HomeMy WebLinkAbout17110-z FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.. Z-17005,,,,,., Date ,,,June 20, 1988
THIS CERTIFIES that thebuildin ADDITION &,ALTERATION
g
Location of Property „475 Rabbit Lane East Marion, N.Y.
House No. Street ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~hlamlet
County Tax Map No. 1000 Section ..31........Block ..1.~...........Lot...13............
Subdivision ...............................Filed Map No. ........Lot No. .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
May 19; 1988 171]0 Z
pursuant to which Building Pernrit No . .
dated . ,June ] 6 , 1 9 8 8 was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for wluch this certificate is issued is .
DECK ADDITION TO EXPAND EXISTING DECK TO EXISTING ONE FAMILY DWELLING
Tl~e certificate is issued to PHILTP P. AGUSTA
lowoer, ig)3S~~S~i~B~iHrytX
of the aforesaid building.
Suffolk County Department of Health Approval , . N/A , , , , _ ,
UNDERWRITERS CERTIFICATE NO.......... ?3JA . . . . .
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
flov. 1/81
gosas xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N fl ~ I? ~.10 Z Dore .~x~, 19IJ.
Permission is hereby grante o:
.~e.....G
...~r..~t.~....~~~r:.~fa
.
at premises located at ~T~....
Caunty Tax Map No. 1000 Section Block ~ Lot No........I--~.........
pursuant to application dated .......:,~~i~~ 19.uC1.., and approved by the
Building Inspector.
O~
Fee $.~~...v1C.:.
. f
Byi~ ng Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ra~.~ to the Building Inspec-
torwith the following; 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 Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.0.0, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
S.Updated C.O. $ 50.00 Date l.g~
NewCon~s~tC~ction,,,,,,OldorPre-existing Building Vacant Land
.
Location of Property ~ ~ L~rn~........ !.'.!~'f°il~f'1
House No. Street Ham/et
Owner or Owners of Property ~ ~ P't~ U S ~^b
County Tax Map No. 1000 Section . Block Lot .
Subdivision ........................Filed Map Not~// Nl~; .Lot Npo. ~.f~N~~.... .
Permit No ~T.~~D.~.. Date of Permit ~„Applicant . J~:e~:t^:e,~ ~...h-.. .
/ Health Dept. Approval ........................Labor Dept. Approval , .
Underwriters Approval ........................Planning Board Approval , , .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ 0.~.? r G?n .
Construction on above described building and pe i meets all applica cod and regulations.
Applicant..
ae~. io-~o-~a
(Zac.. 3 y k ~S
Co ~z 17005
' o®S~F~oc~~o~ ~ z~P z/
HENRY P. SMITH,
JOHN M. BREDEMEYER, III, President ~ TELEPHONE
John rednoslci~, ~Jr. ~ ® ~ (516)765.1892
ALBERT KRUPSKI, JR., Vice-President ~®1 ~~o~'
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
March 25, 1988
Mr. Philip P. Agusta, A.I.A.,M.U.P.
And Associates
Consulting Architects and Urban Planners
111-15 Queens Boulevard
Forest Hills, New York 11375
Re: 475 Rabbit Lane East Marion New York
Dear Mr. Agusta:
Pursuant to your request for a Waiver of the Wetland
Ordinance for the enlargement of your existing wood deck on
property referenced above, please be advised that the Bcard has
inspected the property on March 17, 1988.
Your request for a waiver has been approved to construct a
deck addition as per your plan submitted.
Please remit the $25.00 fee for this application.
Should you have any questions or concerns, please do not
hesitate to contact this office.
Very truly yours,
ohn M. Bredemeyer, III
Board of Town Trustees
JMB:ip
cc: Bldg. Dept.
~ ~ ~
„ , ~ w ~ ~ ~ ~hili~ ~ ~t~u~ta~ X1..9..,4., ~l. ZJ.~?
.y'' . • ,'Y 4x
- .~tnd ~e~ociafee
' ~'~y" ~ ' I Consulting Architects and Urban Planners
~
3, ,
rte" ~ ~ 11115 OUEENS BOULEVARD -FOREST HILLS, NY 11375
r ~ , ~ PHONE: 1718) 2638033
a
fit; ~~f'7' `d
April 20, 1988
The Suffolk-:Times
429 Main Street
P.O. Box F
Greenport, N.Y. 11944
Att: Tina
Re: Notice of Completion
App NYS DEC
Dear Madam:
Enclosed please find the NYS DEC Notice of Complete Application that requires
publication in the Suffolk Times once during the week of April 25th. Please publish
only the material within the box under the heading "SEQR Determination". Only the
one line entry for which a box has been marked should be published.
please provide me with the proof of publication as soon as publication has
been completed. Any questions, please contact me.
Urytuyyors,
Philp P. A sta, R,A., M.U.P. !
E
1
3
i
MEMBER: American Institute of Architects • New York Society of Archltecta • American Institute o} Planners • Former Vlca Chairman/Com•
missioner, N.Y.C. Board of Standards and Appeals ~ New York State Association of Archltecta • Architects Council of New York City
t 1412-4 (1'1186)-27a
NEW YORK 57ATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
! NOTICE OF COMPLETE APPLICATION
Philip Agusta 4/15/88
Applicant: Date:
Address: 111-15 Queens Blvd.
