HomeMy WebLinkAbout18107-z
4
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCOPANCY
No Z-24553 Date AUGUST 6, 1996
THIS CERTIFIES that the building ADDITION
Location of Property 340 ROBINSON ROAD GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 34 Block 5 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MRY 4, 1989 pursuant to which
Building Permit No. 18107-Z dated MAY 10, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate ie
issued ie DECR ADDITION TO ERISTING ONS FAMILY DWELLING AS APPLIED FOR
The certificate ie issued to DAVID MBRZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
rosai 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)
N ° g ~ ~ Z Date 19.
Permission is hereby granted to:
~?~;i:r.....~.......~~
,
? o e~
ct premises located at ...c.l...T.tJ.......~.v.4`~iX~•~!7.......1.1.~
.............................................~~~rll,l~p i~......._............................................................................
County Tax Map No. 1000 Section Block Lot Na........~~........
pursuant to application doted ........:.~5.~T 19..~, and approved by the
Building Inspector. T Jr - ~8~-3~i.-~..-/a,3
Fee $...c:/..a~ ~jLyyf 7 /O ~!J ~ /c3..7
~$~%~~~Buildln t for
Rev. 6/30/80
. Form No. 6 F` n ~r-.i;.-
I, I~ 5 5 ~ ~
'LOWN OP SOU'1'HOLD °
BUILllLNG DI'sPAR'fM[?N'C I p
'T'OWN HALL ~ ~ f~U~ ~ ~ 4,' ~
765--1.802 ii
i
FLOG. E3afL I
TOWN OF SOUTMOLP3 e
APPLICATION FOR CLR'L.U~1CA'i'P, OP OCCUPA~"~~'~T~~"~~~~~~
A. 'T'his application ?mst be EiLLed .Ln by typewriter. OR ink anti subm:LCCed to the building
inspector with the fnJiowJ.ng: for new building or new use:
1. Final survey of property wi.Ch accurate locaC.ion oC a.l_L buildings, proper Cy lines,
streets, and unusual naCU ral or I:opogt:aph.ic features.
2. Final Approval tr.mn health Dept. of water supply and sewerage-dlsposal(5-9 form).
3. Approval oC electrical iusLall.atia? from Board qf_ I~ir.e liuderwriter.s.
4. Swm-n staCement from plumber cert.tFying that the solder used in system contains
less Chao 7_/10 oL 1~ lead.
i. Conunerctal bui.iding, induetriaJ_ buillding, mulll.ple residences and similar buLl.dings
and installations, a certiCticaCe of Code Compliance Crom architect or engineer
responsible f.or the bui.Jdtug.
6. Submit Planning Board Approval oP complleted site plan requirements.
B. 1'or exi.sti.ng bui.ldfngs (prior Co April q, 1957) nun-con Cormi.ug uses, or. buildings and
"pre-existing" land uses:
1. Accurate survey of property showing al.l property ]roes, streeCS, building and
unusual natural or topographic features.
2. A properly completed appii.cati_on and a consent to inspect signed by Che applicant.
if a Certificate oC Occupancy Is denied, Lbe Buil.di.ng Inspector shall scale the
reasons therefor, i.u wr_l.l:ing to Che applicant.
C. Pees
l.. Certificate of Occupancy New dweliiug $25.00, Addictions to dwelling $25.00,
Al ter_aCi ons to dwelling $25.00, Swinmtiug pool $25.00, Accessory building $25.00,
Additions to accessory buiiding $25.00. Businesses X50.00.
2. Cert:iflcaCe of_ Occupancy on Pr.e-existing P,uildine - $L00.00
3. Copy of Certifi.caCe of Occupancy - _25~
4. Updated CerC{CicaCe oC Occupancy - $50.00
5. 'T'emporary Certi.flcaCe oL Occupancy - Residential. $1.5.00, Commercial. $15.(10
Uate ,August, 2.. 1996,
New ConsCrucLi.on........... Old Or Pre-exlsf:ing Bu il.ding
340 ROBINSON ROAD GREENPORT, N.Y.
Location of. Property
house No. SCreeL Ramlet:
Onwer or Owners of Pro~ert DAVID MERZ
Y
Cooney 'Lax Map No 1.000, SeeCion....34........73l.oclc....5...........Lot..13
Stabdl.vis.i.ot~ ....................................Filed Map............Lot......................
Per.miC No.,,18107-Z,,,,,,DaCe Of Permit.. MAY4,,._1989,„AppLicanC..,DAVIDMERZ
11ealCh Dept. Approval ..........................ihulerwri.ters Approval.........................
