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MIN012 ~80/V/S/~
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GEOC?GE-B:d.f;;-HL_~_
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M4TTiTUCI<::.
TOWN OF" :::::iOt..Jn-4OL.O, NY
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Area'" o. 820 Ac.
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30
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.~ '~H:t..AiH.)N OR AOOIftOft
: -" C ....L"Vf" '5 A VIOLAllON OF
:,:--,0"-,<,':1,, ~--~ THE NEW YORK STAT(
ltl, ,AT<.eN lAN.
~QJ1U c'~ T'il$ S\Ji....O' MAP NOT IEARING
. "1 LANO ~U, '~F'!Lr, '1'01<"[0 SEAL OR
d~IOSSfD :'t..,L 5/;AU Nor IE CONSIDEIiD
TO If A VAUO TRlJl con.
OUAAANT~ES INDiCAHD HEIlfON SHALL RUN
ONLY TO THE Pfil.SON fOil: WHOM THE _VE'
IS I'lfPARED, AND ON HIS llfHALf to THE
:mu COMPANY, GOVERNMENTAl AGfNCy ....N"'
lENDING INSTITUTION liSTED HfiION. AND
YO THE ASSIGNUS Of TH~ LENDING ....".
TU1'1ON. GUAIlANTEfS AU NOT JRANIfIlAe
ro AOOlllOHAl INSTlfVr1ON5 OR SUlSfOu.
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Southold, N. Y. 11971
HENRY E. RAYNOR, Jr., ChaimuIn
JAMES WALL
BENNETT ORLOWSKI.1L
GEORGE RITCHIE LATHAM, Jr.
WILUAM F. MULLEN, 1L
TELEPHONE
765.1938
July 22, 1982
Mr. George H. Boehle
Woodcliff Drive
Mattituck, New York 11952
Dear Mr. Boehle:
The following actions were taken by the Southold Town Planning
Board, Monday, July 19, 1982:
RESOLVED that the Southold Town Planning Board declare itself lead
aqency in regard to the State Environmental Quality Review Act in
the matter of the minor subdivision of Georqe Boehle, located at
Mattituck. An initial determination of nonsignificance has been
made.
RESOLVED that the Southold Town Planning Board approve a set-off
106-13 as designated on the map of Georqe Boehle, located at
Mattituck, dated June 14, 1982 subject to completion of the State
Environmental Quality Review Act, and receipt of the filing fee
in the amount of $50.
Upon receipt of the filing fee and six (6) copies of the final map,
we will expedite referrals to the state and county agencies and
notify you when the maps have been endorse~ by the chairman.
If you have any questions, please do not hesitate to contact this
office.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
..........~ .
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MINOR SUBDIVISION
l. 6 copies sketch plan received
,
'I spot elevations
I sent to Planning Board
2. Meet with Planning Board
3. Required changes sent in writing
4. New submission received
5. ,Approval of sketch plan
6. Sent letter with resolution approving
7. Application and fee
If corporation, affidavit of ownership
6 copies of final map
Covenants and restrictions
I
Description of property
Note on plat that sanitation ans water facilities
meet County Board of Health specifications
Developer attend meeting (official submission)
8. Public Hearing (within 45 days)
Advertised
Affidavits of publication received
9. Action by Planning Board (within 45 days)
10. Sent to County Planning Commission
Received County's recommendations
11. Filed covenants and restrictions received
12. Authorization
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party of the first part, and
GEORGE n. BO",liLJ.;. and 3i;;Vt;:iL6Y G. !'OmiLr", Ids wife,
residing at Nassau Pojnt, Cu;:chocue, S111'1'o11: County, Nr'.; York,
party of the second pan,
WITNESSETH, that the party of the first part, in consideration of One and 00(100---------__
----------------------------------------------------($1.00)
dollars,
lawful money of the United States, and other good and valuable consideration paid
by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or
successors and assigns of the party of the second part fore,'er,
ALL that certain plot, piece or parcel of land, W.thX~1;~1f."~~..ilpf9Vlmii!i"'i~I'I"l1\Pli,"",~:&~ ,ituatc,
lying and beingXJ:C~ I1t i'Jattituck, 'rovln of Southold, SW'folk c,ounty, Fe\'.'
York, bounded and described as follows: B.t:GINNIlW at Q rr.onumcnt
tbe intersection of the casterl.y line of Woodcliff Drive witt" tt,e
soutLerly line of Westview Drive; from said point o.t' beg:inninL: J'un-
Eing along said sOl.o.tLerly line of Westview Drive, N. 71 42' 40" ,,;.
