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HomeMy WebLinkAbout17286-z FORM NO. 4 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20173 Date AUGUST 27, 1991 THIS CERTIFIES that the building ADDITION Location of Property 595 CLEARWATER AVE. CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 118 Block 2 Lot 14.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 29, 1988 pursuant to which Building Permit No. 17286-Z dated AUGUST 2, 1988 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR & TO PROVISIONS OF THE BOARD OF TOWN TRUSTEES WAIVER 4/25/88. The certificate is issued to SANFORD & SUE HANAUER (owners) 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 IP'O1Hai NO. 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) 0 0~ 7 2 8~ Z Date 19. ~t.Ld Permission is hereby granted to• /3a....~ ,r......ii.7~ at premises located of ~"~'c.~. ....i ..........................................~~/~O County lox Map No. 1000 Section .....~,/..~1.......... Block ..........a Lot No.......l..~,~i..~Q.~ pursuant to application doted .3./.y:s 1~~.., and approved by the Building Inspector. ~%+T~ 9/~$ ` ~ ~ ~.~G ~ D _ ®2 X16 Fee $.<;.l..v ` ~Buildin rispector Rev. 6/30/80 r {~(j.ft ~ ~/~!J/a.~C...n- Form No. 6 ~ ,::a;i»G., ( i ji i~( ~ 4 ~ ~ ~o o ~u1Ly ~ TOWN OF SOUTHOLD ' ~ f ~S ~9 vJ'C7C~af~-'~ , ~ ° ~ 97 BUILDING DEPARTMENT ~ ~ ~ a ~ . ~ TOWN HALL . z~ 765-1802 ~~.~~~.~„~,,,~ogi._..~i TOVJP! OF SLbJTFt6[-~>.,n..^....,i APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1~ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. 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. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 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 $15.00 Date Dc~'.t: New Construction.... Old Or Pre-existing Building Location of Property........:~~...CL~,aQrPJxF:.C".? Cu T~IDVfi?6................ House No. Street Hamlet Onwer or Owhers of Property......... ScsE, . , SAn7~2© . /~~NAcl ~ ° . . . . . . . . County Tax Map No 1000, Section.... /.~'1.......B1ock.....~.~.......Lot.. l`,f~.o.4 Subdivision .Filed Map............Lot...................... Permit No...~7 ~.(~.....Date Of Permit.... ~/~,1.: ~...Applicant...~4'~fc~~~.'. J,f'g~'.+:`.G...... Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $.......`~`:s:`.9'l) ~A-~ , 4 . C ~ ~ 02 ~ j 73 APPLICANT G 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN LAT ON [ ]FRAMING fNAL REMARKS: DATE U INSPECTOR r'lELD~i:SPECTIU;J ~~UATr. ~ UOi~iMENT° V -u ra 1 . ' .~z, op H ~ FOUNDATION (1st) rh~ FOUNDATIOtd (2nd) _ 2. o ROUGH FRAME & PLUMBING ti H 3. ~ IIJSULATIOfJ PER N. Y. y STATE ENERGY CODE x a 4 , l d FIidAL z ADDITIONAL COMMENTS; ~ to x\ ro H 7] ~ e H 9 V H O Z 1 • r~ H ' ~ d [7 ^o H Frank Kujawski, Jr. , Pres. ``tz ~ HENRY P. SMITH, ~ ~ ~ = JOHN M. BREDEMEYER, III TEtarflozvE CY'~ s ~ (516) 765.1892 John.Bednoski, Jr. ~ O. ~ ALBERT KRUPSKI, JR. , Vice-President .c~~~~ v`~ BOARD OF TOWN TRliS1'EES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O.Box 728 Southold, New York 1 1971 April 25, 1988 b1r. Sanford Hanauer 130 Woodbury Road , Woodbury, New York 11797 Re: 595 Clearwater Lane, Cutchogue Dear Mr. Hanauer: The following action was taken by the Board of Town Trustees during their regular meeting held on April 21, 1988 regarding the above matter: RESOLVED that the Town Trustees grant Mr. Sanford Hanauer a WAIVER of the Wetland Ordinance for the construction of a 16' x 21' + 4' x 22' deck on property located at 595 Clearwater Lane, Cutchogue with the provision that dry wells for roof run-off are installed on the property. Please be advised that this determination is not a determination made for any other department or agency which may have jurXSdiction in this matter. Please check