HomeMy WebLinkAbout17914-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218521 Date NOVEMBER 6, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 14915 NEW SUFFOLK AVE. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 116 Block 03 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 7, 1989 pursuant to which
Building Permit No. 179142 dated MARCH 14, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING
APPROVED BY SOUTHOLD TOWN TRUSTEES
The certificate is issued to WILLIAM CORWIN
(owner, }
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
B ilding Inspector
Rev. 1/81
rows xo. a
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~ 017914 Z Date ........~.c~!:c.~.....~.,`~..........., 19.~.~
Permission ~s hereby granted to:
.a~-Y.~.........
-~°"~..~..p
ct premises located at . ~.~'.9/5......!v9-~~..w1:!:t~. aa~? . ....'~.'~^~....y,..~r.~.~~........
.~~G.:..~.,.~:~-m...-~-~
. .
03..........
Caunty Tax Map No. 1000 Section 11. Block Lot No ~.7..... .
pursuant to application dated .X y \tArS,-fk~ ~ 19.~ and opproved by the
Budding Inspector.
Fee $..~~,~......~J .
~c.c.s~~-
Building Inspector
Rev 6/30/80
TORN OF SOUTDOLD
BUILDING DCPARTHCNT
TOUN IIALL :•y~
SOUTIIOLD, NC47 YORK i 1971 j ~ _
765 - 1802 y
gIDG.OEPT• J
APPLICATION FOR CERTIFICATE OF OCCIIPAN Y '^'""'"~OFSOIJJTPNOLD
DATEll~/_3,1/. Y.tL......
NEH CONSTRUCTION .....OLD OR PRE-E%ISTINC BUILDINC......VACANT LAND..__....
Location of Property. _ VV~~~Id..~~?~!\~Ue_ _ , d ~f1~
IIOUSE N0. STREET UAMLCT
Owner or Owners of Property.~.i.~.~1~rY~...,~(~.~~-L~.1.~.....
F
County Taz Map No. 1000 Section . Block ~ _ . LoC ~ .1.
Subdivision File)dJMap ._.._...Lot........_.
Pcrni[ tio.'~:7.~.7.4~..Date of PermiC ~~!yl?~ .AppLicaot~.IJYl1YDN.rofll~ F~ ~.~1C,
Fort Own/e^
Ucalth DepC. Approval ~J ` Underwriters Approval. ~Ji~......_.
PLZnnioC IIoard Approval ._Jl~~.'I?.....
Request for Temporary Certificate Final CertiFicate ..1/,~...........
O~
Fcc SubaiCted: /////////JJJ~~~
APPLICAN __._.~...~R"....
E tJ V 1 RA >J n'1 t~ tJ* l~~Q% X1.1 c .
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rc~- 10/14/88
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FOUI7DATI0:7 ( 1st }
FOUNDATION (2nd} m~
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P,OUGH FR AI'lE
PLUMBING
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I77SULATIOPI PER N. Y.
STATE EtIERGY '
CODE
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FI;IAL
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ADDITIONAL COMMENTS: ~
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t~^'~~F~~"~CO`` TO~Y'N Ui SUUTIZOI.D
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y~ 4,4 ~c OI~!'IC[: C?r fiU1LDING [NSP£•.CTOR
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~t TOC1N !TALL
• C'~yyo~ SOIJ"IlIOI.D, N.Y. 11971
'I'o S•]hcm Tlu.s May Concern,
h
YIc arc unable ro complrtc your Certificate
of Occupancy becaus•~ of the follocring reasons.
An application for Certificate of Occupancy
is not nn file. ~~e4-ec~
/ / ;to Under:•rritcrs C~:rtificate on file.
1~ d
/ 'i he chcc}c t:. (rntt.cLiLed/nut on file.) d5". ~
No flcalt;r Dept. Approval on file.
Nn final ;.nsl~cct ion has been made.
Plc;a~~ oontact our office on ttri.^, matter. -
Thank you for your cooperation.
Itutlcltr.cJ Pcrmtl' II ~ 7 ~ / ~ Z ~itit_
Iiutlclinq Duet.
