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HomeMy WebLinkAbout27917-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28673 Date: 08/12/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 1010 SALT MARSH LA PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 68 Block 3 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 1, 2001 pursuant to which Building Permit No. 27917-Z dated NOVEMBER 19, 2001 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 ONE CAR GARAGE AS APPLIED FOR. ZBA #5129 DATED 4/18/02 . The certificate is issued to MICHAEL YOUNGMAN & WF. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ut rized ignature Rev. 1/81 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. 27917 Z Date NOVEMBER 19, 2001 Permission is hereby granted to: MICHAEL & WF YOUNGMAN 201 EAST 17TH ST APT 29H NEW YORK,NY 10003 for . CONSTRUCTION OF AN ACCESSORY GARAGE IN THE FRONT YARD AS APPLIED FOR AS PER ZBA CONDITIONS at premises located at 1010 SALT MARSH LA PECONIC County Tax Map No. 473889 Section 068 Block 0003 Lot No. 006 pursuant to application dated JUNE 1, 2001 and approved by the Building Inspector. Fee $ 75 . 00 Au22Sgnature COPY Rev. 2/19/98 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT — TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department wjih-the following: i A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, ad unusual natura or topographic features. t- • i 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 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-$25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00 Date. &-%/, U Z New Construction: �� Old or Pre-existing Building: (check one) Location of Property: j D I 0 ,S4t-r M+K,4;/-/ 14, /CCdA/! 0 House No. L, Street Hamlet Owner or Owners of Property: I�IICI`AEL e I/f. yQ(jAjG It'IIl Al Suffolk Count Tax Ma No 1000 Section s f�c4q Y p p el8 Block 0003 Lot 006 Subdivision Filed Map. _Lot: Permit No. g? q f 7 Date of Permit. //-/9- O/ Applicant: /f'1 Youti j M A 1✓ Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: __ (check one) Fee Submitted: $ 2S 0j� -2:: a%'(o13 GC � a )9ca, Applicant Sign ture Zt✓ APPEALS BOARD MEMBERSQFFU( j O�S �Cp Southold Town Hall Gerard P. Goehringer, Chairman 53095 Main Road Lydia A.Tortora y x P.O. Box 1179 George Horning O W Southold,New York 11971-0959 Ruth D. Oliva ZBA Fax (631) 765-9064 Vincent Orlando �Ol �a Telephone (631) 765-1809 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF APRIL 18, 2002 Appl. No. 5129 —ARLINE YOUNGMAN. Location of Property: 1010 Salt Marsh Lane, Peconic Parcel 68.-3-6 BASIS OF APPEAL: Building Inspector's Notice of Disapproval dated February 22, 2002, stating that the foundation location survey dated February 14, 2002, for an accessory garage does not comply with the front and side yard setback variances granted by the Board of Appeals under Appl. No. 5013, dated October 25, 2001. The survey notes a front yard setback of 19.4 ft. and a side yard setback of 8.6 ft., instead of the 20 ft. front yard and 10 ft. side yard setbacks granted under this prior appeal. AREA VARIANCE REQUESTED: Applicant wishes to modify the variances granted by the Board of Appeals to reflect the actual location of the "as built foundation" of the detached accessory garage. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on April 18, 2002 at which time written and oral evidence was presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: PROPERTY FACTS: The subject property is located on the north side of Salt Marsh Lane in Peconic. The property has 98.29 ft. road frontage on a private right of way, and a depth of 312 ft. to the high water mark on Long Island Sound. The property is improved with applicant's single-family dwelling, and a 12 ft. by. 22 ft. concrete foundation for a detached garage, all as shown on the survey prepared by John Metzger, P.C. dated February 14, 2002. REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted, the board make the following findings: 1. Grant of the area variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The front setback is 8 inches and the side yard 18 inches closer to the property line than that approved by the board. While the board believes that the error could have been avoided had the applicant updated the 1971 survey prior to pouring the garage foundation, the overall effects to the neighborhood are negligible. LIT Page 2—April 18, 2002 J Appl. No. 5129—Arline Youngman 68.-3-6 at Peconic 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance because the foundation has been poured and to cut back 8 inches on the front and 18 inches of the side of the foundation is economically impractical given the degree of the variance. 3. The variance granted herein is not substantial and represents an 8 inches reduction in the 20 ft. minimum front yard setback, and 18 inches reduction in the 10 ft. minimum side yard setback, granted under prior appeal. 