HomeMy WebLinkAbout24972-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26309
Date: 03/02/99
THIS CERTIFIES that the building ADDITION
Location of Property: 6400 INDIAN NECK LA PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 86 Block 7 Lot 2.2
Subdivision Filed Map No. __Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 9, 1998 pursuant to which
Building Permit No. 24972-Z dated JUNE 23, 1998
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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER
ZBA #4550.
The certificate is issued to RUTH MILLER
of the aforesaid building.
(OWNER)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-480397 02/19/99
PLUMBERS CERTIFICATION DATED 02/23/99
DAWSON PLUMB.&HEATING
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. 24972 Z Date JUNE 23 98
Permission is hereby granted to:
R MILLER A/C EEI
PO BOX 190
PECONIC~NY 11958
for :
CONSTRUCT AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS PER
ZBA(%4550 4/16/98) DEC AND TOWN TRUSTEES.
at premises located at
County Tax Map No. 473889 Section 086
pursuant to application dated JANUARY
Building Inspector.
6400 INDIAN NECK LA
PECONIC
Block 0007 Lot No. 002.002
9 98 and approved by the
Fee $
38.00
·
Building Insp~tor
Rev. 2/19/98
ORIGINAL
APPLICATION FOR CERTIFICATE OF OCCUPANCY
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 yith accurate location of all buildlngs~ 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
Upre-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
~asons therefor in writing to the applicant.
C. Fees ·
2. Certificate of Occupancy on Pre-~isting Buildinm - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Co~ercial $15.00
Date .......~ /~ ............................ ~ . ..
New Construction ........... Old Or Pre-~isting Building .................
Location of Property..~ .....~~
................ ..... ...... ........
House No. Street Ha~et
Onwer O~ers of Property ~' ~ ~.l /.~ '
County T~ ~o lO00, Section ..............
Sub division -5 ~.~.~.E i .~j jj .................. Fil2d Map ............ Lot ......................
.............. ~ ...... ~,4_' '~:D',&EL .......
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fca Submitted: .................
..............
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~-- 40 FULTON NEW NY 10038
STREET,
YORK,
Date FEBRUARY 19,1999 Application No. on file 16507898/98 N 480397
THIS CERTIFIES THAT PEP~4IT NO. 24972
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
RUTH HILLER, 6400 INDIAN NECKLA, POLE 1SA, PEC0}~IC, NY
in the following location; [] Basement [] 1st Fl. [] 2nd FL OUT Section Block Lot
was examined on '~]~BRUAR¥ 12 ~ 1999 and found to be in compliance with the National Electrical Code.
FIXTURE
OUTLETS
12 11
DRYERS FURNACE MOTORS
FIXTURES RANGES
FLUORESCENT OTHER
FUTURE APPLIANCE FEEDERS ~PECIAL REC'PT. TIME CLOCKS
OVENS DiSH WASHERS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
NO OF CC COND. A W G. A W, G, A.W. G,
PER (fl OF CC COND. NO, OF HI-LEG NO. OF NEUTRALS
OF HI-LEG OF NEUTRAL
i 2 1
WHIFL POOL BATH-1
PADDLE FAN--1
3 TON-AIR CONDITIONER-1
4 TON AIR CONDITIONER-1
.6OA DISCONNECTS.- 2
ELEC. ROOM HEATERS: I- 1.5 K.W.
PANELBOARDS:I-18 CIR. 125
ELEC. WATER HEATERS:: 1-4.5 K.W.
G.F.C.I:-i
<<< Continued on Page 2
GENERAL MANAGER
Per-
This certificate taus! not be altered In any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THiS COPy OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD.OF FIRE UNDERWRITERS
loelo 3 BU.EAO OF ELECT.,C, Y
~ 40 FULTON STREET, NEW YORK, NY 10038
Date FEBRUARY 19,1999 Application No. onfite 16507898/98 }t 480397
THIS CERTIFIES THAT PERHIT NO. 24972
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
RUTH }~ILLER, 6400 INDIAN NECKLA, POLE lSA, PECONXC, NY
in the following location; [] Basement [] Is, Fl. [] 2nd Fl. OUT Section Block Lot
was examined on P]~BRUARY 12,1999 and found to be in complianae with the National Electrical Code.
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
FIXTURE RECEPTACLES SWITCHES
OUTLETS FLUORESCENT OTHER
DRYERS
SYSTEMS
NO. OF FEET
E R
C
NO, OFCCCOND A.W G. A,W.G, A W G.
