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/ SI 1.) MAP OF PROPERTY ON FISHERS ISLAND, NEW YORK, FORMERLY OWNED
TONE
/ / I BY MARTHA E. HOFFERT, NOW BELONGING TO THE SOUTHOLD SAVINGS BANK,
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NOTES
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p p �/ �� �� 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATEDw O
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FORM NO. 3
TOWN OF SOUTHOLD V
BUILDING DEPARTMENT
I ('
SOUTHOLD N.Y. . r
NOTICE OF DISAPPROVAL
DATE: December 19,m 2017
TO: Stephen Hamm(Wells)
38 Nugent Street
Southampton,NY 11968
Please take notice that your application dated October 27, 2017
For permit to make alterations to an e , 1p ilt e et l?1 lllr g to,convert to a tiv a.:( w ly d,av(j lipg. rtl L�
retail surf shop at
Location of property: Montauk Avenug,,�F iAer's L lend NY
County Tax Map No. 1000 - Section 10 Block 7 Lots 3
Is returned herewith and disapproved on the following grounds:
l 1 c,pa alacase l of slr c3c t c in the Business C� ,Distrietm is not ecc�M tte,�I �tlmsutat. t.cs rtmc...c.. I �aa� ttc�tt (),-48.x,
~ tregulatirats
(lam`lvcpr �lvllirl Haat tc cccd�>�xemciclwl,�rtg�aa�_c,l�l�]ca(� �lie�lell.tp �rrust, c>c�c�I�,lc�cl,hy
the-owner oftheliEgp�r�y
ecorc;lk ra .tc�.a the gpp1icant the dwelling will n tle owner-
. ..: ..:c
1 u tl cmr c.pmcpc polclw. ilm, uitesit 1 � . cu(� 11Rtjigl Q rd.
� y l ,,00O000000k4�
Ai .orixecl Signature
Cc:File, ZBA, Planning
Note to Applicant: Any change or deviation to the above referenced application may require
further review by the Southold Town Building Department.
FOR INTERNAL USE UNC
N
NOV 21 2017
E PLAN USE DETER
MINATIO Soy —
S�� thold Town
Plann4iq Board
Initial petermination
Date Sent; l "_
..
Date:---
Project Narr�e: �
�-
Project Address:
0�
00 '� _ Zoning District: .
No.:1'
V
Suffolk County Tax Map — Awn
and supporting docurnentation 43s to
(Note: Copy of Building Permit Application
ratio►
,proposed use or Uses should be submitted.)
Initial Deterrriination as to whether use is p
ernlitted: _
Ian is require
1-Determination as to whether site p
I nitia
------- - mm --- ector
Signature of Building Insp
Planning Department (P-D.) Referral:
i Date of Comment�� � .-- /- -P.D. Hate Received:
. Co rnen ts:
Signature of Pian
Sig
. De t.•Staff Reviewer . .
F l�l��er itl(tiot
Date*(2�_J,. _ ! ��...
Decl,sion:..� _._ . '
c;,.,ahirP of RTiilriina In.nectnr'.....
FOR INTERNAL- USE UNLY
TERMINATIO 2 i <<��ni
SITE P LAN USE C ..w
R,��«F���� ."
"� vire
M Ranninpr rrkac d.
initial et rl-ination
Date Sent:i .
"
Date: _
�k
„ w
Project Name:_
Project Address:
Zoning District-.-,
Tax Map NO-A 000=_�-
." Suffolk County
. . � � orcin documentation"a to
of Building Permit Application and suPP g
(Note: Copy . ��� "(.
-proposed use or uses should be submitted-)
initial Determination as to whether use is permitted:
�-
��N" require
urination as to whether site plan is reqs' .
Initial-Dete.r _ w
- -� -� Signature of Building Inspector
Planning Department (P-D.). Deferral: 17
Date of Comment:
P,.D. ,Date Received: 1=
a\ 17
,rt
Signature of Pian g Dept. Staff Reviewer
l at Determination
Date*.....
. Decision=..�...__�w..�._._... .,....�..._,_�...w�..._ ..__ . .�,.,". �..�....�-..�.
