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HomeMy WebLinkAbout19516-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22039 Date AECEMBER 16, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 2905 WESTPHALIA ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 10 Lot I Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 25, 2990 Pursuant to which Building Permit No. 19516-Z dated NOVEMBER 14, 1990 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 ACCESSORY GP.RAGE IN REAR, YARD The certificate is issued to CLIFFORD D. POLACEK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-234362 - MAY 7 1992 PLUMBERS CERTIFICATION DATED NfA Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATR OF OCCUPANCY No Z-22040 Date DECEMBER 16, 1992 THIS CERTIFIE5 that the building ADDITIONS & ALTERATIONS Location of Property 2905 WESTPHALIA ROAD MATTITUCK N. Y. House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 10 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 25, 1990 pursuant to which Building Permit No. 19516-Z dated NOVEMBER 14, 1990 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 ALTERATIONS ADDITSON & DECK ADDITION AS APPLIED FOR. The certificate is issued to CLIFFORD POLACEK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-234362 - MAY 7 1992 PLUMBERS CERTIFICATION DATED N/A i1d ng Inspector Rev. 1/81 FD8ffi PTO. 8 TOWN OF SOUTHALD 6UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILbiNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 1951 b z Date ....~/.::~Y 19~ Permission is har~ grant ~ ~ of premises located of .."et.~rr?...~l~l . %~Er~.:........~ ..........................f.7.~~~.~..Q~/..~~fkea/a-!! County lax Map No. 1000 Section ..../.1.7.x......... Block Lot No.......,.,1......,..... pursuant to oppllcation doted ...,~iQ~,.~ 19..gQ and approved by the Building Inspector. ' a~ i Fee ~ Build g I or Rev, 6/30/80 form No. 6 ~;i ~ ~ ~ i ' ~ TOWN OF SOUTHOLD G ~ ~ ,~C:-.c.L~ BUILDING DEPARTMENT '~Yj~ f~ ~ .{.l TOWN HALL 76s-laoz jl qsy ~.y'~tiO%;? ,,.,,,AppLICATION FOR CERTIFICATE OF OCCUPANCY E 4n : r•.enw° ~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 site plan requirements. ,i 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 i 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 Che 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 o£ Occupancy - $50.00 S.' Temporary Certificate of Occupancy - Residential $15.00, C//oCCm~~mercial $15.00 Date ..~ll d .:~Qf J.l.~.~ i~CW Construction.......... nOld Or `Pre/-exist/ing/Buildin Q x Location of Property....~~V: }....1N ~,f~~.vlla:t,~~ ~.G.~....~uJll(.': ~1~.~.~~............ House No. / fin/ Street / Hamlet Onwer or Owners of Property......,~.OjY~~(~~,CL,,~;,~(f,(/, (`t~~~~,,,,,,,,,,,,,,,,,,,, County Tax Map No 1000, nSection....1.1.....Block.....!. Qy...(.(. .Lot....../,~.... Subdivision.....:~~~.:~'..(C.A.~..(~ ..............ril p~.J.~~7. .Lot. / C/ / 7 ) ed Ma Permit No.G.( ~~X:..`~ .Date Of Permit..l~..t~ .~t?,,,ApplicanC...... ~ e health Dept. Approval ..........................Underwriters Approval... ~ J................. Planning Board Approval Request for: Temporary Certificate........... Final Certicate...~..... ' Fce Submitted; ~,~,~G,,,,,,,, ~ r Lill:, y~~8 / APPLICANT r® ~ ~~n ~Q form No. 6 „ ~~w : r , . , , r , . ~ l ~N,,.._~ ."=..z r'~ { i, t~~~ , ' ~ ~ TOWN OF SOUTHOLD o v~~ ' - 'e~~' ~ . ~,C.•a 1.~.' , BUILDING DEPARTMENT TOWN HALL N0~1 3 D I9~'~ 76s-lso2 jl 9~a-' i.' ~ v r ~y~;~1'~i~~,~L„'~a....%~-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: 'r 1. Final survey of property with accurate location o£ 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 o£ Fire Underwriters. 