PER ~ OF CC. COND. NO- OF HI-LEG OF HI-LEG NO, OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
TRACK LIGHTING: -16
DOROSKI ELEC. INC. LIC.#2941-E
425 HONSELL LANE
CUTCHOGUE, NY, 11935
This certificate must not be altered In any manner; return to the office of t~e Board If Incorrect. Inspectors may be Identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
APPEALS BOARD MEMBERS
Gerard P. Goehringer, Chairman
James Dinizio, Jr.
Lydia A. Tortora
Lora S. Collins
George Horning
BOARD OF APPEALS
TOWN OF SOUTHOLD
FINDINGS, DELIBERATIONS AND DETERMINATION
REGULAR MEETING OF APRIL 30, 1998
Appl. No. 4550 - RUTH MILLER PARCEL 1000-86-7-2.2
STREET & LOCALITY: 6400 Indian Neck Road, Peconie
DATE OF PUBLIC HEARING: March 23, 1998 and April 16, 1998
Southold Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
ZBA Fax (516) 765-9064
Telephone (516) 765-1809
FINDINGS OF FACT
PROPERTY FACTS/DESCRIPTION:
The above-identified property consists of a total land area of 2.507
acres situated on the southerly side of Indian Neck Road, Peconic. The
March 6, 1998 survey submitted under this application shows that the
property is improved with an one-story, single-family frame dwelling
which is the subject of this application for a new addition, and three
other accessory buildings in the front yard.
BASIS OF APPEAL: Building Inspector's Action of Disapproval dated
January 26, 1998, which reads as follows:
"...Please take notice that your application dated
January 9, 1998 for permit to construct an addition
to an existing single family dwelling ...is disapproved
on the following grounds: the proposed addition being
located in an R-80 Zone is required to have a side yard
setback of 20 feet minimum and a combined side yard
setback of 45 feet. Pursuant to Article III, 100-32 .... "
AREA VARIANCE ]{F, LIEF REQUESTED BY APPLICANT: The request
made by applieallt is to locate a proposed 20' x 26.2' dwelling addition
with an easterly side yard at 18 feet and westerly side yard at 14.9 to
the existing foundation, or at 8.5 to the top of the step area. The
total side yards to the foundation walls at the sides would equal 32.9
feet, and to the top of the step area (larger than 5' x 6' code
exemption) would equal 26.5 feet. The code requirement is 45 ft. total
both side yards.
REASONS FOR BOARD ACTION~ DESCRIBED BELOW:
(1) The granting of the area variance will not produce an undesirable
change in character of neighborhood or a detriment to nearby properties
because the prOperty is a heavily wooded waterfront lot and a row of
evergreens screens the addition frOm view by adjoining properties to the
east.
Page 2 - Appl. No.i4550 (R. Miller)
1000-86-7-2.2 at Pe¢omc
Board of Appeals Ai~ril 30, 1998
(2) The benefit Sought by the applicant cannot be achieved by some
method, feasible for applicant to pursue, other than an area variance
because the proper~y is unusually long approximately 1250 feet, but its
narrow 87-foot width prohibits expansion of the dwelling without a
variance. '
(3) The requested area variance is not substantial in considering the
modest 20 ft. by 76.2 ft. size of the addition and limited width ~of the
lot area.
(4) The proposed i variance will not liave an adverse effect or impact on
the physical or environmental conditions in the neighborhood or district
because the addition is of minimal size, and it will be an improvement to
the house and near~y properties.
(5) The situation ihas not been self-created and is due to the unusually
long and narrow cop_figuration of the property.
In considering thi~ application, the Board deems this action to be the
minimum necessary land adequate, and at the same time preserves and
protects the char~cte, r of the neighborhood, and the health, safety,
welfare of the comm~mty.
RESOLUTION/ACTION: On motion by Member Tortora, seconded by
Member Collins, it was
RESOLVED, to!I GRANT the relief as applied.
VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO,
TORTORA, HORNING, AND~n was adopted by
unanimous vote (5-~).
~. GERARD _P: GO~.HRI
~/' Approved for l~llng 5/4/98
X~~'A~ SCUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date Feburary 25, 1999
Building Permit No.
Owner Ruth Miller
24972-z
(please print)
Plumber Dawson Plumbing & Heating
(please print)
I certify that the solder used in the water
contains less than 2/10 of 1% lead.
supply system
(plumber's signature)
Sworn to before me this
, ay of ,,,
Notary Public, ~_/c~ //~. County
Notary Public ~
JUNFANN O. 'ZARZEC, KI
Notary PuDlic, St~e oi New Yen%
No, 4961037
Q,~ati/ied in Suffd~ Coun~
My ~r,vm~sifl~ Ex~ir~ Jan, 8~ ~ 0 ·
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Fax (516) 765-1823
Telephone (516) 765-1802
February 22, 1999
Environment East Inc.
