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HomeMy WebLinkAbout26696-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27896 Date: 08/24/01 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 1050 BAYBERRY RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 118 Block 2 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 21, 2000 pursuant to which Building Permit No. 26696-Z dated AUGUST 2, 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 ADDITION TO FIRST FLOOR AND SECOND FLOOR ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN & PATRICIA WOLLEBEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 49876 05/08/01 PLUMBERS CERTIFICATION DATED 07/08/01 CUTCHOGUE EAST PLUMBING a //74rized 2rignature 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. 26696 Z Date AUGUST 2, 2000 Permission is hereby granted to: JOHN & PATRICIA WOLLEBEN 54 STEPHENS RD TAPPAN,NY 10983 for NEW CONSTRUCTION OF A DINING ROOM ADDITION & 2ND FLOOR ALTERATION AS APPLIED FOR WITH TRUSTEES &_ DEC CONDITIONS. at premises located at 1050 BAYBERRY RD CUTCHOGUE County Tax Map No. 473889 Section 118 Block 0002 Lot No. 008 pursuant to application dated JUNE 21, 2000 and approved by the Building Inspector. Fee $ 294 . 60 2' Authori d Signature ORIGINAL Rev. 2/19/98 gKAa eb GOW q7f Form No. 6 0-dc V I g 3S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1.802 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 building: 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: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a,conseut to inspect signed by the applicant. If a Certificate of Occt}pancy 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 Buildine - $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 ... . .. 7131(ol... . .. . . . . .. . . . .. . . .. . ... . . . . . . . . . New Construction. . . ... . . .. . Old Or Pre-existing Building.ln, .� � i.t�,(;I, �(�-eYC1��-tblV Location of House No. f Street Hamlet•. Onwer or. Owners of Property....�.p. . . O. .... . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . County Tax Map No1000, Section. . . 1.1.�. . . .Block. . . . . .:'. . . . . . . . .Lot. . . u . . . .. . . . . . . . .. . . Subdivision. . .. ..• . . . . . . . . . .Filed Map. . . . . . . . -.-.Lot. . . . . . . . . . . . . . . . . . . Permit No.9.�.4Q. 1. � .. . .Date Of Permit. . .. . . l.p�. . .Applicant. ..� Health Dept. Approval. . . . . . . . . . . . . . .. . . . . . .. Underwriters Approval. . ... . . . . . . . . . . . . . . . . . Planning Board Approval. , . . . . . . . . .... . . . .. . . . .. Request for: Temporary Certificate. .. .. . . . . . . Final Certicate. . . . . . . . . . . Fee Submitte . $... . . . . . . . . . . . . . . .. . . . . . .. . . .-. . .. . : . . . . . . :. . .. . :. . . . . . . . Annr rn Af9.., J; �s%3Ffal,rt�o Town Hall, 53095 Main Road y Fax (516) 765-1823 P. O. Box 1179 d • Telephone (516) 765-1802 Southold, New York 11971 `. OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD ' C E R T I F I C A T I O N DATE: f `� 'y x. i jt{ Building Permit No. '!V O 1 1 i V ;r.. F Owner: be_ (please print) Plumber: G 1 no��� -C v GVH ve Q- GST S r �_� (please print) I certify that the solder used in the water supply system -;`a contains less than 2/10 of 1% lead. / /X =� lumbers Signature) Sworn to before meahi 22 �y �J day of i++ . Notary Public, Count Ffe+a r' '., park Electrical Inspection Certificate Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11772 (631)286-6642 Date: 5/8/01 Application No. : 49876 Issued to: J & P Wolleben Street: 1050 Bayberry Road Village: Cutchogue Zip: 11935 Town:Southold Section: Block: Lot: Introduced by. Lademann Electric Inc. Lic.# 4141-E was examined and found to be in compliance with the National Electrical Code ❑Attic ©1st Floor ❑Indoor © Residential ❑ Pool ❑ Det. Garage ®Basement ®2nd Floor ❑Outdoor ❑ Commercial ❑ Hot Tub ❑ NV Defects Switches Receptacles Fixtures GFI Heaters A/C Fans 31 33 52 6 2 2 Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal 1 1 20 1 30 1 40 Furnace Oil Gas Circulator Smoke Detector Bell Transformer 1 ! 