InGnectnr
c;,.naftErP of Ruildina tl "
MATTHEWS & HAM
ATTORNEYS AND COUNSELORS AT LAW
38 NUGENT STREET
SOUTHAMPTON, NEw YOEH 11968
PHILIP B. MATTHEWS -
(1912-1992) 931-283-2400
STEPHEN L. HAM, III FAGSIMILE 931-287-1079
BARBARA T. HAM e-mail:Matthamesq@aol.com October 23, 2017
Town of Southold Building Department
P.O. Box 1179
Southold, NY 11971
Attention Amanda
Re: Application for Building Permit/Notice of
Disapproval for Fishers Surf Shack LLC
SCTM No. 1000-010.00-0 .00-003.000
Dear Amanda:
Further to our recent office and telephone conferences concerning the
referenced property for which my client is seeking a business use, I have enclosed the
following :
1. Completed Application for Building Permit, signed by me,
2. Print of certified title survey prepared for Fishers Surf Shack LLC
by CME Associates Engineering, Land Surveying & Architecture, PLLC under date of
October 11, 2017..
3. Check to the Town of Southold in the amount of the $50 application
fee.
4. Reduced version of the survey showing "Retail Store - Ground
Level' in red.
5. Floor plan of the retail area and bathroom/storage area.
6. Written description of the proposed business to be conducted by
the prospective tenant, Fishers Island Surf Company LLC
Town of Southold Building Department Page 2
October 23, 2017
Please issue a Notice of Disapproval for the proposed business use and any
other features that may require action by the Board of Appeals or let me know if you need
any further information or documentation before you can do so.
I will be out of the office from October 26 until November 21, so there is no
rush as I will not be able to seek relief from the Board of Appeals (and Planning Board)
until I return. However, I would appreciate it if you would give me a call or send an email
upon your receipt of my package in case there is something more you need that I may be
able to provide prior to my departure.
Thank you for your attention to this matter.
Sincerely,
��4,- 4
Stephen L. Ham, III
Enclosures
TOWN OF SOUTHOLD BUILDIN_ :ERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 Survey_
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
t Truss Identification Form
t Storm-Water Assessment Form
q Contact:
pproved 20 (� Mail to:
t Disapproved
Phone:
xpiration 20
B ilding Inspector '1
APPLICATION FOR BUILDING PERMIT
Date OeroB�a iY°e� 2t�17
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy,
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or
Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The
a plicable laws,ordinances,building code,housing code,and regulations,and to admit
au in building for necessary inspections.
OCT 2 7 2017 (Signature of applicant or name,if a corporation)
313 n1JCteur STACCC,
BUILDING DEPT. So J'rM A f 7vd,jJ y t tCt6 8
TOWN OF SOUTHOLD (Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises FISH E R3 50A F SAAC.Ic I-I-C
(As on the tax roll or latest deed).
If applicant is a corporation,signature of duly authorized officer
(Name and title of cofporate officer)
Builders License No.
Plumbers License No. iJjA
Electricians License No, AiIA
Other Trade's License No. Iv 1A
1. Location of land on which proposed work will be done:
9S6 µonlrA-)K,4dENVE C=tSEfeAs tSL�}�✓D
House Number Street Hamlet
County Tax Map No. 1000 Section t�' 0 0 Block O?'0 v Lot 000
Subdivision Filed Map No. A0i Lot N/A
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 3- Fhmi y RE'S i DEt/ce
b. Intended use and occupancy �--FAMit.y RaS/AE�/eE w 1 ONS $dlrit/ffj ujt
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work x_14066 of vSE
4. Estimated Cost VA*PJ0t-W Fee SC.00 CFOX UtSgpt
(Description)
(To be paid on filing this application)
5. If dwelling,number of dwelling units 3 Number of dwelling units on each floor t
If garage, number of cars ,d to
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. n�/A
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Na CHArJUC 7b "%STiN(s Si2dc.TJA6 I Cz+400j0 FcpoR -P a CDwtJE2rEA �Etz 61 R
Dimensions of same structure with alterations or additions: Front Rear ?�hJ
Depth Height Number of Stories
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories
9. Size of lot:Front Rear Depth
10.Date of Purchase 1'1161/17 Name of Former Owner S TEPtfEd N• w Fu s
11.Zone or use district in which premises are situated 9
12.Does proposed construction violate any zoning law,ordinance or regulation?YES ✓NO
13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO
¢tsftAS SuAF SltACk LLC- 3B,JL'GE,jr SF.
