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Home My WebLink About17291-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the,Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18450 Date OCTOBER 6, 1989 THIS CERTIFIES that the building ACCESSORY Location of Property 575 OLD HARBOR ROAD NEW SUFFOLK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 03 Lot 06 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 6, 1986 pursuant to which Building Permit No. 17291-Z dated AUGUST 4, 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 ACCESSORY BOAT STORAGE STRUCTURE AS APPROVED BY ZBA #3717. The certificate is issued to FREDERICK KOEHLER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-092606 - SEPTEMBER 19 1989 PLUMBERS CERTIFICATION DATED N/A OL1. ~-~-0~- ilding Inspector Rev. 1/81 F013D! NO. 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 01.7291 Z Date ................r~............., 19~..lt. Perrmission is hereby grante--d--tw~o: ...../vM~:CX..... ../..A.~..........~~....~.~ «-s.~Q... ta a~.....~~ g...~ :........~'~.r.a at premises located ot ...~...~.......5~`~9''.....4I..~:......~Y1.~.......~ ..~~...F........~s.~:~. County Tax Map No. 1000 Section .......~~.7.......... B/lock ......Q..'$........ Lot No....L?..~o............ pursuant to application dated ..~:'~F'~:~~'^.-~.....W 19~.~., and approved by the Building Inspector. (~~1 Fee $,~5.:. 9 Buildin I actor Rev. 6/30/80 TORN OP SOUTDOLD BUILD I{{G DEPART2tEi:T TONN DALL • SOUTIIOLD, NEN YORK 1(971 765 - 1802 • APPLICATION FOR CCRTIFICATE OF OCCUPAt{GY ~ J ~1 DATE.. ~ I.~. ll-o~ . NEN COi:STRUCTI02i .~,,,,DLD OR PRE-E%ISTING IIUILDING.....-VACAi{T L~{A~i1pD........ Location of Proparty..~5,~:~,..,®1~.,xA/L~QjI;.,~;d•.__, ~_~L!? SuQ~_ a~~. UOUSE NO. STREET llAMLET Ovncr or Ovncrs of Propcrty._~~..~4.~ Couoty Taz Hap No. 1000 Section „ Block Qs~J.. Lot. Q S~ibdivision Filed Map ........Lot...._..... Pecnit xo. 1,7aq~_~..,nate of PcrmiC ..Applicant ..`~.~~~...~!~Q Ucalth OcpC. Approval Undcrvritcrs Approval...._,._.,_,.. PLanninG Board Approval x'~ A RequeCt for Temporary Certificate Fiaal Certificate •.°CC SubwiC[Cd: S, ~S: CJ'z?..,......,, APPLICANT. , . . , . ~ , r -ey• f0/IG/88 f r~ ~ Isysd FORM N0. 6 TOWN OF SOUTIIOLD BIIILDINC DEPARTlfENT TOI1N NALT 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with [he fol;Iowing; for new buildings 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 of Dealth Dept. of water supply and sewerage-disposallS-9 form). 3. Approval of electrifal installation from Board of Pire Uoderwritors. 4. Sworn statement from plumber certifying that solder used in system coa[aios'less • than 2/10 of lz lead. 5. Commercial building, industrial buildings, multiple residences and similar, ' buildings and installations, a certificate of code compliance from the Architect or Engineer responsible for Che 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: I. Accurate survey of properly showing all property lines, streets, buildings and unusual natural or topographic features. 2. A.properly completed', application, a consent Co inspect signed by [he applicant and a certified abstract of title issued by a title company which s~all show single and separate ownership of Che entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in tirricing to the applicant. 3. Date of any housing Lode or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate_ C. For pacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership o1 the entire lot prior to April 9, 1957 shall also accompany the application. If la Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D, FEES: i I. CERTIFICATE OF OCCUPANCY - New Dwelling_$25.00, Additions to Dwelling $25.00, Alteration to Dwe'11ing $25.00, Swi¢ming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy oa pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. Updated Certificate of Occupancy - $50.00 6, Temporary Cettifi~aCe of Occupancy - $J.5.00 Residential $50.00 Commercial I w, 10/14/58 ~ _ C~ THE NEW YORK BOARD OF FIRE UNDERWRITERS art"~ ~ :LCO0'74(} BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date „SJiY9'E14k3PR ")e~9n~i APPlica[ian No. on file 6~~1'~~ii~~P~ ~J {7~%~f.)f; THIS CERTIFIES THAT only the electrical equipment as described 6eloTn and introduced 6y the applicant named on the abode application number in the premiaea of use xcPr,~ll>;~?, rrrar~ If~~snu tai}. , Nx'W ~~r.r~rlxr N.Y. in thefollouinp location: ? Basement L^J Iat F'L ? 