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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-20934 Date AUGUST 12, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 3405 BAYSHORE ROAD GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 53 Block 6 Lot IO
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 23, 1991 pursuant to which
Building Permit No. 20354-Z dated DECEMBER 30, 1991
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 ADDITION & RENOVATION TO EXISTING ONE FAMILY DWELLING AS
APPROVED BY ZBA #4064.
The certificate is issued to WILLIAM AHMUTY III
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-245480 - AUGUST 4 1992
PLUMBERS CERTIFICATION DATED JULY 18, 1992 - H.SMITH PLUMB.&HFATING INC
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ilding In pector
Rev. 1/81
Y08Ai NO. A
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 2 0 3 5 4 Z Date ..~4 ~ 19 9
Permission is hereby granted to:
ta ....:r:~F~a~l:-Yf:.~:'...4~..GQ.W~1Mrf!,...~':..~0it~!~:y:~: O~!E=~..~...~...,1~~?:.,~.
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at premises located at ..sa~.`.~:Q.~' ......~.~...:......4~..e~.F..?
County Tax Map No. 1000 Sect^io^n C].5..~........ Block .......'~.~4......... Lot No...I.~
pursuant to application dated ....1,.,1:4SH~~.....a.~ 19~.~..., 9nd approved by the
Building ``I''nspector.
Fee S..~T~a.
....tSS:..
Building Inspector
Rev. 6/30/80
• Form No. 6 ~CttiQ,~ J380 ~~7.
r;...,.~.,.•,..~-...~,..3~.,dV~4 ~ ~~r~~ 1197/
' ~ ~ I I ! ~ ~ ~ ~ TOWN OF SOUTHOLD
~ ~ , ~ ~ t~ BIIILDING DEPARTMENT
t~ ~ AUG ~ ~ Z i~~~ # TOWN HALL
j ti ~ 765-1802
'T®~;r~(af;rt,t7sJi8F¢3f_~,~1ppLICATION 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 17 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 si:;e 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
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ~ :!l~/...°v7.:f~ .
New Construction........, Old Or Pre-existing Building
Location of Property... r3~/U~.... 7JCLe~J(7O/`e.. ~~I P ..C~~~/DO/r .
.i House No. y~ Street Hamlet
Onwer or Owners of Property....~C::y':.41~~`~~.~f.~(~cL1yy.:,~hmc.~-h~...~,~,......
County Tax MapnNo 1000,E Sectigon... ~.~r..-'......Block..... Q ~.......Lot....~ v
Subdivision..rh.G'~C4ltiJ-: :.!,`~a-:`~. Lo'~~°.........Filed Map ...foS'~....Lot.~./.~..~'.Q ............-.ice
Permit No...1>:U~`Sy.~~....Date Of Permit. 7?/3i~~~J.....Applicant~Uh:?.:Y::.fr::~.'..~~;; 1~e; ;~I~
Health Dept. Approval......... ............../Underwriters Approval......
Planning Board Approval........-
Request for: Temporary Certilficate........... Final Certicate....~....
Fee Submitted: $....~.5.,.(
C~ ~ n ~9 APPLICANT
H. SMITH PLUMBING & HEATING, INC.
MAIN ROAD
SOUTHOLD, N.Y. 11971
(516) 765-3690
C E R T I F I C A T I O N
Date July 28, 1992
Building Permit No. 203542
Owner William Ahmuty III and Wife
Plumber: H. Smith Plumbine & Heating, Inc.
I certify that the solder used in the water supply system
contains less than 2/10 of 19 lead.
enry P. Smith
Sworn to before me this
9ftt.h day of r„i y ~ 1992
19 92
Notary Public, Suffolk County ~ecsLeT~e. d° J_c~2ee-.--
Notary Public
3ERNADETTE L. TAPLIN
iVOTARY PUBLIC gg3MM83
State of Now Ynrk
RaiiOln In Suffdk CauMy
^ommi9elnn ~NPiro? $nRL 30, 0~
INSPECTORS `'b.
