HomeMy WebLinkAbout18528-z
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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCETPANCY
No Z-20319 Date OCTOBER 30, 1991
THIS CERTIFIES that the building ADDITIONS
Location of Property 1350 SOUND BEACH DRIVE MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 106 Block 1 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 13, 1989 pursuant to which
Building Permit No. 18528-Z dated SEPTEMBER 20, 1984
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ADDITION & DECK ADDITION TO ERISTING ONE FAMILY DWELLING
AS PER ZBA #3951
The certificate is issued to JAMES MESROURIS & ORS.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-209244 - OCTOBER 23, 1991
PLUMBERS CERTIFICATION DATED SEPT. 21, 1991 - PETER MESROURIS
°r~_
ildin9 Inspector
Rev. 1/81
roast xa 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)
~.~52$ a c~
N 0 Z Date / 1 ~1....
Permission is h reb granted to:
~Ik~acar~
~a-~
of premises located at ..1..~~~.~~.lry.~~ ......BSI..~Lg....~~~..~~1..6:/..I~GL:.`.,PJ.....^~~i
................................................:.I.y!
il~i~...Cl,~it.............................................................................
~......../..~.-:...F~..-...~~..7,~
................................k..............................~.G.............
County Tax Map No. 1000 Section~.r.....~6.6...... Block ..........~......cgLot No..............
pursuant to application doted 19.Q/., and approved by the
Building Inspector.
Fee S•:3.~~..
!.~~~e".'~1.~'.~
C"''%' ~f~ uiJdln I
/ g nspector
Rev. 6/30/80
P,r~rm Plo: 6 _ ~j
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} i~-~~ TOWN OP~SOUTIIOLD , ~ • , ~ ~
tnt~vy~ r~ ~ BUILDING DEPARTMENT / l~ 1? / ,c~~f `~i
F, ~ : ,UUI 2 ~ ~99~ TOWN HALL r~G'~Y/' /l"/ lam"' /.J ter;
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` _ _ ~ 765-1802
TO1°'" APPLICATION POR CERTIFICATE OF OCCUPANCY
1. This application must be filled in by typewriter OP, 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-O 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 C~:mpliance from archi_ect 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:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
Fees
1. Certificate of Occupancy - New dwelling 525.00, Additions to dwelling $25.00,
Alterations to dwelling 525.00, Swimming pool 525.00, Accessory building $25.00,
Additions to accessory building 525.00. Businesses 550.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5,00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial 515.00
~~G
Date ...:p . RL 1. ~'d
ew Construction.:........ Old Or Pre-existing Building
ocation of Property.....1..~T?.L,
..............~f~.J,'U`~..~fa.~~l.....>~.!:ay~...............
House No. Street Hamlet
awer or Owners of Property.....7.r.'~ L.t~)~t~` ~>>L.ti-t4s:S
aunty Tax Map No 1000, Secti~on~-.y.."...........Block ................Lot......................
tbdivision.~A~}c.yi.~ r<IC4C.~ ,~~.'.-A:~:::':".).........Frilcd Map............Lot
:rmit No.. 7.g, J.....Date Of Permi.C. .~.'."I.~.....Applicant.~6 be1-~- ~J~ h~
alth Dept. Approval,,,,,,,,,,,,,,,,,,,,,,,,,,Underwriters Approval.........
anning Board Approval
quest for: Temporary Certificate........... Final Curticate...........