Forest Hills, NY 11375
Permits applied for and application numbers Freshwater Wetlands 10-88-0439
Project description and location. Townl~Y of Southold County of Suffolk
Applicant proposes to extend an existing wooden deck attached to a single family
dwelling on Marion Lake. The proposed 140 square foot extension is irregularly
shaped and will be 72 feet from the freshwater wetland at its closest point. A
45 foot wide buffer zone of undisturbed, natural vegetation will be maintained
between the wetland and any area of disturbance.
Project site is located at 475 Rabbit Lane in East Marion. SCTM /11000-31-17-13.00
STATE ENVIRONMENTAL QUALITY REVIEW (SEQRI DETERMINATION (Check appropriate box)
L~SEQR-1 Prole<t is not sublet[ to SEQR because it is an exempt, excluded or a Type II action.
?SEQR-2 Protect is a Type 1 action and will not have a significant effect on the environment. A Negative Declaration is on file and a coordinated review with
other agencies performed
?SEQR-3 Project a an unlisted action and will not have a significant effect on the environment, a Negative Declaration is on file.
?A-coordinated review performed ? B-no coordinated review performed.
?SEQR-4 A draft envnonmental impact statement has been prepared on this protect and is on fde.
?SEQR-5 A final environmental impact statement has been prepared on this protect and is on file
SEQR LEAD AGENCY None designated
STATE HISTORIC PRESERVATION ACT (SHPA) DETERMINATION (Check appropriate box)
®SHPA-1 Pro{ect is not sublecl to SHPA: ®A-exempt permit type ?B-federal review performed
?SHPA-2 Prolec[ will not have an adverse impact and an assessment is on file
?SHPA-3 A cultural resources survey has been prepared on this protect and is on file
AVAILABILITY fOR PUBLIC COMMENT CONTACT PERSON:
Appbcations may be reviewed at the address
to the right Comments on the protect must be GEOYge W. Hammarth
submitted [o the Contact Person by no later than: $ldg, 40, SUNY, Rm. 219
May 13, 1988 Stony Brook, NY 11794 (516) 751-7900
TO THE APPLICANT.
1. THIS IS NOT A PERMIT {
2 This is to adwse you that your application is complete and a review has commenced Additional information may be requested from you at a
future date, if deemed necessary, in order to reach a decision on your applita[ion.
3 Your protect is classified MAJOR. Accordingly, a decision will be made within 90 days of the date of this Nottce. If a public hearing is S
necessary, you will be notified within 60 days and the hearing will commence within 90 days of the date of this notice. If a hearing is held, I
the final decision will be made within 60 days after the hearing is completed.
4 Publication of this Notice m a newspaper is: ~ requved ? not required {
If required, please consult the accompanying transmittal letter for further instructions. y
Tn. of Southold
CC Chief Executive Officer
Environmental Notice 6ulletm, Room 509, 50 Wolf Road, Albany, N Y 1 2 23 3-0001
file USF[dS
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pC~-~F' ~77 ~~~7 BOARD OF HEALTH
D k~ -G.Z.- " 7 3 SETS O F PS. A N S .
FORM NO. 1 SURVEY .
MAY 191988 i ~'~Z~TOWN OF SOUTHOLD CHECK u~~-4-e-.M*:o..~
BUILDING DEPARTMENT SEPTIC FORM
L .
€ii€,;mw,~.n'_."~ TOWN HALL NOTIFY
TOtu~'' ~.`'_s~k;rt~._~ n ) SOUTHOLD, N.Y. 11971 ~.~~f : vC~ .
TEL.: 765-1802 CALL
MAIL T0:
Examined ...rQ~~........, 19r~~
Approved 19 l~~Pe it No ~ ~ B~
Disapproved a/c•~'-" ~
(Bu' in Inspector
APPLICATION FOR BUILDING PERMIT ~p
Date j:.~O l~U
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 buiidings 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, b cgd~lto ode, and regulati~s, and to
admit authorized inspectors on premises,and in building for necessary ' sped n~ /
(Signatu e of applic t, or name, if a corporation)
...1/1-15..4.~~~~s... ,Bc?D,. ~o~~sr ..N.lL.4.s.
(Mailing address of applicant) /v l13Z5
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..................D. cuu.l~.e...~...i~.e~u~:r~eT....................................................
Name of owner of premises J .N L4t.V, , ,p ,/~,C1 V.S"C!~ .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.
