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Home My WebLink About22819-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24334 Date MAY 6, 1996 THIS CERTIFIES that the building ADDITION Location of Property. 1080 NORTHFIELD LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 71 Block i Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 12, 1995 pursuant to which Building Permit No. 22819-Z dated O-ONE 13, 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 FRONT PORCH ENTRY ADDITION TO EXISTING ONE Fi%MILY DWELLINO AS APPLIED FOR & AS PER CONDITIONS OF EBA %4308. The certificate is issued to RO~ER & KATHLEEN WILSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL INSPECTION CERT. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 N/A ~8556 DATED JUN~ 23, 1995 ~ng~I~ns~ FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT N~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL OF THE WORK AUT ZED] COMPLETION ~ ~o,,..i ................................... ~.~. ........... ~...~ 228~9 Z . ' Building Inspec~ F~ ~..~...,~ .... Rev. 6/30/80 uildlng Inspeoto~ //' TOWN OF SOUTHOLD BUILDING DEPARTME~NT TOWN 51ALL 765-i802 A~PLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by cype~riter OR ink and submitted to the building inspector with the following: for new building or new use: t. 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 I% lead. 5. Commercial build'ina, industrial building, multiple residences and similar buildings and installations, a certificate of Code Comp'iiance 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)~ ~on-conforming uses, or buildings and 9pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual na~urat 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 Occupancy on Pre-e~xisting Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20~00 4. Updated Certificate of Occupancy - $50.00 5. .Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ete .... .............. ~ew Construction ......~ .... Old Or Pre-~ist~ )uildin~ .... ~ ......... ~ouse No. S Creet ~a~et ooo, .... 71 ....... ...... .... /¢ ............. Subdivision ........................ ........... . Filed Map ............ Lot ..................... . Health Dept. Approval........... .......... .. ... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~ ..... ~ (5 ~6) 286-6642 ELECTRICAL INSPECTION SERVICE INC. 375 DUN'TON AVENUE ~ EAST PATCHOGUE, NEW YORK ':1772 8§§6 ~PP~ICATION NO. ON VILE DATE: 6-23-95 ADDRESS: 1080 NorthfiBld Lane VILLAGE: ISSUED TO: gathl~ & Rocker Wll. m:m INTRODUCED BY: Lad~ara~ El~bri~ Inc. Southold _ TOWN: Southold LIC. NO. 4141-E AREAS LIS'fED WERE iNSPECTED ON;6--T-23-g5 /XND WERE FOUND TO BE IN COMPLIANCE WITH THE - NA,TIONAL EL._ECTRIC~L C~_D~E ..... ~ BASE ?x ,IST ~ot 2ND ~_3RD ~ATTIC .POOL SMOKE DETECTOR DETACHED GARAGE 10 7 REC~-~'~s 9 SERVICE DISCONNEC'IP ' ' ] THIS CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. - ~' ~H~_GO S. SURDI INSPECTORS MAY BE IDENTIFIED BY THEIR CREDENTIALS, PRESIDENT '~' Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 23, Ms. Kathlee~ Wilson ...... 1080 Northfield Lane Southold, NY 11971 Fax (516) 765-1823 Telephone (516) 765-1802 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 The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22819-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 23, 1996 Ms. Kathleen Wilson 1080 Northfield Lane Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22819-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FINAL I1' II 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] INS~ILATION [ ] FRAMING [,~']~FINAL [ I FIREPLACE & CHIMNEY REMARKS. DATE 765-1802 BUILDING DEPT. [ IF 1ST 2ND [ [ ] ROUGH PLBG. [ ]INSULATION ] FINAL [ ] FIREPLACE & CHIMNEY DATE ~/~/,~ INSPECT klOP4'LI FI L.