Princ pal Building I pector p~®$UFFD~~e'`s'
Curtis Horton G~~c SCOTT L. HARRIS, Supervisor
Senior Building Inspector o t_ Southold Town Hall
Thomas Fisher ,`ne ~.a T
Buildin Ins ector ® ~ ® P.O. Box 1179, 53095 Main Road
8 p Southold, New York 11971
Gary Fish ~44j ~°A Fax (516) 765-1823
Building Inspector Telephone (516) 765-1800
' Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 24, 1992
JOUHN BERTANI BUILDER
1380 OARWOOD DRIVE
SOUTHOLD, NY 11971
RE: WILLIAM R. AHMOTY, III ~ WF
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
%R% An application for Certificate of Occupancy is
not on file. (Enclosed)
l~ No Underwriters Certificate on file.
1~.4 The check is not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
R&4 No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
1
BUILDING PERMIT # 20354-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
INSPECTORS
Victor Lessard D~pfFa(~
Principal Building Inspector ~~4~' SCOTT L. HARRIS, Supervisor
Curtis Horton ~ ~
Senior Building Inspector o ! s' . ; z Southold Town Hall
Thomas Fisher d ``v`i ~~~^I, ~ P.O. Box 1179, 53095 Main Road
Building Inspector ~ ,off Southold, New York 11971
BuG~any ~isht~ '~Oj .~`a Fax (516) 765-1823
g p Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 24, 1992
JOIIHN BERTANI BUILDER
1380 OARWOOD DRIVE
SOUTHOLD, NY 11971
RE: WILLIAM R. AHMIJTY, III & WF
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
ffi An application for Certificate of Occupancy is
not on file. (Enclosed)
ffi No Underwriters Certificate on file.
>ru% The check is not on fi1e.)$25.00
No Health Department Approval on file.
No final inspection has been made.
%%7[ No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20354-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
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APPEALS BOARD MEMBERS ~
~~FFD(,~~ SCOTT L. HARRIS
Gerard P.Goehringer,Chairman Of~.~~~. C~Gy~ Supervisor
Charles Grigonis, Jr. ~ ~ 1
Y C-' F. Town Hall, 53095 Main Road
Serge Doyen, Jr. "i ~ ~ ~ ~
James Dinizio, Jr. ~ ` "r P.O. Box 1179
`'fly'{e'~! « ~ ~ N Southold, New York 11971
Robert A. Villa i~~rj~~ w~ ~~~P
~ Fax (516) 765-1823
Telephone (516) 765-1809 Telephone (516) 765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
ACTION OF THE BOARD
Appl. No. 4064.
Application of MR. AND MRS. WILLIAM R. AHMUTY III for a
variance to the Zoning Ordinance, Article XXIII, Section
100-239.4B for permission to construct addition at the rear of
existing principal building with a reduced setback from the
existing bulkhead (and increase of the degree or square footage of
nonconformance although maintaining the same nonconformities at
the side yards). Zone District: R-40 Low-Density Residential.
County Tax Map District 1000, Section 53, Block 06, Lot 10.
WHEREAS, after due notice, a public hearing was held on
November 12, 1991, at which time all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony and
documentation submitted concerning this application; and
WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. By this application, appellants are proposing a 10' by
28' addition (plus 7-1/2+-' by 10 ft. to square off the
southeasterly dwelling), all as more particularly shown on the
survey map amended October 8, 1991 prepared by Roderick VanTuyl,
P. C.
2. The premises in question~is nonconforming as to lot area
containing 7500 sq. ft. and lot width of 50.0 feet (frontage along
the easterly side of Bayshore Road).
3. The premises is located in the R-40 Zone District and is
improved with a single-family dwelling built prior to 1964.
