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HomeMy WebLinkAbout28697-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29937 Date: 12/30/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 675 LOCUST AVE SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 62 Block 3 Lot 32 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 27, 2002 pursuant to which Building Permit No_ 28697-Z dated AUGUST 27, 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 ACCESSORY TENNIS COURT AS APPLIED FOR PER ZBA #5240 DATED 7/25/02 . The certificate is issued to ANDRZEJ & RENATA KOPALA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Signat 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. 28697 Z Date AUGUST 27, 2002 Permission is hereby granted to: ANDRZEJ & RENATA KOPALA PO BOX 1782 SOUTHOLD,NY 11971 for CONSTRUCTION OF AN ACCESSORY TENNIS COURT AS APPLIED FOR AS PER CONDITIONS OF THE SOUTHOLD TOWN ZONING BOARD OF APPEALS at premises located at 675 LOCUST AVE SOUTHOLD County Tax Map No. 473889 Section 062 Block 0003 Lot No. 032 pursuant to application dated AUGUST 27, 2002 and approved by the Building Inspector to expire on FEBRUARY 27, 2004 . Fee $ 75 . 00 1 ori d Signature COPY Rev. 5/8/02 I " 6S - 39�` Form No.6 76S- 3 f ' DEC O 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 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-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 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: (check one) Location of Property: 6 7s L 0(f U 5 T IfVz 50 U T HOL D I✓`( /M 71 House No. Street Hamlet Owner or Owners of Property: /� ND K Z E 7 Ai � 1 0 P h L/I- Suffolk County Tax Map No 1000, Section 06 2, Block O 3 Lot 0 3 2 Subdivision p Filed Map. Lot: Permit No. 2 g 6 I Date of Permit.-51.Z 2002,Applicant: 4(Dg2,E T �VO f)IILI-4- Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ -�-D)937 �^ (✓fo�ab� Ap licant Signal re APPEALS BOARD MEMBERS g p� COG Southold Town Hall Gerard P. Goehringer, Chairman =� 'y� 53095 Main Road Lydia A. Tortora y z P.O. Box 1179 George Horning W ^+ Southold,New York 11971-0959 Ruth D. Oliva ��' p�� ZBA Fax(631) 765-9064 Vincent Orlando l �a Telephone (631)765-1809 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF JULY 25, 2002 Appl.No. 5140—ANDRZEJ. AND RENATA KOPALA. Property Location: 675 Locust Avenue, Southold CTM 62.-3-32 SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type H category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned as a setback or lot line request. PROPERTY FACTS/DESCRIPTION: The applicant's property is located on the corner of Locust Avenue and L'Hommedieu Lane in Southold and consists of 25,000 sq. ft. of land area. This parcel is improved with a one-story dwelling 41+- ft. from the westerly front line and 40.3 feet from the southerly front lot line. BASIS OF APPLICATION: Building Department's March 27, 2002 Notice of Disapproval denying a permit to construct a clay tennis court structure with eight-ft. high fencing, noting that the new construction does not meet the requirements of Sections 100-30A.3, 100-30A.4 and 100- 231. The code requirement is that accessory structures be located in a rear yard, that fence be limited to a height of 4 ft. when located in a front yard and of 6.5 feet when located in or along side and rear yards,and that lot coverage be limited to 20%of the area of the lot. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on July 25. 