with the Building Dept. fox' such a determination. Very truly yourscC, ~~w~ Frank A. K jawski, Jr., Pres. Board of wn Trustees FAK:ip cc: Bldg. Dept. Board of Appeals Planning Board DEC, Stony Brook file ©®~UFFQ~~®~ a C~fl a HENRY P. SMITH ~ - "'t JOHN M. BREDEMEYER, TII, President°•~ APR - 1 ~~H8 ErxoNe John Bednoski, Jr. ~ ~ 1765.1892 ALBERT KRUPSKI, JR., Vice-President "IaDU. I'1'::~~• ~ ~ TOW~S_b~=,SUtfzFfi.51~D ~a~p BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 n gh~~ZS~J~~ Southold, New York 11971~"g~/lt~ a / April 1, 1988 `~1 ~ Mr. Robert A. Greene ~ ~a_ Alternate Regional Permit Administrator New York State Dept. of Environmental Conservation ~G/ Bldg. 40, SUNY -Room 219 Stony Brook, New York 11794 Dear Mr. Greene: Transmitted herewith is Wetland Application No. 623 submitted by Sanford Hanauer. V7e would like to coordinate with you in our role as Lead Agency regarding this application. May we have your comments on same by April 20, 1988. Very truly yours, John M. Bredemeyer, III President Board of Town Trustees JMB : ip Attachments trC cc: Commissioner Thomas Jorling, D. C., Albany (p _ g 8 O~ ~ ~ C~A+~.a~P"~ _ Southold Town Building Dept n~,,,~~, t _._`~..,.u. / ~~UI~~ ' • ~ ~ ~ SANFORD HANAUER ASSOCtAT ES INC D E S I G N E R S 130 WOODBURY ROAD WOODBURY NY 11797 ' 516"692.4404 March 30, 1988 , . Board of Town Trustees Town of Southold Town Ha11, 53095 Main Road P. 0. Box 728 Southold, New York 11971 Gentlemen: Enclosed is a copy of the Notice of Disapproval from the Town of Southold Building Department, dated March 25, 1988, for construction of a new deck within 75 feet of water. I am enclosing a Pfetlands Permit application, together with a check in the amount of $150.00 and a copy of the site plan. Please note that the new deck aligns with the existing stair of the house. We would appreciate your consideration and prompt approval of the above. Very trul urs `..1- J S ford H nau~ S ~:cdk Enclosures ~~G , ~ ~ ~ ~ s--~r~, _ `=a, red, _ : ~ ~ i'~ ~^-;mss,., • ~ T..~ z_,Y,,,~ i TELEPHO~'E (516) 765.1892 BO.1BD OF TO~C'N TRtiSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 1 1971 APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERMITS PURSUANT TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD. APPL I CAT 1 ON NO. o~~ --------DATE OF APPL 1 CAT I ON 3 ` 3G- I DENT I TY OF APPLICANT S,o. p 'p--~ _ s"_~~' .i~l4NPaUE. ~ __________,PHONE NO ADDRESS OF APPLICANT-- 1~0 WoOp$V1~,~___AQ _,rteet3Q Iil9 °1E4caLT~ ~L____ TAX MAP NO. ____1_~$ ___-D7-:____O1'~}.OOI_____________________~-__-_-_-_ AGENT PHONE NO. PERMIT REQUESTED TO_NEMIJ "~F,..C~. ____Y_____________________ LOCATION OF PROPERTY FOR WHICH PERMIT WANTED ----'r-~-'S----Sr1,~~S~tis2At~,_---~'QiJ~_-f-__~ure?±oat,~'F. Iu _ HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION CREEK, BAY OR HARBOR FRONTING PROPERTY SIZE OF PROPOSED WORK _~L~t~],1~F._yy~E A - ~o ~J 1 LENGTH---- IIO ~ ~t_ }-'9_1L't2"'________________________________________ WIDTH HEIGHT ABOVE HIGH WATER~___1~+~~ `F" n. DEPTH BELOW LOW WATER-------_---- YARDS TO BE EXCAV ATED_------~- •-~'Y_---I~LG~-4..~c VARDS TO BE FILLED---------_-~--__---_-- WIDTH OF CANAL. CREEK OR BAY FRONTING PROPERTY,----- DEPTH AT LOW TIDE--------------------._--._-_--_- AVERAGE RISE IN TIDE DISTANCE TO THE NEAREST CHANNEL-_------_FT. DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN T E AREA---------F S TH I S FOR PRIVATE -OpR BUSINESS USE?------- ~Qy~a.'tL,J-_-`-_---------- AREA ZON l NG_--.-._-_ S~TL-~.DYb13Ih L---_--~---_--___-__._---_------------~ MANNER IN WHICH MATERIAL WILL HE REMOVED OR DEPOSITED----------------- `D 1G Hot.'tS o(t oaTltJl~3- 12'~ptAM~-Ae+O R.EwiovII Sett. p INTENDED USE OF PROPERTY ~ ~ C ~ -------------....____----_-_--v---__--_---_..