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HomeMy WebLinkAbout23027-z 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) Q Date ..............f.l..v ............................., 19../... N2 23027 Z Permission Is hereby granted to: .....p�',�r/..6?y'. ✓.. .. u , ........................... ............................................ to . f!7Lr�14 ,........�✓.............A'z?....... ? .. ... .......'J!'r/Gl. ..... �� ��CCj..... ........... ...!� ' / ...... ....�� .......... . .. . . y...G/, °...r9.tou✓r5.� .... .......... ...:......%sr� ...,P�e y ......1 /. ,1.9.3. ... .....v .`....0 /i1D nGr2octty� t�c�c ..................................................................... . Z,9�..................................... ............................ at premises located at.............. ........ ........ ......... .:.................... .................................................................. 'r. ?�A 1..Zq.Ce ...........................................� ............. County Tax Map No. 1000 Section .....I.I.�........ Block......... .7..p... Lot No. ....... ..l...<.11 pursuant to application dated ..........J� �/... .................... 19....,,1. ., and approved by the Building Inspector. !� d Fee $,...'l J.7: seu... ,.... ..:. " ........................................ / BuOding Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24377 Date MAY 21, 1996 THIS CERTIFIES that the building NEW DWELLING Location of Property 470 WILLIS CREEK DRIVE MATTITUCK NY House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 17 Lot 17.11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 13, 1995 pursuant to which Building Permit No. 23027-Z dated SEPTEMBER 27, 1995 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 A TWO STORY SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE AND WRAP AROUND PORCH. The certificate is issued to STEPHEN & SUSAN BUCZAK (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-0051 APRIL29, 1996 UNDERWRITERS CERTIFICATE NO. N385889 MAY 14, 1996 PLUMBERS CERTIFICATION DATED MAY 19, 1996 COTCHOGUE EAST PLUMB & BEAT By lding Inspector Rev. 1/81 Fo w No. o Q 40 - J / 3 y � 111NY Yew D �1 TOWN, OF SOG_HOLD BI;ILDING DEPART_ENT 19 mown 8� MAY 20M 'n5-lso2 9LDG.DEPT. TOWN OF SOUTHOLD P?L-C _IO\ FOR CER_IF_C.kTL OF OCCUPANCY _. =pis application must be t�11ed by typewrite OR ink and submitted to the building -.spector with tae '_oilowing: for new building or new use: 1 . oal sur'Jev of prCDerty with accurate location of a-1 buildings, property _'_nes, streets, and unusual natural or topographic t-azures. 3. Final ApDrCVaI trpm Health Dept. of water SliDp1esposal]-� zprm)V ri . 3. Approval of alectrical inszallation from Board of Fire Underar'_ters. 4. Sworn statement from plumber -___-=wing taac the solder used in syszem contains less Chan 2/10 of 1: Lead. . . Commerz_.al ou:lding, 'industrial building, multiple residences and similar buildings and inszaliazions, a certificate oL Code ComDliance from arcnitect or engineer responsiblefOr the bllildilg. C. Submit PlanRiilE Board Approval of completed site plan reouiremears. D. :or exiszilg builCi.TlEs (,p_-or to April Q, 195 7) mon-conlormiZg llses, or buildings and pore-existiaz" land uses: 1 . Accurate SL':JeV of 7LODer= ' 510&'i7a all orouercv 'lines, streets, bu_df= and unusual natural or zopograpnic =eazures. 3. A orooerlv completed aDD 1.ication and a consent to inspect signed off' Che aDD'_icanz. f a Cert `icac_ of Occnnancv is denied, the 3u'_lding =mspector s, state he reasons therefor in w__tinz to tae aDDL:zant. '_ . Carti_icate of Occupalcv - New dwelling 535.00, Additions to dweIling S_5.00 . Alterations to awe--in-. 525.00, Swi�ming pool ..25.00, Accessory build a S'-5 .00 , Additions t.,^ ry accessobuil_ingr 525.00_ Businesses $50.00. _. Cortilicace of Occupancy on ?re-exiscir•£ 3aildiRs - 5:00.00 3. Copv of Cartiacate of Occupancv - _25c Updated Certificate o' Occupancy - 550.00 5. _emporary Certi=icace of Occupancv - Residential S15.0�0y,_:.o/=ee}rcia_ S'_5.00 Date . . . . 