HomeMy WebLinkAbout26861-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27776 Date: 06/27/01
THIS CERTIFIES that the building ACCESSORIES
Location of Property: 1225 GULL POND LA GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 35 Block 4 Lot 9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 25, 2000 pursuant to which
Building Permit No. 26861-Z dated OCTOBER 23, 2000
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 ACCESSORY ONE CAR GARAGE NON-HABITABLE AS APPLIED FOR.
The certificate is issued to ROBERT & MARIANNE SOBIESIAK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 557162 05/01/01
PLUMBERS CERTIFICATION DATED N/A
d'�- v,
61 Authorized Sig ture
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. 26861 Z Date OCTOBER 23 , 2000
Permission is hereby granted to:
ROBERT & MARIANNE SOBIESIAK
34 I . U. WILLETS RD
ALBERTSON,NY 11507
for
DEMOLITION OF 8X10 SHED & CONSTRUCTION OF 16 ' X 24 ' NON-HABITABLE
ACCESSORY ONE CAR GARAGE AS APPLIED FOR.
at premises located at 1225 GULL POND LA GREENPORT
County Tax Map No. 473889 Section 035 Block 0004 Lot No. 009
pursuant to application dated AUGUST 25, 2000 and approved by the
Building Inspector.
Fee $ 35 . 00 Pmt Fee.
15.00 Demo Pmt.
100.00 Flood Pmt.
TOTAL 150.00
Authorize Signature
ORIGINAL
Rev. 2/19/98
I
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT n1 _jj
TOWN HALL ►�` l��
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 buildTi�s F,p op rt�.y i i s` ,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply, and sewerage--disposal(S 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 residence4 and..similar. bu I;d�
and installations, a certificate of Code Compliance from arch`ttSc o 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 Occqpancy 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.QO. Businesses $50.00. .
2. Certificate of Occupancy on Pre-existing Buildiniz - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . ..!✓�sl�l . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . ... . .. . Old OrPre-existing
Building. . . . . . . . . . . . . . . . . ..,,LL
Location of Property. .�� . . .. S�.�l.��.`a�.[9. .`i�s?G. . . . . . . . . . .. .1::�GX�t�D.4t.��./. . . . . . . . . .
House No.. Street Hamlet
Onwer or. Owners of Property../.�.4 -t'. l. . AC-10JtZ4r.6 . . JO. kI.C.S. (,i .. . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . A .JA . . . .Block. A(/. . . . . . . . . .Lot. . .Q.Q 9. . . . . . . . . . . . .
Subdivision. . .. . . .6 . . . . . . . . . . . . . . . .. . . . . . . . . .. .Filed Map. . . . . . . . . .Lot. . . . . . . . . . . . . . . . .
Permit No.2 .f.l. Z . . .Date Of . . . .Applicant1ri
Health Dept. Approval. . .. . . . .. . . . . . . . . .. . . . . . . .Underwriters Approval. . . . . . . . . . .. . . .
Planning Board Approval. . . . . . . . . . .. . . . .. .. . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . .
Fee Submitted: $. .. . . . . . . . . . . . . . . . . . . . . . . . .
J APPLICANT
•
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
001290 BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
i?ate MAY 01,2001 Application No.on file 12198901/01 N 557162
THIS 0,r; TIFIES THAT PERMIT NO. 26861
only the aleetiTtaal
equipment as described below and introduced by the applicant named on the above application number is in the premises of
IRO 1 R ' SO13IESIAK; 1225 GULL POND LANE GREENPORT, NY
tht jj,iiowttq locatio, E Basement ❑ Ist Fl. 2nd Fl. GAR Section Block Lot
was examined oti ARIL 13,2001 and found to be in compliance with the National Electrical Code.
PfAC�ES, BYIIITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WAS ERS EXHAUST FANS
WMDE EWOREECENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
4 3 1 3
DINER$ F(JIINAE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS ;
K.W bILH�, IiA3 H.P. AMT.: NO. A.W.6. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS
NO:.OF FEET AML WATTS',
SERYL. RCT kap cF S E R V I C E
ETEyk
AIT %INP,. ul�. T r RW i`/ 1W .1 0 1W .l 0 IW No'OF-� OND. �. No.OF A--Q' NO.Of MEUTRAlO Air 6.