2002,at which time written and oral evidence was presented. Based upon all testimony, documentation, personal inspection of the property and the area, and other evidence, the Zoning Board fords the following facts to be true and relevant. AREA VARIANCE RELIEF REQUESTED: Applicants request variances for: (a)the proposed location of a clay tennis court as an accessory structure partly in a nonconforming front yard area and partly in conforming rear yard area; (b) tennis court fencing at a maximum height of 8 ft.; (c) an increase in lot coverage to a maximum of 32 percent of the lot for the purpose of adding 51' x 105' clay tennis court structure. REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted, and personal inspections,the Board makes the following findings: 1. Grant of the area variance will not produce change in the character of the neighborhood. Applicants have accepted as a condition of this variance that the outside of fence areas will be r Page 2-July 25,2002 Appl.No. 5140-A. and R.Kopala 62-3-32 at Southold screened along both the north and south directions (toward road and maintain screening north and south of tennis court) during the existence of this structure. 2. During the hearing applicants testified that they were unable to find a larger piece of property (larger than a half acre) at a price range that they were financially able to spend. After reviewing the record and viewing the site, it was noted that although this parcel is a corner lot, the rear yard area is quite large. Also, there were no objections offered, either in writing or at the hearing. Comments received were in fact in support of the application. 3. Consideration of the relief sought in this application was carefully reviewed by Board Members, and the Board finds that although the tennis court is fairly large, it will be smaller than the average and the court will be of a natural, earth (clay) material, leaving the rear yard visibly unobstructed because it does not give the appearance of a building wall, and the fencing will not take up all of the rear yard area. At the hearing, the applicants furnished a measurement of+-14 ft.,south-between the fence and the front property line. Motion offered by Member Orlando, seconded by Member Horning, and duly carried,to: DENY the lot coverage request of 32% as applied for, and GRANT ALTERNATIVE RELIEF allowing a smaller clay tennis court structure with fencing, subject to the following CONDITIONS: I. Total lot coverage on to for building areas and accessory tennis court improvement not to excee 300 of the total lot area; this allowable lot coverage shall be for a clay tennis court, which cannot be substituted for another building or structure; the difference between dwelling and the clay tennis court will result in the size limitation of the proposed clay tennis court. 2. The Board requests that the setback from the north and south property lines increased - the setback be increased on the public road (south) side fro 1&+-1116 feet. 3. The planting of arborvitaes (evergreens)at a minimum height o 5 feet, pa apart, along the outside of the fencing on the public road uth s screening for the tennis court shall be maintained on north and south after installation of the fence. 4. The tennis court structure must be of clay material only. 5. The tennis court shall not be illuminated. 6. The tennis court shall not be leased,and shall be used only by applicant/owners' • r Page 3—July 25,2002 Appl. No.5140—A.and R.Kopala 62-3-32 at Southold friends and relatives. