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HomeMy WebLinkAbout1000-95.-2-7 sem, FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: March 23, 2016 TO: Gail Wickham(Commerce East One LLC) 860 Commerce Drive t Cutchogue,NY 11935 1 L its Rill , _ ,jr � Please take notice that your request dated April 14, 2016 m 1 For permit to tisa prow as a contractor's yard at Southbid Town Planning Board Location of property: 860 Commerce Drive C utchogue TY County Tax Map No. 1000—Section 95 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: The ro osed use rc uir�site lana _royal 77: Board ri Signature Cc: File,planning FORM NO. 3 TOWN OF SOUTHOLD n BUILDING DEPARTMENT MAP, SOUTHOLD, N.Y. o; Tbwn NOTICE OF DISAPPROVAL --o a,d DATE: March 23, 2016 TO: Gail Wickham(Commerce East One) 860 Commerce Drive Cutchogue,NY 11935 Please take notice that your request dated March 3,2016 For permit to construct a maintenance and equipment workshop at Location of property. 860 Commerce Drive, Cutchog_ue,NY County Tax Map No. 1000—Section 95 Block 2 Lot 7 Is returned herewith and disapproved on the following grounds: The proposed construction requires site plan approval fro Southold Town Piannin pard. Au gnatur Cc: File,planning R - OF LOTS 6, -7 $ "MAP OF NORTH FOR, lNl?U TRI L PARK" MEG,IN flFl t tt E C-6 ofFOL - gogTy .IA.JY 2T; Ay FrtE NO.11215 A UT14 -t, Tom: 5OUTHbLr-> 5VFFC>Lr- COUNTY, NY 5URVETEO AUGUST 22.2006 StWTY TA X,$ - � yin T3tt _ �.' l `, i t. � camp=yoTdrw1 CD AI n V '11 V << , 1 3 4 T s�4 IVL NOTES, _. • REBAR AND GAP - � PROPERTY ZONE.LIGHT INDUSTRIAL OFFICE PARK - - _AREA LOT_b.= 120,OOb SF.Oft 2.1545 ACRES AREA LOT`1 - 120.163 SF.OR 2.'1123'ACRE5 _ $ AREA LOT 0 = 136,D60 S.F.OR 3.1419 ACRES ..=4.. - ..K..... TOTAL AREA 311623 S.F.OR 8.6690 ACRES JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.IIC.NO.50202 GRAPHIC-56ALE 1"= 100' RWERIWAD.RM 1001 369-2239 Fax_M94ZS7 REF.\1Compagscrvcrlpros106\06-233.pro UR S` OF LOTS 6 `7 � N rrMAP OF NORTH FORK I OU TRI L PARK" - FILED:IN TNF_OFFICE T G>E OF FCL.K ,. COUNTY J^WA�?Y 21.W—05 ri:ln No.1€7!0 E 1' J T : GUTHeC-U `s cP' OLr- COUNlY, N1` `ANON` 31 r SURVEYE4 AU6UST 22,2006 TVw .h ` 1 65 %zs i . 7stA Af.T!s` it"1pww= Yeit .41 3 `° Iu Grp. m c- S \� c� Alm , DA mow 06IA ' IL Lg, , a \ a y n pw NOTES, - � REBAR ANO'GAP - IIr HORMENT . PROPERTY ZONE C164T INDUSTRIAL OFFIGE PARK , I AfZF�4. OT Iz lZO,000_SF.09 2:1540 ACRES AREA LOT 1 . 120,163 S.F.OR 2.112}ACRE5 A , AREA LOT 0 =136,B60 S.F.OR 3.1419 ACRES ... SURVEYOR TOTAL AREA- 311,623 5F.OR 0.6690 AGRE5 J\.I , EBLERS -ND L 6RAPHIG SALE I`= 110' RrVEPJJEAD.N 11901 _gll&Fjz 363-626'1 REF.\iCompagscrvcr\pras\06\06-233.pro w".—a I--u Associates Architects ]6:v+rinn,rxY+a+ e ciYk,ny Ci57ti ' (5161471^161, 7„(seuy ts]a»4 V LOT B. t "^'d<rax mn �,✓µCfi7[x nni 'a•• P _q"..... ......._, .._..... _.,....... ------ .. kms. r+w"p 4 arw wxa a ,,.wmr ,n,c,owwwu mwl mcrna IPeconic �.:� �°���,� � mew � I �✓"C�G��?cq ��U1�Ci'tb(.�; Recycling 5'bOCommorceDrivc Cutchoguc,NY J 51TE q r _ Z-7 PLAN �mSi t E PLAN �T . ry°, rYO, i -1,ckcai ru � 1. DiGiovanni& Associates Architects 21p,.,%....— a1VM,rrJ 11519 (Si6�ePq*]ei� ............. }}ucO 14 I I I I � I C � 1 �, arrce mn AfI tvA I A rl� M1I�e !rthl ,�/�' le}1AY M eLt 4Mif 't` I `� 1��� . PEconic �C7rtT i�" �t� w/T Recycling ^ 560 Cwwm Drivc DYIWCutchoguc,NY µ ( 517E 51 FE PLAN _�C7C> PLAN to� r31� � ..SP-1 p1ib",kk� (�T �C FOR INTERNAL USE UNLY � _�_ .� �rk USE ETERMINATI APR 22 2016 SITE PLAN sold Town Planning Board r initial Deterr6ination Date Sent- = Date: - - Project-Name: -- Project Address: - Zoning Distract:= U— Suftolk County Tax Map No.:1000= = Request' Ems` orting documentation-as to (Note: Copy ofuildirg Permit Application and supe .proposed use or uses should he submitted.) initial Deterrriinafion as to whether use is permitted: . Ian is required:— ._ i s to whether site p APR 272016 Signature un npeo B ING Ti Date of Comment: p.D.