Loading...
HomeMy WebLinkAbout18717-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18804 Date FEBRUARY 15, 1990 THIS CERTIFIES that the building ADDITION Location of Property 1675 NARROW RIVER ROAD ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 27 Block 3 Lot 6.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 22, 1989 pursuant to which Building Permit No. 18717-Z dated JANUARY 4, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS PER CONDITIONS OF ZBA APPEAL #3825. The certificate is issued to SUSAN FORBES {owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~~7 ~ Building Inspector Rev. 1/81 roans xo. 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) q N 4 ~ $ 7 .L l Z Date / 9.~d Permission is hereby granted to: .r/~~..... ro s!:P^~~v/.1~..G.~~.~'-~..~t....c?G&G~•~..~.1?.YJ..~k.!7.w .~.Gl".K. ....&2~~~' ~~/...T,~ c ..z`~ ...b.~. .~3~z.5~ County Tax Map No. 1000 Section ...........°2..7..... Block c1 Lot No.......lCJ Z' pursuant to application dated ~..Z- 19.D.~~.., and approved by the building Inspector. Fee $..,Cr. Q! Buil ' g Inspec~~. Rev. 6/30/80 (~r.,,~'t3.. cxr w . T04YN OP SOUTIIOLD IIUILDIYYG DEPARTYICYYT TOUN IIALL SOUTIlOLD, tYCH YOtCK 11971 7GS - IBD2 APPLICATZON FOR CERTIFICATE OF OCCIIPAtiCY / J2 DATE.. f l°~ K.~ . HEA COYYSTRUCTION ..~.OLA OR PRE-E%ISTItYC BUILDZYYG.. VACAYiT LALiD........ Location of Property..Icy..~S...:/'~'!~:city'"~fQ~?Zye----K-~'----~iCi~~T'.. llOUSE NO. ~ STREET HAMLET OvnCr or Ovncrs of Property... ~-~-•j--. ~ 0'~~~5 County Taz Hap No. 1000 Section ~ IIlock ..3.... Lo C' Subdivision..........:~~........_ Filed Map ....-.._Lot..... /7 ~3G 0o rs9 ~-O ~Ino ps+o.z.Ci Pernit Ho. ~Zf7~.?...DatC of PcrmiC .:,1.7~gv.ApPlicant ~-'.~-7-~G-~~y~~ Dealth Dept. Approval Undcrvritcrs Approval....__........ Planning Board Approval Request far Temporary Certificate Final Certificate FCC $nbC11.LCCd: 5--------------•----• nrrLlcnxT....K h:~- ..r?.2!~ ~ y~~ .F ~C°• 10!14/B8 ~~,.~qoo Cam (S~D~~ 1 FORM NO. 6 ~I TONN OF SOUTIIOLD BIIILDINC DEPART!lENT TOUN HALL 7G5 - 1II02 ~ ' APPLICATION FOR~CERTIPICATE OF OCCUPANCY INSTRUCTIONS A. This application must ~c filed in typewriter OR ink and submitted Co the Building Inspector with the fol~.owing; for new buildings or new use: I. Eiaal survey of property with accurate location of all buildings, property lines, streets, and unusua} natural or topographic features. ' 2. Final approval of DCalth Dept. of eater supply and sewerage-disposal(S-9 form). 3. Approval of clectri~al insCallatioo from Board of Pire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less' than 2/10 of 1Z lead. 5. Commercial building;, industrial buildings, multipln residences and similar. buildings and installations, a certificate of code compliance from the Architect os Engineer respensble for the building. ' 6. Submit Planning Board Approval of completed site plan requirements. B. Por existing buildingsi(Pricr to April 9, 1957 non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant If a Certificate ofl0ecupancy is denied, the Building Inspector shall state the reasons therefor in~;vrit~ing Co the applicant. 