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: MembersGoehringer ( nnan), ortor Orlando. (Member Oliva was absent.) This Resolution was ly adopt (4-0). erard P. GochAnIfer, Chairman August 1, 2002 BUILDING PERMIT EXAMINER CHECK LIST DATE ISSUED: / /02 DAT REVIEWED: / /02 APPLICANT: DATPbSUBMITTED: _/_/02 SCTM#DISTRICT: 1,000, SECTION: , BLOCK: , LOT: STREET ADDRESS: CITY: SUBDIVISION: PROJECT DESCRIPTION: 76Ntiis Cvy/LI_ -,ee76,ey. ,*,� A-,% ('eta n.•r e*"a o<c c 92 �4 � ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: FAST TRACK? a SINGLE & SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83: ZONING DISTRICT: CONFORMING? REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR PROR REAR WATER FRONT? DESCRIPTION: PANEL #: FLOOD ZONE: , APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED#): DTE:_/ / PERMIT#:R10- TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or NO 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 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/C/0 Z- , NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. ( SF)- (SF)= SFX$ =$ +$ +$ = $ 2. ( SF)- ( SF)= SFX$ =$ +$ +$ =$ FORM NO. 3 NOTICE OF DISAPPROVAL DATE: March 27, 2002 TO: Andrez Kopala PO Box 1782 Southold, NY 11971 Please take notice that your application dated March 25, 2002 For permit to construct an accessory tennis court at Location of property: 675 Locust Avenue, Southold, NY County Tax Map No. 1000 - Section 62 Block 3 Lot 32 Is returned herewith and disapproved on the following grounds: The proposed accessory tennis court, on a 23,522 square foot non-conforming parcel, with two front yards, in the Residential R-40 District, is not permitted pursuant to Article IIIA, Section 100-30.A.4, which states: "Accessory buildings shall be subject to the same requirements as 100-33 of the Agricultural- Conservation District,"which states, "In the Agricultural-Conservation District and Low- Density Residential R-80, R-120, R-200, and R-400 Districts, accessory buildings and structures or other accessory uses shall be located in the required rear yard." The proposed accessory tennis court is noted as being partially located in the front yard. In addition, the proposed accessory tennis court is not permitted pursuant to Article XXIII Section 100- 231, which states; "Fences, walls or berms may be erected and maintained, subject to the followingheight limitations:" A. "When located in the front yard of residential zones, the same shall not exceed four feet in height"t"and B. "When located in or alone side and rear yards, the same shall not exceed 6 1/2 feet in height." The proposed fencing around the pool in both the front and rear yard portions of the property, is noted as being 9 feet in height. As a result of the proposed construction, total lot coverage will increase from nine (9)percent to thirty- two (32) percent, which is not permitted pursuant to Article III.A., Section 100-30.A.3., which states "No building or premises shall be used and no building or part thereof shall be erected or altered in the Low-Density Residential R-40 District unless the same conforms to the requirements of 1 the Bulk Schedule and of the Parking Schedule, with the same force and effect as if such regulations were set-forth herein in full." 42 uthonA Si a Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Z.B.A. AREA: 23,662 S.F. = 0.543 AC, LOT COVERAGE EXISTING: 2,071 S.F. = 6.89 LY .0.5 E FORM HIDµ 'PERNER 3 R NOW lK &OF 5CRIVP 