1:`. .y {.� . . . . . . . . . . . . . . . . . . ;ew Construction. . . . a'. . Old O//r����Pre-°s ist°ng 3ui1d'ng. . . . . . . . . . . . . . . . . / .ocation of ?ropertv. . . . . . ?� . .W i nt r5. . . 1.CS U. . .�1L(. . . . . . . . . . ./. d..�TKG{�. . . . . . . . . . . . House No. Z/ ` /Street Hamlet inwer or Owners of Propert7. . . . SU54.h. . .Q..Jn _d I- QAC I/V. . .k-)X& . . . . . . . . . . . . . . . . . . . . . . . . :ounty Tax Y.aD No '10000, Sectyion�.'T73RXX, .Block. . .6I .p. . . . . . . .Lot. . � f. '. 17-/I . . . . . . . u6division. j QCR. v?.04 V G:�l:ZQ.I f!??�/< . . . . . ...fled viae . . . l� 1 1. . .Lot.', / q.�.1Z, . . . . . . . . Permit No. .-?J 7 : . . .Data 0= ?erm.it. . .nZ �c `�..�' . . . . .ADDlican.. . . ;5��'F..�?K l�. . .J-.�USflccjl�U(-��E.�. .ea_ta Dent. Apnrcval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwrit_rs Apnrocal. . . . . . . . . . . . . . . . . . . . e / fanning 3oard Approval. . . . . . . . . . . . . . . . . . . . . . . . / ,eeuest [or: ZIPtry Cert=._icate. . . . . . . . . . . ^i1a1 Corticate. . . . . . . . . . . - oe Submitc_d: S . . . . . f�. . . . . . . . . . . . . . . . . . . . . . . . . . . . � &)43 7? ��?LICA L�ZItLtGG«� TRUSTEES pf S%AfFD(K SUPERVISOR John M. Qredemeyer, III, President ���� CpG SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President4zz Henry P. Smith y ° Town I loll John B. Tuthill %A- T } 53095 Main Road William G. Albertson y ��� P.O. Box 1179 Telephone (516) 7654892 � �f41 Southold, New York 11971 Fax (516) 765-1823 a BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 8, 1993 Stephen Buczak 18 Harmony Street $P 3 Manorville NY 11949 Re: SCTM 4115-17-17 . 11 TOW CDEp7 Dear Mr . Buczak: The following action was taken by the Board of Town Trustees during its regular meeting held on December 6, 1993 regarding the above matter: WHEREAS, Stephen Buczak applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 5, 1993 , and, WHEREAS, said application was referred 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 Monday, December 6, 1993 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 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 Stephen Buczak to construct a one-family dwelling with an associated sanitary system and pool with a 40 ' buffer as per revised plans dated Oct. 25, 1993 . Located Willis Creek Drive, Lot W11 off of Beach Meadow Lane, Mattituck. Permit will expire two years from the date it is sighed. 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. Permit will be issued upon payment of the following fees for work to be done below Mean High Water Mark: Fees : Very truly yours , g John M. Bredemeyer I I President, Board of Trustees JMB/djh CC. CAC Board Of Southold Town Tru SOUTHOLD, NEW YORK PERMIT NO. DATE: 1216/93 ISSUED TO STEPHEN BUCZAK Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the j i; State of New York 1952; and the Southold Town Ordinance en- titled "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 Resolution of The Board adopted at a meeting held on 1216193.. . 19 9A and in consideration of the sum of $ 150,00 paid by `j STEPHEN BUC.ZAK. of Mattituck N. Y. and subject to the 1. • Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: To construct a one-family dwelling with associated santiary system and pool with a 40buffer as per revised plans dated il, Oct. 25, 1993. Deep Hole Creek j all in accordance with the detailed specifications as presented in I! the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. Trustees JX_ TRUSTEES rJ''YS�FFO(� r SUPERVISOR John M. Bredemeyer, III, President �O C Albert J. Krupski, Jr., Vice PresidentSCOTT L. HARRIS �S �O OG��,_ Henry P. Smith za 't Town Hall John B. Tuthill rn x n+ 53095 Main Road William G. Albertson p P.O. Box 1179 Telephone (516) 765-1892 y�O� �'a�Dl Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-115-17-17 . 