Plann:ins, Bon rd Approval
Request for: 'T'emporary CerCi.ficate........... T'inai Certicate...........
1'ee Submi.CCed: 25: OO
APPI,I(.AN1
ca~ay5~?
o~~gOFFO(,f-~O
o~ Gy~c
V! x
Town Hall, 53095 Main Road p • ~ Fax (516) 765-1823
Southold, New York 911971 ~~Ol ~ ~~0~ Telephone (516) 765-1602
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 4, 1995
Mr. David Merz
340 Robinson Road
Greenport, NY 11944
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)
No Underwriters Certificate on file.
xx 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 # 18107-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
MELD It;SP~C:IO~J ~~llATr, ~ i;OaKMLNT3
v ~
7. ~ dt
H v
_ _ _ _ H ,p]
FOUNDATION (1st) ~ 1~
a
FOUNDATIOtJ (2nd) _ _ m~
2.
z Ui
o
ROUGH FRAME & 0
PLUMBING
H
3. x
m
ra
IIJSULATIOA7 PER N. Y. . •
STATE ENERGY
CODE
x
a
~p,~/
~i~/"`- OL~Gi c~~ ~ ~r
4 . rh
y I
FIiJAL
o .
z
ADDITIOPIAL COMMENTS: ~
~ ~
\
H \
b ~
1+
H C
O
x
m `
• A C3\
' r a
_ H
x
o.
m
~o
H
a
_
QCCUPANCY OR ~
ti: ,ar tv w.: i-
~tSAJ ,n hua riM m, -
USE IS UNLAWFUL ~ ~ , ~ ° -
WITHOUT ,
f , .z.. F:r::.,~F.: ~ _
CERTIFtCA _ e~,:e.,t a „A
yy~~ qq , «N t~ .
NCY ' r~ r rvt nun r P~GK A'4 ~
e~ ,ore ~~I
i t
f f ~.i ,i Y~ A •
'tr• N Sl r'•'r ~~'n
Y .•~j,
i A~
s . f
n r" rt r 3` ~
~ • rt
ii._._____-
i !
c f
'.1! f i ~ i rte` t ~ f A '
_ ! j `51! ~ J . ff
nI\ tS :.`rC ye 1.. ~"O tA~j ~ lt~ 1 tr/f h it.`
i r, e, ~
~L „r y
' ' 5
~ IW, I i1 y i
~ o- 7~7~/88 8Y
~
n _ J
? ~
t• i.
t i~ ~ E.
, t"
f.. _
.
' / ~ '
-
• ~
1
. , - - ~ ~
- r
I~ /
~4 ~
~ .
_
1
1 .
~n _ _ -~r~.----~-
,D_r
~K s~%'o~.S' ~v`s!t ~'ET ov ~avcc°,~T
~ i~A,~S,
T9T cdr[( QE G?iAE x ,~6" ,r~Ec~~ F,r°oi~ /tr~Tu~Pxrl ~.P,9DEe
~1'G°~ F1a0®P -TOOS'TS~ ~ o?~X ~v c°O.irT,PdCT/0.? CTEAT.Ei> ~ury,Q~~c°~
oa /6" ~,svrs,~c'
l~FC.t~ /.~D.nT,S° ~ /~/j'<~` ~.~rrr~rriu.v ~r ii
DECKiv6 ~/~~'ra. 6 " C'o..~rv?rrio~l ~ c'Eaq~
~QR/1rNG axa"x v' ~irr~=Trs ~rE-os.e~
~
c~UFFO(,~~®~
FRANK A. KUJAWSKI, JR., President o kri,.
TELEPHONE
ALBERT J. KRUPSKI, JR., Vice-President u° Sri
JOHN M. BREDEMEYER, III ~ (516) 765.1892
HENRY P. SMITOH KI JR d,~~d
BOARD OF TOWN TRUSTEE
'~ry~ir,~~a~,~~1\t//`~yj `y TOWN OFSOUTHOLD
9~~ I i Town Hall, 53095 Main Road
P.O. Box 728
r! ~ JUN 2 91988
~ ~ Southold, New York 11971
~'+~'~'"s~~s~~"~~ ~ June 24, 1988
s"C71;~f~!'~Jr sG`11"'?iS iiC i7
Mr. Robert A. Greene
Alternate Regional Permit Administrator
New York State Dept. of Environmental Conservation
Bldg. 40, SUNY, Rm. 219
Stony Brook, New York 11794
Dear Mr. Greene: .
Transmitted herewith is a completed assessment form for the
above referenced project.