P.O. Box 190
Pecontc, NY 11948
RE: Ruth Miller, 6400
Indian Neck Lane,
Peconic,
1000-86-7-2.2.
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 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 # 24972-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
Environment East, Inc.
2885 Indian Neck Lane
P.O. Box 190
Peconic, New York 11958-0190
516-734-7474
Fax: 516-734-5812
February 25, 1999
Southold Town Building Department
P. O. Box 1179
Southold, NY 11971
Dear Sirs,
Enclosed is the Plumber Solder Certificate for Permit # 24972Z. The Underwriters
Certificate has been issued and will be sent to you directly from the Underwriters.
If anything other information is needed please let me know.
Sincerely,
Judy McAfee
Office Manager /
FOUNDATION (
FOUNDATION
ROUGH FRAME &
.FLUMBING'
INSULATION FERN.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ]~N~,~JLATION
[ ~] FINAL~/~~,~
REMARKS:
Henry Smith
Artie Foster
Ken Poliwoda
Southold, New York 11971
Telephone (516) 76§-1882
Fax (516) 765-1823
BOARD OF TOWN T~USTEES
TOV~N OF SOUTHOLD
February 26, 1998
Environment East Inc.,
Joan Wilson
P.O. Box 190
Peconic NY 11958
RE: RUTH MILLER
SCTM ~86-7-2.2
Dear Ms. Wilson,
The following action was taken at the Southold Town Board of
Trustees meeting on February 25, 1998:
RESOLVED, that the Southold Town Board of Trustees approve the
request for an Waiver to construct an addition to an existing
house as per survey dated and received February 6, 1998, with
stipulation that a row of staked haybales be placed along top of
bluff during construction. Located: 6400 Indian Neck Road,
Southold.
However, this does not constitute approval from any other
agencies.
If you have any questions, please call our office at 765-1892.
Sincerely,
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. Building Dept.
Environment East, Inc.
2555 Indian Neck Lane
P.O. Box 190
P¢conic, New York 11958-0190
516-734-7474
Fax: 516-734-5812
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: ~'~ ~
[ ] ROUGH PLBG.
[]INSULATION
New York State Department of Environmental Conservation
Building 40 -SUNY, Stony Brook, New York 11790-2356
Telephone ($16) ~.x.~.-0365
Facsimile (516) ~.~.~.-0360
LETTER OF NONJURISDICTION -TIDAL WETLANDS
Ms. Ruth Miller
6400 Indian Neck Lafie
Peconic, New York 11958
Date: March ~3, 1998
RE: 1-4738-01859/0001
Mfller'~roperty
6400 Indian Neck Lane,
SCTNI No. 1000-86-07-2.2
John P.
Comml~oner
~Peconlc
Dear Ms. Miller:
Based on the information you have submitted, the New Yo~k State Department of Environmental
Conservation has determined that the property landward of the topographical top of the bank as
shown on the survey prepared by John T. Metzger, last revised 3/6/98, 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.
/
cc: Ms. Joan Wilson, Environment East, Inc./
Bureau of Marine Habitat Protection, NYSDEC
File
DMG
Very truly yours,
Permit Administrator
Albert J, Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P,O, Box 1179
Southold, New York 11971
Telephone (516) 765-18~2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 26, 1998
Environment East Inc.,
Joan Wilson
P.O. Box 190
Peconic NY 11958
RE: RUTH MILLER
SCTM #86-7-2.2
Dear Ms. Wilson,
The following action was taken at the Southold Town Board of
Trustees meeting on February 25, 1998:
RESOLVED, that the Southold Town Board of.Trustees approve the
request for an Waiver to construct an addition to an existing
house as per survey dated and received February 6, 1998, with
stipulation that a row of staked haybales be placed alon~ top of
~/~ba-uff..~onstruc~'~on. Locatea~ ~400 indian Neck R~ ~
~outhold. ~ - ''
However, this does not constitute approval from any other
agencies.
If you have any questions, please call our office at 765-1892.
Sincerely,
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. Building Dept.
FOI~'H[ NO. 3
TOWN OF SOHT]tOLD
BUILD:NG DEPARTMENT
SOUTBOLD, N.Y.
NOTICE OF DISAFPROVAJ,
HATE: ~uvo~.20,.l$~ ............