150. J feet to a monument; tbence a long land conveyed 0"' abou t to be
conveyed by the party of the first part to the party of Lhe second
part, S. 110 17' 20" D.. 120.0 feet to a monument; thence !Jlong
Illnd of Proschuk, S. 710 42' 40" ',w. 150.0 feet to a mono on said
easterl;r line of Woodeliff Drive; thence along said easterly line
of Woodcliff Drive, N. 110 17' 20" W. 120.0 feet to tbe ~oint of
becinning.
\'l'OGBThC:R with all the ri(<;ht, title and
the first rar~ of, in and to those portions
Westview Drive aCjacent to said premisei.to
a
interest of the party of
of Woodcliff Drive and
the center lines tLereo;.
SuEJr.:CT to the folloVlins covenants and restrictions:
1. No buildings other' than one private dwelling for t(,e l,se ane
occupanc:y of one fa".ily und one private bara!.>e s1.all be erected on a;
one lot, a lot being defined as a parcel 75 feet in widtt.. ..ny dwell
ing erected thereon shall cost not less than ~,BooO.oO und "ny detacL(J
gsra~e erected tt.ereon shall cost not less ttwn ;;500.00.
2. The pre,uises si1all not be used for the n.nnufaetyre or sale
of mercLar.clise or goods of any kind or for any trarje or' b"siness
whatsoever or for the display of any advertising or cOI"-wercial s'i,j:c
3. No stables or outside toiletssilall be erected on sEoid rre",L
and no nuisance shall be creElted or allowed on said premis,-s and no
"se si,a1l be made thereof that sklll be dnagerc1.l:J to the healt!, of 01
offensive to tbe senses of sight or smell of the party of the first
part, tLeir heirs and assigns, as owners of the rrejd:;es tlujoininG
tbe J,J'e:aises hereof and neigbborini; properties.
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l-ccpt in
No fences or hedges over 4 feet in heisht shall be er~c:ed
premises and s8icl fences or Ledges shall be Iilain1;air:ed and
l;ood 8rreSrl1nC,J.
---- _.. --,-.._--_._-------- ,.---------- ------- --
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In...'....nn..rlon ul' .....1.... l~.L ... ~ h..
10 .f'C(Jt or' LIllY l'UUULur.tu3'\'>I' :u..i.::" ~u~.
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6. l-io i'owl, pOL.ltr;y, elnirf1.als 01" livestoc.k shull be
pcemi:Jes otLer tban domestic l'ets.
~<~pt on 5t.1.(
7. No trailers slwll be kept, used or allowed em 381d prelllis8S
except when Kept within an enclosed garage.
These covenants and restrictions nball run with the land bereb,
conveJ'ed and shall bind and inure to the benefit of the said porties
hereto, their heirs, ad",inistrators and assigns until January 1, 197(
and s&id covenants and restrictions may be enforced by action for
damages or injunctions or both until the 1st day of January, 1970.
1'hese covenant s and restrictions herein imposed sha 11 apply sol'
to the premises herein conveyed and these covenants and r'dstrictions
may be modified, cbanged or released by the parties or tho first pari
their heirs and assigns and the owners of the premises for the time
being, the parties of the first part reserving and retaininG 911
restrj,cting rights of neishboring pro} erties now owned or which may 1
3cquired by them.
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Southold. N.Y, 11971
HENRY E. RAYNOR, k , Chai,man
JAMES WALL
BENNETT ORWWSKI. Jr.
GEORGE RITCHIE LATHAM, Jr.
WILUAM F. MULLEN, Ie
NEGATIVE DECLARATION
TELEPHONE
765-1938
November 8, 1982
Pursuant to Article 8 of the Environmental Conservation Law
State Environmental Quality Review Act and 6NYCRR Part 617, Section
617.10 and Chapter 44 of the Code of the Town of Southold, notice is
hereby given that Southold Town Planning Board as lead agency for
the action described below has determined that the project will not
have a significant effect on the environment.
DESCRIPTION OF ACTION
~rhe minor subdivision of George H. Boehle is a two lot
subdivision located at Mattituck.
The project has been determined not to have a significant
effect on the environment for the following reasons:
An environmental assessment has been submitted which
indicated that no significant adverse effects to the
environment were likely to occur should the project
be implemented as planned.
Because there has been no response in the allotted time
from the New York State Department of Environmental
Conservation it is assumed that there is no objection
nor comments by that agency.
The Suffolk County Department of Health Services has
indicated its agreement with the lead agency designation.
