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Home My WebLink About20401-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21094 Date OCTOBER 14~ 1992 THIS CERTIFIES that the building. 185 WILLIAMSBURG RD. & Location of Property 6540 MAIN BAYVIEWRD. House No. County Tax Map No. 1000 Section 78 Block 5 subdivision Filed Map No. ADDITION SOUTHOLD~ N.Y. Street Lot Hamlet 12 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 21~ 1992 pursuant to which Building Permit No. 20401-Z dated JANUARY 22~ 1992 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 ROOFED OVER DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR & TO CONDITIONS OF ZBA #4056. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A CONSTARTIONH & IRENE MARKOTSIS Rev. 1/81 BUILDING PERMIT ('I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20401 Z Date... r.~..;. ................................... , Permission is hereby granted to: ~ ..... /' ,/~/, / ~ /--~", _ / -- ~.....~~ ......................................... ...~~..~..~..zz.~..~.~ , , ,, - .~...~ ..... ~ .... ~ ...... ,~...~ ......................... co~ ,~ ~op ~o. ~ooo s~,o~ ........ Z~ ........ ~k ....... ~ ....... [,t uo ...... ~ ......... ~u~dln~ Rev, 6/30/80 MaRKOTSIS & LIEBErm^N October 21, 1992 Town of Southold Office Of Building Inspector Town Hall Southold, New York 11971 Re: 145 Williamsberq Drive, Southold, New York To Whom it May Concern: Enclosed please find a copy of the Certificate of Occupancy sent to my parents and a copy of a Certificate issued June 27, 1986. Also enclosed is a copy of a Survey, concerning property located at 145 Williamsberg Drive & 6540 Bayview Road. Our records indicate that the correct address is 145 Williamsberq Drive while your records indicate 105 Williamsburg Road. Please contact my office with any corrections or if I can be of any assistance. Thank you for your cooperation in this matter. Very truly yours, /~/James C.~'Mar~ot~ JCM/dg Form No. 6 TOWN OF SOUTtlOLD 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 ~ith accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2,. Final Approval from ~ealth Dept. of water supply and sewerage-disposal(S_9 form). 3. Approval of electrical installation f~om Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. " $. Commercial building, industrial b~ilding, multiple residences an~ 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.' 3, . For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and ~.pre-exzstzng land uses: '1. ·Accurate survey of property showing all property lines, Streets, building and / unusual natural or topographic features. 2. A properly completed application anR '~ consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Buiiding 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. Cer.tificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate ,of Occupancy - $5.00 over 5 years - $10.00 · &. ,Updated Certificate of Occupancy - $50.00 5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 :w Construction.., ......... Old Or Pre-existing ~i~cLi~g~.. .... House No. Street ........ ' Hamlet .~ 1.~. .~.~;... ~ . ~./.~ ......... ocy Map ooo, sec=ion..2 ........ Block.. ............ Lot.. " ' Filed Map Loc of rm~t No ........ ~.. . Permit ................ Applicant · ~lth Dept. Approval .......................... Underwriters Approval mn~ng ~oard Approval ........................ !uest far: Temporary Certificate ........... Final Certicate ........... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21094 Date OCTOBER 14~ 1992 THIS CERTIFIES that the building I05 WILLIAMSBURG RD. & Location of Property 6540 MAIN BAYVIEW RD. House No. County Tax Map No. 1000 Section 78 Block Subdivision Filed Nap No. ADDITION SOUTHOLD, N.Y. Street 5 Lot Lot No. Hamlet I2 conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 21~ 1992 pursuant to which Building Permit No. 20401-Z dated JANUARY 22~ 1992 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 ROOFED OVER DECK ADDITION TO AM EXISTING ONE FAMILY DWELLING AS APPLIED FOR & TO CONDITIONS OF ZBA #4056. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A CONSTANTIONS & IRENE MARKOTSIS Building Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTIIOLD 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 net use: 1. Final survey of property with accurate location of ail 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 f~om Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder Bsed in system contains loss than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences an~ similar buildings and installations, a certificate of ~ode Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements.· 3. ~ For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · pre-existing land uses: '1. ·Accurate survey ~f property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application an~'~ 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 Building - $100.00 3. Copy of Certificate,of Occupancy - $5.00 over 5 years - $10.00 · 4. .Updated Certificate of Occupancy - $50.00 5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 :w Construction... ......... Old Or Pre-existing ~,~ ' ................... .... House No. Street ....... ~. Hamlet ~nty Tax Map No 1000, Section.·~.~. ........ Block..~"~. ......... Lot ......... " ' Filed Map ~mit No....~. ..... at Of Permi~ ................ Applicant ............. ith Dept Approval · ' ............. Underwriters Approval nming Board Approval ...................... uest for: Temporary Certificate ........... Final Certicate ........... Submi~ ted: $ ..... ~/.~ ....... 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, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OCTOBBR 7, 1992 JAMES E. FITZGERALD, JR. P. O. BOX 617 CU~CHOGUE, NY 11935 RE: CONSTANTINOSM/~OTSIS & I~F 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 ~-~not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumtber Solder Certificate on file. (All permits involving plumbing bein~ issued after April 1, 1984). BUILDING PERMIT ~ 20401-Z Please contact our office on this matter. cooperation. CC: Thank you for SOUTNOLD TOWN BUILDING DEPT. MR. &. MRS CONSTANTINOS MAEKOTSIS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]' ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~]~NAL~ //2 ?OUNDAT!ON (1st) ~OUNDATION (2nd) {OUGH FRAME & ·PLUMBING [NSULATION PER N. Y. STATE ENERGY CODE FI~AL ADDITIONA'L COMMENTS ('ONb'-FAT) NOG ~ pROJECT PLAN TRUS'i~EES John M. Bredemeyer, III, President Hemy P. Smith, Vice President Albert J. Kmpski, Jr. lohn L. Bednoski, Jr. John B. Tnthill Telephone (516) 765-1892 Fax (516) 765-1823 October 1, 1991 Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTt L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 RECEIVED. OCT o 3 1991 FITZGERALD RE: Waiver request for Constantinos Markotsis SCTM#1000-78-5-12 Dear Mr. Fitzgerald: The following action was taken by the Board of Town Trustees during its special meeting held on September 26, 1991: RESOLVED that the Town Trustees approve the request for a waiver to construct a covered deck on property located at Williamsburg Road, Southold. Please note that permits from other agencies may be necessary, as the Trustees approval does not constitute approvals from other agencies. Very truly yours, Bredemeyer, III President, Board of Town Trustees JMB: jt cc: Bldg. Dept. APPEALS BOARD MEMBERS Cerard P. Goehringer, Chairman Charles Grigonis, Jr. Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Telephone (516) 765-1809 Mr. James E. Fitzgerald, Proper-T Services P.O. Box 617 Cutchogue, NY 11935 Re: Appl. No. 4056 - Mr. BOARD OF APPEALS TOWN OF SOUTHOLD October 18, 1991 Jr. 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 and Mrs. Constantine Markotsis Dear Mr. Fitzgerald: Attached please find a copy of the determination rendered by the Board of Appeals concerning the above application. A copy of this decision has also been furnished for the Building Inspector's record and information. Please be sure to return to their office for issuance of appropriate permits or other approvals in this project before commencing building or site activities. Very truly yours, Enclosure Copy of Decision to: Southold Town Building Department Southold Town Board of Trustees Suffolk County Department of Planning APPEALS BOARD MEMBERS O, erard P. Go'bringer, Chairman Char/es Origonls, Jr. 