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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-20991 Date SEPTEMBER 4, 1992
THIS CERTIFIES that the building DECK & ALTERATION
Location of Property 510 BAYBERRY ROAD, NASSAU POINT CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 111 Block 14 Lot 36.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 13, 1992 pursuant to which
Building Permit No. 20821-Z dated JULY 13, 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 DECK AND ADDTITION OF DOOR & WINDOW AND REPAIR OF DRY ROT
The certificate is issued to EUGENE & MARY JANE BOLTER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ui din Inspector
Rev. 1/81
FORM NO. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°-N° 20821 Z Date ....1..1~x 19.9...=.:--
Permission is hereby granted to:
9 o..r`........11-F
1... .
.
to ...Cb- c...4.."....4, 4..s?~A-*? t .j.....`: nj..........
. .,o.~....
-AIL
at premises located at .p ~.°~r. ? lNts.
i
County Tax Map No. 1000 Section ........I./I.......... Block LY Lot No.....:~ ~Pt..T........
i
pursuant to application dated .............~r4......7...................., 19.x, and approved by the
Building Inspector. I
{ Fee
. ~n!..a4... :?!-sE?.
Building Inspector
f
I
{
Rev. 6/30/80
y _ Form No. 6
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 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.
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 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
Date
New Construction........... Old Or Pre-existing Building.
Location of Property... 15./o........,.,,,,,,,,,,,,,,~~(. l r? f0Gc4CJ
House No. ll Street Hamlet
eAF
Onwer or Owners of ProperA..
:4/. ) 7„f 4~~7 ek °
County Tax Map No 1000, Section... Block /l....... Lot.1.-7 `:..T...........,
Subdivision ...............Filed Map............ Lot......................
Permit No..-ZQe„ -.2-.Date Of Permit..l.`. Applicant
Health Dept. Approval CU/ ...............Underwriters Approval.........................
Planning Board Approval... ?Jle / t
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted:
(g7'0
^ MARY JANB•BOLTBR•••,•
APPLICANT
New York State Department of Environmental Conservation 7
Building 40-SONY, Stony Brook, New York 11790-2356
t i9 /5FL
Re:
-~73~~US<tr~°~~
Thomas C. Jorling
!-o Commissioner
Dear
A review has been made of your proposal to: (~lza ~t as 12_ev~7
t
_eKj
Based on the information you have submitted the New York State
Department of Environmental Conservation has determined that the
parcel, project is:
Greater than 300' from inventoried tidal wetlands.
Landward of a substantial man-made structure
greater than 100' in length which'was constructed prior to
9/20/77.
> ~ Landward of the 10' above mean sea level elev tion contour on ~Y
gradual, natural slope. ~G~cy/~C9¢ -4
_ Landward of the topographic crest of a bluff, cliff or dune
which is greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act
(Article 25 of the Environmental Conservation Law). Please be
advised, however, that no construction, sedimentation or disturbance
of any 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 sedimentation or other
alteration or disturbance 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' to 20' wide construction area) or
erection of a temporary fence, barrier, or hay bale berm.
Please note that any additional work or modification to the project
as 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 other agencies.
Very truly yours,
Deputy Regional Permit
Administrator
TRUSTEES o~~SpfFO(K~oD SUPERVISOR
John M. Bredemeyer, III, President SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President h
Henry P. Smith 5 • Town Hall
John B. Tuthill 53095 Main Road
William G. Albertson EO. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 26, 1992
Twin Builders
P.O. Box 749
Mattituck, NY 11952
Re: Eugene Bolter
SCTM# 1000-111-14-36.1 & 36.3
Dear Mr. Sir:
,J
The following action was taken by the Board of Trustees at their
regular meeting of June 25, 1992:
RESOLVED that the Southold Town Board of Trustees approve the
request for a waiver to construct a 6' X 34' deck attached to
existing dwelling.
If you have any questions, please give us a call.
)rjry truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB/jmt
cc: Bldg. Dept.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
j ] FRAMING [ ] FINAL
REMARKS:'
DATE /2-77~;--JNSPECTOR Pi(i
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'OUIIDATION (1st) `I
'OUNDATION (2nd) cn
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INSULATION PER N. Y.
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STATE ENERGY II t!
CODE I `
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ADDITIONAL COMMENTS. m
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BOARD OF HEALTH
FORM NO. 1 ,,-3 SETS OF PLAYS
TOWN OFSOUTHOLD _,/SURVEY
BUILDING DEPARTMENT __,,,ICIIECK _ . _ .
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 NOT, Y.
7 %/J{J
4 CALL .J.! F./ .I.....
Examined , ,I,y, , 1983-- MAIL TO:. 1/
Approved I 199?-. Permit No..c~ 03 ~ I. ~ 7l 71.,-) ; .
Disapproved a/c _ .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 Z
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
slits 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
of 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 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. /
~(J(Signat~uure of applicant, or name, if a corporation
Y.t. 0. /?D. K... ~.Y .
(Mailing address of applicant) 119,3'2-1
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...............................................,,..t.................................................
Name of owner of premises ~~J .
(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. Z~.!~!'.`u......
` . ,x d er r.. ' /r? . Cif
.
House Number Street Hamlet
County Tax Map No. 1000 Section ./i/.^............ Block Lot 0..
