HomeMy WebLinkAbout11037-z FORi~ NO~
TOWN
SOUTH'OLD, N~ Y.
BUILDING P, ER/~IT
(THIS PERMIT MUST BE KEPT ON THE PREMIS~ES UNTIL F JLL
COMPLETION OF THE WORK AUTHORIZED)
N°. 11037Z Dat~
Permission is hereby granted to:
.............................................. ~.~ ....... ?...
~A~'~ 6L~E~AWtPN · ~'0 ~ ~S~t~ ~,~lf~.~.~; ~C.~&~.~'
~o ..~ .....................................
B~u¢~ ~ ... Zg~ ~.C ~.~ , .~rn....~..~,2h.~.¢...~.W.~I~.~ ......................................
et p~omis~ located ~t .................................................. , ......... {t'"*~ ................ ¢ ......................................
..... ~ ......... ~ ........................................................................... ~ .~ ....... ~ .~ .......
Cou~ Tax Map No I000 Soction ...................... ........ ~,..,~, ..... ...... ~ ......................
.... ~.~* ~ a-~lication dated ~.~ ,; ~, 1~; and approv~ by the
Building Inspector.
Fee . .......................
.......... ' Building ~l~ector
Rev.~ 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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
natu ra~ or topographic featu res.
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.
5. Submit Planning [~oard approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peopert¥ showing a~ property lines, streets, buildings and unusuat 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 buildipgs or premises, or other pertinent informa-
tion required to prepare a certificate. ., '
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 /Z,~,
New Building ............. Old or Pre-existing Building .....¢'~'~., .....Vacant Land .............
Location of P operty ....#. ............. ....................
House No, Street Hamlet
Owner or Owners of Property ...... ~?, ,~.~/;~,,5, .... .~., .~..¢¢,,~ ......... : ...................
County Tax Map No. 1000 Section .... 1.~..'~. ...... Block .,. ',~, .~, ........ Lot.../. ~.. .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.//.~, ?...~,. Date of Permit ',~//..~.~..~. / ,Applicant, ¢0.~¢¢'~..
Health Dept. Approval ..... ~ ................. Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .., ~ ................
Fee Submitted $ ~'
Construction on above described building and permit meets all appJic, able codes and regulations.
Appl cant ........
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~'~ BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 1~f38
Ba~e F~ 12., 1981 112257 -
THIS CERTIFIES THAT
only the elec t~cal equipment as described belo~ ond ir~troduced by t~ applicant named on ~he above application number in the premises of
D~ve S~, ~.~ Road~ R~. 25, Pac'it S~eet~ ~tic~k~
in the following location; ~ Basemen~ ~ 1st FI. ~ 2nd Iq. Section Block Lot
was examined on ~' ~/ , 19~ ~ and ~ound to be in compliance witb tbe requirements of this Board.
FIXTURE
OUTLETS
25
rECEPTACLES SWITCHES
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
FLUORESCENT
26 5 9 17 2-,400
DRYERS FURNACE MOTORS FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R V I C E
NO OF CC. COND AW, G. NO, OF HI-LEO A, WG NO OF NEUTRA~ A
PER ~ OF CC COND, OF HI-LEG OF NEUTRAL
Cooda].e Elco. Const. lklc.
RRi ik~ 1Sa }lah~ Road,
Mattit~'~k, N.Y. 11.952
11
This certificate must not be altered in any manner; return to the office of the Board if iincQrrect,
may be identified
j ~corY Fo? BUILDING DEPARTMENT. THIS COPY OF MUST BE ALTERED IN ANY MANNER.
FI~--I~, ~SPECTION
FOUNDATION
FOUNDATION (2nd)
ROUGH FRAME&
PLUMBING
COMMENTS
INSULATION PER N.Y.
STATE ENERGY
CO.D. E
FINAL
ADDITIONAL COMMENTS:
Southold Town
Board of Appeals -30- September 25, 1980
APPEAL NO. 2736. Application of Fan. nS Behlen Comm.unity
Health Center, Inc. for a Special Exception to establish an
ambulatory health care clinic at the south side of North Road,
Greenport, NY.
