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TOWN OP SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
~ (THIS PERMIT MU57 BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
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Permission is hereby granted to: ,
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Caunhj Tox Map No. 1000 Se'c'tion Block .......4.w~~....... Lot No.....
' pursuant to application dated ..!,o.1R........+3r•0.........., 19.$..a., and approved by the
Bui lding~llgnspector.
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Bui ding Inspector
Rev. 6/30/80
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VICTOR LESSARD r^ Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR l~s~--
t +.5' ~ P.O. Box 1179
(516) 765-1so2 ~ ~ ~ ~~s E Southold, New York 1 1971
FAX (516) 765-1823 ~~°'~e '3~ ,
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 8, 1990
William D. Moore
P.O. Boa 23
Mattituck, N.Y, 11952
Re: B.P. 8177352 One family dwelling
William D. Moore S Benjamin Herzweig
Dear Mr. Moore:
I am writing to you regarding the above Build-
ing Permit. The permit was written Jan. 4, 1989 and
to date no work has begun. You must begin work with-
in one year or the permit is void.
If you intend to proceed it will require a new
permit.
Yours truly,
Secretary
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MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.L, N.Y. 11971
o~o~ '='g 1~ TELEPHONE (516) 7651809
APPEALS HOARD
MEMBERS
GERARD P. GOEH RINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR.
ROBERT J. DOUG LASS
JOSEPH H. SAWIC KI INTER-DEPARTMENTAL MEMORANDUM
T0: Southold Town Trustees
FROM: Board of Appeals
_,_„~~.,,y„~ww,
DATE; x~October 15, 1'87
SUBJECT: Matter of William Moore and Benjamin Herzweig
E/s Meadow Lane, Mattituck
Transmitted herewith for your review and file is a copy
of our decision approving the modification of the building
area of the proposed dwelling as requested under Appl.
No. 3654. The modification involves the placement of
the "envelope" 30 feet from the front property line and
38 feet at the easterly sides of the dwelling at its
closest points. (The initial application under Appeal i
No. 3412 requested 43 feet and 38 feet at the northeast
and southeast corners, respectively.)
Please notify the Towra Attorney and the applicants if
it is determined that further review may be necessary
under your jurisdiction.
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Southold Town Board of Appeals -10-June 30, 1987 Special Meeting
(Appeal No. 3439 - BLAIR decision, continued:)
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warrant a`~agrant of the relief requested;
(d) the~,gharacter of the immediate area willeb~e
affected by the granting of the variances requested;
(e) the envirohmtiental nature and hist -~y of this
property does not lend'~~o the reasoning increased den-
sity and housing;
(f) in view of the manger in hich the difficulties
arose and in consideration ofd the above factors, the
interests of justice will bes b~ served by denying the
variances applied.
Accordingly, on tion by Mr. Go hringer, seconded by
Mr. Grigonis, it w
RESOLVED, o DENY the relief requeste in the Matter
of the Appli ation of ARNOLD AND KAREN BLAIunder Appeal
No. 3439, s applied. ~
Vo e of the Board: Ayes: Messrs. Goehringer., Grigonis,
Dougl s and Sawicki. (Member Doyen of Fishers Island was
abse t.) This resolution was duly adopted.
* * *
DELIBERATIONS/DECISION: Appeal No. 3412:
Application of -WILLIAM MOORE AND BENJAMIN HERZWEIG (previously
Cramer and Herzweig) for Variances to the Zoning Ordinance,-
Articles: (a) XI, Section 100-119.2 for an insufficient setback
from wetlands area, and (b) III., Section 100-31 for an insuffi-
cient frontyard setback, for a proposed single-family dwelling
structure at premises known as 675 Meadow Lane, Mattituck Estates
Map #4453, Lot #42, Mattituck, NY; County Tax Map District ]000,
Section 115, Block 05, Lot 007,_containing .51± acre.
