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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22649 Date OCTOBER 8, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 195 MARYS ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 140 Block 2 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 27, 1993 pursuant to which
Building Permit No. 21581-Z dated AUGUST 6, 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 PORCH ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
& TO CONDITIONS OF ZONING BOARD OF APPEALS #4177.
The certificate is issued to JAMES & EILEEN LEDDY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
i
st~on
uil g'Inspcctor
Rev. 1/81
FORM NO.3
TOWN OF SOUTHOLD
SUILDING DEPARTMEM
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date lf 19..9.."'3....
No 2].581 Z
Permission Is hereby granted to:
,..?..1. ?
to W. VWac/ .
. em. .
at premises located at...... 93......j~~~~ y ......!L
..............................................t~v 1..............................,,......................................
County Tax Map No. 1000 Section -~uQ....... Block.awl Lot No..'„j.~r..................
pursuant to application dated ...y ~i 19..~~~~......, and approved by the
Building Inspector.
Fee
Building Inspector
Rev. 6/30/80
Form No. 6 (J'""
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 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 building
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.
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. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dweffigg $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 $15.00
u ~e.n1T oczcN Date .....~F'G.19
New Construction............. Old Or Pre-existing Building
Location of Property..A./7..A1,19Y.~S.,4i X&,4Y7'/.7."iK...........
House No. Q Street Haml.et
Onwer or Owners of Property. ~-c.~.. 1.:.. L fi-.~4F . •
County Tax Map No 1000, Section... G...... Block Lot.... Y5.~t?
Subdivision .....................................Filed Map............ Lot.....................
Permit No. q `:y. F/. Z .Date Of Permit ...Flzaly~.? ....Applicant
liealth Dept. Approval ..........................Underwriters Approval........................
Planning Board Approval
]tequest for: Temporary Certificate........... Final Certicate.....~....
ee Submitted:
Qezf 69 ( 8 1~~ Ya' ~~a..
APPLICANT
INSPECTORS yrr=.-.,
Victor Lessard FF@1!{
Principal Building Inspector r QQp~~
Curtis Horton SCOTT L HARRIS, Supervi.
Senior Building Inspector a 1 n
Thomas Fisher Southold Town Hall
Buikiin P.O. Box 1179, 53095 Main Ro
• ~ ` ~
Building Inspector
Gary Fish < :o +x p! Southold, New York 11971
!j( ~e ax (516) 765-1823
Building Inspector F
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
September 21, 1993
Mr. S Mrs. James Leddy
195 Mary's Road
Mattituck, N.Y. 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
g$x An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
%%B The check is ((not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 215812
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
INSPECTORS
Victor Lessard pgUFi L~(,~
Principal Building Inspector
Curtis Horton SCOTT L. HARRIS, Supervis,
Senior Building Inspector o ' w.x„ e Southold Town Hall
<,7
Thomas Fisher yi- Rr P.O. Box 1179, 53095 Main Roa
Building Inspector Southold, New York 11971
Gary Fish 9~' ya Fax (516) 765-1823
Building Inspector
Vincent R. Wieaorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
September 21, 1993
Mr. S Mrs. James Leddy
195 Mary's Road
Hattituck, N.Y. 11952
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.
gxx The check is (e%*tdate /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 # 21581Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
IELD II: SPEC,iON
~~UAi ~QtKMENT3
l ;r
FOUNDATION (13t)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
3.
INSULATION PER N. Y.
STATE ENERGY
CODE
4.
FINAL `
ADDITIONAL COMMENTS:
x'69-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ] FINAL
REMARKS`
DATE INSPECTOR sq
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ FRAM{NG [ INAL
REMARKS:'
DATE INSPECTOR
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date 4/"Q 19Q3..
1c..1:1; me 77
r.1/761
PLEASE TAKE NOTICE that your application dated . lfG... 199. .
for permit to ~1~~Ldr~..~J• at
Location of Property C(,!