14.Names of Owner of premises Address SOS"+940twi#JY Phone No.431)Z83-7!f"
Name of Architect rat A Address Phone No
Name of Contractor dilA Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO ✓
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO ✓
*IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?*YES NO V
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OFSua''k}
�
1-G PJ'Ed L• �M� being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He 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 this application;
that all statements contained in this application are true to the best of his knowledge and belief;.and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
u rA day of el 20 17
L• f7l'L
- •i-i
Notary Public SARMA AM Signature of Applicant
T.H
Notary Public,State of New YON
No 02HA5061959
Qualified in Suffolk Qounty
Commission Expires August 1,,go ly
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631)765-1802 Planning Board approval
FAX:(631)765-9502 Survey
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 20 Mail to:
Disapproved ale
Phone:
Expiration 20
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date peso$'F#% Z3 2017
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or
Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The
a r plicable laws,ordinances,building code,housing code,and regulations,and to admit
at in building for necessary inspections.
4,/ - I-. h1-,-.-,IN
OCT 2 7 2017
(Signature of applicant or name,if a corporation)
313 r.J0GC#Wr STACEC,
BUILDING DEPT. 5a-i r#A t4#rov,IJ y l l j 6 8
TOWN OF SOUTHOLD (Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
AGE-Jr-
Name of owner of premises F(5H64S $WRF SI+ACk L,L C
(As on the tax roll or latest deed)
If applicant is a corporation.signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. r,)LA
Plumbers License No. et A
Electricians License No. A;JA
Other Trade's License No. iv 1A
1. Location of land on which proposed work will be done:
9 S6 MoNTAJK, VCA1Ve 1= sitFAS t S L,4 dD
House Number Street Hamlet
County Tax Map No. 1000 Section Block Qom`°° Lot UQ 3• c3 0
Subdivision Al/A Filed Map No. 4-)/A Lot N/A
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 3- FhMt 1-7 R E5I beWrZ
b. Intended use and occupancy 2� FAM y 1tBStpENGE w(oNE g0J1,VBSf U fo
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work C-10 t6E or vsE
(Description)
4. Estimated Cost U 0%_W Fee 50,00 C Fol. Dt5Afti-o,t+L_1
(To be paid on filing this application)
5. If dwelling,number of dwelling units 3 Number of dwelling units on each floor f
If garage, number of cars A1IA
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. AJfh
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stones
rJa C"AeJL%C To "%Srt+Jfs 5rA4c.T•JAC C�Ro0'jo Ecao+ gE �,JJERrB7) }SER �ttcs
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories
4. Size of lot:Front Rear Depth
10.Date of Purchase to tti 1t? i Name of Former Owner S r6_PtfE1J tJEet-3
11.Zone or use district in which premises are situated B
12.Does proposed construction violateny zoning law,ordinance or regulation?YES ✓NO
13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES NO
Ft11 s=SwAi: Sw4ckLL1C_ 38►ru&ENrsr.
14.Names of Owner of premises Address SOJ tt ATwA#'Y Phone NAM)283-2!tC"
Name of Architect #Jt A Address Phone No
Name of Contractor rd to Address Phone No.
15 a.Is this property within 100 feet ofa tidal wetland or a freshwater wetland?*YES NO ✓
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of�a tidal wetland?*YES NO ✓
*IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property,is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?*YES NO ✓
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OFS�
4-r,F PNF A/ L- 1j,4f-t,Z being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He 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 this application;
that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
?pfd day of8�� 1} 17
� -ary Public
A T HAM Signature of Applicant
Notary Public,Stats of NeW Y01%
No 02HA5061959
{qualified in Suffolk County
('nmmiscinn Frniras August 15.go I Y