4. Article XXIII, Section 100-239.4B requires that " ..all
buildings located on lots upon which a bulkhead, concrete wall,
riprap or similar structure exists and which are adjacent to tidal
water bodies other than sounds shall be set back not less than
seventy-five (75) feet from the bulkhead...." The setback
i¢
Page 2 - Appl. No. 4064
Matter of MR. AND MRS. WILLIAM R. AHMUTY III
Decision Rendered November 21, 1991
proposed from the closest portion of the bulkhead is approximately
44 feet, and from the highwater mark along Peconic Bay at
approximately 69 feet.
5. Article XXIV, Section 100-241R of the Zoning Code
provides that enlargement of a nonconforming building with a
conforming use may not be increased as to the degree of
nonconformance. The dwelling as exists has nonconforming side
yards at 9'8" and 12+-' as shown on the October 8, 1991 survey
map. The addition is proposed to extend the side yard
nonconformities to not less than the existing side yard setbacks,
supra.
6. It is the position of this Board that in considering this
application that:
(a) there is no alternative available for appellants to
pursue except by variance;
(b) the relief, as requested, is not substantial in
relation to the existing structure and those generally existing in
the neighborhood;
(c) the difficulties imposed are uniquely related to
the property and are not personal in nature;
(d) the grant of the variance will not adversely effect
the essential character of the neighborhood, or be adverse to the
safety, health, welfare, comfort, convenience or order of the town
and neighboring properties;
!e) in view of all the above, the interests of justice
will be served by granting the relief, as requested and further
noted below.
Accordingly, on motion by Mr. Goehringer, seconded by
Mr. Dinizio, it was
RESOLVED, to GRANT a variance for the construction of a
10 ft. by 28 ft. building addition at the rear (easterly end) of
the existing dwelling, with a 7-1/2+- ft. wide by 10 ft. addition
to corner off the existing southeast section of the house, all
with setbacks as shown on the October 8, 1991 survey map prepared
by Roderick VanTuyl, P.C., PROVIDED THAT THE:
1. setbacks be not less than 44 feet to the bulkhead at its
closest point;
2. setbacks be not less than the existing nonconforming side
yard at the southerly side;
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TRUSTEES ~
John M. Bredemeyer, III, President o= ~ SUPERVISOR
Hetuy P. Smith, Vice President ~ ~ SCOTT L. HARRIS
Albert J. Krupski, Jr. G •
John L. Bednoski, Jr. y~01 ~ ~a~~ 53095 Main
Boad
John B. Tuthill
P.O. Box 1179
Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971
Fax (516) 765-1823 TOWN OF SOUTHOLD
November 26, 1991
John Bertani
1380 Oakwood Drive
Southold, NY 11971.
RE: William Ahmuty
SCTM#1000-53-6-10
Dear Mr. Bertani:
The following action was taken by the Board of Town Trustees during
its regular meeting held on November 14, 1991:
RESOLVED that the Town Trustees grant a waiver to add 10' to rear
waterside of an existing residence with the request for drywells and
a debris fence to be placed by the bulkhead while under construction.
A refund in the amount of $115.00 is forthcoming, as a full permit is
not necessary.
Please note that permits from other agencies may be necessary, as the
Trustees approval does not constitute approvals from other agencies.
Very truly yours,
M
John M. Bredemeyer, III
President, Board of Town Trustees
JMB:jt
cc: Bldg. Dept.
