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HomeMy WebLinkAbout27321-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27734 Date: 06/06/01 THIS CERTIFIES that the building ALTERATION Location of Property: 1100 SOUTH DR MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 12 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 15, 2000 pursuant to which Building Permit No. 27321-Z dated MAY 18, 2001 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 ALTERATION TO LOWER FLOOR OF EXISTING ONE FAMILY DWELLING FOR ACCESSORY APARTMENT AS APPLIED FOR "AS BUILT" & AS PER ZBA #2754. The certificate is issued to ESTHER BADENHOP (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 06/04/01 PLUMBERS CERTIFICATION DATED N/A u oyfzed Si nature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27321 Z Date MAY 18 , 2001 Permission is hereby granted to : ESTHER BADENHOP MATTITUCK,NY 11952 for ALTERATION TO LOWER FLOOR OF EXISTING ONE FAMILY DWELLING FOR ACCESSORY APARTMENT AS APPLIED FOR "AS BUILT" & AS PER ZBA #3754 . at premises located at 1100 SOUTH DR MATTITUCK County Tax Map No. 473889 Section 106 Block 0012 Lot No. 004 pursuant to application dated SEPTEMBER 15, 2000 and approved by the Building Inspector. Fee $ 225 . 00 Autho !/d ignat re ORIGINAL Rev. 2/19/98 Form No. 6 - --- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR-CERTIFICATE OF OCCUPANCY ~ A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and -pre-existing land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a.consent to inspect signed by the applicant. If a Certificate of Occgpancy is denied, the Building Inspector shall state the reasons therefor in writing'to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. - 2. Certificate of Occupancy on Pre-existing Building- - $100.00 3. Copy of Certificate of Occupancy - .2510 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 :Date . . . . .���vc:� . . � ���. .. . .. . . . . . . . . . . . New Construction. . . . . . ./. . . . Old Or Pre-exiting Building. . !. . . . . . . . Location of Property. . . .. ,. . . . . . ... . . . Z_ ; . . . . . . . . . . House No. Street Hamlet �� G� CLn-c� Er Onwer or. Owners of Property.. . . . . .. . . .��. ., , , , , , , , County Tax Map No 1000, Section.�.7.3.4 2.9. .Block. c.��,�. . . . . . . . . .Lot.�C) , , , , , . , , , , , . Subdivision. . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . .Filed Map. . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . Permit No,°�.?.3 a.� , . ,Date Of Permit. .V/�.7 . . .Applicant. .'41d. . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .. . .Underwriters Approval. : . . . . . . . . . . . . . . . . . . . . . Planning Board Approval.`/ . . . . . . . .. . . . . . .. . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. !_:�. . . . . . . Fee Submitted: $. . e. . . . . . . . . . . ?� . .. .-. . . . . . . . . . . . . . . . . . . . . . . . . 00 �a*7 93 V APPLICANT l APi,41ALS BOARD MEMBERS S�FFO(,� Southold Town Hall Gerard P. Goehringer,Chairman �� Gyp 53095 Main Road James Dinizio,Jr. y - P.O. Box 1179 Lydia A. Tortora Southold, New York 11971 Lora S. Collins y o�� ZBA Fax(516)765-9064 George Horning l �►� Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF OCTOBER 14, 1999 Appl. No. 4754-SE: ROBERT AND ESTHER BADENHOP 1000-106-12-4 STREET &LOCATION: 1100 South Drive, Mattituck DATE OF PUBLIC HEARING: October 14, 1999 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The applicants' property is known as Lot Nos. 5, 6, 7 and 8 on the 1910 Map entitled, "Bay View Park owned by Clara B. Miller." The parcel consists of approximately 32,900 sq. ft. in area with 140 ft. frontage along an private right-of-way extending from South Drive known asBell Path' and 230 or more feet along Canoe Path,' in Mattituck. The property is