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HomeMy WebLinkAbout22382-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23717 Date JUNE 20, 1995 THIS CERTIFIES that the building AC~3ESSORY Location of Propert~ 2445 PINE TREE ROAD CUTCHO~UE NY House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 3 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 27, 1994 pursuant to which Building Permit No. 22382-Z dated OCTOBER 14, 1994 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 AN ACCESSORY GARAGE TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ~AYMOND T. ~OODWIN of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N353729 PLUMBERS CERTIFICATION DATED Rev. 1/81 (owner) N/A JUNE 2, 1995 N/A Building Ins~pector / FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .X.. .......................... N_° 22382 Z .... ~.,~.~...~.~.s..~.....~.~...~../ ~..~,~,~,.,..~..~~...~ .......... ~..s.........~...~.p...?...~'..d.!.._C'.o.~.,..i... ........ q... .................... .Z.. ............................ ....' a,p,em,ses,ooateda,.....~.~~...'~.~.~ ....... ~ ....... ' .............................. ............................................... ~.../..~.p..~.~ ......... ~....%..,.~. .............................. coumToxMap~o. ~ooo seotion ....... ./...~.~. ,,oo~ ............ .~. ......... ~otNo ..... ~ .................... pursuantto application dated ........ .~..'~ ....... ...~....,~........., 19....2..~...., and approved bythe Building Inspeotor,~ Rev. 6/30/80 BLDG. 'town OF Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. · For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '!pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and ~ unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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 Buildin~ - $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 ew Construction...~../. ..... Old Or Pre-existing Building ........... ocation of Property.,. ~..~.~,~ ..... ?.~.~.~...--~.~.~...~.~..? ...... ]. i~..~..~.'~...~.~.~..~...~_. ........ House No. Street Hamlet nwer or Owners of Property....~.~.~.~..~J~.. ~.--~..%....~..~.~..~f~./..~. .... ounty Tax Map No 1000, Section .... ./.~.¥. ..... Block ....... .~. ...... Lot .... ! .......... ubdivision...~7~..~.~.~.~. ~5 .... Filed Map .... ([7~ .Lot .... ./..~. ~ ermit No ................ Date Of Permit ................ Applicant...~..~..~..o.~...--~.['...~..~..~.p~/~ ealth Dept. Approval ......................... . Underwriters Approval .................... .... . ~lanning Board Approval ............. equest for: Temporary Certificate ........... Final Certicate..'~'~'~ STATE ENERGY New York 'State Degartment of Environmental Conservation Building 40 - S.U.N.Y, Stony Brook, New York 11790-2356 'Telephone (516) 444-0365 Facs~ile (516) 444-0373 August 31, 1994 Lallgdon w~sh comm~ssloner Ray Goodwin 163 Weyford Terrace Garden city, NY 11530 RE:1-4738-00902/00001-0 Dear Mr. Goodwin: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Marilyn Ei~ Peterson Environmental Analyst MEP.jr enclosure file NEN YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION tDEC PER~IT NUMBER ~-47~8-00902/00001-0 FACILITY/PROGRAM NUMBER(S) PEJ JglIT Under the Environmental Conservation Lay EFFECTIVE DATE 8/30/94 EXPIRATION DATE(S) 8/:31/97 ......TYPE OF PERMIT II New D Renewal ti Modification rl Permit to Construct D Permit to Operate Article 15, Title 5: Protection m 6NYCRR 608: Water Quality of Waters Article 15, Title 15: Water Supply Article 15, Title 15: Water Transport Article 15, Title 15: Long Island Wells Article 15, Title 27: Wild, Scenic and Recreational Rivers Certification Article 17, Titles 7, 8: SPDE$ Article 19: Air Pollution Control Article 23, Title 27: Mined Land Reclamation Article 24: Freshwater Wetlands Article 25: Tidal Wet[ands Article 27, Title 7; 6NYCRR 360: Solid Waste Management Article 27, Title 9i 6NYORR 373: Hazardous Waste Management Article 34: Coastal Erosion Management Article 36= Floodplain Management Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control Other: PERMIT ISSUED TO TELEPHONE NUMBER Ray Goodwin ADDRESS OF PERMITTEE 163 Weyford Terrace Garden City, NY 11530 CONTACT PERSON FOR PERMITTED WORK TELEPHORE NUMSER Eh-Consultants, Roy Haje 1329 North Sea Road Southsmpton NY 11968 NAME AND ADDRESS OF PROJECT/FACILITY Soodwin Property 2445 Pine Tree Lane Cutchogue~ NY LOCATION OF PROJECT/FACILITY COUNTY I TOWN Suffolk Southo[d DI3SI~IPTIC]~I C~ A.,rI'H~I7Fr~ ,~--TIVITY WATERCOURSE NYTM COORDINATES Remove remains of 65~ concrete block wall and replace with 65~ railroad tie wall with steps and construct a 34' return. CLear a 3~ wide path Leading to a (3~x50~) fixed pier, (3'x14~) ramp and (6~x20~) float. AIL wok shall be in accordance with the attached NYSDEC approved plan. