HomeMy WebLinkAbout22946-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23861 Date SEPTEMBER 11, 1995
THIS CERTIFIES that the building ACCESSORY
Location of Property 4775 PARADISE POINT ROAD SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 81 Block 1 Lot 24.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 12, 1991 pursuant to,which
Building Permit No. 22946-Z dated AUGUST 18, 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 RELOCATE EXISTING ACCESSORY GARAGE IN FRONT YARD AS
APPLIED FOR AND AS PER ZBA APPEAL #4073.
The certificate is issued to EDWARD & JOANNE CUNMINGS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING AUGUST 28, 1995
PLUMBERS CERTIFICATION DATED N/A
In
Building Inspec or
Rev. 1/81
I
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)
August .d..............................
Date ............................18 19.9........
NG 22946 Z
Permission Is hereby granted to:
Edward M. Cummings
.............................I............I...............
99 Seventh Street
...........................................................
Garden City, N.Y. 11530
.....I.............................................................
Relocate existing garage (Accessory) in front yard as applied for
to ...............................................................................................................................
if as per ZBA $4073.
..................................................................................................................................................................
..................................................................................................................................................................
...............................................................................................................................................I....I.............
.........................................................................................................................
4775 Paradise Point Road Southold, New York
at premises located at...................................................... ...................................
...........................................................................................................................I...................
County Tax Map No. 1000 Section ........$A............ Block.......!.................. Lot No. ,,,24.5
pursuant to application dated ......Sept,;,, 12,,,,,1991,,,,,,,,,,,,,,,,,,,,,, 19................ and approved by the
Building Inspector.
Fee$.........39.,99......
ctor.....
I.................
Buildl�e
Rev. 6/30/80
Form No. G
������
's 'TOWN OF SOUTHOLD
AW 1,740j��'1� BUILDING DEPARTMENT
ii TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use: `
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of coater 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 17. 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
"pre-existing" land uses:
e 1,. Accurate survey of_ proper.-y showing all property linesy streets, building and
unusual natura 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-existing Building - $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
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . .
,Q s
Location of Property. . . .7 . . . . /• •
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .
House No. Street hamlet
Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
;ounty Tax Map No 1000, Section. . . A4 . . . . . . .Block. . . . . ( . . . . . . . . .Lot. ` . . . . . . . . . . .
Subdivisi.on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . I . . . . . . . I . . . . . . . . . . . . . . . . .
ileal Ch Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
'lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
�?equest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
lee Submitted: $. ! �'�e`- �,r.�'V. . . . . . . . .
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FOUNDATION ( 2nd )
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Town Hall, 53095 Main Road 5 Fax (516) 765-1823
9 � �aO� Telephone (516)765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 23, 1995
Mr. Edward M. Cummings
99 Seventh Street
Garden City, NY 11530
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)
xx No Underwriters Certificate on file.
The check is (outdated/not on file. ) $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 22946-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL /
Date 90/ . . . . . . . . . . . . . . . . . . .. 10'/ .
To �ffri
. . . . . . . . . . . . . . . . . . . . .
PLEASE TAKE NOTICE that your application dated . . .�/ . . . . . . . . . . . . . . . . ..
for permit to viz/f�Ce G�� . !?�. .. .G9d �� . . . . . . . . . . . . . . . . . at
Location of Property . . . . . . .ail. . . . �`�. . . . . . . 41J
House No. Street / Hamlet
County Tax Map No. 1000 Section . . . . . . . . . . Block . . . . . 1 . . . . . . . Lot . .
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . .
is returned herewith and disapproved on the following grounds . 1. . . . .
i�o�///f.�0.-3y�,3 . . . . . . . . . . . . . . . . . . . . . . . . L . . . . . .
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�ESuingector. . . . . . .