The department does not recommend the creation of parcels
less than 40,000 square feet in the area when private wells
and individual sewage disposal facilities are proposed.
The project will meet all the requirements of the Code
of the Town of Southold Subdivision of Land Regulations.
Further information can be obtained by contacting Mrs. Susan E. Long,
Secretary, Southold Town Planning Board, Main Road, SouthOld, New York
11971
>
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Copies mailed to the fallowing:
Robert Flack, DEC Commissioner
NYS, DEC at Stony Brook
Suffolk County Dept. Health Services
Suffolk County Planning Commission
William R. Pell, III
George H. Boehle, applicant.
. ,.......... ~ . " . "'~
.
COUNTY OF SUFFOLK
.
PETER F. COHALAN
SUFFOLK COUNTY EXECUTIVE
SEP 23 REC'O
DEPARTMENT OF HEALTH SERVICES
DAVID HARRIS. M.D.. M.P.H.
COMMISSIONER
September 21~ 1982
Mr. Henry E. Raynor, Jr.
Cha i rman
Southold Town Planning Board
Town of Southold, N.Y. 11971
RE: Minor Subdivision of
George H. Boehle
Mattituck (T) Southold
Dear Mr. Raynor;
We are in receipt of your letter dated September 8, 1982 concerning
the above minor subdivision.
This Department is in agreement with your designation of lead agency.
This Department does not recommend the creation of parcels less than
40,000 square feet in area when private wells and ind~vidual sewage disposal
facilities are proposed.
If you have any questions please feel free to contact me.
Very truly yours,
~Q~----"---- ~
Royal R. Reynolds, P.E.
Public Health Engineer
General Engineering Services
RRR: ljr
(;~~~~\
COUNTY CENTER
RIVERHEAD. N.Y. 11901
548-3318
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Southold, N.Y. 11971
HENRY E. RAYNOR, Jr., CIliJi,man
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM, Jr.
WILUAM F. MUl.LEN, ir.
TELEPHONE
765-1938
September 8, 1982
Environmental Analysis Unit
DEC, Building 40, Room 219
SUNY
Stony Brook, New York 11794
Gentlemen:
Enclosed find a completed Short Environmental Assessment Form
and a copy of the map of the minor subdivision of George H. Boehle,
located at Mattituck.
This project is unlisted and an initial determination of
non-significance has been made. We wish to coordinate this
action to confirm our initial determination in our role as lead
agency.
May we have your views on this matter. Written comments
on this project will be received at this office until September 21,
1982. We shall interpret lack of response to mean there is no
objection by your agency in regard to the State Environmental
Quality Review Act.
Yours truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
Ene.
cc: Department of Health Services
.
.
Southold Town Board of Appeals
MAIN ROAD - STATE ROAD 25
SOUTHOLD, L.I.. N.Y. 11971
TELEPHONE (5161 765.1809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER. CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR.
ROBERT J. DOUGLASS
JOSEPH H. SAWICKI July 12, 1982
Mr. and Mrs. George H. Boehle
Woodcliff Drive
Mattituck, NY 11952
Re: Appeal No. 3003
Dear Sir or Madam:
This letter is to confirm that the following action was
taken at a RegularMeeting of the Southold Town Board of Appeals
held on July 8, 1982:
RESOLVED, that Appeal No. 3003, application of GEORGEH. and
BEVERLY G. BOEHLE, for approval of insufficient area and insuffi-
cient depth of two parcels, be and hereby IS APPROVED AS APPLIED
FOR.
This resolution was unanimously adopted.
An official determination and findings will be filed with
the office of the Town Clerk as soon as possible and simultane-
ously forwarded to you for your records. .
If you have any questions, please do not hesitate to call
our office. If you wish to start construction as early as pos-
sible, please return to or call the Building Department for
issuance of your building permit at 765-1802.
Yours very truly,
GERARD P. GOEHRINGER
CHAIRMAN
By Linda Kowalski, Secretary ~~t,
cc: Building .Department
Planning Board..........---
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} 'JI~STRUCnONS;
f (a) In order to answer the questions in this short EAF it is assume.
r that the proparer will use currently available information concerning the
project and the likely imp~cts of the action. It is not expected that
additional studies, research or other investigations will be undertaken.
(b) If any question has been answered Yes the project may be
significant and a completed Environmental Assessment Form is necessary.
(c) If all questions have been answered No it is likely that this
project is not significant.
