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HomeMy WebLinkAbout16131-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17307 Date SEPTEMBER 15, 1988 THIS CERTIFIES that the buildin~ Location of Propert~ 820 House No. County Tax Map No. 1000 Section 31 ONE FAMILY DWELLING TRbq~d~N S PATH EAST MARION Street Hamlet Block 12 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 15~ 1987 pursuant to which Building Permit No. 16131Z dated JUNE 24, 1987 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 ONE FAMILY DWELLING W/ATTACHED ONE CAR GARAGE~ DECKS AND ROOFED PORCH. The certificate is issued to EUGENE & BARBARA PERINO (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOSEPH RUSSO s7-s0-¢s 7/7/88 PENDING AUGUST 26, 1988 Rev. 1/81 · Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16131 Z Permission is hereby granted to: z.~.!..~Z~....Q~...:'~ .................. ..~..~~....~.:..~..,...LLZ~..~.. ,o ....... at premises located at ..... ~ ...... ~ ........ County Tax Map No. 1000 Section ..... ..C~......~..~ ....... Block ...... )...,,~Z,. ........ Lot No .....}....~. ............. Building Inspector. Building Inspector Rev. 6/30/80 Building Department Town Hall Southold, N.Y. 11971 765 - 1802 Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 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 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 p~operty showing all propertv lines, streets, buildings and unusum 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: Additions $25.00 ?O0[S $25.00A[TERATION $25.00 1. Certificate of occupancy ~.~ew D~el[Z~, Accessory ,$I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50. O0 Date ....~...~.t~. ~.~..<.. ! .~.,..).~.S% New C one truct i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.~. .0. Ti~IJ I~ /~ ~J ~ ~pAT H I~A~T t'4Al~.t OAJ I~. House No. Street Ham/et Owner or Owners of Property ,[~0.(-7'~...1~, ~ ..... 4..'~/~i~l-~/9 .... '~.E..~..N..(~ ................... County Tax Map No. 1000Section ~>/ Block /.,~. ....... Lot /~ ........ Subdivision ...4~..~. .......................... Filed Map No ........... Lot No .............. Permit No.[ ¢ 15,1 Oate of Perm tAl. [. Z .Applicant .¢.U.~E, AJ~ I~_~.~/~ O Health Dept. Approval ........................ Labor Dept. Approval .................... Underwriters Approval ........................ Planning Board Approval ..................... . FeRequestpR~ Nmif°rtt eTemp°rarYd ~.~ C~.C~cO.,.certificate'. .--~. ................... C .~.. ~)~ ..................... Final Certificate ..................... ~ Construction on above described building and permit meets all applicable codes and regulations. TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTttOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occnpancy because .of the foll~owing reasons. /--~/An application for Certificate of Occupancy is not on file. /-~No Underwriters Certificate on file. /_t///The check is (outdated/~ on~ /_-~ No Ilealth Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Bui]dJ. ng Permit # L ~ [ ~ ~ g Building Dept. ***/--~NO Plumber solder Certificate on file. ( all permits involving plumbing being issued after April 1,198d TOWN OF soUT] OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~A~ ~ (please print) Plumber _ (pleas~ print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this c~,.~.day of ~.L~//_ ,-~.-~ , Notary Public ~County ~2~ J ~..~'- RuTH J. DEssART ~otan/Public, Stare of New York No. ed in SuffOlk County Qu~lifi -.. ~..~,,~t 18, 19_,~ ~) Commission ~×p~res Notary Public 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ y]~SULATION [ ] FRAMING FINAL REMARKS: DATE /..~/~ ~ ~ [ INSPECTOR ,/~" ~ 765-1802 BUILDING DEPT. INSPECTION 'FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I/NSULATION / FRAMING [~'] FINAL DATE Y INSPECTION FOUNDATION 1ST [ /~ROUGH PLBG. FOUNDATION ZND ~/] INSU~ FRAMING [ ] FINAL REMARKS: DATE ~/~/~Q~ INSPECTO, ~ ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] R/OUGH PLBG. FOUNDATION 2ND [~ INSULATION [ ] FRAMING [ ] FINAL REMARKS:'~ DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ]ROUGH PLBG. FOUNDATION ;ZND [ ]INSULATION FRAMING [ ]FINAL REMARKS: ~'~//r(* ~ :~ 765-1802 BUILDING DEPT. ~,~~ INSPECTION [ ] FOUNDATION 1ST [/ROUGH PLBG. ]/T~OUNDATION 2ND [ ] INSULATION / FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ J FOUNDATION ZND [ ] INSULATION [ ] FRAMING , [~/~NAL REMARKS: DATE INSPECTOR 765-t802 BUILDING DEPT. INSPECTION [ ]?OUNDATION 1ST [ ] / FOUNDATION 2ND ROUGH PLBG. INSULATION FRAMING FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [~'FOUNDATION J. ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE UNDATION {1st) UNDATION (2nd) UGH FRAME & TLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTttOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the foil, owing reasons. /--~/An_ application for Certificate of Occupancy is not on file. /--P/× No Underwriters Certificate on file. /_~/The check is (outdated/~t on file~ /_-~ No Itealth Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Dui]ding Permit t~ L ~ { ~ LZ Building Dept. ***/~/No Plumber Solder Certificate on file. ( all perlnits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 June 26, 1987 TEL. 765-1802 Mr. Gerard P. Geohringer Chairman, Zoning Board of Appeals Town Hall. Southold, NY 11971 Re: Building Permit #16131Z issued 6/24/87. Mr. & Mrs. Perino: Although survey does not indicate the distance to Marion Lake, the applicant has been fully instructed on section 100- 119.2 about distances not only from the edge of the lake, but also about the compulsory distance from the edge of wetland. This was all agreed to before a permit to construct was issued. Once the foundation is constructed, the job will be stopped until all figures are varified by a 2nd foundation, as per law. I trust this clarifies this application. Very truly yours, Victor Lessard Executive Administrator VL/lmr Southold Town Board of Appeals MAIN ROAD- -C:;TATE 1~I3AD 25 ~3UTHI3LD, L.I., N.Y. llCj'71 TELEPHONE (516) 765-1809 APPEALS BOARD MEMBERS GERARD P, GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR. SERGE DOYEN, JR. ROBERT J. DOUGLASS JOSEPH H. SAWICKI June 26, 1987 Mr. Victor Lessard Building-Department Administrator Town Hall Southold, NY 11971 Re: Building Permit #16131Z Issued 6/24/87 Appeal No. 3643 Filed 6/24/87 Matter of Eugene and Barbara Perino Dear Vic: In reviewing the files in the above matter, it has been noted that the dwelling proposed to be constructed under the above Building Permit is located along the shore of Marion Lake. Inasmuch as the survey does not delineate the freshwater wetland grasses above the shoreline, please confirm whether or not a determination has been made by your office or the Bay Constable as to freshwater wetland grasses above the shore line, which would reduce the setback of the new dwelling to less than 75 feet (per lO0-119.2C). The application for a proposed deck in existence. pending before this Department is for attachment to a dwelling not Please respond as soon as later than Tuesday, June 30th. assistance. possible and in no event Thank you for your lk Enclosures Yo~ GERARD P. GOEHRINGER ~ CHAIRMAN VICTOR LESSARD FXECUTIVE ADMINISTRATOR (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 21, 1987 Town Hall, 53095 Main Read P.O. Box 1179 Southold, New York 11971 Mr. Eugene Perino 132 Bayview Ave. East Islip, N.Y. 11730 Dear Mr. Perino: In reviewing your plans, for a home on Truman's Path, East Marion, and on the advice of the Town Attorney, I am writing you to say that there seems to be sufficient facilities to accomodate more than "a single family unit" as restricted by the zoning of your property. Kindly send this office the necessary revis- ed plans, eliminating the second kitchen, so that you may continue with your construction. Failure to correct this problem within a reasonable time could cause your permit to be null and void. Trusting you will do what's necessary, to clear up this matter, VGL:hdv I remain. Very truly yours, Victor G. Lessard Exec. Admin. SMITH, FINKELSTEIN, LUNDBERG, ISLER AND YAEABOSKI October 19, 1987 Victor Lessard, Building Inspector Town of Southold 53095 Main Road Southold, New York 11971 Dear Vic, I received a telephone call at my office this afternoon from a resident of the Town of Southold who lives in the area of Marion Lake. The complaint was directed toward the construction of a new home on Marion Lake by a Mr. and Mrs. Eugene Parino, the complainant had just gotten off the phone with your department and been advised that the Parino home had received a building permit, and that the building permit authorized the two story dwelling with two kitchen facilities; one each on the upper and lower floor together with separate bathroom facilities, bedrooms, etc. The premises are situate in the Residence A Zone and under the current provisions of our zoning ordinance only single family residences are permitted. The ordinance further provides that a single family residence or more properly a single family dwelling, may only contain one dwelling unit which definition would not be consistent with separate cooking, dining and sanitary facilities as are proposed for the Parino residence. Barring some statutory amendment or opinion to your department which I am unaware SI~ITH, FINKELST~IN, LUND]~EHG, ISLEH AND YAKABOS1/I of, I think that the only correct procedure at the moment would be to issue a Stop Work Order pending a review of the facts and circumstances surrounding this matter so that we can