------ DESCRIBE ANY KNOWN PRIOR OPERATIONS CONDUCTED ON THE PREMISE E4t 5 T t r.1 /x---H O U.S 8.-~ S - 3rI. ~ /L AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENT AGENCY--__~__-----..~ O LI~Ca -------------------.--r.---------_----------.---_------------~------- DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF THE PROJECT SITE IF NECESSARY----------------- WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF N07 THE SAME AS THE APPLICANT ~ u ~--~+2A+~~4'~-__~.L~~I:IAl1yC LL AAE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT MOULD PROfiTBIT THIS PROJECT? ~ o COUNTY OF SUFFOLK ) STATE OF NEW YORK )SS: ~.a IJ` ~o(LD f+. pyA~G2- BEING DULY SWORN DEPOSE; AND SAYS THAT HE IS THE APPLICANT FOR TH6 ABOVE DESCRIBED PERMITS, AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, THAT THE WORK WILL BE DONE 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY HE APPROVED HY TH6 TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER DR BY VIRTUE OF SAID PERMIT, IF GRANTED. In completing this application I hereb uth rite the T stees, agent or representative to enter on my pr perty to i pect the premises in conjunction with revi of thi 1' n. S! NATURE F AP LICANT SWORN TO BE F,O',R E~~ M/aE', THIS Jd+~ q ~7 DAY OF M w~~ 1 9 p p ~~~J G1AOL k KOENIG Pe State of Near Yak NOTARY PUBLIC ~•NaSSW tiOU Cemmis~a{ ExG:res March 3,14x-® EXAMINED . APPROVED '~WETLANDS~~ PERMIT (CHAPTER 97) APPROVED °BOAT,DOCKS, WHARVES° PERMIT (CHAPTER 32~ DISAPPROVED 'WETLANDS PERMIT'~(CHAPTER 97) - DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT (GHAPTER 32) CONDITIONS, IF ANY EXAMINING BODY S{GNATURE OF CHAIRMAN COMPUTATION OF FEES approved 2/27J85 ^ . X, - 1 Li6~4 12/871-Tent 12 PROJECT I.D. NUMBER ~ 617.21 SI Appendix C State Environmental Quality Review SHORT EiVVIRONMENTAL ASSESSiVIEi`!T FORM_ For UNLISTED ACTIONS Oniy PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) t. APPLICANT/SPONSOR 2. PROJECT NAME Sn,N ~d.JA~,tEC. C 3. PROJECT LOCATION: Cu1'GNouGL N `'j~ Municipality 59$ CtJ'-y+Q.U~A.TBC LAru'Fs County :Sµ p~„K 4, PRECISE LOCATION (Street address antl road intersections, prominent landmarks, etc., or provide map) wCSY aTl+ V 43sa.,,c ~sr '~e4p 5. IS PROP SED ACTION: New ? Expansion U Modtficationlalteration 6. DESCRIBE PROJECT BRIEFLY: CoAts72u.GCl•b4 0~ ,,~ooa iSZeK - T° At_t~~ wtTK- 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 11s~ ~ Z. l~ .f. 'q r % Z Z t 8. Vllll FROP7SE0 TiON CObl,PL`f VS7TN EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ? Yes No II No, tlescnbe briefly r C er•.fSTQi.R.CCtO~ Wttwtwl 1S d~ WATtS.t. 9. VJ~HA~T IS PRESENT LAND USE IN VICINITY OF PROJECT? vLCI Resitlential ~!ntlustrial ? Commercial ? Agnculture ? Park/Forest/Open space ? Other Describe: 10. DOES ACTION INVOLVE A PERhAIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERA STATE GR LOCAL)? ? Yes No I} yes, list agency(s) and permit/approvals t1. DOES ANY ASP T OF THE ACTIOIJ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ?Yes No JI yes, Ilst agency name and permit/approval 12. AS A RESULT OF ROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ? Yes No t CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantlsponsor name: 'S' ^a ~t~JD ~ArJAr..t.