Following deliberations, the Board took the following action:
WHEREAS, a public hearing was held and concluded on June 18,
1987 in the Matter of the Application of WILLIAM MOORE AND BENJAMIN
HERZWEIG under Appeal No. 3412; and
Southold Town Board of Appeals-ll- June 30, 1987 Special Meeting
(Appeal No. 3412 - MOORE & HERZWEIG decision, continued:)
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:
1. By this application, appellants request Variances from
the Provisions of the Zoning Code, Articles: (a) XI, Section
100-119.2(6) for__permission to locate a proposed single-family
dwelling structure with an insufficient setback at 38 feet and
at 43 feet, from the nearest wetland grasses, from the north- i
easterly corner and southeasterly corners, respectively, and
(b) III, Section 100-31, Bulk Schedule for permission to
locate new dwelling with an insufficient setback at 38 feet
and at 43 feet, from the nearest wetland grasses, from the
northeasterly corner and the southeasterly corner, respectively,
C (b) III, Section 100-31, Bulk Schedule"f.or permission to
locate new dwelling witfi an insufficient frontyard setback at
its closest points at 25 feet, all as shown by Survey prepared
by Young & Young, dated June 5, 1987.
2. The premises in question is known and referred to as
Lot #42, Map of "Mattituck Estates, Inc." filed in the Office
of the SuffolK County Clerk on_September 8,_1965 as File No.
4453.
3. The subject premises is located along the east side
of Meadow Lane in the Hamlet of Mattituck, Town of Southold,
with a frontage of 115 feet, is vacant land, contains an
acreage of .51±, and has a frontage of 95.94 feet along pond
meadow and wetland areas.
4. Article XI, Section 100-119.2 requires all buildings
and structures to be set back not less than seventy-five (7"5)
feet from a tidal water body, tidal wetland edge, or freshwater
wetland.
5. Article III, Section 100-31, Bulk Schedule of the .
~ Southold Town Board of Appeals -12-June 30, 1987 Special Meeting
(Appeal No. 3412 - MOORE & HERZWEIG decision, continued:)
Zoning Code requires a minimum setback from the front
property line for principal buildings at not less than
35 feet, or the average established setbacks within 300
feet. The average established setbacks are not less
than 35 feet from the front property lines.
6. The Courts have held that the area setback
variances must meet the "practical difficulties" standard,
considering at least the following: (a) that the relief
requested is not substantial in relation to the requirements,
(b) that the project as proposed is not out of character
with the neighborhood; (c},.the circumstances._of the
property are unique and are not personal in nature; (d)
that th_e variance will not in turn be adverse to the
safety, health, welfare, comfort, convenience or order
of the town; (e) that the variance requested is the
minimal necessary; (f) that there is no other method
feasible for appellants to pursue other than a variance.
7. It is the position of the Board as follows:
(a) that the relief requested is substantial in
relation to the requirements, being variances of 10 feet
(or 30%) as to the reduction in the front yard, and of
37 feet [or 50%] as to the reduction in wetlands setback; C
(b) the project as proposed is not within the
character of the neighborhood since the improvements
on parcels in the immediate area are in compliance with
the zoning regulations;
(c) the circumstances of the property are unique,
particularly due to the topography and nature of the
.site, which limits the areas of construction;
(d) the alternative relief granted herein will
not in turn be adverse to the safety, health, welfare,
comfort, convenience, or order of the town;
(e) the alternative relief (in the frontyard area)
is the minimal necessary;
(f) there is no other method feasible for appellants
to pursue other than a variance.
