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HomeMy WebLinkAbout32437-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32473 Date: 07/16/07 THIS CERTIFIES that the building ALTERATIONS Location of Property: 1425 GULL (HOUSE NO.) County Tax Map No. 473889 Section 35 POND LA (STREET) Block 4 GREENPORT (HAMLET) Lot 11 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 18, 2006 pursuant to which Building Permit No. 32437-Z dated OCTOBER 18, 2006 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 ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARK BAISCH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 05-1420 12/12/05 PLUMBERS CERTIFICATION DATED N/A ~tt~m' Rev. 1/81 \'u~( ~~;)J I bd) .. OH.. . , TO'''I1" Qf ,,""TYO L..__" Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 OfJfTO /fjJ-t~'~. C filL-- [;/6- qqCJ- '33;1../ APPLICATION FOR CERTIFICATE OF OCCUPANCY This application mnst be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. 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 2/1 0 of I % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certi ficate 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: I. 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 Bnilding Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate ofOccnpancy - 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 r./:;.'/a7 /' Date. New Construction: Old or Pre-existing Building: GUl'- PC"I;) I IT Street ( check one) Location of Property: Il{2 S. House No. /-' ....,.~ilJfll2--, Hamlet Owner or Owners of Property: Y'IlFt-RK !2;.f} )' c, ('_ h ~c:; - Block y Lot 1/ Suffolk County Tax Map No 1000, Section Filed Map. Applicant: Lot: Subdivision Permit No. 3 !J.--Lj-s ? 2... Date of Permit. Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: (check one) Fee Submitted: $ Temporary Certificate f). S. 0 " Final Certificate: ~-V'11 Co~ J;.) If 7.3 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. 32437 Z Date OCTOBER 18, 2006 Permission is hereby granted to: MARK BAISCH 475 ROUTE 25A ROCKY POINT,NY 11778 for : WINDOW ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR WITH FLOOD PERMIT AS REQUIRED. THIS PERMIT REPLACES BP 30655. at premises located at 1425 GULL POND LA GREEN PORT County Tax Map No. 473889 Section 035 Block 0004 Lot No. 011 pursuant to application dated OCTOBER 18, 2006 and approved by the Building Inspector to expire on APRIL 18,2008. Fee $ 250.00 ORIGINAL Rev. 5/8/02 ())/Eb&I<S u '-1 ! ~ ~ 0 'Iff ~ ,:~ W ! 2"'2C' Robert Higgins Architect 50 Hidden Acres Path Wading River, New York 11793 r) LJ- ,OEP"" r("o'A.'N nr ~,...' 'THO' June 20, 2007 Attention: Town of South old Building Department 53095 Route 25 PO. Box 1179 Southold, New York 11971 RE: Town of Southold Building Permit # 324372 1425 Gull Pond Lane, Greenport, NY Town of South old Building Department: I, Robert Higgins architect, hereby certify that subject dwelling meets the New York State Building Construction Code requirements for structural framing alterations performed under the subject permit. In addition, I certify that the subject dwelling wind load strapping as installed in the field instead of the wind load strapping specified on the plans meets the New York State Building Code of2003. Sincerely, Robert Higgins, Architect 3'J--C!3~ TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRUCTION REMARKS~ - " S-7 [ ] ROUGH PLBG. [ ] INJJlUTION [vrFlNAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRAnON cJ,~ DATE (,1/1(,),1 I INSPECTOR " FIELD INSPECTION REPORT DATE COMMENTS ' ' V." V tll"l FOUNDATION (1ST) ,..~ ~~ ------------------------------------ FOUNDATION (2ND) ~,~~ \ I~l ~.........." I' '2: 9 :---. iJrJO ut, ;J ROUGH FRAMING & l"l !"l PLUMBING r (}J &#f"7/>. /I.. . r~~~.J m (~ ~ ~ ~~ f / ~r / rr rr.. "h.\' /'M.AJi. L_ INSULATIONPERN. Y. , --1'.1/.. ....: , ) "5 STATE ENERGY CODE ~ 4-//17 t;7.c. 4 A( . a/.