On motion by Mr. Goehringer, seconded by Mr. Douglass, it
was
RESOLVED, that the Chairman is authorized to send a
letter to the N.Y.S. Department of Transportation for their
input regarding the proposed project of the FannS Behlen
Community Health Center.
Vote of the Board: Ayes: Messrs. Grigonis, Doyen, Douglass,
Goehringer and Sawicki.
RESERVED DECISION: Appeal No. 2710. Application of
Dolores Strong, c/o Richard J. Cron, Esq., Main Road, Cut-
chogue, New York 11935. Re-Hearing held September 25, 1980
to reconsider the decision of this Board made on July 1, 1980
wherein applicant requested permission to display and store
openly boats and marine items outside of enclosed buildings,
Article VI, Section 100-63.
On motion by Mr. Douglass, seconded by Mr. Grigonis,
it was
RESOLVED, to rescind the resolutions made this Board
concerning this variance application, Appeal No. 2710,
previously hereto.
Vote of the Board: Ayes: Messrs. Grigonis, Doyen, Doug-
lass, and Sawicki. Mr. Goehringer abstained.
Southold Town
Board of Appeals
-31- September 25, 1980
RESERVED DECISION: Appeal No. 2710.
Dolores Strong, c/o Richard J. Cron, Esq.,
chogue, New York l1935.(continued):
Application of
Main Road, Cut-
On Motion by Mr. Grigonis, seconded by Mr. Douglass,
WHEREAS, on August 26, 1980
request of applicant to consider
of July l, 1980; and
this Board received a formal
an amendment to its decision
WHEREAS, this Board held a re-hearing on September 25,
1980 "to reconsider the decision of this Board made on July 1,
1980, wherein applicant requested permission to display and
store openly boats and marine items outside of enclosed build-
ings," after duly posting notice therefor;
WHEREAS, the Board determines that by granting of
similar relief: (a) the orderly and reasonable use of
adjacent properties ~r of adjacent use districts will n~t
be prevented; (b) that the health, safety, welfare, con-
venience, comfort and order of the Town will not be adversely
affected; (c) that the general purposes and intent of the
zoning ordinance will be observed; (d) the plot area is
sufficient, appropriate and adequate for the reasonable use
and anticipated operation thereof as planned herein;
NOW, THEREFORE, BE IT RESOLVED, that Dolores Strong,
Camp Mineola Road, Mattituck, New York be r~d a Variance
to the Zoning Ordinance for permission to openly store boats
and related marine items outside of enclosed buildings SUB-
JECT TO THE FOLLOWING CONDITIONS:
(1) That applicant obtain Southold Town Planning Board
approval of the off-street parking plan pursuant to Article
XI, Section 110-112 (100-112 sic) of the Southold Town Code;
(2) That display of boats and relate~ marine items be
permitted only within five feet from the southerly~property
line for a length not exceeding the length of the stucco
building pl'~s twelve feet at the east side, for a total of
approximately 62 feet long;
(3) That a wooden split-rail fence be erected and main-
tained in the frontyard area bordering the area to be utilized
for display or storage of marine items; said fence not to be
located closer than five feet from the southerly property line;
(4) That the Main Entrance of the stucco building will
be either at the side or rear of the stucco building;
Southold Town Boar~ of Appeals -32-
September 25, 1980
(5) That thei existing front entrance of the
ing be used only for emergency purposes;
stucco
build-
(6) That thelwesterly side of the stucco building will
remain open and unobstructed at. all times [never to be used
for storage or display];
(7) That theieasterly side of the stucco building will
remain open and unobstructed for a minimum of 10' for egress
and ingress [never to be used for storage or display];
(8) That a d~rectional "PARK IN REAR ONLY" sign be
placed on the split-rail fence, not to exceed the size two
feet by four feet;.