4. Swozn 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 end 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. Zf a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate o£ Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A1CeraCions 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, C/oGmmercial $15.00 Date ..~d dX.'~ Q~tl.l.g ~ flew ConsCruction.......... Oldt-OrPre/-exist/ing(Buildin/)g . f / Location of Property....~~Q:l....(.M•~~~+r.X1141,,~~...J:~~...~~.(lt~~:~'Ll~.~..~Y Lf House No. j Street / Hamlet Onwer or Owners of Property........ O~ y~(,[~1~ ~Il.(/~:C ~1\ County Tax Map No 1000,[[~Section....l.l./......Block..... c. o...~~.//...Lot......//; ~yy Subdivision/.~j..('.'.Y?(~~2. jf_~l_('.~~.........j..../.FilGed Map.,~~Q,7...Lot.....~.1 Permit No.4.6 til.~l~.. ~ .Date Of Permit., E~ , i ~ ,e,O...Applicant...... ~.C~ ffealth Dept. Approval ..........................Underwriters Approval. Planning Board Approval Request for: Temporary Certificate........... Final. Certicate...~..... ' . ~ ( pG Fee Submitted: / ~`C~~A""" ~,,,1• ~-prC. ~'ti APPLICANT - z THE NEW YORK BOARD OF FIRE UNDERWRITERS ~xr~ 3. 1000788 BUREAU OF ELECTRICITY 63 JOHN STREET, NEW YORK. NEW YORK 10098 Date 07r19H2 App/icationNo.onfNe "i3373,"~9%.f`~f. N 238362 THIS CERTIFIES THAT only Che electrical equipment as described 6e/ow wnd introduced by the applicant named on the above application number in the premises of CLIPBORLI EOGA.COK, ~J~AR pEtFVP, tdY1' 1, Eil~~'i'I~`UCK, N.Y. in the follatcinq location; ® Basement 0 !at F'l. ? 2nd F!. Q~~ 3evtion B/ock Lot rues examined an ~~LZ I.~ 30 + ~ ~ 2 and found to be in conrpkance with the reyuirentents q/this Board. FI%TURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLE$ SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K W. AMT. K W. M11. K.W AMi K. W, pMi. H P. 2I 1.8 26 7~, 1 N ~ DRYERS FURNACE MOTORS ~ FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL UNIT HEATERS MULTI.OUTIET DIMMERS AMT. K. W. Olt H. P GAS H P. MAT. NO. A W. G AMi AMP. AMT. AMPS. TRANS. AMT H. P SYSTEMS AMT. WATTS NO.OF FEET 1 20 9 G00 SERVICE DISCONNECT NO.OF $ E R V f C E AMi. AMP. TYPE METER 1,6' 1W 1 R JW 3 % ~W 3,e' 4W NO. OF CC COND. A. W G. NO. OF HbIEG A W. G. NO OF NEUTRALS A. W. G. EQUIP. PER % OF CC. COND. OF HLIEG OF NEUTRAL OTHE0. APPARATUS: C.N,C.It-.1 '1'BflGK S+,6HT'IN01•;it~ SRtit181'ttOt2 G~GECSBIC INC 1;IC,~#169-0 ~~/f~ P.O. 80% .t8~ A~lU(ad'S17(rllM; r b3Y r t, 19;1 I. GENERAL MANAGER 1t ~ ~ s Per s This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPECTORS Victor Lessard - ~F~ot;r Principal Building Inspector O~'~ V ~'d Curtis Horton ~t~ - SCOTT L. HARRIS, Supervisor Senior Building Inspectar ~ ~ r.,;Y„~ ;j Southold Town Hall Thomas Fisher ' ,~f ~ h ' "r ' P.O. Box 1179, 53095 Main Road Building Inspector O - r .Y Gary Fish ~ `s• •~^v~'A' r Southold, New York 11971 Building Inspector ~ 1 -;*g a , j? Fax (516) 765-1823 ~~-.c~~F%~" Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspectrn Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD OCTOBER 26, 1992 CLIFFORD POLACER 2905 WESTPHALIA ROAD DEER DRIVE MATTITUCR, NY 11952 To Whom This May Concern: We are unable to complete your Certificate of occupancy because of the following reasons: %xX An application for Certificate of Occupancy is not on file. (Enclosed) X10[ No Underwriters Certificate on file. - xa~c 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 # 19516-Z Please contact our office on this matter. Thank you for .cooperation. SOUTHOLD TOWN BUILDING