CAC
New York State Department of Environmental Conservation
Region 1 Headquarters - -
SU~N~Yn, "Build~i~n~g" 40, Stony Brook, NY 11794 DATE: ~~-eQa~~~ ~~~~~+~j
~r~!'~(" /rvvl.~ ~-t~L2Get-~y? p~~ Re: ' t Thomas C. Jorling
20 ~ ~ GL , l{/,(,~r'~~'S ~ `~"i~c~7/2s~(~~~/~~ Commissioner
Dear, /dam ~ ~ -
~ ~.1
A r/e vJiewp has ,b/een made o y/our proposal to: ~®2z 9~t,~~e~C-_ a-- ~U X.3~/,q~,
l.C~...d~-6~~ i7~1i72. CZ Y~ .QIIIS J`-'Gp~~ ~'~~iL~ieK' .~Q,7
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a/~- ~~is~e. , ~lieo-,~e~e //SC ~ ~f.~ //'..U L~ 'o s-e~,.3Y '6 - ~ 0 , -
9ased on the in~ormation you have submitted, the New York State Department
or Environmental Conservation has determined that the parcel
~C~'-project is:
Greater than 300' from inventoried tidal wetlands.
'Landward of a substantial man-made structure u.c
greater than 100' in length which was constructed prior
t'~_~~/77.
Landward of the 10' above mean sea level elev tion c n our on
gradual, natural slope. ~i;~~--~~.e~c_,~'-~L~~ Ce c-~~4-n 7'~s'.r
_ Landward oP the topcgraphic crest o a blucf, cliff or dune which is
greater than 10' in elevation above mean sea level.
`:hereFore, no Hermit is raauired undec 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 anv 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
pale 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. - - -
?lease be further advised that this letter does not relieve you of the _
- responsibility of obtaining any necessary permits or approvals from other _
agencies.
- -
Very tru your~s/, -
_ Regional Permit Administrator _
Qi'/
- -
1 _ -
,u.~,~~r~
APPEALS BOARD MEMBERS , - ~ „;',1+~~~ e('~ SCOTT L. HARRIS
d
Gerard P. Goehringer, Chairman , : ~ ~ Supervisor
Charles Grigonis, Jr. ° E • ~ ~ ' Town Hall, 53095 Main Road
Serge Doyen, Jr. "R
p any P.O. Box 1179
James Dinizio, Jr. ~ ~ U
, _ Southold, New York 11971
Robert A. Villa ` ~ c°~r"
_>7j y'y Fax (516) 765-1823
Telephone (516) 765-1809 'z ~ " Telephone (516) 765-1800
~~>_z,zu,
BOARD OF APPEALS
TOWN OF SOUTHOLD
dt r' r lg
Deoember 17, 199?,' a~G ~ IC
i 9 ,.1 ~31
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4~,
Mr. and Mrs. John Bertani - e„_J t
13II0 Oakwood Drive
Southold, NY 11971
Re: Appl. No. 4064 -William R. Ahmuty III (Addition)
Dear Linda and John:
Attached please find a copy of the Board's findings and
deterrination in the above matter.
Please be sure to return to the Building Inspector (and other
agencies which may have jurisdiction for issuance of other
approvals of this project) before commencing construction
activities.
A copy of this determination has this date also been furnished
to the Building Department for their files and update.
Very truly yours,
Linda Kowalski
Enclosure
Copies of Decision to;
Mr. and Mrs. William R. Ahmuty III
15 Central Drive
Glen Head, NY 11545
Building Department
Suffolk County Department of Planning
. ,
APPEALS BOARD MEMBERS ,^'~gUFFO~,~ SCOTTL.HARRIS
~ G
~ Gerard P. Goehringer, Chairman p~fh~A~,;-y,= 9 Supervisor
Charles Grigonis, Jr. ~ ; ; _ Town Hall 53095 Main Road
Serge Doyen, Jr. ~ + ° r" x aG '
, ~ n, N P.O. Box 1179
James Dinizio, Jr. ~ ~ Southold, New York 11971
Robert A. Villa „,+4 ~~0~ Fax (516) 765-1823
Telephone (516) 765-1809 Telephone (516) 765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
~~G ~ ~
P
ACTION OF THE BOARD sa~~,,
Appl. No. 4064. ~ ~,~,.'ti.'.'~:~; ~ W-~
.-.3
Application of MR. AND MRS. WILLIAM R. AHMUTY III for a
variance to the Zoning Ordinance, Article XXIII, Section
100-239.4B for permission to construct addition at the rear of
existing principal building with a reduced setback from the
existing bulkhead (and increase of the degree or square footage of
nonconformance although maintaining the same nonconformities at
the side yards). Zone District: R-40 Low-Density Residential.