Namlet
House No. '~Street
County Tax Map No. 1000 Section -!,{/O..... Block Lot
Subdivision Filed Map No. Lot No. ................y.
is returned herewith and disapproved on the following grounds
.~~G9n. lG7D~ c'J.0-7..3....~??7~i OS~-!.f/z1...fQO,~,•'L~
.v
7~Ving Inspector
RV 1/80
APPEALS BOARD MEMBERS SCOTT L. HARRIS
M' t < Supervisor
Gerard R Goehringer, Chairman ±3
Serge Doyen, Jr. s>r Town Hall, 53095 Main Roa,
James Dinizio, Jr. p~ P.O. Box 1179
Robert A. Villa Southold, New York 11971
Richard C. Wilton Fax (516) 765-1823
Telephone (516) 765.1809 BOARD OF APPFAT S Telephone (516) 765-1800
TOWN OF SOUTHOID
July 27, 1993
Mr. Paul Leddy
29 Bradford Lane
Bethpage, NY 11714
Re: Appl. No. 4177 - Porch Addition with Reduced Front Yard
Dear Mr. Leddy:
Please find attached a copy of the Board's findings and
determination rendered at our July 22, 1993 Regular Meeting
concerning the above application.
Please be sure to return to the Building Inspector
concerning the building permit and certificate of use/occupancy.
Copies of this determination have been forwarded to the Building
Department for their update and permanent records.
Very truly yours,
Linda Kowalski
Enclosures
Copies of Decision to:
Southold Town Building Department
Mr. Paul Leddy
or James Leddy
195 Mary's Road j1A ? 7
Mattituck, NY 11952 1 i~'
SCOTT L. HARRIS
APPEALS BOARD MEMBERS
4 r Supervisor
Gerard P. Goehringer, Chairman z
Serge Doyen, Jr. r Town Hall, 53095 Main Roa,
James Dinizio, Jr. a ' ''9 p~~y P.O. Box 1179
Robert A. Villa , ,;~1 A Southold, New York 11971
Richard C. Wilton Fax (516) 765-1823
Telephone (516) 765-1809 BOARD OF APPEALS Telephone (516) 765-1800
TOWN OF SOUTHOLD
ACTION OF THE BOARD OF APPEALS
Appeal No. 4177:
Application for JAMES P. and EILEEN LEDDY. Variance to
the Zoning Ordinance, Article XXIV, Section 100-244B (pertaining
to nonconforming lots) and Bulk Schedule, for permission to
construct front porch addition with a reduced front yard setback
at 195 Mary's Road, Mattituck; County Tax Map Parcel No.
1000-140-2-36 (now 36.3).
WHEREAS, a public hearing was held on July 22, 1993 and at
said hearing all those who desired to be heard were heard and
their testimony recorded (no opposition was received); and
WHEREAS, the Board has carefully considered all testimony
and documentation submitted concerning this application; and
WHEREAS, the Board Members have personally viewed and are
familiar with the premises in question, the present use and zone
district, and the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. The premises in question:
(a) is a parcel of land situate along the westerly
side of Mary's Road at Mattituck, Town of Southold, and contains
the following nonconformities:
lot area at 11,484 sq. ft. (preexists zoning)
lot width with street frontage of 66.01 feet;
(b) is improved with a one and one-half-story,
single-family dwelling structure set back approximately 31-1/2
feet from the front property line along Mary's Road and
approximately five feet from the southerly (side) property line.)
(c) is located in the R-40 Zone District by the
Master Plan Amendments enacted in January 1989.
{
Page 2 - Appl. No. 4177
Matter of JAMES AND EILEEN LEDDY
Decision Rendered July 22, 1993
2. By this application, appellant has requested approval
of a 9 ft. porch extension from the front wall of the existing
dwelling which will leave, when using the copy of the survey
submitted with the application, a setback of 26 feet. The new
porch area would be in lieu of the existing stoop area which
extends at the front of the dwelling (see survey prepared
September 29, 1992 by Roderick VanTuyl, P.C.).
3. The relief requested in this application is a reduction
in the front yard from 35 feet to 26 feet. Board Members do not
agree that this is the minimum necessary under the
circumstances, and alternatively find that it would be more
feasible to grant a setback at not less than 28 feet. The
addition would be reduced, of course, by two feet in order to
meet this requirement.
4. In considering this application, the Board also finds:
(a) that the front porch addition as alternatively
granted will not be an adverse impact to the essential character
of the neighborhood, and the relief requested in this applica-
tion is not substantial in relation to those buildings existing
generally in this neighborhood;
(b) that the variance will not in turn be adverse to
the safety, health, welfare, comfort, convenience or order of
the town, or be adverse to neighboring properties;
(c) that the addition is not an activity which would
cause an increase in dwelling unit density or cause a
substantial effect on available governmental facilities;
(d) that the alternative method for a setback at not
less than 28 feet is feasible for appellant to pursue;
(e) in considering all of the above factors, the
interests of justice will be served by denying the relief as
requested, but granted alternative relief, as noted below.