M4h/-'/ Uo i'Iumbcr Solder Certificate on L-ilc. '
( all I~~trtit~ involving piumbin<J being
t~sucd after <1prs1 1,1984 )
~a51(M (9/(16)-?SC NEW YORK E7AYE DEPr1RTMENT Of ENVIRONMENTAL CONSERVA770N
OEC PERMIT NUMBER EFFECTIVE DATE
10-85^0870 ~ 11/7/88
fACItITYWItOCRAM NVMpER(n) pEF{~(T E%PIRATtON DATE{4
' Under the Environmental tonscrv~tion Eaw
N/A !!/30/90
Attlcltl t5, TltlE 3; 6NYCRR 327, ~ 6NYCRR 808; ~ Article 25;
328, 329: Aquatic Pesticides I~~I Water Ouallty Certlllcatlon N Tidal Wetlands
If~''``~I P oltecdon~ofltWater I_,,.1 SPDES t7, Tttles 7, 8: ~ 5otld WasteTlManapeme tRR 360:
I I WailElrtl gupp ytle 16: ~ A i ~allutplon Conttvla ~ Wazardnui Wast® ~Management3~
I-`I Article 15, TIt1e 15: I-1 Article 23, Title 27; f"-"'~ Article 34:
L,J Water Transport~~_'"~""~~I Mined Land Roclamatlon LJ Coastal Erosion Management
Lonig I land WellsS~ I_J Fretshwa er Wetlands ~ Floodplain~ Management
Article 15, Title 27; N-New, R-Renewal, M-Modification, Articles 1, 3, 17, 19, 27, S7;
WRd, Scenic and Recreational C-Construct ("only), 0-Operate ("only) ~ 6NYCRR 380: Radlatlon Control
RWtlrq
PERMIT ISSUED TO
Gtilliam H. Corwin
ADDRESS OF PFRMiTTFE
8 Randolf Ave. Mine HiII, NJ 07801
AGtNT POR PC1lM1TTtrEICtlNTACT HREON TkLEPM@ME NUMMEM
En-Con6ultant~F 1329 North Sea &d., Saul`harnpton, NY 1196$
NAME nNb ADDRESS OF PRO(EtT/FACILITY NF ddkrant kdm PormftWn) r0 rttr , Or i r o rw u o vr. ,
200' west o£ Grathwohl Rd.
1 SfCA710N OF PROIECTIFACILITY COUNTY TOWWCITYNILLADE UTM COORDINATES
New Suffolk Suffolk SouChold
Dtyt-RIPTION Or AUTHORIZrp ACTIVITY
Construct a woodon flack over Che rxistin brick atio on Che north aide of an
rxirtin sin it famii dwr2lin ar ohown on the attached NYSDEC approved plan.
t3ENENAE t`tlWp171pN1
tlv acceptance OI thle parmH, the pnrmhtgD r¢raee that the poem{! I) contingan! upon ekriet OompU-
ance with the ECE, all applicabtq reEplatMna and the cordltlons apcetrivd horcin or attachgd hcrcto.
1 Thn pnrmlttee !hall hta fn the gltlcr of rho approprllW rc¢lOnal permit admtnlslretgr, or otharofElee dq)lynnind In rho evocml rondluOns, a noun o} intontien rr eommoneo
work at leest eB hours m advnncr of iho time OI commnncumont and shall elso noeHy hlmJhor promptly In writing of the eomptOUon of rho work
7 Tlw pormlttnd work shat) bn snbleet to mnpncban by on euthorlxod ropretnntatlvo o{ the Dopanmont of Envlronmamnl Consanatlon which may ardor eho work tuspaMnd II
the public IntnrMt tv rcqulrot pursuent Eq ECL 471-0341 and 4APA 4A01(3),
S The pnrmRtno her eccrpted exproesly, by the wwcutlOn W thu appllntlon, the fu11lO¢al raponelblllty tar all dhmego3, dirrct or Intllroc6 of whntovor naturo, and by whomovor
suffon+d arisln¢ out of the prolgct deserlbgd htmin and has ayrgod to Indmm~dy end faun hnrmtess the Starr }ram sufta actions, dA1nAR0x and costs of Query nnmO and datcdp
ben rrtnlHnq from the sent prolecf
4 The Dupartmont rosarvcs eho right to mbdl}V. suspond or ravoko thVt pcrmlt at any tlmq aftgr due notico, and If rgquostod, held a hearing wham
eho scopr of the pro)eet I) Oxea;dcd a a vfolatlon of any condltlon of [hr pcrmlt or provdlons M ehv Eh artd pornnunt ro¢ulatlom ere round, a
b) the pcrmlt was obtaingd fry mareprewnentlon or falluro to dlselosr relovont taste, or
e1 nuwly dlseovnrotl Information or slgnifleant physlul ehan¢O) am dlsnovarod since IRO purmn wet nsuotl