2nd F'l. 3ertion Biock Lot uas examined on i;LlllsClb`l, 3~r 1t~9 andfourzd to be in cmnplimlre with the requirements q/'this Board. t ' FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FWOREECENi OTHER AMi. K W. AMi. K W. AMi. KW AMi. K W AMi. H P 2G } E1 2h DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT K. W. 011 H P. GAS H. P. AMT NO. A W. G. AMT. AMP AMi. AMPS TRANS. AMT. H. P. SYSTEMS AMi WAiiS NO.OF FEET 3 !t7 SERVICE DISCONNECT NO.OF S E R V I C E MIT. AMP rypE METER 1 ]W 1 3W J.a' 3W 3,a' dW NO. OF CC. CONp. A W G. NO. Of HbLEG A. W'' NO. OF NEUTRALS A. W. G. EQUIP. PER g OF CC COND OF HbIEG Of NEUTRAL OTHER APPARATUS: BaIYFRON'P GO'1"'i"AGS!1 WTRTNr; ('1N1,Y-d PAN~:LBU~,RB~t2~°'!,0 C1:R,. ?iJ0 r.~_c~r~--.? I - D i / ~~'l LR:;f,TF; R.F~~w?XJtaNS) f~:C(x..#$f"r3°LP 11.5 FLC}.RTLIA S'P. r,~ 7?'TifYPJ]'NC+DAJ,N;, SJY, iJ.73R ~-`OEf(€pAt MANAGER f ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma~6e~ietheir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~Gt~thtEN7S , 1ELD I;;S:'vC:1U;7 ~~UATE ~ . ,ti ~ m 9J ~ H H ~ rOUtJDATION ~ (1st) ...i m a rOUNDATIOIJ (2nd) 2, z o ~ J ROUGH FRAME & U1 PLUMBING ~y ~ "t ~ ".t H m 3. m H IIJSULATIOCI PER N. Y, STATE ENERGY L CODE x a .n Y? r F "3 b 4, FIidAL ~ C• O Z L m ADDITIOP]AL COMMENTS: x m x ro H x1 9 "a H O z r x M 9 r _ 5 0 m b H ~ ~ . _ _ G~ 1 - -a k / FORM NO. 3 TOWN OF 50UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL 19 8 .b. Date _ To~ ..~01"'~.na-app-. ~~5.. c2J"~~. ~st. ~M• A.. s.c~L...tS.? :y:..1.1.9.5~.?r... . PLEASE TAKE NOTICE that your application dated :~!-K``.'`~.'~ 5 19 ~ . for permit to '~.J'^.u~:~-t^c.~..~...~f~??'94-Pr3...~~-~.'9.S>--..C~S.~. 'cX~~.)..at Location of Property .~E.^1 S ~a'-.1.+'o'z'• ~ • . • • • • • • • • • . House No. Street Hamlet County Tax Map No. 1000 Section ~ ~1.. , , ...Block ~ ......Lot C9. ~ . Subdivision Filed Map No. Lot No. . is returned herewith and disapproved on the following grounds . ~•~C!?M .o~.. 1 d?~.:~ rr! ! 9. a ...?.~.~-vR.s9.~,.c~.. ~.e.~' Q-a s<~C. . . R~Gs~1ti<< R.- , . l./.~.i.a.,n.cA...~+.:...~-a:-.y,....~•?~nb~!'!Gj.. cw:a.~~ . ~..~,f •e.~X-:~! . Building Inspector RV 1/80 U ~ ~ ~~sa~ P. 0. Drawer A _a .~.z Jamesport, NY 11947 ~e-n~' September 11, 1987 ~ TQVE~'R` „ . ~.1 Victor Lessard, Executive Administrator 3,e` b Southold Town Building Department Main Road Southold, NY 11971 Dear Mr. Lessard: Effective immediately, William Beebe, contract for Mr. Koe~ will be representing Mr. Koehler in regard to obtaining his building permit. Thank you for your consideration and cooperation in this matter to date. Sincerely, Henry E Raynor, r. HER:ml CC: Koehler Beebe Southold Town Zoning Board of Appeals ~ 5~F~0(,;-~o~ Southold Town Board of Appeals ~'~®d MAIN ROAD- STATE ROAD 25 SOUTHOLD, L.1., N.Y. 11971 TELEPHONE (516) 765-1809 APPEALS BOARD MEM6ERS p ~°,.wR..,,,,,s.~..n,.,..~ - Ej T ~ ~ tl~~~' ~4-' ~`~I~ GERARD P. GOEH RINGER, CHAIRMAN r r ~ s CHARLES GRIGDNIS, JR. ~ SERGE DOYEN, JR. ~m~p~J~~y~^~~~(p7~~^ f ROBERT J. DOUGLASS I !i{R ~aI~1.7W a JOSEPH H. SAWIC KI August 17, 1987 ~~r ~ - - - &3LGC;. t3Li~T. YOVU~I C7E 5C7?S d ii49LP3 ,F Mr. Henry E. Raynor-, Jr. - P.O. Drawer A Jamesport, NY 11947 Re: Appeal No. 3496 - ~ ~ ~ ~~~I~ Dear Mr. Raynor: Transmitted herewith is a copy of the findings and determination rendered in the above matter (and discussed previously with you). Yours very truly, GERARD P. GOEHRINGER CHAIRMAN By Linda Kowalski Enclosure Copy of Decision to: Southold Town Trustees Southold Town Building Department Suffolk County Planning Commission Mr. Frederick Koehler, Jr. .._........_w ~ i ~ / / U J ~ f~-~'~ r P. O. Drawer A_ ~ nn~( Jamesport, NY 11947 ~ ~ U GY~I~~ July 7, 1987 ~ ~n,.~.~ s~.,r~~.