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, ali applicable regulations, the Genera[ Conditions specified (see page 2) and any Special Conditions included as part of this permit. AUTNORIZED SIGNATURE / xll~ DATE "?~ ~ L ~C~'~C~ 8/31/94 Page ~ of 5 ~ CC:N)ITICN~ Irtspect 1. The permitted site or facility, including relevant records, is subject to in- inspection at reasonable hours and intervals by an authorized representative of the Deparm'ent of Envirorrmntal Conservation (the Deparlrrent) to determine v~hether the permittee is ccrrplying with this permit and the ECL. Such represen- tat ive may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). A ,colby of this permit, including all referenced maps, drawings and special conditions, rrust be available for inspection by the Department at all times at the proiect site. Failure to produce a copy of the permit upon request by a~ Ceparb~ent representative is a violation of.this permit. Permit 2. Changes and Rene~ I s The Deparb~ent reserves the right to rrodify, a) b) c) d) suspend or revoke this permit v~en: the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is found; the permit v~s obtained by misrepresentation or failure to disclose relevant facts; nevv material"inforrmtion is discovered; or enviromental conditions, relevant technology, or applicable law or regulation havematerially changed since the permit v~es issued. The permittee must submit a separate written application to the Department for renewal, rrod ification or transfer of this permit. Such applicationrrust include any forrrs, fees or supple~'ental info,~'ation the Department requires. Any rene~l, rrodification or transfer granted by the Depart~rent must be in wr t ng. 4. The permittee must submit a renewal appl ication at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination Syste-n (S~CES), Hazardous Waste Management Facilities (t-~d~/F), major Air Pollution Control (AFC) and SolidWaste Manage-cent Facilities (S/I~F); and b) 30days before expiration of all other permit types. 5. Unless expressly provided for by the Depar~¥ent, issuance of this permit does not rrod ify, supersede or rescind any order or determination previously issued by the DeparuYent or any of the terms, conditions or requireTents contained in sucht order or determination. Other 6. Lega~ Cbligations of Permittee The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all d~uges, direct or indirect, of whatever nature and by whcrrever suffered, arising out of the project described in thi permit and has agreed to indu,~ify and save harmless the State frcrn suits actions, d~uges and costs of every nu~u and description resulting frcm thi project. This permit does not convey to the permittee any right to trespass upon th lands or interfere with the riparian rights of others in order to perform the permitted v~rk nor does it authorize the irr~airrrent of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. The permi~tee is responsible for obtaining any other permits, approvals, lands easements and rights-of-v~y that may be required for this project. Page 2 of 5 ADDITIONAL G~N[RAL CONDITIONS FOR ARTICLES 15 lTi{le 5), 24, modlticatlon ol the watercourse hereby authorized shall not be com- pleted, the ownels ~hallr without expense to the State, and to such and flood callao ~tV of the watercourse No clam~ shall be made against the 5tare of Now York on accotmt of any such removal or alteration 10 That the 5t,~te ut New ~ork ~halt m no case be liable for any damage by or result Irom tuture operatmons undertaken by the State for the 11 Gmantmng of thms permmt does not relieve the appimcant of the responsm- the US Army Co*l)s ut Fng,neers, U S Coast Guard, New York State TIDA~ WETLANDS 25, 34 and 6 NYCRR Part 608 { other environmentally deletemous matemals associated w~th the project 13 An,/material dredged in the prosecution ut the work hereto permitted shall be removed evenly, without leaving large refuse plies, ridges across the bed of a waterway or floodplain or deep hole~ that may have a tendency to cause damage to nay*gable channels or to the banks of a waterway