3. Dale of any housing'code~' or safety inspection of buildings or premises, or other pertinent informaCign required to prepare a certificate. C. For Vacant Land CcrtifcaCd of Occupancy; 1. An application for onto t land Certificate of Occupancy shall be submitted, and a certified abstrac of title issued by a title company showing single and separate ownership o,f~t a entire lot prior to April 4, 1957 shall also accompany the application. I~ a ertificate of Occupancy is denied, the Building Inspector shall state the rcas,ons therefor in writing to the applicant. D. FEES: 1. CER`IIPiCAT'L•` OP.C7CCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 -'Businesses $50_00_ 2. Certificate of Oiccupancy on pre-existing dwelling - $100.00_ 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 , 4. Vacant Land Certificate of Occupancy $20.00 , 5. Dpdatcd Certificate of Occupancy - $50.00 6. Temporary Certif;icaCe of Occupancy - $5.00 Residential Commercial ~ ev_ 10/I /S8 - TEL. 765-1 E~~ C~' T0~'1`I OF SOIITIZOi.D o,,~z~ ti Q:.. ~ ~ ~ , /i~~j L,,,,,i~ Y„ OI~1'ICI: Ul' GUILDIIvG tNSPrC'T'02 Fes-, ",~~4~.~., [~~4'~",aO ~ 1'.O. UOY 1 1 79 , . ;r=•d r"''•;'i.'t~ ~ TONN HALL :,vim b ~i • O~y~ fit- SOLITIIOLD, N.Y. i 1971 ~?~,j,~-•,,~ February 14, 1990 MACDONAYD WOODWORKING HOG POND ROAD ORIL~NT, N.Y. 11457 4 RE: SHSAN FORBES To t•Ihom 'I'hi~ May Concern, Y 4.e arc unable r.o complete your Certificate of oc~c _ ancy because of the folloe•~ing reasons. /_~?J ,1n application for Certificate of Oc~upancl is not nn fi7.c. (E1dCLOSED) *to tlndcrwritcrs Cc:rtificnte on file. / fhe checF; .i::{ry~l/nut on file.) $25.00 / I No flaa].th Dept. Approval on file. / No final inspect:ion has been made. Plcauc contact: our office on this matter. Ttwnk you for your cooperation. I:u.ildir;q Perm.it•. ¢ I B 7 1 7~ Z Duildind Dept. / tlo Plumber Solder Ccrt.ificate ott f-i1e. ( all I~rrmit•s involving plumbing Icing i~sucd after April 1,196A ) Tss-xsoz BUILDING DEPT. INSPECTION [ ]FOUNDATION x5T ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ~ INS TION [ ]FRAMING [ FINAL REMARKS: ~C_~. DATE ~ ~ INSPECTOR ~'llATF. , OOMMENTS 'r'1c~.D II~SI'EC;IU,J m ~ ~ ~ a 1. y ~ FOUNDATION w (1st) - ~ FOUNDATION (2nd) _ 2. o ROUGH FRAME & PLUMBING V H b H 3. ~ IIJSULATION PER N. Y. STATE ENERGY 5 CODE 'Y r /3 i~ 4. FINAL N o ADDITIONAL COMMENTS: x co x \~y ro H ~ \ 9 y `n . N \`J O 2 x m a ~ r•\` d m . -o H ~ ~ ~I'~ r Memorandum from . BUILDING INSPECTORS OFFICE ~ TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765.1802 January 4, 1990 Dear Susan: 1 am returning your check fl10b3 which yon submitted in January 89. A Building Permit was issued on Jan. 4, 1990. Ren Strachan applied for it and paid with his check. Yours truly, v~ Secretary 1P ~ a~ ~'b~y~6 i ~~M.~ ~vV ~ G SU~FOI,~~~G~ ~ South®ld Town Board of Appeals o., ~ ®t' MAIN ROAD- STATE ROAD 25 SDUTHOLD, L.I., N.Y. 11971 '~,~p~ TELEPHONE (516) 765-1809 APPEALS BOARD MEMBERS GERARD P. GOEHRINGER. CHAIRMAN D ~ [-c? ~ - CHAftLES GRIGONIS. JR. r'~ SERGE DOYEN, JR. JOSEPH H. SAWICKI MAR 2 ~2 i9~9 JAMES DINIZIO. JR. 1'®W~VI OF SOUTPdOLD ACTION OF THE BOARD OF APPEALS Appeal No. 3825: Upon application o ~SU~5AN A. FORB~ for a Variance to the Zoning Ordinance, Article III, Section 100-31, and Article