S 7hr pnrminoe n responxl6la for kooplny uto pcmlt eeehn by submlleln¢ a ronmval epplleatlon, Including say formL Foos qr mpptomentrl Information whlefi may bn roqulrod
by thr Daporlmnnt, no IOCOr than 34 day! prp days Por SPDES or 4o11d or Naiarduous Watte Manaynmrnt pmmletl prior to ShO nxpirotlon dotO
h Thh parmll that{ net bo cgrotruud at canvuglnq b the applmont arcv dyht to trnspnss upon the Lands m Infnrrgte with thq riparian rights of rthnn In order m poAorm tM
pormluud wdrk qr at authgrlElny the ItnpNrlNe4t e} any rtEhtl, tltlu aI Intlr¢at In real of paftnnal propgtty ladd er veltod RI A pnngn eat a party q Ina pgtmu
7 Tha pmr[hltWa h nt)dontlbla for obplrtlny any Other pennlir, apMaYalA land), aa)emaan and rlphU ohwey which may be laqulrpd for this prolnrr
luuanca of this pormlt 6Y the Department door hOt, unl¢aa OxptHEly plovlded f6f, mddl{y, Sdpattgdn at t46Clnd as atdgP Dn CgntdnP of d¢t4fmlRptlep t+V the QpmmInlNlat
IseuOd hormolero by the DOponmont a env of rho arms, ntmdleons, w requlrgmgnts tontelnnd In wylllpr¢ptprAdpp{p)I{~atipn f, „t
9 Any modltlenNOn of thin pcrmlt Iranta hY thr Daparemnnt must o In wrillnq and attached hemte
PERMIT ISSUANCE DATk PE A f J ATOR ADDRESS , i - ~ } t K
11/7/8$ chriatine Costa oulos sa
AUTNORI2ED SIGNATURE
Pa e 1 of 3_
r*niT~ ,
i,, 1. , 1 111 I 1 l F kJ
• r
oSZd6a dies)-xsc
ADDITIONAL GENERAL CONpIT10NS FtlR ARYtCLef tb (Tills 5~, 24, 4b, Z4, 36 and 6 NYCRR Part 608 ( ]
70, That If future operations by eW Snd of New York nqulra an al• other envuonmontrlly delatafWUf materials asruciatid with the
teration In the pvsiuvn of the structure or work hariln authorized, or protect
If, In efm opinion of the Department of 4nvlronmintal Lonservatlvn 74 Any malarial dredged in the prosecution et the work herein permitted
It shall cause unreasonable obstruetlon w the frii navigatlan of said shall ba rimaved evenly, without leaving large nfusi pda, ridges acme
waters or flood flows or endanger the ftealth, safety or w¢Ifara of the bed of a waeerway or floodplaln or deep holes that may have a
the piopla of the Stara, or cauN toff or dameructlon of the natural tvndaney to cause damage to navlgabli channels or to the banks of
resources of the State, she txvnor may by ordered by the Oepartment to a watarway~
remove or alter the Structural work, obatrucuont, or hsaards caused 7S There shalt btl no unreasonable mtorforence wnh navigatatii by the work
Cheraby without expense to the 5nn, and if, upon eW expiration or fierwn authanaed,
rsvoeatlon of thn permkL tW structure, fill, excavation, or atMr 76, If upon [he exprneion or revocation of this permrt. the project hereby
modlfka[fon of the Waeercoursi hereby authorised shall not be eom• aUthgnxld has net Win Completed, she applicant shall, without exprnre
plated, the ownrn, !hall, without rxprnea to the Stan, and to such to aria face, and to turn ixtenr and in such lima and manner as thr
!silent and 1A lY4h Ilfnri artd fnslnnar It)1ha Dapenment of pnvirenminial piparlm9ht irf ffiWrgnMilnt#I GeNffystlrn htay frgwira, remote all srr
Ggn34watlon may require, removtl all ar any portlnn of thr uncompleted any portion of the unCOmplezed atructur! qr ldl and rcstare tba site
strueluro it rill and retnra n its ferrnes aondlklan sRe naulgabla Fa Ies format condnlon, Na Claim shall W made against the 4nte of
and flood capaalty of the watercourse No clam shall be made against New York on iccount of any such remvva) or alteratwn.