-Date Received: if Lf 3Q-1 Ilk a - a comments: Signature of Planning epi Staff Reviewer Final laet �inaion Date: ` DeClsion: .�fi erP ()f Ruildina IngnPctnr 4 � v LLT 16 FORINTER ONLY x ? f � E � SITE PLAN USE DETERMINATI4 2Z ,U Southold Town Planning Board Initial Determination Date Sent: f_ Date* '—� - Project-Name: Project Address L/ m _ � Zoning District: �T v Suffolk County Tax Map NO Request' mentation-as to late: of Suildi Permit Application and supposing dog proposCopy 9 ed use or uses should be submitted.) Initial Deterniination as to whether use is permitted: � 'tial-Determination as to whether site plan is required:_ ln� , Signature 0- ui ing In peck r - Planning Dep artment P.D.) Referral: � .- � " Date of Commend P.D.Date Received:__ Comments: a a a Signature of Pl nning p..-Staff Reviewer ina1otermination Date: Decision: c;.,t,afi�rP of Rtiildina In_qnPrtor LAW OFFICES WICKHAM, BRESSLER& GEASA; P.C. 13015 MAIN ROAD, P.O.BOX 1424 MATTITUCK,LONG ISLAND ERIC J.BRESSLER NEW YORK 11952 WILLIAM WICKHAM(06-02) ABIGAIL A. WICKHAM JANET GEASA 631-298-8353 TELEFAX NO.631-298-8565 awickham@wbglawyers.com March 3, 2016 Attn: Damon Rallis, Building Inspector Town of Southold Building Department 53095 Main Road P.O. 1179 Southold, New York 11971 Re: Owner: Northfork Recycling Property, LLC Premises: 810 Commerce Drive, Cutchogue, NY SCTM#: 1000-95-2-6 Owner: Commerce East One, LLC Premises: 860 Commerce Drive, Cutchogue, NY SCTM#: 1000-95-2-7 Dear Damon: I enclose the following amended applications in connection with the building permit applications submitted for Notices of Disapproval on the above referenced lots on January 28, 2016: 1. For Tax Lot 6: Amended building permit application for Notice of Disapproval and revised map; 2. For Tax Lot 7: Amended building permit application of Notice of Disapproval; The $50.00 fee for each application was also submitted on January 28, 2016. Please advise if you need any further information. Very tryly yours, i AAWldin -bigail A. Wickham encl. r = 301shdbdnod2016 ....... ..... TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNSTREET VILLAGE ER .. _ . ._.... ....�...m___,._ ._. w_ _�._..... � � � DIST. SUB, LOT 2ACfj ]Ft �e �II I 2.I S Z ACR 1 REMARKS � 2705 3 ,� as- � t t ,t ` � ' G - v t S TYPE OF BLD. „� 91 (,�� 0 - I PROP LASS _ �._ �C _ ,dQ fo , T. LAND IMP, TOTAL DATE r FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT 3, (4 r� l��© Ifo TOTAL ZWLIANt-T ti 211 A?PL!CAT ION CHECKLiSi BUILDING DEPARTMENT Do y ;ave or need the following,before applying? TOWN HALL Board of Health SO17- LD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval Fes: (631)765-9502 Su Vey SoutholdTown.NorthFork.net PERIMIT NO. Check Septic Forur, N.Y.S.D.E.C. `sr ustees C.O.Application Flood Permit Examined 20Sirg;e&Separate Storm-VIater Assessment Forn Contact: Ac pr=Ve .20' Mail to: Disapproved alc _�* I- Phone: Ex iratio 20 Pg pe `' APPLICATION FOR BUILDING PERYIIT Date March 3 � rd INSTRUCTIONS a. Map i aW641 ST be completely filled in by typewriter or in ink and submitted to the Building In with c sets ofpans,accurate plot plan to scale.Fee according to schedule. ,3�, Edcat's°on of lot and of buildings on premises,relationship to adioining premises or public Streets or areas; 1 _, t' '• +1�} :F e wo.r caverecy 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 nail t.e kept on the premises available for inspection throughout the work. e.N`o 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.T he 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. zz�///&,x igniiwte of appli an+or narne,i-a corporation; P.O. Box 1424, Mattituck, NY 11452 (Mailing address of appicant) State ,whether applicant is ow-ner,lessee,agent,architect,engineer,general contractor,electrician,plu.,_ber or builder Agent Name of owner of=,raises Coumerce-East One, LLC (As on tre tax roll or latest deed) if applicant is a corporation,signature of iuly authorized officer (Name a+d title of co orate officer) Builders License No. Pl:l rbers License No. Electricians License No. Other Trade's License No. 1. 