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Edward Webb,Chairperson �,f, • Town Hall Annex
Anne Surchin,Vice Chair .- 54375 Route 25
Donald Feiler PO Box 1179
James Grathwohl Southold,NY 11971
Robert Harper Fax(631)765-9502
James Garretson Telephone: (631)765-1802
Joseph McCarthy www.southoldtownny.gov
Tracey Dwyer,Administrative Assistant
Town of Southold Historic Preservation Commission
Tuesday,April 16, 2019
RESOLUTION #4.16.19.1
Certificate of Appropriateness
RE: 1800 Village Lane, Orient, SCTM# 1000-24.-2-22
Owner: Lance Jensen
RESOLUTION:
WHEREAS, 1800 Village Lane, Orient,NY is on the Town of Southold Registry of Historic
Landmarks, and
WHEREAS, as set forth in Section 56-7 (b) of the Town Law(Landmarks Preservation Code)
of the Town of Southold, all proposals for material change/alteration must be
reviewed and granted a Certificate of Appropriateness by the Southold Town
Historic Preservation Commission, and,
WHEREAS, the applicant is requesting permission to install a fence, and,
WHEREAS, a public hearing conference was held regarding the matter on February 5,2019,
and finalized at a public hearing held on April 16,2019.
NOW THEREFORE BE IT RESOLVED,that the Southold Town Historic Preservation
Commission determines that the proposed work detailed in the above referenced application
meets the criteria for approval under Section 170-8 (A) of the Southold Town Code and,
BE IT FURTHER RESOLVED,that the Commission approves the request for a Certificate of
Appropriateness.
MOVER: Commissioner Garretson
SECONDER: Commissioner Harper
AYES: Chairperson Edward Webb,Vice Chairperson Surchin, Commissioner Garretson,
Commissioner Harper and Commissioner Joseph McCarthy.
RESULT: Passed Unanimously
Please note that any deviation fi-oin the approved plans referenced above may require further
review from the commission.
Signed•
Tracey L Dwyer,Application Coordina or for the Historic Preservation Commission
Date: April 22,2019
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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: January 15, 2018
TO: Lance Jensen
1800 Village Lane
Orient,NY 11935
Please take notice that your application dated December 27, 2018
For permit to install a fence at
Location of property 1800 Village Lane, Orient,NY
County Tax Map No. 1000—Section 24 Block 2 Lot 22
Is returned herewith and disapproved on the following grounds:
The proposed fences is not permitted pursuant to Pursuant to Section 170 of the Southold Town Code.
The proposed construction is subject to Historic Preservation Commission approval.
Authorized Si ure
Note to Applicant:Any change or deviation to the above referenced application may require further review by the
Southold Town Building Department.
Cc:File, HPC
i
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
South oldtownny.gov PERMIT NO. Check
Septic Form
r;.. L,.,,4� �/ N.Y.S.D.E.C.
Trustees
C.O.Application
D
MAY 2 4 2019� D Flood Permit
Examined 120 Single&Separate
Truss Identification Form
TOWN OF sou Via�,moi Storm-Water Assessment Form
ntact:
Approved 20 Nam lbrl-te1G (
Disapproved a/c
Phone:
Expiration ,20
Y((� Building Inspector
�,sn
D
APPLICATION FOR BUILDING PERMIT
®�
DEC 2 7 2018 Date
INSTRUCTIONS ''
�� '�.;
'tea' rt.
�O$ ,® UST be completely filled in by typewriter or in ink and submitted to the Building Inspector v' h 4
sets of plans, a!�uratep4to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall_be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of.
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or
Regulations,for the construction of buildings,additions, or alterations or for removal or demolition as herein described. The
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.
(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
f
0NR • of owner of premises 1 11' , , �14113C ��}`�e LR u� :!rews { ) �11,b
(As on the tax roll r 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.. ocatiorns�o�f land n which proposed work will be done: �
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot ��-
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work check which applicable): New Bind' l ��� j `
( 1rg� x ,.,. Alteration
Repair Removal Demolition , Other Work . 1 r 1/
,•__ �. +. (Description)
4. Estimated CXnumberdwelling
Fee
(To be paid on filing this application)
5. If dwelling, its Number of dwelling units on each floor
If garage, nl ;�6. If business, ccupancy, specify nature and extent of each type of use.
7. Dimensions of existing strictures, r ny: Front Rear Depth
Height Numb of Stories-
Dimensions of same structure with alters ' ns or add'i ' s: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: F t Rear ! ( ', (-Depth �'
Height ber of Stories ��'!4 '1 U
9. Size of lot: Front Rear >epth
10. Date of Purch Name of Former Own
,..•wA1.N.v .e
k J
11. Zo or use district in which premises are situated
'32RAoes proposed construction violate any zoning law, ordinance or regulation? YES NO X
Will lot be re-graded? YES NO_Will excess fill be removed from premises?YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15UM. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO x
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
y .,`�:b Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
Are there any covenants and restrictions with respect to this property? * YES NO
X—
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
K 0C'Vv3 Pd 6t 110-0 being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contrator,Age , Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn t, before me this
day of Afflenn]Xr 20 /5
TRACEY L. DWYERv
NOTARY PuI3LIC,STATE OF NEW Y RK
Notary Pub i NO.01 DW6306900 Signature of Applicant
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,29A —