(d) Environmental Assessment
1. Will project result in a large physical change
to the project site or physically alter more ~
than 10 acres of land?....................... Yes No
2. Will there be a major change to any unique or - _ /
-unusual land form found on the site?......... Yes [/No
3. \'Iill project alter or have a large effect on - .---:/
existing body of water?...................... Y~s VNp
4.. \'Iill project have 0 potentially large impact --;-. lit.
on groundwater quality?....................... Yes 'No
5. \'Iill project significantly effect drainage --- --
flow on adjacent sites?....................... Yes ~o
6. \'Iill project affect any threatened or - 7-
endongered plant or animal species?.......... Yes No
7. \'Iill project result in 0 mojor adverse effect - -
on air quality?............................... Yes L1l0.
8. \'Iill project hove 0 major effect on visual - -
character of the community or scenic views or. ~
vistas known to be important to the community? Yes No
9. \'Iill project adversely impact any site or - ~~
structure of historic, prehistoric or .
paleontological importance or any site
designated os 0 critical environmental area . /
by 0 local agency?... ........~,.~v..~.v.v~..v Yes ~o
10. \'/ill project have 0 major effect on existing - -V"
or future recreationol opportunities?........_Yes No
11. Will project result in !"ajor traffic problems -
Or cause 0 major effect to existing . J .
transportation systems?...................... Yes ~o
12. Will project regularly couse objectionable - -
odors, noise, glore, vibration, or electrical
distur~an~e os a ~esult of the project's ~ .
operol~on.. .......... .. .. ........ .. .. ............................ ...... .. .......... Yes No
13. Will project have any impact on public health - -
or . saf ety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes '11'0
14. \'Iill project affect the existing community by - -
directly causing 0 growth in permanent
population of more than 5 percent over a one
yoor period or hove 0 major negative effect
on the character of the community or ./
neighborhood? . . . . . . . . . . . . . .. . .. . .. . .. . . . . . ... Yes'::"t-}o
15. Is there public controversy concerning the - ~_
project? ........ ... ..... ........... ... .. .... ._Yes_No
SHo:n EN'll RO W,tH AL ASSESSW.:N I
rUl-af1
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PREPARER'S SIGNATURE
REPRESENTING
C/h~ .fJ~
~/A-' 1? ~
/' '. .
DATE
c//:y~"1-
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APPLICATION FOR APPROVAL OF PLAT
To the Planning Board of the Town of Southold:
The undersigued applicant hereby applies for (tentative) (final) approval of a subdivision plat in
accordance with Article 16 of the Town Law and the Rules and Regulations of the Southold Town
Planning Board, and represents and states as follows:
L The applicant is the owner of record of the land under application. (If the applicant is not the
owner of record of the land under application, the applicant shall state his interest in said
land under application.)
2. The name of the subdivision is to be ... .tI.~~~. ':!-Z/1~...
...............~...':t~.~.~../.'7..~.~...............
3. The entire land under application is described in Schedule "AU hereto annexed. (Copy of deed
suggested. )
4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as
follows:
Liber ..)(..0.'./1............ Pa'f~.6..?............. On ya~~;
Liber ..H.~ (/............. PaJO.-:-:.?.;t.............. On ff~.~.r. ;
Liber ........................ Page
......................
On
. . . . . . . . . . . . . . . . . . . . . . . ,
Liber ........................ Page
......................
On
.......................,
Liber ........................ Page
. . . . . . . . . . . . . . . . . . . . . .
On
.......................,
as devised under the Last Will and Testament of .......................................
or as distributee~~.. '~'i-i' '77>G."iYiiii,:.' ',' 8;:J,i, '(1CAiL. )1i.D' ii ':!;;.o~ 3'Go-o.e4} ft
. ...............................................................................................
5. The area of the land is .... ~.~. ( ~. . . . .
acres.
/ ~ 0 .fr X/S-O Fr-/ ;t;}<JO 4tf
6. All taxes which are liens on the land at the date hereof have been paid--'~J'l .. ?/1i,(). .
...............................................................................................
7. The land is encumbered by ...... F h./J,.1i. . . . f:. . <?-.A 4.1'1.1':. . . . .. . . . . . .. . . . . . . . . . . .
mortgage (s) as follows:
(a) Mortgage recorded in Liber .............. Page.................. in original amount
of $. . . . . . . . . . . . .. unpaid amount $ ..... . . . . . . . . . . . . . . .. held by ......................
.............. address ..................
...............................................
(b) Mortgage recorded in Liber ......... Page ....................... in original amount
of .............. unpaid amount $...... . . . . . . . . . . . . . . .. held by ......................
