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Home My WebLink About28380-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29895 Date: 12/09/03 T~IS CERTIFIES that the building ALTERATION Location of Property: 1045 FIRST ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County T~u~ ~ap No. 473889 Section 117 Block 7 I~t 26 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 6, 2002 pursuant to which Building Pe/wait No. 28380-Z c~ated MAY 13~ 2002 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 WINDOW ALTERATION TO AN EXISTING NON-FLABITABLE ACCESSORY BUILDING AS APPLIED FOR. CONSTRUCTION CERTIFIED BY ENGINEER. · ~ne certificate is issued to WERNER KLrNZ of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF ~IEALT~ APPROVAL BLEt-£KICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'£~3 N/A N/A N/A Rev, 1/81 ~/t h~/e~Signature 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. 28380 Z Date NEAY 13, 2002 Permission is hereby granted to: WERNER KUNZ BOX 668 NEW SUFFOLK, NY 11596 for : WINDOW ALTERATION TO AN EXISTING NON-HABILTABLE ACCESSORY BUILDING AS APPLIED FOR WITH FLOOD PERMIT at premises located at 1045 FIRST ST NEW SUFFOLK County Tax Map No. 473889 Section 117 Block 0007 Lot No. 026 pursuant to application dated MAY 6, 2002 and approved by the Building Inspector. Fee $ 175.00 COPY Rev. 2/19/98 Fm:m No. 6 TOWN OF SOUTH{~LD 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 with the following: A. 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. 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-ex.l~_~l~ t~n~es: 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 respect s~gned by the apphcant. Ifa Certificate of Occupancy ~s 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 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: 'a° ~" /~//'J~ House No. Street Owner or Owners of Property: /~(./~a' '/2 .~.] ~'-' x~ &~ ./~f DQtO ~- Suffolk County Tax Map No 1000, Section 1 [ '~ Block Subdivision Permit No. 2495000- ~ Date of Permit. Health Dept. Approval: Planning Board Approval: ¢,z -v3 (check one) Hamlet Request for: Temporary Certificate Fee Submitted: $ Filed Map. ~//¢g"~- Applicant: .__~,~' Underwriters Approval: Final Certificate: "-7 Lot Lot: AT, cant Signature OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD VILLAGE SUB. LOT FOP~M ER OWNER SEAS. LAND IMP, tESc~ /' AGE X Fillable -illoble -iilabie Noodland ~wam[ ~rushl qouse Fora I DISTRICT ACREAGE ~/~; NEW NOR~MAL BELOW ABOVE F R ON TA~7~.JD~u~A~A~~ ~ Farm Acre Value Per Acre Value FRONTAGE ON ROAD/6~-~ ~ A',~¢, :~ le 1 ~ BULKH~D e 2 D~K e 3 and ond Plot ~ ~ TYPE OF BUILDING · - o'lfJ34TH T. T.EILRY TOWN CLEI1J( OFFICE OF THE 'TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 2q, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be, used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Developmen.t Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)]. BLDG. TOWN OF $O'L~OLO Southold Town Clerk August 25, 1993 APPLICATION PAGE TOWN OF SOU1 HOLD FLOODPLA2N DE,\rE, LOPMENT PEtLMFT AJ~PLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS fAPFLICANT to read and 1. No work may start tm~ a permit i~ issued. 2. The permit may be revoked ii' any false statements &re made herein_ 3. If revoked, all work must cease until permit ks re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance ks issued. 5. The permit will expire. il' no work is commenced within six months of issuance. 6_ Applicant ks hereby informed that other permits may be required to fall"ill local, state and federal regulatory requirements. 7. Applicant hcrcby glve~ consent to thc Local Administrator or his/her representative to make reasonable · ;n~pccfiOus reqUite, xl to ~ compliance. 8. I, THE APPLICANT, CERTIFY TIq~ALL STAT'/~..MENTS HEREIN AJqD IN ATTACI-hMENTS TO - THIS APPLICATION ARE, TO TI;t'E BEST O F J(/,'~',I~2qOWLED GE, TRUE AbfD ACCURATE. SECTIQN 2: PROPQSED DEVELOPMENT (To'be completed by APPLICAZ,W} NAME APPLICANT BUILDER ,,kD DRESS TELEPHONE ENGINEER To avoid delay in procv~ing thc application, please provide enou_~h information to e.a~ily identify thc project location. Provide the ~a'eet addresx, lot number or legal dezcription (attach) and, outside urban areas, the distance to the neare.