Accordingly, on motion by Chairman Goehringer, seconded by
Member Wilton, it was
RESOLVED, to DENY the relief requested at a setback of 26
feet for a proposed front porch addition; and
BE IT FURTHER RESOLVED, to GRANT ALTERNATIVE RELIEF for a
reduced front yard setback at 28 feet for a proposed porch
r
a Page 3 - Appl. No. 4177
Matter of JAMES AND EILEEN LEDDY
Decision Rendered July 22, 1993
addition by maintaining the southerly side yard at five feet (as
exists for the house).
VOTE OF THE BOARD: AYES: Messrs. Wilton, Goehringer,
Doyen, and Dinizio. (AGAINST: Member Villa felt the new
setback was not warranted under the circumstances for a porch).
This resolution was duly adopted (4-1 margin).
lk
~.GERARD P. GOEHRIIGER, CHAIRMAN
16
APPEALS BOARD MEMBERS - a° SCOTT L. HARRIS
Supervisor
Gerard R Goehringer, Chairman u3 a
Serge Doyen, Jr. Town Hall, 53095 Main Roa.
r P.O. Box 1179
James Dinizio, Jr. fit, r
Robert A. Villa Southold, New York 11971
Richard C. Wilton Fax (516) 765-1823
Telephone (516) 765-1809 BOARD OF APPEALS Telephone (516) 765-1800
TOWN OF SOUTHOLD
NOTICE OF PUBLIC HEARINGS
NOTICE IS HEREBY GIVEN, pursuant to Section 267 of the Town
Law and the Code of the Town of Southold, that the following
public hearings will be held by the SOUTHOLD TOWN BOARD OF
APPEALS, at the Southold Town Hall, 53095 Main Road, Southold,
New York 11971, on THURSDAY, JULY 22, 1993 commencing at the
times specified below:
1. 7:32 p.m. Appl. No. 4172 - To reconvene hearing in the
Matter of JANET A. FERGUSON (continued from June 22, 1993).
,Central Avenue, Fishers Island, NY; County Tax Map Parcel ID
No. 1000-066-08-006.
2. 7:35 p.m. Appl. No. 4182 - KELLY McDERMOTT. Variance to
the Zoning Ordinance, Article IIIA, Section 100-30A.3 (Bulk
Schedule) for permission to expand house and accessory garage
which will exceed the 20% lot coverage limitation. Property
Location: Northeasterly corner of Oysterponds Lane and
Skipper's Lane (a/k/a State St.), Orient, NY; County Tax Map
Parcel No. 1000-24-1-8. This property contains an area of
t
Page 3 - Notice of Hearings
Southold Town Board of Appeals
Regular Meeting of July 22, 1993
permission to construct front porch addition with a reduced
front yard setback at 195 Mary's Road, Mattituck; County Tax
Map Parcel No. 1000-140-2-36.
6. 7:55 p.m. Appl. No. 4178 - JAMES AND DOROTHY FITZGERALD.
Variance to the Zoning Ordinance, Article XXIV, Section 100-244B
(schedule pertaining to nonconforming lots) for permission to
construction open deck addition with an insufficient rearyard
setback. Property Location: Southwest Corner - Intersection of
Oak Drive and Haywaters Drive, Cutchogue; County Tax Map Parcel
No. 1000-104-5-25. This parcel is nonconforming at 19,602+- sq.
ft. in this R-40 Zone District.
7: 8:00 p.m. Appl. No. 4180 - JOAN AND ROY BERMAN. Variance
to the Zoning Ordinance, Article IIIA, Section 100-30A.3 for
permission to construct addition to accessory storage-garage
building which was recently altered under Permit No. 20895
issued 8/18/92. Proposed addition would reduce the required
frontyard setback and would be in excess of 200 lot coverage
limitation for all buildings. Property Location: 520 Rabbit
Lane, East Marion, NY; County Tax Map Parcel No. 1000-31-18-11.
This property is nonconforming at 2614+- sq. ft. in this R-40
Zone District.
Page 5 - Notice of Hearings
Southold Town Board of Appeals
Regular Meeting of July 22, 1993
the Southold Town Zoning Code, Article III, Section 100-31B for
use as a philanthropic home as provided by Subsection 5 thereof.
Property Location: South Side of Middle Road near the end of
Highway 48, House #6760, Mattituck, NY (present owners: Joseph
and Patricia Stiefer). County Tax Map Parcel ID No. 1000-121-
4-8.1, containing 13+ acres.