she State of New York on account of any such removal or alt.ntion• t x If granted under Aniele 36, this permd does not signify m any way
77 ~ That the Stale of New York shall in no ease be liable far any damage that the prolatt will W free from flooding,
or Iniury to Me structure or work hcrmn authorised which may bi caused qg If granted under 6 NYCRR Part 608, thv NYS Department of Enwron•
by or rtsult from future operations undertaken by the Scan Far the msnnl Conservation hereby certifies that the sub)ect prolate wdl not
consarvatlan or Improvement of nawgatron, ar for other purposes, and contravene effluent Iimitanom or other hmltatlons or nandardt under
no claim or right to compensation shall aecrw from any ruck damage, SaCtions SOM1, 302, 3W, 306 and SOY of the Clsao water Act of 1477
72 Crtnting of this permit does not relieve the applicant of the rosponsi• (~L 95.277) provided that all of the conditions hated herein are met.
hlhry of obtaining any other permtnwn, eome+et or approval from 19 All act)mtles auehonsad by this permit must W in sand conformance
the U.S. Army Corps of Englncan, U,S. Coati Guard, Naw York 5taM with ttka approved plans submitted by eha applicant or ha agent as part
O}fic0 of General Servicm or local gwemmarrt which may W required, of the pemit apphcatwn,
7a, RII a9pWYtity praewtiins shalt be taken to pncludi connminatton Al+eh i4(rreyeal plartl W~ri pragarW Pp a>r 1,ro. r •naittled
at any wetland or walifwsly by suLpolidad ibtltls, tBdiHiifllF, futi5, nCgrwin Raaidanea i dated 9/B/SH
wlvenes, IubrleanG, epoxy coadnpr, palnw, eont:nti, bachati or any on ,
SPECIAL CONDITIQNS
1. Tha decking shall extend no further north or weal than the existing patio.
2. There shall be no diaturbanca to tidal wetlands resulting from Chia project.
3. The cinder block/brick mall located on the north edge o! patio rshall not be
removed or disturbed.
Ar Any mateiral ettcavsstad Eor Beak ,footings aha11 ba placed on parmitteers upland
a minimum of 19' Prom tidal wetlands.
5. No construction matrrial or debris :hall enter the tidal af3tlxndtr,
Supplementary Special Condationa (A) thru CJ) aCtached.
DEC PERMIT NUMBER
1 -
PROGRAMIFACILI7'Y NUMBER
N A Pa a 04 3
1 ' 1 I 1 l t 1 - ~ I
SUPPLEMENTARY 38EGIAL CONDITIONS
The following conditions apply to all permits:
A. Y£ any o£ the permit conditions are unclear,the permittee shall con-
tact the Division of Regulatory Affairs at the address and telephone
noted below.
B. A copy of this permit with supplomentary conditions and approved
plans shall be available at the prp~ect site whanevez authoziaad
work is in pragrQaa.
C. The permit sign enclosed with the permit ar a Copy o£ letter of
approval a3ha11 D9 protected from the weath¢r and posted in a con-
spicuous location at the work site until completion auhhorired work.
D. At least 48 hour6 prior ko commencement of the project, the permittee
shall complete and return the top portion of the enclosed receipt form
certifying that he is fully aware o£ and understands all provisions and
conditions of this permit. Within one week of completion o! the
permitted work, the bottom portion of that form shall also be com-
pleted and returned.
E. For projects involving activities to be accomplishoC aver a pwrsnd of
more than one year, the permittee shall notify the Regional Permit
Administrator in wzitfng at least 48 hours prior to Che commencement
of resumption of work each year.
F. xf project design modilicdtione take pidce altec perruit isauanpe, the
permittee shall submit the appropziate plan changes for approval by
the Regional Permit Administrator prior to undertaking any such m~di-
fications. The permittee i8 advised that aubatantiai madifiCation
may require sugmission of a new application for permit.
G. All necessary precautions shall be taken to preciuae oc,nt,aminatian at
shy +aEtiknd~ ar wAtecw~y by atsapsnded saliBs, sediment. Fuels,
salvunte, lubricants, •poxyy coat3.ngl, ~lliritSi Cl9?®r@t!i ~~~gkldhC9~ Qz
any other enviranmentaily deleterious materials aasacsated with fhb
project work.
H. Any failure to Comply precisely with all o! the terms and conditions
o£ this permit, unless autriorized in writing, snail be treated as a
violation of the Environmental Conservation haw.
i. The permittee is advised to obtai» any parmita or appravaia that may
be reqquired from the U.S. Department of Army Corps of Engineers, NY
?istrSct, 26 Sederal Blaaa, New York, NY 10278, (AttRntion: Regulatory
Functiana Hranah), prior to commencement of work authorised herein.