Submitted: $ / '
~~.t ~ ar6~
APPLICANT
n- 2 ~ n4 t o
~ s;
APPEALS BOARD MEMBERS ~ rn SCOTT L. HARRIS
~ ~ Supervisor
Gerard P. Gcehringer, Chairman ,if Y
Chazles Grigonis, Jr. `~~,(fl Town Hall, 53095 Main Road
Serge Doyen, Jr. P.O. Box 1179
Joseph H. Sawicki Southold, New York 11971
lames Dinizio, Jr. BOARD OF APPEALS Fax (516) 765-1823
Telephone (516) 765-1809 TOWN OF SOLITHOLD Telephone (5l6) 765-1800
RECEIVED
onr N ~ isst
ACTION OF THE BOARD OF APPEALS
a'E. FiiZGERALD
Upon Application for CHRI5, JAMES and PETER MESKOURIS
for a Variance to the Zoning Ordinance, Article IIIA, Section
100-30A.3 for approval of insufficient area, width and depth of
parcel with an existing single-family dwelling (re-separate lots
that are merged), Article III, Section 100-31A, and Article
XXIII, Section 100-239dA(2) for proposed deck construction which
requires approval as to insufficient sideyards, excessive lot
coverage, and reduced setback from the minimum required setback
from the ordinary high-water mark of Long Island Sound.
Property Location: 1350 Sound Beach Drive, Mattituck; County
Tax Map No. 1000, Section 106, Block 1, Lot 36.
WHEREAS, public hearings were held on June 27, 1990 and on
September 26, 1990, concerning the Appeal Application filed by
Proper-T Services, Inc. in behalf of CHRIS, JAMES AND PETER
MESKOURIS under Appl. No. 3951;
WHEREAS, at said hearings all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the Board has carefully considered all testimony'
and documentation submitted concerning this application; and
WHEREAS, Board Members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the Board made the following findings of fact:
1. The premises in question is located in the "Low-Density
Residential R-40" Zone District and is referred to as District
Page 3 - Appl. No. 3951
Matter of CHRIS MESKOURIS & OR5
Decision Rendered October 17, 1990
(a) the subject premises are nonconforming not only as
to lot area and width but is believed to have been improved with
a dwelling structure built during or before 1960;
(b) lots in the immediate vicinity of the subject
premises to the west and east are of a similar size in this
preexisting subdivision of Cpt. Kidd Estates;
7. In considering this application, the Board also finds
and determines: (a) the relief as granted will not in turn
increase the dwelling unit density, since the parcel is believed
to have been improved with a dwelling before 1960; (b) the
evidence submitted and practical difficulties claimed are
sufficient to warrant a grant of this variance; (c) there will
be no substantial change in the character of the immediate
neighborhood or detriment to adjoining properties; (d) the
difficulties cannot be obviated by some method feasible to the
appellant to pursue, other than a variance; (e} that similar
relief was granted to County Tax Map Lot 1000-106-1-35
(Subdivision Lot 37) located to the west of this parcel;
(f) that in view of the manner in which the difficulties
arose, and in considering all the above factors, the interests
of justice will be served by granting the variance, as
conditionally noted below.
Accordingly, on motion by Mr. Doyen, seconded by
Mr. Grigonis, it was
RESOLVED, to GRANT the relief as requested (and noted in
paragraph #5, supra), in the Matter of the Application of CHRIS,
JAMES and PETER MESKOURIS under Appl. No. 3951, SUBJECT TO THE
FOLLOWING CONDITIONS:
1. That the deck be constructed at a height not to exceed
16 inches above grade;
2. That the deck remain open, unroofed and unenclosed at
all times (as proposed);
AF F S DAV = T
I, JAMES MESKOURIS, as one of the owners of the properties
identified by Suffolk County Tax Map Nos. 1000-106-1-36 and
1000-106-1-37, state that to the best of my knowledge, based
upon personal conversations with the former owners of the
properties and/or their attorneys, with owners of neighboring
properties, and with others having long-term knowledge of the
area, that both properties as identified above have, since
1957, never been used for any purpose other than as private
residences, and that such use of each residence has been
continuous from the time of original construction of each
residence.
r
J. ES MESKOLSRIS/A~ /
Date: .!...C....9~
G IS~A
LO" N E 5p 02,
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~ µaK
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~ W SURVEY OF
~ $ BLOCK 2 -
. ~I ~ ~ ~ fl~° w+ a-
LOT 38 ~
~ MAP OF ,
CAPTAIN KIDD ESTATES
~ FA£D JAN. 19, 1919 fftE NO %M,¢;
~f` '°°°Q' ~w.„~ TOWN OFT
SOUTHOLDT
SUFFOLK COUNTY, N. Y.