XXIV, Section 100-244 for approval of open deck addition with an insufficient front yard setback. Lot area of premises is nonconforming at approximately 11,300 sq. ft. in this R-80- Zone District. Location of Property: 1075 Narrow River Road, Orient, NY; County Tax Map District 1000, Section 27, Block 3, Lot 6.2. WHEREAS, a public hearing was held and concluded on March 9, 1989 in the Matter of the Application of SUSAN A. FORBES under Appeal No. 3825; and WHEREAS, at said hearing 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, the 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: Page 2 - Appeal No. 3825 Matter of SUSAN A. FORBES Decision Rendered March 16, 1989 1. By this application, appellants request a Variance under Article III, Section 100-31 and Article XXIV, Section 244 for approval of an open deck addition (with portico entrance) as shown on the architectural rendition prepared by Forbes-Ergas Design Associates, Inc. dated May 12, 1984 (Drawing No. D-1. 2. The premises in question is a parcel of land containing a total lot area of 11,325+ square feet situated along the north side of Narrow River Road in the Hamlet of Orient, Town of Southold, and more particularly identified on the Suffolk County Tax Maps as District 1000, Section 27, Block 3, Lot 6.2. 3. The subject parcel is improved with an one-story single-family house set back 25.7+- feet from its closest point to the south (front} property line {exclusive of the subject deck and portico extension}. 4. Article III, Section 100-31, and Column iii of the Bulk Schedule of the Zoning Code provides for a minimum front yard setback for parcels in the R-80 Zone District to be 60 feet. 5. Article XIV, Section 100-244 of the Zoning Code provides relief to legal nonconforming lots with an area of less than 20,000 square feet for a minimum front yard setback of a principal building at 35 feet. 6. The area of jurisdiction before this Board is that area toward the street within the 35 ft. front yard restriction. The setback at its nearest point (at the southwest corner) requested by this application is at 14-1/2 feet. The portion of the extention in front of the dwelling extends out eight feet (see architect's sketch and site plan). 7. The amount of relief requested in relation to the requirement is substantial, being a variance of 20-1/2 feet, or 58%, for a 14-1j2 feet setback (in lieu of the required 35 feet). The reduction in relation to the existing nonconforming setback is also substantial, being a variance of 31%, or eight feet. 8. It is the opinion of this Board that an alternative to the requested variance, which would allow for a lesser percentage of relief, is a four-foot deck extension from the front of the house. r , Page 3 - Appeal No. 3825 Matter of SUSAN A. FORBES Decision Rendered March 16, 1489 9. It is the position of this Board in considering this application that: (a) the circumstances are uniquely related to the premises, particularly due to the front yard and lot area noneonformities; (b) the relief as granted is not unreasonable and is the minimal necessary; (c) the relief as granted will not alter the essential character of the neighborhood; (d) there is no other method feasible for appellant to pursue other than a variance; (e) the variance, as 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) the interests of justice will be served by granting alternative relief, as noted below. Accordingly, on motion by Mr. Dinizio, seconded by Mr. Goehringer, it was RESOLVED, to ~.N~.;alter~at~~~~ ~;~o,~~a~.