10. 8:20 p.m. Appl. No. 4183 - JOHN AUSTINE. Variance to the
Zoning Ordinance, Article IIIA. Section 100-30A.4 for permission
to locate accessory one-story garage building partly in the side
yard with a setback at approximately five feet from the
southerly side property line. Location of Property: 3735 Deep
Hole Drive, Mattituck; Lot No. 54, Map of Deep Hole Creek
Estates. County Tax Map Parcel No. 1000-115-16-20. This
property is substandard in size at 21,710 sq. ft. in this R-40
Zone District.
11. 8:30 p.m. Appl. No. 4120 - MATTITUCK AUTO CENTER, INC. and
WILLIAM GOODALE. Variance to the Zoning Ordinance, Article
XXI, Section 100-212B for relief from the front yard landscaping
provisions of the zoning code. Location of Property: 7655 NYS
Route 25 (Main Road), Laurel, near Mattituck, NY; County Tax
Map Parcel No. 1000-122-6-30.1 (previously 30).
Page 6 - Notice of Hearings
Southold Town Board of Appeals
Regular Meeting of July 22, 1993
12. 8:30 P.M. FINAL HEARING on Appl. No. 4119SE - MATTITUCK
AUTO CENTER, INC. and WILLIAM GOODALE. Special Exception to the
Zoning Ordinance, Article X, Section 100-101B(12) for a permit
authorizing: (a) a new car sales-rental establishment; (b)
an establishment of an accessory use incidental to the proposed
new car sales establishment for the sale and/or lease of used
vehicles; (c) outside display of vehicles for sale; (d)
accessory office use incidental to the new principal use as a
new car sales establishment. Location of Property: 7655 Main
Road (NYS Route 25), Laurel, near Mattituck, NY; County Tax Map
Parcel No. 1000-122-6-30.1.
The Board of Appeals will at said time and place hear any
and all persons or representatives desiring to be heard in the
above matters. Written comments may also be submitted prior to
the conclusion of the subject hearing. Each hearing will not
start before the times designated above. If you wish to review
the files or need to request more information, please call
755-1809 or visit our office.
Dated: July 6, 1993. BY ORDER OF THE SOUTHOLD
TOWN BOARD OF APPEALS
GERARD P. GOEHRINGER
CHAIRMAN
By Linda Kowalski
x
r r
Page 4 - Notice of Hearings
Southold Town Board of Appeals
Regular Meeting of July 22, 1993
8. 8:05 p.m. Appl. No. 4039 - CLIFFSIDE ASSOCIATES, INC.
(Owner)-. This is a request which concerns the April 26, 1991
and April 9, 1991 Notices of Disapproval issued by the Building
Inspector concerning an application for permit to include
kitchenettes in motel units citing Article III, Section 100-13
which is the Definition Section of the Zoning Code pertaining
to the April 9, 1991 Notice of Disapproval which reads,
" ..hotel or motel transient which says in part that there will
be no cooking facilities..", and pertaining to the April 25,
1991 Notice of Disapproval which reads, " ..hotel or motel
resort. Action required by Zoning Board of Appeals to permit
cooking facilities in individual motel units...."
The subject premises previously had received a conditional
determination for a Special Exception filed 11/28/89 under
Application No. 3542 for use of the premises for 68 motel units
without individual kitchenettes or dwelling uses. Location of
Property: 61475 C.R. 48, Greenport, NY; County Tax Map Parcel
No. 1000-045-01-001 and 002 (now 2.1), containing approximately
7.5 acres. The subject premises is located in the
Resort-Residential (RR) Zone District.
9. 8:10 p.m. Appl. No. 4181 - AABR Realty Facilities Holding
Corp., a Type C Not-For-Profit Corporation (now or formerly
known as "Association for The Advancement of Blind and Retarded,
Inc."), as Contract Vendee, request a Special Exception as per
r T
Page 2 - Notice of Hearings
Southold Town Board of Appeals
Regular Meeting of July 22, 1993
8710+- sq. ft. and is located in the R-40 Residential Zone
District.
.3. 7:40 p.m. Appl. No. 4179 - THOMAS D. DUFF, JR. and ELAINE
DUFF. Variance to the Zoning Ordinance, Article III, Section
100-32B for permission to con£ruct deck addition along west
side of existing dwelling with a reduced side yard setback.