improved with a one-story/two-story wood frame residence and accessory garage. BASIS OF APPLICATION: Applicants are requesting a Special Exception pursuant to Article III, Section 100-31, subsection B-13 for approval of an " Accessory Apartment"use within the footprint of applicant's existing principal residence. BOARD FINDINGS: In considering this application, the Board has reviewed the requirements set forth pursuant to Article III, Section 100-31B-13 for the Accessory Apartment and finds that the applicant complies with the requirements for the reasons noted below: 1. The Accessory Apartment is located within the footprint of applicants'dwelling. 2. The Accessory Apartment is subject to a Certificate of Compliance issued by the Town Building Inspector with-respect to all other rules and regulations pertaining to occupancy, as well as the N.Y.S. and local Building and Fire Codes. 3. Mr. andf Mrs. Badenhop, the applicants herein, have through their attorney submitted a copy of their current deed indicating that they are owners of this property. The deed was recorded April 1, 1980 in the Office of the Suffolk County Clerk. The owners of the dwelling plan to continue occupancy of one of the dwelling units as their principal residence. 4. Applicants have submitted the following information with regard to floor area: (a) the existing principal building contains a total of 2,414 sq. ft. (b) the Accessory Apartment will be 814 sq. ft. of floor area; (c) the remaining floor area for the owner's residence is 1,438 sq. ft. with 1,600 square feet on the first floor. 5. The Accessory Apartment meets the code required 450 minimum livable area and contains 814 sq. ft. of livable floor area. "Page 2-October 14, 1999 ZBA Appl.No.4754(Badenhop) Parcel 1000-106-12-4 at Mattituck 6. The 814 sq. ft. Accessory Apartment comprises 33.7% of the total 2,414 sq. ft. area of the existing building and therefore does not exceed the code limitation of 40 percent for an Accessory Apartment. 7. The applicant's plans comply with the on-site parking requirements and provide for a total of three parking spaces as a minimum: two for the principal use and one for the Accessory Apartment. 8. The applicants show conformity in meeting the requirements for a dwelling unit as defined in 100-13 of the Zoning Code. 9. The plans indicate that exterior entry to the Accessory Apartment of the existing building will retain the appearance of a one-family dwelling. 10. The existing building has a valid Certificate of Occupancy issued prior to January 1984 as required. Certificate of Occupancy No. Z-3462 was issued April 18, 969 for a private one-family dwelling. 11. In addition, the applicants have agreed to comply with Section 100-31B g, j, k, I, n, o, p, and q• 12. In addition, the Board has reviewed the General Standards governing Special Exception uses set forth in Section 100-263 and finds that: No special exception approval shall be granted unless the Zoning Board of Appeals specifically finds and determines the following: A. That the use will not prevent the orderly and reasonable use of adjacent properties or of properties in adjacent use districts. B. That the use will not prevent the orderly and reasonable use of permitted or legally established uses in the district wherein the requested use is. located or of permitted or legally established uses in adjacent use districts. C. That the safety, the health, the welfare, the comfort, the convenience or the order of the town will not be adversely affected by the Accessory Apartment use and its location. D. That the use will be in harmony with and promote the general purposes and intent of this chapter. E. That the use will be compatible with its surroundings and with the character of the neighborhood and of the community in