1000 - 106 - O1 - 36
- ~ Scale 1" = 20'
~ March 27, 1989 F~
r~, o.r /,~RCfl~~ ~ MaY 4, )990 (revise
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pRf VE
. SOUN p BEACH
AREA 1O,545sq.ft. i
CERTH7ED TO:
TO T!E LINE UTOPIA ABSTRACT CORPORAT/ON
T/TLE NO. 3B5 - 3 - JB60
rrr:,~rz TEL. 7G5- i
~c;~FFOCX O TOWN OI' SOUTIIOLD
~
::rz ~~'a~.~ ~ OPI~ICE OI: BUILDING INSPECTOR
° P.O. BOY 728
~ r TOWN FALL
SOUTIIOLp, N.Y. 11971
of ~a
L /s/
To 4ihom This May Concern,
We arc unable to complete your Certificate
of~~Occupancy because of the following reasons.
An application for Certificate of Occupancy
i> not on fiic. ~.c-tLts~c~
/ / C1o lJnderwriter~ Certificate on file.
/ The check is (ot~a~€lfnot on file.) Y~~2~ cP
/_J No Iicalth Dept. P•.pproval on file.
No Linal inspection has been made.
Pleaae coriL-act our office on this matter.
Thant you for your cooperation.
Bui]di-nq Permit i~ / ~ ~ ~ 2
L'uildi.ncj Dept.
/ No Plumber S~1der Certificate on file. '
( all pcrmiCS involving plumbing being
i :sued after ~~pril 1 , 19II4 )
X ,
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAG'r', 1
25023 BUREAU OF ELECTRICITY f
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date OCTOBER 23,1991 ApylicotionNo.onfile 68810090/90 N 209'7.44 j
THIS CERTIFIES THAT
only the electrical equipment as described GelaLP and introduced by the applicant named on [he above application number in the premises of i
MESKOURIS, N/S 1300 SOUND BEACH DR., MATTITUCK, N.Y. '
in the following GFeatian: Q Basement ~ l.at Ff. ? 2nd F'l. OUT .Section 8fork Lat
sraa esaminedon OCTOBER 10,1991 and fomedtu br in cump(iunm u~ille the retptirementr a/this lJoard. ~
i
p%TVRE ECEPTACFES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS MCANDESCENT RUORESCENL OTHER Mli. K W. Aµi. N. W. MAT. K.W. pMi. K W. M1i. H P
19 2 27 12 13.8 1.2 6 c^
DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS RELI UNIT HEATERS MUtT1~0UTLET DIMMERS
SYSTEMS
AML K. W. On H. P. GAS H. P. AMi. NO. A, w. G. qMT. AMP. AMT. AMPS TRANS. Amt H. P NO. Of FEET A'Ni. WAIIS
3 F 1 30
5lRVIC4 DISCONNEGi NO.OF S E R V 1 C E _
METER No. Of CC COND. A w c A. W.G A w c.-
AMt. AMP, TYPE EOOIP L6' ]W i ,a' 3W 7 %3W 3X AW pER 9 Of C<. COND NO OF H4lEG ~ HI lE0 NO O: NEUTRALS OF_NEVTRAL
1 loo CB 1 X 1 4 i I4 I
OTNFR APPARATUS:
G.F.C.I:-3
SMOKE DETECTOR:-1
HANK'S ELECTRIC LIC.#2675 C~j~~
121 SHEEP PASTURE RD
SETAUKET, NY, 11733 GENERAL MANAGER
11
Per
This certificate must not be altered in any manner; return to the office of fhe Board if incorrect. Inspectors may be identified by their credentials.
. • t7r'rir~ TEI,.7G5-1802
o~oS~FfotkcoGy TOWN OI' SOUTIIOLD ,
::?z ~',,t~;~# r`c Or•FICB OI' BUILDING IN§PcCTOR
~ P.O. BOX 728
~ TO1VN HALL
001 ~ ~a~~ SOUTIIOLp, N.Y. 11971
7~r c ~5/
r,
To blhom This May Concern,
we are unable to complete your Certificate
o~L-~Occupancy becau~c of the following reasons.