Property Location: South Side of Crescent Avenue (North Hill),
Fishers Island, NY; bounded west by Nitze; east and south by
Zabohonski; County Tax Map Parcel ID No. 1000-6-2-3.2; also
referred to as Lot 25 on the unfiled "Map of Henry Walsh." This
parcel is nonconforming at 1.003+- acre in an R-80 Zone
District.
4. 7:45 p.m. Appl. No. 4160 - SUSAN TASKER. Variance to the
Zoning Ordinance, Article XXIII, Section 100-239.4A for
permission to locate dwelling structure with a reduced setback
from the bank or bluff of the L.I. Sound. Property Location:
58235 C.R. 48, Greenport, NY; County Tax Map Parcel No.
1000-44-2-11. This parcel is nonconforming at 5,775 sq. ft. in
this R-40 Zone District.
5. 7:50 p.m. Appl. No. 4177 - JAMES P. and EILEEN LEDDY.
Variance to the Zoning Ordinance,'Article XXIV, Section 100-244B
(pertaining to nonconforming lots) and Bulk Schedule, for
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT .CHECK
TOWN HALL SErTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t: FY
CALL ?.,C....
Examined .la ./.Q„•,•„.,, 19~~133 TO:
Approved 19g .Permit No.~~J~~ ~
Disapproved.a/c J??G.
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19~ J.
INSTRUCTIONS
a. This application must be completely filled in by typewri ter 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 he 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 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 premises and in building for necessary inspections. .2c
- (Signature of applicant, or name, if a corporation)
(Mailing address of applicant) ((7U(
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(5'4WL ....~QC~~ccIS.
Name of owner of premises
(as on the tax roll or latest deed)
If applicant is a corporation, si nature of duly authorized officer.
.
ame and title of corpor tt officer)
Builder's License No. .....3 I ....l. .
Plumber's License No. 4 /
Electrician's License No. t
Other Trade's License No. ! J....... .
1. Location of land on which proposed work will be done . .
1 y. ~ ~ r 7T ~::ate....:.............
House Number Street Hamlet
County Tax Map No. 1000 Section ...:..11 Block Lot. ...3.(:......... .
Subdivision Filed Map No. Lot
(Name)
2: State existing use and occupancy of premises and intended use and occumrr.,y of proposed construction:
a. Existing use and occupancy ......v/N. AIi1A~.Alt+.:C ''I'm .
b. Intended use and occupancy mfr... 1 t ra{ , y J
3. Nature of work (check which applicable): New Building Addition .4'• • • • • • • • Alteration . .
Repair Removal Demolition Other Work
. . (Desc
4. Estimated Cost T Fee .
} (to be paid on filing this applicai
5. If dwelling, number of dwelling units i........ 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 Rear ,JOB Depth .
Height Number of Stories 1.Y~ .
Dimensions of.~s/'$jne structure with alterations or additions: Front s- Rear r... .
Depth T Height i' Number of Stories /.yam:..:.
8. Dimensions of entire new construction: Front ...3r~........ : Rear Depth ..~f .
Height ber of Stories ........I i......... • ,
9. Size of lot: Front , Rear .....5-6 Depth ~.'V........
10. Date of Purchase 1~.~......... Name of Former Owner
11. Zone or use district in which premises are situated .
12. Does proposed construction violatey zoning law, ordinance or regulation: A) .
13. Will lot be regraded AM .~..,.~^~rl Will exce fill e re ove~from premises. : X e.
14. Name of Owner of premises ...~Fd~(!7 Address ./.5.lU. Phone No.. W7
Name of Architect Address Phone No.... 7.. .
Name of Contractor 4. i4 / ~ . Address ( .1hone No. , d17t~
15. Is this property within 300 feet of a tidal wetland? *Yes........ No.........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimens
property lines. Give street and block number or description according to deed, and show street names and indicat
interior or cornea lout.
AP R ED AS NOTED
5;T.3 B.P. # ~L57g/
DATE:
FEE; BY.
NOTIFY BUIL' G DEPART T AT
765-7802 S AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION • TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATIO
4. Fi`!AL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
D+ESIraN OR CONSTRUCTION ERRORS
STATE OF NEW YORK, S.S
COUNTY OF ...............f.
2%1 86p being duly sworn, deposes and says that he is the
(Name of individual signing contract)
above named. f~
He is the............ .fit J ..j.~cr~
(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 an
application; that all statements contained in this application are true to the best of his knowledge and belief; ar
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.........day of.....!! 1
Notary Public, L-~ Count,,
MIX Public. £sste at lY~w11W! ~C ~ ! /!ga
Nc.48Ti46T
of
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