DEPT. III^- it .:~M~•te.NrC `~yl a7~ln~.. pia H Y )tIDATI09 (1st) ~ ~ - - i ~ U13DATIOSS (2nd) - m ~r-~ ry~ o UGH FRAi4E & j ~ Q~ m PLUMBING • ~ ~ m r i ~ n~ _ a IISULATI0;1 PER N. Y. STATE ENERGY I ~ , I CODs ~d~ ~ ~ PILL' FI;IAL I . ~ o x ADDITIOP3AL COMMEP]TS: ~ / ~~I6 i ' X • ro V~\ ~ \\p' H ° \ O N 1 . ~ x - } x ~ b [+7 -q 65-1802 ILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ) ROUGH PLBG, (]FOUNDATION 2ND [ ]INSULATION ~MING [ ]FINAL REMARKS: ~Z_ DATE ~ INSPECTO 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROU PLBG. [ ]FOUNDATION 2ND ( INSULATION i (]FRAMING [ ]FINAL REMARKS: o E _ , `s f DATE ~ INSPECTO l~sl~ ~?ss-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ FRAMING [ 7 FINAL REMARKS: i t i i I 1 R E DATE ~ D INSPECTOR E ~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FO RATION i5T [ ]ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: i i DATE ~ C7 INSPECTOR K 765'180 BurLplNa DEPT. iNSP~CTtQN [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: '~~i~r.. ~ ~a {k 4 _ _ s t i I s t } i DATE ~ 7 INSPECTORS / p ? C 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION i5T [ ]ROUGH P<_BG. [)FOUNDATION 2ND [ ]INSULATION [ 1 FRAMING [ l FINAL REMARKS: ~ DATE o2 ~ INSPECTOR r i New York Stale Department of Environmental Conservation ,;.y~ `ff'' 8u/ii~d{n(g 40-SONY, Slony Brook, New Yvrk 11784 > l / (!'1~l~,a~~. !c~-~'~ DATE: (/I °iLlrlO UUUUUU~~~~V -1 .(x 1 f '~'r)1'3'-cz~/'•ID/vc-aol~-C.~ ,Uy~// errs j~.~p~~.~~,~~ m~~{ ; i/ ~:ir~1~. ~Nc:.^^- u.w'" ~''r~v~c~',~(~y,.i Thomas G Jorifng i,., c 4.ti.c~ lJ.wi_Z~'~~~ Commissioner n ~ ~ Mk.,U..t..~ ~ Dear !c,(c~~'~ .S;c;,`l.h1uJ /D"( /cxx7- A review has been ma~~de~ of your proposal to: ~;rw~~ ~ 0 ~ c.,,~ ~'r t.+~y~ -c2~j~.at~'^"r~. 0~-~-{~. c_~.~J~r~Gt. ~ t./~ry -.:,'1~,,~w~, U-~,~(~. l.~.r.u0 ~ V Based on the information you have aubmltted, 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 n~an-made structure greater Chan 100' in length which waa constructe prior to 9 20 77. Landward of the 10' above moan mea luvel elevation contour on a gradual, natural slops. Landward of the topographic crest of a bluff, cliff or dune which is . greater than 10' in eievation 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 oc topographic crest without a permit. It is your responsibility to etnsure tent all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface oc 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 rtiodLfication to khe project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this latter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. (,~i# Very truly yours, Doputy Regions Permit A ministrator k - ~+im:`` ~e s ..'.kaCd:rn` ~xG[,.w n4nAN'wM, v n:. a :,ni; - , ~ , , r , - - ~"v_ ~ _ mt' ~ ash..~e-. , r n@~'' . 1 qsf~ 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [)INSULATION [ ~RAMING [ ]FINAL REMARKS: ~ ~/D ~ ~~r~ ~ ~ ~ S' DATE ~ INSPECTOR ~~~~u~~©c~-~~~ TRUSTEES r~'ia f 2 SCOTT L. HARRIS u~ v; Supervisor John M. Bredemeyer, III, President ' - Henry P. Smith, Vice President '~~f! Town Hall, 53095 Main Road Albert J. Krupski, Jr. P.O. Box l l79 John L. Bednoski, Jr. Southold, New York t 1971 John B. Tuthill BOARD OF TOWN TRUSTEES Fax (516) 765-1823 Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (5l6) 765-1800 , D ~ ~ November 15, 1990 ~ ~ 61 V Roy Stakey, Builder pr. ~ T®yVN p 1JY.