-L b xLS BOARD MEMBERS derard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robea A. Villa Lydia A. Tortora BOARD OF APPEALS TOWN OF SOUTHDOFLDAppEALS ACTION OF THE BOARD O Southold Town Hall 53095 Main Road EO. Box 1179 Soufiaold, New York 11971 Fax (516) 76%1823 Telephone (516) 765 - 1809 DATE OF ACTION: May.3, 1995 APPL. #4308. LOCATION OF PROPERTY: 1080 North pi~eld Lane, Southold. 1000-71-1-17. .' Disa reval issued by the B .uilding Inspector on. BASI OF APPEAL: Notice of. P.P ...... ,f--w~ an R-40 Zone." ------ S ~ ' rronl; rtl ~ ...in , ^~-;' 12 1995 "Insufficlent sxae an?. ,,~-'~Y~ e~+~, lnO-244B. ~ '?--*-~--J-Z--J~*LED FROM' Artmte pROVIStom~ ~rr=~ ' ¢ REQUESTED: Varqance for location of proposed porch with reduced front RELIE- ~- .... = ~eek with ln.quffieient side yards at 13 feet at the yard at 32 feet anct propo~u u ............ ~-~",, =ide ~ortherly end and existing 18 ft. seroacX a[ tau ~ou[a=-,, ~ - MOTION MADE BY: Robert A. Villa, Member SECONDED BY: Gerard P. Goehringer, ACTION/RESOLUTION ADOPTED: GRANTED as applied_previded there be no further reduction of side yards and front yard. , , REASONS/FACTS: The percentage of relief requested is sot substantial, being a variance of 3-1~2 feet on the side, and three feet on the front. Future enlargement shall be toward the rear yard, or on a second-story level. This request does not increase unit density. The relief requested will not produce an adverse effect or impact on the physical or environmentnl conditions of the neighborhood- VOTE OF THE BOARD: Ayes: Serge J- Doyen, Member James Dinlzio, Jr., Member Robert A. villa, Member Lydia A. Totters, Member Gerard P. Goehringer, Chairman-Member "'~-ERARD P. GOERRINGEIC, CHAIRMAN FORM NO. 3 TO~YN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ..... : ......... 19 To . gARRETT a..S.T..I~..G A/C ROCER & .K.A. ?m~ggN ~ILSON P.O. BOX 1412 SOU~OLD, ~ 11971 PLEASE TAKE NOTICE that your application ~ated ~RIL 11, .... ........................... 19 95 . for pemit to ...~R~q~ A .PORC? ~DITION A~ A DECK ~ITff STAIR ~DITION Location 1080 'NOR~F~ELD ~ of Property ............................. SOU~OLD No. ................. Ham/er County Tax Map No. I000 Section 71 17 .............. Block . . J '. .... Lot Subdivision ................ Filed Map No ................. Lot No .................. is returned herewith and disapproved on the follow~g grounds. I~S~ICI~ SI~ ~ ~RO~ YA~ .SETBACK.AS SET FORTM IN ~ B~K SC~D~E F~. ~E R-40 go~ OF ~'ZONING COD~ OF '~. ~O~ OF SOU~OLD ACTIOH ~QUI~D BY ~ ZOHIHG BOA~ OF APP~LS. Rv 1/80 APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Lydia A. Tortora BOARD OF APPEALS TOWN OF SOUTHOLD Sout/loId Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1809 10, 1995 Mr. Garrett A. Strang P.O. Box 1412 Southold, NY 11971 Re: Appl. No. 4308 - Roger and Kathleen Wilson Dear Garrett: Enclosed please find a copy of the Board's determ{nati°n regarding the above variance application. A copy of this determination has been furnished to the Southold Town Building Department perto!ning to the original building permit application request. However, it will be necessary for you to contact the Builrting Department (765-1802) to be sure your building permit application is on file and in complete for further processing- Issuance of a building permit is rectuired before commencing construction activity. Also, since the subject property is located within 500 feet of a State highway or waterway, a referral and review is required by the Suffolk County Department of planning. Copies of the file have already been tr~n.