KR R F C;CON0. OF NI•LE9 OF go? -
ARA�il3
:`PA 3QAR 8,:i--3 CIR 60
-2
' CO,; AVI' CHESHIRE I -
:. ELflCTR L C.#953 E �JL
9Z80--,,'-,`$,M, AVE
GENERAL MANAOER
'`V TOM NY, 11952 11
Per
n s t the Q I a Of Ihg 60 1x i IlaC# In#I? LI' 'Vii! Ib cl lkril�Kik#I
FF01
Town Hall,53095 Main Road p 1 Fax(516)765-1823
P.O. Box 1179 V Telephone(516)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
June 4, 2001
Robert & Marianne Sobiesiak
34 I.U. Willets Rd.
Albertson, NY 11507
RE: 1225 Gull Pond Lane, Greenport
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy because of the
following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
XX The check is (not on file• )$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) •
BUILDING PERMIT 26861-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Town Hall,53095 Main Road p Fax(516) 765-1823
P.O. Box 1179 W Telephone(516)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
NOTICE OF VIOLATION
October 17, 2000
Robert&Marianne Sobiesiak
34 I.U.Willets Road
Albertson, N.Y. 11507
Please take notice that in review of the application dated August 25, 2000 for a building
permit for a New Accessory Garage at 1225 Gull Pond Lane, Greenport, N.Y.
County Tax Map Number 1000 - Section 35 Block 4 Lot 9
The shed that is indicated on the survey submitted to us is in violation of Southold Town
Zoning Law.
§ 100-33. Accessory buildings. [Amended 4-10-1990 by L.L. No. 6-1990]
In the Agricultural-Conservation District and Low-Density Residential R-80, R-120, R-
200 and R-400 Districts, accessory buildings and structures or other accessory uses shall
be located in the required rear yard, subject to the following requirements
On lots containing more than twenty thousand(20,000) square feet up to thirty-nine
thousand nine hundred ninety-nine(39,999) square feet, such buildings shall be set back
no less than five (5) feet from any lot line.
This violation needs to be addressed and the shed must be relocated or removed.
If there are any questions you can contact us at(631) 765-1802 between the hours of 8:00
a.m. and 4:00 p.m.
Re tfully yo
B no Semon
Building Inspector
CC:file
Enc.
y �UtI ut.j
,JUDITH T. TERRY I�F-- ti,,,,
Itna<1
1 �
TOWN CLERK =5 •=. P.O. Rm 1174
Southold. Nc%� l (,rk I I'171
(tEGls'rRAR Of v1TA1.STATIS11CS �✓ (C�_ "'
OFax (S I6) 765-I PP
MARRIAGE OFFICER _ '�� y� Tcicrl",nc (516) 7(,C_IHOI
RECORDS MANAGEMENT OFFICER / 1 _
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 :
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of the Code of the Town of Southold: ('Floodplain Development Permit
Application" [FDP(93) ] , and "Certificate of Compliance for Development in
Special Flood Hazard Area [C/C(93) ) .
I
TOWN OF S0:!R!OLD
Judith T. Terry
Southold Town Clerk
August 25, 1993
APPLICATION
PAGE 1 of 4 --
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sian):
1. No work may start until a permit is issued.
2. The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable
inspections required to verify compliance.
8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
_ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE.
(APPLICANT'S SIGNATURE) DATE
SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT)
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER
PROJECT LOCATION:
• To avoid delay in processing the application, please provide enou information to easily identifythe project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing
the project location would be helpful.
FDP(93)
APPLICATION
PAGE 2OF4
DESCRIPTION OF WORK (Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
❑ New Structure ❑ Residential (1-4 Family)
❑ Addition O Residential (More than 4�Family)
❑ Alteration O Non-residential (Floodproofmg? ❑ Yes)
❑ Relocation ❑ Combined Use (Residential & Commercial)
❑ Demolition P ❑ Manufactured (Mobile) Home (In Manu-
❑ Replacement factured Home Park? ❑ Yes)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES:
O Fill ❑ Mining ❑ Drilling ❑ Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
❑ Road, Street or Bridge Construction
O Subdivision (New or Expansion)
O Individual Water or Sewer System
❑ Other (Please Specify)
After completing SECTION 2, APPLICANT should submit form to Local Administrator for review.
SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
The proposed development is located on FIRM Panel No. Dated
The Proposed Development:
❑ IsI'M Iocated in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
❑ Is located in a Special Flood Hazard Area.