~. nl~ Tuthill s Lane Aquebogue, NY 11931 RE: Waiver request / Clifford D. Polacek SCTM #1000-114-10-1 Dear Mr. Stakey: The following action was taken by the Board of Town Trustees during its regular meeting held on November 15, 1990: RESOLVED that the Town Trustees APPROVE the request of Roy Stakey, Builder on behalf of CLIFFORD D. POLACEK for a waiver to construct a 34' x 28' garage and inclose a 40' x 12' deck with the following condition: that drywells be installed to contain run off from house and garage. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. Very truly yours, John M. Bredemeyer, III President, Board of Town Trustees JMB:jb cc: Bldg. Dept. CAC File F-+~'£Y:a+ich~~Lk:,::w K„~'n,;,,~, ...i`~x.«t. .~~rs .-x wfa h.~e:,. awv r,4n .~~~.'N ,,+x+,~--,.... .+K .,s f.. x.; slr,t hxa..u~r. l+..a~.r a,~+l"S%'r.#v"ts~'i. ~ `.Yw^r ° Ya&"w'''iffiA4M1L1L:i~a2Li`. FORM NO.3 TOIVN O~ SOUTHOLD BUILDING DEPARTMENT TOGYN CLERK'S OFFICE ~ SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ~p ~ Date 19~f0.. . ....:g/.. P/LEASE TAK,, ENOT~~ICE that your application dated f©~~,~~ 19~~.~ . . for permit to C'~"//!¢!,! ~~./..G,~'~.-'~~_/ ~~c°"f,., at Location of Property . ~9pS • •d(f~~~c~y •,(~%r. • r%1•k / _ • • • • House No. Street j~('• H•mlet County Tax Map No. 1000 Section Block • ~Q ....Lot . Subdivision Filed Map No. Lot No. . is returned herewith and disapproved on the following grounds . ..G•c~ • ...1LL..~ • .G7e/q/p~,~~ j;l~Lf.~i~ ....~%r: `".~...:~1~?7i'C' ....t~q ~~i `~6~rG~crl'~.Z~ ...si2~~.. ~~`P`G~t ..G~~ f ~~.-..~a~ . } ui ng ~ nspec or ~ ~ • RV 1/80 i New York State Department of EnvlronmeMal Conservation 18ullding 4/)0--5UNY, Stony 8roak, New York 117A4 / Cl1~~,~, lc~~~ DATE: i)/a~.~~D U~• ~.n.u~u ~ , ~ ° y7. i ~s' _c:z:>/'^IU~c'ac~ ~ "C.i ayU.S lte: ~ ~r~N _ ~ Crt.~4.~, Nc~~.•U~~+~+~r~~<~ Thames G Jorfing ,~i.Gt,, e r~~ W.+dQ ~ Gommissloner Dear ~ C„ ~d /cx~c7- ~ .qy,G,~ A review hae been made of your proposal to: ~n~ 0. ~ ~,ry ; czn -fLj~.a~""c~, t~.{~. f~~~~ ~ cam, -r•%~ 4-~.~~ ,.yr,a(~ c~sr~~~ ~'v ~h on .4cti rv ~ G1, ~ ~ ,1/ t~ V Based on the information you have aubrnitted, the New York State Department oY environmental Conservation has determined that the parcel -,•x-~•'-- p r o f ec t i e Greater Chan 300' from Inventoried tidal wetlands. Landward of a subatnntial man-made atruckure greater than 100' in length which was conatrucke pr or to 9 20 77. Landward of the 10' above mean ass level elevation contour on a gradual, natural slope. Landward of the topographic crest of a b1uEE, cliff or dune which is . greater Chan 10' In elevation above rusan 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 Copoyraphle crest withouk a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration oc disturbance to the' ground surEaca or vegetation !n this area as a result of your project. Such precautions may Include providing adequate work area between the 10' contour or topographic creaC and the project (I.e. a 15' to 20' wide . construction area) or erection oP a temporary Eence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by Chia 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. V`ery truly yours, Deputy ttegiona Permit A ministrator 1 i. ~~D BOARD OF HEALTH Q tL55`~ 3 SETS OF Pj.e1NS . FORM NO. 1 SURVEY r ~%l ~ M~ ~I f ~ ~ 1 ~ . . . . . . . . . . . . . . . . ~..v..,.~.~..®,.n...~~" = TOWN OF SOUTHOLD CNCC1~` i~.;.r BUILDING DEPARTMENT SE IC )iORM t ~ I TOWN HALL L W'r9''^"""' BLDG. DkP'i. TOWN OF SOt17H01_t7 ~ $OUTHOLD, N.Y• 11971 NOTIFY o _""""F_.`."./_~.~7" e,.,.~.....I,.,-.'~J TEL.: 765-1802 CALL .Za7::35Q~... ! 19 MAIL T0: . Examined I~ ~ ~.~I'j Ca•, • , . Approved . 19Permit N ~1.`:5/~ /.I~,J . Disapproved a/c ~~~.:/.jr.22 1 ~J J~ cF~~~~~ ~ ~ ~ , ~ • ~ ~ uilc ' g Ins • tor) )1\\ p ~ 5 l~ APPLICATION FOR BU{LDfNG PERN7IT ful~ BLDG. DE Date 15 . TOWNUFSO dLa~"''~ - ` INSTRUCTIONS s7 ` a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c.