11 Chapt. 97 - Wetlands NAME: Stephen Buczak Chapt. 37 - Coastal Erosion DATE: October 29, 1993 RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617 , Section 617. 10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration 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. TYPE OF ACTION: DESCRIPTION OF ACTION: Stephen Buczak request permit to construct one-family dwelling with associated sanitary system and pool with a 40' buffer. Located Willis Creek Drive, Mattituck. LOCATION:SCTM #1000-115-17-17 . 11 REASONS SUPPORTING THIS DETERMINATION: 1 . An on site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and reviewed and completed by the Board of Trustees, has indicated that no significant adverse effects to the environment are likely to occur should the project be implemented as planned. CC: C' C IT ra SP `� � ¢ sb THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK NY 10038 Date Application No.ors file THIS CERTIFIES THAT F. only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of `PI:117 f31j;;AF , 971?) WRIM3 CREEK. DRIVE, HPLWTTL'CK, N.Y. E in thefollowing location; El Ise FL El 2nd FT, 17.1 P/f'f°FTi I OUT Section Blork Lot Q f p' Basement E was examined on f II?`' G•'',`1y9., and found to be in compliance with the National Electrical Code. C FIXTURE FIXTURES I RANGES COOKINGDECKS1 OVENS I DISHWASHERS EXHAUST FANS C OUTLETS ECEPTACLES SWITCHES INCANDESCENTJ FLUORESCENT OTHER AMT• K.W. AMT. N.W. AMT K.W. AMT, K.W MIT. H.P, _ n v DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SFECUL REC'PT TIME CLOCKS �Ll UNIT HEATERS MULTI.OUTLET DIMMERS AMi, K.W. OIL H.P. GAS H.P MIT. NO. A.W.G. AMi. AMP. A7 AMPS, TRANS. AMi. H.P. SYSTEMS AMT, WATTS NO.OF FEET _ _I t 90c" i SERVICE DISCONNECT NO.OF S E R V I C E MAL. AMP. rms METER 1 X tW 1$SW ]$3W 3 X KW �'OF CG COND. A.W.G. NO.OF HbLEG A.W.G NO.OF NEUTRALS A.W.G. EQUIP, PER d Of CC.COND, OF HI LEG OF NEUTRAL OTHER A"ARATUS: FATH-i H,r. ,1-2.505 H.P. .1--4 H.P. H.P, t'i2JF;%:ry= gjL . 7- 1 C'.TF.. 60,1-1 CIR. Eld p_ Tt—„ LL i' 07 FTyF,t° :INC: LIC, V':'9:''dF, OENERAL MANAGER 1561 LINCOLN AVE. ury,]RurI()F; fly, 11741 _ a Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be Identified by their credentials, COPY FOR BUTLDTNG DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL.765-1802 c� V TOWN OF SOtJTi3t)LU OFFICE OF 131JILDING INSPECTOR Q ti �.n P.O. 13OX 1179 _3_ TOWN HA LL Of p� SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N 4 rate 1 3 d Building Permit No. 6O2 � Z • - ` Owner_ 15(fG Z (please print) �} �( Plumber C �L�6tjUe E4$ Iy plurf 1,c I i�ktjln J j (pleas print) ' J Ii i I certify that the solder used in the water supply system j contains less than 2/10 of 1% lead. I 4(plum0e r' s signature) j 5,worn to before me this day of Notary Publh:, State of New York1/7 19 � 6 , No. 36-4637216 Qualified in Nassau County Not Pl1b1iC Commission Expires Match 30.19 notary Public , yfYSS County ��O�gUFFO(q-c0 co w a Town Hall, 53095 Main Road O Fax (516)765-1823 P. O. Box 1179 'j' 516 Telephone 765-1802 Southold, New York 11971 '11Q1 �a0 P ( } OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD May 17, 1996 Mr. Stephen J. Buczak 18 Harmony Street Manorville, NY 11949 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 xx 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 # 23027-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. lG�.~ 1117,1'CCTI011 Riil'OR'I UA't'E COMCIENTS '�„ 7OIINDA'I'IOUT ( 15'i') j T — IT --- —_ MURN rRAMR d H t'LI1MIs INR 1 -- --- il.