EN-CONSULTANTS ROY HAJE ]2/11/93 LAST REVISED 7/22/94 SPECIAL CONDITIONS Any debris or excess material from oonstruotlon of this project shall be completely removed from the adjacent area (upland) and removed to an approve~ uplan~ area for disposal. No debris is permi~te~ in tidal wetlands and or prote=te~ buffer areas. There shall be no disturbance to vegetate~ tidal wetlands or protected buffer areas as a result of the permitted activity. ~11 peripheral berms, cofferdams, rock revetments, seawalls, gabions, bulkheads etc. shall be completed prior to placement of any fill material behin~ such structures. Equipment operation below apparent high water is strictly prohibite~. Dock or timber catwalk shall not exceed 4 feet in width and shall be a minimum of 3'%" feet above grade* over tidal wetland areas (* as measured from ground to bottom of dock sheathing). Floats and ramps may not rest on or be stored in any vegetated tidal wetland. 1-4738-00902/00001-0 Page __ of NEW YORK STATE DEPARTMENT OE ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 2S Tidal Wet lands For Art c e. (. ) 9e No permanent structures may be installed on dock/catwalklfloat without first obtaining written Department approval (permit, modification or amendment). Docks/catwalks/floats may not (a) exten~ laterally beyon~ property lines, (b) be placed so that docked boats extend over adjacent property line, (c) interfere with navigation, (d) interfere with other landowners riparian rights. The INTERTIDAL BEACH AREA shall be planted with SPARTINA PATENS ON ONE FOOT CENTERS and the applicant shall ensure a minimum of 85% survival of plantings by the end of five growing seasons. If this goal is not met, the applicant shall re-evaluate the restoration project in order to determine how to meet the mitigation goal an4 submit plans to be approved to the Bureau of Marine Habitat Protection, Building 40 SUNY, Stony Brook, NY 11790-2356. Supplementary Special Conditions (A) thru (F) attached. ?ER,HIT NUM[~[ 1-~738-00902/0000 PROGRAM NUMBER Page 4. or 5 SU?PLE~%{EI~TA~Ry SPECTi~L CO19qDITIONS The Following Conditions Apply To All TIDAL WETLANDS[ FRESi~i~AT~R WETLANDS; COASTAL ~qOSiON ~qAG~--~4F~T; and WILD, SCLWiC, and REC.qEAT!ON~L R-~V~-~RS P?3~MITS: k .copy of this permit, including all conditions and approved plans, shall be available at the projec-~ site whenever aur~kcrized work is in progress. The poi-mit sign enclosed with t-he permit shall be pro~scted from t--he weather and posted in a conspicuous location at the work site until all authorized'.work has been completed. B. The permittee shall rec,/ire that a_ny contractor, project engineer, or other person responsible for the overall supe!-vision of this project reads, understands, and complies with this permit and al! its general, special, and supplementary special conditions. A~ny failure to comply precisely with ali of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of t--he permit conditions are unclear, the pe-~-mittee shall contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. C. If pr. 0ject design modifications become necessary after pe_~-m~_e shall subm_~ the ammroDriate plan changes for approval by the Regions! Permit Administrator prior to undertm-king any such modifications. The pe_~-mittae is advised that sue~stan=ia! modification may require submission of a new application for pe~it. D. At least 48 hours prior to com~enceenent of t~he project, the pe_-~ittse and contractor shall sig~ and return the top potion of t_he enclosed notification form certifying that t_key are fully aware of and understand all terms and conditions of ~his permit. Within 30 days of completion of tlne Del-mitred work, the bottom portion of that for~ shall also be signed and returned, along with photographs of the completed work and, if required, a su--~-zey. E. For projecns involving activities to be u~ndertaken in phases over a pericd of mcre ~_han one year, the pe-~-~ittee shall notify t~ue Regional Permit Administrator in writing at least 48 hours prior to reco~.~encing work in su~bsequent years F. The gr_anting of t_his pe-~-~it does not relieve the permittee cf 't~ke responsibility of obtaining a ~__ant, easement, or c~-her necess~t approval from the Division of Land Utilization, office of General Se-~-;ices, Tower Building, --.~..Dire State Plaza, Albany, .