RV 1/80
J APPEALS BOARD MEMBERS ® SCOTT L.HARRIS
C'
Supervisor
Gerard P.Goehringer,Chairman
Charles Grigonis,Jr. a
,, . Town Hall,53095 Main Road
Serge Doyen,Jr. \ c P.O.Box 1179
James Dinizio,Jr. ,®� ��fl� Southold,New York 11971
Robert A.Villa Fax(516)765-1823
Telephone(516)765-1809 Telephone (516)765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
January 31, 199,2
Mr. and Mrs. Edward M. Cummings � . � = ��
P.O. Box 1900 T%tv++ C>6aeS C9CiIA$a
4775 Basin Road (Paradise Point)
Southold, NY 11971
Re: Appl. No. 4073 - Variance for Garage Location
Dear Mr. and Mrs. Cummings:
With reference to the above matter, please find attached for
your records the Board' s findings and determination rendered
on January 23, 1992.
Please be sure to return to the Building Inspector' s Office for
issuance of the permit. A copy of this determination has also
been furnished this date to the Building Department for their
permanent recordkeeping.
Very truly yours,
L
Linda Kowa ski
Enclosure
Copies of Decision to:
Suffolk County Department of Planning
Building Department
APPEALS BOARD MEMBERSiS9��.g„e x ��G SCOTT L.HARRIS
Gerard P. Goehringer,Chairman y.
a'a Supervisor
Charles Grigonis,Jr. W . zp '!
a ,Jr.
v. rn Town Hall,53095 Main Road
g Y s� P.O.Box 1179
Ser Doyen,
James Dinizio,Jr, rr ® Southold,New York 11971
Robert A.Villa Fax(516)765-1823
Telephone(516)765-1809 Telephone (516)765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
ACTION OF THE BOARD OF APPEALS
Appl. No. 4073:
Matrer of MR. AND MRS. EDWARD M. CUMMINGS. Variance to the
Zoning Ordinance, Article III, Section 100-33 for permission to
relocate existing garage to another location in the front yard
area. Location of Property: 4775 Paradise Point Road,
Southold, NY; County Tax Map Parcel No. 1000-81-1-24. 5 .
WHEREAS, after due notice, a public hearing was held on
January 23, 1992, and at said hearing all those who desired to
be heard were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerning this application; and
WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1 . By this application, appellants request permission to
situate a 20 ft, x 15 ft. accessory garage building, replacing a
previously existing garage at the southeasterly yard area close
to the existing dwelling, to a position in the southwesterly
yard area at not less than 40 feet from the front property line
along "Private Road” and at not less than five (5' ) feet from
the westerly (side) property line.
2. The premises in question is a described parcel of land
containing a total nonconforming lot area of approximately
22, 080 sq. ft. and nonconforming lot width of 119 feet in this
R-80 Residential Zone District. This parcel is improved with
a single-family, 1-1/2 story frame dwelling situated at 45-1/2
feet at its closest point from a private road referred to as
"Basin Road," and at 65+- feet from the edge of the rear deck to
the tie line along ordinary high water mark of Peconic Bay (see
survey map as amended May 21, 1990 prepared by Roderick Van
Tuyl, P.C. ) .
Page 2 - Appl. No. 4073
Matter of EDWARD M. CUMMINGS
Decision Rendered January 23 , 1992
3 . Article III , Section 100-33 of the Zoning Code provides
that accessory buildings shall be placed in the required rear
yard, subject to a maximum height limitation at 18 feet, etc.
4. The rear yard area of this parcel is in the board' s
opinion not a feasible location to place an accessory building
due to the variations of contours from the bluff line at 24 feet
above mean sea level (MSL) to a five ft. contour (within a 33
ft. distance) . To locate this accessory building in the rear
yard would require not only variances from Section 100-239.4 of
the zoning code, but also would require variances from the
N.Y.S. Department of Environmental Conservation for a wetlands
permit and Southold Town Trustees under the Coastal Zone
Management Laws before issuance of any permits may be
considered.
5. This accessory building is proposed to be used for
garage and storage purposes which are accessory and incidental
only to principal dwelling, and although electricity will be
utilized, no plumbing facilities will be installed.