3075 Indian Neck La.
~econic Ny J19~ ....
PLEASE TAKE NOTICE that your application dated ~D~rY.P~ .......... ~gP~ ....
Location of Property . 6400 Indian Neck Rd. Peconic
House No. Street Hamlet
County'Tax Map No. 1000 - Section 86 BLOCK 07 LOT 2.2 .
Subdivision ............................ .. . Filed Map No .......... Lot No ........
grounds ...P..P ......................
is returned herewith and disapproved on the following the ro osed addition .
being located in a~ ~-80 Zone is required to have a side yard setback of 20 feet
minimum a~ a combine~ side yard setback of 45 feet. Puysuant to Articl? III
{p0-32: ~P ~9~ by the Zoning Board of Appeals.-
B~LDING~INSPECTOR
RV 1/80
Environment East,!nc.
2885 Indian Neck Lane
P.O. Box 190
Peconlc, New York 11958-0190
516-734-7474
Fax: 516-734-5812
Mr. Gary Fish
Southold Town Building Dept.
P. O. Box 1179
Southold, NY 11971
RE: Permit # 24972Z, Miller Residence
Dear Gary,
Enclosed are photos of Miller's welded and bolted columns as well as cemented fuel lines
as required for fin~-----~,
Please,~call if there~ ~uestions.
Sincerely, [X~~
Peter R. Stoutenbur /
President ~
Environment Ea~
Encl. ~
PRS:jm
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND
FRAMING
[ ] ROUG~.BG.
[ ] INS~ATION
[/~NAL
[ ] FIREPLACE & CHIMNEY
INSPECTOR
DATE
765-J.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ]~UGH PLBG.
[ ,,~ INSULATION
[ ] FRAMING [ ]FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
INSPECTOR
765-~.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ L~ROUGH PLBG.
[ ] FOUNDATION 2ND [
[ ~FRAMING [
] INSULATION
] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE :~¢~ ,NSPE~OR
Environment East, Inc.
2885 Indian Neck Lane
P.O. Box 190
Peconic, New York 11958-0190
516-734-7474
Fax: 516-734-5812
MILLER RESIDENCE
6400 INDIAN NECK LANE
PECONIC
PERMIT # 24972Z
MR. JOHN BOUFUS;
July 13, 1998
PLEASE NOTE THE ATTACHED HEADER DETAIL AND AMEND
THE PERMIT FOR THIS PROJECT TO INCLUDE REPLACING THE
EXISTING 8'0" CELLAR DOOR WITH A NEW 9'0" DOOR.
THANK-YOU,
Yr='~'~ ~ F~ 1t ~V?'~ r-, ~' ' BOARD OF HEAbTH .........
IIE~F III1 TOWN OF SOUTHOLD , .,. ~,, ~'.-~,,.
lU~/ JAN -9 ~ IE BUILDING DEPARTMENT CllgCK~.~7./.~ .~g.'g~ ...
J . J J TOWN HALL SE~TZC FO~H ..... ~ .........
I AL , _ L:__ ",~ SOUTHOLD, N.Y. 11971
'~? . . , ~i'-~L CALL ...................
E~aulnled ..
Dias roveda//' ' ............. ' ....
.... ~.~.~..~..~~.~,,.~,~/~..~...~--- - ., : , ,
'// ~ - ,,~~'~~/~ / ~
..... ~ " .; ,
Inspector) ~ - ~ . '. '
~NS~AUCTIONS
a. TMs application must be completely'filled in by Wpewfiter or inink and submitted to the BuildMg Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot pl~ showing location of lot and of build~gs on premises, relationship to adjoining premises or public streets
or areas, and givMg a dot,led description of layout of property must be drawn on the diagram which is pa~ pf this appH-
atlon,- , , : ' '
.c. The work covered by tMs application may not bo commenced before issuance of Building Permit.'
d2 Upon approval of this application, the Building Inspector will issued a BuHdMg Pe~it to the applicant. ;Such p¢~it
ah~ bo kept on the premises avaHable for Mspection throughout the wdrk.
~. No building shall be occupied or used in whol0 or in p~t for any purpose whatever until a Ce~ificate of Occup~cy
~hall have been granted by ~e Building Inspector.
APPLICATION IS HEREBY MADE to the BuildMg Dep~tment for the issuance of a BMtding Pe~it pursuit t0 th~
Building Zone Ordnance of the Town of Southold, Suffolk County, New York, ~d other applicable ~wa, OrdM~ces or
Regulations, for th~ const~ction of buHdMgs, additions or alterations, or for removal or demolition, as hereM described.