~1 ;~of~ ~i~~1~`~,'~6~Y'C3 OYJ0E3 rC1E'.',4.`~+`~"~S'~'Yd1C~llrti.W~l.1§~~X~"s,~1~"`l ~n~"~ ~ n`~"~~'~ i~,xh~~£c~i~~xll~i~g~; ~rici~~6' ' .,,x•}~ por'tieb~~r~; ~~f~er.~~~#~i~a~~~Td: s3 ~~~in the Matter of SUSAN A. FORBES, SUBJECT TO THE FOLLOWING CONDITIONS: 1. Eeck~ex~engioT' not. pr'otxritti~~ln~i~~;=,t~tx~nF$o,~.~~~et.v~f.©rwas~d of~~ the fron-t~~,oE--bhe~~~~~hotl~~e, across its entire proposed length. 2. r~D~C~C ;area >ribt be kgq~"ed c)r;$~n~~},s~~e~3„ ~4~:'=1~5:va*le„=flb4r area. Vote of the Board: Ayes: Messrs. Goehringer, Grigonis, and Dinizio. (Absent were: Member Doyen of Fishers Island and Member Sawicki (out-of-state}.) This resolution was duly adopted. GERARD P. GOE RINGER, AIRMAN FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ~7 - Date ~A~n-atG.iL!-I.. C~:4....., 194.. . a.~.y v PLEASE TAKE N~OTICEy~t~hat your application dated M1.Kat'1.+... c~ .a~ 19 . for permit to ~:?~^-a.~.u,~.~. a ..~~..0.:~.RQ:4. ~;".`!~....((.jj.'" at Location of Property ~.?.S ...!v.9.......... ~'?!tiQ............ ~ . House No. Street Ham/e[ County Tax Map No. 1000 Section 6~?-.Z .....Block E?. w~ ....Lot ~o : . Subdivision Filed Map No. ~ Lot No. ........,,pp.,,........... . is returned herewith and disapproved on the following grounds r L.. ~e.+".~?'~r. 1 lam.. ~ l~'•..C?. ..,~~..w~:>~ ~ . ~t:,.~:.:~.a.-~' .Building Inspector RV 1(80 .t ~ S~FFDL/~c~G~ Southold Town Board of Appeals ~~y~o~ ~ MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.I., N.Y. 11971 TELEPHONE (5761 765-1809 APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR. SERGE DOYEN, JR. MdrCh 21, 1989 JOSEPH H. SAWIC KI JAMES DINIZIO, JR. Ms. Susan A. Forbes P.O. Box 802 Orient, NYi 11957 Re: Appeal No. 3825 - variance Dear Miss Forbes: Transmitted herewith for your perusal and file is a copy of the Board's determination recently rendered by the Board of Appeals granting alternative relief in the above matter. Copies of this decision have also been furnished to the Building Department Office to update their files. Please be sure to return to the Building Department and other appropriate agencies/departments for other approvals or documents which may be necessary. Yours very truly, GERARD P. GOEHRINGER G iRMAN By Linda Kowalski Enclosure Copy of Decision to: Office of the Building Inspectors I I •J- ~-_'s?•~1 fir, _ r•. / „~P~ ~•r N~~ ~ ~ ~9' R' ~%r~ ~ r ~ . .i o. :FaE%` •o. i. - ~ ~ N3. ~ . ~ 1J`. ~ `~A _ ~ _ E.~ sy' ~ M ~ t p~,: 7 1 ~ C? q. `s ~ r" - l~ w ~ S ~ _ t ! :i ; ~ G r.., rrn. ' ~~~,5` ~ ~4 k ~.y+ y> > . O1 ! ~ ~ C. ~ ( .i• ~i ~ ~ r~ Y Ly{y~:. . ~ _ ~ S. t 1 R ~ ~ - i ~ 15'., r _ ~ ~ fy ~ ~ 44~ 4 t ~ p i r t C ~ a" ~ t' i , ~ ~y ~ ,r ` ~ w5 ~ r t!1 ~ Ys ~ G ~ ~ ~ 1 ~C ~ ~ ~ ~ i i. , N~ c'rJ-+D ~ tr ~ ~ a f~I Th.' O ~ < ~ Oq oe ~ ~ -'V ~ ~ ~ ~y rY n in ~ ~~3~). ~~~ftr ~ N C~ 0 ~ ~ r { row ~ ~ o. C~ N e b m ~5x o i, ' ~ "2' o. ~ ~ ; ~ .i`. 