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Home My WebLink About26442-Z FORM NO. 3 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) PERMIT NO. 26442 Z Date APRIL 7 , 2000 Permission is hereby granted to: FRANCIS E GR CZEWICZ 1090 THREE XATERS LA ORIENT,NY ,11957 for . ALTERATION & ADDITION TO AN EIXIISTING SINGLE FAMILY DWELLING. i at premises located at 1090 THREE WATERS LA ORIENT County Tax Map No. 47 889 Section 015 Block 0006 Lot No. 020 pursuant to applic ion dated FEBRUARY 10, 2000 and approved by the Building Inspect/or. Fee $ 75 . 00 b� � Authoriz&d Signat Q l J COPY Rev. 2/19/98 FIELD INSPECTION REPORT DATE COMMENTS =¢a==asaaasaasaasaxsaaaaa�xsassaaal'a=a=s�aaaaaa=ax===aa=asasaxaaaaasaaaaxaaaaaa=saxasaaaaa _^ n �I II U H 1�1 FOUNDATION OST) u _ _ Iii FOUNDATION (2ND) ----- _______________________ --- -------- --------------------------------------------- ---__ II II II ir ROUGH FRAME & PLUMBING 1 II 11 n IIS_— JI II II II U U (!J INSULATION PER N. Y. II STATE ENERGY iI _-moi CODE I - j 41 =aoo==xaaaa==aasaxaaaaaaa�aaa= — Ilaaa —s aeras as mss— aaaaaaaaa=aaaaaaaaaa a \. II 11 K/✓ II —_II it FINAL u ° � n n ADDITIONAL COMMENTS: n � r✓ — _ H r r� Applicant/ //, Date <)w ners Name C� ri C Z-Prw l C Reviewed Architect/ � ® Date I'ngineer. ut�mitted 110 SCTM ll: _ District: 11000 Section I_5— Block Lot ProjectC Subdivision Location —!.� - /h.t ee KIQ �-- pr ,j Dir Name i Single& separate Required certification (Yes/No) _ 0 -- R cq Kul. L.oningOISUICI _ �� [I�(sv,c � /dual �_ )I,�,t<o��uaf, �OQI'iilxi;cd --- � Rcq r Rcq , Rcq (Prone Yard 02�Proposal ) (Side Yard Plopow,j ) )Rear Yard /J Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A./ NO YES Number Suffolk County Health Dept. V New York State D. E. C. -- Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: �,64 c �• c BOARD OF HEALTH . .. .. . . .. . . ... . FORM NO. 1 3 SETS OF PLANS ... .. . . .. . ... .. TOWN OF SOUTHOLD SURVEY ............... . ........ FFa I 0 ?iq BUILDING DEPARTHM CBECK ..6.099.0.0........ TOWN HALL SEPTIC FORM ......... .......... --------- SOUTHOLD, N.Y. 11971 IT. TOWN � TEL: 765-1802 NOTIFY: � �p TOWN OF SOUTHOLD- 2.2 CALL ........ .�. . .... . . .. ... . . . >�nined. .. v MAIL TO:..... Approved.. .... ..7., Permit No. � �z?�. ................................... Disapproved a/c .................................. ................................... ................................... ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT or- , D Date.�.:6:.. . . . . . . ...19. . . . INSTRUCTIONS a. this application mist be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on W miles, 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 application. 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 issue a Building Berndt to the applicant. Such permit shall be.kept on the premises available for inspection thro flout the work. e. No building shall be occupied or used In whole or in part for any purpose whatever until a Certificate of occupancyshall have been granted by the Building Inspector. APPIMATICH IS HWY MADE to the Building Department for the issuance of a Building Pesmdt pin==t to the Building Zone Ordinance of the lbws 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. 1he applicant agrees to comply with all applicable laws, osdinaooea, building code, housing code, and regulations, and to admit authorized inspectors on premises and in bui for inspections. C� �:.......0. ............................... or mance if a ration) (Sigpa=e of applicant, carpo ..................... (1wlirg address of applicant) State whether applicant is owner, lessee, argent, architect, engineer, gra alr. electrician, plumber or builder :...................................................................................... E s Par�P c .f `v� Name of owner of premises .. :1................ .. .............1 .Z. ....4:2.............................. (as on the tax sell or latest deed) If applicant is a corporation, signature of duly authorized officer. ...............................I.............. (Name and title of corporate officer) Builders License ND. A.M� . �- Plumbers License No. ......................... Electricians License No. 6666................. Other Trade's License No. 1. Location of land on which proposed work will be done............................................................... .......109v.................r�'C? E.moGj�1. :............................� :I NT..N; . �1C.��..Z...... House Number Street Hamlet n County Tax Map No. 1000 sectio, ..