(9) That this matter be reviewe~ by the Suffolk County
Planning Commission pursuant to Section 1332 of the Suffolk
County Charter. ;
LocatiOn of plroperty: 11455 Main Road, Mattituc~ New
York; bounded north by Mileska, south by Burgon, west by
Wickham, east by Main Road. County Tax Map Item No.
1000-142-2-17.
Vote of the Bioard: Ayes: Messrs. Grigonis,
Douglass, and Sawi.cki. Mr. Goehringer abstained.
Doyen,
On motion by iMr. Goehringer, seconded by Mr. Douglass ,
WHEREAS, appllicant has submitted an environmental assess-
ment in the short ;form which indicates that no adverse effects
were likely to occur to the environment;
~ IT IS RESOLVED, that in Appeal No. 2743 , application of
Leon.K~ementz for :a Variance for permission to construct de-
tached garage in t!he front and/or side yard area,
this Board determi!nes that this project if implemented as
planned herein is iclassified as a Type II Action, not having
a significant effe]ct upon the environment; and pursuant to
the New York State Environmental Quality Review Act, Sections
617.13 and 617.5(~), and the Southold Town Code, Section 44-4,
no further determilnation or procedure is required in the SEQRA
standards of process by this department. (This declaration
should not be considered a determination made for any other
d~partment or agedcy, which may be involved.)
Vote of the Board: Ayes: Messrs. Grigonis, Doyen, Doug-
lass, Goehringer and Sawicki.
Southold Town Board of
Appeals -13- September 25, 1980
MEMBER DOUGLASS:
in the deeds?
Did you ever have a--did anybody go back
if
MR. SMITH: Did I ever have anybody go back in the deeds?
MEMBER DOUGLASS: Yeah, or look back in the deeds to see
it ever was?
MR. SMITH: There would be nothing on my deeds to--
MEMBER DOUGLASS: Because it was Stevenson that closed it
off. Stevens, or whatever that closed it off.
MR. SMITH: Well, I am hopeful that you may grant the
variance; and it was suggested to me that it was the better
way of proceeding to simply go forward with our work, rather
than trying to prove that a road was there. I'll tell you
personally that I think that if there ever was an easement
over in front of the present Wainer property for vehicular
traffic, that it probably has been extinguished. I would
not argue the same with respect to my house, but I would
prefer not to have to go through the argument.
MEMBER DOUGLASS:
information, or if you
it somewhere,
had
found
I was just wondering if you had the
had found it anywhere, because if you
why it still would be in existence.
MR. SMITH: Yeah, but it's--unless I have to do it, I,
it's not worth all that--
MR. CHAIRMAN: If there are no further questions, I'll
vote for a resolution closing the hearing and reserving
decision.
On motion by Mr. Grigonis, seconded by Mr. Douglass, it
was
RESOLVED, to close the hearing and reserve decision in
the matter of Edgar J. Smith, Jr., Appeal No. 2738.
Vote of the Board: Ayes:
lass, Goehringer and Sawicki.
Messrs. Grigonis, Doyen, Doug-
RE-HEARING. Appeal No. 2710. Application of Dolores
Strong, Camp Mineola Road
, Mattituck, New York (by Richard J.
Cron, Esq.) for a re-hearing to reconsider the decision of this
Board made on July 1, 1980, wherein applicant requested permis-
sion to display and store openly boats and marine items outside
of enclosed buildings. Location of property: 11455 Main Road,
Mattituck, NY; bounded north by Mileska, south by Burgon, west
Southold Town
Board of Appeals
-15- September 25, 1980
(Mr. Cron continued)
if the Board determines that to be feasible. I don't think
it's necessary to go into all the reasons why. We had gone
into this on the intial application in terms of the granting
of the original variance; but the point is we've got to have
as much area from the building line towards the sidewalk line
as is reasonable in order to properl~ do what we want to do
on the subject premises. I'd ask the Board to be as reason-
able and as fair as they can to extend the area in which we
can operate.
MR. CHAIRMAN: Thank you.
for this? Mr. Strong.