5 Meter Amps Phase UG/OH Telephone Television Carbon Monoxide 200 ®/ ❑ 1 Other Equipment. w Hugo S. Surdi President Building Permit No. This certificate must not be altered in any manner Inspectors may be identified by their credentials New York State Department of Environmental Conservation Building 40 -SUNY, Stony Brook, New York 11790-2356 A& Telephone (516) 444-0365 Facsimile (516) 444-0360 John P.Cahill Commissioner LETTER OF NONJURISDICTION -TIDAL WETLANDS Date: June 8, 2000 Mr. John Wolleben RE: 1-4738-02649/00001 54 Stephens Road Wolleben Property Tappan, New York 10983 705 Bridge Lane, Cutchogue Dear Mr. Wolleben: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the property landward of the 10 ft. elevation contour on a natural, gradual slope, as shown on the survey prepared by John C. Ehlers on 3/15/00 and last revised 5/22/00, is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence,barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. lee trul s, inistra r cc: Catherine Mesiano, Inc., 12 Mill Pond Lane, East Moriches, New York 11940 Bureau of Marine Habitat Protection, NYSDEC File DMG j StafFO(�- �� C'0 Town Hall Albert J. Krupski, President ��� l/y 53095 Main Road James King,Vice-President c < P.O.Box 1179 Henry Smith y x Southold,New York 11971 Artie Foster p • Ken Poliwoda Telephone(516) 765-1812 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 13 , 2000 Mrs . Catherine Mesiano Catherine Mesiano, Inc. 12 Mill Pond Lane East Moriches, NY 11940 RE: JOHN & PATRICIA WOLLEBEN 705 Bridge Lane, Cutchogue SCTM#118-2-8 Dear Mrs . Mesiano: The Southold Town Board of Trustees reviewed the survey dated March 31, 2000, and received in our office on April 10, 2000, and determined that the construction of a first floor addition, second floor addition, and pool, to be out of the Wetland jurisdiction, under Chapter 97 of the Town Wetland Code. A row of staked haybales should be placed down along the 10 ' contour in order to avoid any run-off into the lagoon. However, any activity within 75 ' of the Wetland line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call . Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms New York State Department of Environmental Conservation Building 40 -SUNY, Stony Brook, New York 11790-2356 Am Telephone (516)444-0365 Facsimile (516)444-0360 lmftw John P.Cahill Commissioner LETTER OF NONJURISDICTION -TIDAL WETLANDS Date: June 8, 2000 Mr. John Wolleben RE: 1-4738-02649/00001 54 Stephens Road Wolleben Property Tappan, New York 10983 705 Bridge Lane, Cutchogue Dear Mr. Wolleben: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the property landward of the 10 ft. elevation contour on a natural, gradual slope, as shown on the survey prepared by John C. Ehlers on 3/15/00 and last revised 5/22/00, is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NY CRR Part 66 1) no permit is required under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence,barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. e trul rs, e inistra r cc: Catherine Mesiano, Inc., 12 Mill Pond Lane, East Moriches, New York 11940 Bureau of Marine Habitat Protection, NYSDEC File DMG Town Hall Albert J. Krupski, President ��� �/y 53095 Main Road James King,Vice-President cwt P.O.Box 1179 Henry Smith y x Southold,New York 11971 Artie Foster Ken Poliwoda �y �� Telephone(516) 765-1812 �lJ�l �a0 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 13, 2000 Mrs. Catherine Mesiano Catherine Mesiano, Inc. 12 Mill Pond Lane East Moriches, NY 11940 RE: JOHN & PATRICIA WOLLEBEN 705 Bridge Lane, Cutchogue SCTM#118-2-8 Dear Mrs . Mesiano: The Southold Town Board of Trustees reviewed the survey dated March 31, 2000, and received in our office on April 10, 2000, and determined that the construction of a first floor addition, second floor addition, and pool, to be out of the Wetland jurisdiction, under Chapter 97 of the Town Wetland Code. A row of staked haybales should be placed down along the 10 ' contour in order to avoid any run-off into the lagoon. However, any activity within 75 ' of the Wetland line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call . Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms STATE OF NEW YORK ) ss.: COUNTY OF SUFFOLK ) at4D%OQ*-``ILE being duly sworn, deposes and says.- That ays:That deponent is over the age of 18 years, and resides at (oho 01.16 70L"16 L ij M t'TT IN GK That on the 2 2 day of Tl)O '—:' , 1999, deponent, being the arch itect/engineer, licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Buildingo (9 NY r rchitect/Engi e r Sworn to before me this -4,�_day of *98• Notary Pubic LINDA I COOPER Notary Public.State of New York 4 Suffolk countyN Term Expires December 3 cc: applicant � ' JU, 3 2000 GO Town Hall,53095 Main Road 0 Fax(631)765-1823 P.O.Box 1179 ?i O�� Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD August 14, 2001 Sid Beebe& Sons Builders, Inc PO Box 979 Cutchogue, NY 11935 NOTE: Before the Certificate of Occuancy can be issued, the architect must certify the TJI attachment above living room. (Per inspection dated 12/15/00. TO WHOM THIS MAY CONCERN: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not in 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 # 26696-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. DONALD G. FEILER - ARCHITECT 11725 Main Rd•Box 1692•Mattituck,NY 11952•631 298 5453•Fax 298 1380 August 22, 2001 Mr. Gary Fish Town Of Southold