~mitted for their review and determination as required under the County's Administrative Code, and their response is expected within the next ten (10) days. If you have any questions, please feel free to call. Very truly yours, r,inda Kowaiski Enclosure Copies o£ Decision to: Builrllng Department Suffolk County Department of plmanlng APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Lydia A. Tonora DATE OF ACTIO · BOARD OF APPEALS ACTION OF TI-I~ ~,~r,.~ ,~,- ~ APPL. ~4308 ~. Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1809 APPLICANT: ROG~~EN.~?I~L'SolOdN~an~ South. old 1000-71-1-17- LOCATION OF pi{OPEI~TY- I ~ · b the Buildln ~ -. Notice of Disa reval issued ~__,_t~_e B ~u~_dl~ , 40 Zone" BASIS OF APPEA. L~- ~2 .~.jl~.an t¢--°-o ~o~- ^--~ 12 1095. tnsuxnexe~t[ ~ .... .~r~xr Section 100-244B. ~APpEALED FROM: Article ~,x~, I~ELIEF REQUESTED: Varq~nce for loc~tion of proposed porch with reduced front ard at 32 feet .and p.r~.posed de e s at la feet at the Yorthert end and existing 18 ft. s=~o,~ .... MOTION MADE BY: Robert A. Villa, Member SECONDED BY: Gerard P. Ooehringer, Cbalrman ACTION/RESOLUTION ADOPTED: GRANTED as applied provided there be no further reduction of side yards and front yard._ · , - · The ereentage of relief requested is dot substantial, b_eiUg a p. EASONS/FACTS. P .... ~ .a~o feet on the front. ~'uture "--7- ~-112 feet on the s~e, ~u~,, .... . ~-~--, level This enlargement shah be towarct tae ~ ~ request does not increase unit density· The relief requested will not produce an adverse effect or impact on the physical or environmexxtal conditionS of the neighborhood · VOTE OF THE ReAl{D: Ayes: Serge J- Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Lydia A. Tortora, Member Gerard P- Goekringer, Chairma~a-Member This resolution was u31nnimously adopted- ,' ~ '< / / ~? - 5' -- -" - " L"'" (' :'~ .... ~N .,-7' ~-ERARD P. GOEHRINGEI~y' CIIAI .gtYl~ APPEALS BOARD MEMBERS Gerard R Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Lydia A. Tortora BOARD OF APPEALS TOWN OF SOU _TI-I_O~LD. -PEALS ACTION OF TIlE BOARD (3~' a~' Southold Town Hail 53095 Main Road P.O. Box 1179 Southold, New york 11971 Fax (516) 765-1823 Telephone (516) 765-1809 DATE OF ACTION: May 3~ 1995. APPL. #4308._ · · ROGER and ICATHLEEN WILSON. APPLICANT- ~~~.- anon ~ln,-th Field ~Southold. 1000-71-1-17. LOCATION OF pROPErTY- ~uo~ : 'ce of D~D~v~ ~sued ASIS OF APPEAL ~~etbac~ -.-~ ~ ~-40 ~one.- ~ONS APPEALED ~ut~. --- ~ELIEF REQUESTED: Valance for lo~On of p~posed porc~ y~d at 32 f~t ~d p~posed deck ~ ~ficie~t side yards ~t 13 feet at ~e ~or~eriy end ~d e~S~ 18 ft. setback a~ ~e sou~erly side. MOTION ~DE BY: Robe~ A. V~, Member SECONDED BY: Ge~ P. G~ger, C~r~an ACTION/RESOLUTION ADOPTED: GRATED as app~ed p~ded there be no fur~er ~ducfion of side yards ~d f~nt REASONS/FACTS: The pereenta~ of relief requested v~Ce of 3-1/2 f~t on ~e side, ~d ~e feet on the f~nt. Futu~ e~argement s~H be toward ~e ~r yard, or on a second-sto~ level. T~s ~quest does not ~ere~e ,nit densi~- The ~Sef requested adverse effect ov ~pact on the physi~ or enviromen~ eon~fio~ of the ne~borhood · VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member Jmes D~o, Jr., Member Robert A. V~, Member Ly~ A. Tortom, Member Gerard P- Goe~r, C~r~-Member .-'"":~ERARD ~ GOEHRINGEK, C~IR~ SOU ii LD ..... Town Clsrk, ,~own c~, ~-~,.,t-.,-,5'5__ ,.1) ..' 5 Examined ................. 19. FORM NO, 1 TOWN OF SOUTHOLD -BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 765 ..... TO: $0~-¢~/-05~0 Approved ................ , 19... Permit No ............ · ............ i ..... · .. Disapproved a/c .............. ,, ApR I 1 1995 . (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ...... · Apr t.