0180.48 c0.2 " m�c0 �y 60000y' 0 0 i o °E Ut �� FENCE 2 Z i Z�4 • 3 40 Nc� N6 3 $ 0'X'02 m x CD, FCOR ER _ 5 Y Sc 3. PO?E 06 O RA "Y A t ORIVEY7 _', m 0 0 1 pp m yn0 3 OZ w f o 0 P �c �0E CN �0 �� z� e• FS�� 6 V ' ? A 0 M til I "'m- �0•�, E N � C� CS O Z t 6'S "VJ S C�6��� � PO 50� CERTIFIED TO: ANDRZE J. KOPALA SURVEY OF RENATA KOPALA SUNRISE ABSTRACT CORP. DESCRIBED PROPERTY Gu4pmm ANDIOR SUBSURFACE STRUCTURES THE OR UNRECORDED ARE NOT GLNRANTEED UNLESS PHYSICALLY ENDENT ON IHE PREMI,ES RS THE 7FO OF OM 7HE. GWVEY IS PREPARED. HEREON IS B RUN ONLY TO TH£PERSON(,) FOR WHOM L S/TUATE AT AGENCY AR PREPARED, ANO ON NS BEHALF TO THE AND TO GOVERNMENTAL AGENCY AND LEHOMO GUARANTEES RELISTED HEREON. AND TO THE ASSIGNEES OF THE LENDING R/SRTUI/ON GLNRANNEES ARE NOT 7DINE DIMENSIONS) TO ADOHEREL /FROMTHE SOUTHOLD ST AUTURES NT OWNER,. THE DINES A (OR R A SPECIFIC SHOWN HEREON FROM THE STRUCTURES 70 NNE PROPERTY LINES ARE FOR A SPON O PURPOSE AND USE AND TOWN OF SOUTHOLD THEREFORE ARE NOT INTENDED ND GU/OE S T BUILDINGS OF FD ANY TILERREWNING WTRUC POOLS. PAIlO$ PUWTlNG ARFAS A00/IKJNS TO BUILDINGS ANO ANY OTHER CONSIRUCAON. SUFFOLK COUNTY, NEW YORK PAT T. SECCAFICO SCALE.' 1 '=40' DATE: APRIL 5, 2001 PROFESSIONAL LAND SURVEYOR, P.C., S.C.T.M. DIST. 1000 SEC. 062 BLK. 03 LOTOJ2 — SUCCESSOR TO — DONALD TASE, L.S. JOB NO. FJ492 IE EWr RICHARD WILHELM AND ASSOCIATES C j.sec o PROFESSIONAL LAND SURVEYORS REVISIONS: NORTHSTAR SURVEYING, P.C. STAKE FOUNDA77ON 06/12/2001 a PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S. UNDER CONSTR. 06/27/2001 * GOOD GROUND SURVEYORS, P.C. FINAL OB/J112001 CERTS, SANITARY 09/06/2001 1 326A Main Street 107-4 W Montauk Highway UPDATE 10/04/2001 F q- Center Moriches, NY 11934 Hampton Bays, NY 11946 PROP. TENNIS COURT 06/22/2002 04 07 PHONE: (631) 878-0120 PHONE: (631) 728-5330 UPDATE 07/16/2003 FO LAND SLiR J� FAX: ( )631 878-7190 FAX: (631) 728-6707 N.Y.S. LIC. NO. 049287 COPYRIGHT — 2002 PAT T SECCAFICO P.L.S., P.C. AREA: 2J,662 S.F. = 0.543 AC. LA LOT COVERAGE EXISTING: 2,071 S.F. = 8.8% PROPOSED ADDITIONAL: 5,012 S.F.a� t' PROPOSED TOTAL: 7,083 S.F. = 29.9% . pEPT.EQUT110LD OCCUPANCY OR APPROVED AS NOTED a USE IS UNLAWFUL °A $1� 2> Pa WITHOUT CERTIFICATE N T UILDIN DARTY T AT OF OCCUP C 78 %4A 4 PM FOR THE NOWORSORNP�Ic �1ao qS+ CTIONS:c i • TWO REOUIRED NCRETgUNGH�K R p`�Uj NG &�UMBING 3 INSULA 10 OE 4. FINAL - C WCT101y '(��YIUST ,3�j'A� sPLrt p1? BECOMP T -.0. y o ALL CONST UC ALLET cE 6 b THE R UIP ME OF THLs' p1PE N oyNsST UC N & ENER4 , 014E °• 21' IID#, N ESP SIBd E FtSW'<, O b I ON RUC N PS ^ ` ) 6 7,�m� N a C0;, 2� �, E N ��1P� //I N �• �PIP, N ' 10a29 f� e '200 O �1 5� 0 X10 Z ¢SV 06'50aW g92/�9�3I m m � 5o y1P ` }21 � D 99 4 6.9 '1 r 1 L'tR1rr7ED T0: ANDRZE J. KOPALA SURVEY OF RENATA KOPALA SUNRISE ABSTRACT CORP. DESCRIBED PROPERTY EAs0w�T7s AND/OR su6suRFAcr s7RucnTREs RECORDED OR uNREcaRDED ARE Nor CWRAN/EED IW1655 PMSIGU.Y ENOflIT ON Tiff PREMISES AT 7NE 7w aF swwy.. OU/RINTEEss YMMI7E0 HEREON 9WL RUN ONLY M THE PERSON(s) FOR WM WE SITUATE AT SUTWY 6 PMV%RED AND ON HS 9EHIIF 70 THE TIRE CONPANI: GOWRNMENAL AGENCY ANO 1ENwnn 067=06 LWW HEREON AND TO DE AssR.YlfES OF INE 1&"W#&TFnm0N 0U4ffiWnxs ARE NOT 7RANWVm&E TD ADW VAAL M=URONS SOUTHOLD SnWMn 7 PROPiR7 TY L ARE( MR A OR ) �PURPa5f ANNAND u�AW TOWN OF SOUTHOLD PO MMFEAM% PL4NTM ARF�IS�AW WF W&MM roAa S W& AND AW a CGNSRErANNO �ININ. SUFFOLK COUNTY, NEW YORK PAT T. SECCARCO SCALE: 1"=40' DATE: APRIL 5, 2001 PROFESSIONAL LAND SURVEYOR, P.C. S.C.T.M. DIST. 1000 SEC.062 BLK. 03 LOT 032 — SUCCESSOR TO — DONALD TASE, LS. JOB NO. FJ492 RICHARD WILHELM AND ASSOCIATES Of NfITY PROFESSIONAL LAND SURVEYORS REVISIONS: hQI�S. SEC /� NORTHSTAR SURVEYING, P.C. STAKE FOUNDATION 06/12/2001 9 PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S. UNDER CONSTR. 