~- Date; 3 - ~O^~g Signature: gl..A~~.t~~ It the action is in the Coastal Area, and you are a state agency, complete the Coasta4 Assessment f=orm before proceeding with this assessment OVER 1 _ , - - NTAL ASS>vSSMENT (To be completed by Agency) , r PART II-ENVIRONME _ A. DOES ACTION EXCSrED',ANY TYPE 1 THRESHOLD IN 6 NYGRR, PART 617.12? If yes, coortlinate the review process and use the FULL OAF, ?Yes GNO 8. WILL AOTlON RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYORR, PART 617.61 If No, a negative tlaclar; may de superseded by another fnvolvetl agency. L J Yas ? No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Ans•xers may be handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste protluctlon or dlsp~ potential for eros(dn, drainage or flooding problems? Explain briefly: - r.r ~~n4 ' ~ ~ C2. Aesthetic, agdculWral, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain b C3, Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, of threatenetl 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 lantl or other natural resourcesl Explain t C5. Growth, suusequant development, or related activities IIKe,Iy to be Induced by the proposed action? Explain briefly. G6. tong term, short term, cumulative, or other elfects riot Idenlifled in Ct-C5? Explain briefly. C7. Other impacts (incluUing changes in use of either quantity or type of energy)? Explain briefly. 0. IS THERE, OR IS 'iMERE LIKELY i0 eE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IAIPACTS7 ? Yes No If Yes, explain briefly PART III-DETEAMINATI,ON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, tletermine whether it is substanfial, large, important or otherwise signltir Each effect should be assessed In connection with its (a) setting (I.e. urban or rural); (b) probability of occurring; (c) duratior irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure explanations contain s~fflcient detail to show that elf relevant adverse impacts have been identified and adequately addressed. ? Check this box it you have identified one or more potentially large or significant adverse impacts which b!A' occur. Then proceed 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 6NILL NOT result in any significant adverse environmental impact • AND provide on attachments as necessary, the reasons supporting this determination: . N.uur nl 1 vdb AKcnay 1'nnl ur Yp~+ n,IInY 01 NC~pulriiblC Ul hcl(m L,.Ud Apl•IICY NIIU ul Itc~pan NUIC Ullicer )igndlure ur Kespanuble Uthcer m lead Axrncy Sixnarure of 1'ngrarcr Ili dnlerent from reyponuole ou¢erf Pale 2 • FORM NO. a ~~ic=r'i"t','.~~~~C' i TOWN OP SOUTFIOLD `y'"'""`~` BUILDING DEPARTMENT ddi TOWN CLERK'S OP'f ICE - - - . SOUTIIOLD, N.Y. NOTICE OP DISAPPROVAL 1=ilc I\'o . Date as......, t9~.~.. . C'~ >c.l.t~. nom... t~2 l ~ 9 .~.5 \ 1'f.EiASE'CAl<E NOTICE that your~ap~p~~ica}t-ion dated t'.~~~ . 19 `~.g. . 1'or t~emiit to construct ..4?.~?-~ ~:R'-[-`~~.......(~ at Location ofPropcrty s.9.~'......C~a.~ Wa~R.t, ~R"'Lx. itC-- House No. Strcaf Hom/ct County Tax Map No. 1000 Section Block ..............Lot . Subdivitiion Filed Map No. Lot N . is returned herewith and disapproved on the tbllowing grounds .l.~:c~..s.-L~t.~? x-1.9 :1- C-. w~~~ . .r;o-.~.. a ~ 4-~? u~i a;c; pi,, W x,.~, oc;..,e~ j~~-G. V~ .:1; ~.4~+ ~~r~. ~ r~,.~~~ , ......................U..~ . ' Building Inspector RV 1/EO r ~ : ~f g , ~ y ~d :~~`i!. . ~ _ F"}, ~ w tt-. ~ ~ y W ` / Q i ~ ~ ~a~ E ~ ~ ~ ~ ~ ~ ~ ~ ~ , ~ ~ ~ a r ~ :~i ~r~ ~ ~t ~ ~ ~ ~ w ~ ~ ~ ~ i.~ i ~ ~ ~ ~ a ~ ~ a s~ _ n ~ ~ ~ ~ t~ ~ Q ~ 4~ Sr i ~ i ~ ~ ,a 4 ~ ~ I ~ \ s ~ Q ~ ~ ~ ~ ~ / h ~ _ - ~~ua ~ - Q _ S - ~ ~ _ / ~ ~c9 ~ coq ~ - a n~ ~ o ; ~~ka toy A? pcPy ~ DVS to ~ r..-k ~aa ~-r4~Au~&CaM Fa w ..tPi r t t *f',-tr,~f :,h?.!sd,e.,,iA.'d.ns . T-,+4,'.rYn.,v.:a 3~s/ wa.?du~..~Yvii~aarv"xii5~sr,.x,•a1'v i ~b`3:d"~'~` e4+~tifiizes5wcw ~ ~ ~ ~ 3` ~ s o E ~ .t Q i ~ d N I ~ `l ~a a y, . N 1 ~~c 2 ij ~f ~ O ~ 'ice` v. - ~ N z 7 m ~ N I ~ l ~ ~ K I r ~ ~ hi ~ ivl ~ N i I N v f m I \ ,Q ~N V r I C, . - - - ' T- ~ ~ ~ _ - i- ~h O.. Q a~1~0 ~ iq VIE U i ' } , ">"~,~1 d lcaf,9 X~Z - oa oiz p~~, 03 X63 i 1 ~„E~~ K . . . ~ : ~ ...m'!,r '-~s.t,.S n.f k. xt>. _,o s, , .va~.xwau. ss niJ[.c FORM NO. ~ To~vN or soUTxoLD BUILDING DEPARTMENT TOWN CLERK'S OECICE SOUTIIOLD, N.Y. NOTICE OP' DISAPPROVAL File No . llute as......, 19d~.