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Home My WebLink About21236-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22252 Date APRIL 9, 1993 THIS CERTIFIES that the buildin~ Location of Property 240 KNOLL CIRCLE, House No. County Tax Map No. 1000 Section 37 Subdivision Filed Map No. ADDITION EAST MARION~ N.Y. Street Hamlet Block 5 Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 16, 1992 pursuant to which Building Permit No. 21236-Z dated FEBRUARY 23~ 1993 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 DECK ADDITION TO EXISTING ONE FA~4ILY DWRLL1/~G TO CONDITIONS The certificate is issued to OF ZONING BOARD OF APPEALS~ #4118. GLADYS J. MILNE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ldi~g Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMZT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N? 212~11Z Dote ~..~,,,.~.. ...................................... , ~9.~..~. Permission is hereby granted to: _. // ~.'.~..~ .................................. ..~.,.~.....~ ................................ ~~' ~~ ~,~, //~ ~~...~..~.~~~~.~~.....,~., ~. ~_,~ ~ ..~ .=_~_ ..~~~~......~.~ ................................. ~.....~=~=~.~.~Z~.~.z=~ ........... ~ .......... ~....r ................................ ....... Coun~ Tax Map No. 1000 Section ....... ~.~ ......... Bilk ....... ~ ....... Lot No ..... ~ ............. ~u~.o,, ,o ~.,,:~,,o. ~,~ .... ~~ ............................. ,,. ........ .~.. ~..o~ .~ ,,~d~ng ~,~.:tor. ~ ~/~ ~/~g Fee ......... Rev. 6/30/80 Ae Form No. 6 I~ ~ ~ BUILDING DEPARTMENT I~ ,!! TOWN HALL T. OW!~ C~: fk.:<~::'C~('~ ~, ~PLICATION FOR CERTIFICATE OF OCCUPANCY This application mu'st be filled in by [ypewriter 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 fo~). 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 Z/lO Sf i% lead. 5. Co~ercial 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. C. Fees 1. C~rtificate 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction .... ~ ..... Old Or Pre-existing Building ................. Location of Property...'~,</e. L~, ....... ~ .................... ./~.? House No. Street Hamlet Onwer or Owners of Property ....................................... County Tax Map No i000, Section .... ~?. ...... Block .... .~. ......... Lot ..... ¢.~ ............... Subdivision ..................................... Filed Map ............ Lot ...................... Permit No.~.[~.~.~. .... Date Of Permit..~Ja$.l~. ¢...Applicant ..................... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval...... .............. . . . . Request for: Temporary Certificate ........... Final Certicate ........... INSPEGTORS ~i~or Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-180Z SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD APRIL 5, 1993 R. MILNg & I~F P. O. BOX 294 240 KNOLL CIRCLE EAST MARION, NY 11939 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) No Underwriters Certificate on file. The check is g~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 ~ 21236-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. .) ;OUNDA'TION (1st) ~OUNDATIO:~ (2nd) IOUGH FRAME & .PLUMBING £NSULATION PER N. STATE ENERGY CODE FI;;AL ADDITIONA'L COMMENTS 765-J.802 BUILDING DEPT. INSPECTION [ 'l FRAMING [/~FINAL ATE' ~'~ ~INSP£CTOR _~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION ~]~RAMING [ ] FINAL REMARI4~: ~~/~ ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION [ ] FRAMING ZND [ ] INS/UId~ION ~]'~NAL DATE INSPECTOR,/~ / GARDINERS BAY ES; REAL ESTATE COMMITTEE, ATES HOME OWNERS ASSOCIATION INC. Gerard B Serge Doyen, Jr. James Dinizio, Jr. Rober~ A. V½11a Richard C. Wil~n Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 INTER-DEPARTMENTAL MEMORANDUM TO: FROM: DATE: SUBJECT: Building Department Attn: Gary Fish, Board of Appeal~.~ April 2, 1993 Your Memo Received March 31, 1993 Re: ZBA Appeal No. 4118 1000-37-5-15 Building Insp. Milne Member Dinizio and Chairman Goehringer have both viewed the elevation of the deck, and although the deck is higher near the stoop area, the Members recognize that the owner had no alter- native, except to dig. The Board's intention of Condition No. 4 was to prohibit digging or other disruption of the existing grade. There is no objection to the height elevation to which this deck has been constructed, provided that there be no roofing or enclosure, that all setbacks comply, and there will be no outside lighting affecting other nearby properties (as noted in the Board's decision). Thank you. GG:lk INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Su~ervistn