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FORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No..Z~9~.51 ..... Date . .F.e.b.F:4~y ....
THIS CERTIFIES that the building located at ~?f90. J~i.~.m.e~! .h~. j~.l.y.d.: ... Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ... July .... 16 ....... , 19.7.7. pursuant to which Building Permit No..9.1t0~.~.-.'91+05Z
dated ... July ..... 16 ........, 19.77., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .... Accassory..!hailding ..............................................
The certificate is issued to ..... i~,. Lo.r~etta .Vom .Lelm .............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE No. N/R
HOUSE NUMBER 2~.00 Street Minn.ehaha Blvd
So~thold~ N Y
Building Inspector
souT~oca, N~.¥.
BUILDING pERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 9405 Z
Date A'I! g 16. 19-.?.~/.
Permission is hereby granted to:
g. Loretta VomLehn
............. ..q.o..~.o.~..¢ ...............................................
Bu~._d na'~r accessory bul].d~.ng (approved by Bd Appeals~
~ ~/S Minehaha Blvd . .......
at premises located u, .................................................................................
Southold
pursuant to application dated .............................. ~'~-~)-.]:~- ....... ..~.., 19.....r/.~ and approved by the
Building Inspector.
F * 10-.00
TOWN OF $OUTHOLD
Building Delm~tment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector with the following; for new buildings or new use:
i. Final survey of property with accurate location of oil buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept· of water supply and sewerage disposol--(S-9 form or equal).
3. Approval of electrical instal(arian from Board of Fire Underwriters.
4. Commercial buildings, (ndustrial buildings, /V~ult/ple Residences and similar buildings and
installations, a certificate of Co~e compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April )9.57), Non-conforming uses, or buildings and "pre-existing"
land uses:
l. Accurate survey of property showing all property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings.
3. Dote of any housing code or safety inspection of buildings or prem/ses, or other pertinent in-
formation required to prepare a certificate.
C, Fees: 1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ......................~.', ....................
. . ~1~ :~
~ew ~ Mm~ .................... ~1~ or Pre-existin~ BuiM~n~ ............................ Vocont Land ............................
Locotlon Of Property ~/~2~ ~/~/~//~ ~ ~/~*
....... ...... ....
Subdivision ...~.~.~ ...... ~.~.~ ............. ~ot ~o...~... ~oc~ ~o ............. House ~o..~.(.~:~¢
Permit ~o...~.~.~. ~ote Of Permit .~/~..~ppficont .**~..~.,~.~~ ...... ~.~....~
Heo~t~ Oept. ~pprovol .........................................~ ~o~or ~pt, ~pprovo~
................. .................... ..
Reques~'F~r Tempem~ Ce~iflcete ........................................ Finel Certificete ..........................................
Fee Submitted $ .....~,~.,.'::. ....................
Constr~ction on above described budding end permi~ m~ oil opplicoble c~es ond re~.
Sworn to before me
Not~ry Public~_ :~ ,~..~.~:ounty
FRANK A. KUJAWSKI, .tR,, President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, $3095 Main Road
P.O. Box 728
Southold, New York 11971
June 2, 1989
J.M.O. Consulting
P.O. Box 361
wading River, NY 11792
Re: Minnehaha Blvd. N.Y.
Dear Sir:
The following action was taken by the Board of Town Trustees
during their regular meeting held on May 31, 1989 as follows:
W~IEREAS the Town Trustees have conducted an on site inspection of the
subject property, Minnehaha Blvd, NY.
RESOLVED that the Town Trustees approve the request made by J.M.O.
Consulting for a waiver to construct deck and storage shed landward
of timber bulkhead on above mentioned property.
Please return to the Building Department for a determination on
the need for any other permits which may be required for this project.
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:kjw
-cc: Bldg. Dept.
Board of Appeals
file
New York State Department of Environmental Conservation
Building 40--SUNY, Stony Brook, New York 11794
Thomas C. dorling
Commissioner
Dear 'm'~ L-~ ~
A review has been made of your proposal
Based on the information
of ~nvironmental Conservation has determined that the
~, project is: '
Greater. [han 300' from inventoried tidal wetlands.
