Loading...
HomeMy WebLinkAbout18853-zFORM NO. d TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19637 Date JANUARY 7~ 1991 THIS CERTIFIES that the building. RENOVATION Location of Property 3350 WEST CREEK AVENUE House No. Street County Tax Map No. 1000 Section 110 Block, l Subdivision Filed Map No. CUTCHOGUE~ N.Y. Hamlet Lot 12 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 7~ 1990 pursuant to which Building Permit No. 18853-Z dated MARCH 9~ 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 RENOVATE EXISTING REST ROOMS AS APPLIED FOR, The certificate is issued to (owner} of the aforesaid building. SUFFOLK COUNTY DEPARTM]ZNT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 CUTCHOGUE HARBOR MARINA~ INC. N-135916 - JUNE 15~ 1990 DEC. 27~ 1990 - HENRY J. SMITH & SONg INC. TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 18853 Z Permission is hereby granted to: County To× Mop No. 1000 S.t~on ...... (./..~, ......... B~o~k ....... ~..l ......... Lot No...Z~ .............. pursuant to application dated ......~....~. ........................... , 19.~.,.~.., and approved by the Building Inspector, Fee $../. .................... Building Inspector Rev, 6/30/80 i INSPECTORS ,- Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Pmilding Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hail P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 TO: FROM: SUBJECT: DATE: Matthew C. Kiernan, Assistant Town Atty Thomas J. Fisher, Building Inspector Cutchogue Harbor Marina August 23, 1993 On July 22, 1993 along with Bay Constable Don Dzenkewski, we made a visual inspection of Cutchog~e Harbor Marina. We could not determine if any cesspool renovations have been made. The laundry consists of one washer and one dryer. This room is always locked with one permitted by coded keys only. Alterations to pre-existing, washrooms were permitted under Building Permit $18853Z and CO Z-19637 was issued. TJF:gar HENRY J. SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N.Y. 11971 (516) 765--3690 IrlC, BLDG. TOWN~O.r-. S~'~ CERTIFICATION 0 w n e r Cutcho_~_u_e_H_a~rjp~r_J~3~n& ....... Plumber Henry J. Smith & Son~__Inc_. Date December _2~7~_19QQ__ I certify that the solder used in the water system contains less than 2/10 of 1% lead. Sworn to before me this 27th day of _D~e_r .... ~9 90 supply Notar~ Public Notary Public, Suffolk County Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. 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 i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Ac~L~.~G~ry building $25.00, Additions to accessory building $25.00. Businesse~~ 2. Certificate of Occupancy on Pre-existing Building - 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 ..-~-r ........ ~.r ....~-,--.-. ° ~'~J'. '~¥./' ?' '~. '/. ~ew Construction ........... Old Or Pre-existing Building ................. Location of Property.,.~?..~. -- ' - , ~'~..c.~.z&.qn . ~.'-,' /./ ....... House No. Street Hamlet 3nwer Owners of ' County Tax Map No 1000, Section .... %~...~. ..... Block ..... , .......... Lot ...................... ~ bdivisio Filed Map L ii 'ermit No .... ~ ....... Date ermit ........ Applicant .............. .. ..... . lealth Dept. Approval ..................... .. . .. Underwriters Approval .... . .................. .. . Planning Board Approval ................. ... . .. . ~lequest for: Temporary Certificate ........... Final Certicate...,~.. ..... c o '? Y " 2600 Nest Creek Ave. P.O. Box 1173 Cutchogue, NY 11935 August 17, 1992 Mr. Vincent R. Wieczorek Ordinance Inspector Southold Town Building Dept. P.O. Box 1179, 53095 Main Rd. Southold, NY 11971 Re: Cutchogue Harbor Marina Dear Mr. Wieczcrek: I am in receipt of your letter of August 12 and appreciate your response to my inquires of July 9, 16 and 31. I accept your letter to mean that your office is the proper location to address my concerns relative to the above referenced fa- cility. Please be advised that after dark on the evenings of August 13 and 14, Jim O'Brien, Manager of the Marina, Mr. and Mrs. Hassildine and I met on our property to again review the ex- cessive glare condition created by the directional floodlights at the Marina. The following summarizes the discussions held and obversations made: AUGUST 13: Mr. O'Brien stated that they had made two adjustments to' the specifically troublesome lights and after they, them- selves, determined the first "did not correct the problem" they made the second and wanted to review the effect with us. If, in fact adjustments were made, no improvement could be noted. Four specific lights were identified as the ones creating the primary problem in our direction. If problems exist in other directions they were not discussed. Mr. O'Brien shutoff two of these fixtures and acknowledged that they did, indeed, create a serious glare condition that was