Sbuthold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 TO: G. Goehringer, Chairman, Zoning Board of Appeals FROM: Gary J. Fish, Building Inspector SUBJECT: Appeal $4118 - Building Permit $21236- Z Gladys Milne Premises at 240 Knoll Circle, East Marion, N.Y. Suff. Co. Tax Map $1000-37-5-15 DATE: March 30, 1993 Please advise this office if you have made an inspection of the above premises, and if it is alright for this office to issue the Certificate of Occupancy for the deck addition. Thank you. INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wleczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisgr Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD TO: FROM: G. Goehringer, Chairman, Zoning Board of Appeals Gary J. Fish, Building Inspector SUBJECT: Appeal ~4118 - Building Permit ~21236- Z Gladys Milne Premises at 240 Knoll Circle, East Marion, N.Y. Suff. Co. Tax Map #1000-37-5-15 DATE: March 30, 1993 Please advise this office if you have made an inspection of the above premises, and if it is alright for this office to issue the Certificate of Occupancy for the deck addition. Thank you. APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Mr. and Mrs. R. Milne P.O. Box 294 240 Knoll Circle East Marion, NY 11939 September 8, 1992 JAN I 5 1993 Re: Appl. No. 4118 - Wooden Deck/Patio Replacement Dear Mr. and Mrs. Milne: Please find attached a copy of determination recently rendered application. the Board's findings and concerning your variance It will be necessary for you and/or the builder to return to the Building Inspector and any other agencies which may have jurisdiction on this project for issuance of appropriate permits. Copies of this determination have been forwarded to the Building Department and the Suffolk County Department of Planning pursuant to the Administrative Code of Suffolk County which governs projects within 500 feet of the sounds, creeks, estuaries, county lands, etc. Very truly yours, Enclosures Copies of Decision to: Southold Town Building Department Suffolk County Department of Planning APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (516) 765-1809 SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD Appl. No. 4118. Upon application of GLADYS L. MILNE~ A Variance is requested under Article XXIII, Section 100-239.4B and Section 100-244B for permission to build a wooden patio deck with an insufficient sideyard setback, insufficient setback from existing bulkhead, and with lot coverage at more than 20% of the code limitation. Location of Property: 240 Knoll Circle, East Marion; County Tax Map District 1000, Section 37, Block 5, Lot 15; Gardiners Bay Estates Lot No. 31. WHEREAS, a public hearing was held on July 29, 1992, at which time all those who desired to be heard were heard and their testimony recorded; WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; WHEREAS, Board Members have personally~ viewed and are familiar with the premises in question, its present (R-40) zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. By this application, appellant seeks a variance under Article XXIII, Section 100-239.4B for approval of a new wooden deck over the existing patio area and extending in a northerly direction, along the westerly side of the dwelling. The setback requested is approximately one foot from the westerly property line and 36+- feet approximately from the outer edge of the existing southerly bulkhead. The lot coverage variance requested would be 821 sq. ft. over the allowable 20% (or 29.4%). 2. The premises in question is identified on the Suffolk County Tax Maps as District 1000, Section 37, ~lock 5, Lot 15 and contains a total lot area of 19,550+- sq. ft. 3. The dwelling as exists presently has the following nonconformities: (a) sideyards at 11+_ ft. at the easterly side, and total sideyards at 23+- feet; (b) setback between the existing stone/concrete wall and the lower bulkhead approximately 30 feet; (c) setback from the southerly {rear} Page 3 - Appl. No. 4118 Matter of GLADYS J. MILNE Decision Rendered August 18, 1992 JAN I 5 1993 (f) in view of all the above, will be served by granting alternative relief, noted below. the interests of justice as conditionally Accordingly, on motion by Mr. Goehringer, seconded by Mr. Dinizio, it was RESOLVED, to DENY the relief as requested with a setback at one foot from the side property line; and BE IT FURTHER RESOLVED, to GRANT alternative relief with a yard setback from the westerly property line not closer than three feet, and SUBJECT TO THE FOLLOWING CONDITIONS: 1. The setback from the bulkhead shall not be less than 36+- feet - as exists for the patio and must be landward of the timber retaining walls, as requested; 2. The open deck construction shall remain open and unroofed, and shall not be permitted to be enclosed in any manner; 3. The setback from the westerly side yard shall be not less than three feet; 4. The patio area may be replaced only with wood construction and with no other structural changes - the deck shall be stepped out of wood with no disruption of existing grade; 5. Copy of final construction diagram shall be submitted for review and acceptance by the Z.B.A. Chairman to show set- backs, lot coverage, etc. before issuance of building permit. 