~ !9 ~ ~ 87 f ~ Henry P. Smith, President R'OVvNOF50U7'h101.® Southold Town Trustees Main Road Southold, NY 11971 RE: Permit #317 Dear Mr. Smith: Enclosed please find building plans for the Frederick Koehler cabana. I would request an amendment to include the decking for this beach house, which is landward of the existing bulkhead. Thank you for your consideration. Very truly yours, enry E~, Raynor, Jr. HER:ml ENC. CC: Frederick Koehler ~.r~.a, ~~y ~ Southold T®wn Board of A eats o ~ PP y MAIN ROAD - STATE ROAD 25 50UTHOLD, L.I., N.Y. 11971 TELEPHO(VE (516) 765-1809 APPEALS BOARD MEMBERS 'may c~ GERARD P. GOEHRINGER, CHAIRMAN D CHARLES GRIGONIS, JR. SERGE DOYEN, JR. i 8 August 5, 1988 ~ ~ 4; JOSEPH H. SAWIC KI BLDG. DEFT. Mr. James L. Gray TOWN OF SOUTF{OLD Pudge Corporation Main Road Southold, NY 11971 Re: Appeal No. 3717 - _ : ~ ~ ~ ~ ~~e~e~' Dear Mr. Gray: Transmitted herewith for your file and perusal is a copy of the official findings and determination recently rendered by the Board of Appeals, the original of which has this date been filed with the Office o£ the Town Clerk. Please be sure to return to the Town Building Department for issuance of any permits and other approvals in writing as may be applicable. Please do not hesitate to call either. our office (765-1809) or that of the Building Inspector (765-1802) if you have any questions. Yours very truly, GERARD P. GOEHRTNGER Enclosure y Linda Kowalski Copy of Decision to: Building Department ' o ~~FF01~~~~~ ~ ,e~ ~ South®ld Town Board of Appeals w MAIN ROAD - STATE ROAD 25 SOUTHOLD, L. L, N.Y. 11971 nE~ TELEPHONE (516) 765-1809 APPEALS BGARD MEMBERS GEftARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGON{S, JR. SERGE DOYEN, JR. ACTION OF THE BOARD OF APPEALS -RBBERfi'i-9BCfttA33 JOSEPH H. SAWICKI Upon Application of FREDERICK KOEHLER, JR. for a Variance to the Zoning Ordinance, Article XI, Section 100-119.2B for permission to locate accessory structure along existing bulk- head at Cutchogue Harbor, premises known as 575 Old Harbor Road, New Suffolk, NY; County Tax Map Parcel No. 1000-117-3-6. WHEREAS, a public hearing was held oh June 2, 1988, in the Matter of the Application of FREDERICK KOEHLER, JR. under Appeal No. 3717; and WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; 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. This is an Application for a Variance under Article XI, Section 100-119.2B, as amended May 17, 1988, for permission to locate an accessory storage building incidental to the existing residence of the premises and for inside storage of the owner's boating and yard equipment as more particularly shown on the architect's rendition dated May 27, 1987, prepared by Samuels-Steelman. 2. The premises in question is identified on the Suffolk County Tax Maps as District 1000, Section 117, Block 3, Lot 6. 3. The premises in question is a described parcel containing an area of 2.8+- acres, with frontage (lot width) along Old Harbor Road of 329.42 feet, and average depth of 660+- feet. Page 2 - Appeal No. 3717 Muter of FREDERICK KOEHLER, JR. Decision Rendered July 14, 1988 4. Article XI, Section 100-119.2E of the Zoning Code (as amended) requires all buildings or structures proposed on lots upon which a bulkhead, concrete wall, rip-rap or similar structure exists and which is adjacent to tidal water bodies other than Sounds shall be set back not less than seenty-five (75) feet from the bulkhead. 5. on-site inspections find as follows: (a) the immediate area of this neighborhood does consist of parcels improved with accessory buildings with minimal setbacks from the bulkhead and Bay; (b) the height of the neighboring accessory buildings near the bulkhead and Bay are one-story (or less) in height and are used solely for storage purposes incidental to the existing residence and not for sleeping or income purposes; (c) extensive regrading and construction of a timber retaining wall has taken place since this board's previous decision under Appeal No. 3496 which appear to have rectified the previously-existing eroded and unstable bluff toe; (d) the slope is vegetated with Rugosa rose and appears fairly stable; (e} there is a wooden-plank walkway in a continuous slope without steps and very steep. (f) the premises is also improved with a single-family dwelling and accessory garage presently located in the northerly yard area {see architect's rendition for particulars}. 