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Home My WebLink About16857-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20086 Date JULY 17, 1991 . THIS CERTIFIES that the building. RENOVATION Location of Property RIGHT OF WAY OFF FOX. House No. Street County Tax Map No. 1000 Section 6 Block 6 Lot 7 Subdivision Filed Map No.__ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated___~CH 17, 1988 pursuant to which Hamlet Building Permit No. 16857-Z dated MARCH 25, 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 RENOVATION ON EXISTING INTERIOR WAI.LS AS APPLIED FOR. The certificate is issued to THOMAS & ALLISON SARGENT (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/~ N-036376 - SEPTEMBER 28, 1988 N/A. UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 ~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~16857 z Permission is hereby grant~.~ (~ .~.~l.~.....~.:.......,~..~ ~ ............ ...~...z~ ........ ~.!...~ .................. ..CJ~.~~.o..~ ...... o.~...~..~.~ ,o ....~:..~...f~..~z..~....~...~.....~.,...... · ~..-....w~~ .......... m ............... ~"~' ........... r'"~' ....... ~' ......................... at premises located at ........ .'~.~.~....~.., ........ ~-~...~..,~ ........................ County To× Map No. 1000 Section ..... ..~....~ .......... Block ....... ..~..~. ......'Lot No ...... .(~..~. ........... pursuant to application doted ...... ' '..~C)~.~t~...J[..'~ ................. , 19.~..~..,-- and approved by the Building inspector. Rev, 6/30/80 Form No. 6 TOWN OF SOUT[[OLD BUILDING DEPARTMENT 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. Commercial building~ industrial building, multiple residences and similar buildings and installations, a certificate of Code Cempliance from archiuect or engineer responsible for the building. Submi~ Planning Board Approval of completed site plan requirements. existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and ;. For "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. ~ · Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swirmning pool $25.00, Accessory building $25.00, Addi~ions 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 - $i0.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.OO ew Construction ........... Old Or Pre-existing Buildi .~.....~.... / ..... IIouse No. Street Hamlet nwer or Owners of Property ..... mnty Tax Map No i000, Section ........ '' · .... .....-.....Lot.. .~. ... ..... ,..... ~bdivision ............................ Filed Map Lot :a 1 th Dept. Approval .......................... Underwriters Approval ~.~.~Z ...... anning Board Approval quest for: Temporary Certificate. .......... Fisal Cer ticate ........ CRUSER & HILLS June 20, 1991 Southold Building Department Town Hall Main Road Southold, New York 11971 Attention: Mr. Curtis Horton Re: Thomas Sargent Right of Way to Fox Ave., Fishers Island Dear Mr.. Horton: At your request, enclosed please find application for new construction building permit and check to the Town's order for $25.00, in connection with the above matter. Ve~ truly yours, J~ie Ball ~ecretary to Michael Hills FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .FLUMBING INSULATION FER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Charles Grigonis, Jr. Serge Doyen, Jr. Joseph H. Sawieki James Dinizio, Jr. Telephone (516) 765-1809 BOARD OF APPEALS TOWN OF SOUTHOLD TOW~ Or ~;o: I~'~'~'',i ?,~ ,SuPervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 ACTION OF THE BOARD OF APPEALS Upon Application of THOMAS SARGENT for a Variance to the zoning Ordinance, Article IIIA, Section 100-30A.3 for approval of insufficient area, width and depth of parcels, each with an existing single-family dwelling, in this pending division or reseparation of merged properties, and for approval of reduced yard setbacks between existing structures and property lines as proposed. Property location: Private Road off Fox Avenue, Fishers Island, NY; County Tax Map No. 1000-006-06-007. WHEREAS, public hearings were held on July 25, 1990 and on September 26, 1990, in the Matter of the Application of THOMAS SARGENT under Appeal No. 3960; and WHEREAS, at said hearings all those who desired to be heard were heard and their testimony recorded; a~d WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; and WHEREAS, Board Members have personally viewed and are familiar with the premises in question, its present zoning, the surrounding areas; and and WHEREAS, the Board made the following findings of fact: 1. The premises in question is located in the "Low-Density Residential R-40" Zone District and is referred to as District Page 2 - Appl. No. 960 Matter of THOMAS SA~.GENT Decision Rendered OOtober 17, 1990 1000, Section 006, Block 06, Lots 012 and 007 on the Suffolk County Tax Maps, situate along a private right-of-way off Fox Avenue, Fishers Island, Town of Southold, New York, as conveyed to Thomas A. Sargen? and Allison D. Ijams. 2. The subjec~ premises as exists: (a) contains a total combined lot area of 26,983+-sq. ft. and has frontage along a private right-of-way off Fox A~enue; (b) was Donveyed by separate deeds to the Sargents as follows: (1) County Tax Map Lot No. 12 was conveyed on May 20, 1987' by deeld at Liber 10330 cp 251 from Cecilia Smith Abbott; (2) County Tax Map Lot No. 7 was conveyed on Novem- ber 3, 1986 by dee~ at Liber 10169 cp 01 from J.B. Hartsfield and Audrey Hartsfield; (c) the Iminimum lot area requirement in effect during the 1986 and 1987 donveyances was 80,000 sq. ft. per lot and were merged due to Icommon ownership. 3. Article IiIA, Section 100-30A.3 of the current zoning code (as a~ended January 9, 1989) requires a minimum lot area per lot of 40,000 Square feet. 4. The relief sought by this application is a variance for approval of: (a) proposed Lot #1 with a lot area of 4,938 sq. ft. and lot width of 40 feet, said land presently improved with an existing one-family dwelling and accessory garage structure; (b) probosed Lot 92 with a lot area of 5,331+- sq. ft. and lot width Of 44.92 feet, said land presently improved with an existing o~e-family dwelling; (c) proposed Lot 93 with a lot area of 16,714 +- square feet and 25i ft. frontage along a private right-of-way, said land also imDNoved with an existing single-family dwelling and accessory (storage) shed structure. 5. For the ~ecord, it is noted that: Page 3 - Appl. No. 3960 Matter of THOMAS SARGENT Decision Rendered October 17, 1990 (a) the subject premises are nonconforming not only as to lot area and width but as to the number of separate dwelling units {three of which are believed to be preexisting of zoning}, however, a Certificate of Nonconforming Premises and Buildings (Pre-COs) for Lot Nos. 7 and 12 must be obtained and. be in full force and effect prior to effectuation of this variance; (b) lots adjacent to the subject premises to the north consist of lot areas each of approximately 6,000 sq. ft. in area; 6. In considering this application, the Board also finds and determines: (a) the relief as granted will not in t~rn increase the dwelling unit density, since there are three preexisting dwellings; (b) the evidence submitted and practical difficulties claimed are sufficient to warrant a grant of this variance; (c) there will be no substantial change in the character of the neighborhood or detriment to adjoining properties for reasons as noted in the above paragraphs; (d) the difficulties cannot be obviated by some .method feasible to the appellant to pursue, other than a variance; (e) that in view of the manner in which the difficulties arose, and in considering all the above factors, the interests of justice will be served by granting the variance, as conditionally noted below. Accordingly, on motion by Mr. Goehringer, seconded by Mr. Doyen, it was RESOLVED, to GRANT the relief as requested (and noted in paragraph ~4, supra), in the Matter of the Application of THOMAS SARGENT under Appl. No. 3960, SUBJECT TO THE FOLLOWING CONDITIONS: 1. That there be no further subdivision, set-off or conveyance of land other than that as applied for and as shown by the minor subdivision plan dated August 6, 1990, prepared by Chandler Palmer & King; 2. That the accessory shed structure on Lot ~3 (referred to as 16,714 sq. ft.) be used only for storage purposes {and never to be converted or used for sleeping or habitable purposes}; 3. That the accessory garage (gar. & apt.) structure on proposed Lot ~1 may continue its present nonconformance (without any increase in size) for a period of not more