1.oceuon of land on which proposed work will be done: 860 Co--erce Drive Cutchogue House Number Street Hamlet 9' Black Golu ty Tax.Map No.. I000 Section � Lot 7 V .v 1111 ILI lCl'k IIUUs LL 1G1 f'i"jC rllt'u lviuP1NU. iP:/1 —uL 0 .e existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant, with temporary storage of trucks,trailers & containers b. Intended use and occupancy Building Contractor Yard v. I\Tature of work(check which applicable):New Building Addition Aiteraton Repair Removai Demolition Other Work x outside storage (Description) d. Estimated Cost Notice of Disapproval Fee $50.00 ,To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor I garage, number of cars 6. If business,co=--rcial or mixed occu-anvy,specify nature,and extent of each t f pe of use. Dimensions of existing structures if any:Frc rat N/A Rear De,t. Height Number of Stories i en's o7s of same structure With alterations or additions: `rout Rear Depth Height Number of Stories d. Dimensions o`entre n evv construction:Front 240 Rear Same Depth 501150` Height Less than 35' Number of Stories One 7. Size o. 0 :Front 335 Rea; 570 Depth 337 lv.Date of Purchase e;��GL- Name ofror_mer Owner 1 t -1- J 11.Zone or use district in which premises are si[:uated LIO 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO x 13.Will lot be re-graded? YES NQ x Will excess fill be removed from premises?YES NO x 11.Names;.f Owner of premises- �,� �.�I ddress l-li 'lN41:none N � -S Name of Architect David DiGiovanni Address Sea Cliff, NY Phone No 516-671-3624 Name of Contractor Address Phone No. 15 a.is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO x *IF YES, SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 3"v0 feet of a tidal wetland?*YES NO x *IF YES,D.E.C.PERMITS MAY BE REAL?IRED. 16.Provide survey,to scale,wild, accurate foundation plan and distances to property lines. .Ii-elevation at any point,on proper iy is at 10 feet or below,must provide topographical data on survey. &.^.re there arty covenants and res-ictions wifn respect to this proper y YES NO IF YES,PROVIDE A COPY. SATL OF NIE r$k'YORE.) SS: CO NTTY OF SUFFOLK) Abigail A. Gvickham being duly sworn,deposes and says that(s)he is the applicant Name of individual"signing contract)above named, (S'an He is the Agent Contractor,Agent,Corporate O-Mcer,etc.) of said owner or owners,and is duly authorized-Ito perform or have performed the said work and to make and file this pplication; that all statements contained in this application.are true to the best ofhis knowledge and heli performed in the manner set forth in the application filed therewith. 1, 1114- A"=W=t, '= u- roc' .'u+r Sworn tq before me anis ` = day 0! f 20 D MA McGAHAN J Notary Pub c,State of New Yo ,}; C `,:4851459 ` Notar;Public Qualified in S:.ffOlk County S azure of p iicant Aun. 18.