1~_/I hn application for Certificate of Occupancy
is not on file.
/ / No IJnderwriter~ Certificate on file.
/t// The check is (o~/not on file.) yg,2~ ac•
No tlcalth Dept. P~.pproval on file.
No final i.n~pecLion has been made.
Plea~c contact our office on this matter.
Thank- you for your cooperation.
Build3.ng Permit / ~ r'a ~ 2
Bu.ildi.nq Dept.
/ No Plwnber Solcler Certificate on file.
( all permita involving plumbing being
.i^~uccl after April 1,198 )
/~s~
7'65-1802
BUILDING DEPT.
INSPECTIQN
[ ]FOUNDATION i5T [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
r
DATE °Z' < 6 INSPECTOR
~s~-~
765-1802
BUILDING DEPT.
INSPECTIQN
[FOUNDATION 1ST ( } ROUGH PLBG.
[I~F/~OUNDATION 2ND [ ]INSULATION
[l,3~FRAMING [ ]FINAL
REMARKS:
DATE ! L~ INSPECTOR ,
1
765-1802
BUILDING DEPT.
f NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ }FOUNDATION 2ND [ INSULATION
[ ~ FRAMING _ f [ ] F/,INAL
REMARKS: ~J~,ti~2-~X ~~t~5i,
l7lC- ~ ~N-~t
DATE ~ ll INSPECTOR i~
' /
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_ I _ y~
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FOU;IDATIO;7 ( 2nd ) _ _ m
2 . -
o
.ROUGH RAi'fE &
PLUMBING
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ZI]SULRTIO:I PER N. Y. • • "3
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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
~ ,Q _ Q /Date ~ 19 .~jfn. .
To 7[~5~•'~J!h . /G'.. !fr"-r1.. ~.~-'~A-i~Lt!~1.~/'
..:d3~jl sue
PLEASE TAKE NOTICE that yourl applica~*',^(n~da+ed ~~~:....c./!~Jq.../~~.~'y~~19 A.~. .
for permit to L-'f7'XQ1i~~d~'c~~G9„~LG . ~D ~v~y g?'~E~ % / 02 _`e~y~a
Location of Property ~ . ~ , , _ _ _ Q~/ V .......f N~
House No. ct~ Street Gf~ ~ ~i/~/ Ham/et
County Tax Map No. 1000 Section ....~~.Ga.... Block .......Lot ....3~7.......
Subdivision Filed Map No. Lot No. .
is returned herewith and disapproved on the following grounds . .
o.S~Ga~r oo
-.~o. few ~~~~r-e:?~.. .~~t~nj~
.
.~of. ~
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. .ter..,
~
Bu'~ di ~ ~ nspector
RV 1/80
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1 l r~: 53' 32' 00" E 50.02`
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'LOT 37 c f LOT 38 ~ 5 ~ LOT 39
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SDUND BEACH . DRI V,~
ARE
New York State Department of Environmental Conservation
{y~Building y40~-SUNY, Stonfy Brook, New York 11794
~i~~.~ i~\~CJ:~..~'l'F!~~OUY~S DATE: 7/~~,ff~9
yo-oi~' ,m1
o((c~~~a~~~ ~ s-~- • ( Re. `'~E'11(~~/ 1v7~Thoma~ng
L1~T1~. Vl?el.~, rV~ ~~~IC.'_..) 5c~+~^t~IVc('~._!t~( - ommissioner
Dear ~1~ . ~~s. 1 ~~sK~v{ ~s~,
A review has been made of your proposal to: c,~f~S~~v c~ CZC<<~ I ~ 1 ~ Y~
~ ~~ck on~~ c~~v~~1~ v~ S ~ ~ 1
a~~a.~.1~~ ~c~. +n ~~~c~ ~3~ ~ ~ ~ 1 ca~~c~ ~ h So ~ v~
Based on the information you have submitt~d, the New York State Department
of nvironmental Conservation has determined that the parcel
project is:
_ Greater than 300' from inventoried tidal wetlands.