4. The alleged difficulty has not been self-created. 5. The variance granted will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district. No evidence has been submitted to suggest that the variance will have an adverse impact on physical or environmental conditions in the neighborhood. 6. Grant of the requested variances are the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an accessory garage, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Tortora, seconded by Member Oliva, and duly carried, to: GRANT the Variances, as applied for, to modify ZBA Decision No. 5013. This action does not authorize or condone any current or future use, setback or other feature of the subject property that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: Members Goehringer (Chairman), Tortora, Horning, Oliva, and Orlando. This Resolution was duly adopted - G card P. _ oehringer,• aim n X5`'30 2. 110Z ro . IS i i APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman ��O CO Southold Town Hall James Dinizio,Jr. 53095 Main Road Lydia A. Tortora Go P.O. Box 1179 Lora S. Collins v- • Southold,New York 11971-0959 O George Horning 4f'�►�l . ! ZBA Fax(631) 765-9064 Telephone(631)765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF OCTOBER 25, 2001 Appl. No. 5013—ARLINE YOUNGMAN. PARCEL 1000-68-3-6 STREET& LOCALITY: 1010 Salt Marsh Lane, Peconic DATE OF PUBLIC HEARING:. October 18, 2001. FINDINGS OF FACT 0 PROPERTY FACTS/DESCRIPTION: Applicants' property is located on the northerly side of Salt Marsh Lane in Peconic. A copy of a former surrey of applicant's property shows the property 98.29 ft. along the private right-of-way and 312 ft. in depth to the high water line of the Long Island Sound for a total lot size of 30,576+- sq, ft. The property is improved with a single-family dwelling and accessory structures. BASIS OF APPEAL: Building Inspector's August 14, 2001 action which reads that the building permit request, to locate a 12 x 22 ft. accessory garage in a front yard (the yard facing the applicant's access/right-of-way), is disapproved under Article III, Section 100-33C for the reason that the front setback is less than 40 feet to the front line. AREA VARIANCE RELIEF REQUESTED: The applicant requests an area setback variance to locate an accessory garage in the front yard area of this waterfront property. The original request of the applicant was to locate the garage at five feet from the west side line and 15 feet from the southerly front line. The Zoning Board of Appeals held a public hearing on this matter on October 18, 2001, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal observation by Members of the Board, and other evidence, the Board finds the following facts to be true and relevant. ADDITIONAL INFORMATION At the October 18,2001 public hearing, the Board requested, and applicant'agreed, - increase the requested front yard setback from 15 feet to 20 feet. On October , 22, 2001, applicant submitted an amended plan locating the 12 x 22 ft. garage at 10 feet from the westerly side line and 20 feet from the front line (along applicant's right-of-way). REASONS FOR BOARD ACTION DESCRIBED BELOW: Based on the testimony presented, materials submitted and personal inspection, the Board makes the following findings: .; 1. Grant of the area variance will not produce an undesirable change in the character of the neighborhood or detriment to nearby properties. The proposed 12 ft. by 22 ft. accessory garage would be located in the front yard of a long, narrow soundfront lot in a heavily wooded area served by an unimproved right-of-way. Most of the garage will be screened from view by the woods and brush and its front yard location will not harm nearby properties. f 'Page 2—October 25, 2001 Appl. No. 5013—Arline Youngman 10001-68-3-6 at Peconic +' s' } 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance because location of the garage on the lot is limited by mature trees, a driveway and a pump house. 3. The area variance is not substantial and relates to the environmental considerations to preserve the wooded nature of the lot near the eight-of-way and the character of the neighborhood. 4. The proposed variance will not, have an adverse effect or impact on the physical or environmental conditions in the neighborhood because the variance will permit the accessory garage to be located within an area that will preserve mature trees in a wooded area. In considering this application, the Board deems this action to be the minimum necessary and adequate for the applicants to enjoy the benefit of a new accessory playhouse structure with deck, and that the grant of this variance will preserve the character of the neighborhood, and the health, safety, welfare of the community. RESOLUTION/ACTION: On motion by Member Tortora, seconded by Member Horning, it was RESOLVED, to DENY the original location of the proposed garage, and ALTERNATIVELY, TO GRANT a variance, permitting applicant to construct a 12 ft. by 22 ft. accessory garage in the front yard to be set back 20 feet at its closest point from the front property line and 10 feet from its closest point to the westerly side property line, SUBJECT TO THE FOLLOWING: 1. The accessory building shall be for garage or storage purposes incidental to the principal residence. 