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 ACTION OF THE BOARD Appl. No. 4056. Upon application of CONSTANTINOS MARKOTSIS. Variance to the Zoning Ordinance, Article XXIII, Section 100-239.4B for permission to approval of screen-enclosed deck addition at less than the required 75 feet from the bulkhead. The subject premises is substandard in size and is located in the R-40 Zone District. Location of Property: Corner of the south side of Main Bayview Road and the east side of Williamsburg Drive (private road), Southold, NY; County Tax Map Parcel No. 1000-78-5-12. WHEREAS, a public hearing was held on September 26, 1991, and at said hearing, 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 zoning, the surrounding areas; and 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 a 30' wide by 16'4" deep screened-in deck addition at the rear (southwest) portion of the existing single-family dwelling, which, inclusive of wooden steps, is requested to be set back 71'2" from the existing bulkhead at its closest points (see project plan prepared by Proper-T Services dated August 14, 1991). 2. The subject premises in question is identified on the Suffolk County Tax Maps as District 1000, Section 78, Block 5, Lot 12, has a frontage of 160 feet along the south side of Main Bayview Road and 180 feet along the easterly side of Williamsburg (private) Road. This parcel contains a total lot area of approximately 28,000 square feet. Rage September 26, 1991 Regular Meeting Appl. No. 4056 Constantinos Markotsis (Decis'ion, continued:) 3. The setback distances of the existing dwelling are shown to be 19.5 feet from the westerly (front) property line, 17.7 feet from the southerly (side) property line, 78 feet to the bulkhead/ramp area at its closest point, and 92+- feet to the northerly (front) property line. No accessory storage buildings exist at the premises currently. 4. Article XXIII, Section 100-239.4B of the Zoning Code requires all buildings and structures located on lots upon which a bulkhead, concrete wall, rip-rap or similar structure exists and which is adjacent to tidal water bodies other than the Long Island Sound to be set back not less than seventy-five (75) feet from the bulkhead. 5. The amount of relief requested by this application is variance of one foot for the enclosed porch, and four feet for the step area. a 6. In considering this application, the Board finds: (a) the relief as requested is not substantial in relation to the requirements; (b) the relief as requested is not the minimum necessary to afford relief; (c) the relief as alternatively granted will not alter the essential character of the neighborhood; (d) the practical difficulties are uniquely related to the property and are not personal; (e) the relief, as alternatively granted, will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town, or be adverse to neighboring properties; (f) in view of all the above, the interests of justice will be served by granting the relief as alternatively and conditionally noted below. Accordingly, on motion by Mr. Doyen, seconded by Mr. Grigonis, it was RESOLVED, to GRANT relief for a screened-in deck (porch) addition at the rear of the existing dwelling, SUBJECT TO THE FOLLOWING CONDITIONS: 1o That the construction shall be not closer than 74 feet (as applied), at its closest distance to the bulkhead; Page Constantinos Markotsis Appl. No. 7056 Decision Rendered September 26, 1991 2. That the porch (screened-in deck) addition remain unheated, as applied; 3. That the porch (screened-in deck) addition not be permanently enclosed (i.e. glass or similar enclosure, although plexiglass will be permitted); 4. That the step area be relocated to the northerly or southerly ends of the deck (rather than on the seaward portion). (Any structural enlargement or expansion within the 75 ft. setback from the bulkhead, or other nonconforming yard areas, will require further application to and approval by this Board.) Vote of the Board: Ayes: Grigonis, Dinizio and Villa. adopted. Messrs. Goehringer, Doyen, This resolution was duly lk TOWN OF SOUTIIOLD BUILDING DEPART3IENT TO~VN CLERK'S OFFICE SOUTtlOLD. N.Y. NOTICE OF DISAPPROVAL Date Jffi. Y 26, ........................... ;9.9.L.. To PROPER-T-SERVICES a/e CONSTANTINOS I~M1.KOTSIS P.O. BOX 617 CUTCHOGUE~ N.Y. I 1935 PLEASE TAKE NOTICE that your application dated ....... .J~L..Y..2.4 ............... 