general, particularly with regard to visibility, scale and *Page 3-October 14, 1999 ZBA Appl.No.4754(Badenhop) Parcel 1000-106-12-4 at Mattituck overall appearance. F. That all proposed structures, equipment and material shall be readily accessible for fire and police protection. RESOLUTION/ACTION: On motion by Member Dinizio, seconded by Chairman Goehringer, it was RESOLVED, to GRANT the Special Exception for an Accessory Apartment as applied for, and pursuant to the Conditions of the Code listed at Section 100-31B(13). VOTE OF THE BOARD: AYES: MEMBERS Goehrinrgiozi5r�a Ins. mber Homing of Fishers Island was absent during this resolu ' s y opted (4-0). GERARD P. GOEH GER, CHgd AN For Filing 10/19/99 2- 7E:� M_1802 BUILDING DEPT. INSPECTION ( ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUL TION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS• ;DATE S'130101INSPECTOR i BUILDING DEPT. i INSPECTION [ ] FOUNDATION IST [ ] ROUGH pLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS c,� .J� DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: I �� -- '� U7� s — c � DATE IN8PECT0 FIELD INSPECTION REPORTMATE COMMENTS ---------------- II ------- =-, ------ W :cep=—_-----_—...------_-- x--- _---- �tJ II FOUNDATION OST) 11 1 II 'i II I FOUNDATION (2ND) ===u_________________ �I JI ROUGH FRAME & �� p PLUMBING II II II E.Y; INSULATION PER N. Y. ;$ STATE ENERGY I CODE l u i H �1 fl II jj 1 FINAL � p ADDITIONAL COMMENTS: od 1 H � H O x _.. H H d44 OCT 1 81999 IL U Y i 1 COMPLAINT REPORT , NAME r. �.._e r vt�. �� DATE ) t ADDRESS Y� Tri T v\ C V-- PHONE# HOW RECEIVED, TEL MAIL IN PERSON LOCATION OF COMPLAINT ii o o SOL-i T t--E- �J 2 NATURE OF COMPLAINT L A S hJ S u 0 P L I G7 A ASSIGNED TO INSP. DATE REMARKS T �?� �� ✓ ir s � t ACTION TAKEN tc--ZB4 FILE # (IF APP CABLE) �o � RE-INSP DATE NYSRPS ASSESSMENT INQUIRY DATE 09/08/1999 473889 SOUTHOLD SCHOOL MATTITUCK SCHOOL ROLL SEC TAXABLE ` PRCLS 210 1 FAMILY RES TOTAL RES SITE 106. -12-4 TOTAL COM SITE 1100 SOUTH DR ACCT NO 14 OWNER & MAILING INFO ===I=MISC I________ ====== ASSESSMENT DATA ----------- ------ ----------- BADENHOP ESTHER IRS-SS ( **CURRENT** RES PERCENT 1100 SOUTH DRIVE 1 1 BLAND 3, 100 **TAXABLE** MATTITUCK NY 11952 1 BANK ITOTAL 10, 100 COUNTY 10,100 **PRIOR** TOWN 10,100 BLAND 3,100 SCHOOL 10, 100 TOTAL 10, 100 ==DIMENSIONSSALES INFORMATION ---------------------------------- -------------------------------- ACRES . 65 IBOOK 6 SALE DATE 00/00/00 PAGE 00033 PR OWNER ----===TOTAL EXEMPTIONS 0TOTAL SPECIAL DISTRICTS 4 ----- CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE IFD030 IPK071 IWW020 ISW011 F1=NEXT PARCEL F3=NEXT EXEMPT/SPEC F4=PREV EXEMPT/SPEC 75 .10- 03 -050 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU NOTICE TO TENANT September 8, 1999 Ms. Catherine Hajak 1100 South Avenue Mattituck, NY 11952 Re: Rent 1100 South Drive Mattituck, NY 11952 The sum of $1,040.00 for rent for the period August ($363.00 owed) and September 1999 ($677.00 owed) remains due and unpaid. TAKE NOTICE that you are justly indebted to the Landlord of the above described premises as set forth above, which you are required to pay on or before the expiration of thirty (30) days from the day of the service of this Notice, or surrender up the possession of said premises to the Landlord, in default of which the Landlord will commence summary proceedings under the Statue to recover the possession thereof. Esther Badenhop, Landlor 1100 South Drive Mattituck, NY 11952 tont -�[ousirtg A((iance, Inc. (FORMERLY THE GREENPORT HOUSING ALLIANCE) 1 10 SOUTH STREET ADEQUATE HOUSING FOR ALL GREENPORT, NEW YORK It 944-1 61 9 ` (5 16) 477-1070 FAX (516)477-1769 BEVERLY HALLOCK, PRESIDENT EDWARD REALE, EXECUTIVE DIRECTOR ',I. �:,�',�• +^ TANYA PALMORE, ASSOCIATE DIRECTO 6/4/99 Esther Badenhop 1100 South Drive Mattituck, NY 11952 Catherine Hajek 1100 South Drive Mattituck, NY 11952 r23: Sec,,Ioq s Landi0:d: T..: dw2i tiigIis �iiSj;2Ct J J Oil Lc �E?0.. 