2. The accessory building shall not be used for sleeping or living quarters. 3. The only utility shall be electric for lighting or outdoor_plumbing. 4. The accessory building shall remain at one-story height. This action does not authorize or condone any current or future use, setback or other feature of the subject property that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. ,- VOTE OF THE BOARD: AYES: Members G ring (Chair Tortora, Collins. This Resolution was duly adopted (4-0). (Mem r Horn' of Fis ers I s sent.) r• RD P. GOEH GER, CHA MAN APPEALS BOARD MEMBERS o�Og�FFO��-c y Southold Town Hall Gerard P. Goehringer, Chairman 53095 Main Road James Dinizio, Jr. ti P.O. Box 1179 Lydia A. a Z Southold,New York 11971-0959 Lora Collins • �� ZBA Fax (631) 765-9064 Georgee Horning y'�pl �.a0 Telephone (631) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD November 2, 2001 Ms. Arline Youngman P.O. Box 118 Peconic, NY 11958 Re: Appl. No. 5013 —Variance for Garage Location Dear Ms. Youngman: Enclosed please find a copy of the Appeals Board's determination rendered at the Board's October 25, 2001 Meeting. Please be sure to follow-up with the Building Department for the next step in this building permit review process. A copy of the enclosed determination was forwarded today to the Office of the Building Inspectors for their update on the Notice of Disapproval and for their permanent records. Very truly yours, i Gerard P. Goehringer*7 Chairman Enclosure Copy of Decision to: Building Department APPEALS BOARD MEMBERS �Og11FF0�,�c O OG Southold Town Hall Gerard P. Goehringer, Chairman =� y� 53095 Main Road Lydia A. Tortora y Z P.O. Box 1179 George Horning u- Southold,New York 11971-0959 Ruth D. Oliva ZBA Fax (631) 765-9064 Vincent Orlando y��l X00 Telephone (631) 765-1809 http://southoIdtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD TOWN MEMO To: Building Department, Attn: Damon Rallis From: Linda Kowalski, ZBA Secretary Date: April 19, 2002 Re: Appl. No. 5129—Arlene Youngman This will confirm that the following action was taken by the Board of Appeals at its April 18, 2002 Meeting.- BOARD eeting:BOARD RESOLUTION ADOPTED APRIL 18 2002: On motion by Chairman Goehringer, seconded by Member Tortora, it was RESOLVED, to approve the variance, as applied for. Vote of the Board: Ayes: Members Goehringer (Chairman), Tortora, Horning, Oliva, Orlando. This Resolution was duly adopted (5-0). This Resolution was duly adopted. � � Q _ �. TOWN OF SOUTHOLD PROPERTY RECORD CARD , yf� OWNER STREET �✓ teE DIST. SUB. LOT FORMER OWN N n ACR. y4l W TYPE OF BUILDING RES. 'SEAS. �p VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS r S - 43P o 1 o sfi. a��Q;�;at) �i2ae5-0oaj 040.0, .<. ° .. � o o ✓ a /y� ;Ao AGE BUILDING CONDITION NEW' NORMAL BELOW ABOVE FAWi Acre Value Per Value` o Acre Tillable 1 Tillable 2 Tillable 3 Noodland Swampland FRONTAGE ON WATER 02 o O 3rushland FRONTAGE ON ROAD -iouse Plot - DEPTH BULKHEAD total DOCK r ■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■NMIS1 !�O■■■■■■■ ■■■SOME ■■■MOI�■�.■iiM�®■■■■■■■ rra��rr no MONO ■MMM■I�S1■■■■No m MORE mi'l ■■■■■■■■■ NEW wmmmmm: MONO No ME No No ^v M■■N■N■MN■■■■■■■oJ■MMN■■■■MENEM= W FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: August 14 2001 TO: Michael and Arline Youn Tian PO Box 118 Peconic,NY 11958 Please take notice that your application dated June 1, 2001 For permit for construction of an accessory garage at Location of property 1010 Salt Marsh Lane Peconic County Tax Map No. 1000 - Section 68 Block 3 Lot 6 Subdivision Filed Map # Lot# Is returned herewith and disapproved on the following grounds-proposed construction not permitted pursuant to Article III Section 100-33C which states In the case of a waterfront parcel, accessory buildings and structures may be located in the front yard, provided that such buildings and structures meet the front yard setback requirements as set forth by this Code. Front Yard setback on parcel, +/- 31 512 sq. ft. pursuant to bulk schedule is fort40 feet. Proposed structure is shown at fifteen(15) feet from the front lot line Authorized Si 6e FORM NO. 3 NOTICE OF DISAPPROVAL TO: Arline Youngman DATE: February 22 2002 1010 Salt Marsh Lane Peconic, NY 11958 Please take notice that your foundation location survey, dated February 14, 2002 In reference to permit #27917-Z (November 19 2001) to construct a 12 x 22 square foot garage at Location of property: 1010 Salt Marsh Lane Peconic NY County Tax Map No. 1000 - Section 68 Block 3 Lot 6 Is returned herewith and disapproved on the following grounds: The construction of the 264 square foot garage is not pennitted.pursuant