�a✓_"" - -`---- -----------------=--- NSIILATION PER N. Y . — CK-C ----- STATE IiNERGY cont•. ��- --- -- ��-'�-� `-� ----- I — I _ or J FINALJ 1 ADDITIONAL COMMENTS:-------------- n ------------ - - ---- ----- ; -- -- --------- ---- --- Z r, r' I 1 U C003 %S O Lai W Cd o o 1- colo " o � N z LL cc O �- 1 Z N >' 00 W 0 z LU V A Q 4' ILO Y. N 0 = W iy V W N 'O ~ m ju W N O � N LU O v z y z tA Q� _ C/, y `' . a _ SEP f 3 1995 New York State Department of Environmental Conservation Building 40—SUNY, Stony Brook, New York 11790-2356 (516) 751-1389 �� Thomas C. i SEP 13 11ga Commission Cp r "�c�1�N OE cn.pry- Werner L. Adel, Jr. 1 1 t 12 Fox Meadow Lane Huntington, N.Y. 11743 sRE: Application A1-4738-00279/00001-0 Owner: Werner Adel Property - Lot All "Harborview at Matcituck" Subdivision a ^ Dear Mr. Adel: A review has been made of your proposal to construct a single family dwelling, septic system and driveway at the above referenced location, SCTM' 41000-17-17-17. 11 , as per the survey by Howard W. Young dated j 2/ 12/91 and last revised on 5/6/91 . Based on the information you have submitted, the New York State p# Department of Environmental Conservation has determined that the project ' is landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Therefore , no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conse"tion law) . Please beadvised, however, that no 5 construction, sedimentation or disturbance of any kind may take place seaward 1 of the 10' contour or topographic crest 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 in this area as a result of your project . Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e . a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. The New York State Department of Environmental Conservation has also determined that the project is more than 100 feet from regulated Freshwater Wetlands. Therefore, no permit is required under the Freshwater Wetlands Act (Article 24 of the Environmental Conservation Law) . Please notet that any additional work, or modification to the project as described, may require authorization by this Department. Please contact this . office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvalsfrom other agencies i Very truly yours, David DeRidder Deputy Regional Permit Administrator DDR/LJS/rw r��gUFFD(Kc Albert J. Krupski, President �p� OG Town Flail John Holzapfel, Vice President yet 53095 Main Road William G. Albertson y x P.O. Box 1179 Marlin H. Garrell O Southold, New York 11971 Peter Wencael ��j�l ��Odto Telephone (516) 765-1992 1r1� Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 26 , 1994 Stephen J. Buczak 18 Harmony Street Manorville, NY 11949 RE: SCTM #115-17-17. 11 Dear Mr . Buczak: The following action was taken by the Southold Town Board of Trustees on August 25, 1994 : RESOLVED that the Southold Town Board of Trustees grants an amendment to permit #4264 to add a gazebo 10' in diameter. Located Willis Creek Drive, Mattituck. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees i ? AJK:jmd JJJ cc: Bldg. Dept. SE 1 3 "' ou of Cj::I -a l 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE r� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLAC�EA& CHIMNEY RE ARKS: f DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU 'PLBG. [ ] FOUNDATION 2ND [ =SULATION [ ] FRA�IIING [ ] FINAL [ FI/REPLACE & CHIMNEY REMARKS: C t / DATE��l�7ig(�� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R UG PLBG. [ ] FOUNDATION 2ND INSULATION [ ] F G [ ] FINAL [ FIREPL14CE & CHIMNEY REMARKS: � DATE // INSPECTOR , M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY �J REMARKS: DATE j INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ OUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REMARKS: DATE r J INSPECTOR 76S-1802 BUILDING DEPT. INSPECTION [ ] FO �4TION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLAC A CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ Vf FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ l FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY l REMARKS: Et=-.r, .4 V DATE &L3 &c5- -INSPECTOR "' BOARD OF HEALTH . . . . . . . FORM NO. 1 ,, 3 SETS OF PLANS . . . . . . . . TOWN OF SOUTHOLD veSURVEY . . . . . . . . . . . . . . . . . BUILDING DEPARTMENTCIIECF . . . . . . . . . . . . . . . . . . TOWN HALL LIZSEPTIC FORK . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NDTIFY . . . . . . . . . . . . g 2 CALL Examined . . . . . . 19 ./.� �5 � 1,?[ L� TO : Approved . . . . . 9 �7. . . ., 191Krmit No ?jgWl . .. - _ . . . . . . . . . . SSP 138% . . . . . . . . . . . . . . . . . Disapproved a/c TOWN Of SOUTTHOt r, (Buzldi b Inspector) APPLICATION FOR BUILDING PERMIT _ � 7 Date . . /. . . . . Xl ., 19 . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stiee or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app: cation. c. The work covered by this anp.lication may rct be commenced L•efore issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Brildi:.b Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describes The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary mspe ts. ) /I{� ( ignature of applicant, or name, if a corporation) (Mailing address of applicant) / 4,11y c State whether aprlicant is owner, lessee, agent, architect, en 'neer, general contractor, electrician, plumber or builder � . . . . . . . . . . . . . . . . 7 . . . . . . . .. . . . . . Name of owner of premises . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. Plumber's License No. a2 77 Electrician's License No. . el?,��: .�.( . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . :. Lu..aiiun ui ianu an which proposed work will be done. 0/ . . . . . . (' . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . . . . . . . . . . . ... . . . . . . . . . . .... . House Number Street Hamlet County Tax Map No. 1000 Section . . �3 F yy . . :11=5 . . . . . . . . / 1. y. ./. Block . . . . Lot . .. . . . . . Subdivision . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . x. ,�. . Lot . . . . . . . r•�• •�/ (Name) , ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exis[Zng use and occupancy . . . : .,? � . ✓`� ` `'1' � ,t� . .. /. . . . . . . �1 . b. I,-kended use and occupancy . f`.}.'' . .!. . /� �' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . Addition . . . . . . . . . . Alteration . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . : . . . . . . . . . Other Work . . . . . . . . . . . . / (Description 4. Estimated Cost . . . . J. . . . ..r. . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . .f . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . A. . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent ofeach type of use . . . . . . . . . . . . . . . . . . . 7. Dimensions of e fisting structures,if any: Front . . X! . . . . . .!. . . / Rear Depth . . . . . . . . . . trn�e4UStories L : . .Height . h Dimensions o same struc ure with alterations or additions;Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . Depth . . . . . ... . . . . . . �+ j `. Number of Stores . . . . . . - . . 8. Dimensions of entire new con strdction:�'ront . . �( . . . . . . : Rear . . . .�f Cr. . . . . Depth . .f� - , Height . . {1.� . . . . umber of Stories . . .v . .�. . . . . . . . . . 9. Size of lot: Front . . . ,C.� 5/.-`;:. . . . . : . . Rear . ??t ' Y. . . . . . . . . . Depth _,��i' P:. ✓G� n v?Jt 10. Date of Purchase . . . . . . �, :.X . . . . . . . . . . . . . . . Name of Former Owner 11. Zone or use district in which premises are situated . . (-r . /°a j "N"W //S 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . :��. . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . .y? j. . . . . . . . . . . . . . . . . . .Will excesswfll be remov d from premises: Yes 14. Name of Owner of premises t//!. . .✓ `'1/C. . . Address /{f i?�!! d J�t' .Phone No., Name of Architect 0 !144. . . . . . Address fry . >>. . Phone No. .7 Name of Contractor . . . . . . . . . . . . . . Address"J.q d!/!P�� j. . . Phone No. . . . . . . . . . . . . . 