1:'aS :il=;3eC�cd f0t a —, 6/1/99 T . ,e r',- �, rINTS" 01 `(idC�\;'' r• �E,: �! . . .�s rc�eivcd "PASS �,�,'j-r , STAi�iDARDS r�� �� c- __ �^ ratin; .;ccc!dr. t;- N�iD Q[!ALi T Y Ti-ieO1 Lii:s CCS J:L IS accaChecl) QGtIC:�I`1�J ' r��:�/ Off' L• _ pace a it . �•• �3' ' n• _ .. tee: lois: Ci' :',�- -�.. :,r ,ate" (;.� '' Lli ,! ✓c 1 J1• t,.!. 10 �/CGLlC �c=�c:::. �-_; _r, ' •'I:V", e S!�i:a::C` GL:lit�.Js L••�.1 �i rl v: i-i L:..1:.. '.i� t, 1 I`•::USC, L:,ese 1L :1..1 LUST 0:: 6/1/00 G ''l.�V y a7��� r '..^. �'•^ ...C:.... ii..'�. L•v LCL:r.•�.�•.. :�t1a� '.�. �� �- -- •- --. t .: :� ar1:'s film. r: ..:_. r �.._tl::li c: a iti7".i= '• -_. cc; i 8i3:.:3t pa C FUNDED BY NEW YORK STATE DIVISION OF HOUSING & COMMUNITY RENEWAL AN EQUAL OPPORTUNITY EMPLOYER AND PROVIDER dm wnicn resuueo In a raring of'Fail"or"Pass with Commts.' In Date of Inspection Address of Inspected Unit 1pection � Initial �Special einspection Dumber Reason for"Fail'or"Pass with Commentttss'VRabng jmm� vW e Al1d✓� � � form HUD-52580 'Previous editions are obsolete Page 6 of 6 ref Handbook FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27321 Z Date MAY 18, 2001 Permission is hereby granted to: ESTHER BADENHOP MATTITUCK,NY 11952 for ALTERATION TO LOWER FLOOR OF EXISTING ONE FAMILY DWELLING FOR ACCESSORY APARTMENT AS APPLIED FOR "AS BUILT" & AS PER ZBA #3754 . at premises located at 1100 SOUTH DR MATTITUCK County Tax Map No. 473889 Section 106 Block 0012 Lot No. 004 pursuant to application dated SEPTEMBER 15, 2000 and approved by the Building Inspector. Fee $ 225 . 00 Aut or' ze Signa ure COPY Rev. 2/19/98 SECTION 8 HOUSING CERTIFICATE i�RbdRAM NOTICE OF CHANGE TO LEASE AND 'COkTRACT 1 HAP Contract No. : V-64B _ 1 The HOUSING ASSISTANCE PAYMENTS CONTRACT ( ' CONTRACT' ) entered into between the Owner, Esther Badenhop, and the PHA, NORTH FORK HOUSING ALLIANCE INC. dated 08/01/99 , on behalf of the LESSEE ( ' FAMILY' ) , CATHERINE M. HAJEK, who holds CERTIFICATE OF FAMILY PARTICIPATION NO. V12064 for the following described unit 1100 South Drive 2 , Mattituck, NY 11952 is amended as follows : The reason for this change is due to: REEXAMINATION Annual Review of family income and/or composition. [ ] INTERIM ADJUSTMENT Interim change in family income and/or composition. [ ] RENT ADJUSTMENT The owner/agent request for a rent adjustment. ( ] CHANGE IN FAMILY COMPOSITION Name Adult Minor ADJUSTMENT IN PAYMENTS: FROM TO Hap Payment $ 479 $ 137 Tenant Rent $ 314 $ 677 Total Rent to Owner $ 793 $ 814 EFFECTIVE DATE This change to the Housing Assistance Payments Contract and Lease Agreement will be effective 08/01/99 . The next reexamination is due on 08/01/00 . This change is presented to you in accordance with the terms and conditions of the Housing Assistance. Payments Contract and/or Lease Agreement and shall be attached to and made a part of your Housing Assistance Payments Contract and/or Lease agreement . All other covenants, terms and conditions of the original Housing Assistance Payments Contract and/or Lease Agreetaent remain the same . * TO THE TENANT ONLY If you disagree with this decision, you may request an informal hearing. If a hearing is desired, you must submit a written request to this office within 5 _ days of this notice or your right to a hearing will be waived. Signatures Owner. Esther Badenhop 1 -�� ;F4" Signature Official Title Z Date F ' ly CATHER E M. JEK Signature ,--Z�2 Date Spouse or Co-Head' s Signature Date Hous ' Agenc NORTH FORK HOUSING ALLIANCE INC. Signature Edward Reale. Executive Director (Official Tit e) 3 Date D ECEOV[E 11121111, SECTION 8 HOUSING VOUCHER PROGRAM ou NOTICE OF CHANGE TO LEASE AND