~U£-12242 (5~-6) 474-2195, which ma~_; be required for any encrcacb-~en= upon Stats-owned lands u~nd e_~-~at ar. Page Q ,,., ~OL~THAr~PTON N. ¥. J .d ~,,)UTHAi'~PTON N, ¥, 11968 A~ber! J.,Krupski, President John HolzapfeL Vice President William G. AIbcrtson Marun H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P:O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 March 2, 1994 En-Consultants 1329 North Sea Road Southampton, NY 11968 Raymond Goodwin SCTM #1000-104-3-3 Dear Mr. Haje: The following action was taken by the Board of Town Trustees during its regular meeting held on Thursday, February 24, 1994 regarding the above matter: WHEREAS, Eh-Consultant on behalf of RAYMOND GOODWIN applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 27, 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 Thursday, February 24, 1994 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 En-Consultants on behalf of RAYMOND GOODWIN to remove and replace an existing concrete block wall and construct a 65' retaining wall and 34' return on south side. Wall will attach to and be in line with railroad tie wall to north and will be above AHW. Backfill with 150 c0y. of clean fill to be trucked in from upland source. Construct a dock consisting of a 3' X 50' fixed elevated walk, a 3' X 14' hinged ramp and a 6' X 20' float secured by (2) 2 pile dolphins. Board recommends dry wells, french drains, planting plan for 10' landward along seawall, gutters, and a non-turf area 10' behind the wall. Located 2445 Pine Tree Lane, Cutchogue. Permit will expire two years from the date it is signed. Two inspections are required and the Trustees are to be notified upon completion of said project. Very truly yours, President, Board of Trustee AJK:jd cc: CAC Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4285 DATE:.E~b. 25, 1994 ISSUED TO ...... Raymond .,Goodwin Pursuant to the provlsJons of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the 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 meeflng held on Feb. 2~ 19 94 , and in consideration of ~he sum of $ 996.00 paid by Raymond Goodwin of .... N.Y. and subject to the Terms and Conditions lis+ed on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: To remove and repl~ce an existing concrete block wail and 65' retaining wall and 34' return on south side. Wall will attache and be in line withrailroad tie wall to north and will be above ah Backfill with 150 c.y. of clean fill ~o be trucked in from upland al[ in accordance with the defaiJed speci{icafions as pre.hied ~n the originating application. Construct a dock consisting of 3'X50' fixed elev.walk, 3' X14' ramp, 6'X20' float (2)2pile dolphins Drywells, IN WITNESS WHEREOF, The said Board of Trustees here- by causes ih Corporate Seal ~o be affixed, and ~hese presents ~o be subscribed by a majority of the said Board as of +his daf,e. French )'non-turf area along seawall,gptters. TERMS and CONDITIONS The Permittre Raymond Goodwin residing at 2445 Pine Tree l,~ne. Cutchngue N. ¥., ~ pa~t of the consideration for the issuance of the Permit do~ understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold axe released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any oper- ation performed pursuant to this permit, and the said Permit~tee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permltten assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of ~he Town of 5onthold 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later daw. 3. That this Permit should be retained indefinitely, or as long as the said Permlttee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that anth- orization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if furore operations of the Town of Sot:timid require the removal and/or alterations in the location of the work herein anthorlzed~ or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstrumon to free navigation, the said Permittee wiH be required, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee os the completion of the work anth- orized. 9. That the Permittee will obtain all other permits and coments that may be requited sup- plemental to this permit which may be subject to revoke upon failure to obtain same. 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~] FOUNDATION []FRAMING [ ,~/"FINAL THE NEW YORK BOARD OF FIRE UNDERWRITERS 1195147 BUREAU OF ELECTRICITY ~- SS JOHN STREET, NEW YORK, NEW YORK 10038 ~ D.t. ~ JUNE (}2,1995 ,4ppli~etJo. Mo.o.I.e 87946~95/95 N 353729 THIS CE~I~IES THAT o~y the ol~trie~ equipment ~ ~scHbed ~ a~ intr~uc~ by t~ appl~ant ~med on the a~e application number in the p~m~es of ~.