15. Is this property within 300 feet of a tidal wetland? *yes. . . . . No. . . . . . . . . *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions fro, property lines. Give street and block number or description according to deed, and show street names and indicate whethc interior or corner lot. STATE OF NEW,):O r S.S COUNTY OF . . . . . . . . . . . . being duly sworn, deposes and says that he is the applican (Name of individual signing contract) above named. -above is the . . . . . . .��•` . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi application; that all statements contained in this application are true to the best of his knowledge and belief;and that thi work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . .~ day of. . . . 1te�( . :!r. . . . . . .. 19 .7.1 CHARLES JEAN OBER Vota Public, Notary Public, State of New,ygr¢, , , , , , , , County ry . . . . . . . . . NO.'30=4 7121 t3 . . . J Qualified in Nassau County !s ^ fre,sL M,�1are'Az 30,t9� w/naiure oure o tF�� (Sigf ap 3� F.F14.P 0 lel :�•Ie.P 2 3 VIA _ & rf.N. 900 GaL. E i�N, l'h)G(9 x4 aE67 -------_— [ 9"I, TANK L ': as ?a- 5 µn5.o .S aW E�• i.Z ro p N — QILOPo5E0 �AV4I TAR'i---- �E TA y N a ANDS y'pUNO ^' LINE OF TIDALMI YOUNG G E FE ME Is%' YO N N � A Lot 1 o w L001111 LVACANT0150odpoA fig*61Az� z I A- - r f C 1 —1 -- — cI w, ) �I — 5c- -I_ O rn p � v -- w5 -- -cj j 1 A ..J4✓ -- 00 cl) Z +. t I I `o LocA�u6E f • yt. n Q-�-G) -0) t 1 t l I �� ce m > ( N O 1 m O L7 m I tt I I 1 •�,____-___.o r,e m � a �,�pL ci -4 n ON U s ! I m .4 z ON N L &W If (1 m (J o) O j / = Or m N u� + I o I m O «) �l m ko ° m // < m Ip V f } 0 lw 3 n It � �'o I Lot I I Lo — Area = 46747 s.f. t i5o.00 ` 19Un 8.07 :U V3 \ 5 w S 7.,034'3 l2 1-°tT) L VACAN NOTE: I. ELEVATIONS ARE REFERENCED TO NGVD (MSL 1929). 2. ----8----=EXISTING CONTOUR 4 SURVEY FOR STEPHEN J. BUCZAK & SUSAN L. BUCZAK =UfFOLK COUNTY DEPARTMENT OF HtA/LLIH SEHVK-t LOT NO. II HARBOR VIEW AT MATTITUCK " JULY 15, 1994 ,�G�/Joy✓ S'�vGy f' c�vli� -(2d/F j',� OCT. 25 , 1993 AT MATTITUCK DATE', AUG. 5, 1993 �RTl��'7b OF corlsTeucTK)r+ S�) / CTOWN OF SOUTHOLD SCALE 1 "= 40' l �3 J � SUFFOLK COUNTY, NEW YORK N0. 93 - 0597 DATE �D NWMUTNORIZEo ALTERATION OR ADDITION TO THIS CERTIFIED TO: SURVEY s A VIOLATION OF SECTION 7201 OF THE STEPHEN J. B NEW YORK STATE EDUCATION LAW SUSAN L wPROVED N COPIES OF THIS SURVEY NOT BEARING THE LAND LAWYER E COMPANY SURVEYOR'S INKED MAL O EMBOSSED SEAL SHALL NOT BE CONSIDERED TO DE A VALID TRUE COPY (TI. '6 *GUARANTEES INDICATED HEREON SHALL RUN ONLY TO HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSI'RUC T THE PERSON FOR WHOM THE SURVEY IS PREPAREDAND a HIS BEHALF TO THE TITLE COMPANY,GOVERN- * NEAREST WATER AlA1M MI *SOURCE OF WATER; PRIVRTE PUBLIC— MENTAL AGENCY AND LENDING INSTITUTION LISTED * �f M SUFF CO. Ti IIA► m"FE QSECTIOM 111L_BLOCK 17 LOT 17 11 HEREON, AND TO THE ASSIGNEES OF THE LENDINS O *THEM AMC NO DWELUNBS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRAMSFEIIIIABLE OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUASEOUENT * THE WATER SURELY AMD SEWAGE DISMAL SY{TEAT FOR THIS R1310ENCE OWNERS WILL CONFORM TO TME STANDARDS OF THE SUPFOLN COUNTY OEPANTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES OF HEALTH GOIVICRS. TO EKISTING STRUCTURES ARE FOR A SPECIFIC APPLICANT. s� vLZf� PPROPERTYALINESRONFORTTHEEERECTIONEOiiMClS �LAND S�` ' s ADOErf ,h, xecL AYOR E YOUNG & YOUNG RM D,NW NOTE:O=REBAR a = MONUMENT ALDEN W.YOUNG,PROFESSIONAL ENGINEER SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG. 21, 1987 AS FILE NO. 8377. AND LAND SURVEYOR N,Y.S.LICENSE NO.12845 HOWARD W.YOUNG, LAND SURVEYOR *TNELOCATMOFW&L(W),EEPTICTANK(gn*CENWOOLS(CP)OKMIINEREON N.YS.LICENSE NO.45893 + ME FROM FIELD OWWATIONS AND OR DATA OBTAINED FROM OTHERS GRANDIS A SONS INC. v v74 fill �9 78. mac" 40.00 59 78* 0 00 >M J N 3� n N ���9N � TIDAL WEtLANDe roUNO � m iT r N DETERMlN1 99, ypUNG ¢ DN FEB.11, w LOt Ip o 222.23 — {y 61 "0000 E. reaool N s A F- r r z 1� o — La '— m U� N ` n< o I"n e \ e >m N w / 0 1 y\,,�11�. �1,�� v 106.8 ------- 14,0` E.4 c.P(�\�L/l�(l 1 1` D i B.T. ) 1 D u O j.. S.d no m m LL N r N u / / RI (0 a P M 14k ° % o 3 ad i � m I � A x W �1 10 M i I m r n TO m O J I < N = C C Q It .A T r /� 1I No Lot II ORul ( tD- lj(r I w s P., 1. Area = 46747 s.f. R�p �? 