than ten (10) years, or when the structure is abandoned or permanently vacated by the present tenant, whichever shall occur first. The Page 4 - Appl. No. Matter of THOMAS S~ Decision Rendered O 960 ~GENT :tober 17, 1990 occupancy of this n~nconforming garage-apartment shall then automatically ceasei and become null and void, and the kitchen and cooking facilities must be removed, returning the use of the building to an accessory storage/garage building without evidence of sleepin~ quarters or habitability. Vote of the Board: Ayes: Messrs; Goehringer, Grigonis, Doyen and Dinizio. (Absent was: Member Sawicki.) This resolution was duly adopted. lk CRUSER ~ ~IILLS Hay 23, 1991 Town Hal 1 53095 Main Raod P.O. Box 1179 Southold, New York 11971 Attention: Holly Re: Thomas A. Sargent SCTM¢1000-6-6-7 Dear Holly: Pursuant to your request, enclosed please find copy of recorded covenants and restrictions for ~]omas Sargent. Very truly yours, Michael N. Hills 5~hjb Enc. DECLARATION made this ~ ~" day of . 'I4ay ', 199t, by THOMAS SARGENT and ALLISON IJAMS, his wife, residing at 16 M~.l~ Park, Newton, Massachusetts, hereinafter called the Owner. Since the Owner owns pre~nises more particularly des~,ribed in the attached Schedule A, which is made a part of this document and since the Owner has obtained the approval of the Southold Town Planning Board and the Zoning Board of Appeals for subdivision of the described property into three (3) Lots. The Owner dec/ares that such land is held and shall be conveyed by it subject to the following covenants, restrictions and conditions, which shall run with the land: 1. There shall be no further subdivision in perpetuity. 2. That the accessory garage (gar. & apt. ) structure on proposed Lot ~1 may continue its present non conformance (without any increase in size) for a period of not more than ten (10) years, or when the structure is abandoned or permanently vacated by the present tenant, whichever shall occur first. The occupancy of this nonconforming garage-apartment, shall then autcmatically cease and become null and void, and the kitchen and'cooking facilities must be removed, returning the use of the building to an accessory storage/garage building without evidence of sleeping quarters or habitability. 3. These covenants and restrictions can be modified only at the request of the then owner of the premises with the approval of a majority of the Planning Board of the Town of Southold after a public hearing. Adjoining 11259P 531 ......... property owner shall be entitled to notice of such public hearing but their consent to such modification shall not be required. 4. That the accessory shed structure on Lot #3 (referred to as 16,714 sq. ft. ) be used only for storage purposes (and never to be converted or used for sleeping or habitable purposes). IN WITNESS WHEREOF, the Declarants, THOMAS SARGENT and ALLISON IJAMS, his wife, have affixed their sign~th~d~y, 1991. STATE OF MASSACHUSETTS) COUNTY OF ~ ) SS.: On the ~ day of May, 1991, before me personally came THOMAS SARGENT and ALLISON IJAMS, to me known and known to me to be the individuals described in and who executed the foregoing instrument and they duly acknowledged to me that they executed the same. %-; N~tary Public ALL that certain plot, piece or parcel of land, situate, lying and being at Fishers Isl~]d, Town of Southold, County of Suffolk and State of New York, being more particularly bounded and described as follows: BEGINNING at the southerly terminus of a 25 foot right of way leading to Fox Avenue (289' to center line of Fox Avenue) and the southerly side of land now or formerly of Stephen Figall, which point is located North 77 degrees 22 minutes 20 seconds East 177.43 feet from a monument located North 4,585.93 feet West 1,719.37 feet from U.S. Coast and Geodetic Survey Triangulation Station "Pros"; RUNNING THENCE from said point or place of beginning South 3 degrees 47 minutes 30 seconds East 85.50 feet to the northwest side of land'now or formerly of Regina .3. Py/e; THENCE along said land the following two courses and distances: 1. South 55 degrees 10 minutes 00 seconds West 78.80 feet; 2. North 78 degrees 03 minutes 20 seconds West 112.00 feet to the easterly side of land now or formerly of Stowe C. Phelps; ~ENCE along said land North 3 degrees 47 m/nutes 30 seconds West 156.21 feet to land now or formerly of J. B. Hartsfield; iTHENCE along said land now or formerly of Hartsfield North 78 degrees 41 minutes 30 seconds East 120 feet to the aforementioned right of way to Fox Avenue; THENCE along said right of way South 3 degrees 47 minutes 30 seconds East 84.92 feet to the southerly terminus of Fox Avenue; THENCE along said southerly terminus of the right of way to Fox Avenue and land now or forr~rly of Stephen Figall, North 77 degrees 22 minutes 20 seconds East 57.03 feet and the point or place of BEGINNING. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date .. 4W~*. ?.5, ................ ,19.90.. To . .T.hg.m.a.s. 6:. 6.6.1.1 .i.s.o.n..S.a.rge.nt ....... % Michael Il. Bills .... 71)6..II0.~.~0~1~. ~ln~ ................... RIIIERltEAI), Iq.I(. 11901 PLEASE TAKE NOTICE that your application dated . .J.u.n.e~. !9. ................. ,19 .~0.. subdivide a non-conforming lot for permit to .............................................................. at Location of Property Pvt. Rd. off Fox Ave. Fishers Island h~js'o ~Jo~ ....................... '~'t/e~i ....................... Hamlot County Tax Map No. 1000 Section ....06. ......... Block . .I)6. .... Lot ... 05 ......... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds . U.n.d.e.r..A..rt. i.e. 1. e.. I. I. I.~. ............ .s?.~.t.t.o.~..~9.0:.~9.~.~::p.r.ope.~v.a..~?:..~ .o.t .v.~,t t..h.a.v~.. ~.~. s?..f.fi..c. ~. e.n.t..V~a, t.h., .d.e. pt.h. .......... and totaI lot area for this district. ld~g Insp~cto~ T~OMAS J. FISHER RV 1/80 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTbIENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL .... ~.~.~..~.~ ......... PLEASE TAKE NOTICE that your application dated ..... ~ ................ 19 ~. County Tax Map No. I000 Section ... ~ ......... Block ..... ~ ....... Lot .... ~ ........ Subdivision ................. Filed Map No ................. Lot No ........ ' .......... is returned herewith and disapproved on the following grounds. ~./~,....~..~ ~ '~ . ~_~/_~....~. ?~..~.. :.-...~.~.. .... RV 1/80 · n a~uemoran~um from.... BUtLOINO iNSPECTOR'S TOWN OF SOUTHOL~ TOWN HALL, SOUTHOLD, N. 765-1802 TOWN OF gOUTHOLD March 18, 1988 Mr. Thomas Sargent 100 High Street Charlestown, MA 02129 Dear Mr, Sargent: I return herewith your application. Please have Please also submit 3 sets of the repair work. Thank you. building permit same notarized. of detailed plans SOUTHOLD TOWN BUILDING DEPT. Georgia Rudder, Secretary THE NEW YORK BOARD OF FIRE UNDERWRITERS 1.000656 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 -- ~F, PT~{'iB~R 28~ 198~ 54240088/88 ~ 036376 ~ ~pplication Wo. on /il~ THIS CE~IFIE$ THAT inter, low.gloat' ~ examin~ on .ndf~nd to ~ in ~mpliance with the r~ui~ments of thb ~. fiXTURE FIXTURES ~ COQKING B~CKS OVENS EXHAUST FANS OUTLETS SWITCHES r-LUO~SCE~q' DIWEIES PUI~NACE MOTORS FUTUIIE ARIUANC! ~ 11M~C:LOCKS UNITHIATIRS MULII.O~JTSIT DIMMERS SVSTAMS S~RVIC~ DISCONNECT OTHER A/f~MIATU$: SMOKE DETECTOR :- 1. Z & $ CONTRSo INC, FI'SB~R ~S],AND P.O. BOX 202 NEW Y()RK~ NY~ 16390 LYCE~SE NO. 924 E their creda~ials. ~ FO~ BUILDIm DEPARTMIEHT. TH~$ COPY OF CJERTIFICAT~T NOT ~ ALT~Y ~. BOARD oF HEALTH ...... 3 SETS OF PLANS ....... ~ 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DSPARTMSNT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Examined..~.o,.&.~.'..~..~, 19 .~.~. Approved · .~..'..~....~ .~"7., 19.~.~. Permit No./.~. Ot~..~. 7.''~'' Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 co. de, and regulations, and to authorized inspectors on premises and in building for necessary inspections~s~ fz admit ........ .~. ./. / ?. . e.%.J. ~- ~~ . :... .... (Signature of applicantS, or na~e, it a%orporat~on) · ~ .cp.: ~.~. ~.. ~ ~ ¢:...ST>. ~,. ~*. ¢.~.~. ~ ' ' (Mailing address of applicant) State' whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r~') t.,~$ ~,~. ~ .................................. Name of owner of premises.. :..['~. i.,~ yy'.,.4/.~ .%~... ~'~ .,.. :S .='¥C .~ .'Ct..~l. '..~. ................................ (as on the tax roll or latest deed) I,f 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 ...................... ~ ,...~..~~ kk .~.