CONTRA T HAP Contract No . : V-69 THE HOUSING VOUCHER CONTRACT ( ' CONTRACT' ) entered into between the Owner, Esther Badenhop , and the PHA, NORTH FORK HOUSING ALLIANCE INC. dated 08/01/97, on behalf of the LESSEE ( ' FAMILY' ) , CATHERINE M. HAJEK, who holds HOUSING VOUCHER NO. V12069 for the following described unit 1100 South Drive, Apt . Mattituck, NY 11952 is amended as follows : The reason for this change is due to: [ REEXAMINATION Annual Review of family income and/or composition. [ ] INTERIM ADJUSTMENT Interim change in family income and/or composition. [ ] RENT ADJUSTMENT The owner/agent request for a rent adjustment. [ ] CHANGE IN FAMILY COMPOSITION Name Adult Minor ADJUSTMENT IN PAYMENTS: FROM TO Hap Payment $ 572 $ 381 Tenant Rent $ 178 $ 389 Total Rent to Owner $ 750 $ 770 EFFECTIVE DATE This change to the Housing Voucher Contract and Lease Agreement will be effective 08/01/97 . The next reexamination is due on 08/01/98 . This change is presented to you in accordance with the terms and con- ditions of the Housing Voucher Contract and/or Lease Agreement and shall be attached to and made a part of your Housing Voucher Contract and/or Lease agreement . All other covenants, terms and conditions of the original Housing Voucher Contract and/or Lease Agreement remain the same . * TO THE TENANT ONLY If you disagree with this decision, you may request an informal hearing. If a hearing is desired, you must submit a written request to this office within '_i days of this notice or your right to a hearing will be waived. Signatures Owner: Esther"BAdenhop - Signature Official Title Date i Fa zi�ly�: CATHERINE M. HAJEK Signature 7�f l u Date Spouse or Co-Head' s Signature Date Ho ing Agerfc NORTH FORK HOUSING ALLIANCE INC. gnature . Bessie Swann, Executive Director (Officia Ti le) Date .North Tork Aousing Athance, Inc. (FORMERLY THE GREENPORT HOUSING ALLIANCE) 110 SOUTH STREET GREENPORT, NEW YORK 1 1944-1619 (516)477-1070 FAX(516)477-1769 ADEQUATE HOUSING FOR ALL BESSIE E. SWANN, D.H.L., EXECUTIVE DIRECTOR, BEVERLY HALLOCK, PRESIDENT FAILED N.Q.S.INSPECTION LETTER Date: 8/13/98 TO: Esther Badenhop 1100 South Drive Mattituck, NY 11952 RE: Catherine Hajek 110 South Drive Mattituck, NY 11952 Dear Section 8 Landlord: The dwelling unit listed above was inspected for an (Initial, Renewal, Special, Exit) inspection by Mr. Ralph Mims on 7/31/98 . The unit received a "FAIL" rating according to the H.U.D. HOUSING QUALITY STANDARDS report. (A copy of the findings is attached). ABATEMENT OF RENTAL PAYMENTS: By H.U.D. regulations, we are not allowed to remit Housing Assistance Payments (HAP) for units that do not pass H.U.D. HQS standards. Therefore, be advised that rental payments will be abated effective the day after your failed inspection: 8/1/98 , until the unit passes the HQS inspection. (Tenants are not responsible for any HAP portions of abated rent). REQUIREMENTS FOR REPAIRS: YOU ARE REQUIRED TO MAKE ALL NECESSARY REPAIRS, THAT ARE NOT TARGETED AS "FAMILY FAILS", WITHIN THIRTY (30) DAYS FROM THE DATE OF THIS LETTER. Please notify the Section 8 Office at 477-8888 when the repairs indicated, have been completed, so a re-inspection can take place. No retroactive payments will be made after the allowed thirty (30) day period, all rent will be abated at that time. FUNDED BY N.Y.S. DIVISION OF HOUSING &COMMUNITY RENEWAL, VEATCH FOUNDATION, DIOCESE OF ROCKVILLE CENTRE AND NATIONAL GLOBAL MINISTRIES. AN EQUAL OPPORTUNITY EMPLOYER AND PROVIDER . f\ Should the extent/nature of repair(s) or personal circumstances prevent you from correcting deficiencies.within the required thirty (30) days, you must request an extension, in writing, within ten (10) days from the date of this letter and our office will advise you of the decision of the request. A re-inspection