(Name and title of corporate officer)
ALL CONTRACTOR'S U T BE SUFFOLK COUNTX,_LLGENSED_ /
Builder's License No. ~ '~"fi° ( ~ UT
Plumber's License No . ~,A~~,~~~„ /53p! ff
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
....41S...R.A63,t:T,, LnaEa.:~.99T..~!tbt2tolJ•! jDWU oF..SD.v.THAIA.L!J:':~.•
House Number Street Hamlet
County Tax Map No. 1000 Section 0~ ~ Block 11, , , , , , , , , , , , , , Lot ..0I 3 ,
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existin use and occu anc 2 S,Tott~1„ ~i2:~ur~ DWEt,t.taG • ..I. FA~!t~y IAII'f~ ,A OvQ e@tt.,llp,2nfl~
g P Y .
b. Intended use and occupancy ~ S.T.4~Y.. ~~-9!1~.. ELt t Uq , ( ~QKIL~(, WlZb9,A, 41JE, C~@, ,ytalap!{,dt,
3. Nature of work check which a licable :New Buildin ~ f ~ ~
( Re op ) g • • Addition , Alteration .....;..j, . .
Repair yal , . ion Other ~}!p k
„To, E 7q vo;.:~Y.Tq
tUOap peuG(9p~~ T ( ripiipn~
2 Sots emo t
R-1?AR op owecwu4 -
4. Estimated Cost .
~ Fee
(to be paid on filing this application)
5. If dwellin , number of dwellin units b.'!~ F Number of dwelling units on each floor . Q?a~.......... .
g g
If garage, number of cars .4K~. '',r; !J4 , u.?o u.!< orJ, E•~;T4 ,yaReyE~ . .
6. If business, commercial or mixed, occupancy, specify nature and extent of each type of use .A14.T, , app ~g4,an,~,~, , , ,
7 Hemh;~sions of exisrting structures, if any: Front 21,1. ~ , ;Rear ; ..2.1 A. Depth . 3.g: 3 .
g ....24..,....... Number of Stories . . .
Dimensions of-same structure wi}h alterations or additions: Front .?.l.°.~~`.......... Rear ~L'-.4"........... .
p ~ r ..Height ..?.4 Number of Stories .:I.~'P................ .
' Dimensions of~e fire new construction: Front . . Rear Depth .
Height Number of Stories , , , .
9. Size of lot: Front q-O.-.4 . Rear ...~.9,~ S$, , , , , , , , , , , , , Depth 7s °/.3. /!2z'!r~i:..... .
10. Date of Purchase ~?!.H ~...l9',8.7 N~ me of Former Owner G.A ILu2 ~ .t. ~Ar?p~ l b
? ~i y 1 fr Ldo TZ~
11. Zone or use district in which premises are situated ;~....1Z+'~if ! P~u.'C 44G.:.~4.~ 1z I,GULT'ua.,~, , , , , , , , , , , , ,
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded , U Will excess fill be removed from premises• hlo Yiil$' No
14. Name of Owner of premises p~ tt. ~ P... ~:.+~!i~Sr~ddress .t!(-l,~,~,v~¢,uS. ~!~Phone No~/~ Zd3': BG3.~.. .
Name of Architect . Pu.il.lu! . P ~ ~(1 S.T.a'1?2. A •.Ml~.t~ddress ll.(. ; L5 ..Q~~,~N~ . A4+14Phone No.. s.... .
Name of Contractor A:uT~V:(.. GAS~D~~, , , , , , , ,Address ....:..............Phone No.
15. Is this property located u7ithin 300 feet of a tidal wetland? *Yes 1(... No
*If yes, Southold Town Trustees Permit ma be required. SIEIE WA1Vg2OF WE'C%-~•ud OIZOr.vAUCq
PLO DIAGRAM (yy fStJ, o R "Cvw~? T+w4T~•¢5) cF
S vutiknl,D or,-riLn ,finau+ zS~ 14 s8
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
properly lines. Give street and block cumber or description according to deed, and show street names and indicate whether , .
interior or corner lot. '
APPROV D AS N0~
~F3.R a
DATE:
FEE: -~®V. E T AT
NOTIFY B ILOIN tOD ~
~ pOR THE
FOLLOWING MSpECTIONS:
TWO REQUIRED
1 ~ FOP POURED CONCRETE
j 2, ROUGH -FRAMING & PLUMBING
6i q, f NAI~T'O CONSTRUCTION MUST
~"m 8 d ~jpm 9E COMPLETE FOR C.O.
0/ ALL CONSTRUCTION SHALL MEE
5
ATE EaONS
RUCTION & TENERGY
DESIGN OROCONSTRUCTION ERRORS
STATE OF NEW YORK, S' S
COliN'I'Y OF
(Name of individua~signin• ~ ~ ?~•Tib • • ~ ' ' ' ' being duly sworn, deposes and says that he is the applicant
g contract)
above named,
He is the ................aw!~~~:...:~1'DG.fcen.,.T.................,................,..............
(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 contaiped in this application are true to the best of h' wledge and belief; and that the
work will be performed in the manner ;Set forth in the application filed therewi
Sworn to before me this
.day of ~ , _ _ ~
19 /
Notary Public, ..~v:~-~!n~ ...r! County
NELEN K DE VDE ~ ` '
NOTARY PURIIC, State of NAw York Si nature of a licant
i Nn. 470%BiR,Su9folk~pY~t9 ( g PP )
Term expires March 30,1x',.,_...
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