The applicant agrees to comply with all applicable laws, ordinances, buRdMg code, housing code, and regulations, and to
admit authorized Mspecto~ on premises and M buildMg for necessa~ inspections.
.. ~ 9. ;~o.~ ~x...~.. J.e 9.:..
~ ' (Signature of applicant or aa~e if a c0~p~raQ$0)
· . ;.a
(Mailing address of applicant)
:
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises .... .~. p.~_L-'~
(as on the tax roll or latest deed)
If app ' 's a rp~ rat'on, signature of duly auth~orized officer.
(Name and title of corporate officer)
Builder's License No....~.~.~..~.....~..~-~ .......
Plumber's License No ........................
Electric. lan License No '
Other Trade's License No ......................
1. Location of land on which proposed work will be'done.
' House Number Street Hamlet
: B~ ¢..7. 7~ E. ' '
Coun.ty Tax Map No. 1000 Secti(m .................. Block ................ Lot ...................
Subdivision ....................................... Filed Map No ................ Lot ...............
(Name)~. , '
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~ ..........
b, Intended use and occupancy .......... : .......
3. Nature of work (check which applicable): New Building .......... Addition ..... .... ;' !Al'~'eration ·., .........
Repair .............. Removali .............. Demolition ............. Other Work ...............
~? ~e~ .. i: ;~ ':~:(Desc~r, iption)~
4. (to be paid o~
5. If dwelling number of dwelling unilq ........ I ....... Number of dwelling units on
If garage, number of cars, ....... ~& ...............................................................
6. If business, commercial or mixed occupancy, specify nalure~and extent o f eacl~ ty~e o[ nsc ... ~ ~ ..............
5. Dimensions of qxis~ing structures, i{ any: Front .... ~5'.~ ...... Rear . .~ q~.~ ...... Depth...~ ~.'. ~ .....
Hmght . . .~ ......... N nber[ofStones ...~ .................................. ~ ...... .. · ·
Dhnensions of same structure with ~lterations o[ a~iti~s: Front ... ~ ~ .~ ....... Rear . . .~.,.~ .........
Depth . ~' ~ Hei~t ~+~ -~. Number of Stodes
8. D~mens~ons of entire new constmctmn: Front .... ~ 7~ ...... Rear .. ~O.. ~ ...... Depth . .~...~ ......
Height . .~e~...Numbe~ofStories . ~ ......... '
.... ~ '2 .... ~ .......... ~ -~
9. Size of lot: Front ..~-t,&O .... ~ ........ ltear ....... ~.-~ ............ ~epm [..~ ......... ~ ........
~0. mt~ ofP,~h,,~ ...[q.g.~ ..... ~, ...... . ......... ~,m~ of Fomer Ow,~r .~¢~..~ ........
]~ Z .... hp '~ ' ~rflg:
, CBC or uso district m whit reml es arc situated ..................................
12. Does proposed construction vJolate~any zoning law, ordinance or regulation: ..........................
13. Will lot be regraded ..... ~... ~ ................ Will excess fill be removed from prem~ses.
14. Nm* o~Owner o~ premises ~..~t.~... Address ~. :OP.~N~:Phone No. 7~..Z~.~ .~.
Nme of Architect ..... ~...~ .............. Address ................... Phone No ......... ' .......
N~e or Contractor ~ .~P~T.~ ~. Xd~ress ~: tqg.g4 ~P.n (9... ~hone No ~. ~7~ ~'...
· 5. Is chis properCy w~Chtn 30~ feeC of a ctdal wetland? ~Yes ........ No .........
·If yes, Southold To~n Trustees Permt~ may be requlred.
' PLOT DIAG~
Locate clearly and distinctly ~1 b~lld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensJo~s from
property lines. Give street ~d block nul abet or desc~ptJon accord~g to deed, and show street nines and indicate whether
inte~or or corner lot.
STATE OF NF:~r'5~ORK['7~ [ I. o ~
COUkrrY OF. _.~..1-~..~[7~.O. 1..~ ~
(Name of individual sig~nl' contract)
above named.
[~e is the .......................
>f said owner or owners, and is duly
application; that all statements contain
work will be performed in the manner s
·. being duly sworn, deposes and says that he is the applicant
tuthorized to perform or have performed the said work and to make and file this
· ~d in this application are true to the best of his knowledge and belief; and that the
forth in the application filed therewith.
Sworn to Before me ~}~
' -- :392 .,I .....
' -- 't~ ;,~£,£~o09 '$ .......