`ME - WICKHAM,BRESSI_L k GEASA,P.C. C0� NY�I1952 ATTORNEY BUSINESS ACCOUNT 13015 MAIN ROAD P.O.BOX 1424 50-7911214 4;13,2016 MATTITUCK, NY 11952 (631) 298-8353 PAY TO THE Town gf Soud'())d ORDER OF Fifty and OG1100,xx ""#°` DOLLARS Town of Southold MEMO tJv toy 1 Peconic'Tlansfer 8@02022711' 402140?9121:11'42241,00236 211' Phone: v.xp F a ion �20 Building Inspector APPLICATION FOR BUILDING PERMIT Date March 3 .20 lb INSTRUCTIONS a. I iRap Il at MUST be completely filled in by ypewritel or in ink aad submitted to the Building Inspector with sets of plans,accurate plot pian to scale.Fee according to schedule. location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,4Ae his appIioation 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. C.No building shall be occupied or used in whole or in part for any purpose what so ever until the Buiiding inspector issues a Certificate of Occupancy. f.Ever building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has no,been completed within; 18 months from such date.If no zoning amendments or other regulations affecting the proper 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 oft'e 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 applicant agrees tc 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. , ttsi natute cf aapg cant or name,if a corporation) P.O. Box 1424, Mattituck, NY 11952 (Mailing address of applicant, State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Agent Name of owner of premises Coirmerce-East One, LLC (As on the tax roil or latest deed) if applicant is a corporation,signature of duly authorized officer (Narne and title of corporate officer) Builders License No. u -°bens bice e No Electricians License No. Other Trade's License No. 1. Location of land on which proposed worst will be done: 860 Comerce Drive Outchogue House Number Street Hamlet 7 County T ax Map No. 1000 Section 95 Block 2 Lot .C%Fl ivvi�u ruix iiuua�t�ai tr'`ait� L'11GCt 1viG�,71V U. «� LUi. existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant, with temporary storage of trucks,trailers & containers Intended use and occupancy Build .ng Contractor Yard 3. Nature Cf work(check which applicable):New Building Addition Alteration Reuair Removal Demolition Other Work x Outside storage LDeSGr,ptiCn) 4. Estimated Cost Notice of Disapproval Fee $50.00 (To be paid on filing this application_) If dwelling,number of dwelling units Number of dwelling units on each floor f garage, number of cars 6. Ifbusiress,ocrrLmerciai or maxed occupancy,specify nature and extent of each ype of use. DImeP.siCr.s of exiS:ing Strutt IeS,if�P rCnt N/AReare <. Height Number of Stories Dimensions of same s11 ct!re with alterations or additions, Front Rear Depth Height Number of Stories 8. Dimensions of en tine new construction:Front 240 Rear Same Depth 50,1150' Height Less than 35' Number of Stories One 9. Size of lot:Front 385 Rear 570 Depth 337 10.Date of Purchase Cu Q-1 Name of Former Owner I(-40- 11.Zone or use district in which premises are situated LlO 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO x 13.-Viii! lot be re-graded?YES NO X71-111 excess fill be removed from premises?YES NO x po i �I 14.Names Cf Owner ofpreMsest 01111 1� -ddress' 1 aTie - Name of Architect David DiGiovanni Address Sea Cliff, NY Phone No 516-671-3624 Name of Contractor Address Phone No. 15 a.IS this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X *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 x IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. _..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 ,F YES,PROVIDE:A COPY. S TiATE OF NEW YORK) SS: COUNTY OF S FOOLX Abigail A. Wickham being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Agent (Contractor,Agent,Corporate Officer,etc.) Of said owner or owners,and is duly authorized to perform or have performed the said work ana to make and file this=t=ulicat or,; ;W-�.. that all statements contained in this application are true to the best of his knowled e and belief,and that the work be performed in the manner set forth in the application*sled therewith, y. c t' ;, t' -_7_11r____". f r t Sworn to before me this day cF 20 r (r E)ONNA McGAHANV 1\ 4k fr 4F Notary Puo'i ,F