Building Department Southold Town Hall Main Road, Southold, New York Re: Prolaosed Additions & Renovations to the Wolleben Residence Bridge Lane, Cutchogue, New York Building Permit # 26696Z Dear Mr. Fish: In regard to the TJI joists installed at the second floor of the above mentioned project, I can verify that the construction methods used conform to manufacturers recommendations and are structurally adequate for its use. Ztruly yours, Donald G. ler Town Hall,53095 Main Road p Fax(516)765-1823 P.O.Box 1179 Telephone(516)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 21, 2001 John 8 Patricia Wolleben C, 1050 Bayberry Rd• Cutchogue, NY 11935 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. xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) • BUILDING PERMIT # 26696-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. �l (49 rss-iso2 BUILDING DEPT. INSPECTIO [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FO ATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,DATE I U INSPECTOR �c2� M-ssoz BUILDING DEPT. INSPECTION [ UNDATION IST [ ] ROUGH PLBG. [ " FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARK ,DATE111Vqn7'- INSPECTOR �`,� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [fes ] ROUGH PLBG. i [ ] F NDATION 2ND [ ] INSULATION [ 1 FRAMING [ ] FINAL [ ] FIREPLACE CHIMNEY REM RKS: LC L7Z 4e�rW_ 42 , � ey ,DATE / jllffyMef 1-100 INSPECTOR G-9& BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ ] FINAL [ ) FIREPLACE & CHIMNEY REMARKS: ,DATE Y 0 INSPECTOR ZL -�j 76S-iso2 BUILDING DEPT. INSPECTION ( ] FOUNDATION IST [ ] RO H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,DATE �� INSPECTOR IVZL---7 '-ELD TNSPECTION RF,PORT DATE_ _ OMMENTS � --- --- - - ----------- H 'OUNDATTON OST) li °— ------------- ----------- --------- -- ----- -- (� II It '---DATION OND) ------I�===� I -_ --------------- it Y .142 u JI if------��—�i �'LGGJC� -- zp LOUGH FRAME & jj �i '7 O PLUMBING li ii__, . , ®/�►� �i fi- n II jj 1 H LENSULATION PER N. Y. II STATE ENERGY CODEco i! u u � 1 0) H Illill--- a4 II —� FINAL II ADDITIONAL COMMENTS: C� � N �H1 y�• H O z r� ro H BOARD OF HEALTH . . . . . . . . . . . . . . . J FORD! NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . SEPTIC FORM TOWN HALL . . . . . . . . . . . . . . . . . . . fC SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: In-e� CALL . . .?7 . �91l. . . . . Examined..4c� ..°'1..., aMO. MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved.................. 19.... Permit No. .... . "..&. .................................... Disapproved a/c .................................. .................................... ...................................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Da t e�)p2 IJ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector unit 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 application. c. The work covered by this application may not be cammenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be.kept on the premises available for inspection throughout the work. e. .No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. tj?MCATION IS HEREBY MALE 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 td c6mply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in bui ding'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, electrician, plumber or builder ....................................................... n Name of owner of premises ... .Jo.�.�.r..!�0.�-;r� c ,.�... l,J v e: .............. b. .. ................................. (as on the tax roll or latest deed) If icant is a corporation, signature of ly authorized officer. (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. Location of land on which proposed work will be done.7 U:�..�1� G�:E:..Li4... t� ......... ....................................................................................................................... House umber Street Hamlet County Tax Map No. 1000 Section ...J I S ........ dB}ock ........I....... Lot .3.......I...... Subdivision AT".1 r 1Y�3-�1.A-..: ..A1•lLt& iF led 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 ... 4 Q... �.. ...... ...... .......... (( 1 �AiIfU1►� b. Intended use and occupancy S e Crq,.,,r0 SOrwM�1 M tl. ..mus YRKtOM .:.... ....... ... .. 1�A...... ro au11 qx_s t-r:�T Nature of work (check which applicable): New Building .......... Addition Alteration Repair ............ Removal ............. Demolition ............ Other Work ........................... S (Description) Estimated Cost .. ..,�.U.-�?..��. fee ....................................... .... 1 ,(to be paid on filing this application) If dwelling, nuhher of dwelling units ............ tkrdxr of dwelling units on each floor ................ Ifgarage, rxnber of cars ...................................... If business, eamiercial or mixed occupancy, specify nature and extent of each type of use... ................ Dimensions of existing structures, if any: Prom t.. + �.V........ Rear ......v....... Depth ..$ y Height ......................... Number of Stories J................... �J Dimensions of same structure with alterations or additions: Front ............... Rear ........... Depth .................... Height .................... Nrmber of Stories .o2............ Dimensions of entire new construction: Front ................ Rear ............... Depth .............. 11664it ..................... (� Number of Stories ................. Size of lot: Front ....a:�.!..... .... Rear ..4:.. ......... Depth .1 6 d............ 1. Date of Purchase ..................... Name of Former Owner ........................................ �. Zone or use district in which premises are situated .... .4 ................................................. '.. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 3. Will lot be regraded ...(?a..`........... Will excess fill be removed from premises: YES NO �. Names of Owner of premises ..... Address 5.`!.�W �. l..r�. 7v��,2. M1,�b.R! Name.of Architect ................... Address .............................. Phone No. ............. Name of Contractor .................................... Address ...............................Phone No. ............. i. Is tlhis property within 300 feet of a tidal wetland? * YES ... NO .......... *IF YES, SODIlUD M%N TRDSIMS PERMIT MAY BE RE(XTIRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions rom property lines. Give street and block number or description according to deed, and show street names and indicate Tether interior or corner lot. rAIE OF N;W Ytw, JMIY OF ...... .. SS .... &-I a C.r(g. L."")......................being duly sworn, deposes and says that he is the applicant dame of individual signing contract) xr4e named, isthe ..... ................................................................................ (tractor, agent, corporate officer, etc.) r said owner or owners, and is duly authorized to perform or have performed the said work aril to make and file this pplication; that all statements contained in this application are true to the beat of his knowledge and belie N, and Ihat the work will be performed in the mener set forth in the application filed therewith. wornto before rre this f ...U`.�.... .day of ..`` th t ar y .• .�..'.••.•.� -: 1 PUbli ................. .. ..... UMY P�K 9"NW •(Signatwre of Applicant) VA 0001ed in SSuuft&C 7&m Expires Namb 6.9mdo BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name: D ,J P Reviewed: 73�1 -6 a Architect/ _ / Date .�-e Engineer: �� .de re-cu Submitted: -1/ SCTM #: / District: 1.000 Section)l0a Block: Lot: ProiecvvS-a Subdivision Location: N-&4" Name: o Single&separate Required n /d certification: (Yes/No) Z" Zoning District: �' [Lot size: Actual: ��] [Lot coverageProposed: <<_] Req. / — Req. Req. r— [Front Yard Proposed: �` 1 [Side Yard ZA Proposed: �r 1 [Rear Yard �6/ Proposed: Project Description: 7 AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. v�ri..+c Nc�.► Tu,.s. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: Notes: 7) Z-% Sy" 5URVEY OF LOT # 121 N "AMENDED MAP B OF 5ECTION 8 NA55AU POINT CLUB PROPERTI E5, INC." W E FILED X45 MAP # -75q \, 51TUATE: NA55AU POINT � TOWN: 5OUTHOLD S 5UEEOLK COUNTY, NY - \ SURVEYED 03-15-00 AMENDED 03-31-00, 05-22-00 SUFFOLK COUNTY TAX # 00 \ 1000 - 118 - 2 - 8 \ GERTIFIED TO- JOHN WOLLEBEN PATRIGIA WOLLEBEN NORTH FORK BANK COMMONWEALTH LAND TITLE IN5URANGE GOMPANY 0<0 w Q \ a N 3 v rt 1- •� '— a°$ L \ or \ N o 'un autnorizea alteration or addition to a urvey near in9 a ]�cenndsurveyor s seals is a •x•11 W id of section]20sed land sup division 2 of the Ne.York State Education Lak copied fro.She original of tsif survey $ n 'ark kits gcons of the land veyor NOTES; ,tamped eal nail der ea tg ne valid true copies' ■ MONUMENT _ 'Certifications indicated hereon signify that this s' y was prepared i ac,1r1an1e kith the et fisting Code of Pract icenfprcLanO Surveys adopted by the New York State Association Of Professional Land Surveyors. Said certifications shall r Only o PIPE p the person far wham the s ve, is Oreparea, and on his..half to the title company, gpvernmen- tal agency and ]ending institution listed hereon, and to the a sign,,,of the]ending institution. Certifica- AREA = 1.06 ACRES TO TIE LINES ti.n,=ar.not transferan tg additional institution. ELEVATION5 REFER TO M5L N61/D '2a JOHN C. EHLERS LAND SURVEYOR 6RAPHIG SCALE I"- 40' 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 - RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.-TIGER\PROS\20-126