�57.......... Block ...f>..6........ lot ..gyp.......... D /� Y7NE SE�ti1/vv. S7 F' 7 Subdivision ...19.. r...I3..............:....... Files I�p.No. ......?./..t1.. 1st : 7.,z........ (Name) 2. State existing use and occupm y of premises and intended use �and occ:pamcy of proposed construction: a. Existing use and occupancy ...fJ.�J. '��..f¢.::::lIs,o W. ... ....................................... b. Intended use and occupancy''...avAo ?L......................0..........0......66::66................... f Y Nature of work (dn&which applicable)t New Building .......... Addition .......... Alteration ...... Repair ............ Removal ............. Demolition ............ Other Work ....................:............. (Description) 1. Estimated Cost . 5 v.:............ fee .............................................. (to be paid on filing this application) i. If dwelling, nuaber of dwelling units ..........'.. Number of dwelling units on each floor ................ Ifgarage, atmixer of cars ...................................... i. If business, ial or mixed occupancy, specify nature and extent of each type of use..' .................. �. Dimensions of existing structures, if any: Front..:S.Z........ Rear . .?.......... Depth j:�............. sleight .... .7................. Number of Stories .Y., Dimensions of sane structure with alter gtions or additions: Front ................ Rear '�a ........ Depth Bei0t ................ Number of Stories .2r............ B. Dimensions of entire ne�aoostn:ction: Front L,rn P�;;Lr;1.e;?. Rear u:1 dh�— . Depth .4 ....... Height ....&................... Number of Stories ..................... 9. Size of lot: Prbnt .t/.f q............ Rear .............. Depth .5........ . 10. Date of Purchase ?�:? ............ Name of'Former Owner ........................................ 11. Zone or use district in which premises are situated ............................................................... 12. Does proposed construction violate any zoning lora, ordinance or regulation: ..../.r�............... 13. Will lot be regraded ...h:4.............. Will excess fill be rammed frompremises: YES U D �f 2fE W�FPf Ore{� �L3�d D 14. Names of Owner of premises '�iE;NC/.S"..�T./ h'1� : Address ..x.9...1.................... Phone No. ........� Name of Architect .................................... Address .............................. Phone No. ............. Nage of Contractor V4:Yl-'L F'AIG/l&e .. Address 3®�1�5/y'�l�V D............./EN7Phone No.3z :: 8(6', ........................6.. . . .. 15. Is this property within 300 feet of a tidal wetland? * YES .......... N0 ..✓....... *IF YES, SWM01D M &3 MWIRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether eZdsting or proposed, and.indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. lale as-e r-uZ, e j a_ .I SME Or NOW YORit� r S aotlNlY Or ...... `'.............. �?�, ,l,�„ c ;✓...................being duly sworn, deposes and says that be is the applicant (Name of individual signing contract) above named, Ile is the .. ............... ............................................................................... (Contractor, t, 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 ........ V ....day of . .... .. ... .. Notary Public ROBEiI�{(-geC�'1" .....• .. .d�l. . .............. ry Public.State of vwYork •(Signature of Applicant) Qualified in Suffo County No.01 SC47 0 o O . Term Expires May 1; - SUR VE Y OF LOT 15 SOUND VIEW ROAD � �� H �� $, ��ORI EN T— 8 Y— THE--.SEA FILED NOV. 21, 1957 FILE NO. 2777 AT ORIENT POINT TOWN OF SOU THOLD s SUFFOLK COUNTY, 1000-15-06^-20 ® ' 20 Q 20 40 as FE 0.2'S 7.40. ' UTILITY POLE 0.4'W go.8's �oaN Scalp 1 20' * pr g Dec. 23, 1997 AOVI cv r�W• i O � W r! 2.1� - YDxIr /3 Q N PFI�osZ rt ' o , i V) a+ W N p ��•••// _ J C�ONCAEIE IIlNT F.isYro o Q ® - ME BLUESTONE DRIVEWAY St+E o IF. W L20.7' C_ 3 f W � CERTIFIED T0, Lid _ AREA = '12.500 sq. ft. FRANCIS E. GRICZEWICZ = N PATRICIA C. GRICZEWICZ ~ FIDELITY NATIONAL TITLE �,,.� FE N INSURANCE COMPAf lY OF NEW YORK Z , 0.6'N05'E S.R. S.R..F F FE O 0.3 PIPE N W 1 N z 0.4'W 0.3'N ` 4 � �t0NNEyr y� c'tQ' xx",'I. Merzo �P,f _0 ., Y.�;� ��10. 18 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ECONIC�S S. OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. (516) 765 - 5 EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS P. 0. SOX 5 .9 �e . HERE SAID MAP OR ARE VALID FOR COPIES BEARS MAP AND THE IMPRESSED COPIES SEALHOFETH OSURVEYOR 1230 TRA UELER S LA496'%'b-, D WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 1 97 - 409