Is there anyone else to speak
DAVE STRONG: Yes. I'd just like to--I know we've been
over this before, but in addition to these things, I have
spoken to a couple members of the Board, and we do intend to
have an access door in the rear and on the east side of the
building so that people may park in the back and will not
have to walk the way around to the front. Just one thing
to what Mr. Cron said, it's not so much the footage of the
thing, and I think we're all aware of displaYing the boats,
if it were feasible to get it--we're not trying to overrun
the sidewalk or anything like that--a reasonable limit, yes.
Just by the nature of the beast, and there is no set size
in a boat, it's awful hard to limit and say you have "x"
amount of feet. And so I'm certainly going to appreciate
any help we can get and the greatest distance that we're
allowed--and it's certainly not going to all come out that
way. It's goi~.g to be staggered naturally. Aside from
that, that's about all I have to add.
MR. CHAIRMAN: Thank you. Is there anyone else? Does
anyone want to speak against this for any reason? (Negative)
Any questions from any of the Board members? (Negative) I'll
offer a resolution closing the hearing and reserving decision.
On motion by Mr. Grigonis, seconded by Mr. Goehringer, it
was
RESOLVED, to close the hearing and reserve decision in the
matter of Dolores Strong, Appeal No. 2710.
Vote of the Board: Ayes: Messrs. Grigonis, Doyen, Doug-
lass, Goehringer and Sawicki.
PUBLIC HEARING: Appeal No. 2744. Application of Committee-
to-Elect George Sullivan, Main Road, Box 837, Southold, NY 11971
for a Variance to the Zoning Ordinance, Article XI, Section
DATION~--
. Sou%hold Town Board of Appeals -2- July 9, 1980
were likely to occur to the environment, and review of the
documents submitted therewith, this Board has determined
that this project if implemented as planned is classified
as a Type II Action, not having a significant adverse effect
upon the environment; and pursuant to the N.Y.S. Environmental
Quality Review Act, Sections 617.13 and 617.5(a), and the
Southotd Town Code, Section 44-4, that no further determination
or procedure is required in the SEQRA standards of process.
This declaration should not be considered a determination
made for any other agency.
Vote of the Board: Ayes: Messrs. Grigonis, Tuthill,
Douglass a~d Goehringer. Absent: Messr. Doyen.
Re: Appeal No. 2710. Application of Dolores Strong.
On motio~ by Mr. Douglass, seconded-by Mr. Grigonis~,
WHEREAS, this Board is in receipt of correspondence
dated July 8, 1980 from Richard J. Cron, Esq. as attorney
for the applicant herein, Dolores Strong, requesting the
Board to reconsider Condition No. (2) in its formal deci-
sion dated July 3, 1980; and
WHEREAS, the Board has reconsidered Condition No.
(2), and it is their feeling that reasonably sufficient
parking area be available at the front of the subject
premises; and
WHEREAS, the exact location of the property line
~s questionable;
NOW, THEREFORE, BE IT RESOLVED, that Condition No.
in this Board's resolution as adopted July 1, 1980 be
amended to read as follows:
(2)
(2) That storage or display of boats and related
marine items be permitted within eight [8'] feet from
the southwest front and within ten [10'] feet from the
southeast front, a length not exceeding 77 feet, of the
existing "one-story stucco restaurant" noted on the
survey dated October 7, 1968 submitted with the subject
application.
Vote of the Board: Ayes: Messrs. Grigonis, Tuthill,
Douglass. Messr. Goehringer abstained from vote. Messr.
Doyen was absent.
HENRYE RAYNOR, Jr..Chairman
FREDERICK E GORDON
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM.$r.
Southold, N.Y. 11971
August 29, 1980
TELEPHONE
765- 1938
Mr. David Strong
P. 0. Box 1033
Mattituck, New York 11952
Dear Mr. Strong:
The following action was taken by the Southold Town Planning
Board at a regular meeting held August 20, 1980.
RESOLVED to approve the proposed off-street parking of
Dolores and David Strong' for property formerly known as "Black
Forest Restaurant" on map presented August 12, 1980.