FIRM zone designation is
100-Year flood elevation at the site is: Ft. NGVD (MSL)
❑ Unavailable
O The proposed development is located in a floodway.
FBFM Panel No. Dated
❑ See Section 4 for additional instructions.
SIGNED DATE
APPLICATION #
PAGE 3 OF 4
SECTION 4: ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATOR)
The applicant must submit the documents checked below before the application can be processed:
❑ A site plan showing the location of all cxistiug structures, water bodies, adjacent roads, lot
dimensions and proposed development.
❑ Development plans,drawn to scale, and specifications, including where applicable:details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water
resistant materials used below the fust floor, details of floodproofmg of utilities located below
the first floor and details of enclosures below the first floor.
Also.
❑ Subdivision or other development plans (If the subdivision or other development exceeds 50
lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations
if they are not otherwise available).
❑ Plans showing the extent of watercourse relocation and/or landform alterations.
❑ Top of new fill elevation Ft. NGVD (MSL).
❑ Floodproofing protection level (non-residential only) Ft.'NGVD (MSL). For
floodproofed structures, applicant must attach certification from registered engineer or
- architect.
❑ Certification from a registered engineer that the proposed activity in a regulatory floodway
will not result in any increase in the height of the 100-year flood. A copy of all data and
calculations supporting this finding must also be submitted.
❑ Other:
SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
I have determined that the proposed activity. A. ❑ Is
• B. ❑ Is not
in conformance with provisions of Local Law , 19 . The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED , DATE
If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated
fee.
If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a hearing from the Board of
Appeals.
APPLICATION
PAGE a OF a
APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No
Hearing date:
Appeals Board Decision --- Approved? ❑ Yes ❑ No
Conditions
SECTION G: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered professional engineer or a licensed land surveyor (or attach a certification to this application).
Complete I or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard
ea , bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FT. NGVD (MSL).
2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant.
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to
ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ONO
DATE BY DEFICIENCIES? OYES ONO
SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR)
Certificate of Compliance issued: DATE: BY:
Attachment B
SAMPLE
CERTIFICATE OF COMPLIANCE
for Development in a Special Flood Hazard Area
' h
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(OWNER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
Cl EXISTING BUILDING
❑ VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19AS MODIFIED BY VARIANCE #
DATED '
SIGNED: DATED:
C/C(93)
• � O�OSaFFOlI-coG
Town Hall,53095 Main Road p -� Fax(516)765-1823
P.O. Box 1179 y x Telephone(516)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
NOTICE OF VIOLATION
October 17, 2000
Robert &Marianne Sobiesiak
34 I.U.Willets Road
Albertson, N.Y. 11507
Please take notice that in review of the application dated August 25, 2000 for a building
permit for a New Accessory Garage at 1225 Gull Pond Lane, Greenport,N.Y.
County Tax Map Number 1000 - Section 35 Block 4 Lot 9
The shed that is indicated on the survey submitted to us is in violation of Southold Town
Zoning Law.
§ 100-33. Accessory buildings. [Amended 4-10-1990 by L.L. No. 6-1990]
In the Agricultural-Conservation District and Low-Density Residential R-80, R-120, R-
200 and R-400 Districts, accessory buildings and structures or other accessory uses shall
be located in the required rear yard, subject to the following requirements
On lots containing more than twenty thousand(20,000) square feet up to thirty-nine
thousand nine hundred ninety-nine (39,999) square feet, such buildings shall be set back
no less than five (5) feet from any lot line.
This violation needs to be addressed and the shed must be relocated or removed
If there are any questions you can contact us at(631) 765-1802 between the hours of 8:00
a.m. and 4:00 p.m.
Re tfully yo
B no Semon
Building Inspector
CC:file
Enc.
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH P
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING NAL
( ] FIREPLACE 8 C111MNEY
REMARKS•
1
,DATEINSPECTO
BUILDING DEPT.
INSPECTION
[ j FOUNDATION 1ST [ ] ROUGH P BG.
[ ] FOUNDATION 2ND [ ] IN TION
1 FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ��D bde,
e-w�� AI
�- =12
,DATE INSPECTO
T65-1802
BUILDING DEPT.
NSPECTION
[ FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACES CHIMNEY
REMARKS:
AW4,
,DATE � � INSPECTO
-93
"ELD INSPECTION REPORT DATE
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ADDITIONAL COMMENTS: '
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_FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . .. . . . . .