to appeal number 5013 (October 25 2002) which states• "Resolved, to deny the original location of the proposed garage and alternatively, to grant a variance Permitting applicant to construct a 12 ft by 22 ft accessory garage in the front yard to be set back 20 feet at its closest oint from the front property line and 10 feet from its closest point to the westerl side of the property line " The foundation location survey, as required by the Southold Town Building Department, notes a front and set of 19.4 feet and a side and setback of 8.6 feet. utho zed Signat CC: file, Z.B.A. BUILDING PERMT T IIEW C- r �� IISI Applicant/ Owners Name: �y Date Architect/ f 6/ Reviewed: p Engineer: — Date SCTM #: Submitted: !v l o District: 1.000 Section: Block: Lot: _ Project Location: Subdivision Name: Single 81 separate Required centfication: Yes/ o C Zoning Distiricr .1710 Req. - - - (I,oc size: Rey. Aclual:_ �� T7�_) (Loroverage , Req Req. 1 MIX'sed (Prom Yard � I Prd sed: I (Side,Yard proposed: Rcea 1 (Rear Yard Proposed. I Project Description: ��C'St�>Rn nTrTr REQ IUR EJ2 FOR RFvrrw N.A., NOer YES mi t . Suffolk County Health Dept. / umber New York State D. E. C. Town Trustees � G Town Zoning Board approval: —=-r Town Planning Board approval: Flood Plane Elevation??? Flood Zone: e • Jr Al��ln/ i� 765-1802 BUILDING DEPT- WS hECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ INSULATION [ ] FOUNDATION 2ND [ ] [ ] FINAL [ ] FRAMING [ ] FIREPLACE A CHIMNEY _ R ARKS: DATE 1 7 INSPECTOR 7 7Z 765-1802 BUILDING DEPT. INSPECTION rOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATES INSPECTOR ,,�-� T6S-1802 BUILDING DEPT• 1 NSA' ECTION ROUGH PLBG• � ] FOUNDATION 1ST [ INSULATION ] Fou TION 2ND � ] � ] FINAL FLAMING ] FIREPLACE A CHIMNEY REMARKS: }� INSPECTOR DATE T6S-1802 13UILDING DEPT- IN SPECTION � ] FOUNDATION 1ST C ] ROUGH PLBG• ] FOUNDATION 2ND L ] 1 LATION FINAL ] FRAMING ] FIREPLACE A CHIMNEY REMARIKSO. r r DATE INSPECTOR Ln—" INSPECTION "PORT DATE - a COMMS S FOMATION ( 1ST)' ATIUN (2ND) ROUGH FRAME & c .PLUMBING INSOLATION PER N. Y. }� STATS ENERGY '{ CODE. A 'O FIHKL C _ c ADDITIONAL COMMENTS: Ic c) ,G tku ------------ o 4 TOWN OF SOUTHOLD " 'BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT r Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 _ 3 sets of Building Plans TEL: 765-1802 eY PERMIT NO. �9Check -- Septic Form N.Y.S.D.E.C. Examined—oil-_,20 oC 1 Trustees ontact: pp Approved 41 q ,20 01 Disapproved a/c wilding r APPLICATION FOR BUILDING PERMIT Date 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 ad oining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. A Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy is issued 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, forthe 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. (Signature of apphcanor name,if a corporation) x 11 Sr Pt&carvz C- N''� 11 C% 8' '(Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises y 0 U NCr MArj M I C H II C L. cI- W r� (as on the tax roll orlatest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. 0 -per Qn� � Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: foto 519Vr MMRSM L-AN6�-- Pec-0njaL House Number Street i• Hamlet . County Tax Map No. 1000 Section 1�7 3 $ g q Block 6,$ >� Lot 3—V 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 b. Intended use and occupancy G A R A G E 3. Nature of work (check which applicable): New Building___k--'� _Addition Alteration Repair Removal Demolition Other Work 4. Estimated CostFee 02. 5- v (Description) (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 oi✓c' 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 Number of Stories Dimensions of same structure with alterations or additions: Front Rear // Depth Height Number of Stories B. Dimensions of entire new construction: Front_____L1.1=21= Rear 1 Z r r Depth 2 2 )ZIT Height / Z �r Number of Stories 1 9. Size of lot: Front 27S Ac, Rear S.2� r t Depth 31 Z J I 10. Date of Purchase ?ulv 21. 19'1-LL_Name of Former Owner FM4P le- MA -&-i%0 R 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: i 13. Will lot be re-graded N a Will excess fill be removed from premises: YES NO 14. Names of Owner of premises M. j o urN 4 N frew Address Pe'<o.i t` n,IPhone No. "7 b S - Zy 3 9 Name of Architect V G-R iS neo S Address P�j2 Phone No Lja - Z 1 -. 'Z_- Name of Contractor fe v-p Address cu;chw w c-, hone No. -13 y . 6 3 e 15. Is this property within 100 feet of a tidal wetland? *YES NO S/ • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale,'with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ` being duly sworn, deposes and says that(s)he is the applicant (Name of individual sighing contract)above named, (S)He is the 9 OD k q9 (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 �3 0 day of .200 Notary Public Signature o pplicant ANGELA GENETT a kdIt,state of New yet* in New'cork Ceu Reg N0.314859s .' 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