5`5 ~ ~ / ~ ~ ~ Cn ~r n a ~ - x ~ 5 i ^ ~ ° ~ ~ a ° ~ v U 1 t.o ~h n r- 5 ~ 1 ~ v~ - ' . ~ o - ii ~5 ~ •5 ~ ~ ~S5 5 ~ ~ i ..i ~ S i •i _ e • j ~i 4 x . ' ASS t A ~ f' , ry,' 1 ~ ~ 1 1' _ ~ ~ ~ 'i 1 ~ ~ < ~ _ ?yy ~ ~ ± 1 ~ f + ' i ~ IjY ll'. ~ 1S y~ ,`11 ~[1 ~t } l~ IBS t ~ { l Y f ; i ro ~ t ~ l ~ } t % ~ i ! 'i~ I ~ V . 1;j,.' ~ ~ F 1 ~ ~ ~ j ~ ',~1 1 t ' T~ i ~ ' ~~r ~ lG~ 1 t5 t` ~ + l 1 ;t~z i i ~ ' ` i ~ ~ = ~ ~ ~ ~ ' i 1 Jv ~ .yr ~ ~L 1 j ~ ~ + 1 1 ~ f it ~ t + ~ ~ _ ~ ~ ~ ~ a '~1 r+. .i ~ , i 1~,~ r ~ . r. ~ ~ , ~ • .a ' ~ t #yYl` = . ..r/~ BOARD OF HEALTH 3 SETS OF PLANS FORM N0.1 SURVEY TOWN OFSOUTHOLD CHOCK BUILDING DEPARTMENT SEPTIC FORPf TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY b ` O TEL.: 705.1802 CALL . Examined .//y • • • • • • • 19 MAIL T0: Approved 19!".dPcnnit No.. Disapproved a/c . (Buildin^ nspector) APPt1C:ATION FOR BUILDING PERNi1T Date /2~4 I9 INSTRUCTIONS ;i a. Tlus 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 which is pan 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 Rc;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all a licable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectd'F~'a irpi~misle{s}d2i~~~r building for necessary inspections. RJR i ~ /7t~Cr~on/}3.~;~. ~o.a o w ore .G/r?G- Coif' p P -.at > (Signature of a plicant, or name, if a cor oranon) >xvrC. *tt: a~°: v /1.~. a:..!°. °w.P.. ~ I~t.?T..~/.9SJ (Mailing address of applicant) f~~ liila lr J'~'; State whether applicant isgnwner, 4es5ee; agent,- architect, engineer, general contractor, electrician, plumber or builder. mm ,1 n' ~ n " lV 1.~~~i~- . .s) 1 i ' Name of owner of premises ! , ,J,'.vs f?1~.,.:..G.4/L!?,~i,J . ar (as on the tax roll or latest deed) ' ~fz9 IC applicant is a corpvO,;athgn„srg~}aiure of duly authorized officer. (Name and title of c6rporate officer) Builder's License No. ~.,~?.3..(91y.!.......... Plurnbcr's License No . Electrician's License No . Otlrcr Trade's License No . . Location of land on which proposed work will be done; House Number Street. Hamlet County Tax ~\tap No. 1000 Section ~.7• • • • ~ • • • • . Block d. r3:.......... Lot L:..... , , Subdivision Filed Atap No. Lot . (Name) ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy l~1-:. . /~,/~r ...~r..t/. b. Intended use and occupancy ......:S<¢!r1~• • ~ ~..~~~~,1,GOr~ •,Q~6L: . v .ki.. 3. Natpure of wort. (check whiRpanpoplacable): New quilding , Addition G%re'f~:~~ Alteration . Re air ~ Demolition ....!........Swimming pool........... . Tennis Court Accessory Suilding..........Fehce ...,...Other Work............ 4. Estimated Cost O„Q.Q r.a.~ . Fec , (to be paid on filing this application) 5. If dtvcllin;, number of dwelling units . ,~~0,"....... Number of dwelling units on each floor . If garage, number of cars .......!.N.~ , , , , , , , , , , , , , , 6. 1f business, commercial or mixed occupancy, specify nature and extent of each type of use ?v . 7. Dimensions of existing structures, if any: Front , , Rear Depth . . Hciglrt Numbe,'r of Stories . . Dimensions of same structure with] alterations or additions: Front . Rear , . Depth . :Height Number of Stories . 8. Dimensions of entire new constntction: Front Rear ...............Depth . Height . Number of Stories , , . 