Landward of a substantial man-made structure ~L1
greater than 100' in length which was constructed prior to 9 20 77.
_ Landward of the 10' above mean sea level elevation contour on a
gradual, natural slope.
Landward of the topographic crest of a bluff, cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25
of the Environmental Conservation Law). Please be advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the 10' contour or topographic crest without a permit. It is
your responsibility to ensure that all necessary precautions are taken to
prevent any sedimentation or other alteration or disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale berm.
Please note that any additional work, or modification to the project as
described, may require authorization by this Department. Please contact
this office if such are contemplated.
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours,
Deputy Regional PC~rmit Administrator
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BOARD OF HEALTH
0 ~ LS (t M 3 SETS OF PL<1N5
u 1! V L5 FORMN0.1 SURVEY
TOWN OFSOUTHOLD CHECK .
A(~j••~ ~ BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
BLDG. DEPT. .riOUTHOLD.N.Y.11D77 NOTIFY
• 70WNOFSOUTt+!tir•~ TEL.: 765-1802 CALL
MAIL T 0
Examincd...~.~."~.......,19.~7 r '
Approved 19 Permit No............ ~ "7 ~ 5 - /
Disapproved a(c ..Q f/.a. f./~~. L
................/...../.......~%gC~~..........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
' Date ...................15.
INSTRUCTIONS
a. This 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 stye:
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 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 perri
shalt 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~
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 ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of bui]dings, additions or alterations, or for removal or demolition, as herein describe
Tkte 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 ' pef/e-- pnps.
(Signature of applicant, or name, if a corporate )
~ ,
.............v
(Mailing addre of applicant) //9~
State whether applicant is ownY) ,lessee, agent, azchite t, engineer, general contractor, electrician, plumber or builde
Name of owner of Premises . 1~t~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) ~f
Builder's License No. ......?.S
Plumber's License No . .
Electrician's License No .
Other Trade's License No . .
1, Location of land on which proposed work will be done. , ,~~~~-?~-j/h." ,
House Number Street. Hamlet
y
County Tax htap No. 1000 Section ~O.~P...... Blvck , , , , , , , • Lot ~ .
Subdivision Riled Atap No. Lot .
(Name)
State existing use and occupancy of pre/mpi~-ses~and~intended us and occupancy of proposed construction:
a. Existing use and occupancy t.rl."• Lam .
r
b. Intended use and occupancy .
3. Nature of work (check which applicable): New Building Addition... ~Uteration .
Repair Removal Demolition Othcr,lVOrk .
(Description)
4. Estimated Cost lr.4Z~ Fee
(to be paid on filing this application)
5. If dwellin„ nurnber of dwelling units Number of dwelling units on each floor .
Ifgaragc.numbcrofcars
6. IC business. commercial or mixed occupancy, specify n lure and extent of each type of use ,
7. Dimensions of 'ling structures, if any: Front , Rear ....~0, f...... Depth ...BSc , , , , , , ,
Hci^ltt Number of Stories / .
Dimensions same structure with alterations or additions: Front Ce Rear .
Depth ~P............ Ilcight , , , , , , . Number oC Stories ,.4eriysR..¢,~, , , , , ,
Dimensions of entire new construction: Front ....~p Rear P........ Depth . .
Hci_ht .-~!'.'L--r.... Number of Stories .
9. Size of lat: Front Rear Depth
10. Date of Purchase . . .Name of Former Owner
.
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
l3. will lot be regraded Nill excess fill be removed from premises: Yes 1`
14. Name of Owner of premises l.).. Address Pftonc No......... , .
Name of Architect .Address ...................Phone No............. .
Name of Contractor ...........................Address Phon .
15.Is this property located with in 300 feet of a tidal wetland *YES....NO....
*Zf yes, Southold Town Trustees Permit may be requi>=ed
PLOT DIAGRAM ^
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro;
property lines. Give street and block number or description according to deed, and show street names and indicate whetht
interior or comer IoY.
