The URL can be used to link to this page

Home My WebLink About25931-zFORM NO. 4 TOWN OP SOUTHOLD BUILDING DEPARTMENT offioe of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26773 Date: 11/04/99 THIS CERTIFIES that the building ADDITION Location of Property: 800 GOOSE CREEK LA SOUTNOLD (HOUSE NO.) (STREET) (HAMLET) county Tax Map No. 473889 Section 78 Block 8 Lot 1 Subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in thio office dated JUNE 22, 1999 pursuant to which Building Permit No. 25931-Z dated AUGUST 9, 1999 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HOWARD & RUTH EILENBERG (O~ER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A Building ~ ~ 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. 25931 Z Date AUGUST 9~ 1999 Permission is hereby granted to: HOWARD & RUTH EILENBERG 800 GOOSE CREEK LA SOUTHOLD~NY 11971 for : CONSTRUCTION OF A DECK ADDITION AS APPLIED FOR AND TO THE CONDITIONS OF THE DEC AND TRUSTEES. at premises located at 800 GOOSE CREEK LA SOUTHOLD County Tax Map No. 473889 Section .078 Block 0008 Lot No. 001 pursuant to application dated JUNE 22 1999 and approved by the Building Inspector. Fee $' 75.00 Authorize~/Si~natu~ Rev. 2/19/98 ORIGINAL BLDG. DEPT. t '' '.~ ' R, TIFICATE OF OCCUPANCY 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 buildir 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings a~ "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 Occupancy 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 Qccupancy on Pre-existing Buitdin~ - $100.00 3. Copy of Certificate of Occupancy - , .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $1~.00, Commercial $15.00 //--~/, Date .... <':.,:. ::. .......................... New Construction ........... Old Or P~re-existing Building ..... ...>:,~:~,~ )_) Location of Property. &qf G~ ~ ~--~-7k7 /~?V~~-' House No. Street Hamlet Onwer or Owners of P~v~L~ ........................................................ County Tax Map No ~000, Sectton..07~. ...... Block.....~. .......... Lot .................. Subdivision Filed Map Lot · · Permit No ..... 4. ..... .~..Date Of Permit ................ Applicant ......................... Health Dept Approval ~ Underwriters Approval ......... Planning Board Approval ........................ ~ Request for: Temporary Certificate ........... Final ~erticate ........... 7o51 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INFLATION [ ] FRAMING ~FINAL [ ] FIREPLACE & CHIMNEY DATE ~ INSPECTOR / 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] ,~SULATION [ /,~ FINAL [ ] FIREPLACE & CHIMNEY ~NspECTION RgPORT DATE COHHEN~$ ~o0NDATI ON ( 2ND ) ~ PLUMBING II il 11 ~SIILATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 765-J,802 BUILDING DEPT. FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING I I FINAL FIREPLACE ~ CHIMNEY __ DATE~/~ Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ISSUED TO ~"/ O~ DATE: .3~25/98 . . HOWARD E!L~NBERG kntl arixatian Pursuant fo the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance eh- rifled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resoluflon of The Board adopted afa meeting held on 3/25/98. 19 98, and in conslderafion of the sum of $ 150.00 paid by . P.roper-T services for. HOWARD EILENB,ER.G. .......... of ...... ~ou..~hQ!~ ..... N.Y. and ~ubiecf to the Terms and Conditions lis~ed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit for the construction of deck attached to house and a 12' X 24' swimming pool with surrounding deck, and fence around pool all with condition that a 35~ buffer be maintained. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these p.resents to be subscribed by a maiorlty of the smd Board as of fh~s date. Trustees NeW York State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (516) 444-0365 I.,~,csirnile {'516) 444-0360 John P. Cahill Commissioner May 12, 1999 Mr. Howard Eilenberg P.O. Box 1732 Southold, NY 11971 RE: 1-4738-00634/00005 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Kevin A. Kispert Environmental Analyst KAK/ls Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-00634/00005 FACILITY/PkOGRAM NUMBER(S) PERMIT Under the EnvironmentaL Conservation Law EFFECTIVE DATE May 12, 1999 EXPIRATION DATE(S) May 12~ 2002 TYPE OF PERMIT · Mew [] Renewal [] Modification [] Permit to Construct D Permit to Operate [] [] [] [] Article 15, Title 5: Protection of