County Tax Map District 1000, Section 53, Block 06, Lot 10.
WHEREAS, after due notice, a public hearing was held on
November 12, 1991, at which time all those who desired to be heard
were heard and their. testimony recorded; and
WHEREAS, the Board has carefully considered all testimony and
documentation submitted concerning this application; and
• WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and. ,
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. By this application, appellants are proposing a 10' by -
28' addition (plus 7-1/2+-' by 10 ft. to square off the
southeasterly dwelling), all as more particularly shown on the
survey map amended October 8, 1991 prepared by Roderick VanTuyl,
P.C.
2. The premises in question•'is nonconforming as to lot area
containing 7500 sq. ft. and lot width of 50.0 feet (frontage along
the easterly side of Bayshore Road).
3. The premises is located in the R-40 Zone District and is .
improved with a single-family dwelling built prior to 1964. .
4. Article XXIII, Section 100-239.4B requires that "...all
buildings located on lots upon which a bulkhead, concrete wall,
' riprap or similar structure exists and which are adjacent to tidal
water bodies other than sounds shall be set back not less tl~n
seventy-five (75) feet from the bulkhead...." The setback
1-, -
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APPEALS BOARD MEMBERS o~OgUFFO(k~oG SCOTT
pe1HAoRRIS
Gerard P. Goehringer, Chairman y
Charles Grigonis, Jr. o° Town Hall, 53095 Main Road
Serge Doyen, Jr. ~ P.O. Box 1179
James Dinizio, Jr. O ~ ~ Southold, New York 11971
Robert A. Villa ?~Ol ~a0~ Fax (516) 765-1823
Telephone (516)765-1809 ~ Telephone (516)765-1800
BOARD OF APPEALS
TOWN OF SOUTHOLD
December 17, 1991
Mr. and Mrs. John Bertani
13II0 Oakwood Drive
Southold, NY 11971
Re: Appl. No. 4064 - William R. Ahmuty III (Addition)
Dear Linda and John:
Attached please find a copy of the Board's findings and
determination in the above matter.
Please be sure to return to the Building Inspector (and other
agencies which may have jurisdiction for issuance of other
approvals of this project) before commencing construction
activities.
A copy of this determination has this date also been furnished
to the Building Department for their files and update.
Very truly yours,
L~ K~ski
Enclosure
Copies of Decision to:
Mr. and Mrs. William R. Ahmuty III
15 Central Drive
Glen Head, NY 11545
Building Department
Suffolk County Department of Planning
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date .../C~/l~`-'......~.........., 19 .9~.
Tol,~.~~~`~~Q?/.lr.. . ~?rcr.,. ~G ~~ao~ G~~t d~L 1~bL Gl%~i
PLEASE TAK,,E~N~TICS that your appl~ica~ti'on dated ~O/. ~ 19 . .
for permit to ~e~'as"c~~4.-?7..~~:~~~~!?.Gd'J...~.!~''L.G~y.'~iF..~G2'2'!C°~/~......at
~ ,.CFA'. ~rr'•~ (/f~
Y
Location of Property ..J~. Y'U. ,J i:........... ~,~~I
House No. Sheet amlef
County Tax Map No. 1000 Section Block Lot ~P~......... .
Subdivision Filed Map No. Lot No. .
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is ret/ulrn~ed heryrye~with/and disapcp~rovle~dJOn the following grounds ..~~-~t. G%yo~•
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7651802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ )ROUGH PLBG.