6. Lighting must be shielded to the property and sbal! not create glare to other areas. Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Dinizio, and Villa. This resolution was duly adopted. lk GERARD P. GOEHRINGER, CHAI.R~ New York State Depa~ment of Environmental Conservation Building'40--SUNY, Stony Brook, New York 11790~2356 ~ommlssioner Dear~.~,~ A review has bee~ made O~ your oroposai to:~ /~~ -~ased on the information you have submitted, the New York State Depart ent of Environmental Conservation has determined that the __ parcel / project is: '" Greater than 300' from inventoried tidal wetlands. ~ / Landward of a substantial man-made structure ~' g~eater than ~00' i~ length whiqh was constr~cted prior to 9/20/77. Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. Landward of the toDograDhic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore', no permit is re~ired under the Tidal Wetlands Act (Article 25 of t~e EKviro~ental'Conservation La~). Please b~--advised, however, that no construction,.sedimentation or disturbance of any kind may t~ke place seaward of the 10' 'contour or topographi% crest without a permit. It is your re~onsibility to ensure that all'necessary precau~ns'are taken'to' prevent any sed~entation or other alterabion-o~d~sturbance to the ground su=face or vegetation in this area as a result of ~our project.. Such precautions ~y 'include providing ade~ate work are~ between !0' contour or topographic 6rest and ~he project (i.e. a 15' to 20' construction area) or erection o~ .a t~porary fence, barrier, or hay bale Please note that any additional work, or modification to the project a~ described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any. necessary permits or approvals from othe~ agencies. Very truly your.s~ · Deputy Regional Permit Administrator August 5, Gerard P. Gqehringpr.~ Chairman Board of Appeals Town of Southold Town Hall P.O. Box 1179 53095 Main Road Southold, NY 11971 GARDINERS BAY ESTATES HOMEOWNERS ASSOCIATION, INC. East Marion, New York 11939 Re: Application 4118 Oladys J. Milne Gardiners Bay Estates East Marion, NY 11939 M~. Goehringer: The Real Estate Commltt~e has n6 objections for the'abo~ applicant to construct a deck addition with insufficient side yard setback, etc. We call your attention to the'New York State Uniform Fire Prevention and Building Code to section 716.3c. Open porches, verandas, and balconies, or enclosed porches with at least 60 per cent of glazed area on three sides, may be constructed ef combustible materials provided they do not extend outward more than 10 feet from the building, or upward more than four feet above .the ceiling of the second story, and. are not less than 3 feet distant at any point ~om a lot line or from similiar appurtenances on another building; if ~hey exceed said limitations, they shall be constructed'of noncombustible materials. The committe's interpretation is that the first three feet would have to be fire retarded wood. If the applicant doe not wish to have fire retarded lumber, then they would have to go before.the New York State review board for a variance. Copy of this letter is being sent to the Town Building Deparfiment as it would probably be under their jurisdiction. cerely, Warren A. Sambach, Sr. P.E. cc: Town of Southold Buidli~ Departmen / , ~ :~"~ ,,, .i APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD SCOT¥ L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 September 8, 1992 Mr. and Mrs. R. Milne P.O. Box 294 240 Knoll Circle East Marion, NY 11939 Re: Appl. No. 4118 - Wooden Deck/Patio Replacement Dear Mr. and Mrs. Milne: Please find attached a copy of determination recently rendered application. the Board's findings and concerning your variance It will be necessary for you and/or the builder to return to the Building Inspector and any other agencies which may have jurisdiction on this project for issuance of appropriate permits. Copies of this determination have been forwarded to