6. It is the position of the Board in considering this
application that:
(a) the circumstances are uniquely related to the
land and buildings and are not personal in nature;
(b) the relief is not substantial;
(r.) the relief as granted will not be an increase of
dwelling unit density or cause a substantial effect on available
governmental facilities since the building is a garage and
storage facility related to the existing dwelling and will not
be used for habitable purposes;
(d) the relief requested is not unreasonable due to
the uniqueness of the property;
(e) there is no alternative for appellants to pursue
other than a variance;
( f) the variance will not in turn be adverse to the
safety, health, welfare, comfort, convenience, or order of the
town, be adverse to neighboring properties, or alter the
essential character of the neighborhood since there are other
accessory buildings located in the front yard area for parcels
within the immediate vicinity (see Appl. No. 3229 rendered
5/17/84 {Griffo) and Appl. No. 1467 rendered 9/30/71 (Dawes) .
Accordingly, on motion by Mr. Goehringer, seconded by
Page 3 - Appl. No. 4073
Matter of EDWARD M. CUMMINGS
Decision Rendered January 23 , 1992
Mr. Grigonis, it was
RESOLVED, to GRANT a Variance to locate a 15 ` by
20' accessory one-car garage in the front yard area as applied
with a setback at not less than 40 feet from the front property
line along Basin Road (private road) and at not less than five
( 51 ) feet from the westerly (side) property line, SUBJECT TO THE
FOLLOWING CONDITIONS:
1 . That the accessory garage structure be used strictly
for storage and garage purposes, accessory and incidental to the
principal dwelling use of the premises;
2 . That electrical utilities may be installed (no plumbing
bathroom facilities) ;
3 . That the garage structure not exceed the height
provisions of the code ( 18 feet) .
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
DInizio and Villa. (Member Doyen was absent due to poor weather
conditions. ) This resolution was duly adopted.
lk � -- l—� ! //lia..
, _RARD P. GOEHRINGE , CHAIRMAN
FORM NO.3
i
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVA
L
Date 9./ ' . . . . . . . . . . . . . . . . . . .. 19 .gl .
To
. . . . . . . . . . . . . . . . . . . . .
PLEASE TAKE NOTICE that your application dated . . .�,/J1�. . . . . . . . . . . . . . . . ..
for permit to / /i 2G'CE✓�?�. . . . . . . . . . . . . . . . . . . . . . at,
Location of Property . . . . . . .7. . . . . .��a�,XL�1�j, , /�,y,L , ,r,�`� Jj��t
House No. Street Hamlet
County Tax Map No. 1000 Section . . . . . . Block . . . . . . . . . . . . Lot . . . y!lfr, . .
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . .
is returned herewith and disapproved on the following grounds . ?� (2 . . � ,-r'f (�
. . . . . . . . . . . . . . .a . . . . . � ' . . . ,,% -. .° . . .
. . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. ss . . . . . . . . .
Buil ing Inspector
RV 1/80
0 V2
gpFF01
APPEALS BOARD MEMBERS ���®,r i �O� SCOTT L.HARRIS
Supervisor
Gerard P.Goehringer,Chairman
Charles Grigonis,Jr. _
Serge Doyen,Jr. Town Hall,53095 Main Road
` ' - P.O.Box 1179
James Dinizio,Jr. '�✓dj�� + ,���fe Southold,New York 11971
Robert A.Villa Fax (516)765-1823
Telephone (516)765-1809 Telephone(516)765-1800
BOARD OF APPEALS
i` TOWN OF SOUTHOLD
January 31, 1992
Mr. and Mrs. Edward M. Cummings
P.O. Box 1900
4775 Basin Road (Paradise Point)
Southold, NY 11971
Re: Appl. No. 4073 - Variance for Garage Location
Dear Mr. and Mrs. Cummings:
With reference to the above matter, please find attached for
your records the Board' s findings and determination rendered
on January 23, 1992.