State of NewYh ' L 4859459 Notary Public Qualified In Suffolk County Signature of Applicant __ ­;, Fvnirac Aim. 98.201` yr 15v u i nvi.0 BUILDING PERMIT APPLICATION CHECKLIST ING DEPARTMENT Do yo: ve or need the following,before applying? HALL Board of Health 'HOLD,NY 11971 4 sets of Building Plans (631)765-1802 Planning Board approval (631)765-9502 curve", choldTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit amined ,20 Single&Separate Storm-water Assessment Form Contact: ap roved 20 Mail to: isapproved a/c Phone: <piranon 20 Building Inspector s. A APPLICATION FOR BUILDING PERMIT 10 1�2rc, Zgt Zcvff� Date March 3 20 16 INSTRUCTIONS a,This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 ;ts 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 -eas,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 Zail 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 sues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of :nuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the roperty have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an ddition 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 uilding Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or .egulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The pplicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit uthorized inspectors on premises and in building for necessary inspections. 2 i &LLI' r =Signature of applicant or name,if a corporation} d P.O. Box 1424, Mattituck, NY 11952 (Mailing address of applicant) ;tate whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Agent vame of owner of premises Commerce East One, LLC (As on the tax roll or latest deed) f applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) 3uilders License No. 'lumbers License No. 1lectricians License No. Dther Trade's License No. Location of land on which proposed work will be done: 860 Commerce Drive Cutchogue House Number Street Hamlet County Tax Map No; 1000 Section 95 Block 2 Lot 7 Subdivision North Fork Indust- al Park Filed Mag No. 1121'; Lot $ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant, with temporary storage of trucks,trailers & containers b. Intended use and occupancy Building Contractor Yard 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work x outside storage (Description) 4. Estimated Cost Notice of Disapproval Fee $50.00 (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front N/A Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front 240 Rear Same Depth 501150' Height Less than 35' Number of Stories one 9. Size of lot:Front 385 Rear 570 Depth 337 10.Date of Purchase (E:c G0& Name of Former Ownerp- 11.Zone or use district in which premises are situated LIo 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO x x3. N71",1 lot be re graded?YES NO x Wi11 excess fill be removed from premises?YES NO x 14.Names of Owner of pr misest t t31w-+ L-4&LL dd.e , hone No '9'� Name of Architect David DiGiovanni Address Sea Cliff, NY Phone No 516-671-3624 Name of Contractor Address Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO x 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 x *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 OF SUFFOLK Abigail A. Wickham being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Agent (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 P-pnlication: that all statements contained in this application are true to the best of his knowled e and belief an`that the work' performed in the manner set forth in the application filed therewith. O ic3 tUt U� c & cur >v Sworn before me this_ day of jn � 201 , ' DONNA McGAHAN t Notary Public,State of New Yo � --� -®sero-#'�1C4851458 Notary Public Qualified in Suffolk County Signature oo'a�licant V __ . Pvni,p-Aua.18.2019