Southold Town Board of Appeals '13'June 30, 1987 Special Meeting
(Appeal No. 3412 - MOORE & HERZWEIG decision, continued:)
8. In making this determination, it shall be understood
that the alternative relief granted hereunder would permit
construction within the limited building envelope area, to
wit, 30 feet from the front (west) property line, 38 and 43
feet from the wetland boundary (to the east), minimum 10 ft.
and 15 ft. sideyards [as regulated by the Bulk Schedule of
the Zoning Code, Co.umn "A"], without the necessity of
re-application for reconsideration by this Board concerning
possible amendments in the design, style, length, character,
etc. of the proposed dwelling•structu_re. .Any reduction of
the setbacks to less than_that permitted by this variance
and the zoning regulations ("building envelope") will
require future application and consideration. "
9. It is noted for the record:
(a) that conditional approval was rendered by the
Southold Town Board of Trustees for Wetland Permit No. 312
for the construction of a single-family dwelling;
(b) that a Final Environmental Impact Statement has
been prepared and submitted to the Southold Town Trustees
as Lead _Agency pursuant to Part 617, NYCRR, Article 8 of
the Environmental Conservation Law, and Chapter 44, Code
of the Town of Southold;
(c) that both well and sanitary systems were condi-
tionally approved by the Suffolk County Department of Health
Services on September 13, 1985 under Ref. No. 85-50-164; _
(d) that lot point(s), with catch basins, are to be
incorporated into the westerly (driveway) area to collect _
storm-water runoff; gutters and leaders to be connected to
dry-wells; no construction of sewage-disposal systems or
water-supply facilities will be constructed below the
10-foot contour; "'natural buffers" are to be designed
within the entire area below the 10-foot contour line;
there will be a natural buffer during and after construction
adjacent to the wetlands;
(e) a September 4, 1985 waiver has been issued by the
-N.Y.S. Department of Environmental Conservation waiving a
permit for the construction of a single-family dwelling
landward of the existing 10-foot contour elevation above
mean sea level (on a gradual, natural slope).
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~ Southold Town Board of Appeals
®°a~~~ Y~ ~v~~~ MAIN ROAD • STATE ROAD 25 SDLJTHOLD, L.1., N.Y. 11971
""Y' TELEPHONE (516) 765-1609
ACTION OF THE ZONING BOARD OF APPEALS
Appeal No. 3412
Application Dated May 19, 1987 as Amended
T0: William D. Moore, Esq. [Appellant(s)]
Clause Commons, Suite 3
P.O. Box 23
Mattituck, NY 11952
At a Meeting of the Zoning Board of Appeals held on June 30, 1987,
the above appeal was considered, and the action indicated below was taken
on your
I ] Request for Variance Due to Lack of Access to Property
New York Town Law, Section 280-a
[ ] Request for Special Exception under the Zoning Ordinance
Article Section
IX] Request for Variancesto the Zoning Ordinance
Article III Section 100-31 and
Article XI Section 100-119.2
[ ] Request for
WHEREAS, a public hearing was held and concluded on June 18,
1987 in the Matter of the Application of WILLIAM MOORE AND BENJAMIN
HERZWEIG under Appeal No. 3412; 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:
1. By this application, appellants request Variances from
the Provisions of, the Zoning Code, Articles: (a) XI, Section
100=119.2(6) for permission to locate a proposed single-family
dwelling structure with an insufficient setback at 38 feet
and at 43 feet, from the nearest wetland grasses, from the
northeasterly corner and the southeasterly corner, respectively;
(b) III, Section 100-31, Bulk Schedule for permission to
locate new dwelling with an insufficient frontyard setback at
its closest points at 25 feet, all as shown by survey prepared
by Young & Young, dated June 5, 1.987.
2. The premises in question is known and referred to as
Lot #42, Map of "Mattituck Estates, Inc." filed in the Office
of the Suffolk County Clerk on September 8, 1965 as File_No.
4453.
3. The subject premises is located along the east side
of Meadow Lane in the Hamlet of Mattituck, Town of Southold,
with a frontage of 115 feet, is vacant land, contains an
acreage of .51±, and has a frontage of 95.94 feet along
pond meadow. and wetland areas.
4. Article XI, Section 100-119.2, requires all build-
ings and structures to be set back not less than Seventy-
(CONTINUED ON PAGE TWO)
DATED: June 30, 1987. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
Form ZB4 (rev. 12/81)
~a
Page 2 - Appeal No. 3412
Matter of WILLIAM MOORE & ANO.