Please be sure to return to the Building Inspector`s Office for
issuance of the permit. A copy of this determination has also
been furnished this date to the Building Department for their
permanent recordkeeping.
Very truly yours,
Linda Kowa ski
Enclosure
Copies of Decision to:
Suffolk County Department of Planning
Building Department
1';
FEB - 3 02
..
APPEALS BOARD MEMBERS SCOTT L.HARRIS
Gerard P. Goehringer,Chairman " tc r Supervisor
`
Charles Grigonis,Jr. �"'+ a� �+r Town Hall,53095 Main Road
Serge Doyen,Jr. p,0.Box 1179
James Dinizio,Jr.
Robert A.Villa '-I ?s ",ii' Southold,New York 11971
Fax(516)765-1823
Telephone(516)765-1809 Telephone(516)765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
ACTION OF THE BOARD OF APPEALS
Appl. No. 4073:
Matter of MR. AND MRS. EDWARD M. CUMMINGS. Variance to the
Zoning Ordinance, Article III, Section 100-33 for permission to
relocate existing garage to another location in the front yard
area. Location of Property: 4775 Paradise Point Road,
Southold, NY; County Tax Map Parcel No. 1000-81-1-24.5.
WHEREAS, after due nptice, a public hearing was held on
January 23, 1992, and at said hearing all those who desired to
be heard were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerning this application; and
WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. By this application, appellants request permission to
situate a 20 ft. x 15 ft. accessory garage building, replacing a
previously existing garage at the southeasterly yard area close
to the existing dwelling, to a position in the southwesterly
yard area at not less than 40 feet from the front property line
along "Private Road" and at not less than five (51 ) feet from
the westerly (side) property line.
2. The premises in question is a described parcel of land
containing a total nonconforming lot area of approximately
22,080 sq. ft. and nonconforming lot width of 119 feet in this
R-80 Residential Zone District. This parcel is improved with
a single-family, 1-1/2 story frame dwelling situated at 45-1/2
feet at its closest point from a private road referred to as
"Basin Road," and at 65+- feet from the edge of the rear deck to
the tie line along ordinary high water mark of Peconic Bay (see
survey map as amended May 21, 1990 prepared by Roderick Van
Tuyl, P.C. ) .
Page 2 - Appl. No. 14073
Matter of EDWARD M. CUMMINGS
Decision Rendered I7anuary 23, 1992
3 . Article III, Section 100-33 of the Zoning CodeP rovides
that accessory buildings shall be placed in the required rear
yard, subject to almaximum height limitation at 18 feet, etc.
4. The rear yard area of this parcel is in the board' s
opinion not a feasible location to place an accessory building
due to the variations of contours from the bluff line at 24 feet
above mean sea level (MSL) to a five ft. contour (within a 33
ft. distance) . Tollocate this accessory building in the rear
yard would require not only variances from Section 100-239.4 of
the zoning code, but also would require variances from the
N.Y.S. Department of Environmental Conservation for a wetlands
permit and Southold Town Trustees under the Coastal Zone
Management Laws before issuance of any permits may be
considered.
5. This accessory building is proposed to be used for
garage and storagelpurposes which are accessory and incidental
only to principal dwelling, and although electricity will be
utilized, no plumbing facilities will be installed.
6 . It is thelposition of the Board in considering this
application that:
(a) the circumstances are uniquely related to the
land and buildingsland are not personal in nature;
(b) the', relief is not substantial;
(c) thee, relief as granted will not be an increase of
dwelling unit density or cause a substantial effect on available
governmental facilities since the building is a garage and
storage facility related to the existing dwelling and will not
be used for habitable purposes;
(d) the relief requested is not unreasonable due to
the uniqueness of the property;
(e) there is no alternative for appellants to pursue
other than a variance;
( f) thea, variance will not in turn be adverse to the
safety, health, welfare, comfort, convenience, or order of the
town, be adverse to neighboring properties, or alter the
essential charactez of the neighborhood since there are other
accessory building's located in the front yard area for parcels
within the immediate vicinity ( see Appl. No. 3229 rendered
5/17/84 {Griffo) and Appl. No. 1467 rendered 9/30/71 (Daves) .