will automatically take place at your unit thirty (30) days from the date of this letter: 9/13/98 , unless you have been granted an extension. If your inspection fails for the second time, and you have not contacted our office regarding your intentions/requested extension, the contract will be terminated and your tenant will be advised to seek alternate housing. Sincerely yours, ylvia Smith Program Administrator cc: Tenant Ralph Mims, Inspector File t sn Summary(Optional) summary description of each Item which resulted In a rating of'Fail'or"Pass with Comments.' J No. Ins/actor 15:D—ateo7flnspection i Address of Inspected Unit /pe of Inspection Ej Initial ❑Special reinspection I ' Q(� �04�� r i Item Number Reason for"Fail'or'Pass with Comments'Rating 1J O l c) AuC W a -:h aT4- �SPT„ CA XX form HUD 52580 t Previous editions are obsolete Page 6 of 6 ret Handbook 74 i i . BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS , � TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . t..,� BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . ... . . . . . LDG. DEPT. SOUTHOLD, N.Y. 11971 T i F QLH01,D TEL: 765-1802 NOTIFY: (� CALL 2 p�P::5 Y Q J. . . . . . Examined.................. 19.... --1122 MAIL TO: . . . . . . . . . . . . . .. . . . . . Approved.................. 19.... Permit No. �:1.,1�J. .. .................................. Disapproveda/c .................................. .................................. ...................................................... (BuildiInspector) APPLICATION FOR BUILDING PERMIT g q ' Date. . . . . . . . . , 19. ./ . INSTRUCTIONS a. Ihis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector w 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 mist be drawn on the diagram which is part 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 throughiout 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 MAIL? 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 fiame, if a corporation) TT/FVlJ /✓. "/ ...........................e.... .. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder =V.. `.......................................................................................................... Name of owner of premises ... S 7;7f L r:.......C�•4 �/�f v� ..................................................................... (as on the tax roll or 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. Location of land on which proposed work will be done.............................................................. .....� c.0 SQ v77-! Da M-p TT ( Tv C (c .......................................................................... ........................... House Number Street Hamlet County Tax Map No. 1000 Section .l . J .C��?...��..... Block ................ Lot 3,� / . ........ Subdivision .....y. a e......[fl�?J�............ Filed Map No. ....2......... Lot ........................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................../-/-C,"` C ` .....F/00/2 ©W n/E!� ..........r...... ............................... b. Intended use and occupancy ... .`.7,nq CA/ G0,,I/2 //LOa.vc ........ ...... ..................................... .................... J. Nature of work (check which applicable): New Building .......... Addition ....�• •teration .......... . Repair ............ Removal ............. Demolition ............ Other Work ... ........... (Description) 4. Estimated Cost ..6>.................... fee .............................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ Number of dwelling units on each floor ... .......... Ifgarage, number of cars e .................................. / 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.. 6.............. 7. Dimensions of existing structures, if any; Front............ Rear ..