~t intersecting road or well-known Landmark. A sketch attached to this application showing the projecl location would be helpful. FDP[93) .~PPLICATI O N ~ PAGE 2 OF ~ DESCRIPTION OF WORK (Check ~11 applicable boxes) A STRtJCTUR~L DEVELOPMENT ACPIVTI'Y ,~f_R U Cq'U R E TYPE [2] New Structttr¢ [] Addition [] Alteration [3 Relocation [] Demolition [] Replacement [] Residential (1-4 Family) [] Residential (More than 4 Family) [21 Non-residen6al (Floodproo[mg7 [] Yes) [] Comb[ned Usc CR~idenfial & Commertnal) [] Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) E,SWIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: fil~F'dl I~lvlining 134J)rilli.g [3~Grading I~ Excavation (Except for Structural Development Checked Above) El Watercourse Alteration (Including Dredging and Channel ModLfic. atio~) [] Drainage Improvemenm (Including Culvert Work) El Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] lndix4dual Water or Sewer System [] Other (Please Specify) Alter completing SECTION 2, APPLICANT should submit form to Local Administrator [or re~4ew. SECTION 3: FLOODPLAIN DETERMIN,KTION {'To be completed bY LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated. The Proposed Development: [] h.l~_~ kmated in a Spex:ial Flood H:~-~rd Area (Notify the applicant that the application review i~ complete and NO FLOODPLAIN DEVF_,J.,OPMI!il'qT PF_.R. NflT IS REQUIRED). C] lc located ia a Special Flood Hazard A~rca. FIRM zone de.qignation i~ 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is Iocaled in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNIED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADD[TIQNAL INFORNIATION RE~I_R_ED (To__be completed bv LOCAJ~ ADMINIST~ Thc apphcant must submit the documents checked below before thc appticatJon can be processed: [] A site plan showing the location of all c:cisthag structures, water bodies, adjacenl roads, lei dimensions and proposed development [] Development plans, drawn to scale, and specification, including where applicable: details for anchoring structures, proposed elevation of lowest Floor (including basement), types of water resistant materials used below the £trst floor, details of floodproof'mg of utilSties located below the Fo-st floor a~d details of enclosures below the ftrst floor. Subdivixion or other development plans (If the subctivixion or other development exceeds 50 lots or 5 acres, whichever ix the lesser, the applicant must provide tOO-year flood elevations if they are not otherwise available). 13 Pla~s showing thc e, xt~t of watcrcoussc relocation and/or landform altcratioms. Top of new f'RI elevation Ft. NGVD (MSL). F'loodprool-mg protection level (nou-re.sidcntial only) Ft.' NGVD (MSL). For floodproofed structure-s, applicant must attach certification from registered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this £mding must also be submitted. [] Other: SECTION 5: PERMIT DI~FERMINATION (To be completed BY LO(~AL ADMINIo-TRATQR} I have determined that the proposed activity:. A. VI Is B. I-I Is not in coaformanc~ with provisions of Local Law ~__, 19__. The l~rmit is issued subject to the couditious attaehed to and made peri of this p~rmit. SIGNED , DATE ,~BQX .A_ i~ checked, the Local Admimstrator may issue a Development Permit upon payment of designated fee. !f BQX B i~ ch~:cked~, the Local Admlnistralor will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPFJ~J-S Appealed to Board of Appeals? C} Yes [] No Hcazmg dale: Appeals Board Decision --- Approved? [] Yes Conditions ~ No APPLICATION PA(5[' 4 OF ~ ~5~ECTION 6: A.5-BU1LT ELEVATIONS fTo be s~bmi ted by APPLICAJ~F before Ce~rtificate of Compliance is~issued~ The following inJ'ormation mnst be provided for project structures. This s~ctioa mnst be completed bY a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas. bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGV'D (MSL). 