;�► SOUTHOLD, N.Y. 11971 DEC
TEL: 765-1802 TRUSTEES
NOTIFY: . . . . . .
/a�/6 CALL . . . . . . . . . . . . . . . . . .
mined... // ....... "20.90 MAIL TO: . . . . . . . . . . . . . . . . . .
roved.....Za l!Z...... 24 P.R. Permit No.
................................
approved a/c .................................
...................................................
........... .............
Lapp
.(BuildingInspector)
PPLICATION FOR BUILDING PERMIT
G Z 5x000 i _ �' Date. . .INSTRUCTIONS
'Ihly filled in by typewriter or in ink and submitted to the Building Inspector
Of plans, accurate plot plan to scale. Fee according to schedule.
Plot plan showing location of lot and of buildings on premises, relationship -to adjoining premises or public
s or areas, and giving a detailed description of layout of property must be drawn on 'the diagram uhich is part c
pplication.
'Ihe work covered by this application may not be co a)enced before issuance of Building Permit.
Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Suc
shall be kept on the premises available for inspection throughout the work.
No building shall be occupied or used in chole or in part for any purpose whatever until a Certificate of
ncy shall have been granted by the Building Inspector.
PPLICATION IS HgMW MAD' to the Building Department for the issuance of a Building Permit pursuant to the
ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein
bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and
tions, and to admit authorized inspectors on premises and in building for--necessary inspections.
... ��C�!?T.... ..
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
,6-ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plurber or buil
...................:Q.W.P.C C........................... .................................................
E owner of premises ...&.b cr.,,,
W!c�41A ....1...M.4Y.1.4�t
(as on the tax troll or latest deed) .
licant is a corporation, signature of duly authorized officer.
. •..................
and title of corporate officer)
lilders License No. .........................
.utters License No. .........................
_ectricians License No. .....................
her Trade's License No.
. ...............
)cation of land on which proposed work will be done..
Lse U ber .....................Street..........................................................................
Hamlet
xunty Tax Map No. 100//0Section ...Q: f.4.Q.. Block 5��.� ..... Lot
lbdivision ...FQr.�( gW../�4C:G�....... .... .....4..
(Name) Filed Map.No. c3:�..l.? ..... Lot ..........
:ate existing use and occupancy of premises and intended use and occupancy r cuuparucy of proposed construction:
Existing use and occupancy .........................r C rs.I r................................
Intended use and occupancy .............V ,ar,
l
3. Nature of work vAiid: applicable): New Building .......... Addition .......:. Alteration ..........
Repair. ............ Removal ..e.......... Damlition ............ Other Work .. .......................
/ (Description)
4. Estimated Cost ..1 3,A d.......... fee ............................................ . .
(to be paid on filing this application)
5. If duelling, nud)er of dwelling units ............ Nurber of. chael.ling :nits on each floor ........ ........
Ifgarage, number of cars ....... .........................
6. If business, cemnercial 'or mixed occupancy, specify nature and extent of eadi type of use.................
7. Dimensions of existing structures, if any: Front...f),si'v3..... Rear .. ...... Depth
13eight ......................... Rnber of Stories .....Z...............
Dimensions of same structure with alterations or additions: Dont ............... Rear ...............
Depth .................... height .................... Rnber of Stories ...
£l. Dimensions of entire new construction: Front .....L!rc l..... Rear .... /..... Depth ...Z.,S�.�.....
p i
}eight C#/ rax'..f,3........ &nb-er of S ories ...I................. p /
9. Size of lot: Front .. Q:�
..� . I.�r..3./.... Ream k.[.Q�/........ Depth .�.!. /. .I r t
IY .,q l4�
10. Date of Purchase ... .` .7..�...... &are of Former. Owner Q.r 1(.R � Wl�1...r G ......
11. Zone or use district in which premises are situated ...RAO............................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................
13. Will lot be regraded .......n.0........ Will excess fill be removed from premises: YES
14. Nares of Owner of prenisesRd`el'i4-. .Ieait*C.:-?GiIC. 4Address.3S(Z.:,a,.4)r.I/.0 -f.. .. Phone No.
l�1bertad,.INy/-o-v7' riy 7Pel,--11r79
11.-xne of Architect ................ Address .............................. Phone No. .
Nave of Contractor ................................... Address ................................Phone No. .