�n ......... Deptlh Height .....r:�I............... Number of Stories ......t......... Dimensions of same structure with alterations or additions: Front ...5.......... Rear ............... Depth .................... Height ............... . .. Number of Stories ............... 8. Dimensions of entire new construction: Front .�W!i.......... Rear ............... Depth .............. Height ......................... Number 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 violate any zoning law, ordinance or regulation: v................... 13. Will lot be regraded ........... Will excess fill be removed from premises: ,iti?S NU 14. Names of Owner of premises E.S-n rE n 2?`�� �vl/?�r'. Address ./l00,�c9;/`?1�..��........ Phone Name of Architect ..1................................. Address .............................. Phone Nlo. ............. Name of Contractor fY14.............................. Address ...............................Phone No. ............. 15. Is this property within 300 feet of a tidal wetland? * YES .......... No QJI11rg !�..,... *IF YES, SD Tadd TRDSIMS PMff MAY BE REtQJIRED. 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. SUVIE Or NU MURK, SS OOONIY Or. .��, D�'� ...... CS�h e Ya . en vO ..................... ...l : ....being duly sworn, deposes and says that he is tthe applicant (Name of individual signing contract) above named, Slieis the ........... .............................................................................. (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 �. ......l19•.........day of � �' .. Notary Publi . /7.&&� !/.w ..... �p LOMA R KOMLWj (Signature of Applicant) NOWY Pubikk State of New York No.52.4524771 Qualified in Suffbik cowity CCwnmission Expires Nov.30, CONSENT TO INSPECTION S7c� �/���N �( a �: the undersigned, Owner(s) Name(s) do(es) hereby state: That the undersigned (is) ( the owner(--,,-) of the premises in the Town of Southold located at _0077-f DaW C—_ T4 T7` / TUCK which is shown and designated on the Suffolk County tax map as District 1000, Section%L661'y, Block Lot 00 ` O Q a That the undersigned (has) fie) filed, 'or caused to be filed, an applica- tion in the Southold Town Building Inspectors Office for the following: 2 IL 0 / Al C 5�j_ _ r ,OPAlq T W G /L/ 7- That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all, of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained In the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: l (signature) (print name) (signature) (print name) { + ��' } a' ' .M..r-+rte+--+ww,T.�....^ r � �'�"„^"P'.... - • .. ^1 1 � � Srltxa:!htf•tZE�`8Ft9i 3tlOn Or 8d,:121OR + { to thiS s_rvev is a violation of A _ Sec',on 72M of the Now fork Statc: Iducation Law. Copes of this stttvSy map not bearing the'and surveyor's inked sea{o. :mho:: ed sesi;half not be consleered I to br a valid true copy. a _ Guarantees indicated hereon shall run - on ty to thB Person tot v hrm rtia sur lob Y is pre,arei £rd an h,`s a� to the ttie rc n.an ,governmen -i a.ercy and t �tQ�-E: 1�'�IE fZC AE3 kirr --,roar,±utir n hcteJ hr;rsan and �. PICT r RA�1l�1�If D � - to th }ss of the lending inati- ltL_. a. tution uc�ra•-rias are not transferable to sr,,.:,,onal institutions or subsequent , i W ow saki. G LL P O F:7 ..,OTS { t4a.o AT t ,ro � I O i1I •� a - �. { BAY VIEW PAR K ►� ' 0 SU;:rrO K COONTY SAAP N0. 578> ' tj G,AR t 1 p �pF.fV6 � . } y _ L�+ pt,_irtO MAR' O.. g ry G -X: 1 * ns < .+r aK Cr Q. �,• 'L -(5256 J LAND j¢ i�T tw •4e Crc+lctilyd + be.46' ["""�, t' ..h'c�'r��+ .;a� °,. •# end`;'"C'a9 Wo1 r ,. x � .'7^• Y' -�t/ ,n,+rye •T`{'_ ;.� � t �1 ,... 4 t eni uM' erl �oucd aiG �£ o's.QE ✓'F-a �i�' V �� peo P")S �} 4 i V t l A eco � . . \\ 910 r r S j"U r �3 , r f - i f Y J/ ii l r, �Jg �jf� ✓ +1 i` J J s _ _ 11 , J" r oo eon �z p Al Dc� Of 14 Ivool 4 t ,a _ — 5 --- . - I