` The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector 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 constrvction 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, ousin~ cod and regulations, and to admit authorized inspectors on premises and in building for necessary inspectio f~~, d (Signature of plicant, ©r name, 'f a corpora ion) t ~q m (Mailing address of applicant) ~f y///y~, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .........S ~ iN~ P . (as on the tax roll or latest deed) ICappiicant is a corporation, signature of duly authorized officer. (Name and title of corporateppoffi//cer) Builder's License No. <..4........... . Plumber's License No. ~7( . Electrician's License No. ~ Other Trade's License No . ~O 1. Location of land on which proposed work will be done; `--~J~---~- ( ' "~~a5.......~.1JeS,l,~,~t:w~,~r~....12-~:. ......y.Y\:a~l~l•v..c~L,F,/'~.- ..~1c~3.Z.. house Number Street, Hamlet ~ • / r County Tax plap No. ! 000 Section ~ ~ • ~ ~ • • • • ~ BI'nck , d, , , , , , , , , , hot ~ , • Subdivision ~'Q2.1~.....~~.Y~ Filed Map No. . 3 ~1 Lot . (Name) State existing use and occupancy of premises and intended use and occupQancy of proposed construction: a. Existing use and occupancy N ~~'.d';/1 L ~.tif ~ P ~,t,I~.Pr?C• P: • • , • . • • , . • . • • . b. Intended use a d .............S0.V)~ ? ~r~~.~cos~........~ n occupancy ~J I . b ~'"it Py4 y~~,,~~i~ 3. Nature of work (check which applicable): New Building Addition . Alteration , Repair , R~movaJ . Dem 1' ion ,Swi Tennis Court „ " ~7~q//'~~~~gqACCessory Building. ,~+-"T-'-' • • •Fehce .Ot er Wor 4. Estimated Cost .....~~.tl~O~O~/ . . . Fee , (to be paid on tiling this application) 5. If dtvclling, nurnber of dwelling units , , , , , , , , Number of dwelling units on each floor . . If garage, number of cars , , _ • 6. If business, commercial or mixed occupancy, specify a rre and extent of c ct~, ty(p_e of use . . 7, Dimensions ex{'stin structures, if any: Front . . `~~,~•a~j, , , , ,Rear . ~j`~t 1J4 , Depth . , ~~.d , ~ • Height ....~.f ~ .C4~~... Number of Stories .....i.Y. Z......... ~ C , , • , , , , Dimensions o~slme structure wii}i' alterations or drrdSSitions. Front ~a Rear '1~,~.yc, , , Depth.... f~~Height.....~W. ....Num~c,{~ofSto s .~~!7.-. ' 8. Dimensions of~i~tire new Front . !Q . Rear , M:9'~~Q ?t~~. Depth . , ,~a, Height 1F. N~}~nber ot; Stones . 9. Size of tot: Front G a h.~ l ~~/I ..-1-„ I~{ tt'',, r~ ' . Rear . .1~A.•.~,~.... , Deppth i, E~.`!4~ J. t lU, 'Da~@ of Purchsse ~ O::a~:.K`.1 . .Name. of Former Owner 11.1110 ff~..~,R,yG~?,~„ , . , , , s , , 11. Zone or use district in which prertiises are situated . . . , . ; , , , . I2. Does proposed construction violate any zoning law, ordinance or regulati3Tr: 1~.0..;,;,, . ..:........r. iy 13. 1Vill lot be regraded (a ~1...... . Nill excess fil 'be mpvc f o ~retd~c~s,., Yes . p/,~. 1~. Name of Owner of premises .5 ,~1~.~CS f~ D: ~O~Lf~~Address .~,.~,~~4~r'JI~~IIGi~p}tone No.. ~.q~.:~t). ~J.3, Name of Architect ,Address Phone No.. ' n .I Name of Contractor !°~py, ,!S,~O~`~;~ , , , , ,Address ~tt~!~i,( ~G E~~I.~~NP~Oo~te No..N'l.~t~ ~ . . IS.Is this property to aged withi 100 feet of a tidal wetland? *YLrS.