Decision Rendered
June 30, 1987
five (75) feet from a tidal water body, tidal wetland edge,
or freshwater wetland.
5. Article III, Section 100-31, Bulk Schedule of the
Zoning Code requires a minimum setback from the front
property line for principal buildings at not less than
35 feet, or the average established setbacks within 300
feet. The average established setbacks are not less
than 35 feet from the front property lines.
6. The Courts have held that the area setback variances
must meet the "practical difficulties" standard, considering
at least the following: (a) that the relief requested is not
substantial in relation to the requirement; (b) that the
project as proposed is not out of character with the neigh-
borhood; (c) the circumstances of the property are unique
and are not personal in nature; (d) that the variance will
not in turn be adverse to the safety, health, welfare,
comfort, convenience or order of the town; (e) that the
variance requested is the minimal necessary; (f} that
there is no other method feasible for appellants to pursue
other than a variance.
7. It is the position of the Board as follows:
(a) that the relief requested is substantial in
relation to the requirements, being variances of 10 feet
(or 30%) as to the reduction in the front yard, and of
37 feet (or 50%) as to the reduction in wetlands setback;
(b) the project as proposed is not within the
character of the neighborhood since the improvements on
parcels in the immediate area are in compliance with the
zoning requlations;
(c) the circumstances of the property are unique,
particularly due to the topography and nature of the site,
which limits the areas of construction;
(d)- the alternative relief granted herein will
not in turn be adverse to the safety, health, welfare,
comfort, convenience, or order of the town;
(e) the alternative relief (in the frontyard
area) is the minimal necessary;
(f) there is no other method feasible for
appellants, to pursue other than a variance.
8. In making this .determination, it shall be understood
that the alternative relief granted hereunder would permit
construction within the limited building envelope area, to
wit, 30 feet from the front (west) property line, 38 and 43 feet
from the wetland boundary (to the east), minimum 10 ft. and l5
ft. sideyards (as regulated by the Bulk Schedule of the Zoning
Code, Column "A"), without the necessity of re-application
for reconsideration by this Board concerning possible amend-.
ments in the design, style, length, character, etc.
of the proposed dwelling structure. Any reduction of the
setbacks to less than that permitted by this variance and
the zoning regulations ("building envelope") will require
future application and consideration.
i.
Page 3 - Appeal No. 3412
Matter of WILLIAM MOORE & ANO.
Decision Rendered June 30, 1987
9. It is noted for the record:
(a) that conditional approval was rendered by the
Southold Town Board of Trustees for Wetland Permit No. 312
for the construction of a single-family_dwelling;
(b) that a Final Environmental Impact Statement has
been prepared and submitted to the Southold Town Trustees
as Lead Agency pursuant to Part 617, NYCRR, Article 8 of
the Environmental Conservation Law, and Chapter 44, Code
of the Town of Southold;
(c) that both well °and sanitary systems were condi-
tionally approved by the Suffolk County Department of Health
Services on September 13, 1.985 under Ref. No. 85-SO-164;
(d) that lot point(s), with catch basins, are to be
incorporated into the westerly (driveway) area to collect
storm-water runoff; gutters_and leaders to be connected to
dry-wells; no construction of sewage-disposal systems or
water-supply facilities will be constructed below the
10-foot contour; "natural buffers"' are to be designed
within the entire area below the 10-foot contour line;
there will be a natural buffer during and after construction
adjacent to the wetlands;
(e) a September 4, 1985 waiver has been issued by the
N.Y.S. Department of Environmental Conservation waiving a
permit for the construction of a single-family dwelling
landward of the existing 10-foot contour elevation above
mean sea level (on a gradual, natural slope).