~..10. ~. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ;eta of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street ar areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli :ation. ¢. The work covered by this application may not be ¢$mmanced before issuance of Building Permit. , d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi · ;hall 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,. ~ ;hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th. 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appLicable Laws, Ordinances o Zegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described Fhe appUcant agrees to comply with all applicable laws, ordinances, building code_, housing code, and regulations, and t~ idmit authorized inspectors on premises and in building for necessary inspection~ . -- (Signature of applicant, or name, if a corporation) Garre~'~ A. Strang~ R.A. .P., .O...B.o..x..1.4.! ~,..S.o..u ~h.o. ~ .d,. .N.Y. ,. .1.17. 7J... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............................................ A r ¢ h.~.:t;~ .c/c ................. : ....................... Name of owner of premises . .R.o.g .e .r . .&. . .K g.~.h. J: e. .e .n' .~.~..]..s.o.n. ............................................ (as on the t,ax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) .Ye+~ . Builder's License No...N.o.~...S.e.l.e.c..'t.e.d. ....... Plumber s License No ......................... Electrician's License No. "..... ................. Other Trade s License No ...................... Location of land on which proposed work will be done = 108.0 Nort~hfield Lone Sout~hold llouse Num bet Street Hamlet .7.'1 BI 01 L 17 County Tax Map No. 1000 Section .... ock . .'. . ct ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy 5. i. n.q 1 e. ..................................... ............... Family Residence ............. b. Intended use and occupancy ........ Sgm.e. 3, Nature of work (check which applicable): Nc',v Building .......... Addition .... .,~)/... Alteration ,..IXX ..... Repair ............. Removal .............. Demolition .............. Othv. r Work., ,)* ........... ... (Description) Estimated Cost 50,0Q0 00 .... Fee ...................................... 4 ' ' ' (to be paid on filing this application) of dwelling units .On.e. Number of dwelling units On each floor ................ $. If dwelling, number ............ If garage ........................................................ ' nature and extent of each type of use ' commercial or mixed occupancy specify ................ 6. If business, , 4~ Depth 2[2 ?. Dimensions of existing structures, if any: Front ..... 6.~. ........ Rear ......................... .2 Q Number of Stories .Opp. Height ................................................................. .6.8 ~. Rear 6./[~ ~ . Dimensions of same structure., with alterations or additions: Front ...... ' ...................... Depth .... .3.6 ................ Height ....... ;Z.8. ............ Number of Stories ..... ~[VP .............. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............. Number of Stories ................................................., _ , 9. ~Size of lot. Front ..... 1,00~.9.~,~ ......... Rear ....... 1.0.4 ............ Depth . ~.8.7. ..... 2[ 17 ........ 0. Date of Purchase · · .¢d~/. 3./) .......... (. ........ Name' of Former Owner · ri, a. 7:'~.-v. ,,,/-..~:2 ¢~ ~..~' ...... 1. Zone or use district in whicl~ premises are situated .............. R .....4!0 ............................ ,,Ye 2. Does proposed construction Violate any zoning law. ordina.n, ce or regulation: ........ ~.~¢..~ · ~ .~ ............. 3. Will lot be regraded ...... ?..No ................. Wdl excess fill be removed from premise~:' × Yes N~ 4. Name of Owner of premises ~. 3q J, ~. ~.o.n .......... Address .~ t: om.f.q r cl..~ ..... Phone No. 7~.fi':4. 60,5 .... Name of Architect .......... ,~ $ ¥ p~.g .......... Address ...S p.u.'c.q 9 [.d ........ Phone No. 7.6.5': 5.45.5~ .... Name of Contractor ..... ~ p.~.. S..e .1.e.q ~..e .d ....... Address ................... Phone No ............... 5. 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 b. uildings, whether existing or proposed, and. indicate MI set-back dimensions fror ,roperty lines. Give street and block number or description according to deed, and show street names and indicate wheth¢ nterior or corner lot, , ~ee A¢¢ached TATE OF NEW y~ogl~, S.S ~urtolk OUNTY OF ........... ~ ' ' Ga r r e 'c % .A.. S.t..r 9D ~ . being duly sworn, deposes and says that he is the applicl (Name of mdw dual signing contract) hove named. Aclen~ - Archit~ect is the... ........................................ ) (Contractor, agent, corporate officer, etc. said owner or owners, and i:s duly authorized to perform or have performed the said work and to make and file pphcation that all statements 'contained in this application are true to the best of his knowledge and belief; and that 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this \ ........... l l .¢..h. ....... day of. _~%~: £~./~..~ ...... ,19,9,5 otary Public,...,~..~' '~' County CLAIRE t. GrEw NOTARY PUBLIC, State of NO. 4879505 1 . (~ualif~d in Suffolk ~nty commission ~.xpirss Oecem~'r · .~...-7'~7.. .... (Signature of applic; FOiIM NO. 1 TOWN OF SOU'rl IOLD BUILDING DEPARTMENT TOWN IIALL SOUTHOLD, N.Y. 11971 Examined ~ICATION FOR BUILDING PERMIT i, i: JUN i 21995 Dale ................... 9,. INSTRUCTIONS a. This application must be complelely filled in by lypewlifer or in ink and submitted to Ihe Building Inspector, with sets of phms, accm'ale plot plan to scale. Fee according lo schedule. b. Plot phm showing 19cation of lot and of ~uildings on premises, relalipnship to adjoining premises or public slieel or areas, and giving a detailed description of ]ayottt of properly must be d~awn on the diagram which is part of lifts apl>Ii cation. c. The work covered by tiffs application may not be commenced before issuaace or Building Permit. d. Upon approval of II}is applicallon, the Building Inspector will issued a Building Permit Io Ihe applicant. Such permi shall be kepi on Ihe lnemises available for inspection Ihroughoul lhe work. e. No buihlh~g shall be occupied or used in whole or in pa~t rot any purpose whalever until a Certificale of Occupanc' shall have been granled by lhe Building Inspector. API'LICATION IS IIEREBY MADE Io the Building I)epa]tment for Ihe issuance of a Boilding Permit pmsuant Io Ih. Building Zone Ordinance or Ihe Town or Soulh~ltl, Soffolk Courtly, New York, and other applicable Laws, Ordinances o Regulations, for th~ construction or Imlldings, additions or alteralions or for ten ova ~1' ( e m o as herein describe{ ' I e ~ ppi cant agrees to comply wilh all appl cab e aws, ordimmces, buikling code, housing code, and ]egulations, and h admit aulholized inspeclo~s Oll l)l'emises and in building for necessary insl)ections, t . (Signature of a~plicant, or ~me, if a corpmalio ~) (Mailing address of applicant) Slale whelher applicant is owner, lessee, agenl, archilecl, engineer, general conhaclor, electrician, l)lumber or builde~ (as on the lax loll or latest deed) If applicanl is a cmporatioq, signature Pr duly authoHied o['ficer.