2. Actual (As-Built) Elevation of floodproo£mg protection ia FT. NGVD (MSL). NOTE: ~.ny work performed prior to submittal of the above information ia at the risk of the Applicant. .SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on ir~pection of the project to eusure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIF. S? El YES [] NO DATE BY DEFICIENCIES? E] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be cq~mple[ed ,bY LO(3AL ADMINISTRATOR} Certificate of Compliance issued: DATE:. BY Attachment B SAMPLE CERTIFICATE OF COMPLIA/~CE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECL, k)L FLOOD HAZAJLD AKEA (OVV/'4ER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING U1 EXISTING' BUILDING [] VACAN~i' LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HYEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW # ,19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: OF OF Cie(si) DONALD G. FELLER "ARCHITECT 8 ~ Soptombor 24, 2003 1 ~ 725 Main Rd · Box 1692 * Maffituck, NY 11952 * 631 2985453 * Fax 298 1380 Mr. Gary Fish Town of Southotd Building Department Town Halt, Main Road, Southold, NY Re: 1045 First St, New Suffolk B.P. # 28380 Z Dear Mr. Fish: I have examined the window alteration installed at the above referenced project, and I can certify that it conforms to the requirements of the Building Code of New York State. Donald G. Feiler Werner Georg Kunz 875 King Street - Box 668 JAN Z 8 3~3 New $~fFolk NY 11956 631 734~23'7~ werner~wernerkunz corn Sunday, Janua~ 26,2003 Town of Southold Building Department Town Hall Southold NY 11971 Re: Building Permit 28380-Z Dear Madam/Sir: On December 4, 2002 I have written to you informing you that the work under the above-mentioned building permit has been completed and returned the said permit requesting the issuance of the certificate of occupancy. It's been nearly 2 month and I have not received a reply from you. May I kindly ask you to confirm the receipt of above shown building permit and proceed with the issuance of the certificate of occupancy. Your assistance in this matter is greatly appreciated. ~.~eorg r~unz Werner Georg Kunz 87'5 KJng~ ~;tr'eet B,',)× 668 New Suffolk NY 11956 631 734-23'4 Wednesday, December 04, 2002 Town of Southoid Building Department Town Hall Southold NY 11971 Re: Buildin,q Permit 28380-Z Dear Madam/Sir: I am writing to you to inform you that the work under the above mentioned permit has been completed. As stated on the notice of the building permit I am herewith returning the above mentioned permit and would like to obtain a certificate of occupancy. Your assistance in this matter is greatly appreciated. BUILDING PERMIT EXAMINER CItECK LIS3[' APPLICANT: ~... $CTM# DISTRICT: 1,000, SECTION: _ I~- , BLOCK: ~ , LOT: ~.~, DATE ISSUED: /02 DATE REVIEWED: ~//,~/02 DATI~'$UBMITTED: ,.~/& /02 STREET ADDRESS: ~ PROJECT DESCRIPTION: 0t:E ESTIMATED PROJECT COST: 44~- ARCHITECT / ENGINEER: CITY: k)~ ~b'~q~.4~ . SUBDIVISION: FAST TRACK? SINGLE & SEPARATE CERT1FI(?ATION-REQUIRED? LOTS40,000St (024 Lo rec g rtl CPdAIII befoieJune~0 1983) UND.{SZE)L(iI'SH{OM JAN.1997 100-25 bleige~ (Anonconlblnmigatanylm~catk~ 7q/ ZONING DISTRICT: REQ. LOT SIZE: qO~ REQ. FRONT ./ REQ. REAR CONFORMING'? ~oo ACT. LOT SIZE:~ REQ. LOT COY. / ACT. LOT COV. '~ PROP. FRONT ~ .P~EQ SIDE ~ ACT. SIDE ~, PROP. REAR .~? ~ a~rf~,~ t~ ~'r-~ ~_ t,~ ~ WATER FRONT? PANEL #: FLOOD ZONE: DESCRIPTION: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or~, (BED #):__ TOWN SEPTIC RECEIPT: Y or ~) NEW YORK STATE DEC: ePm-~zc 9/l/,S YES or~ SOUTHOLD TOWN TRUSTEES.-~7~ YES or{~ TOWN ZONING BOARD APPROVAL: YES ort~ TOWN PLAN. BOARD APPROVAL: YES or~.,~ TOWN HISTORICAL PRE (SPLIA): YES or~ DTE: / / PERMIT #:Ri0- NYS ENERGY: YES OR 1~: ~/'~ EGRESS (18 H min.? 4 sq total) ~-/,~ VENT(SQ. FT. x4%) ,~/,~, LIGHT(SQ. FT. x8%) ~'A BUILDINGPERMIXSq~PEN/EXPIR,ED: BPa~'{~ '2----Z/C/OZ~ dT~[~ , c.,!;2J~--¥-x~ HAVE PRE CO'S Y{t'~__~RN~-~>/~/~I~ff~'BP,~-~;~i::~-Z/C/0 Z- :~e[(~ ,o,¢_~ ~ NOTES: ~/( ~ - \ - FEE STRUCTURE: FOUNDATION: FIRST FLOOR: SECOND FLOOR: OTHER: TOTAL: I. Q SF)- ( Sir): SF X $ 2. ( SF)- ( SF)= SF X $ SF SF SF SF 1NIT OTHER TOTAL SF FEE FEE FEE ftllOtO,"t.~dlT EXAMINER CHECK LIST DATE 1S~SUED: / /02 DATE REVIEWED: o'~/2~/02 DATI~'SUBMITTED: / /02 BLOCK: J) LOT: ~ J-/,,- ,- -J- CITY: /~3e--~ _~z~ )fl~ SUBDiVISION: ARCHITECT / ENGiNEER: q-REQUIRED? NOTES: FAST TRACK? ........ ane 30, 1983), UNDERSIZED LOTS FROM JAN.1997 I00-25 Merger (A nonconforming at any time after 7/1/83 ZONING DISTRiCT: REQ. LOT SIZE: REQ. FRONT REQ. REAR CONFORIvliNG? ACT. LOT SIZE: REQ. LOT COV. PROP. FRONT REQ SIDE PROP. REAR ACT. LOT COV. ACT. SIDE WATER FRONT? PANEL #: FLOOD ZONE: DESCRIPTION: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-n~cgn/?$ YES orNO SOUTHOLD TOWN TRUSTEES: YES or NO TOWN ZONING BOARD APPROVAL: YES or NO TOWN PLAN. BOARD APPROVAL: YES or NO TOWN HISTORICAL PRE (SPLIA): YES or NO _ DTE: / / PERMIT #:RI0- NYS ENERGY: YES OR NO : EGRESS (18 H min.? 4 sq total) __ VENT (SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z / C/0 Z- , HAVE PRE CO'S: Y OR N BP -Z/£/0 Z- , FEE STRUCTURE: FOUNDATION: FIRST FLOOR: SECOND FLOOR: OTHER: TOTAL: 1. (_ .SF)- ( SF): SF X $__ 2. ( .SF)- ( SF)= SF X $ SF SF SF SF IN1T OTHER TOTAL SF FEE FEE FEE =$ =$ +$ +$ = $ +$ +$ = $ FOUNDATION (1ST) FOUNDATION (2ND) ROUG~ F~G & PL~rG ~S~ATION PER N. Y, STA~ E~RGY CODE TOWN 0~: SOUTHOLD BUILPlNG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 Examined ~/~ ,20_ ~ Approved__ ~,/~' ,20 ~' Disapproved wc Expiation ll///3,20 $ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 s~ts of Building Plans planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ., 20 ac~9~fii~31ication 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 waterways. c. The work covered by this application may not be commenced before issnance of Buildlng Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a perm/t shall be kept on the prem/ses 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not comme~lced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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 here'm described. The applicant agrees to comply with all applicable laws, ordinances, building code, hous~[mg codg, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · (Signature of applican[ or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of oxvner of premises &~:,~ XJZ-")e ~'~- ~"- ~.'~/~,/~ (As (~n the tax roll or latest deed) If applicant is a corporation, signature of duly author/zed officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Local~o_n of land on whictl proposed work will bec_done: House Number Street County Tax Map No. 1000 Section Subdivision (Name) Hamlet Block 7 Lot Z~ Filed Map No. Lot 2. occupancy of proposed construction) · State existing use and occupancy of premises and intended use and a. £xisting use and occupancy ~.q ~ ~gz~ff b. Intended use and occupancy /d-f~ ,~y 3. Nature of work (check which applicable): New Buildin~ Repair Removal Demolition 4. Estimated Cost ~ g/~9 Fee 5. If dwelling, number of dwelling units. If garage, number of cars ~ ~ Addition Other Work Alteration (Description) (To be paid on filing this,app~lication) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. _ '/~//'~ 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth 9. Size of lot: Front Rear .Depth 10. DateofPurchase ~.~.~.'qq Name of Former Owner ~--,, 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO V~ 13. Will lot be re-graded? YES __ NO V/Will excess fill be removed from premises? YES__ NO V'~ I4. Names of Owner of premises ~/J' 4. Name of Architect f" Name of Contractor ~" 15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES * 1F YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. 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: __ ( ../ ' / ~/f~ ¢ being duly sworn, deposes and says that (s)he is the applicant '-'U~lame ~f individual sigriing contract) above named, ! (S)He is th~ (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 tree to the best of his knowledge and belief; and that the work will be performed in the rammer set forth in the application filed therewith. Sworn to before me this __ ~-{ _day of 0 N°t~d ibu~lic d 20 , No. 4~i~50~ NOTIFY BUILDING DEPARTMENT AT ?$S-1802 $ AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY OCCUPANCY 0,~ USE IS UNLA~VFUL WITi-IOUT C£RTIFIC;,TE OF OCCUPANCY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Wemer-Georg Kurtz 875 KinE ~treet New Suffolk NY 11966 Exlsltina E~ist F~oade Wemer-Georg Kunz 875 King Street New Suffolk NY 11956 Oete: Alii 2002 E.st Facade