.. . . . . . . . . . . . .. address ..................
..............................................
'-..
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(c) Mortgage recorded in Liber .............. Page................ in original amount
of .............. unpaid amount $...... . . . . . . . . . . . . . . .. held by ......................
. . . . . . . . . . . . . . . . . . . . .. address .............
............................................
8. There are no other encumbrances or liens against the land except .... /.'Y.'.<?<<~. . . . . . .
.......................................................................................
9. The land lies in the following zoning use districts .d:.R~~y. ~'...
....................................... ...............................................
10. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex~
cept ......... .1V~;v,t:;. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. The applicant shall at his expense install all required public improvements.
12. The land (does) (does not) lie in a Water District or Water Supply District. Name of Dis-
trict, if within a District, is ..............................................................
13. Water mains will be laid by ............................................................
and (a) (no) charge will be made for installing said mains.
14. Electric lines and standards will be installed by
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
lines.
.....................................
and (a)
(no) charge will be made for installing said
15. Gas mains will be installed by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and (a) (no) charge will be made for installing said mains.
16. If streets shown on the plat are claimed by the applicant to be existing public streets in the
Suffolk County Highway system, annex Schedule "E" hereto, to show same.
17. If streets shown on the plat are claimed by the applicant to be existing public streets in the
Town of Southald Highway system, annex Schedule He" hereto to show same.
18. There are no existing buildings or structures on the land which are not located and shown
on the plat:-
19. Where the plat shows proposed streets which are extensions of streets on adjoining sub-
division maps heretofore filed, there are no reserve strips at the end of the streets on said
existing maps at their conjunctions with the proposed streets.
20. In the course of these proceedings, the applicant will offer proof of title as required by Sec.
335 of the Real Property Law.
21. Submit a copy of proposed deed for lots sho"ring all r('strictions, covenants, etc. Annex
Schedule "D".
.
.
.
22. The applicant estimates that the cost of grading and required public improvements will be
$. . . . . . . . .. as itemized in Schedule "E" hereto annexed and requests that the maturity of the
Performance Bond be fixed at ..... . . . . . . . . . years. The Performance Bond will be written by
a licensed surety company unless otherwise shown on Schedule "F".
DATE.. ~~ ~-:-. .'...1. .~........, 198~.... .~~-:C-f~. .'lJ..~...
(;I"'" (Name of Applic.tn"t)
By '~10-../3.~....
(Signature and 'Pffie)
'" .k.~. a!'..~j).,1. .l#'~-<tf'
(Address)
STATE OF NEW YORK, COUNTY OF ...
. . . . . . . . " S5:
On the... .l.lit\1.......... day of... ..;r!1A~....... .............,198.2..., before me personally came
. . George. .13ol'l1J.e. . . . . . . . . . . . . . . . . . . . . . . . .. to me known to be the individual described in and who
executed
the foregoing instrument, and acknowledged that.... .he..... executed the same.
~2.~f<'~' 'SARAH .MAY.Q....
otary u IC NOTARY PUIll.IC. Stat. of New Yo'"
No. ~73721>4
Qualified in $ulloli< County "
Comml,,1on Expi_ Mar<h 30. 19 [f:J....
. . . . . . .. S5:
STATE OF NEW YORK, COUNTY OF. ... . .
On the.. .l6th........ day.."........ of ..... June...., 19..e<!.., before me personally came
G.eorge. )~Qe!1.:Ie. . . . . . . . . . . to me known, who being by me duly sworn did de-
pose and say that ...h<.:...... resides at No. ...ff~~9.~...............
-91t' aa &~.. . . . . . . . . . . . that ..... #fIt#. .. .. .. .. .. .. ... is the ..........
. . . . . . . .. .. . . .. '" of .........................................................................
the corporation described in and which executed the foregoing instrument; that ............ knows
the seal of said corporation; that the seal affixed by order of the board of directors of said corporation.
and that. .. ......... signed..............
name thereto by like order.
~.>tdl_yo.................
N tary il151'll: SARAH MAYO
NOTARY PUBliC, Stat. of New Yolk
No. 4737264
Qualified in Suffolk County
Commlaslon Expir_ March 30. 19 fa
.
/
.
FORM NO.3
.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No. ...............................
To .. .7?9.E/-I: ~ I!. I.. ~'!.~'f!.6.~.. .t...
~O_ Bo"A. 958
. . . . 1.'-' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date.............. /1.1:f.'.':-.. .6:19~ 7....