(]FOUNDATION 2ND ]INSULATION
[ ]FRAMING ]FINAL
REMARKS: a
DATE ~ ~ ~-'INSPECTOR ~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] iNSULATiON
[ ]FRAMING [ INAL
REMARKS:
r9''%
~
L'.d-
i
DATE ~ INSPECTO r
T65-1802
DUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [~~OUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
~MING [ ]FINAL
REMARKS:
DATE 1/ INSPECTOR
~3~~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
i
f
s
DATE ~ 7i INSPECTOR
~~s ~
765-1802
BUILDING DEPT.
t NSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ 1 INSULATION
[ ]FRAMING [ ]FINAL
~c~
REMARKS
DATE ~ / v 1~ INSPECTOR
~,S ~ mayy, i~t !l7pidll~ BOAFD OF HEALTH
,.5~~ UGC 2~.~ ~.7J~ iF,'~ k i{ FORM N0. 1 SURVEY OF~LANS ~
3 ~ ~ Gv
g; j s i,, I, s ~Ii TOWN OF SOUTFiOLD CHEC>; .~r..6.~~~', • ~ • • ~ • • • _
t~+' ! i. ,la BUILDING OFPARTMFNT SEPTIC CORM ~ ~ ~ ~ •
t
X TOWN HALL 17tic.
t'_~ $OUTIIOLD,N.Y.11971 NOTIFY;
TEL.: 7G5~1II0? CALL . , , 7~ij'-~S/n
Examined . ~~~1' 19~~ t•IAIL T0:
Approved . ~•Z~a,p~
~.I...., 19 Permit No. ~3, 5~'~. .
Disapproved ale ./0~`6, - :.=W • ' ' • ' ' ' '
~ €`l~.'r~ OC ~ 991
. , . ' ~ st.r~:
~~wT.
r~ no Inspector) • YOWI~I OF SOLITriOE~ST
APPLICgTION FOR BUILDING PERPAIT
Date 15~~.
• INSTRUCTIONS
a, Tlus application must be completely filled in b ~h
sets of plans, accurate plof plan to scale. Fee accordin Y typewriter or in ink and submitted to the IIuildir>; FrsPecior, wifh 3
to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
ar areas, and diving a detailed description of ]ayout 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 PerTniL
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the appliani Such permit
sh~l! be kept on the premises available for inspection throu;ltout 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 hFADE 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 Yoik, and other applicable Laws, Ordinances or
Rc=ulafions, for the construction of buildings, additions or alterations, or for removal or demolition, as hcrin described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housin; code, and mou(arions, and to
admit authorized inspectors on premises and in building for necessary inspections.
• (Signature of applicant, or name, if a corpora;ton)
(Mailing address of applicant) ~ ~ .
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~G! r ~G'Y2.......
Name of ownerofpremises .,fu~a~~;,{.?~!'C~(:/ege9,(„ ~Q~,¢'~.td~.,s~~
(as on the tax roll or latest deed)
ICapplicant is a corporation, signature of duly authorized officer. ,
(Name and title of corpora a officer) s,
~f /
Builder's Liccnsc No..•.%//~~. ,r<~ , , , , , ,
Plumber's Liccnsc No. ('(~(,~:C,/1lsy,~~nl -
Elcctrician's Liccnsc No. ~T`'~, .C'a~~..~".'e,~{Cr. , ,
Other Trade's License No. .;rQ~
ri`'„~(~j ,-~'t~`~it~-/.
• Location of land on which proposed work will be done;
Rouse Number ~ ~ ~ ~ ~ Street .
Count .Hamlet • •
Y Tax Atap No. 1000 Section ,s~ BI'ock , ~o ,;i:
Subdivision ZaF~~{G, ~~6a Lot ....~.o .,i!: .
• y l~7l~~S-c".~ F,ilcd Afap No. , , ~ ;.t~
(Narfrcj ~ • Lot
State existing use and occupancy of premises and intended usernd occupancy of proposed construction: • . • • • • •
a. Existing ~ - 1
,use and occupancy ~r
b.Intendcd ~
use and occupancy Q~G~Z..~.~i'4
}~i • • ,~~,Gt~(. ~~F.tB~... •
i
3. Nature of work (check which appyicable): New Ouilding Addition • ,Utetatran
Repair , , , , , , , RFinavpl . . Demolition ,Swi:anin ; pool. . .