~?C.NO.... *If yes, Southold TownlTrustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all puildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or desctiption according to deed, and show street names and indicate whether interior or comer lot. ' li «Y l~~w ~r° l~- i ~ i j i ~ ce ~~W ~ °0 e~ i,~ t> ~ ~ ~ ~ ~ ~ ~ ~ 1~ ~ G t 3 ~ ~ ~ I / .....e--• l ~ ~ .ww . STA GOFNEIVYORI:, jS.S _ • • • • • • • • • • • ' ; • • • • . • • • • • being duly sworn, depascs and says that he is the applicant COUNTY O (1\am of individual si n ' d contract) above named. • I3•cisthc ~ • (Contractor, agent, corporate officer, etcJ ~ • • • ~ • • of said owner or owners, and is duly authorized to pcrfprm or have performed the said work and to make and Gle this application; that all statements contained in this application arc true to tare best of his knowledge and belief; and that the work wit( be performed in the manner set forth in the application filed therewith. ' Sworn to before me this ~ ..day~o'f . .~ll , 19~~•~ i Notary Public, 1:'':-: •v?:', 1) !JD- Vd~ County NOTARYPUBUC,~to~utftewYork . • • • • . ' (Sign re of applicant) pIk Caun No.4T018 A SuHI • • • • • • ' • -Term Expires Much, 1 V BOAaD OF HEALTH fir, ; l VII 3 SETS O F Py,1 N S . ~ ~ ~ FORM NO.1 SURVEY ~l if ~ b TOWN OF SOUTHOLD CHECKI:.. . BUILDING DEPARTMENT SEPTIC goad ~~~~.~.....~.~.~..._.~..9..~ t3LCC3. t}!?i. TOWN HALL ,SEC Wz'^N'""' ' TOWN Or SOil';i-(`!.!' $OUTHOLD, N. Y. 11971 ~"NOTIFY ~ rt...~...i,....... TEL.: 765-1802 CALL . 3SQ . Examined .~1/<........., 19~~ riAIL TO Approved , 19 Permit No.. . / ~ Disapproved a/c . ..w.~......................... I ~ ~ L' I .,I i+ ` ' (Building Inspector) c ~t~~'~ ~ APPLICATION FOR BUILDING PERMIT BLDG. t)EP7: Date 15 - TOWN OF SOUTHOLD ' INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ 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 ~vltich is part of this appli- cation. e.' 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 shalt 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 ar alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, lousing cod ,and regulations, and to admit authorized inspectors on premises and in building for necessary inspectio + ~1 (//I ~//1 1~') (Signature ot`~~licant, or name, f a corporatton) ! , . d~.`~~.Q,>J...~~1n,~ rtii,l ir•..~~ t l: ~~:I~!! f.l.%:4 C1 - •a- ' (Mailing address of applicant) 1//I~,~ , State whether applicant is owne~r',tlessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :v. N 2:'.a:....Li. ~.t,FFoR.~... ~'oL/j C.E ~ Name of owner of premises .........~c~1"~ F (as on the tax roll or latest deed) IC applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plurnber's License No. L~ Electrician's License No. ' titer Trade's License No . . 1. Location of land on which proposed work will be done; - House Nuntbcr Street. Hamtet ~ County Tax ~~tap No. 1000 Section ~ l • • • • • • Block J. D.......... Lot ~ ..r~.1'PQ.~'.... ~~y~t ; Subdivision . .Filed M11ap No. , ,a-;0 , , , , , Lot blame) . State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy P... ~Cl,l~; L1.~(.. ~ P J .(,C,`t,P!?( e . b. Intended use and SCE V`.1 ~ , occupancy _O 3. Nature of work (check which applicable): New Ouilding Addition • Alteration . . Repair Removal Dem I'tion ..............Swimcr~ng, pool....... , . Tennis Court Acc((e~~ssoryllBuilding...~.....Fence .......0th r Work............ 4. Estimated Cost .....~..t~ ~i.~~~.lJ.,.~.~,J Fee (to be paid on filing this applications 5, If dwe(lin;, number of dwellin units Number of dwelling units on each floor s If garage,numbcrofcars ' ' 6. If business, commercial or mixed occupancy, specif a re and extent oC c c tyffp--e of use { J . ~ • . . 7. Dimensions f ex44st~ing_structures, if any: Front . , `~`~c3..... Rear ~j~+,>,k Depth . . Height ~.~1.`4C-.... Number of Stories .....1 t g, , rjj . . Dimensions o s me structure with, alterations or dditions: Front ...