Accordingly, On motion by Mr. Goehringer, seconded by
•L
Page 3 - Appl. No. 4073
Matter of EDWARD M. CUMMINGS
Decision Rendered January 23 , 1992
Mr. Grigonis, it was
RESOLVED, to GRANT a Variance to locate a 15' by
20' accessory one-car garage in the front yard area as applied
with a setback at not less than 40 feet from the front property
line along Basin Road (private road) and at not less than five
( 5' ) feet from the westerly (side) property line, SUBJECT TO THE
FOLLOWING CONDITIONS:
1. That the accessory garage structure be used strictly
for storage and garage purposes, accessory and incidental to the
principal dwelling use of the premises;
2 . That electrical utilities may be installed (no plumbing
bathroom facilities) ;
3. That the garage structure not exceed the height
provisions of the code ( 18 feet) .
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
DInizio and Villa. (Member Doyen was absent due to poor weather
conditions. ) This resolution was duly adopted.
lk
GERARD P. GOEHRINGER, CHAIRMAN
i
765_1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CqiMNEY
REMARKS: C
Ll
�j
DATE �c0 INSPECTOR
4
r
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001071 BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
AUGUST 31 1995 10041895/95 N 362394
Date T Application No.on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
EDWARD CUMMINGS, 4775 PARADISE POINT RD. , SOUTHOLD, N.Y.
in thefollowing location; ® Basement ❑ Ist Fl. ❑ 2nd Ft. GAR .Section Olock Lot
was examined on AUGUST 28,1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS E%HAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT I OTHER AMT. I K.W. I AMT. I K W AML I K W AMT K W AMi H P
1 1 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPICIAL REC'PT TIME CLOCKS BELL UNIT HEATERS I MUL 1'2U LET DIMMERS
AMT. K.W. OIL H.P. GAS H.P AMT I NO, A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF SYSTEMS T AMT. WATTS
FEE
SERVICE DISCONNECT NO.OF S E R V I C E
AMi, AMP. TYPE METER 1,e'EW 1,e 3W 3 B'3W 3,e'4W NO.OF CC COND. A.W.G. NO.OF MI-LEG A'W'G' NO.OF NEUYRAIS A.W.0.
EQUIP. PER.P OF CC.COND. OF H, OF NEUTRAL
OTHER APPARATUS:
FEEDER TO GARAGE ONLY-1
f G & S CONTRACTOR LIC.#578E
I BOA 215
SOUTHOLD, NY, 11971 GENERAL MANAQER
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 BUILDING [DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Ld 0�
BOARD OF HEALTH . . . . . . . . .
FORM NO. 1 3 SETS OF PANS . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY _ _ , , _ , , , .
BUILDING DEPARTMENT CHECK ,M.40.—. X35.00. . . . . . .
BLDG. DEPT. TOWN HALL SEPTIC FORK . . . . . . .
TOWN OF S6UTNOLD SOUTHOLD, N.Y. 11971
TEL.: 765.1802 r"GTIFY
Examined .'/ 2 . . . 19%,
CALL . . . . . . . . . . . . . . . . .'. .
" " " ' '• h1AIL TO :
AUG. 18, 22946Z . . . . . . . . . . . . . . . . . . . •
Approved . . . . . . . . . . . . . .... .1 19 . . . Permit o. . . . . . . . .
Disapproved a/c . '.�i,/ �7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ZBA APPROVAL 0(4073 dated Jan. 23, 1992
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-- THOMAS J. FISHER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
" (Building Inspector)
APPLICATION FOR BUILDING PERMIT
04710
_ ?
Date
�. 9
. .