Accordingly, on motion by Mr. Sawicki, seconded by
Mr. Douglass it was
RESOLVED, to GRANT the following relief in the Matter
of the Application of WILLIAM MOORE AND BENJAMIN HERZWEIG
under Appeal No. 3412, for the location of a single-family
dwelling:
(a) with an insufficient setback at the most north-
easterly corner of the proposed dwelling structure at 43
feet from the nearest wetlands grass, and at 38 feet from
the most southeasterly corner of the proposed dwelling
structure from the nearest wetlands grass, as shown by
the June 5, 1987 survey prepared by Young & Young, as
applied; and
(b) with an insufficient setback at not less than
30 feet from the front property line at its closest
point(s), as an alternative to the requested 25 feet.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
Douglass anal Sawicki. (Member Doyen of Fishers Island was
absent.) This resolution was duly adopted.
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GERARD P,, GOEHRINGER, CHAIRMAN
July 8, 1987
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e~r^ ° ~ South®ld Town hoard of Appeals
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~~0~ MAIN ROAD - STATE ROAD 25 SOLITHOLD, L.L, N.Y. 11971
TELEPHONE (5161 765-1809
ACTION OF THE ZONING $OARD OF APPEALS
Appeal No. 3654
Application Dated July 23, 1987
mn. (pnnal,la_nt(g11
w~iiraw u. i~uura, Eay.
Clause Commons, Suite 3
P.0. Box 23
Mactituck, NY 11952,
At a Meeting of the Zoning Board of Appeals he n October 8, 1987,
the above appeal was considered, and the actiq ndicated below wa aken
on your [ ] Request for Variance Due to Lack of Access to Property
New York Town Law, Section 280-a
[ ] Request for Special Exception under the Zoninq Ordinance
Article Section
[X]„ Request for Variance to the Zoning Ordinance
Article XI Section 100-119.2
[ ] Request for
Application of WILLIAM MOORE, ESQ. and BENJAMIN HERZWEIG, ESQ. for
a Variance to the Zoning Ordinance, Article XI,.Section 100-_119.2 for
permission to establish "building envelope" with setbacks of not less
than 38 feet from nearest wetlands along existing two-foot contour and
not less than 30 feet from the front property line (as approved under
Appl. No. 3412, June 30, 1987). location of Property: 675 Meadow
Lane, Matti tuck, NY; Mattituck Estates Lot No. 42; 1000-115-5-7.
WHEREAS, public hearings were held on August 20, 1987 and
September 10, 1987 in the Matter of the Application of WILLIAM
MOORE AND BENJAMIN HERZWEIG under Appl. No. 3654; 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:
1. By this application, appellants request a Variance from
the prior decision of this Board rendered under Appl. No. 3412
on June 30, 1987, and from Article XI, Section 100-179.2 for
permission to establish a "building envelope" with- setbacks
at not less than 38 feet from all easter.1y corners at its near-
est points from wetlands (along the existing two-foot contour),
all e:s shown by survey dated July 21, 1987 prepared by Young &
Young, P.E.
2. The previous application requested specific setbacks
from the easterly (rear) portion of the proposed dwelling at
43 from the northeasterly corner and at 38 feet from the
southeasterly corner, and the applicants have asked for an
- (CONTINUED ON PAGE TWO)
DATED: October 8, 1987. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
Form ZB4 (rev. 12/81)
s
Page 2 - Appl. No. 3654
Matter of MOORE & HERZWEIG
Decision Rendered October 8, 1987
3. The premises in question is known and referred to as
Lot #42, Map of "Mattituck Estates, Inc." filed ~n the Office
of the Suffolk County Clerk on September 8, 1965 as File No.
4453.
4. The subject premises is located along the east side
of Meadow Lane in the Hamlet of Mattituck, Town of Southold,
with a frontage of 115 feet, is vacant land, contains an
acreage of .01±, ana nay a ~~oncage ur 90.54 reec aiv~ig Nunn
meadow and wetland areas.
5. Article XI, Section 100-119.2, requires all buildings
and structures to be set back not less than seventy-five (75)
feet from a tidal water body, tidal wetland edge, or freshwater
wetland.
6. In this Board's prior decision under Appl. No. 3412
n which alternative relief was granted for insufficient
setbacks from wetlands as well as insufficient setback from
the front property line at 30 feet, it was determined that
the project met the "practical difficulties" standards set
by the Courts.