~b: ~3 • • • • • • • • Rcar :-I~.4lD.... . Depth t L, Height Num c of Sto c(s ....Z, y7 8. Dimensions of r)tire new t`?~~n: Front . :~Q, Rear ...~.~i Depth , ~jC......... , Height Ntt}}mber of Stories , .Q... -i . 9. Size of lot: Front G ~.'j 21oa Rcar `~~a.• , Dep~ I1...~: ~,i.~~o, 6 ~J.:. . 10. Date of Purchase • l0: a:.`~~~ .....Name of Former Owner 1,!~.t O(Gi. ~(~.9ay~ Q.y~~.:........ . . 1 1. Zone or use district in which prerrjises are situated . . 1'~. Does proposed construction violate any zoning law, ordinance or regulation: l~.f7...,.• • ~ • • • • • • • • • • • • • • 'ay 13. \Vill lot be regraded SJ...... hh , Nill excess G! be emovcd, fro re~ises: Yes . o . . 14. Name of Owner of premises . ~•~,4F~-, p Y.•~4~A~.f`~Address ~.~ti~.J 4~':!'J~P'~'`w~Sct P G~,M~~~Pone No.. :3~Q~ , . Name of Architect , t ....Address Phone No.. Name of Contractor ~D: J • J.~Gl.4~.'; : ~ . ...Address ~Gt.~ ~.il ~ GG iv!?~,~`~!I!'~"~~l~one No.. 2~~ :.a.~~.~•~. , . IS.Is this property located within 100 feet of a tidal wetland? *YES_~:~NO.... *If yes, Southold Town,Trustees Permit may he 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 n}tmber or description according to deed, and show street names and indicate whhther interior or comer lot. •s ~ aA ~~.I. ~ + !J-'` l ' ~ ~ c'a r ~ I ~ - - ~ ~ ~ ~ I l ~ ~ ~ a. I e GAL. , STATE OF NEN YORK, $ S COUNTY OF. ........~~y~` ~~a~ being duly sworn, deposes and says that he is the applicant (A'am of individual sign'', o contract) above named. 1-Icistltc (Contractor, agent, corporate officer, etcJ oC said owner or owners, and is duly authorized o perform or have performed the said work and to make and Cile this application; that all statements conta,'ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannc; set forth in the application filed therewith. ' ~ Swam to before me this ~ i Notary Public, f:!. l1:.', ^ :9- V~ County HELENwDEVQE NOTARYPUDLIC,SditeatNerlYorM (Sign' re ofapPlicanf) No. 4707878,Suttolk~ - -Term Expires M:rch 30.FF 1 . \ ~ESTp ` yqC /q s `JB ~E J~6 0~% „ /247,3 Rv'4~ 4x6 ? ~ 1 y~~ / J .a Q s`` I . wcu r - np < / a Ir y We `j ~co`' / 1 oW ~2° ,~0 moo,. a/ b ~ Asa. ' 3~ / 1P k0 ~~x e" 9sX z s sea •z.3. Ol •222 9 'v<. < v4 ,"~°°ac z`~j' _ Cpl OyTS ~ (e• s c e 4, ~ I fN / lyb _ ~A ~ n O« l^~` V f 3O ~ ' 0 $Rl V~~ aoN04 ~oN Q ~ O 9Ql 1». ASSN col z>. G~ 6p ~0 606 7e ~~r y' ~~6 °o o° d`~ d6 ex O~ ~ I NOTE, • = MONUMFNT. - SUBO/V/S/ON MAP F/LEY% /N THE OFF/CE OF THE CCERK OF SUFFOLK COUNTY ON NOTES JULY 25, /960 AS F/LE NO J204. I. SUFFOLK COUNTY TAX MAP 01ST 1000 SEC7. 110 BLK 10 LOT I , REVIS1oNS YOUNG & YOUNG OCT. 22, 1990 400 057 RANGER AVENUE, RIV ERH EAD, NEW YOflK AUG 6, 1991 ALDEN W. YOUNG HOWARD W.YOUNG PROPEfi610Ng1 ENCINECR qN0 LPNO SV flV4YOR n 9lIxVEYOR N Y 6. LIL. NO. 12845 N Y 9 LIC. NO. 45093 7 P f M SURVEY •FOR: ux urxwrzc0 amnamx oa nomrmx io CL/FF POLACEK 6,~PSE OF NEh, / ~ iXl9 9UNVEY 15 1 VIOLA,ION Of 9ELilON 1309 OF ixf NEW YOaX Sr4rE EOUL4rIOX tqW LOT NO. /9, °DEER P R ~PRD w ` o~ coPlES of rXls sxnvfv NqP xor eEPXlx6 'y r uxB suavEYOn's Ixafo sEU BX ~ y0 OG ' sE~ Su • E xo E cox5m[aEO A gNTE . EroBeEgVAtIB~rFUf`LBPY.X A7 nnArr/TUCK ° . 1~ q:.vr(f„c lNOlc4rfo xEa[oY sXgv. aux TOWN OF V V ;v'Y ,B • Ea5„I fE> xx:•, •~E r SOUTHOLO uaVFV 19 1'aEDPXF0, 4Y0 9 [ BFNq,F ( ry i0 iNE IliEt LOMDgNV, 60YEexxEYiO~ Bx. a ~ ~ Iq a -XLY qxa iExaxB asi.nr.oN IsrE° $UFFOLk 00., N. Y. } NEXEON, PNO i0 THE P39~GYEE9 OP ,NE Eg01XG INSrir.