corrected when shutoff. (IT IS TO BE NOTED THAT, IN MY JUDGEMENT, MORE THAN SUFFI- CIENT LIGHTING WAS STILL AVAILABLE IN THE MARINA AREA WITH THESE SHUTOFF. THIS WAS NOT DISCUSSED WITH MR. O'BRIEN). Mr. O'Brien street side problem. acknowledged that the northerly light on the fixture of the North Basin was also a serious He stated he would report to "his be able to try to make some major to correct the problem. people" and expected to changes to further try It was clearly stated to Mr. O'Brien that we felt realign- ment might not resolve the total problem but we would work with him until his realignment efforts were exhausted, assuming this would be addressed immediately. We again stated that we felt the type of lights used and the elevation at which they are set is the cause of the glare condition and a different fixture, even at the exist- ing elevation, could rectify the transmitted glare. On August 14 realignment was made on three of the fixtures and a shutoff switch installed on the north light on the street side fixture at the North Basin. We met again after dark on the l~th with Mr. O'Brien and the following summarizes the discus- sions held and observations made: AUGUST 14: Realignment of three fixtures has significantly improved the glare condition. Ail glare has been eliminated from the cne closest to the warehouse building, a significant reduc- tion x~[~[:[:[~[~[~[ was made on the fixture furthest south and near the house and a major change was made to the fixture closest to the creek. On the creekside fixture, readjustment resulted in the re- introduction of direct light transmission into the living room of the Hassildines and a lessor, but continuisg glare on my property. Mr. O'Brien agreed ~dditional readjustment efforts would be made and baffling installed if required. Mr. O'Brien shutoff the street side fixture at the East end of the North Basin and a very significant improvement was noted. He agreed this would be permanently left shutoff and a re- lightin~ system to handle the North side of the North Basin would be designed that would not create problems to surround- ing properties. Mr. O~rien also shutoff the dockside fixture for, at least the weekend to eliminate the glare condition in the living room of the Hassildines and committed to rework this fix- ture to eliminate this problem and the remaining glare on my property as soon as possible. We are pleased with the current positive efforts being made and hope they will continue. I acknowledge your statement in your letter of August 12 that you are "still attempting to resolve the issue with the owners" and trust the above noted information will be of some value. Please keep us advised of your progress and I will be in con- tact with your office as required te apprise you of progress, or lack thereof, on the part of the Marina to honor their commitment to correct this condition. . . . ~ I~ reference to the question I raised relative to the installa- ti0n of a laund~-y facility without a dockside wast~ pumpout unit, I find your response to be difficult to accept for the following reasons: 1. Accepting as fact as you have stated, that a building ~ permit was issued to "upgrade the existing (at that time) ~ laundry", please note that the "existing" facility was _n=ot ~ a laundry as you stated, but housed an engine and m~ ~ maintenance shop and restrooms. It did not house a laundry. The machine shop was not upgraded, instead, it was converted to a utility room for hot water heaters and electrical con- trols, the two restrooms were expanded and "upGraded" to triple their size and capacity and, at the time of apparent completion, a room with no identifiable use. I have been given to understand that subsequent "off-hour" work resulted in installation of additional cesspools in the summer of 1991 and installation of laundry eqhipment. during "off-hours" in the spring of 1992 to make the pre- viously identified vacant room a laundry. (coin operated) If, in fact, the building permit is for a LAUNDRY, this would be more than an "upgrade" and I find it inconceiv- able that code requirements would not be insisted upon. To better understand your response it is requested that you send a copy of the specific building permit you referred to ~u~ec~t~eh~pa~nt~t~Pli~nt~b~i~l~C~h~sC~l issue is appreciated and I look forward to your response to this '~etter as soon as~possibl~. Yours very truly, MILLARD S. POLLOCK cc: Mr. & Mrs. Hassildine file PLANNING BOARD MEMBERS Bennett Orlowski, Jr., Chairman George Ritchie Latham. Jr. Richard G. Ward Mark S, McDonald Kenneth L, Edwards Telephone (516) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOTT L, HARRIS Supervisor Town Hall, 53095 Main Road P,O. Box 1179 Southold. New York 11971 Fax (5161 765-1823 April 22, 1992 Donald Betterbed Cutchogue Harbor Marina West Creek Avenue Cutchgue NY 11935 RE: Site Plan for Cutchogue Harbor Marina, West Creek Avenue, Cutchogue Zoning District: Marine I SCTM9 1000-110-1-12 Dear Mr. Betterbed: The Planning Board has received the enclosed letter dated February 4, 1992, from the Southold Town Trustees. Please provide an "as-built" site plan containing the information listed in the Trustees memorandum. If you need assistance, please contact staff member Robert Kassner at this office. cc: Victor Lessard, Very truly yours, Bennett Orlowski, Jr. Chairman Principal Building Inspector ~/ TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupsk[, Ir. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-I823 SLrPER'ClSOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 TO: FROM: RE: DATE: Bennett Orlowski, Jr., Chairman Planning Board John M. Bredemeyer, III,~dent Board of Trustees ~ Cutchogue Harbor Marina SCTM ~1000-110-1-12 February 4, 1992 At the Trustees January 16, 1992 worksession the Trustees again reviewed the materials submitted by the Cutchogue Harbor Marina and are of the consensus that an as-built site plan should be required of this operation. The plan should contain a detailed accounting of all parking spaces, boat slips, water using or producing ~ixtures, paint/toxics storage information, Sanitary Systems, sources of surface water run-off, garbage disposal, lighting and such other information as is ordinarily on a licensed survey for water-front uses including but not limited to ordinary highwater mark on undeveloped shoreline, all bulkheads and bulkhead lines, pilings and docks. Please do not hesitate to provide a copy of this memo to the marina owners/operators. The Board is chiefly concerned with the water and wastewater constraints to this site, which we believe are severe. We cannot encourage the operator enough to make provisions for a pump-o~t station and the handling of pu~p-out waste should be a high priority for this operation. Thank you for your assistance in this matter. JMB: jmt SOUTHOLO PLAr'INING BO,~P9 PLANNING BOARD MEMBERS Bennett Orlowski, Jr., Chairman George Ritchie Latham, Jr. Richard G, Ward Mark S. McDonald Kenneth L. Edwards Telephone (516) 765-1938 i~EMORANDUM TO: FROM: RE: PLANNING BOARD OFFICE TOWN OF SOUTHOLD Victor Lessard, Principal Building Inspector Bennett Orlowski, Jr., Chairman Cutchogue Harbor Marina [AKA Boatman's Harbor) West Creek Avenue, Cutchogue SCTM ~ 1000-110-1-12 SCOTT L. HARRIS Supervisor Town Hall. 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 DATE: OCtober 23, 1992 On Tuesday, October 6, 1992, this site was inspected by yourself and Valerie Scopaz. The Planning Board would appreciate your review of the following field inspection notes: A review of the Building Department's file is needed to confirm if building permits and Health approvals were issued for the two-car garage with a two story addition that appears to contain living quarters upstairs at the southernmost portion of the site. There is a new deck that connects the new garage and addition with a pre-existing building which contains the office, and packaged snack foods for sale. The steps to the office lack handrails, as do the steps to the new deck. The deck contains several propane barbeque grills. There are new floating docks adjacent to the bulkhead that have been added since the Building Inspector's last visit. Dockside water and electric service has been installed the length of the bulkheading. We go not know if Health Department approval has been obtained for the water supply. The northernmost building has been added to, with a garage facing the street. This work must be compared ~/~, with the plan for which a building permit was issued to ensure conformity. Extensive landscaping, including street trees, has ~ been added along West Creek Avenue. ~ The lights appear to have been shielded. However a field inspection at night is needed to determine if the shielding accomplished the stated objectives. 7. There is a large drainage pipe that appears to discharge directly into the marina, We were unable to determine what area the pipe drains. No catch basins could be found in the portion of West Creek Avenue that adjoins this spot. Further investigation is needed. The existing boat ramp was widene~ and resur~aced. ~ Use of this ramp necessitates the use of West Creek ~A Avenue for backing trailers down the ramp. The applicant is asking this Board to accept the enclosed as-built site plan. Your review of same, and your recommendations are being sought as to whether the site is in conformance with Code. Encl. TRUSTEES ' · 3,4 lohn M. Brcdcmeyer, III, President Albert J. K_rupski, Jr., Vice President Henry P. Smith Johr~ B. Tuthill William G. Albe~'tson Telephone (516) 765-1892 Fax (516) 765-1..823 April 10, 1992 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Charles T. Ha]hilton