6. It is the opinion of the Board that due to the erosion factors in this area, and the precedents established in the immediate area, an accessory building in the area noted below (as an alternative to the location requested )-for the purposes of storage incidental to this parcel is not unreasonable. 7. It is the position of this Board that: (a) the relief as alternatively granted herein is within the character of the immediate general area; (b) the relief requested is substantial in relation to the requirements; (c) the relief is related to the uniqueness of the property; (d) the variance, as alternatively granted, will not in turn be adverse to the safety, health, welfare, comfort, convenience or order of the town, or be adverse to neighboring Page 3 -Appeal No. 3717 Matter of FREDERICK KOEHLER, JR. Decision Rendered July 14, 1988 ie) there is no other method feasible for appellant to pursue; (f) in considering the above factors, the interests of justice will be served by granting the following alternative relief. Accordingly, on motion by Mr. Goehringer, seconded by Mr. Grigonis, it was RESOLVED, to GRANT a Variance under Article XI, Section 100-119.2B (as amended) in the Matter of the Application for FREDERICK KOEHLER, JR. under Appl. No. 3717, SUBJECT TO TAE FOLLOWING CONDITIONS: 1. That the accessory storage building be located a minimum of ten (10) feet from the lower bulkhead'{exclusive of overhangs, deck walkway, or step areas}; 2. That the accessory storage building not be larger than the size 20 ft. x 12 ft. (exclusive of overhangs, steps, deck, walkway areas), and proposed four-ft. overhang can have posts within the above-mentioned 10-f t. setback; 3. That the accessory building be used for storage purposes incidental to the residence and not be used for sleeping or living quarters; 4. That the doors to showers must be on outside wall of the accessory building and not an interior doorway; 5. That plumbing facilities will be permitted for the shower(s) only; 6. That the height of this accessory building shall not exceed one-story (12 feet high); 7. Deck areas shall be permitted as proposed at ground level to the bulkhead, provided the height is not higher than two feet (2') elevation above the bulkhead; 8. Size of deck may be of a size as proposed on the May 27, 1987 rendition prepared by Samuels-Steelman, Architects. Vote of the Board: Ayes: Messrs. Goehringer, Grigonis, Douglass and Sawicki. (Member Doyen was absent.) This resolution was duly adopted. * * /f* GERARD P. 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Raynor, Jr. [Appellant(s)] as AGENT FOR MR. FREDERICK KOEHLER P.0. Drawer A Jamesport, NY 11947 _ Mr Frederick Koehler, c/o Bud Realty Farmingdale NY 11735 At a Meeting of the Zoning Board of Appeals-held on July 27, 1-987, the above appeal was considered, and the action indicated below was taken 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 Zoning Ordinance Article Section [X] Request for Variance to the Zoning Ordinance Article XI Section 100 119.2(6) [ ] Request for Application of ~`R~~D~~O^I~~~KOB~H~IE')R -~1 Variance to the Zoning Ordinance, Article XI, Section 100-119.2 for permission to construct. 38' by 16' beach pavillion and attached deck areas extending a length of 124± feet and width of 28 feet (exclusive of stairs), accessory and incidental to the established single-family residential use of the premises, not to be operated for sleeping or habitable purposes and not operated for gain, within 75 feet of ordinary highwater mark and/or landward edge of tidal wetland, along Peconic Bay, 575 Old Harbor Road, New Suffolk, NY; County Tax Map District 1000, Section 117, Block 03, Lot 06, _ WHEREAS, a public hearing was held and concluded on Jury i6, 7987 in the Matter of the Application of FREDERICK KOEHLER, JR. under Appl. No. 3496; 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, appellant requests a Variance from Article XI, Section,100-119.2 of. the Zoning Code for permission to construct a 38' by 16'.beach cabana with attached decks as more particularly shown on site plans dated May 27, 1987, prepared by Samuels-Steelman, Architects. 