEL IS LOCATED IN FIRM ZONE A4 (BASE EL 8.0') / AS INDICATED ON FLOOD INSURANE RATE MAP 360813 0118C DATED JUNE 15, 1983. 5. ELEVATIONS SHOWN HEREON ARE REFERENCED TO N.G.V.D. (MSL 1929) SURVEY FOR: ARTHUR L. SMITH JR. & MARILYN S. SMITH At: LAUREL Town of: SOUTHOLD Suffolk County, New York Suff. Co. Tax Map : 11000 1 128 1 6 117 District Section Block Lot Young Young, Land Surveyors 400 Ostrander Avenue, Riverhead, New York 11901 516-727-2303 Alden W. Young, P.E & L.S. (1908-1994) � DATE :JULY 20, 1995 Howard W. Young, Land Surveyor _ SCALE :1"=30' Thomas C. Wolpert, Professional Engineer - Kenneth F. Abruzzo, Land Surveyor JOB N0. :95-542 O John Sehnurr, Land Surveyor SHEET NO. :1 OF 1 F UNAUTHORIZED ALTERATION OR COPIES OF THIS SURVEY MAP NOT BEARING DISTANCES SHOWN HEREON FROM PROPERTY LINES CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY THE LOCATION OF WELLS(W),SEPTIC ADDITION TO THIS SURVEY IS A THE LAND SURVEYOR'S INKED SEAL OR TO EAS71NG STRUCTURES ARE FOR A SPECIFIC o iS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING 0 TANKS(ST)4 CESSPOOLS(CP)SHOWN NOLATION OF SECTION 7209 OF THE 0 EMBOSSED SEAL SHALL NOT BE CONSIDERED 0 PURPOSE AND ARE NOT TO BE USED TO ESTABLISH INSTITUTION LISTED HEREON,AND TO THE ASSGNEES OF THE LENDING INSTITUTION. HEREON ARE FROM FIELD OBSERVATIONS NEW YORK STATE EDUCATION LAW. TO BE A VAUD TRUE COPY. PROPERTY LINES OR FOR ERECTION OF FENCES. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEOIENT OWNERS. AND OR DATA OBTAINED FROM OTHERS. „ m , r : ...• .., � '. .. -. ,.,'�,�"m,eP�"rt.� .�p xr a`+k`,',!x�"T M.z�.",�^R4 ,,.,pt1M�.�R.^n msw.,"d"'7.” td'I""°° .=,r�,tSP'^*er-' "Mi,7 T!+p m , .- e _ :.. 'W m :m tm»:n•nm.' ..�'�a1d1>"�"*."w.:d� " ++,Cv�&"r,�w're:,T,«` .M�'_Y"1 a ,iE.�' .. ^ ,.. . /f :.. 1 ,, - - � �• .5,k✓CAW'b'Cn>.k,°1 'M�° M�ifp'�w :+..u':'°uns~„„,w_....,::.5«,..e•.r:roS' i UNDERWRITERS CERTIFICATE REQUIRED OCCUPAKY OR � o Novo. . ' AUG 8 W5 Pat USE IS Fp DON PR �IEDW B.P.# ��-` fR MIN L S EY VFUL If , "011111, IEI ,M1Ic3 ,� ,- of Fou aTION I � .�I Ai�ll T'0 ��'M FOR THE l�` GI�,t �td`I� II�BPRC'rlc�nl�: . HA NA VED. <' Or _ `# tjjRED , , � USA " I �. `+4t . �. , eft a „ PLUMBER CERTJFICATIO/V N LEAD COIVTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER t. I'UPPLy Sy STEIVY AfV OT CEFD 2/10 , Of 11 LEAD. 'a `t1 O t S I } PLUMBING -. 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