Permit Administrator NYSDEC Bldg. 40 SUNY Rm. 219 Stony Brook NY 11794 Re: Dear DEC 91-4738~00096/00001-0 Cutchogue Harbor Marina/JMO Consulting Chffck. SUPERVISOR SCOTT L. HARRIS 'Ibwn Hall 53095 Main Road RO. Box 1179 Southold, New York 11971 The Southold Town Trustees are in receipt of your lead agency coordination request of March 26, 1992 in reference to the above noted application. The Southold Town Trustees are interested in taking lead agency status for this project under the Southold Town wetlands ordinance, wherein the entire site is jurisdictional for this board. We have not yet reviewed an application for this proposal. The board has been to this site numerous times. We are concerned that the applicants are now attempting to avoid the substantive requirements of SEQRA in that they have made no mention to you in their application of their request to us to waive our wetlands ordinance to install additional roof drainage and install an additional bathroom in the storage/workshop building with wasteline to existing non-permitted sanitary facilities installed only 30' from surface waters. The board has verbally indicated to the owners/managers on at- leased three occasions that it does not want additional bulkheads on this site. Numerous neighbor complaints were received in 1991, most involving water supply and sewage treatment issues. Absent major changes, I will recommend my board issue a positive declaration when we receive an application from JMO Consulting. I will also ask for a site plan approval from the Southotd Town Planning Board and the help of our wetland consultant. Thank you for your referral in this matter. S~ncer,ely, President/Board of,Trustees cc. Building Department ~ Planning Board . JMB/djh PLANNING BOARD MEMBERS Bennett Orlowski, Jr., Chairman George Ritchie Latham, Jr. Richard G. Ward Mark S. McDonald Kenneth L. Edwards Telephone (5 t 6) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall. 53095 Main Road P,O. Box 1179 Southold. New York II971 Fax (516) 765-1823 MBMORANDUM: FROM: Subject: Victor Lessard, Principal Building Inspector Bennett Orlowski, Jr. Chairman ~0.~/~/~5 Cutchogue Harbor Marina [AKA Boatman's Harbor~ West Creek Avenue, Cutchogue SCTM$ 1000-110-1-12 DATE: Decen~ber 7, 1992 The attached memo to you of October 23, 1992, requests your review of eight items that you and Valerie Scopaz uncovered as a result of your joint inspection on October 6, 1992. To date, we have not received your review comments as to whether the site is in conformance with the code. We would appreciate your comments ASAP as the applicant is asking this Board to accept the attached as-built site plan. Encl. DE[; - 8 FLEE ECK PROPERTY OWN~OCIATION, INC. p..~~-.~-~ 5 4 CUTCHOGUE, N Y ,1193 July 19, 1993 Board of Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 JUL I 9 igg3 TOWN OF SOUTHOL[ Re: Cutchogue Harbor Marina Gentlemen: It is our worst fear realized. The well at 1200 West Road (Ruth Moore) is dry. At a new site and at 40 feet they have still not found potable water. Other well disturbances have been reported in the area, including the replacement of one well, pumping problems and an excess of rust and minerals. We have drought conditions, but yet at Cutchogue Harbor Marina underground sprinkling systems go on several times a day and night; restroom and laundry facilities in use for transient and long-term boat residences; extensive boat washing; and not one, but two residences are currently occupied. There is no tangible proof that these problems are caused by the marina, but the circumstances are coincidental with the expansion of marina services and residential well problems that were witnessed last summer and exacerbated this summer. The resident at 1200 West Road has lived there for 20 years. She is a law-biding, tax- paying resi4ent who is devastated, physically, emotionally and financially, by this condition. Her yard is ripped up, and at several levels there was unpotable, salt- water intruded water, with little hope remaining of finding potable water, or at best, at considerable expense to locate another well elsewhere on her property. The time has come for the Town of Southold to stop the paper- and foot-shuffling regarding the Cutchogue Harbor Marina. As we have indicated over the past three years, the marina has violated environmental, zoning, building and health codes, and it is business as usual for the marina while the residents, in proximity especially, are bearing the brunt of the marina's disregard for the law and the environment. Your timely response is necessary before other negative circumstances surface. Fleet's Neck Property Owners Association cc: Scott Harris, Supervisor ?OUND~' 2. ROUGH FRAHE & .PLUMBING iNSULATIOn! PER.N. STATE ENERGY CODE Fi~IAL AD[ rTIO~AL C0,~,~ENTS: HARVEY A. ARNOFF Town Attorney MATTHEW G. KIERNAN