I attach copy of map.
Yours truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Muriel Tolman, Secretary
Copy to Zoning Board of Appeals/
URVEY POR
'OBERT E. 8~ FERNE
;ATTITUCK
OWN OF SQUTHOLD
UFFOLK.COUNTY, N Y
C,ALE : I"~ 40'
CT. 7, IDGB
MCGRATH
'\
GUARANTEED TO;
SECURITY TITLE ~ GUARANTY CO.
LAND SURVEYOR
f4.Y.S. LIC. hlO.
__RIVERHEAD~ N.Y.
~o6thold Town Board of Appeals -26- July 1, 1980
(5) Said sign shall not be erected prior to receiving Suffolk
County Planning Commission approval, and after such approval said
sign shall not be erected prior to 30 days of the event for which
it is advertised, and said sign shall be removed within seven days
after the date of said event advertised.
(6) said sign shall no% be less than five feet (5') from any
property line; the bottom edge of said sign shall not be less
than four feet (4') above ground.
(7) Said sign shall not be illuminated.
(8) Said sign permit hereby authorized shall in no event be
in effect for more than three [3] years except by approval of this
Board after receiving a formal written request thereafter and in
accordance with all the conditions listed herein, and
(9) said sign sh~ll comply with the rules and regulations
of the Federal Highway Beautification Act and Pederal Funding
Act for Highways, if applicable in the circumstances.
Location of property: 8700 Main Road, Laurel, New York;
property now or formerly of Frank Murphy; County Tax Map Item
No. 1000-122-007-6.2.
Vote of. the Board: Ayes: Messrs. Grigonis, Doyen,
Douglass and Goehringer. Absent: Messr. Tuthill.
RESERVED DECISION: Appeal No. 2710. Application of DOLORES
RONG, Camp Mineola Road, Mattituck, New York, (by Richard J.
Cron, Esq.) for a Variance to the Zoning Ordinance, Article VI,
Section 100-63 for permission to display and store openly boats
and marine items outside of enclosed buildings. Location of
property: 11455 Main Road, Mattituck, New York; bounded north
by Mileska, south by Burgon, west by Wickham, east by Main Road;
County Tax Map Item No. 1000r142-02.00-017.00.
After investigation and inspection, the Board finds as
follows:
The subject premises contains approximately 25,000 square
feet, and existing on the premises are an one-story stucco
building, formerly used as a restaurant, and an one-story
building towards the center of the premises which apparently
has recently been utilized as living quarters. Applicant
requests permission to store boats and related marine items
outside of buildings for display purposes.
$o~thold Town Board of Appeals -27- July 1, 1980
The Board determines that by the granting of such relief:
(a) the orderly and reasonable use of adjacent properties or
of adjacent use districts will not be prevented; (b) that
the health, safety, welfare, convenience, comfort and order
of the Town will not be adversely affected; (c) that the
general purposes and intent of the zoning ordinance will be
observed; (d) the plot area is sufficient, appropriate and
adequate for the reasonable use and anticipated operation
thereof as planned herein. The Board agrees with the reason-
ing of the applicant.
On motion by Mr. Douglass, seconded by Mr. Grigonis, it
was
RESOLVED, that DOLORES STRONG, Camp Mineola Road, Matti-
tuck, New York, be GRANTED a Variance to the Zoning Ordinance
for permission to openly store boa~ an~,related marine items
outside of enclosed buildings, SUBJECT TO THE FOLLOWING CON-
DITIONS:
/
(1) That applicant obtain Southold Town Planning Board
approval of the off-street parking plan pursuant to Article
XI, Section 110-112 (100-112) of the Southold Town Code;
(2) That no storage or display of boats and items be
permitted closer than 25 feet from the street property line
(Route 25);
(3) That the west sideyard area must have at least 12 feet
clear and unobstructed to the rear around the building for
accessibility;
(4) That only one business be permitted on the subject
premises without the prior express written approval of this
Board after formal application therefor;
(5) That the east sideyard area must have at least 8 feet
clear and unobstructed for accessibility;
(6) That this matter be referred to the Suffolk County
Planning Commission pursuant to Section 1332 of the Suffolk
County Charter.