properly address what seems to be a serious descrepancy in our interpretation of the zoning ordinance. cc: Town Board FJY;dkw SMITH, FINKHLSTIgIN, LUNDBERGo ISLER AND YAKABOS] ATTORneYS ~D COUnSelOrS AT LAW October 23, 1987 i TOWN 0t: SOUYH~LD ~,~, Victor Lessard, Building Town of Southold 53095 Main Road Southold, New York 11971 Inspector Dear Mr. Lessard, Following up my letter to you of the 20th of October, 1987, relating to two-family dwellings, I would like to further amplify on my thoughts in this regard. I feel that not only should plans which indicate the presence of two kitchens thereby two dwelling units in most instances, in a single-family residence to be constructed in a single-family zone should be disapproved. But also, upon inspection during the course of construction, any attempt by the contractor or owner to rough out plumbing or electrical service to a secondary kitchen area should be prohibited. It is my view that the zoning code of the Town of Southold is clear in its intent that there are to be no two-family homes constructed except under very limited circumstances, and then on a minimum of four acres after special exception approval. I feel that your Department, the Board of Appeals, Planning Board and myself, at Town Attorney must abide by the clear intent of the Code and act vigorously to prevent two-family construction in the township. Very truly yours, FRANCIS J. YAKABOSKI cc: Town Board FORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTltOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ ./..=..~..%%o.~...0~..... ....... ~- ~=~., ,~..~:..~.~.~. PLEASE TAKE NOTICE that your application dated .. ~~. ~ .......... 19 .~. ~ for peru,it to const~ct..~ .~&..O.~...~. ~ ....... , ....a Location of Property ha~e~o~.,, ~~~. ~...~...~~ . . · Street Ham/et County Tax Map No. 1000 Section . .'. ~.~.~ ..... Block .... ].~ ...... Lot . .~ ~ ......... Subdivision .................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds. O..~.~7fL. -,. Cb~...'.&....~....~.~L,:,,. ~ ?.-.,..~..~.,..~...~4,1 .~...v. ~.'-:..~. ~~~ ~ ~...~..' '~e.... ................... ': .......................... .......... Building Inspector RV 1/80 Southold ?'own Board o eals MAIN ROAD- STATE ROAD 25 SOUTHOLD, L.I., N.Y. 119'71 TELEPHONE (516) 765-1809 ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 3643 Application Dated June 24, ]987 TO: Mr. and Mrs. Eugene Per%Do ]32 Bayview Avenue East Is]ip, NY ]1730 [Appellant (s) ] At a Meeting of the Zoning Board of Appeals held.on September the above appeal was considered, and the action lndica~d-~be~- was on your 1987~ ~en [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request for Special Exception under the Zoning Ordinance Artiqle , Section [ ~ Request for Variance to the Zoning Ordinance Article XI , Section 100~119.2 [ ] Request for Application of EUGENE PERINO for a Variance to the Zoning Ordinance, Article XI, Section ~~~ permission to locate proposed dwelling with or without deck addition within 75 feet of nearest wetlands along the shoreline of Marion Lake. Location of Property: West Side of private right-of-way known as "Truman's Path," East Marion, NY; County Tax Map Parcel No. 1000-31-12-16. WHEREAS, a public hearing was held and concluded on August 20, 1987 in the Matter of the Application of MR. AND MRS. EUGENE PER,NO under Appl. No. 3643; and WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; and WHEREAS, the Board has carefully considered all testimony and documentation submitted concern~n§ this application; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question~ its present zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: t. The premises in question is a described parcel of land containing a total lot area of approximately 20,300 sq, ft., frontage (lot width) of 75.36 feet, and is presently vacant. 2. The subject premises has a frontage along Marion Lake of 75.36 feet, the shoreline of which is set back at varied distances of 23 feet on the southwesterly.corner and up to 43 feet on the southeasterly corner. 3. B~ this application, appellants request permission to locate a proposed new dwelling with a setback of 63'10" from the nearest wetland grass and with the proposed deck addition to dwelling a setback of not less than 55 feet from the nearest wetland grass, as shown by the sketch submitted under this application. (CONTINUED ON PAGE TWOI DATED: September 10, Form ZB4 (rev. 12/~~ ~ 1987. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS Page 2 - Appl. No. 3643 Matter of MR. AND MRS. EUGENE PERINO Decision Rendered September 10, 1987 4. Article XI, Section 100-119.2, requires all buildings and structures to be set back not less than seventy-five (75) feet from a tidal water body, tidal wetland edge, or freshwater wetland. 