9. Size of tot: Front . Rca.* Depth , , I0. Y)ate of Purchase , , , i . ............Name of former Owner , . 1 1. ,one or use district in whir,.lx prcrrtrses are situated , ~/.f.. , .~:..../,a . . . 12. Does proposed construction violate a y zoning law, ordinance or regulation: ....N. R . . 14. Namle of Owner o f remrses .1v3.~3 ' ' 'Will excess Gl} be removrd from premises: .Yes ; NG , . P f ~~4°~f.... ,Address ,~YttiR, ~ P Phone No . . Name of Architect , . .Address .....Phone No.. . Name of Contractor !5'Hwo~;}~P, pro a~,uo~.~~/!'~-Address . .P.41~>, :"T... .Phone No. ?.z? ? ~~.r' IS.Is this property located within 100 feet of a tidal wetland? *Y>;5....NO.r *Zf yes, Southold Town '',Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all Uuildings, 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. S;~f~ l3-Tr9c~H ~ ~ P L-F3~S " AP ~~~E,D AS NOTED DATE:17L~~, ~ B.P.M /f•~-~7~7 FEE:. ~ N 8Y: NOTIFYFY 81~~DEPA TAT 765-1802 8 AM 10 4 PM FOR THE FOLLOWING INSPECTIONS: T. FOUNDATION TWQ REQUIRED FOR POURED CONCRETE 2. ROUGH • FRAMING & PLUMSINf3 3. INSULATIf)N 4. FINAL - CON5TRt1CTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET TWE REQUIREMENTS OF THE N.Y, STATrLL CONSTRUCTION ~ ENERGV l`C! IFS. NOT RESPONSIBLE FOR !.'t~,iC,N OR CONSTRUCTION ERRORS STATE OI' NEN YORE, 'iS.S COUNTY OF (flame of individual Sinn' ~ ~ ~ ~ ' • ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant • • . • . • • , . , • • ing contract) about named. , Hcisthc ~ - (Contractor, agent, corporate officer, eteJ ~ • ~ ~ • • of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that aii staternenu contiiined in this application arc 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 1' Notary Public, , . !~I`~rx.~•rK!„ ,1.- ~ ~t,/;E. (/K.; County Hp.EN K DE VOE NOTARY PUBLIC, State el New Yak • • (Si;nat eofapplicant) No. 4707876, $UtfDIA Term Expires MarcA 30.1 `~~°-r...~.I....~,....1."`~"~'`""'Y BOARD OF HEALTH ~ ~~1~'a L_~\U/ j~ 3 SETS OF PLANS • . • , s,.,..,,w,~._..,.~(tt FORMN0.1 SURVEY ~1~11 ~F JAN P 3 ~ ~ j~P TOWN OF SOUTHOLD CHECK . 6UILDING DEPARTMENT SEPTIC Foarl , ~.--p-n~.,,.,,.,,..m., ..e,~ ' ` " ~ ~ TOWN H A L L ¢ 4 _..f 3 f3LUa, ~)F'li~', tl °pUTHOLD, N. Y. 11971 NOTIFY --~YUtrJ{uC:p~t;tJi'h107.p ! v TEL.:7G5-1802 CALL Examined .................19... MAIL T0: Approved 19 Permit No........... . Disapproved a/c r ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT - Date -..rL.3...., 15~ INSTRUCTIONS a. Tlris 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 stree, or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl • 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 perm: ( 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 Occupant 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 th t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 tc admit authorized inspectors on premises and in building for necessary insp~ectQions. 1~y .1~, ' . (Signature of applicant, or name, if a corporation) • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. t'~~ ' Name of owner of premises ~Y~..N . (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 . . o ........~o ~s^ ~k~^?.1.?~~. .