15o.0O 198.07 R .p s. CT1 S 77°3435 W L Ot 12 a;:•; SURVEY FOR _ APR. 11, 1996 STEPHEN J. BUCZAK & SUSAN L. BUCZAK Nov. T, 1995 OCT. I I, 1995 LOT NO. 11 HARBOR VIEW AT MATTITUCK " JULY 15, 1994 OCT. 25, 1993 AT MATTITUCK DATE : AUG. 5, 1993 TOWN OF SOUTHOLD SCALE; I 40' SUFFOLK COUNTY, NEW YORK N0, 93 - 0597 *UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO: SURVEY W A VIOLATION OF SECTION 7ZO9 OF THE STEPHEN J. BUCZAK NEW YORK STATE EDUCATION LAV SUSAN L. BUCZAK R COPIES OF THIS SURVEY NOT KARWG THE LAND LAWYERS TITLE INSURANCE COMPANY OTISDOLEAADSRECOYHALLNtONIERED BEMBOSSED TRUE ( TITLE NO.93-AS -6342) KGUARAMTEIS INDICATED HEREON SHALL RUN ONLY TO HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED AND NIS GENALF TO THE TITLE COMPANY,4OVLAM• r qt r +`V R NEAREST MA WN SAIN MI • *SOURCE OF WATER- PRIATE•_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED 0 SNIFF CO. TAX P pET D&2SECTIOM 115 NOCK 17 LOT LLU HEREON, AND TO THE ASSIGNEES OF THE LENDING P E *TMEME ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT K THE WATER SUPPLY AND SMSE DISMAL SYSTEM FOR THIS ROIOENCE OWNERS WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT "DISTANCES SHOWN HEREON FROM PROPERTY UNES OF WEAL TH SERVICES, TO EXISTING STRUCTURES ARE FOR A SPECIFIC APPLICANT, PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION O/ FENCES ADDRESS -0 AGQQ T" YOUNG & YOUNG � YOR E NOTE I 1 REBAR • = MONUMENT ALDEN W.YOUNG,PROFESSIONAL ENGINEER SUBDI VISION MAP FILED IN THE 7 AS IL THE CLERK OF14, SUFFOLK COUNTY ON AUG.21, 1987 AS FILE NO, 1337T. AND LAND SURVEYOR N.Y.S.LICENSE N0. 12E45 HOWARD W YOUNG, LAND SURVEYOR N THE LOCATM OF W@L(W),WJITIC TANKISflB CESSPOOLS(CP)SHOWN HEREON N.Y.S. LICENSE N0.45093 ME PROM FIELD OBBERATIONS AND ON DATA OBTAINED FROM OTHERS SRANDIS A SONS INC. a3oa? 7 ��o �y i b� T n N Or TAL WETLANOS pOUNG DIETERM�ED BY � LINO 0 q" ON FEB.11,1991. N Lot 10 o 4 D. . m 222.23 N.81 OOO,OO"E. 15Dod I 11 A r z o _ r I o of Ln (� 48,. 12' It ED.4 e O FOUNDATION = LeIlk. Q a) 8 9 m b CELLAR m CDD( 9 ENTRANL6 }. 'r N D C m IN 2 I ; n !LI g W 1 7. n c\IV W 1 m o _ I m K W W z J 0 O r D 51 W Y % I ` 4 i 0 1 No Lot 1 I ~l `} ° U>- 0 pArea = 46747 s.f. � � D %5006 198•p7 L S 77'3435 W' Lot l2 SURVEY FOR 1995 STEPHEN J. BUCZAK & SUSAN L. BUCZAK OCT' li; 1995 LOT NO. I1 , " HARBOR VIEW AT MATTITUCK JULY t5, 1993 OCT. 25 , 1993 AT MATTITUCK DATE', AUG. 5, 1993 TOWN OF SOUTHOLD SCALE: I "= 40 SUFFOLK COUNTY, NEW YORK NO, 93 - 0597 R UHAUTMORII[D ALTERATION 014 ADDITION TO THIS CERTIFIED TO: 5UAVEY M A VIOLATION OF SECTION 7209 OF THE STEPHEN J. BUCZAK H[W YORK !TATE EWCATION LAW SUSAN L. *COPIES OF THIS "VEY NOT B[ARWG THE LAND LAWYER ITLE N CE COMPANY SURVEYOR'! INKED PEAL OR EMBOSSED SEAL SMALL l b, ' NOT GL CONSIDERED TO BL A VALID TRUE COPY (TIT N "g '�c1 03UARANTEE9 INDICATED HEREON SMALL RUN ONLY TO HEALTH DEPARTMENT-OATH FOR APPROVAL TO CONSTRUCT TME KRSON FOR WHOM THE SURVEY IS PREPARED F '9QQ O AND ON HIS BEHALF TO THE TITLE COMPANY, DOVIRN- R NEAREST WATp MAIN MI I *SOURCE OF WATER: PRIVATE_.PUBLIC MENTAL AGENCY AND LENDING INSTITUTION LISTED �.