J. The grantsng a! this permit dose not relieve ti~a pF3CE1~.t~8S Cat ~hw
responsibility a! obtaining a grant, easement, or other xaeaereary
approval from the Division of Land Utilization, Office of General
Services, Tower Building, Empire State Plaaa, Albany, NY 12242, which
may be required for any encroachment upon State-owned lands underwater.
Regional Permit Administrator
I;-r.
~ /-~/IP,QPItUIik~ tle ~Cte~
_ ,
_ _ A Environment East, Inc
4 R R PVo 3 - 3075 Indtan Neck Lane
e-~~ Pecomc, New York 11958
~ 516.7347474
~ ~ ~1-
_ "-~'yo~
March 9, 1989
$ti lxthold '1~4Wh BU}1dlnQ Dept.
Town Hall
Main Road
Southold, NY 11971
Dear Sirs,
Enclosed is a copy of the bEC permit for the proposed deck at the
Corwin residence in New Suffolk.
Please include thf information with our application far a permit
fog canatruction.~
'Cltnf~kt ynat, ,
;~iu~:c:xc:lY,
Peter R. Stout 9~~ ~h
President
Envirpnment East, Inc.
Enc1~~~
PR 5 : ? to //1
MaR ! 3 !9~
:3lOG [3EPT
TOWN Of SOUTHOCO
j
~~F f
FRANK A KUJAWSKI, JR ,President c ' -
ALBERT J KRUPSKI, jR ,Vice-President ts~ F~ TELEPHONE
iy , ~ (516) 765.1892
JOHN M. BREDEMEYER, III Oyu
JOHN L. BEDNOSKI, JR ~
KENRY P SMITH ,~Ol ~ ~~O
BOARD OF TOWN TRUSTEES •
TOWN OFSOUTHOLD
Town Hall, 53095 Maln Road
P.O. Box 728
Southold, New York 1 1971
March 7, 1989
En-Consultants for
William Corwin
1329 North Sea Road
Southampton, N.Y.11968
Re: Application No. 10-88-116-3-17- New Suffolk Ave., New Suffolk,
N.Y.
Dear Mr. Haje
The following action was taken by the Board of Town Trustees
during their regular meeting held on February 28, 1989 regarding the
above matter:
WHEREAS, En-Consultants on behalf of William Corwin applied to the
Southold Town Trustees for a permit under the provisions of the
Wetland Ordinance of the Town of Southold, application dated October
6, 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 February 28, 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 determl.ned 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 William Corwin BE AND HEREBY
IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO: construct
wooden deck on single family dwelling, install drywells and natural
plantings between lawn and wetlands.
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 the following fees:
$10.00 Wetland Inspection fee
Very truly yours, Q~
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FAK:jas
cc: Bldg. Dept.
Conservation Advisory Council
file
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G~ /?ew S..ffa/r- Town of Flf~r,7' q~r,
, ~ , (6Nn suw~uFYof? •1rf~aca
~7/ 765-1802
BUILDING DEPT.
1 NSPECTION
]FOUNDATION i5T f ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS CATION
[ ]FRAMING FIN/A~L7
REMARKS: ~ mot/
DATE Y y INSPECTOR
/ ~~i ~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ~ ] ROUGH PLBG.
[ ~ FOUNDATION 2ND [ ]INSULATION
~RAMING [ ]FINAL
REMARKS: ~,,Gtuze
DATE ~ ~ I l INSPECTOR
l~e~..vBOARD OF HEALTH
t3 SETS OF PLAN$ , : (C•.... .
FORM N0.1 SURVEY ; iS
TOWN OF SOUTHOLD CHECK ?':c, tsStQ, . _ _
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
- TEL..7G5-1802 CALL
I' a MAIL T0:
Examined ..R-tnU~l .1.~ f7..., 194!.
.\pProved .~4-:-~4h . ~ : t . .,'19~ J Permit No r.~.`~ ~ ~ .Z~.-.
Disapproved a/c .
............t
, -:..'J4
(Bwldmg Inspector) y „
1
APPLICATION FOR BUILDING PERMIT
Date . ?•?flrch ,7,. ~9~9., I5
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wt•
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 ad~oming premises or public str.
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap
cation.
c. The work covered by this application may not be commenced before tssuance of Building Permit.
d. Upon approval of this apphcaGon, the Building Inspector will issued a Building Permtt to the applicant. Such pe,
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 Occupy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the tssuance of a Building Permit pursuant to
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appiicable Laws, Ordmance•
Reculahons, for the construction of buildings, addthons or alterations, or for removal or demohhon, as herein descnt
The appltcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized mspectois on premises and m building for necessary inspections.