Tennis Court . A'ocessory Building..........Fence ......Other lJork.....•.•......•..
y4. Estimated Cast ~r`.l,`2~SOA.S7..~ Fec
(to be paid on filing this application)
5, IC dtvctling, nutnbcr oC dwelling units Number of dwcllittg units on each floor , .
If garacc, number of cars . .
6. If business, commercial or mixed ~pccupancy, specify nat~re and extent of each ty~pc of use • .
7. Dimensions of cxts ing structures, if any: Front . ,,,.r~,8', , , , Depth . , • ,
Hei~_Itt ~ Rear .
, Numbl~:r of Stories ,l, f,Q, • , , , ,
Dimensions of same~ctntcture with alterations or additions• Front • .Rear . ~ ~ ~ ~ • •
Depth Hcir;itt ....v{2~. ..........Number of Stones ....`.Z •
S. Dimensions of enti~rc new constnt~tion: Front . . r?.~:. Rear Depth . _.,¢.d, , ,
Height N ~mb',cr of Stories .
9. Size of lot: Front ,'.t'4. , , Rcat . ..'SA Depth ...:!3, 2 .
10. Date of Purchase , , , , , , , , , . • I~ , • • ~ , , ,dame of Former Owner ~ ~ • ~ ~ •
11. Zone or use district in which premises arc situated . , t~ , ,%~r<s~.,~„~".~;:~ . ~ ~ •
l^_. Does proposed construction viola4c any zoning law, ordinance or regulation: ..~Q
13. \Vill lot be regraded ,1Vill excess Gl! be removed ~ff,rom premises: Yes No')(.
i4. Name of Owner of premises /((Q' (IJfl,4Af[( /~j~,
~Address /.'~C&~(1Kd4.~/1.~~.N6~raPhone No.. , .
Name of Architect .f.~T.e-~. /?QQL,~gS........ , Address T ZFtS
. SE~~'hone No.3.~1
' . . .
Name of Contractor :~~~.t(./~rY , Address~~L9~Wf~7~ Phone No.'7./z~
.~,>~Sl:...
IS.Is this property located within .100 feet of a tidal wetland? ^Y>:S. NO....
*If yes, Southold Town'Trustees Permit may be required.
PLOT DIAGRAhI
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions farm
property lines. Give street and block nktmber or description according to deed, and show street names and indicate whether
interior or comer tot. '
J'~ ~ scl2t/stc~r ~i
i
. ,
• ' '
'
I
I
STATE O F NE1V Y I~
COUNTY OF Q.d~ S; S
i•n•~~ • . • • • bcin~ dul sworn, de
. • • • • • • • ~•(Namc of ind~idua~i nit~~~~n • ~ y poses and says that he is the applicant
• ig contract) ,
above named.`,,
EFc is tltc ....~~Aa~:..Cr
' (Contractor, agent, corporate officer, etc.) . ~ ~ ~ ~ ~ ~ ~
oC said owner or owners, and is duly~'lauthorizcd to perform or have performed the said work and to make and file this
application; that all statements contaijted in this application arc true to the bcs[ of his knowledgt: and belief; and that the
work will be pcrlbmtcd in the manner isct forth in the application filed therewith.
Sworn to bciorc me this ; ry
......day of . 19~.~
Notary Public . ~S'daF.~:4~:L.. County - ~
BERNADETTE l.. TAPLIN
1~¢i'NOTARY PUBLIC M4B448B3 , ' `-'-E;C~``^--
SUte of Now YorN (Si;naturo of applicant)
Raldlng in Sutldk Courtyy 3
Commtultm F.tpI/1Y,8+pt• 50.19..