Waters Article 15, Title 15: Water Supply Article 15, Title 15: Water Transport ArticLe 15, Title 15: Long Island Wells Article 15, Title 27: Wi[d, Scenic and Recreational Rivers [] 6NYCRR 608: Water Quality [] Certification [] Article 17, Titles 7, 8: SPDES [] [] Article 19: Air Pollution Control [] [] Article 23, Title 27: Mined Land Reclamation [] [] Article 24: Freshwater Wetlands [] · Article 25: Tidal Wet[ands Article 27, Title 7; 6NYCRR 360: Solid Waste Management Article 27, Title 9; 6NYCRR 373: Nazardous Waste Management Article 34: Coastal Erosion Management Article 36: FLoodplain Management Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO Moward Eilenberg TELEPHONE NUMBER (516) 765-4913 ADDRESS OF PE%MITTEE P.O. BOX 1732F Southotd, NY 11971 CONTACT PERSON FOR PERMITTED WORK James E. Fitzgerald, Proper-T Permit Services, P.O. Box 617, Cutchogue, NY 11935-0617 TELEPHONE NUMBER (516) 734-5800 NAME AND ADDRESS OF PROJECT/FACILITY Eilenberg property~ 800 Goose Creek Lane LOCATION OF PROJECT/FACILITY Southo[d, NY 11971 COUNTY I TOWN Suffolk SouthoLd DESCRIPTION OF AUTHORIZED ACTIVITY: WATERCOURSE NYTM COORDINATES Construct deck on existing house as shown on the attached pLans prepared by Proper-T Permit Services last revised 4/14/99 and NYSDEC approved on 5/11/99. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the · ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: RoRer Evans (KAK) AUTHORIZED SIGNATURE ADDRESS Building 40, SUNY, Room 121, Stony 8rook, NY 11790-2356 DATE May 12, 1999 Page 1 of 4 1000-78-8-1 HOWARD EILENBERG 800 GOOSE CREEK LANE SOUTHOLD, NY 11971 1000-78-8-2 FRANK PRIMICH 8200 BOULEVARD EAST NORTH BERGEN, NJ 07047 T~O-P~ P.T ¥ LI~P-- 'T 1000-7~-1-1 JANE TAGGART 700 GOOSE CREEK LANE SOUTHOLD, NY 11971 TIDAL WETLANDS LINE AS PER NYSDEC PERMIT 1-4738-00834100001 WHICH EX- PIRED 6130/95. iS C~A'b~T2 I I I ! I - ~oT~-'-RT'f COVERAGE: EXISTING STRUCTURES PROPOSEDSTRUCTURES TOTAL LOTAREAc COVERAGE: 1895 sq. ft. 1079 sq. ffl NYSDEO 2974 sq. ft. 2og3o ~g. ft..~rr~I'W~'-~C~p~-'-~sT~ vw too PROJECT PLAN Application regarding the property of Howard Eilcnherg, SCTM #1000:78-8-I Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue, NY 11935 James E. Fitzgerald, Jr. 516-734-5800 Revi~cl Anti! 14 1990 Albert J. Krupskl, President James King, Vice-President Henry Smith Artie Fester Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1842 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 26, 1998 Proper-T Services Jim Fitzgerald P.O. Box 617 Cutchogue NY 11935 Re: HOWARD EILENBERG SCTM 978-8-1 Dear Mr. Fitzgerald, The following action was taken by the Board of Town Trustees during its Regular Meeting held on March 25, 1998, regarding the above matter: WHEREAS, HOWARD EILENBERG, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 9, 1998 and, WHEREAS, said application was ~eferred to the Southold Town Conservation Advisory Council for their findings and recommendations, and · WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 25, 1998, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this.application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of HOWARD EILENBERG to construct a deck attached to house and a 12' X 24' swimming pool with surrounding deck, and fence around pool, all with condition that a 35' buffer be maintained. Located: 800 Goose Creek Drive, Southold. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC ACE Dept. of State Bldg. Dept. 9~-2o-1 (8~87)--9d New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Region.a.I Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit Number Expiration Date Regional Permit Administrator JOHN W. PAVACIC NOTE: This notice is NOT a permit NEWYORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee to Require its Contractors to Comply with Permit The permittee shall require its independent contractors, employees, agents and assigns comply with this permit, including ail special conditions, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the iands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when written or verbal notification is provided by the Department at least 24 hours prior to such inspection. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY BIdg #40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure !o disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DECPERMITNUMSER PAGE 2 Of 4 1-4738-00634/00005 , , PERMITTW, rev 10/98 NEW yORK STATE DEPARTMENT OF ENV RONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES '15 (TITLE $), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) If future operations by the State of New York require an alteration in the position of the structure or w~ork herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Granting of this pe'rmit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. AIl necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. Any material dredged in the prosecution of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. if upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. if granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that ail of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned1 along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by ~d~~ ~' ~ / ~, ?~0/¢ DECPERMITNUMBER PAGE 3 OF 4 1-4738-00634/00005 -- NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix h'ucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2: Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposak No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil ~flsturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a, Stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.). 5. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 6. A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 25 linear feet from the tidal wetland boundary, or as per NYSDEC approved plan, at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 7. Roof runoff must be directed to drywells a minimum of 75 linear feet landward of the most landward edge of the tidal wetland boundary, and must be installed a minimum of 2 feet above seasonal high groundwater. 8. This permit does not authorize any alteration, expansion or replacement of existing septic systems. DEC PERMIT NUMBER PAGE 4 OF 4 1"4738-00634/00005 NOT/CE OF COMMENCEMENT OF CONSTRUCTION RI,;TURN Tills FORM TO: Reghmal Mmmger Bareau of Mariae I labilat Protection New York State Deparlment of Enviroomental Cooservalion Bklg. 40 - SUNY, Room 223 Stony Brook, NY 11790-2356 PERMIT NO.: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to Supplementary Special Condilioa D of the referenced permit, you are hereby notified that the authorized activity shall commence on . We certify that we have read lite refere ~ced permit and approved plans, and fully understand tile authorized project aud all perm t cond t OhS. We have nspectet lite project site and can complete the project as described itl the pemdt and depicted ou the approved plans iu full compliance with all phm notes aod permit couditions. Tber Permit sigh, permit, and approved plans will be available at the site for iuspection iu accordance with General Condition No. 1. PERMITTEE DATE CONTRACTOR DATE Tills NOTICE MUST BE SENT TO TIlE ABOVE ADDRESS AT LEAST TWO DA 1~ IN AD VANCE OF COMMENCEMENT OF TIlE I'RO~: FAILURE TO RETURN TIIIS NOTICE, POST TIIE PERMI~,T., SIGN, OR HA VE TIlE P.,ERMIT AND APPROVED PLANS A VAILA BLE Aff~t4E WORK SITE MA I' SUBJECT TIlE PERMIITEE AND/OR CONTEACTOR TO AI'PLICARLE SANCTIONS AND PENALTII?S FOR COMPLIANCE WITll PERMIT CONDITIONS. ~;: ~ ~LDG. DEPT. L_ '[OWN 9F S0UTHOLD · F01LM NO. I TO~N OF SOUTItOLD BUILDING DEPARTMENT TONN HALL SOUTHOLD, N.Y. I TEL: 765-1802 Disa~j~oved a/c .......................... .. . ... .. BOARD OF HEALTH . .,,~_ ........... ,'~3 SETS OF PLANS ~ ............. SURVEY ' . ........... ....... SEPTIC FORM NOTIFY: CAL r. Y.C.L? ....... MAIL TO: .................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application mast be c~pletely filled in by typewriter or in ink and submitted to the l~dlding Inspector wi 3 sets of plmm, accurate plot plan to scale. Fee according to schedule. b. Plot plato showing location of lot and of buildings an premises, relationship to adjoining premises or public streets or arean, and giving a detailed description of lay(mt of property mast be drm~a an the dlagran ~fich is part of this application. c. Tbe work co. red by this application my not be ccrmmnced 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 an the premises available for in~pectlon thrunghont the ~rk. e. No building shall be occupied or used in ~aole or in part for any parpase ~aatever until a Certificate of Dccupaacy shalI have been granted by the Building Inspector. APPLICATH~I IS I~Y ~ to the Building l)eparment for the issuance of a Building Pemit persunnt to the l~ildlng Zone Ordimmce of the Tc~n of So~thold, ~ffolk County, Ne~ York, and other applicable La~s, Ordinaocas or Regulation, for the construction of buildings, additions or alteratlo~, or for raroval or demolition, as herein deserihed. The applimt agrees to eanply with all applicable la~s, ordlna~es, building code, ho~sing code, and regulations, and to ~l~it authorized inspectors on pr~ulses and in buil~i~ for necessar~aspec_ tlor,~s. .......... (Sigt~ature of ap~llc~mt, or nam. if./~ corporarion?