Location of property: 11455 Main Road, Mattituck, New
York; bounded north by Mileska, south by Burgon, west by
Wickham, east by Main Road; County Tax Map Item No. 1000-
142-02.00-017.00.
Vote of the Board: Ayes: Messrs. Grigonis, Doyen,
and Douglass. Messr. Goehringer abstained from vote.
Messr. Tuthill was absent.
FORM NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
(owner or authorized agent of owner)
........... 11952
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance ............... ~ ..........................
Other Applicable Laws, Ordinances'or Regulations ............................................
at premises hereinafter described in that ~.g.~.~..~..~...~.~.?..~..9..g~g.~...~..q.~.~..b...Li.~..~.~.~..~.~`~..~.~.~.~.~..
(state character of violation)
......... ~...~.~ ~.~, £.C ~,.g.~.~..e....9..~L ...q g,9..u. ~ ~..0.g.~. r. ........................................................................................
in violation of ........ ~...t'..'.....X..Z...V..~,,.,~..e...c.~..'..,.l...0..0...-..1.~./j.. .........................................................................
(State section or paragraph of applicable law, ordinance or regulation)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Iow and to remedy the
conditions above mentioned forthwith on or before the ......... ~.~. ........................................................
day of ...... ~,~ ['.~ ~, ..................................... 19..8...2..-
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
~`~1~``~5`~````~`~`~[~t`~``~`q`~``c]``t````~`~`a``t~```~``:~:`f~``~`c`~`~``~` .............. County of Suffolk, New York,
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or bath.
Building Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ...... ...~.?.'7...., 19 .W
Approved .......
Disapproved a/c ........... ~--~:~.. .....
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 have been granted 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 authofized inspectors on premises and in buildings for necessary insp~.~.~ e(fi- ~/~//_
(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.
(as on the tax roll or latest deed
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location'of land on which proposed work will be done.t ........ I'.l?~).~.....,.>.t.~..r¢ ..........................
...... ................. .................. ..................
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ./.~..2T ....... Block . .~. .............. Lot.. ~.~. .............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premisesp~£ and i_n. tended ~ Xt~//g use and~)~3 ~,f,p~q~°ccupancy of proposed construction:
a. Existing use and occupancy ....... ~.~.. 5 ....... ~; ..... ] ......... ' ........... ~ .................
b. Intended use and occupancy ................ ~y ..... J: ....'..~...~ ...... '...~.:...~ .........
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
z/. Estimated Cost .............................. Fee ....................................
i (to be paid on filing this application)
5. If dwelling, number of dwelling ¢nits ............... Number of dwelling units on each floor ................
If garage, number of cars ..... ' ...................................................................
6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use' . ....................
7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................ '
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth .................... i. · Height ...................... Number of Stories ......................
8. Dimemions of entire new construction: Front ....... ; ....... Rear ............... Depth ...............
Height ................ Num!ber 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 violhte any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ..................... Address ................... Phone No ................
Name Of Architect .......... ~ ................. Address ................... Phone No ................
Name 6f Contractor ......... i ................. 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 lot.
STATE OF~NEW YORK,
COUNTY OF..X. ...... is's
.... .~.~.t/i P.....~.-...~..'~..,~0.~t'.6i .................... being duly sworn, deposes and says that he is the applicant
(Name of individual si~ning contract) '
above named.
He is ~he ..................... ; ...................................................................
: (Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authored to perform or have perfo~ed the said work and to m~e ~d file this
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will be perfo~ed in the m~ner set forth ~ the application filed ~erewith.
Sworn to before me this
........................ day of..~ ........ '~ .......
Nota, Public, ~.~~~~ ....... County
r~o. 52-452477~ (Signature of applic~t)
I Qualific~ in SuffoLk
Commiss~,m ~xptr,s March ~0~