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Home My WebLink About13857-z MOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N~ 13857'Z Date ............ L ................... ,, J 9..~...~ Permission is hereby granted to: ...~_~,.~ ...... ~.....~..: ............... o~...~ ............. ~ ......... ~./... ........ Count,/ Tax Map No. 1000 Section~.......~....-?,..°.. ...... Block ....... .L..O. ......... Lot No ......~)-.c~..:...):~t... ..... ( ~-,,'o 'o ~'--- pursuant to application dated ...~f,,~......l ............................ , 19.m~.., and approved by the Building Inspector. Building Inspector Rev, 6/30/80 FIELD INSPE~TI~.~ FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: zparlmenl o~ Environmenta~ Conservation zglons 5-9. Addlesses on back page JOINT \ APPLICATION FOR PERMIT ~.,d o~ No. xructions on back before completing this ap[dicaUon, please type or print clearly in mk. Use separate ,a and exhibits to provide afl required data and explanations for which space on lhe form is inadequate, gTICLE 15, TITLE 3 (CONTROE Of AQUAIIC INSECTS, WEEDS, OR UNDESIRABLE FISH) ~£TICLE 15, TITLE 5 (PROTECTION OF WAIERS) wharf, built on o~nwork supports, which has a top surface area 6f more than 200 square feet. ARTICLE 15, Titl~ 15 (WATER SUPPLY) ARTICLE 24 (FRESHWATER WETLANDS) SECT ON 10 (RIVER & HARBOR ACT OF 1899) for structures and, work in navigable waters of the U. S. SEC]ION 404 (FEDERAL CLEAN WATER ACT OF 1977) for disposal'of dredged or fill m~teria[ in waters of the Deparim~nt (~ the Arm); BuffMo District, Corps of Engineers 1776 Niagara Street Buffalo, New York 14207 I NCBCP-S Corps of Engineers Application NO. 1. NAME DJ~ APPLI~:A/qT: Eh-toni;tilt't-:aLs; ] nc. ' '- 2. APPLICANT iS A/AN [] individual [] partnership [_] Association .~j Corporation [] Municipality' [] Governmental Agency 3. NAME & TITLE OF , OFFICIAL SIGNING APPLICATION - Roy _'J,, STREET ADDRESS ~-'' PHO~IE 283-6360 STATE ~'~' Zip ~ODE [5 11968 N^M'~ & ^b6~s~ OF OWNER (if not applicant) ~_%~f8 F, da,~n OR P. O. BOX ~ ~ POST OFFICE 5. pROJECT LOCATION; a) City ~ Viii,age of Town of, ~O~:hold :' ', b) S~cific ~roject site or area is marked on U.S.G.S. or equivalent maO, attached as Exhibit No. _ ~ Public ~ Commercial, ,. , STATE OWNED LAND? ~AME OF STREAM OR OTHER WATER BODY: If appropriate; if un-named, show on map - See item II0. FEE OF$ IO ENCLOSED il. PROJECT DESCRIPTION: (Feel of rip-rap new channel; cubic yards Of material to be removed; drain;ag, dredg~ng~ !, ,:, .- t.,,., ,- . '! , · ' ad ocat'on ofdis osa s es typeo st uc u e to be installed fie ght of dam; site of b,,poundment;. ~&.ad g~l~,~(~.'~ r.-~ ~ fill ng n P - ~ ca~acities'of p~oposed water sources; extent of d~strlbuUon system; ~tc.) '~ ~ ~0~ e~, ~ .O~ h~esite to'r~uired f.f el. (.8'). Constcttct o.f, hoase,' decks';; saaitary 8ySte~"aaraBe, d~ve~ay~.etC;, Construct n t,~be: dock ,consisting of a 30'.X~6,~ fixed' elevated (minimum 3' -..a~e"g~e) Cet~alk, 12' x 4' hinged ramp ~nd 20' ~ 6' float ~e~ur~d by .(~) 8e,.p~l~ngs, 12. This project will require the following additional permits, applications for which are the responsibility of others: [] DAM [] DOCK [] STREAM DISTURBANCE [] SPDES/NPDES [] WATER SUPPLY L~ FR£SHWATERWETLANDS 13. NAME AND ADDRESS OF OFFICIAL NEWSPAPER OF LOCALITY WHERE PROPOSED WORKS ARE LOCAI::D: LONG I~LAHD TRAVEI~R-WAfGtI:'L~{F .,ray. clef ,%trcet~ S'guth~ld, i~Y 11971 14. IS ANY PORTION OFTHE ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BECUN OR COMPLETE? ~ YES ~ NO If "YES", explain In addenda, giving reasons and dates, and show existing work on drawings or maps. 15. PROVIDE SEPERATE LIST OF NAMES, ADDRESSES, AND PHONE NUMBERS OF OWNERS OF PROPERTY AD)OINING THE WORK (~CORPS" PEPJ'AITS ONLY), NOTE that the CORPS OF ENGINEERS CANNOT process appllcaUons lacking this information. CERTIFICATION: t bereb~ affirm finder ~enolly of perjury that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statemenls made herein are punishable as a Class A misdemeanor pursuant to Section 2t0.45 of the S~at~ Penal Law~ A~ a condition to the issuance of a permit, the applicant accepts full legal responsibility'for all damaRe, direct or indirect, of whatever nature, and by whomever suffered, arising our of the project described hereto and aRrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from the said project. In addition, Federal Law, 18 U.S.C. Section 1001 provides for a fine of not more than Sl0,000 or imprisonment for not more than five years, or both, where an applicant knowD;'l:' and willfully falsifies, conceals or covers up a material fact~ or knowingly makes or uses a false, fictitious or fraudulent statement. Oecec~ber 9, 1983 DATE SIGNA FURE ~-19-3 (4/80) -SEE REVERSE SIDE-- NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Building 40, SUNY--Room 219 Stony Brook, NY 11794 (516) 751-7900 AMENDMENT TO PERMIT EXTENSION OF EXPIRATION DATE RE: Permit No. Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that there has not been a material change in environmental conditions, relevant technology or applicable law or regul- ations since the issuance of the exist~n~ permit~ therefore, the expiration date is extended to /~./''~6- -/~ ' This letter is an amendment to the original permit and as such, shall be attached thereto, and a copy posted at ~e Job site. Ail other terms and conditions remain as written in the original permit. Very truly yours, Regional Pc'gmat Administrator RAG:c~ "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~.'....1./ ..... , 19i~jf ' 1 Approved ~.. ! ..... 19 .~ f Permit No. ~..~'..~..~.7..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application r~ust be completely filled in by typewriter or in ink and submitted 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 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, 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, etectrician, plumber or builder. Name of owner of premises ....... /~.~./.~....~.'t . . .~.~.15~aO ......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...... ....... (Name and title of corporate Builder's License No .... /.?/. .................. Plumber's License No... ~/~-*~e'. Electrician's License No...~'.~.q'.~... '.J~. ~../J~'.~... Other Trade's License No. Location of land on which proposed work will be done .................................................. ........... .......... ............ r,O ................. House Nnmber Street Hamlet County Tax Map No. I000 Section .... ~..7.~.) ......... Block ../..O ............. Lot .... .~.~,.'..~.. ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~. ~/1~/2. ~ ..................................................... b. Intended use and occupancy . ~d. ~'.. :.' .~14'&t p~ ' ' ~ ' 7 ppli ~ 3. Nature of work (check which a cable): New Building ......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... / (Description) 4. Estimated Cost / .5~..~! ~ Fee I *" (to be paid on filing this application) 5. If dwelling, number of dwellingiunits .............. Number o f 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. Dimansions of existing structures, 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 .... ~-~, / ~ t~ 2-'~'J/(.,~' r- ' .......... t' ' ' ;~ ' ' 8. Dimensions of entire?ew const~mction; Front .... ~ ~..Ud'... Rear .... ,..~?....6~.... Depth .... ~-~.w.~ ..... Height ..... ,/2, ~. ..... Number of Stories ....... /. ~. ' .,~..~.., ......................... 9. S~ze of lot: Front ......... ~t49 .......... Rear ........ ~.g-? ........... Depth .. ~..4~...~.. ~ ~..o .... 10. ])ate of Purchase .......... i .................. Name of Former Owner ............................. ' 1 1. Zone or use district in which pr~mises are situated ....... ... . ~. ~. ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. /L./.O .............. 13. Will Io~ be regraded . . )~/.~././~P ................ Will excess fill be removed from premises: Yes ~ No 14. NameofOwnerofpremises d~t/~.t~.. /~ .,~./?..f(~/~. Address . /~.,~. Phone No Name of Architect ....... ., ................. Address ....... ~..C/~.. Phone No ................. Name of Contrt~ctor rJp.//.j¢.//;~ .......... Address .~O/~t.~..x~.' ' ~ Phone No PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWYORK, _ ............ ................ being duly sworn, deposes and says that he is the applicant (Name .... of ~nd~wdual s~gu.mg contract) above named. He is the ~. ~./~" .... i (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 manne.r set forth in the application filed therewith. Sworn to before me this ....................... day o ............ , Notary Pub lc, a-~'. Co U~IOA a. CO0~ i .................... ] NOTARY PUBUC, State of N~ ym'~; (Signature of applicant) ~ No, ~221~63, 8uffMk CouhW~ I PLUMBER CERTIFICATIO~ /ON LEAD CONTENT BEFORN ' ~C~,RTIFICATE OF OCCUPANCY' ! ,,~OLDER USED IN -WATER i~UPPL Y SYSTEM CANNOT ~\~EXCEED 2/10 of 1% LF:,AD, · If co,~pcr ~ubing is'use¢! . for wrder ~i~tributlng :~ system; pip~,~g shall be ~L o~ ~pes K or L~y Ap?~m'"-D AS NOTED 765-1802 9 A~ ~ - FOR DATE' JOHN BERTANI INC. $OUTHOLD, NY z ~.97 JOHN BERTANI $OU'FHOLD, NY JOHN BERT^NI ' %OUTHOLD, lt¥ i )~F) JOHN BERT,~NI BUILDER INC, DRAWING NUMBER 7 BUILDER INC. Oolon~al Road NUMBER JOHN BERTANI BUILDER INC. JOHN BERTANI BUILDERINC. NY 119