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 4!~SQ d1 e
b. Intended use and occupancy
3. Nature of work (check ~hich applicable): New Building Addition ~~~KAlteration/~/ . 1 t ~y~Jy
Repair oval . 0•pp4,~,Nf~y Demolition Other Workpky,koc 1`•~oJld~j~
U0 85~a Desf'ri tion)
4. Estimated Cost . 2 d
os ..............................p......
(
(to be paid on filing this application)
5. If dwelling, number of ...n~ units Number of dwelling units on each floor
.
,
If garage, numberofcazs
6. If business, commercial or mixe .1 ~d , , , , , , ,occupancy,, ,,,specify,, , , , ,nature, •and extent of each type of use
Height . . . . .
7. Dimensions of existing sttructure's, if any: Front ReearDepth .
of Stries
Depth 5-k, • • • th Halterations or a dido tions: front Rear ..L..... .
. . . . . . . . Nu b.. eight . Number of Stories z' .
Dimensions of same structure ruction. Front . . . . Rear ...............Depth
8. Dimensions of enure new const
Height .
9. Size of lot: Front • Number Stories
Numl.....of. Rear Rat . Depth .
101. Zone or used strict in which ra • Name of Former owner , .
12. Does r misnyaresituated . . . .
g pr
ate an zoning law, ordinance or regulation : .
13. Will lotof Owner of radeastruchon vtol l Will excess fill be removed from premises: Yes No Name Name of Architect , . . . . . . • • • • • • • • Address . Phone No.......
pre
mises
P Address ...................Phone No.... , .
15. 11smthis property n c . . . .
......Address ...................Phone No........... . .
thin 300
yes, feet o'f a tidal wetland?...............
No.........
*If Southold Town 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.
STATE OF NEW YQRKj SjS
COUNTY OF w `
. . .
,C Y.G..
(Name of ~individual signin being duly sworn, deposes and says that he is the applicant
g contract)
above named.
fie is the , ......4~ c G r,~i.....`^L...G~.uJrle r . . .
U (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly ;authorized to perform or have perforrned the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of. ..C'` r;l?-..... 19°~a
Nota ublic . .~q, County
ELIZABETH ANN N ILLY
.
Notary Public, Stateo Kew York
No. 52-8125850, Suff Ik Co (Signature of applicant)
Term WWI
Expires October ~1,18.:(~
SURVEY OF PROPERTY
SITUATED AT
NASSAU POINT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-111-14-36.1 W JAN ~.~t~
1000-111-14-36.3 N/0/F N/0/F RUST S°
SCALE 1"=30' 3tiS 5
JUL. 22, 1991
WUNNEWETA POND
21B
S 6334'10" E~ P/O LOT 216
/ 30.44'
5 89.3812( E N 71321'20„ E a ~
60.00'1 n 762120 11 E 1_
1 i
i' / II o M~ A I 1 1
1
PLOT 278 1
i 1 5 22'02'21" W
N 30'09'17" W 'I 61.08'
i
3 ,333 ~g f 6" E - - N 305".1493'2'
5.43'
a
F, II N 56'27'17" W d pro II 3.53' LOT 217 w°
B a o
I
I ~ M
S 4334'06° E Mb Mai ' I
O i 4) WAS / 31.50' 01 i' /A - I I \
I
I evE I
LOT 215 I\ N 79 I
I I
LOT 216 a* w. so '
V 7 _ FFANE HOUSE I~
ez.~im rt uq _-WATER
ywk I / ~ n'7
=i, wpm
i WcauE 43.39, I
ryry 27,7 i \ ISyD r,""",o __-see•eo a,aq I
fro mh ~q I
i I ~y
.6 / ~ 5 ~T53'15 W
PIZ. I 3 3 rV rtu\ I ~ O
7220\`.. \ .8., I nin rnT qfa '(ONIMPROLe. IA
/ 0 0
O1 e4.eD• 9692'
N 86'29'44 W / a iov.ie
N 86'56'10" W (v PM D® esv PILE ase) a
« (4s PEq Deer UM iozei PME 4z7) 301.92' ACTUAL ~ 300.00' DEED w
P/0 LOT 214 `
~0 WUNNEWETA POND k POND
N/0/F McSHERRY
/ 0g 1A 1~ Vd
5
I
CERTI CERTIFIED TO: NOTES:
CHICAGO TITLE INSURANCE COMPANY 1. LOT NUMBERS AND THE LOCATION OF ISLAND PATH EUGENE BOLTER REFER TO "AMENDED MAP A OF NASSAU POINT-
MARY JANE BOLTER FILE No. 156, FILED AUG. 16, 1922.
2. WETLANDS IF ANY ARE NOT SHOWN.
Joseph A. Ingegno
Land Surveyor
Nps AREA = 104,794.34 sq. ft. em nE UN0 2.4056 a.ms
° °5 e 1186 East Main Street ay "
9
* Prepared in accordance with Uts ° Riverhead, New York 11901 ' (dance with the minimum s surveys as established by
standards for tile surveys as er and approved and adopted
(516)727-2090 N.Y.S c No 49666 the L I. A. L S. and approved ea ntwfor such use by The New Yak St 'he New Yak Stab Land
Fax # (516)369-2009 title Assoctatton.
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