7. It is also the determination ..f this Board that
the requested modification is minimal and meets the
"practical difficulties" standards for this amended area
variance.
8. It is noted for the record:
(a) that conditional approval was rendere y th
Southold Town Board of Trustees for Wetland Permit No. 312
for the construction of a single-family dwelling,
(b) that a Final Environmental Impact Statement
has been prepared and submitted to the Southold Town Trustees
as Lead Agency pursuant to Part 617, NYCRR, Article 8 of
the Environmental Conservation Law, and Chapter 44, Code of
the Town of Southold;
(c) that both well and sanitary systems were
conditionally approved by the Suffolk County Department of
Health Services on September 13, 1985 under Ref. No. 85-SO-164;
(d) that lot point[s], with catch basins, are to be
incorporated into the westerly driveway area to collect storm-
water runoff; gutters and leaders to be connected to dry-wells;
no construction of sewage-disposal systems or water-supply
facilities will be constructed below the 10-foot contour;
"natural buffers" are to be designed within the entire area
below the 10-foot contour line; there will be a natural
buffer during and after construction adjacent to the wetlands;
(e) a September 4, 1985 Waiver has been issued by-
the N.Y.S. Department of Environmental Conservation waiving a
Page 3 - Appl. No. 3654
Matter of MOORE & HERZWEIG
Decision Rendered October 8, 1987
permit for the construction of a single-family dwelling land-
ward of the existing 10-foot contour elevation above mean sea
level (on a gradual natural slope).
Accordingly, on motion by Mr. Grigonis, seconded by
Mr. Sawicki, it was
RESOLVED, to GRANT a Variance for the Modification of
the easterly setback of Lhe proposed "uuiiuing enveioNe
for the construction of a single-family dwelling, with set-
backs at not less than 38 feet from the nearest wetland
boundary, along the present two-foot contour (as well as
a setback of not less than 30 feet from the front property
line at its closest point), as applied.
Vote of the Board: Ayes: Messrs. Goehringer, Douglass,
Doyen and Grigonis. (Member Sawicki ~~as absent.) This
resolution was duly adopted.
GE P. GOEHR
LAGER, C IRMAN
BOARD OF HEALTH .
3 SETS OF, Jp"CANS .
FORM NO. 1 SURVEY • .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
°,OUTHOLD, N.Y. 11971 NOT ~ ~ 7~
TEL.: 765-1802 CALL • • •
a~ q It, T0:
Examined . Q~.~..., 199 ~ _ .
Approved ~ ~ 19~ J. Permit No. ~ ~ ? ,4.~• ~ l L~'i
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Disapproved a/c ~ ~1 ~ ~ 3 ~ ~~88 ~ s
S ~t
C~; i;~:. i)t;3=t
Tut~r~ ~r ~sku-rr~ft~t_~ ~,.a
(Building Inspector).
APPLICATION FOR BUILDING PERMIT
Date DLGtrW1tSER• •Z9• • 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
`b. Plot plan showing location of lot and of buildings,on premises, relationship to adjoining premises or public streets
or, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector wIll issued a Building Permit to the applicant. Such permit , .
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificafe of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for remova or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code s' co e d regulations, and to
admit authorized inspectors on premises and in building for necessary inspections
(Signature of applicant, or name, if a corporation)
y?o Box,23. M~w.u~,c.~N`~..llgsv...
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~ w~ I.........`~
...............o..............~.............................. .
Name of owner of premises . y.V . . ~ ~~:2`~. • ~ b~-!'~~'`rr!? • •%`!'"~Z,W,E/(? • , , , • , , , , , . ,
(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. . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
House Number Street Hamlet ~-7
County Tax Map No. 1000 Section Block Lot .
Subdivision .....~~~~G/C. Sr~~.... Filed Map No. yyS-.~~....... Lot . y~ . • • • • • • •
(Name)
2. State existing use and occupancy of per/emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....V..~G~'.~ 7 •
b. Intended use and occupancy ......................7........P..
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