Assis{ant Town Attorney OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD EO~qFfDEN'TIAL MEMORANDUM SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Soathold, New York 11971 Fax (516) 765-1823 Telephone (516) 765~1800 TO: FROM: DATE: RE: Victor C;. Lessard, Principal Building Inspector Richard G. Ward, Chairm:n, Planning Board(~ Matthew G. Kiernan, Assistant Town Attorne~ April 2, 1993 Cutchogue Harbor Marina On March 3, 1993, I forwarded the enclosed confidential memorandum to you with regard to the above-referenced matter. To date, I have had a response only from the Zoning Board of Appeals and would request that you direct your attention to this matter at your earliest convenience. P.S. Dick Ward Valerie did speak to me about this matter and indicated that she would put a package together for me. cc: John I~. Bredemeyer, III, President, Board of Trustees. BUILDING DEPT. INSPECTION FOUNDATION 2ND [ ] INSULATION [~RAMING FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~AL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] IN~..T. ION FRAMING [ P']*"FINAL DATE ~/~ INSPECTOR 765-1802 BUILDING DEPT, INSPECTION /'/, I NSPECT~.~~ 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST ~ R~~OUGN PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL REMARKS: INSPECTOR FORM NO. 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL Examined... )q/~0~t,C~ ,C~ .., 19 ~..~ Approved...~. ~.~ .~., 19 ~.~. Permit No..].?.~..~..~...~ Disapproved a/c ................................... ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... SURVEY . . CHECK FORM ............. : TO: BLDG, DEPT. ~TOWN OF SOUTHOLD INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Ifispector, 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. The work covered by th~s 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 pe~ shill 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 Occupan ~h,all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build/ng Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of build/ngs, additions or alterations, or for removal or demolition, as herein describ, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary iz~spections. / ~, ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, age~¥ architect, en~neer, general contractor, electrician, plum0er or build~ , ...................................... Name of owner of premises . . . ?....~9'~,<.~..t~. q'~L'/~' .~2.; ......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No..~)~./~6~_._~ ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location o,~fIand on which proposed,york wdl be done... ~.~.. 7~.L ~.Q~'(4;4,~...~..~.../ ................... ............... ...... .... House Number Street Hamlet County Tax Map No. 1000 Section ... Il ~) ........... Block ..... I ............. Lot../..~. .......... Subdivision ..................................... Filed Map No ............... Lot ............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..... ! ...... '/ ...... , ' t ......................... b. Intended use and occupancy .... .~..f-~..'~. (~. ................................................... 3. Nature ofwork,,(check which applicable): New Building ..... ' ..... Addition .......... Alteration . .-5..~ .... Repair ·../~. ........ Removal .............. Demolition ............ Other Work ............... 4. Estimated Cost , o.?· c= ~ ~- ...... · ..................... Fee . ./. ~ ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of e~isting structures, if any: Front ............... Rear .............. Depth ............... He, ight ............... Number of Stories ....................................................... ............ Rear Di~enmons of same structui'e with alterations or addmons: Front .................................. D~pth ....................... Height ...................... Number of Stories ...................... Dimensio{l~f~'n~ir~ll~w construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLO~f 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. '8. STATE OF NEW YORK, COUNTY OF .~.,,~.~..~/=.,:5" ..... S.S .... ~.~(~ .~F.~ .................... being duly sworn, deposes and says that he is the applicant (Name of indMdual signing contract) above named. He is the ..... O. .~ .< ....................................................... (Contractor, agent, co,orate officer, etc.) of said owner or owne~, ~d is duly authorized to perfo~ or have perfo~ed the said work and to m~e ~d Hie application: that all statements contained N this application are true to the best of his knowledge and belief; and that the work wffl be perfo~ed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ........ 7. ...... ~ ...... dgyof .... ~ ~.~. ..... 19~.~ ,~ARY PUBLIC, State of New Y~* .... O ~~' ~ '/~'~ ' ' ' Ro. 52-4528621. Suffolk Coant~ ~ [ /(giannYur~ 0¢ ann '