2. The premises in question is a described parcel contain- ing an area of 2.8± acres, with a frontage (lot width) along Old Harbor Road of 329.42 feet, and average depth of 660± feet. 3. The site plan prepared May 27, 1987 by Samuels-Steelman, Architects, depicts the following improvements: (a) li-story, Single-family dwelling set back 1651 feet from the 30'high contour and 218± feet from the existing bulkhead below the (CONTINUED ON PAGE TWO) DATED: JUIy 27, 1987. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS Form ZB4 (rev. 12/81) BOARD OF HEALTH 3 SETS OF PLANS FORMN0.1 SURVEY TOWN OF SOUTHOLD CxECK . BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL SOUTHOLD, N. Y. 11971 NOTIFY TEL.: 765-1802 CALL MAIL TO: Examined how . l 19g~pp. . Approve. ~ 19~ 4. Permit No. ~.7.a 9 ~ Disapproved a/c .VVVVVV (Building Inspector) APPLICATION FOR 6UILDING PERMIT Date ...................15... 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 far 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 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .~?Q:".'~:°3 . GAL . . . . (Sigr2ature of applicant, o a > if a corporatton) - . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....T':........ K.~~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 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. ..5,`75, ,IT~O~.'~l)•a-c.~ea~, /.ED: , , IV~;W k I~~ House Number Street Hamlet County Tax Map No. 1000 Section Block O,3 , , , , , , , Lot .....V. ,l?, , , , . , , , , . , Subdivision Filed hlap No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy op proposed construction: ~ - a. Existing use and occupancy • • • • _ ~ ~ ~ ~ ~ , , , , Qc.c~,a..~aua.C~... b. Intended use and occupancy • ~ n i 3. Nature of work (check which applicable): New Building ~ Addition . Alteration . Repair Removal Demolition ...Other Work . ~ ~ (Description) Fee . a~•J:..." . 4. Estimated Cos to be ( ~ paid on filing this application) 5. If dwelling, number of dwelling 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. Dimensions of existing structures, if any: Front Rear Il Depth . . Height ...............Number ofStorics...........................~.....................•...... Dimensions of same structure with alterations or additions: Front . Rear . Depth ......................Height ......................Number of Stories . " 8. Dimensions of entire new construction: Front Rear .......Depth . Height ...............NumberofStories.......................... 9. Size of lot: Front . Rear .Depth . 10. Date of Purchase . Name of Former Owner l . 11. Zone or use district in which premises are situated , . 12. Does pro osed construction violate any zonin law, ordinance or re elation; 1 . p g g 13. Will lot be regraded Will excess fill be removed from premises: ,Yes No 14. Nacne of Owner of pxemises ....................Address 1 Phone No............... . Name of Architect ...........................Address ....Phone No............... . Name of Contractor .Address . i . ..Phone No........ . 15.Is this property located within 300 feet of a tidal wetland? *Y$5....NO.... *If yes, Southold Town Trustees PLOTDIAGRAM a requiredi. Locate clearly and distinctly all buildings, whether existing or proposed, and, irdicate all set-hack 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 ~I STATE OF NEW YORK, S S COUNTY OF . s s /F v ~ • • • ..F2 CA4°.~!.~ •..k o e (r L CR . ~ , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Iieisthe (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed tfte 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 ma this day of ! . 19 Notary P~g~~AV • . ~ . ounty STi4TE OF N YOAK • ~~4+e!~,'~•` <.1 . 0.30-478831 t 4UAlJF1ED IN NASSAU COUNTY (Signature of applicant) TEAM EXPIRES MARCH 30, 19.9 FORM N0. 