5. The Courts have held that the area setback variances must meet the "practical difficulties" standard, considering at least the following: (a) that the relief requested is not substantial in relation to the requirement; (b) that the project as proposed is not out of character with the neigh- borhood; (c) the circumstances of the property are unique and are not personal in nature; (d) that the variance will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town; (e) that the variance requested is the minimal necessary; (f) that there is no other method feasible for appellants to pursue other than a variance. 6. It is the position of this Board as follows: (a) that the relief requested is not substantial in relation to the requirements, being a variance of approximately 26% of the reuqired 75-ft. setback requirement; (b) the project as proposed is not out of the character of the neighborhood since the improvements on parcels in the immediate area similarly exist; due to of the (c) the circumstances of the property are unique, the nonconforming §ize, width, and general nature site; (d) the relief if granted will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town; (e) the relief requested is not the minimal necessary since there is ample .land available to meet yard setback requirements; all (f) there is another method feasible for appellant to pursue [without a variance]; (g) the relief requested 'is not unreasonable. 7. It is noted for the record that Building Permit #16131Z was issued June 24, 1987 for the placement of a new dwelling at or more than 75 feet from the nearest wetlands; however, date, no construction has taken place. 8. It should be understood that applicants are aware of the restrictions of this variance as conditioned below and agrees by acceptance of this conditional variance to no further reductions to less than the requested 55 feet from nearest wetland grasses.in the future. 9. It is further noted for the record that (a) a Wetlands Permit'is pending at this time before the Southold Town Trustees in accordance with the requirements of Chapter 97 of the Town Code, and (b) Permit No. 10-87-0054 was issued May 7, 1987 by the N.¥.S. Department of Environmental Conservation, with conditions, as noted therein. Page 3 - Appl. No. 3643 Matter of MR. AND MRS. EUGENE PERINO Decision Rendered September 10, 1987 Accordingly, on motion by Mr. Douglass, seconded by Mr. Doyen, it was RESOLVED, tO GRANT relief under the Provisions of Article XI, Sectio~-ll9.2 in the Matter of the Applica- tion of MR. AND MRS. EUGENE~PERINO under Appl. No. 3643 for permission to locate new dwelling-with deck addition at a setback of not less than 55 feet from nearest wetland grass (or shoreline, whichever is closer), AS APPLIED AND SUBJECT TO THE FOLLOWING CONDITIONS: 1. There be no disturbance of land within 50 feet of the lake's shoreline; 2. There be no further setback reductions for structures to less than 55 feet from nearest wetland grasses, or lake's shoreline, whichever is closer; 3. The proposed deck addition remain open, unroofed and never be enclosed; 4. The deck addition be placed not closer than 55 feet to the nearest wetland grasses, or lake shoreline, whichever is closer, with the exception of entrance/exit steps. 5. The foundation of the proposed dwelling and dwelling structure be located not closer than 64 feet from the nearest wetland grass, or lake's shoreline, whichever is closer; 6. Executed covenan{s and restrictions as to Conditions No. 1 and No. 2, supra, shall be filed with the Suffolk County Clerk's Office, copies of which shall be furnished to the Southold Town Board of Appeals for permanent recordkeeping. Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Douglass and Sawicki. (Member Grigonis was absent.) This resolution was duly adopted. lk ~,~FI":~'CEOF THE TOWN CLERK ;"~¢/'["~,..., Town of Southold Judith T. Terry, Town t4erl~"' ' Town Hall, 53095 Main Road P. O. Box t179 Southold, New York t1971 Telephone (516) 765-1801 TOWN OF SOUTHOLD Appl'cabon No./.~--~'-_ Construction~ Alteration ..... Residential Non-Residential SOUTNOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No, APPLICANT NAME; APPLICANT ADDRESS; SEPTIC I~CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY:~~_._ ,* /'~/"~Z~,Z~,,'~,, OWNER MAILING ADDRESS: L~cg ~YU/~ ~ .,. OWNER PROPERTY ADDRESS; ~/~ ~~ ~ TAX MAP NO,; Section~/ Block /~ ~Lot CROSS STREET:~ ~7~ ~ ~ ~O~ ..... BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of b,,'n C'.,-;k Southold m BOARD OF HEALTH FOHM NO, ] SURVEY .......... BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 CALL · Approved ,, 19~. ?. Permit No.. I..(&. ]...~/.~.. ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... .~J 17. ......... 