~.. ~'~'- 1. Location of land on which proposed work will be done .... ..~..~. ...... ........ .... ..... .................... ' ' 'Street --' }louse Nomber Hamlet County Tax Map No. 1000 Section ~ ¢ Block .~.~. - .............................. LOt . ..,~ J, ' ,..>.;. Subdivision ..................................... Files Map No ............... 2. State existing use and occupancy of premises and intended ese and occupancy of proposed const[(ct~o3,' a. Existing use and occupancy q'!, ~ ...... '. b. Intended use and occupancy . ~5'~..~.. ~. .S~ Repair ..... [~. ....... Removgl .............. Demolition .............. Other Work..~.4.~Y.~v..t~ (Descrip.tion) 4. Estimated Cost.. ~ / (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................ If garage, number of cars ................................................ - ....................... 6. ILhllsiness, commercial or mixed ~ccupancy, specify natnre and extent of each type of use' 2...; ................ 7. Dimensions of existing structures if any: Front .* .... Rear Depth ...,. He)ght ............... Numb ,r of Stories ..... ~ ........... , ..................... ~ ........ ,~ ....... Diinensions of sa.ne structure wit:~ altcratio,~ or additions: Fron£ Y~.. ~...~t,td~'-r~ Rear .~.O..~. ~c5. :?.~.~. t{~... Depth. ...................... ~. Height .................... Number of ~ries ........ .~] ]~ 8. Dimensions of elltirc~nq~w, cqnstru~tion Front .......... ..... R~r ........ .'~.... i'l~epth ...... i ........ Height ........... , ....Nutn,b~r of Stori~ .. ....................................................... 10. tJareo~rurcnase ...r;]:./.~.W. .............. Name of Former Owner .~,~,.//.q' (4~,'.¢'~.' .... 1 1. Zone or use d~stnct in whictf pren~mes are mtuated ................................................ 12. Does proposed construction viola~e any zoning law, ordinance or regulation: ...~/..~. ...................... 13. Will lot be regraded ...... /0.~.I ................ ,.. Will excess fill be removed from premises: Yes Name of Architect ........... [ ................ Address ................... Phone No ................ Name of Contractor .......... ................ Address ................... Phone No ................ 15. Is this property located w~thin 300 feet of a tidal wetland? *Yes ..... ~ ..... *If yes, Southold Town Truskees Permit~maybe required. ' PLOT DIAGRAM Locate clearly and distinctly all 6uildings, whether existing or proposed, and~ indicate all set-back dimensionsTrom property lines. Give street and block n~ interior or corner lot. tmber or description according to deed, and show street names and indicate whether OR USE IS tlNtA NSUL APPROVED AS NOTED STATE OF NEW YORK, S'.S COUNTY OF ................. (Name of individual signiag contract) above named. It~ COMI.:'[E~ FOR ALt CONSTRUCTION SHALL MEET / THE REQUIFtE~EN*I'S OI~ THE N.Y / STATE CONSTRUC'~IO~ & ~NERGY CODES, NOT t~E~PONS~.l~ FOR ~IGN OR CO~STRUEYION ERRORS, being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this application; that all statements contaiged in this application are true to the best of his knowledge and belief; and that tlie work will be performed in the manner 'set forth in the application filed therewith. Sworn to before me this Notary Publiq ..... '.. . County ~ ~) ynatfi~e of applicant) NOTI~ BUI[,D~NG DEPARTMEN T ~k4802 9 A~ TO 4 ?M ~R THE FOLLOWING INSPECTIONS: FOUNDATION *~0 ~EOUIRED FOR POURED CONCREYE ROUGH F~AMING & PLUMBING INSULArlOH FINAL CO~ISTRUCTION MUST FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHoLD. N.Y. 11971. TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT gOARD OF HEALTIi ......... ] 3 SETS OF PLANS SURVEY ........... C,,EE~ .~;~,; ................ SEPTIC NOT I FY: c^L~...;4,~,,~d..~/./.;. ....... HAIL TO:~ ...... .~o1 .... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Buildingl~PeCtor sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location or lot and of buildings on premises, relationship to adjoining premis~ or public streets or areas, and giving a detailed description o£ l,~yout of property must be drawn on the diagram which i. rpar: o£ this appli- cation. c. The work cOvered by this application may not be commenced before issuance of Duilding Permit. - ' d. Upon approval of' this application, the Building Inspector will issued a Building Permit to the applicanL Such permit shall be kept on the premises available for inspection throu-.ehout the work. c. No building shall be occupied or used in whole or i-n part for a.ny purpose whatever until a Cer~illc:a~ o£ Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to thc Building Department for thc issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo'rk, and other applicable Laws. Ordinances or Regulations, for thc construction of buildings, additions or alterations, or for femoral or demolition, m~ herein described. Thc applicant agrees to comply with all applicable laws. ordma admit authorized inspectors on nremis .... ,q :_ ~...:,~- ' nces,, building code, housin~ code , ' ,- ~ ,*.,., ~u, uuuumg for neccss.ary q~spections. , and regulations, and to · . .,- , ur name, 1I a Corporal;ion) ·. ' - · .~.~.~...~..O.~:~?.<.~..%.r, ~.~<d~.~<'~/~/ . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ Ou2~e£ .............................. Name of Owner o remises. · " ppli as on thc tax roll or latest deed) ' Ifa cant is a corporation, signature of.duly authorized officer. c r) Builder's License No ........................... Plum bet's License No ......................... Elcctricinn'~ License No ....................... Other Tradc's License No ................ ~ ..... Location of.land on which proposed Work will bc done; A-)O co 0r-~' l:5~t'/o /get .... r,~ ? e b rT/F. -- ' ' .ouse ~un, b= StreJ ....................... h;n, ld ..................... County Tax Map Nol 1000 Sect/on ..... .~ .......... ~ Block .................. Lot..~. I;'" SUbdivision ...... · .......... : (Name) ' " ' ............. Lot ........ ' State existing nsc and occupancy of premises and intended use and occupancy of. proposed construction: · and occupancy ~.,wg ,Z/ /'~/o~er ~ . . b. Intended Use and occupancy e~.. O .Z.Y.~ .~.~..~.'qd~' ........ · ~mated Cost ..... ~ ......... ~ ....................... Fcc'. ...... !~ ', ' . , (to be paid 9n fH.i. ng thiis application) $. If dwelling, number of dwelling un{tX .... ~.. . .......... Ir garaee, number of cars .......... ~]]'i ~. Number of dw~nmg umts on each rigor .......... If business, commercial or mixc~q~CUpancy, specify nattlre and cxro~r ~c ~h ,. ~ ~f ,,<~ Hci=ht Numbc~ of Stories .... ;;;i ........ ' ......... ...................... Dimension: me structure withlalteration~ or additions: ' ' Rear ................ Depth !tlei~t ' ............................................ Number of StoNes ...... 8. Dimensions of eq,~ire ncxv construction Front ... ~ ......... Rear ~. n..)h ' ~ · 9. Stzeoflot: Front Rear ........ ~.<. ......... Depth ..[~[4 .... ~ .............. - .... i ................ ~ame of Foyer Owner ~Zq~(~gL~ ...... 1 I. ~un~. u. ~ae atstrtct ~n x~tcll premises are situated.. ~L ...................... ' ........ l 2. ~oe$ proposed construclion violet~ a ...... :-, ..... ~ ;/~ ...................... 13. wet tot ue regnded .; ........ A//~ Will exce.g fill be removed from premise~: Yea .... fp · . 14. N~e of Owner o remise$ .. · .... Address ....... Phone No. N~e of Architect ....... ; ............... ..... i ............... Addres~ ................... Phone No ................. N~e of Contractor 1 , ..... Address ............... Phone No ..... ~". ..... i .. 15.I$ thla property Geared within {00 feet of a .tidal ~etland? elRS .... HO .... ~lf yea, Southold ~oun ~ruateea Permit may he required. , PLOT DIAG ~M Locat= flatly ~d diat~etly ~I ~' ' bp~dmgs, whether existing or proposed, ~d, indicata ~I set-back d~ensiona from prope~y ~nes. Give street ~d block number or description accord~g to deed, ~d show street n~es and ~di~ata whether interior or comer lot. STATE OF NEW YORK, ............. : .................. being duly s~vorn, deposes a. nd says that Itc is th~a licant · (Name of individual signing contract) PP ]bore named. ,, (Contractor agent corporate officer ftc ) ' :f :aid owner or o, nets, and is duly: uthortzed to pe,rform or have performed lhe said Work and to make and file this 'Pplication: that al b~.tements contained in this applies, fica arc true to ti e best of I s knowledge and belief. york w01 be perfot qtn tile manner s/~ forth in the application ~lcd therewith. ,and that !he :otary Public, ....... .. · · County · · '-"' J