the Building Department and the Suffolk County Department of Planning pursuant to the Administrative Code of Suffolk County which governs projects within 500 feet of the sounds, creeks, estuaries, county lands, etc. Very truly yours, Linda Kowalski Enclosures Copies of Decision to: Southold Town Building Department Suffolk County Department of Planning APPEALS BOARD MEMBERS Gerard P. Ooehringer, Chairman S~rge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (51.6) 765-1809 SCOTF L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1.179 Southold, New York 1.1.971 Fax (516) 765-1823 Telephone (516) 765-1800 BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD Appl. NO. 4118. Upon application of GLADYS L. MILNE. A Variance is requested under Article XXIII, Section 100-239.4B and Section 100-244B for permission to build a wooden patio deck with an insufficient sideyard setback, insufficient setback from existing bulkhead, and with lot coverage at more than 20% of the code limitation. Location of Property: 240 Knoll Circle, East Marion; County Tax Map District 1000, Section 37, Block 5, Lot 15; Gardiners Bay Estates Lot No. 31. WHEREAS, a public hearing was held on July 29, 1992, at which time all those who desired to be heard were heard and their testimony recorded; WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; WHEREAS, Board Members have personally viewed and are familiar with the premises in question, its present (R-40) zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. By this.application, appellant seeks a variance under Article XXIII, Section 100-239.4B for approval of a new wooden deck over the existing patio area and extending in a northerly direction, along the westerly side of the dwelling. The setback requested is approximately one foot from the westerly property line and 36+- feet approximately from the outer edge of the existing southerly bulkhead. The lot coverage variance requested would be 821 sq. ft. over the allowable 20% (or 29.4%). 2. The premises in question is identified on the Suffolk County Tax Maps as District 1000, Section 37, Block 5, Lot 15 and contains a total lot area of 19,550+- sq. ft. 3. The dwelling as exists presently has the following nonconformities: (a) sideyards at 11+_ ft. at the easterly side, and total sideyards at 23+- feet; (b) setback between the existing stone/concrete wall and the lower bulkhead approximately 30 feet; (c) setback from the southerly {rear} Page 3 - Appl. No. 4118 Matter of GLADYS J. MILNE Decision Rendered August 18, 1992 (f) in view of all the above, the interests of justice will be served by granting alternative relief, as conditionally noted below. Accordingly, on motion by Mr. Goehringer~ seconded by Mr. Dinizio, it was RESOLVED, to DENY the relief as requested with a setback at one foot from the side property line; and BE IT FURTHER RESOLVED, to GRANT alternative relief with a yard setback from the westerly property line not closer than three feet, and SUBJECT TO THE FOLLOWING CONDITIONS: 1. The setback from the bulkhead shall not be less than 36+- feet - as exists for the patio and must be' landward of the timber retaining walls, as requested; 2. The open deck construction shall remain open and unroofed, and shall not be permitted to be enclosed in any manner; 3. The setback from the westerly side yard shall be not less than three feet; 4. The patio area may be replaced only with wood construction and with no other structural changes - the deck shall be stepped out of wood with no disruption of existing grade; /.5. Copy of final construction diagram shall be submitted for review and acceptance by the Z.B.Ao Chairman to show set- backs, lot coverage, etc. before issuance of building permit. 6. Lighting must be shielded to the property and shall not create glare to other areas. Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Dinizio, and Villa. This resolution was duly adopted. lk J~t 5~993 GARDINERS BAY ES' REAL ESTATE COMMITTEE~ ~,TES HOME OWNERS ASSOCIATION INC. -G~-~ -~-~.v~,~- ~ ~ - / tSj,[>:3. [5. '.L.. Disapproved a/c ......................... ~./.~..~.. t f .................... ~ -' . ' ' = ~ct( ) APPLICATION FOR BUILDING PEHMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971' TEL.: 765-1802 BOAR!D OF HEALTH ................ !' SEPTIC FORH Date .................. , 19... INSTRUCTIONS a. This 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 streets 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 wi/1 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the w6rk. e. No building shall be occupied or used in whole or in part for any purpose whatever 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 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 to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors On prdmii~s and in building for necessary ii3~ections.