19...9.1. for permit to CONSTRUCT AND ENCLOSE A DECK ADDITION TO DWELLING. 105 WILLIAlqSBURG ROAD & ....................... at Location of Property 6560 HAIN BAYVIEW ROAD SOUTEOLD, N.Y. h~s; k/o~ ........................................................ Street Hamte t County Tax Map No. I000 Section 78 . Block 5 12 ............. - .......... ...Lot ....... . ...... Subdivision ................. Filed Map No ..... Lot No .............. is returned herewith and disapproved on the following grounds ............................... UNDER AR?'rCLE -~1III SECTION 100-239.4 B PROPOSED CONSTRUCTION I/ILL BE LESS THAN ~.5. ~EET FROM 'rm~ ~..~L..r~..A?.. ACTZON REQUIRED BY 'r~ ZONINC ROA~ O~ APPEALS. A.C.T,~ON ALSO REQUIRED BY 'l'flE .BOARD OF TONN ,TRUSTEES AND N.Y. STATE DEPARTMENT' OF ENVTRONMENTAL CONSERVATION. ................................. :::::: RV 1/80 ,, >'., . < .," ~ ,,~" ~/~ I 8' "~ ,, / .'. ..~.~,~ , , ~ ,~. ~ y ~,, _~ -, v ~/' ~- ~1 ~.~,~..,~ . d?,,_, ''-/_.~.{~ .... ~ v', '- "~' '~ - ,'- ' v'-P%' - ~ o~ '~nv~onm~[a[ Cgnse~va~o~ has ~m~e~' ~ha[ ~h~ ~ · "-;~.~'" p~o~ec~ la: '" " ~ " ..... ~n~wa~ oE-~h~ 'lO' abov~-m~zn sea [oyeZ'elevation co~o~ on.a Therefora, no permit is required under the Tidal Wetlands Act (Article 25 of the Env.ironmental Conservation Law). -Please be advised, however, thaE no construction, sedimentation or disturbance ~ny kind may take place seaward of the 10'-contour or topographic crest without 'a permit. ~It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentati'on or other alte[ation or distbrbance to the _ ground-surface or vegetation in this area as a result of your project .... Such precautions may-.include providing adequate~ work area between the 10' contour or topographic crest and the:project- (i.e.'a 15' to20' wide -con~'ruction area) ?o'c-e~ection of a temporary fence, ba'rrier, 'or' hay ba.le berm. ' Please note that any additional work, or modification to' the project as '-.'--desccibed, may-'r~qu'ife 'authorization by this Department/' Pl~as~ c~h't~c-t-- this office if such are contemplated. Please be further adv_ised that this letter does not relieve you of tb.e responsibility-o'f obtaining any necessary permits or appro%;als from other agencies. 'Ve'ry truly yours', ' ~pu ty Re~ ~ona FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Buil~g ~or) BOARD OF HEALTH ............ 3 SETS ?F. PLANS . ..t..~-.--.--.--.~-,.~.....~.. .... SURVEY...... .::~':.- C.ECK .......... . . SEPTIC FORM ................ MAI~L TO: . APPLICATION FOR BUILDING PERMIT Date . .5...a.n.u.a.~.y..2.1 ...... 1992. INSTRUCTIONS , a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ot areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work, e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other~applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterationJ or,or iemov.~d~tmolition, as h~m described. The applicant agrees to comply with all applicable laws, ordinance~g'.t ild~g code/~~ and/e~ul]]ions, and to admit authorized inspectors on premises and in building for necessaW4.r James E. ~t~rald, Jr. P,O. gex 617, Cu~chogue, NY ! 1~$ Fhon~: {$16) 734-5800 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, effgineer, general contractor, electrician, plumber or builder. Applicant is the agent of the owner. Name of owner of premises........C°nstantin°s .... Markots.i.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..T. 9..b.c.. ~.uN.r~J, sh.e.d. ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ~ ~ .O'~'....W..i. 3,1;[a,'nsburg .Rd..