This project is unlisted and an initial determination of non-
significance has been made. We wish to coordinate this action to
confirm our initial determination.
May we have your views on this matter. Written comments on
this project will be received at this office until July 13, 1988.
We shall interpret a lack of response to mean there is no
objection by your agency in regard to the State Environmental
Quality Review Act, and our agency will assume the status of Lead
Agency.
ery truly ours,
1
r ~ . uj GLtJk
L(,~ .
President
Board of To n Trustees
FAK:ip
. Attachment
cc: Commissioner Thomas Jorling, D.E.C., Albany
Bldg. Dept. ?
Planning Board
Town Clerk's Office -
Board of Appeals
r
Page 2. - En-Consultants, Inc. for David Merz
C.A.C.
En-Consultants, Inc. for David Merz file
i
R rrr J46~4 (21871-Text 12 ~ l
y I • PROJ
ECG
T-
I.p.
NUMeER
617.21 ~
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Onty
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT /SPONSOR
David Merz by En-Consultants, In~ 2. PROJECT NAME
3. PROJECT LOCATION
Moniolpality Robinson road, Greenport coprny Suffolk
4. PRECISE LOCATION (Street adtlress antl road inlersectlons, prominent lantlmarks, etc., or provitle map)
Robinson Road, Greenport
5. IS PROPOSED ACTION:
? New ? Expansion ~ Modilication/alteration
6. DESCRIBE PROJECT BRIEFLY;
SEE ATTACHED
7. AMOUNT OF LAND AFFECTED:
Initially 1~2 acres Ultimately 1/2
8. VJILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ? No II No, descnbe briefly
9. VlHA7 IS PRESENT LA f:7 USE IN VICINITY OF PROJECT?
~Residennal ?!ndustnal ?COmmercial
Desenbec ? Agnculture ? park/Forest/Open space ? Other
70. DOES ACTION INVOLVE A PERF417 APPROVAL, OR FUFJDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERi
STATE GR LOCAL)?
~.1'es • ? No If yes, list agency(s) and perms/approvals
DEC, COE, DOS
11. DOES ANY ASPECT OF THE ACTIOFJ HAVE A CURRENTLY VALID PERMIT OR APPROVAL
? Yes ®NO II Yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
?Yes QNo
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVR IS TRUE TO THE BEST OF MY KNOIVLEDGE
Applicant/sponsor name: DdVld rZ -COTI5U.LtantS, Inc. 5/13/88
Date:
a
Slgnature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessmen'. Form before proceeding with this assessment
OVER
1
PART N-ENVIRONMENT ASSESSA7ENT (To be completed by Agerl~ ~ ~
A. DOES ACTION EXCEE A~YPE I THRESHOLD IN 6 NYCRR, PART 617.72? If yes, coordinate the review process and use the FULL
AF,
? Ves
e. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDEp FOR UNLISTED ACTIONS IN 6 NYCRR, PART 677.6? 11 No, a negative declar
ma be superseded h•,~nother Involved agency.
Yes ~ No
- C. CO LD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING (Answers may be hantlwritten, If legible)
C7. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dlsp
potential for eroslo~n, drainage or flooding problems? Explain briefly:
~~u~
C2. Aesthetic, agricultdrMal, a^rchaeological, historic, or other natural or cultural resources; or community or nelghborhootl character? Explain t
/ /
C3. Vegetation or fauna, fish^shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain
C5. Growth, subsequent development or related activities likely to be induced by the proposetl action? Explain briefly.
~~C
C6. Long term, short term, cumulative, or other effects not Identified In C7-C5? Explain briefly.
' C7, Other Impacts pncluding changes m use of either quantity or type of energy)? Explain briefly.
r
D. IS THERE, OR IS TH LIKELY TO 6E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
? Yes No ~ If Yes, explain briefly
PART III-DETERMINATION OF SIGNIFICANCE (fo be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, Important or otherwise signlfi
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duratlo
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed
? Check this box if you have identified one or more potentially large or significant adverse impacts which h1A
occur. Then prodeed directly to the FULL EAF and/or prepare a positive declaration.
? ChecK this box'if you have determined, based on the information and analysis above and any supportin
documentation, that the proposed action WILL NOT result in any significant adverse environmental impact
AND provide on attachments as necessary, the reasons supporting this determination:
~;0?.R(1 (t;' "fC?;'JI`t •rhliS7 ~E:`
' t N,inn• ~r I v. a ~nAi,puY .