.. ..(1,I:.:!. I. 7 U. ~~!S .. f'f: X . .. . 0. 9,' 5 2-- .
f1 It- it.. '2. "2- 8" J.-
PLEASE TAKE NOTICE that your application dated. . . . . . . . . . . . . . . . . . . . . . . . . ., 19. . . . .
. VItO,NT t..f>.Nb C''C
for pe",u.LL Lv '--VJl;)LJ.u\,..l. . . . . . . . . . . . . . . . . . . . . . . . ."7. : . . . . . ~ . . . . . . . ':.' bR' . . . . . . . . . , . . . at
Location of Property .. .t:~S.~ .~~I.~L~~ 'P.'K.: (-!~~~t-.u~~.~np~J~:~~~~~ . tt.f\;-y' ~7!'~t<. . . . .
House No. Street Hamlet
County Tax Map No. 1000 Section.. . . . (07. . . . Block ....... r.. . . Lot )'1. 1-:.1) .. ...
Subdivision. . . . . . . .~ . . . .. Filed Map No. .....~....... Lot No. .. .~. . . . . . . . . . .
. t dh 'th dd' d th'II' d IN5'lff=r=I('~f\lT
IS re urne ereWI an lsapprove on e 10 owmg groun s . . . . . . . . . . . . . . . . . .. .,.........
A.7<.t:;..~.... ~. . .l?r;.F:.'!'.I:I:. ) . . . AR.T. .-!-! L. . .. ,( .C:C!.--:.~.I. .. 'J' . ! 1'/. . . !?!.~~ .. ..
A.. .~.d:'~v.,J;;.,,,-.'.~. .((~py~~. .~i. ~~!:......................
.. .... ............................. ................... ... ........ ....... ..... "0
])kSC!?r&C
ft./-
111/257 VICI;/ b"R........... .4< .;:':::~y.
Building Inspector
MAY FAMJE'R, 1:>'1<...
E-
RV 1/80
s - t)Rt...O~v<Jkl - 6"RAE13
LtJ - ~1/~o.D c.'I../ FF bR
~., ".;{! ",,,t?': alr->! .:<r 7JC ;Z~~ 73...", t t2ffnJ ,/:
p""d j--;t;0 @''''",.,~ 'R'O^J.. -fa,- :;a<..U"\ o/T'M;~ . ~~'"' ~
C~ ad $""", f'rL ;#.w-. ~(c.t;-ln'tA... /-,) a~ (' ~t~ .~4
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.
FORM NO.6
TOWN OF SOUTHOLD
Bu ilding Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
~! s JPpliCdtion must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
:r-;r 'tilth ttia following; for new buildings or new use:
1. Findl surJey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. "inal approval of Health Dept. of water supply and sewerage disposal-(S.9 form or equal).
3. ,"-pproval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
fions, a certificate 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-existiC\g"
land uses:
1. Accurate e;.JrJ"y of paoperty showing all property lines, streets, buildings and unusual natural or
topogrophic features.
2. SI,'.Jorn statement of owner or previous owner as to use, occupancy and condition of L.Juildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion rW"jUired to prep<Jre a certificate.
c. Fees:
1. Cutific;,te of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy S1.00
$5.00
Date. . . ;J I ~. ~/.<f. .;;. . , . . . .
New 8uilding .... . . . . . . . . . Old or Pre-existing Building ............ Vacant Land .....~...
Location of Property. f,<;/ (z..rrid.1{ ~ . .of- I!'! (/.1 ';-:1:-.0. ~~.'ft:-. II pr,.. . . . .. ./.J.:1.t1?e.r. ':'.9~
House No. Street Hamlet
Owner or Owners of Property . G.J ~:'.~'. ~/~. . It:. . f..8. (z: f':~~ !./lft . ~~ ...l? '?/.-:((4!Z
County Tax Map No. 1000 Section ~o~-I<7?:q'.-~1Block ........... _. .. Lot................
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fiied Map No. ......... .Lot No. .............
Permit No. ....... . .. Date of Permit ......... .Applicant . . . . . . . . . . . . . . . . . . . . . . . . _. . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................
Underwriters Approval. . . . . .. . . . . . . . . . . . . . . . . .Planning Board Approval. . . . . .. . .. . . . . . . . . . . . .
Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate
Fee Suhrnincd S 6', ()-O
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Construction on ab d 't,l .. . .
ove escn )eu building and permit meets all applicable codes and regulations.
Applicant. . ./.k-:&;-;:-7 . %. . le/ ~. . . . . . . . . . . . .. .
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