~.....~Rt~.ter......il~s7 House Numbcr Street Hamlet County Tax klap No. 1000 Section ...nom, t...... Blpck Lot . Subdivision ................lame) F.;Ied Map No. Lot . 2. State e~istim~ use and occupancy of premises and intended use and occupancy of proposed construction: a. Extsung use and occupancy ....'~~~1.,~. l'•1""~.. . . b.In[ended use and occupancy ....=?>~`~t~ 3. Na f~ eck t~ v~i~m pliable): New E3uilding Addition Alteration Repair pval Demolition Other 1Vork , , , , , . (bcscription) on 4. Estimated Cost ...............~f..~L`?............... Fee...................................... (to be paid on filing this application) , 5. If dwelling, number of dwelling'units Number of dwelling units on each ?oor , , , , , , , • , • , . If garage, number of cars . I 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , , , , , , , , , , , , , J 7. Dimensions of existing structures, if any: Front*aJ,~ ~ ",t~"........ Rear t ~-1 Deptht.?,.~~;-p", , ...15.-D Num Hei^ht ~ r .x ber of Stories r i r..i....... tmenstons o same structure w r I ' " r Depth G,~p, ; p • , . • • ith alterations or additions: Front Rear . ,MCP, ;o , , , , , , _ . , ~ u IIeig}tt ..............Number of Stories . 8. Dimensions oC entire new constYUCtion: Front ~1. Vii?`...... Rear ..'?~.-4....... Depth .q:Q, :gyp, , , , , , , , Height Nutt~bcr of Stories . , , , , , ; . • 9. Size of lot: Front 1~+.~3 r.72, • , • , , , , , gear ...1.<P:Z s Depth g1.?Q! OO • o ........Name of Former Owner .Mf~lMT~ 1-4,$T41?.`~.~~:E ~ p mises are situated . 11. Zone P r uP ecdistrict in which rate any zoning law, ordinance or regulation: N~? . 1... Does ro osed construction vro~, i !3. Will lot be re^raded , , , ~ _ p • \Vill excess Gll be removed from premises• Yes No ^ `-~.`•-r~`1{j ~~Address ...................Phone No~~l'~:~3~F-l7ll.. . 14. Name of Co tractt rcm~es . ~ • • • • • • • , • • • • • • • • • Address ...................Phone No . or Address ...................Phone Nc~~°.3~~-~..°l: ;7,°d°l~ . 15.Is this property located within 300 "feet of a tidal wetland? *YES....NO,X *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail'', buildings, whether existing or proposed, and. indicate all set-back dimensions fro.•n property lines. Give street and block'pumber or description according to deed, and show street names and indicate whether interior or corner lot. I t - STATE OF NE~V 1'ORR, S.S COUNTY OF •••••'•••••~•-•••••••••••••••r•••••••••••••••.... bcingdulysworn,deposcsandsaysthatheistheapp]icant (1\amc of individual signieg contract) above named. He is the . (Contractor, agenf corporate officer, etc.) of said owner or owners, and is duly, authorized to perform or~have performed the said work and to make and file this application; that all statements con[ajned in this application are true to the best of his knowledge and belief; and that the wor • w' anncr set 1. ill be performed in dte m ~ forth in the application filed thcr~with. Sworn to before me this ...............°?:3. ..day oC ~ 19~l. o t a ~ vo"" ryPublic, . Count , Y HELEN K OE VOE ~ . . . NOTARY FUOLIC, State of New York' c= ~~'~~+R~-~'~' 1 No.A7078TS,SuffolkCountY Si^nature of a Iicant) d' ~ r PP Teem Expires March 30,19