~ - _. .............. (Signatureg6f a~ldlicant, or name, if a corporation) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises ..... .~..,.,. q .s ........... .~. ~,__< ....................................... (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 ...................... 1. Location of land on which, proposed work will be'done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .. ~~ .... Black .................. Lot .................. Snbdiv/sion ..................................... Filed Map No ............... Lot ............... (Name) . State existing use and occupancy of premises and intended Use an~ occupancy of proposed construction: a. Existing use and occupancy ~e~ ,.. ? ..,? .,,~ ~..', ................... ~ ............... ~x ~7' ':' ~' r A},I., · 7-5q)~ ............ b. Intended use and occupancy ............................ }~. · n. ~¢'(~i'~; ¢~",* ~a[~ · · · 3. Nature of work (check which applicable): New Building .......... Addition .... Alteration .. :'. ...... Repair .............. Removal, .............. Demolition .............. Other Work ............... Cost .~. ~./. ~ ' (Description) 4 Estimated , ; (to be paid on filing this application) $. If dwelling, number of dwelling units ... / ........... Number of dwelling units on each floor...;.. .......... · If garage, number of cars i ., 6 If businesscommercial or ........................................................................ mixed 7' Dimension's of existing structures Oficupancyif any: Fr~nStpecify nature, ap~; ;':',.. extent of each type of use ..................... · , .......... Rear .............. Depth ............. Height ............... Numbe~r of Stories ......................................................... Dimensions of same structure withl alterations or additions: Front ................. Rear .................. Depth 1 Height Number of Stories 8. Dimensions of entire flew construction: Front ~o Rear ~ Depth e -- · Height Num bdr of Stories .................. ~ '~' "'"' ......... 9. Sizeoflot: Front ..... ~.t ........... / "l'"-" . Rear ~'~./ ............. ePth /.,~../. l 0. Date of Purchase .... J. · .' ' . . Name of Former Owner ~ P~.~' 11. Zone or use district in which premises are situated..~.~.5../p. ~Ar~, t48 & .......... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: ........... Will lot be re*raded ~('.~ .~ i Will excess fill be removed~rom premises: Yes ' No 14, Name of Ow~er of premises (f ' : ".gflJ~. ' :. ~.4z ./?~. . , . .~ ....... ....... ~ctdr~ ,~O AO3O~-~- c l,~c~z e Phone N~ ~2.?' -~.?~' ~' Name of Architect ' ~ ~'t*' 7~ .............. ' Phone No .--~~ ............ ~ ............... Address ................................ Name of Contractor .5~..~..,~.q .g4.~..~ ........... Address ............. ,, .....Phone No. '(~,~.'77-.4~· '.~... 15. Is this property within 30~ feet of a tidal wetland? *Yes...%~. .... No ......... ' · If yes, Southold To~n Trustees Permit may be required. ". PLOT DIAGRAM Locate clearly and distinctly all b¢ildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nc tuber or description according to deed, and show street names and indicate whether interior or corner lot. AP, PIlOtED -- FEE' ~--'~.~ nv, NO/ FV BU LOr.' " 765-1802 9 AM 113 4. PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION, TWO REQUIRED FOR POURED CONCRETE 2, ROUGH . FRAMING & PLUM~ING 3, INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.C. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF TIlE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YJDrCK. , :ov ¥ OF .... .m. .... s.s .......................'i'Name of' iddividual '¥ &'" ~signinglcontract)~x being duly sworn, deposes and says that be is the applicant ,bove named. [e is the ..........................I ...................................................... (Contractor, agent, corporate officer, etc.) .f said owner or owners, and is duly apthorized to perform or have performed the said work and to make and file this pplication; that all statements containqd in this application are true to the best of his knowledge and belief; and that the :ork will be performed in the manner se1 forth in the application filed therewith. worn to before me this ..:.;...: ......... ......... [ota ubli , . County /7. ·. ~r'~r41~l~,$1,~ pp' nt) T REAL ESTATE COMMITTEE[ ESTATES HOME OWNERS ASSOCIATION INC. N ·