& ~S. ~ODWIN, 2445 PI~ TRE~ RO~, CUTCHOG~, in thefottowlng location; ~ Easement ~ Ist Fl. ~ 2nd ~3. G~/OU~ ~s examined on ~Y 30,1995 Section Bilk Lot and found W be in compH~ce ~ith the Na~on~ Electrical Code. EERVIC~ Gi:~ONNECt' OTHER APPARATUS: S R V I L~' 2WI I ~' 3W 3 .ff 3W 3 .e' 4W NO. O~ERCC, b.¢OND A, W. G, j NO. OF H,.LEG OF CC. CONE*. SYSTEMS ' ' ' NO. OF FEET C E A. W G. NO. OF NEUTRALS OF HI.LEG SPRIN~ ELM. INC LIC.#3921-~ 13MD E. JEFFRYN BLVD GENERAL MAN~GER D~R PARK , NY, 11729 ThisceHificate must not be altered in any manner;returnto the office oftheBoard ifincorrect, lnspectors may be identified by their credentials. BLDG. DEPZ ~ Examined ....... ~.. ..... ^pproved ...... 19. ermitNo..:Z_...Z. .r.2 Disapproved a/c ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Z BOAKD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY CllECK s pT c ;oR,,, .... NO?I py: .. ..... HA]EL TO: '' ' APPLICATION FOR BUILDING PERMIT V ,. , Date ................... 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 s'ti'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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 whatbver until a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of South01d, 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 describbd. The 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 insper4ions., -- _ ..... :. ...... (Si°nature of applicant, or name, if a corporation) ...... ..c.,.T .... .. (Mailing address' o ftapplicant) State whether applicafit is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises ... Pr~...~'t~.~t.Q. O a~ '1> ~//~/ ' (as on the tax roll or latest deed) If appl'cant is a corporation, signature of duly authorized officer. ; (Name and title of corporate officer) Builder's License No... ~.'.F..~.3.. Z/.'~..I ........ Plumber's License No ......................... Electrician's License No. ~Oo t~ Other Trade's License No ...................... Location of iand on which proposed work will be'done ltouse Number Street Hamlet Cotmty Tax Map No. 1000 Section .. ~.- .O...~/..~..O....'. Block .. Subdivision. ...o.?...~...,~'..~. ?...'~'..~..~..~.~..... FileaMapNo...].(.'77~ ..... Lot .../..C/..~ ..... (Name) Stat~ ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ' ' '3. Nature of work (check wh2ch applicable). New Buildine . . Aam,~, · ...... Alter Repair .... Removal .............. ~Demoht,on .... : 7~.'~ i i ~&°~t°L' · ' '"" . .. OtherWork 4. Estimated Cost... · ............ Fee ................ ~ (to be paid on filing this application) If dwelling, number of dwelling units .... ' · If garage, number of cars ...O...~/.ifk.. · .......... , Number of dwelling units on each floor ................ 6. /~i~bnues~;ieoS~; Co~.n~;;ic~als~u~[~r9~ occupancy, specify p,a,t~e and extent of.each, t~yt:)e of use. . .... /.. 7.. ~ ~ g !s if any Front . .~.'-~.. .. R~- ~.,o ,3" '~: .... /.~ r .... Height ,/.?.. '.-k. ~. Number ~- ' ":° ..... ,as....!..~ ......... Depm... ~..q ... ~D~m.e, nmons 9f same structure W~th alterations or additions: Front .. ~ ' 'l~iJ .... 2z. ............ 8. nnre new construction: Front , . /.~. . / ' ' ~ ;/ · ......... Rear ... l~. ......... Depth ...~, .......... · Height P~o.~.../.~..r.,,.. w' Number of Stories ....... /. . 9. Size of lot Front .. b'~ 88' t . " 11. Zone or use district in which prlemlses are situated ...................... , .. 12. Does proposed constructi0nyio'late any zoning law, ordinance o'r r;g~l'ati~n'.'il ~iC. ' ~T..~. ' ~t.' ,.~. 'iO~ ~' .~.' .' i . . , ¢ zaa± wetianu. *Yes ..... No ' If yes, Southold ~own Trustees Permit may be requ~i~.~r~'' ......... . .. ? PLOT DIAGRAM Locate clearly and distinctly alll buildings, Whether existing or Proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NF~O~ I ~/ 'S cOUNTaqOF . . 9..L ' (Na~e of individual signin above named, contract) being duly sworn, deposes and says that he is the applicant (Contractor ................................................... , agent, corporate officer, etc.) said owner or owners, and is duly tuthorized to perform or have performed the said work and to make and file this tpplication; that all statements containled in this application are t'rue to the best of his knowledge and belief; and that the ?rk will be performed in the manner s~t forth in tlie application filed therewith. ~worn to before me this/' . . __ pu. allfi_od in Suffolk COU~r ~// ' ' ' ' ' . ' (Signature of applicant).