~ 3~
STATE OF ~E1V YORE, S.S
COU:v'TY OF .
• being duly sworn, deposes and says that he is the applica~
(Name of individual signing contract)
above named.
fie ist}te
(Contractor, agent, corporate officer, etc.)
~C said owner or owners, and is duly authorized to perform or have performed the said work and to make and tilt tl:
tPplication; that all statements contained in this application are true to the best of his knowiedg~ and belief; and that t]
vork wHl be performed in the manner set forth in the application filud therewith.
itivorn to bcCore me this
day of..... 19
:oiary Public, C!-5-?`~'.`; .~.^::e.'!~........ County ~ ~ ~~--L~~
C"
FIFlEN K pE V0E " .
~NaY4707~8~7~,S~Mdkl!°"nh g/ (Si;nature of applicar
lam E*Pkea M~sd~ 3Q.18.~-~•
SOAfD OF HEALTH
R In. (~y ~`,j Q ~ ~ FORM NO. 7 3 SETS OF PL 1YS ;I':`': N:
t ~ OWN OF SOUTHOLD SURVEY t~.'K_ _ _ . .
1 I~~ ILDING DEPARTMENT C!lECT; # ~?.3 .
~ TOWN HALL SEPTIC FORM _...r!~.-....
S UTHOLD, N.Y. 11971
BLDG. DEPT. TEL.:765-1802 t: DTI FY;
TOWN OF SDUTHOLD / ~ CALL _ _ .
Examined 19 ~ MnI L T0:
Approved~-..'' , I9 Permit No............
Disapproved a/c \T. ~~s•~~ . .
_
...................................~~'~....~~%~f~ ~ ~i .
(Building Inspcctor)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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
hall 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
hall 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
;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessaryctions.
.....10..
(Signature of applicant, or name, if a corporation)
. U `ICJ . l! ltl"
(Mailing address of a plicant)
IV
Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
dame of owner of premises C."r.~t3~C„ , /~-C~4, _ , t~;! ~;c....
(as on a tart[ Yoll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. . S..`~ t . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . ~
Location of land on which grogosed work will be done . .
/3~'.a........:5.~ /J..~:...... rn-i.,~.~Tu.
fem...........
House Number ~St;eet ~ Hamlet
County Tax Map No. 1000 Section Block Lot 3.~.
Subdivision G~~,,~.,~.~~ ,5 Filed Map No . Lot .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:'
a. Existing use and occupancy :?/f~~~• '
b. Intended use and occupancy .
3. Nature of work (check which applicable): New Building Addition tion .
Repair Removal Demolition ther Work .
(Description)
4. Estimated Cost ~rl . . . Fee
J
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on"each floor .
_Ifgarage,numberofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front Rear Depth .
Height ...............NumberofStories.......................................................,
Dimensions of same structure with alterations or additions: Front Rear .
Depth ......................Height ......................Numberof Stories .
8. Dimensions of entire new construction: Front Rear Depth .
Height ...............Numberof Stories .
9. Size of lot: Front Rear Depth .
10. Date of Purchase .............................Name of Former Owner
11. 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 within 300 feet of a tidal wetland? *yes........ No.........
*Lf yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
Gr'p~,p Q FG f` ~
L c~1 C~~t` ~X g~,
~ G~ jv CYLr- C-L
r ~ ~ h t re„5
- (
i t ~ ~ ' ,
3b q ~ ~~i, ; fi ,
z~
~
~
_ , _
j! ~1
~ N
STATE OF NEW YORK, S.S
COUNTY OFy./-.. .
, /..~~r`•- • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.)
~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
rpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
vork will be performed in the manner set forth in the application fled therewith.
iworn to before me this
..p._..day of ....14,~/I.,-t;._........, 19 9~.
Qotary Public, !`!t~?~-.. ~ VI'.:!~-+- Co y f /l ~j~-'-'
HELEN K DE VDE ~ k,~ •c~ • ~ ' • ' • • .
~~tAM~47o787s S~uttoelk~u~ ~ ~ (Signature of applicant)
Term Expires Merch 311, t9_.~+3