1977. iNSTRUCTIONS a. Tl~s app~icati~n must be c~mp~ete~y ~lied in by Wpewriter ~r in ink and submitted t~ the Building Inspect~r~ w~th 3 Rets 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 issued 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, adaitions or alterations, or for removal or demolition, as herein described. The appIicant 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, jqspections. ~ (Signature of applicant, or name, ii' a corporation) / 8A'lv, . .w. .E. .. ..... E. . I. .,.5.L. . . !./.7.3.o (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ........................................................ Name of owner of premises ...~..~.~.~.. ~...~.... [~'.~fl..~....~..~.S/~../~. ..... p.~..~. ! ..1~..O. ................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......... ................................ (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ......................... Plumber's Licehse No .... o~.0. . $.c/. .l? ........... Electrician's License No ....................... Other Trade's License No ...................... To 56 DgrE£ 41 £p 1. Location of land on which proposed work will be done..../,~.~ .~.....~. t .~.~....~..~....~.U.~4AA/.' ·~. . .~.~.T./'/.. ................................ L . p.a.~& .~. ., ............... House Number Street Hamlet County Tax Map No. lOOO Section .... ,~. I ........... Block ....... ( ~ ........ Lot .... ./.~. ............ Subdivision ..... ~ [.t~ ........................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: fl. Existing use and occupancy ..................................................................... b. Intended use and occupancy .~./V. -~'. E,q.Hl.~.¥ .0~.~.~.~.. i ...... i ..................... 3. Nature of work (check which applicable): New Building. ...~... . .. Add~t!qn,' * *~: . .' ..... .. Alteration;: ......... Repair .............. Remloval .............. Demolition .... ..; i. .... Other Work... :, ~ ......... Estimated Cost ~..~.e. .~/~ ..... Fee.2 ~ ~tO be paid on filing this apP?~ation) . t . I Number of dwelling units on each floor..~/~ ....... If dwelhng, number of dwelhng umts ............. If garage, number of cars .... ~ .......~ ............................................... ':. If business, commercial or mixe~d, occupancy, specify nature and extent of each type of Use . .~/~ .............. structures, if any: Front .... ~ ....... Rear .... ........... Depth .............. Dimensions Of existing Height ............... Number' of Stories ........................................................ D~ensions'of same structure ~ith alterations or additions: Front Rear ~-.8. Dimensions of entire new construction: Front .... ~... ..... Rear ..... t~elght . ~ ......... ; Number of Stones . .~ ........ ~ ....................... ~..~). .... Sizeoflot: Front ...~ .... ~ ........... Rear .... 7~ ............... Depth ~ ........ ~. .... Date of Purchase ~ ~.~... }.0 ~ ........ Name of Fomer Owner Zone or use district in which premises are mtuated ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~0. ........................... ' 13. Will lot be regraded I~g~, .~g~ · · O. · · .~... Will excess fill be removed from~yemises: ~ Yes No 14~ Nme of Owner of premisesffO8~.~. ~gl.~... Address I~..~1~.~.. ~~ ~.. II.~. . N~e of ArchitectUre..Tg[~{¢~ ...... ~. Address .~ ~OR ~... Phoae No ...... N~e of Contraetor~. ~[ .~MI~.~ ..... Address .... : .............. Phone No ...... ' ..... '~' ' ' 1.5. Is thls property located .wSthln 300 feet of a~wetland~ ~Yes ~.. No ..... · If yes, Southold To~ Tru~stees Permit maybe required, PLOW DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block lumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK COUNTY OF ........ $.S (Name of individual signiog contract) being duly sworn, deposes and says that he is tlie applicant above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulylauthorized to perform or have performed the said work and to make and file this application; that all statements contai,ted in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner get forth in the application filed therewith. Sworn to before me this ' 7. dayo i l, ............... I. ..; ..... 2. ........... Nota. Publio.. .... .... County HELEN K. OE HE NOT~RY PUBLIC, State of ~ew Yod~ (Signature of applicant) ~ No. 4707878, Su~lk County~ ~ Te'm Exp re~ Ma ch 30, 19--.~ r~ o o >'Oz ~-o Ld U' ,,o > ~- ~o -2' STATEMENT OF INTENT THE WATER SU~Pt_Y AND SEWAGE DISPOSAL. ~'~fSTENIS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT OF HEALTH SERVICES. (Si , , APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CON'ST~UCT ION ONLY OATIr: .. H.S. REF. NO ~ l-~,,J ~L~ ,aPPROVED: SUFFOLK (.O TAx MAI~ n~¢!nNa~'^r' DIST 'SECT BLOCK PCL '~'~-N E RS ADDRESS: ~: A" '" ' - 5~_ L_762 ~ DEED: L. !.