~ Landward of a substantial man-made structure '~%~
greater than 100' in length
to:
you h~ve submitted, the Me~ York State Department
~arcel
which was constructed prior to 9/20/77.
Landward of the 10' above mean sea level elevation contour on a
gradual, natural slope.
Landward of the topographic crest of a bluff,' cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25
of the Environmental. Conservation Law). Please be advised, however, that
ho construction, sedimentation or disturbance of any kind may take place
your ~sponsi~41it~-to ensure t-he,~ all nec~sar~ ~recautions are taken to
prevent any sedimentation or other alteration.ok disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale. berm.~
Please note that any additional work, or modification to
described, may require authorization by this Department.
this office if such are contemplated.
the project as
Please contact
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours, ~
Deputy Regional'd~ermit Administrator
jv~ ',l N N E H A H A
~LVD
LPARCEL
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,.T. LONN
~LIp
TOWN OF ,SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined Aug 16 19....7..7..
Approved Aug 16 197..?. Permit No.
Disapproved a/c too close to p. roperty lzne
........... .~.p. roved by bd appeals. . c:
.......................... ........................... /
APPLICATION FOR BUILDING PER~IT
Date Jul~ 16 19Z7
INSTRU~IONS
o. This application must be completely filled in by typewriter au in ink and submitted in triplicate to the Buildlng~
Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee ~ccording to schedule.
b. Plot plan showing Iocotio~ of lot and of buildings on premises, relationship to odjo n nn nremises or nub ic streets
oreos, and gmwng o data I~ descrmpt,on of layout ofproper~ must be drown on the diagram which is pod 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 h~ve been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment 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 o~terations, or for removal or demolition, as herein described.~
The applicant agrees to comply with all applicable laws, ordinances building code, hous ng c~e, and regulations and to~
admit authorized inspectors on premises and in bui dings for n~essa~ in~ections. '
(Signoture o~ opplicont, or n~me, if o corporation)
Minehaha Blvd Southold
................................ ............................... m
I
State whether applicant is owner~ messee, ogent~ architect, engineer, general controctor~ emectdcion, plumber or bu)lder~~
m
m
owne ~ 8
Nome of owner of premises J. Lo~ ~ B. Lotett~ Vo~
If opp(icont is o co,orate, signature of dumy authorized officer.
(Nome and title of corporate officer)
Builder's License No...~.~ ................................... ~ F~ ~- ~' L~
Plumber's License No .............. ~ ..............................
Electdci~n's License No .......... ~ ..............................
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Map No.: ...... ..L.o..u.g.h...i..n..g..~.a...t. erLot No...~ ...............
Street and Number .... .~/.~.....~J~LD,e.h~l~.~..]~..],.l~l. ......... ~.QlJ, l~]9.kQ],~ ..... .....................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy vacant lot & occupied lot
b. Intended use and occupancy same with accessory storage building on PL.
3. Natdre ~o~ work (check which applicable): New Building' .....~ ..... Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ...................................................
(Description)
(to be paid on filing this application)
5. If dwelling, number of dwelling units .......... ..O. ............... 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 ............................ 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 ........................................................ P, eor. ......................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated ...!!X~!!...g~.~.~ ...............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded no Will excess fill be removed from premises: ( ) Yes ( ) No
Name of Architect .............................................................. Address ................................ Phone No .......................
Nome of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner
see attached plan
STATE OF NEW YORK, IS S
COUNTY OF .... I!$.~.~0.1.~ ........... f ·
................................................................................................ being duly sworn, deposes and says that he is the applicon
(Name of individual signing contracO
above named.
He is the owD. er
(Contractor,. agent, 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 to before me this
.................... .1.6day of ..................... ~l~g. ............... , 19.....'7.~---'r~ / --~ ~__.,_,~//
Notary Public, . ............. ,~x..~...~..~..9.~..~ ............... County ...~~.... ................. ; ....................................
· / - ///MARY E, DAWSON
~NOTAI~ PUBLIC, State of N~w
No. 5;'-4643721, Suffolk Cour~..
Term Expires March 30,