~ State ~/cether applicant is oaeer, lessee, agent, architect, engineer, general contractor, electrician, plunber or builder ............. .... ;. ...................................................................................... ........... .......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (l~m and title of corporate officer) Builders License No ......... Pl~hers Licease No ..... Electricians Licease NO .................... . . Other Trede's License No ..................... ]. I~0catlon ot laan on wozco prope~ea ~or~ w~ti ne oone..~,.: ................................ ) ...................... Nouse Nm~er Street Hanlet County Tax Map No. 10~0 Section.. ?.Z.?. ....... Block .... '~. ........... Lot ................ Subdivision .............. Filed Map No ................ l~t .. . 2. State existing use and occupasey of premises and intended tree and occupancy of proposed~.construction: a. K~isting use and eccupmncy __....v( . . . - ik . . b. Inter,led use and eecupenc7 ............................................................................ Repair ............ Rs~val ............. property lines. Give street and ~lmther interior or corner lot. l)ematitina Other I~ork ~..,~ ~..;./7~ (Oeat~ri~tion) I '~ ' ' Estimated Cost ' (to be paid on filing this If &~lling, nult~er of ~lling Onits ......... flUOr of fl~lllng onits na each iflco~, ... ............... If Ixminees, emmerciel or mixed ineeupaney, specify nature and extent of saeh typa of uae ...................... Dimensions of existing stn~ztureo, if any: Front ........... Rear .......... ~pth . .~. ............. Dimensions of sine structure mitl~ alteratlnas or additions: Front ............... Rear ............... l~pth .................... ltelgh[ .................... Ix~uber of Stories '. .............. Dimenalona of entire ne~ construction: l,'ront ................ Rear ............... Depth .............. tbight ......................... l ber o£ Stories ..................... Size oE lot: Front .d'-..i ..... i .......Rear .................... l~epth .................. Date of l~trdmse ...... ! ..... ~ of Fonmr O~mer ........................... Zone or uae district in.d~ich Vremizes am situated .................... ~ .................................. I}c~s proposed construction violate any zoning la~, ordinance or regulation: .].V..~. ................... ~ of Contractor .............. i ................. :... Mdreea ............................... H~ne No ............... Is tins property within 300 feet iof a tidal ~etland? i PLOT DIAGRAt4 I~cate clsarly and distinctly al~ buildinge~ ~tmtber existing or proposed, and indicate all set-back dimesaiona Iflnek hauber or description according to deed, and sho~ street names and indicate ffrA'IE (~r N~ SS (Hame of indlvldua~ signing cmtract) I~ is the ........................... (~tractor, ~ent, co~ .. ................. being duly ~n~, deposes and says that he is tim appl. ica~t ~orate officer,' etc.) o. ~.~d ¢~er or ~ner8, and ts duly au~horxzed to perform or have perfota~L~'d tile said ~rk and to make a~d file this applxcatica~; that: all statements contal0ed in this appllcati~ are true to the best of his knowledge and beliefj end that the vork will be performed in tile denser .~et forth ia the application filed there~th. ,%om Lo before me this [ ..... ,,... UN~ J. CO~ Nma~ Pu~, Sm~ ~ ~ -- SUFFOLK CO. HEALTh DEPT. APPROVAL ~7 DEC 19 199A ~EAL'fH SERVlUr-- N~- 3FFOLK COUNTY DEPAR'rti{ENT OF HEALTH SERVICES STATEMENT OF INTENT thE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE CO/ D~PT. F EALTH SERVICES SUFFOLK ~,/~.,~/,Z~,~ 2~¢~ ~, ~ ' APPLICAI~ SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR ~ APPROVAL FOR CONSTRUCTION ONLY DATE: h. S. REF. NO.: APPROVED: · SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: u DEED: L.Sg~ TEST HOLE SEA1