~ ~ . . ~ . . ....... lqumber's l.icense No ......................... Elechician's License No ....................... Olher Trade's 1..icense No ...................... I. Location oflaml on which ploposed work will be done ................................. :... ............. . . . . ........... ...... .. ................... I louse Number Sheet llamlet Courtly Tax Map No. I000 Sedion ...:.Z/ .......... Block ..... O/ ' Lot .... /,7 .......... Subdivision ........ . ............................ '. Filed Map No ............... Lol ............... (Name) Slale ex}sling usa and occupancy of p~emises ami illlended Ilse and occupallcy of proposed coilslrtlcliol]; a. Exisling use and occupancy ..... . . b. hHcnded Ilse IHId occtl lallcy .......... Repair P,e.l~vfil Delnoljllon .... : ......... Olher Wink .... ~! ......... (l)escl iplion) ....... Fee ...................................... (lo lie paid on filing this apllticalion) 5. If dwellin~, ri.tuber of dwellin~ imlls , . . .~..~.~ ...... Number of dwelling units on ead~ floor ................ If g f j - ~ft ' ~ ;~ ~f~ ........ I .................. ~, ........................ 6, )tlSlltess, commercifi or Illlxet occupancy~ spec JiM, re am eXlCll[ of each type o Ise .............. , ..... '7. D e~ s ohs ol exmm~ structure), if any: Front ..... ~.~ ...... Rear .... ~.~ ....... Deplh , ,, ~ ........ llcifih{ ..... ~O ........ Ntm~)e'ofS ores ' Dimensions o shine slrttehl e wilh filterfillons or additions: Front ~ ~ Rcfir .... j~ ........ i)el)ll~ ' . ............ ~.. ' . , ~ Ileight ....... &,~.' ........ :,: Humber of Stmiea ~ ' 8. 1) n ensmns of entire new conslUmlion: Front .............. ; Rear . .............. Depth ............... I leifiht ...i ........... Num]berofSmcs .... 9. Szeo' or' ;mt , /~6" ' r,__ ' 'fi~' ....... ' ................................ ~0. ~,,~ o~ p,,~,,~ ...... ~/.~.. (~.~.... ......... N,,,,,~ ot Fo. ~ 0,~ ~ ~.~?~- ~ ~&;'~' ....... I I. z.ouo m use dishfct in which In,raises lire fi ti filet . ~ ~0 ........... " ....... 12. Does In oposed conslruclion vlolDte fi.y zoning law, ordinance or regulation: . , ,~.~) ......................... 13, Will lot I)e ~egrfided ...... ~0~ .................. Will excess fill be removed front premises: Yes No 14, NamcofOwncrofpremises ~[15°~ ~ .,Ad(hess ,~SeFY~..~.'..l'honeNo. ~'~0 ,, Name of Archil~ct ...... ~.~ ............. Address ,, ~g9 ........ Phone No.. ~,~ ,~.~5~.. Name of Cont~fictor ., , ,~., i. (,~¢~ ....... Address ................... Phone No ................ 15, l.s Lh.Ls properly wi. thin ~00 feet of a tidal 'wetland? *Yes...~,,, No ......... all yes~ Soukbold 'llomt Trustees Permik may. im raqul, red. ' .. ; PLOT DIAGRAM Locale cleady mid distinctly all jlmildings, whellmr existing or proposed, and. indicate all set-back dbnenskms froln pmpelly lines. Give streel find block ]mmber or desclJpliol~ according to deed, find show sh'eet names and indicale whether JlllelJor or corner lot. !1, S'I'A'['I~ OF NEW YORK, , ., ,, ' ~ Z ...... i ........ ~ ' ~ ........... ~ .................... being duly sworn, deposes find sfiys thfit be is tim applicant t(Name of individual sig.i ~g conlrficl) ~le is the ~ i I (c ........... , ....... ) ................ , ............ i onlrfictor, agent, cor'porate officer, cie. oF said owner or owners, and is dul~ authorized lo Im[form or have perfommd Ihe sfiid work and Io make and file Ihls application; thai all slateme ~ts contained la II is a >phcaho ~ are Irue lO rite best of his knowledge and belieF; alld Ihfit Ibc svm k will be pet formed in the m annerJ set forth in the fipplication filed therewith, Sworn Io be[me me tiffs ........... / or .. °mrZ~'ublic, Staoof~ w o ' ( ~ ' (Sigllalure ofal)plicanl) ..... , ~,re,, October 3 ~, 19~