Southold, L I . N.Y l1(?71
nn ur IYVe yin ul a (run Y~ble UlllCe m Led AgmcY ~ title ut He+pun•,ble UII¢er
I
)ignd Lure m Hes onslb • UPacr Lcad Agency Sixnmurc or I npanr III dmerent Irom responvnlc mlmeq
~a/ i
odic
2
k' _
"'pG
FRANK A. KUJAWSKI, JR., President o : ~-s ~T, .
ALBERT J. KRUPSK[, JR., Vice-President U~ "~y,~ ~+~,~~t; ~ TELEPHONE
JOHN M. BREDEMEYER, III ~b~ ~ (516) 765-1892
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH x -
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
a Southold, New York 1 1971
May 2,~ 1989
En Consultants
1329 North Sea Road
Southampton, N.Y. 11968
Re: Permit number 5-88-34-5-13
Dear Mr. Haje:
The following action was taken by the Board of Town Trustees
during their regular meeting held on April 27, 1989 regarding the
above matter:
WHEREAS, En Consultants on behalf of David Merz applied to the
Southold Town Trustees for a permit under the provisions of the
Wetland Ordinance of the Town of Southold, application dated May 19,
1988 and
WHEREAS said application was referred to the Southold Town
Conservation Advisory Council for their findings and recommendations,
and
WHEREAS, a public hearing was held by the Town Trustees with respect
to said application on April 27, 1989 at which time all interested
persons were given an opportunity to be heard, and
WHEREAS, the Board members have personally viewed and are familiar
with the premises in question and the surrounding area, and
WHEREAS, the Board has considered all the testimony and documentation
submitted concerning this application, and
WHEREAS, the Board has determined that the project as proposed will
not affect the health, safety and general welfare of the people of
-the town,
NOW, THEREFORE BE IT
RESOLVED that En Consultants ON BEHALF OF David Merz BE AND HEREBY
IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO: construct 150
linear feet of stone revetment along Spring High Water Line of
Sterling Creek, and construct wooden deck on one story house.
Property located at Robinson Road, Greenport, N.Y.
This permit will expire two years from the date it is signed if
' work has not commenced by said date. Fees must be paid and permit
issued within six months of the date of this notification. Two
inspections are required and the Trustees are to be notified upon
completion of said project.
Please take notice that this declaration should not be
considered a determination made for any other department or agency
which may also have an application pending for the same or similar
project.
Permit will be issued upon payment of $10.00 inspection fee.
Very truly yours,
• fu-~ ~LC2~,~,~ ~t .
Frank A. Kujawski, Jr. //1~~
President J
Board of Town Trustees
FAK:jas
cc: Bldg. Dept.
Conservation Advisory Council
file
_
BOAFD OF HEALTH
3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•oart
TOWN HALL
SOUTHOLD, N.Y. 11071 NOTIFY
' TEL.: 765-1802 CALL .~~77.: ~?6"of • • • • • • •
Examined 19Q.~ / g- MAIL T0:
Approved ..v'/~........, 19 Permit No. <.Q~~.~~ (c? ~~'p' .
Disapproved a/c D t~ lJ
'~r~^~~~~~`" 70WNLUF SOUTNOLD
(B ddin~ector)
APPLICATION FO(((///R BUILDING PERMIT
Date ...................15...
INSTRUCTIONS
a. Tlus 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 Bui]ding 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 Buildin; 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 or alterations, or for removal or molition, as herein described.
Tlie applicant agrees to comply with all applicable laws, ordinances, building code, ho ~ de, and regulations, and to
admit authorized insp~~q~~p~a}~3~§~s~d in building for necessary inspections.
(Signature o"ap a , or name, i a corporation)
~r~.. 1'a~S~F~1~tA~~li°t t:+'~~fti ~lltG. ~"~1 }(•.ii
Ita, ~it,?"I 1 ~ r~I ~,.a ~j sarl>1 x, ~eav~'at! ....~~,~.~m~r../l~., f~s/Y.yy.
' p;y„ ~ Mailing address of applicant)
iT~IY#1g1.. i}+vgl1 443al4LitFsc.tt!-: r
State whether apphcana~Bt~~~e~4lIS~#el'i~Ye~t, architect, engineer, general contractor, electrician, plumber or builder.
' x' IRtitAPl..!!R a~1 %1~ts'•9~,k~~ • 43r"4tt~)i'A
1~t1~?gw~ia~l':~~+81~~t2t,:f ,;,_,4,
Name of owner of premi~gs,xl<3~.f~~/Dl;s. . 3 "/;'/,~.f'.Z. ..//rel.. P~ .