.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
;ets 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
)r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:atiun.
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 issued a Building Permit to the applicant. Such permit
;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 Occupancy
,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 the
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
flee applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Sig. . . C . . . . . . . . . . . . .
nature of applicant, or name, if a corporation)
(Mailing paddress of applicant) I
State whether applicant is owner, lessee, agent, architect, engint q,
-
u._
�� gii>aer&i"p�iitraotor, electrician, plumber or builder.
ac.i$'411,�'J ata
. . . . . ........ .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fame of owner of premises . . . . . .1.I. l ...
(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. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . .. .
Location of land on which proposed work will be done. . p"
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
House Number Street Hamlet �/
County Tax Map No. 1000 Section . . . ./. . . . . . . . . . . Block Lot . �.! :�
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 . e�' -D' " , e
b. Intended use and occupancy T
. . . . . . . . . . . . . . . . . .
3. Nature of work (check which apftlicable): New Building . , . . . . . . Addition . . . . Alteration
. . . . . . . . . . . . . . . . .
4. Estimated Cost , OpRemoval . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other 1V
Repair
yiJJ�-�� vH
escription)
q 0 0
Fee . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. If dwelling,number of dwelling units . . . . . . .1, . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . .
Ifgarage, number of cars . . . . ./. . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use7. . . .
Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . , . . . . . . D.ep. .th . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . , . . . .
P (h alterations or additions: Front , . . . . , . ,
. . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth stops of same structure . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . .
8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . •
. . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . .�Number of Stories . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . , , . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
I , , , , , , , , , : Rear . . , . . . ,
. . . . . . . . . . . . . . . Depth . . . , . . . . . . ., . . . . . . . . . . .
101. Done or ate of archse district. in which re • • Name of Former Owner . . . . . . . . . . . :. . . . . . . . . . . . . . . . .
premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: . F
. . . . . . . . .... . . . . . . . . . . . . . .
3. Will lot be regraded . . . . . . . . . . . . . . Will exce s fill be removed from premises: Yes �Io
l4. Name of Owner of premises . tQ• �ddress�� /� � d3v�.J j,7 . . . Phone No. y4-. ..... .. . . .
Name of Architect . . . . . . . . . .?��. . . . . . . . . . . . . Address . S.r ,� /1y6yphone No.0?.
15. Is this
Iprope ty within 300f Addetlanress . . . *Yes. . . . . . . . No. . . .. Phone No. . . . . . . . . . . . . . . .
Name of Contractor . . . . . . . .
uthold
property Y QO feet of a tidal wetland? *yes. . . . . . . . No .
own Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
7 CY 0R
A!'P'R LF1F AS k1OTF�9
r�p•p'�IHCATE DATE: _�! 95—B.F= srQ2�2YL��
OF OEEUpAiNCY
�� o??
NO'➢�F`t %1IL.MNG t:etf Nil ENT AT
cf r'.Ji C) 4 KA POR THE
1. FOUNDATION - 'TANO REQUIRED
l=oll POURED CONCRETE
2, tI(')UGH - FRAMING tat PLUMBING
R
i� 3• INSULATION
NpERWRITERSCERTIFICATE 4. SINAL - CONSTRUCTION MUST
Br COMPLETE FOR C.O.
ALL CONSTRUDTI( i SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & 'ENERGY
n CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
i
;TATE OF NEW O S S
'OUNTY . . ,
acme of � ' • • . • being duly sworn, deposes and says that he is the applicant
( al signmp contract)
bovc named.
Ie is the . . . . . . . . . . . . . . . . . . . . 0. a
(Contractor, agent, cor rte officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
;tplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the
ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
.day of. . . . . . . . . 19C(
County
otary Public, County
. <• • �, ��� ^ n
ROBERT I. JR. .• •.. . . . . .. . . . . . . . .
NOTARY PU State of N.Y. (Signature of applicant)
472508 , uffolk CoyygqI
rm ExPI May 31, 19Y
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