,Fpy~r?nment E~.st~ Inc. _
(Signature oi' appltcant, or name, if a corporation)
3075 Indian Neck Lnne
• .Baeanic ~..rIY.1L9.58 .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, enaneer, general contractor, electrician, plumber or butl~
'3eneral Contractor
Name of ow,-,er of premisesldSll.iam. Cortai.n
(as on the taY roll or latest deed)
If pli nt i c ~~ra on, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. [556..x2...... . .
Plumber's License No . . .
Electrician's License No
Other Trade's License No .
1, Location of land on which proposed work will be done . .
1c~
...l . L q Ne:,z -.Suffolk. ~,,u~ .NQh~. S.u~~O~k .
House Number Stree[~ Hamlet
County Tav Atap No 1000 $~CLtOn .1~. ....~~il.... BIQck . ~ Lot...d,7...........
Subdivision Filed i\lap No Lot .
(Name)
~ State c~istmg use and occupancy of prenuses and intended use and occupancy of proposed construction.
a. Etiisting use and occupancy ...~ge..f:amily..dwel.lin~• • , , , , •
6. Intended use and occupancy ..One. Sam1l~.duell;iri~• •with..dsck
•
3. Nature of work (check whtch appttcable) New f3uddmg Addttton ..K AlteraROn .
Repatr Removal Demolttton Other ?York .
,~t (Dcscnptton)
4. Esttmatcd Co~ / .~.p0. Fee .
(to be patd on Ghng Ihts apphcatton)
5. If dwelling, number of dwelimg units Number of dwcllmg untts on each floor .
If garage, number of cars .
6. If business, cotnmerctal or mired occupancy, specify nature and extent of each type of ttse .
7, Dtmenstons of existing structures, tf any. Front . , ,3.Q! Rear 2iI-.'........ Depth ,~8! .
Het_ttt Number of Stones .....I.... .
1 t n
Dtmensto6rtls ~f same structure wtth alterations or additions Front 4Q~.5".. Rear .....3;k , , , , , ,
Depth lIctght . Number of Stones I
8. Dtmenstons of entire new construction Front . 10! Rear ....2j.}.6"- • • . • Depth 2.3 t . , , , , , ,
Height ...............NumberofStones...........
9. Size of lot Front x-13 t Rear ...135!............. Depth 1b~?
10. Date of Purchase ...............Name of Former Owner .
11. Zoneerusedtstrtctmwhtdtpremtsesaresttuated..,Fesi,dent,ial,,,,,•,,,
12. Does proposed construction violate any zoning law, ordinance or regulation• Ye_s , , , , , , , , , , , , , , , , , , , , , , , ,
13. Ndl lot be regraded No \Vtll ccss ~iil be removed from premtses Yes N
t'd;::~orwi~ri ' Randolph O1 66-6182
14 Name of Owner of premtses . , .........Addres Phone Nc~ .
over NJ'07801'
Name of Architect ....Addres 0'~~ nd3an' i3k3ck' ~-'hoe No
Name of Contractor ?yi r o rime ~nt _E z sa , . I ne . ,Addres Pfione No.7.34r.71{.'~h..... .
sT'e~•onic• • •"dlY• 11 ~8
15.Is this property located within 300 feet o a ti'da we~Tand? *YES.g..NO....
*If yes, Southold Town Trustees PermiC may be required.
PLOT DIAGRAM
Locate clearly and drsttnctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro,
property lines. Grve street and block number or descnpuon according to deed, and show street names and indicate wheth~
tntenor or comer lot.
STATE OF NER' YORK, S S
COUNTI' OF . .
being duly sworn, deposes and says that he is the appltca
(Name of individual signing contract)
above named
lictstlte
(Contractor gcnt,corporatc offtccr,etc.)
of said owner or owners, and is duly autho e o perform or have performed the said work and to make and file tl
apphcaton, that all statements contained m this apphcltion are true to the best of his knowledge and belief, and that t.
work wtll be perlamtcd to the manner sc[ forth m the apphcatton filed therewith
Sworn to bctorec~me thu A ~j
\otaryPubhc, !\:.!*/.L.11.~..... County
NOTARY PUB 1C ~te~MewYerk (St.nature of apphcat
No 470781&,SuftolkCoufiy.p9
Term txpues Match 30, t4._.°