I3;gF1~! ,t,l~,y€8 fyLtap~ag_yr1,;t{y~^a ; - (as on the tax roll or latest deed)
If applicant is a Nbr$~ati~l, SigrY)iigtYli€~"hiTtrl~ aG€thorized officer.
"-'°lf1?~ F$ H~Ft17€ g~'€'ti~Mt,'=-A :1'>~,'
t~.f
S'',lP~ ~.Jf#1,%?t.~f f'•tr!-133 'd'#15
•.5••t;• i •i.Pt
(N3~r~iC did ~it11~ of zC'orp'o~ate officer) '
Builder's License No. ~pG,?..€!?r,%f° .
Plumber's License No. .:(/~~-.~/g!ii.t~ .
Electrician's License No. ~,lt.?N.>~.r°........... .
Other Trade's License No. ..~.u!.?i,~ir°.......... .
1. Location of land on which proposed work will be done. .J,u,Fr, Gy; ~X ~rp ~O~/~/.
~f/_~t'_/3
OA'/N.1J.r/ . ?.t~.....~•~~N/.~Q~.. /.4~?.+1.. G1~ . ~-r!dTs/O!o C .
House Number Street, " ' • " " •
Hamlet
County Taxi\tapNo. 1000$CChOn Bl'ock ..S Lot..~~••,,•,,,••••.
Subdivision Filed ~Iap No. Lot .
(Name)
State existing use and occupancy of premi es and intende usernd occupancy of proposed construction:
a. Existing use and occupancy ..../~:C.. Pv.?.. ~`.?°~'f~.... .
b. Intended use and occupancy .~~11~d'.'~..„, :~~~t~S~"fBdA?~"..••'•••••1••••.••••••••.•••••••.••
3. Nature of work check which applicable): New Building , Addition .lY....... Alteration .
Repair Removal Demolition .Other SVork .
rq/ I
4. Estimated Cost ..4r~~~UU (Description)
' Fee
5. If dwellin", number of dwellin (to be paid on filing this application)
• . g 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, H~ia! isions of existing stru Nures, if any: Front . . Rcar • ' • ' ' ' '
" mberofStorics. Depth
Dimensions of same structure with alterations or additions: Front ~ • ~ • • • ' ' ' ' • • ' '
. lIcight , Rear .
' 'Dimes ofentire nett' construction: Front , ' • ' ' ' ' ' ' • • • Number of Stories .
Height Rear............... Depth
. Nuinbcr of Stories .
9. Size of lot: Front Rcar .......................Depth.......................
10. Date of Purchase " • " " " " " '
p••••••••••••.....,,NameofFormcrOwner
11. Zone or use district in which 'remises are situated,,,,,,,•,,,,,•,.,.
P
l3. V ll lot beore
dra ed truction viplate any zoning law, ordinance or regulation : .
o
Will excess fill be removed from premises: Yes No
14. Name ofOtvnerofpremises,,,,,,,,,,,,,,,,,,,,Address.......,
Name of Architect • • • • • • • • • • • Phone No .
Name of Contractor. •••••••••••~•••"""'••Address ...................Phonr,No..
.....Address . .Phone No.':
IS.Is this property located within X00 feet of a tidal wetland? *YES.. .NO-.
' *If yes, Southold Towin Trustees Permit ma be re uire -
Y 4 d.
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 whethei
interior or corner lot.
r
s~~
APPS D A8 NdiED
O
DATE: 6.P N ~
NOTIFY UI 0 pEPA AT
785.1803 9 AM TO 4 PM POR THE
FOLLOVVINIi INSPECTIONS:
1. FOUNDATION TINO REQANRED
POR POURED CONCRETE
3. ROtN3M -FRAMING !t PWMBING
3. INSULATION
b. FINAL - CONSTRUCTON MUST
SE CAMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OP THE N.Y.
STATE CONSTRUCTION 6, EROS
' , DESIGN OR CONSTRUCTION ERRORS
STATE OF NE~V O K,
COUNTY OF S•S
• • • • • " • • • G""~ ' ~ ` ~~4~~...... being duly sworn, deposes and says that he is the applicant
(Name of individual si Wing contr et)
above named.
(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 Gle this
~Pplica[ion; that all statements contaihed in this application arc true to the best of his knowledge and belief; and that the
vork will be performed in the manner set forth in the application Glcd therewith.
~wom to before me th/is
............::7,~.-day of., \
. 19~.~.
rotary ublic, , , , , , County
EU7ASETH ANN NEVU18 .
Notary pubflRStaMpfNwyYgrk Signature of applicant)
No. 62.81368860, 8uHo6t
Term Expirsa Ootobsr 81,1