1 - TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £~OUTHOLD, N.Y. 11971 ~ TEL.: 765-1$02 amined .................19... Heceived...........,19... ~prtlved „ 19 Permit No........... . sapproveda/c (Building Inspector) APPLICATION FOR BUILDING PERPdIT Date 19 . INSTIZLJCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 > 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 ireas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~on. , 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 11 be kept oh 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 It have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to t}te Building Department for the issuance of a Building Permit pursuant to the riding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ' :applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to nit authorized inspectors on premises and in building for neces inspections. ~,k . A.... (Signature of applicant, or name, f a corporation) (Mailing address of applicant) ' rte whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. me of owner of premises .....~:".~t4~C'~r4~.~~-:~~:~.~.~ (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized offices - (Name and title of corporate officer) Builder's License No . ' ' Plwnber's License No . . Electrician's License No . . t.".cr T::~'c'e Lip.,....:'.`?o . . Location of land on which proposed work will be done . . ' ~S .(S/; . ;.fv;c~.~,t ~'i.rn~,~ ~~Lr...~ °t `.•~IA.a~r-~'~b y~7~s..re^..., : = f . ~c,4~ ~ ~f~ ~~..7 ~ 5 (y VFI . (louse Number Street lIF }iamiet County Tax Map No. 1000 Section ~l.~.t®.Q..... Block G 3.r.o.~~. , . , , , , Lot ~~t:'°.'.~a.t:~.... . Subdivision filed Map No. Lot............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constriction: :=a. Existing use and occupancy b.lntended use and occupancy 3. Nature of work (check which applicable): New Building Addition ..I~, , . Alteration . Repair Removal Demolition Other Work , , , . (Description) 4. Estimated Cost Fee..........i............................ (to be'paid on filing this application) 5. If dwelling, number of dwelling 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. Dimensions of existing structures, if any: Front ....:..........Rear Depth , , , , Height ..............'.NumberofStories.........................,..i............................ Dimensions of same structure with alterations or additions: Front Rear , . Depth ......................Height Number of Stories . 8. Dimensions of entire new construction: Front Rear ........',,.......Depth . Height ...............NumberofStories........................... 9. Size of lot: Front Rear ~,llepth . 0. Date of Purchase ..........................Name of Former Owner . 1. Zone or use district in which premises are situated . ...........'..........I,...................... , , . 2. Does proposed construction violate any zoning law, ordinance or regulation : . 3. Will lot be regraded . .................Will excess Gli be removed from premises: Yes No t. Name of Owner of premises ....................Address , ........i.... Phone No, . Name of Architect ...........................Address • ..Phone No............... . Name of Contractor ..........................Address , ,Phone No............... . PLOT DIAGRAM Locate clea~•ly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. II I! ' I , I! 'ATE OF NEW YORK, AUNTY OF 5.5 ~ • • • • • • • • • • • • • • • . • being duly sworn, deposes and says that he is the applicant (Name of individual si ning contract) we named. is the ~ . (Contractor a ent cor orate officer, etc. > g , P said owner or owners, and is d ly authorized to perform or have performed the si<id work and to make and file this ~lication; that all statements co twined in this application are true to the best of his knowledge and belief; and that the :rk will be performed in the man er set forth in the application filed therewith. orn to before me this ......................day f....... „ 1~... I tary Public . (?`ouzaty , • • ? . • • . ' ~ . • ~ (51 mature of applicant)