15. Is this property within 300 feet of a tidal wetland? * YES .:c..l... NO ..........
*IFE
YS, SaUI UD MV MMMPmirr.my BE MQUIRM' .•.
i
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dime
From property lines. Give street and block nzrber or description according to deed, and show street names and
whether interior or comer lot.
SCAui (I1' told Y(M'
SS
OCM1Y or .......................
l�(? > ;...... / ......................being duly sworn,, deposes and
says that he is the app
(Name of individual signing contract)
above rkwed,
lle is Elie ...0.'!!?YP!L....................
(Contractor, agent, corporate officer, etc.)
or: said ckmer or owners, and is duly authorized to perform or have performed the said work and to make and ME
appl.icatim; that all slatemenl-s contained in this application are true to the best of his knowledge and bel.iel
that the work will be perforn-ed in the inanner set forth in the application filed therewith.
Sworn to before me this
z�
..... .... .... .day of . . ......:2oc9a
Notary Publi .� � :!/.. .. ,,jj '' •
.. ...�l ................
EUMSMASTA a (Signature o. Applicant)
lVO. 8008 WrARYPU873.Su(folkq
Tom Expirn Jum 8.
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BUILDING PERMIT REVIEW CHECK LIST
DATE REVIEWED: A0 l lad
APPLICANT NAME: 6/,4'1< DATE SUBMITTED: &"/,26/C6
PROJECT LOCATION
STREET: /2�-S ' << /'G�ac CITY: SUBDIV. NAME: o�
ARCHITECT/ ENGINEER: FAST TRACK: YES oR NC
SCTM# --- DISTRICT: 1,000 SECTION: BLOCK: LOT:
ZONING:
ZONING DISTRICT4�' R80 AC CONFORMING: YES o�'1✓ REQUIRED LOT SIZE: -66,1< SQFT.
WHERE ACTUAL LOT SIZE FROM? T� �;Ao ACTUAL LOT SIZE: -<26 ' SQFT.
REQ. REQ. REQ.
FRONT: 'PROPOSED: SIDE YD: & '/2�6' ' PROPOSED:—'/—' REAR:SO 'PROPOSED:
LOT COVERAGE: ALLOWED.-26 % EXISTING:7S.2_ sf 3 % NEW: 3cW sf;2 % TOTAL:1136 sf-Z5 %
"A — 6,4r—
CORNER?
.Fr— ^
CORNER? YES o WAT ER FRONT? YES R NO DESCRIPTION: C ' ,4�4
SINGLE & SEPARATE CERTIFICATION-REQUIRED: YES oC)OTES:
LOTS 40,000SF --100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM
JAN.1997 100-25. Merger. (A nonconforming at anytime after July 1, 1983.)
PROJECT DESCRIPTION: ADD,ALT,ACa OR N/D;��g G,• _ /—L�p
AGENCY PERMITS REQUIRED FOR REVIEW
NEEDE
TOWN SPETIC PERMIT: YES or
SUFFOLK COUNTY HEALTH DEPT: YES o O BED #): DTE: / / PERMIT#:R10-
NEW YORK STATE DEC: YES oL 11"o
SOUTHOLD TOWN TRUSTEES: YES o ��'? � Q s✓�vr�, oF,r s�-nu��zu�
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES or
FLOOD COMPLIANCE ZONE: PANEL #: /7 6 FLOOD ZONE:,
NYS ENERGY: YES O jam: EGRESS: V NT: LIGHT:
NOTES: ex- a,, /. Seo J
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR 3 -- SF
SECOND FLR SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
OT( 3 - SF)- S( OU SF)= SFX $ =$ �� +$ ` —+$ 160 = $ /s(�
-------- --
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SURVEY OF LOT # 13 �
l "MAP OF EORDHAM AGRES, SECTION ONE" ?_
FILED MRGH -71 I a62 W -i E
AS FILE # 351cl
AT CvREENPORT
TOM OF SOUTHOLD r � / / NCO o
SUFFOLK COUNTY, NY s / 1.,:15
00,
SURVEYED 02-16-ciq �` �� to000
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SUFFOLK COUNTY TAX #
1000 - 35 - 4 - 9 ��A �' \O. `0 �
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CERTIFIED TO: op '
ROBERT 50BIE51AK
MARIANNE 50BIE51AK
5TEWART TITLE IN5URANGE COMPANY k
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O PIPE FOUND ,y � j
A.H.W.M = AVERAGE HIGH YVATER MARK l/1 .f��0 C-E/I �O
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SURVEY OF LOT # 13 �
"MAP OF FORDHAM ACRES, SECTION ONE" W � � E
j FILED MARCH /, IcI62
AS FILE # 351a
AT 67REEN'ORT / / � sN o s
TORN OF SOUTHOLD F / 00 03@,,
SUFFOLK COUNTY, NY
SURVEYED 02-I6-49 \ i� ` • �� •O ` �' �`�
SUFFOLK GOUNTY TAX #
1000 - 35 - 4 - a �� 9
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GERTIFIED TO:
ROMARIANNE 50BIE51AK BERT 50BIE51AK �r��� �� l
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STEWART TITLE INSURANCE COMPANY ���, � �, t:300 ;;p _ 7 ; I - O
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NOT�ILS: OIC �� LaRc a Seal 5-11 e=ccoll—Ild t.t- _aria c
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4 co
G-RAPHIC SCALE 1 ' � "'�. � * � * - - - - �I. _I �.