06/27/2001 GOOD GROUND SURVEYORS, P.C. FINAL 06/31/2001 CERT'S, SANITARY 09/06/2001 328A Main Street 107-4 W. Montauk Highway UPDATE 10/04/2001 Center Moriches, NY 11934 Hampton Boys, NY 11946 PROP. TENNIS COURT OB12212002 qp, PHONE. (631) 878-0120 PHONE: (631) 728-5330 IA FAX. (631) 878-7190 FAX. (631) 728-6707 N.Y.S. LIC. NO. 049287 COPYRIGHT — 2002 PAT T. SECCARCO P.L.S., P.C. M-1802 BUILDING DEPT. INSPECTION [ J FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ J 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY mwmARK 114 DATE INSPE FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) � x -------------------------------------- -- S � C FOUNDATION (2ND) -- -------_--- --s L�� O ROUGH FRAMING& -- - PLUMBING y INSULATION PER N.Y. - 3 STATE ENERGY CODE FINAL ADDITIONAL COMMENTS O S Z m - - z a s m - ya 'o _ J y � 0 ,tv z f � e b TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIS BUILDING DEPARTMENT Do you have or need the following,before applyin TOWN HALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 `1 9 Survey PERMIT NO. C> 1 f Check I Septic Form N.Y.S.D.E.C. ZTrustees Examined 20_ Contact: Approved 20_]_, Mail to: Disapproved a/c Phone: 7,6S- - 939Li Expiration ,20_ 30 y O g1B Insp APPLICATION FOR BUILDING PERMIT " R2520 a03P1-;-1r!1cation Date 3/ Z� 20oZINSTRUCTIONS 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 issuance of Building Permit. d. 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within IS 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 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) PO $O>� RV2 S0011iOt3> NY11371 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises NDRZEJ pENPrTA kDPALA (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 675 LQC05r Rvt $oyTHoly House Number Street Hamlet County Tax Map No. 1000 Section 62 Block .3 Lot 3?- Subdivision ZSubdivision Filed Map No. Lot r (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed consti-uct?on: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work TEN/Jl S Coy rt'T CLAY (Description) 4. Estimated Cost I i 0. 0 o O Fee (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 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 +Y S. Dimensions of entire new construction: Front Rear Depth 105 K S Height Number of Stories r 9. Size of lot: Front Rear IZS I Depth Zoo, til ' 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO 13. Will lot be re-graded? YES V NO Will excess fill be removed from premises? YES NO_ 14. Names of Owner of premises R I? KoPAL/k Address_5oVTNoL2 PhoneNo631 - 76f-639y Name of Architect Address Phone No Name of ContractorddressCoUT4HoC�UE Phone No.G3( ' 73q -576'7= 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ✓ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO V * 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) U CONTY rO�F sou K©T ftL-A A t1-91)�ZE_ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the KO ML A A AjD P,2C-j (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. Swom to efore met day of Zp�� 4s***** �^ Notary Public eof A licant NOTARY P PUBLIC,Stattee of New York No. 20932 Qualified In Suffolk County Term Expires March 8, 20 j I