~r10 n' C„4Xaxif E3 GAE [)ATE' A,i iaq„Sf, XR6EE iB 40CIr'CN4l SCALE. / 40 MAR. 27, 1990 0188 ~NSr'lVr~.CNS ON CJBSEOUENL LbNFP3. ' ~ e ~ M A R S H ` / z~`_ IFS TP'`~gL /q fa.sf k.s lasJ_,. S 1 1 fogy E ~ v ; ; % ; for ,.v ~ o4,f /z.z) CC0 ~ ~ ~ ~ ~q Area ~ ~ 2 weAL % ~ ~ n ~ ~ u' i / , i3 ~ I .f ~ G ,~4 ,S~C / f .a Ivy cp / ~ ~ \ / ~ l i / / O~Q / y E,,V (fie • a~ . ~ ~ /~6L ~ / \ / ill ~In / ' ~ 0 _ Fa / N ~ v/N~' G'4Q "aA m 3 G / 2.r ~ 24 pQ - ~ OA ~ //oP` 04.DY ~e~4°o Q~\i s'z I's ~ U` `p ,Y~~~ ' ..ice//30 (y IA' e~ / 't, ~e Im O~ \~yy~ wa _d`~ / IIS. I) a SP ( ~ A ~4y,~ CP ~ \I-uN 1~~ / / "aT"aj ~Y'~ ~'^R es. ~ ~ B F'YSP gQ,U / ~ ro f ~~`yYr , 3' M P fl f~aC~ r TD 0~0~ 00 OQOyo ~ ~ o' VAS • / ~ NOTE • .MONUMENT, SUBO/V/SIGN MAP F/LEIJ /N THE OFF/CE NOTEf OF THE CLERK OFSUFF04K COUNTY ON I. SUFFOLK COUNTY TAX MAP JULY 25,/960 AS F/LE N0.3204. DISC 1000 SECT. 114 94K 10 LOT I - ~ ~ ' 2. ELEVATIONSSHOWN THUSI (1$.p'ARE REFERENCED TO N.G,V. D. (MSL 1929). ReVIS1oNS 1"OUNG YOUNG- ' OCT. 22, 1990 j 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ~ , , S - ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL~ENIi1NEER AND LAND SURVEYOR LAND 9URV EYOR. N,Y.9. L(¢ NO, 1,2545 N.Y.S. LIC. NO. 44893 SURVEY fOR: ~,UNAUTHORIZEO ALTERATION oR aoomoN rD: - CL/FF POLACEK < ' THIS SURVEY IS A VIDLATION OF SECTION 'i209 OF THE NEW YORK STATE EDUCATION ~ - ,LAW _ ~ ~ p T ~ ND. /9 , „D-EER P~7 ~s~ ~t COPIES OF THIS SUflVEY MAP NOT BEARING ~ THE LAND SURVEYORS INKED SEAL OR - ~ ~ ~ ~O~ ' EMBOSSED SEAL SHALL NOT BE CONSIDERED ' i0 RE A VALID TRUC'60PY A AT ~ (j ~ E ' GUARANTEES INDICATED HEREON SHALL RUN „ONLY TO iNE PERSON FCR WHOFI 'HE - TOWN OF ./p 3w.t~? suRVEY IS PREPARED, AND ON HIS BEHALF ~ S~? ~HVL(J ~7 70 THE TITLG COMPANY, GOVEflNMENTAL _ - ' fit AGENCY ANO LeND1NC INSJi7U h0N Li6TED 9 ' HEREON, AND TO THE ASSIGNEES Of THE JUFFOLK CO.~~.N.. I,. ~ qy b?' ~ LENDING INSTITUTip F, OUANAN fEES ARE - NOT TR~NSFF,RABLE TO ADD[TInryAL .SCALE: / I/~ ~ DA`f Ef - 'NS r17U IONS DR'3U9SEUUENf,OWNERS. MAR. 27, ( a~ I { t t 4 i , V f.',~ t !E • s °{6 70 „ 1 E V~~~ o" 1 {24.73 - Rv'4~ Z~ / 1 ~ Im C ~ ~S , /ii OAQ ~LwV Q/~\ / \ 3\ P 3~ / ~ `N 3' , y0 of ~o ~e e z s>•e r ze - ~ t7-yam ~ i'~ ~ ~tt t ~ ~ - iG , ~ ~ _ - ~ - F's~_-, sf' ~ so. zz c. / 19,,,a 2 , `mss w ~r , 20..3. J s ~ ` 4 ~ °e"A~3* 9> O 6y pQ gyp, k% aeF r e Q ~A Q. pQ` ~ ~~T X04}i~•y Q4p a0~ 4'~( 27.7, tp~g < er~• o SOP ~Nd C~ - ~0 LQ~~ ` 13~~ L _ Ql 9 ~ - c r ^ 1 O ~ NOTE • .MONUMENT. SUBD/V/S{ON MAP F/LEL' /N THE OFF/CE " NOTE ~ OF THE CLERK OF SUf'FOLK COUNTY ON I. SUFFOLK COUNTY TAX MAP JULY 25, /960 AS F/LE NO. 3204. DIST. 1000 SECT. 114 BLK 10 LOT I , REV1s1oNS YOUNG & YOUNG OCT. 22, 1990 400 OSTRANDER AVENUE, RIVERHEA D, NEW YORK ' AUO. 6, 1991 ~ " ' ALbEN W. YOUNG HOWARD W. YOUNG - PROFE9910NAL•ENGINEER AND LAND SURVEYOR ~ N, LANp 9URV EyOR, N.YS. LIC. NO, 12845 N. Y. s, LIC. NO. 48893 SURVEY ,FOR: UNAUTNOR12E0 ALTERATION OR ADDITION TO TNIS SURVEY IS A VIOLATION OF SECTION CL/FF POLA CEK x,` aF ro ~j 7209 OF THE NEW YOPK STATE EDUCATION C~'~P ' F~ 1 / ~ ,z ~ ~ L O T ~ ND. /9 , °DEER P R ~~,pD K. °~i~aa ~ ~ COPIES OF THIS SURVEY MAP NOT BEARING "„y Q LO T THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL 9NALL NOT GE CONSIDERED ' 10 RE A VAL10 TRVE COPY af' AT n~,~ ~ T~^ v A ANT ?UARANTEES INDICATED HEREON SHALL RUN 'Y' l~ ,l ~ ` 9NLT TO 'HE PER30N FOR WHGM THE TOWN OF ~ SO~UTHOLD ' SURVF.T IS PRE PARED, ANO CN HIS BEHALF TG THE TITLE COMPANY, GOVE.4NMENTAL ~ AGENCY ANO LENDING 1N3T ITUTION LISTED BY Y} ~ `S;+_. HENEON, AND TO THE ASSIGNEES OF THE SU FFOLIE CO., N. Y. LENDING IASTITUTION GUARANTEES ARE NDT TRl~NGFERARLE ?0 ADDITIONAL - SCALE: II ~ DATE: - ~rvST~iVTlgN3 OR 9UBSEPI)ENT oWNFRS. / 40 MAR. 2.7, 1990 -Q~$$