~.. Co Sa-~.~.d-.. N..cw,«..ta-~-........... PI,f:ASI'1'AKE NO'1'ICI; thatpyour apphica}t-ion dated Y?~~~ , ~.S' . • . • . • • 19 ~.g. . at for permit 4o construct Q:.qQ?-elf ~~-:~4'-!-`.-~'w . . LocationoPProperty ..5.9~......~01-d-.~:. Hnuse No. Stre~+ ~ ~ f~~~nler County "1'ax Map No. 1000 Section Block ..............Lot . Subdivitiion l~ilcd is returned herewi(h and disapproved on Map No . Lot N . the t'ollowing grounds .~..5.-~-~ ~ifD•~ 11.9 c.M~. ~i..~ . ~l, a r . W c~Isi.., Vt. W~,~a,...e0 . l~-~~•V: ? .:t: ~1 ~-~-4::? ........................:..b...................... . Building Inspector flV 1/CO BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 MAIL T0: Examined ..~./-.~r:......, 19 „n s A roved ~~r-.; 19 .t~UFermit No. Disapproved a/c ..(?Y~.~~~r~~ >3~z`:~~ r~ ~ ~2,I/~~' 4L-. ! ( 'ding Inspector) APPLICATION FOR BUILDING PERI411T 194. Date ...3.+. ys.. 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 Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment 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 re val or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil code, ousing code nd regulations, and to admit authorized inspectors on premises and in building for necessary i ections. (Signature applicant, or name, if a corporation) „/3 o tvconBu~E.~!... ~P~ulouaeu2~/ .~-y, (Mailing address of ap licant) /r~97 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ cc.~ •tJ v' 2 Name of owner of premises .......~~S~.F':"v ~/e!'v~.4 ~ . (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 . . S S GC.,~,a~u?~ ~ alb . House Number Street Hamlet County Tax Map No. 1000 Section .....~~8......... Block ......a v Lot . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......'s.!'v.E~G~`.... f ~f"~- , ; b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition ? Alteration . Repair Removal Demolition Other 1Vork . 'vaO'`~ oa~~ (Description) 4. Estimated Cost ......,7~..:d~Poo.,d0 Fee . ` (to be paid on filing this application) 5. If dwellin , number of dwellin units Number of dwelling units on each floor . If garage, number of cars s.',, . 6. If business, commercial or mixed occupancy, specify nature and extent of each type.of use . 7. Dimensions of existing structure, if any: Front ..:......Rear Depth . Height ...............Number"of Stories . Dimensions of same structure with alterations or additions: Front; Rear . Depth ....................'i.. Height , Number of Stories . 8. Dimensions of entire new construction: Front Rear ...............Depth . Height ...............NumberofStories...............................................'......... 9. Size of lot: Front Rehr Depth 10. Date of Purchase I; .................Name of Former Owner . . 1 1. Zone or use district in which pre~rtises 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 l ................Address ....:..............Phone No............... . I5. Is this property located within 300 feet+~~+of a tiqidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO'1' DIAGKAMed. Locate clearly and distinctly all'',buIldings, whether existing or proposed, and, indicate al] 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. I t STATE OF NEW YORK S COUNTY OF 'S • • • • • • • • • • $w,~°•'~ • • • • • • • ,'~i4~f1 • being duly sworn, deposes and says that he is the applicant (Name of individual signipg contract) above named. 'i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner,set forth in the application filed therewith. Sworn to before me this .......•......~j......day of ~~:'......,19~~. Notary Public, ~ I~'~ ,/C/ ~ • , County Nd.EN K DE YOE NOTARY PUDLIG State of New Yak ~ . No. 4701878, Sottalk CouMY Tam Fxgres Marah 30,18 (Signature of applicant) I -