�. B TIFF CO. TA%MA► DOTZQ4.Qt[CTIONJ 'J5 BLOCK 17 LOT 1711 HEREON, ANO TO THE ASSIGNEES OF THE LENDING �/ O %THEM ARE NO OWELL/NSS WITHIN 100 FEET OF VMS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSF *ABLE { x OTHER THAN THOSE SHOWN HEREON TO ADOITIOMAL INSTITUTIONS OR SUBSEQUEAT K THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS 111MIDENCE OWNERS WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT R DISTAMCEt SHOWN X[REON FROM A LINEf ��. TO[%ISTIM• STRUCTURES ARE FOR ASPECTlPLCIFIC � APPLICANT- BMNIC[f. PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FENCE% �LAND ADDRESS 'uLNI YOUNG & YOUNG R400 RRHETA0, N YAYO NUE NOTE:O -REBAR ■ =MONUMENT ALDEN W.YOUNG,PROFESSIONAL ENGINEER SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG.21, 1987 AS FILE NO. 8377. AND LAND SURVEYOR N.Y.S.LICENSE NO.12543 HOWARD W.YOUNG, LAND SURVEYOR RM LODATON OF IEBLL(W),WJMC TANKO"ll CSSWOOLS(0)MIOWPI HEREON N.Y.S.LICENSE N0.45893 ARB PROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS ARANDIS A BONS INC. 1 -- --- _ -- - r _.... 1. ALL WORK ANFI/►NDEO.I'1 ANT SHALL B 1N' ' r%SrEV"a�7yr>q la. �.� .,:, ----- - A � q } PROVIDE OPENINGS FOR PLUMBING -- - AGGPRRAHOEIT -NEW KOP3 SW ATE QNIFOAM B INR qtr ALL PLUMBING WASTE 1 H TQ� z.x e soLE rLAtE RE MERGENCY ESCAPE AS A WATER LINES NEED -- _ OGRE AN $ NEW qK STA .E ERaY �GJN$E,R IRN,-' enowDE soup bUDcklNa_ 1 ; REQUIRED BY PART. 714 OF TESTING BEFORE COVERING - COD$ ANI ' 4 AUr h'IE& - bENEArH I3 ^Dp9id11 , ALL ip e: LLCONGA asr$ , , . ._PLYWOODSWATtaNO N,YSTATE BUILDING CODE. AY$ , OCCUPANCY OR �'" �}1:,� USE IS UNLAWFUL M �� �^�B�JaF stiqula4¢ R 3P�'RA'� �FII � � fr �*xt - : PLUMBER CERT/FICAT/ON WITHOUT CERTIFICATE ) --G � � °i"a ,f3 p4H „ F< � '' � �' ' " ` ON LEADCOAATENTBEFORE OF OCCUPANCY Y4p „A' a II PROVIDE% NR. FIRE SRT/F/G4TE OF OCCUPANCY, & SS=z3-o nl 9a',%61 N 'o"3A-zs" ` + ' P IDIS t3, UNLE hs A p7, 1, sR$ AT A', �TAIP'� ND j i�nMitE ernEl h.6,sILL seAL RATED SEPARATION TO ;SOLDER USED IN WATER 5 , F� oA Rf+'ENIND$ AND AR4�ARTiTI()) $ PARL 717.3 (f) (1)OF SUPPLY SYSTEM CANNOT OBE , �' QA_r aLL JdI0T"$AND FLooRFD f Y _r3hAriE-b"BELOW N.L$TATE BUILDING CODE. EXCEED 2110 of 1% LEAD, AP ROVED AS NOTED $'tig ,yr aPA'nlN.g3vTTa FT ; I rYPICAL:rLgoFI J IaT TOP Or GONCIIETE - - sl �, AI,.1. DIMS�1SIQN I' NN'IWi14RS 70 $IIS VEgJFJEa.i3`f { v�± �� , ir- DATE: j� S.P.M OL� G kTRAC M'( ,R . ; ' �AT RF C:Rkg bTIRN hfVI7 2 x b IC SILL PLATE x :"Is ; NRATI N RJ N I _ FEE: BY; Lw$ of Haub W2TbANUS r --` � DL�Rj IANC' . ',}q �I PI>LS1 OIF TW,O TS �.' .f DD NOT PROCEED WITH NOTIFY BUILDING DEPARTMENT AT I - 211iI11_ 1 o Q, + '� � ' "�' rot Al $ ALLiiRf ' A-.1/2" dkb"ANCIfoN BOLT - f:OppeF tUbing ii Used 786-1802 9 AM TO 4 PM FOR THE, ^ sItE As%,t1Ei ATIVE Derr FRAMING UNTIL SURVEY for water distributing FOLLOWING wsPEcnoNs: 3 �'-0 D.C. TYP.) f REQUIRED sBY, M , P}H..81iN CRNRAETE w System:Piping Shell be 8 a la'w,aG OF FOUNDATION LOCATION FOR POURED CONCRETE RE s ' _ HAS BEEN APPROVED• of types K of L only p ROUGH - FRAMING & PLUMBING L� bI G T! A44 CFIS 4.ti )'k, 4EN NAND'© gq 70 SUP,PP9TgD " i " BY { L ql ,"IFp AND 0 BY TAf UPRIO Ts: { � UNDERWRITERS CERTIFICATE 3. INSULATION N <_¢ro-74� s-F �_ CJI aACt HEADGRao NIP OF of hAs 4R • eHgwry ON REQUIREDFINAL - LxTIIO - DRAWINI9: _ 4 BE COMPLETE FORRC.O. MUST ^ ALL CONSTRUCTION SHALL MEET G S. DQ NYrf . L♦RAWIINAS;, ¢, _ -- _._. __-_ _---_-_-_ __� --__-_-. _-_._ _ - THE REQUIREMENTS OF THE N.Y, ' B SOXLE $ FrSU{.TAN�., ,QR,qEEQFiD AR HITEq'f-ENOINFFp,ARE. '„ ��." ...-.WATEbPnOOKI1LL aUn -__- ? ',�T", _ STATE CONSTRUCTION & ENERGY I .-- S, Rq I $ �iONo' 1rflp QON$UCTIQNPEOT.VI$IRN, OR „ t P) FAUEb - „ CODES. NOT RESPONSIBLE FOR P.or ougC I MINWM Dep C 'BELOW OpAb AW 14'-0 DESIGN OR CONSTRUCTION ERRORS \' d, ,. .� ti, � s, .,. .� •' .. PCAN.'�`4(oEN FROM `kPa \ �\ ; GRA -`'CTIt1 N N ,L . e(gJAX+„_A CEN A&R Zto) `/•/ Peoe elervEwn7 \\�p�\ �\�, �\\C\ -1` 10,' THIS-J NIANP S ENT NE„ v.LF•N ;, FAG1L'!S A U4TE%D-.oZt¢(jER 2s i%9.3 'I.' , I:1 ,�\ \� �•� ., Anl+cx If '', f:OH '9 y9-4hYEe kA'NR01WN�,Ip F J^� OED'. lie^QXhAN9 M'$DAL_ �A, ,;7 - --- ---- — — ------- --- - --- - -1 -- -- -.__- -- ---- - —T — R p `,' . .,,r YI x A^KEYYM,Y� - - - ' T i - _' -_ ,i '✓—� — ,— --_— — ---- T -.— -- — -._� t1 'I,, $B`q � '911 I DRI ATi*T3i1PP4Y S. 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