(.pri.v<ate) ............. $oa~'ghot6 ................. House Number Street Hamlet 78 5 12 County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ................................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed constroction: Existing use and occupancy P. rivate si~g%~.-~.am$1y. ~idence ..... b Intended use and occupancy ' S.ame 3. Nature o.f w. o~k (che k winch apphcable). New Building . ~ ........ Addition .... .X ..... Alteration .......... Repair ........... Rempval .............. Demolition .............. Other Work .............. i ; (Description) 4. Estimated Cost ......... ~..5,.O.O.0. .................. = .... Fee ...................................... ,~ ' (to be paid on filing this application) $. Ifdwelhng, numberofdwelhngumts N./..A . . Num '~ nitn chfloo N/~ · ..... _ her of dwelhno u .... on ea ...... r ....... 6, If business, commercial or mixed occupancy, specify nature and extent of each tYp. e of use . . . 7. Dimensmns of existmg structureS, ffany. Front .... 3.6· .,,..\.. Rear ....4.6 . Depth Dimensions of same structure wilth alterations or additions:i Front ....... 4.6! ....... Rear ..... 4~.t ......... Depth .... 5g.t. .a, PP~e.ox .... .. Height .... .1.{$~. , O.;P.D~gX ...... Number of Stories ..... ,one ............ 8. Dimensions of entire new constr~ction: Front ...3.0 ~ 7.2.'!i ..... Rear ..... :'.-.'~ ......Depth ... ;I 6?.': ~ ? .... Height 1. 2. .~..a.t~9 .rp.x.. Number of Stories one si ofl" F 9..0.' i .............. , .................... D pth )'6'O.'; ........... · ze of: font ................... ear... ............... e 10. Date of Purchase ........... ! .................. Name of Former Owner ............................ 11. Zone or use district in which premises are situated ....... '.. ~.-.4.Q ........ i ............................. 12. Does proposed construction violfite any zoning law, ordinance or regulation: . ~'.e.8. ;.. ~.e.e..a.$.'l;i~Qhoc, l' .l:la,~¢~e~... 13. Will lot be regraded ....... }19. .................. Will excess fill be removed from premises~/A. Yes No 14. Name of Owner of premises ...~,e.e...b.e.l.o.w. ....... Address ................... Phone No ................ Name of Architect .......... ; ................ Address ................... Phone No ................ Name of Contractor ......... ~ ................ Address ................... Phone No ............ ;... IS.Is this property loea¢ed vithin lOG feelt of a tidal vet;land? ~If yes, Southold To~,,n{ Trustees Permit may be required. PLOT DIAGRAM · '. ! Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. Owner: Oonatant±no~ Markot8±8 ~0 Park Avenue Hicksville, iNY See attached drawing, jurisdiction lette:~. 11801, survey, ZBA variance, Tru'stee waiver, DEC non- STATE OF NEW YORK, COUNTY OF S.I James E Fitzgerald .Jr (Name of md,v~dual s~gnmg contract) above nam'ed, i being duly sworn, deposes and says that he is the applicant Notary Public, . . N0 48~3108, Suffolk C0unt~ u0mm*ss~0~ expires February (Signature of apj~ant) He iff the ' ] (Contractor, ager~t' ', corporate'; ............... officer etc.') ............................ of said owner or owners, and is duly a!uthorized to perform or liave performed the said work and to make and file this pphcat~on; that all statements containqd in this application are true to the best of his knowledge and belief; and that the Work will be performed in the manner s~t forth in the application flied therewith. SWorn to before me this ........................ day of..i ....... .........,.,19..,~ CERTIFIED TO: SECURITY TITLI: INSURANCE CO/~ PANY SOUTHOLD SAVINGS BANK LAWRENCE ':P.' I~RANNIGAN LAWRENCE'," 'SIMON, GLORIA S'IMON "'' PECONIC SU~V~YOHS ~ ENGINEERS, P.O. BOX 909 MAIN ROAD SOUTHOLD, N.Y. 11971 SURVEY OF PROPERTY AT BAY VIEW TOWN OF SOUTHOLD SUFFOL:KCOUNTY~ N.Y. 10(~0'.':~,78. *' 05 - sc ,L NO~. ZI'. 1985 Prepared in accordance with the minimum wtondard~ for lido ,urvoy~ o~ eetabl~hed by lbo L.I.A. L ,~. and approved and adopted Jet ~ch ~ by T~ NoW York ~lme Lend lit~ ~iption. 85 - 390 ./