S1 --'HI1 EHE :11G S_iR E �R
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RI'dERI,E i _1 I
0202 ��� 69-cc'' o r�° gib- REFEREPJTE _ -115
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SURVEY OF LOT # 13 �- -- - -- -- - - - - � - - _ -- -
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"MAP OF FORUNAM AGRE5, SECTION ONE \
FILED MARCH -71 IQ62 -A5 # 351-cl_ � <9 W � E
e�
51 TUATE: 6REENPORT " fp
TONIN: 5OUTNOLD �s0
l 5UFFOLK COUNTY, NY'
SURVEYED 02-16-qq
GARAGE ADDED 03-01-01
SUFFOLK COUNTY TAX # / n 1
1000 - 35 - 4 - q
ELEVATIONS REFERENCE U565 BENCHMARK
STAMPED X325 Ig43 NGVD '2q
j PROPERTY FEMA FLOOD ZONE AE EL. 8 ti0)Oel 20 -(�<• ` °"
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CERTIFIED TO: p
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ROBERT 50BIE IAK \o� '
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MARIANNE 50BIE51AK 000 6 �✓ v . J M
STEV4ART TITLE INSURANCE COMPANY
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a
a saneetny ere.n, �nst:.ac s_1V
.:ons are net transf_rat!e to aCC:t.onal :nst itIt:cns
AREA = 24, 8g8 S.F. JOHN C. EHLERS LAND SURVEYOR
G P A P H i- C F A L E - C 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
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RIVERHEAD,N.Y.11901
369-8288 Fax 369-8287 _ N - 9 9-g g q
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SUR\/EY OF LOT # 13 \
"MAS' OF FORDHAM AGRE5, SECTION ONE"
FILED MARCH -71 I a62
A5 FILE # 351 cl
AT &REENPORT S s
TOY4N OF 5OUTHOLD o N� ;3@
SUFFOLK COUNTY, NY 100,-ool
SURVEYED 02-16-99 ��� o �� •`� 'O � �-��
SUFFOLK GOUNTY TAX # Q -p
1000 - 35 - 4 - q
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GERTIFIED TO:
ROBERT 50BIE5IAK �
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MARIANNE 50BIE51AK
5TEYVART TITLE INSURANGE GOMPANY Vp
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NOTES:
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MONUMENT FOUNDt 1-1-
= F
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A.H.W.M = AVERAGE HIGH YVATER MARK G'Ey��9`O
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DATE ® ig R R
FEEIR 3BY
NOTIFY BUILDING DEPA
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AT I
7861802 9 AM TO
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PM FOR THE
FOLLOWING INSPECCTM
7 7. FOUNDATION R
FOR
POORED rn 1419
O - FRAl & PLUMBING
3. INSULATION Ww.
i
- - 4. FINAL -COMPLETE
CO.CONSTRUCTION MUST BE COMPLETE POR C.O '
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N,Y.
STATE CONSTRUCTION & ENERGY
CODES NOT RESPONSIBLE FGA
"� -. -- -- — - - - - - - - DESIGN OR CONSTRUCTION ERF
it
I
OCCUPANCY OR
j USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
DO NOT PROCEED WITH
FRAMING UNTIL SURVEY
JF FOUNDATION LOCATION
HAS BEEN APPROVED.
RWD,DAR40E PRDVENTM
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