-/-I' ,/ -" A*, ...J1 .'hZ I ~"'~"', ," ,-( / '27 7 " ~ 17/', J_o ArA r/."l '" 'f 1'/ /1 nfl {;' 'A ~ ')-:, " ~ v '\... W ./ , 1> FINAL ~ I' t. , , ADDmONAL COMMENTs (tI - I:) !> ~ . , CA _0 t:: :E ~ ~ , ~ k ...L , ~ ;:' ~~ G ~ I =: l"l .. \ ~ "-..., . =: I;l l"l ." ~ \)b ...1:.- <.Y ~ ~ t . ,,, , ~ " '~ . -.;:1 TOWN OF SOUTHOLD PROPERTY RECORD CARD 1-5 DIST. SUB. V ~(I--'r' ;", ~; ,A1- 2 ~ (ES. ~l() LAND SEAS. VL. FARM COMM. CB. MISe. TYPE OF BUILDING / .l,r"" ~, \ . . L~~e.(\~'1 1 . ,'/ Mkt. Value c' , .. N FORMER OWNER ,.-- Co Ga hn.-z j S W ?~() JhtJ IMP. TOTAL ~EMARKS .3 (Jt'J :-... tH> ;;..../ ()--.'l . () 00 i=~%OI' L( ~f'O r o HJ.II~'l"B'f , ".._'....".,..",_.,'-A~."..;,.~... " ..-. ,..,.-.....;,.......{,#/Jfi> Tillable 1 Tillable 2 nllable 3 Naadland ;wamplond 3rushlond FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD ',Ip.,c.';."""'"' -louse Plat -- rata I DOCK J i , ~..., '-. ~ "'~ . ~.... " ~ ~ ~ " '';.' .:' i, , COLOR T\ 141 , ..~~.... 'c 7, " > I , .",.' . I ,~~ . .. . 00"" fH u ~ , . . i . II I' [;.- j , TRIM .~ " > ~ t il" RCl )." . .... f$ ( '; \ ..' " I . ler., .. "'1 1 h V '" , IJ. 11'1 I '<I( 17 i Ir7 , , < ., - 7 I; I ~ 5 I 12/l3l./ M. Bldg. /?,X J 7= ~'2.1 ) . Foundation te-hvlio~';('.t Bath I~' <, Dinette 'f~)(~~~ ~~,-; , Extension ~.~~ L'2 Q Basement r;~ Floors ~ K. .'~ -.. , I' ...,.. ...-, :( 7.:J7 - 1/4: uJJ .,. O~I\ Extension I~XI/.l'='/g2 Ext. Walls Interior Finish LR. ". Extension SIC. 18 '" <;0 Fire Place I I Heat ~~, ~W DR. I. --- I' .. ,., / - A' .... Type Roof Rooms 1 st Floor BR. ... 'rN. /0)( J < - J.~ fl ~.5/) ....-- Recreation Roon Rooms 2nd Floc FIN. B. Porch Dormer Breezeway Driveway tot<<~e ? 1.)(' ') .c:-" t:;"7r::: 1.1S' 7/9' ~~K..S (0 ,)('2.b.=:;{.~' (.:<:7 . "1.("' I>=::.0.. ''ij",;,,_ r. O. B. ,12.!K <10 := .fil60J ~ .. I . Total 7.......7 , . )} ,r--. . 1< ! .~. -- 1 ) ... J ...... . 3'0&5'5' " . , J'tlpn:H T TERRY tOW1'l CLEfU{ (llWn ILtIl. 'ill)I.J<,I.'la, -. '. I' I, P,O, nil" 117" Sllulhnld New.Yur"- I , FJ)': L'i l(ll 7n~.IR"'"" Telephone (.'i 1('1 7(ls:--i ,t .... ItECISrnM or VlTN. ST^TlSllCS MAnn.tACr. OfTtCI.:n RECORDS Mi\J'lACEMENT OFrICf::1l rnEEDOM OF INf"ORMi\1l0N ornCEn 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 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under tlie Flood Damage Prevent regulations J of the Code of the Town of Southold: "Floodplain Development Pe rmit I I of Compliance ?fr Deve~<;,pmen I in Application" [FDP(93l), and ;:'Certificate ~..r Special Flood Hazard Area [C/C(93J], fQI:~\0;!~~~ ~i : 8L:iCi. or::rr TOV.;1 OF SOlITHOLD l " jH .~- ~~ ~T.T~ Southold Town Clerk August 25, 1993 '. " ., ., . . APPLlCA TION fI r^GE I of 4 TOWN OF SOUTHOLD fLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. , SECTION I: GENERAL PROVlSIONS (APPLICANT 10 read and ,iO!T1): 1. No work may start until a permit is issued. 2. The permit may be revoked if allY faise stalemenll are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall Dol be U5ed or occupied until a Certificale 01 Compliance is issued. 5. The permit will expire if DO work is commenced within six months of issuance. 6. AppliCaJlt is hereby informed thai other permits may be required to fulfilllocaJ, state and lederal regulatory requiremenlS. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable . inspections required to verify compliance. . 8. I, mE APPUCANl', CERTIFY 11IA T ALL STATEMENTS HEREIN AND IN A TTACHMEJ'ITS TO _ mlS APPUCATION ARE, TO mE BEST OF '.:bi' KNOWlEDGE, TRUE AND A<:C~1J' (APPLICANTS SIGNATURE)-,L!~ /4/7/' I)ATE.~'>/C"i " / / / ./SECTION 2: PROPOSED DCYELOprhENT (T~. ~e comolcted hv APPLlCANTl/1 NAME ADDRESS APPLICANT /l1!flK- G. fbfJ. ~cll I q,).~ BUlLD~ A . )J; L.,//MtL,'tt. ENOl (JUn! fI,''f?!.''~ s. TELEPHONE ~t([L f>>#J L,A, ~)/F !;;/ 6 ~ ~Cf? - 3. stJ-. / 6'1,/ - ,2o~ PROJECT LOCATION: To ~vcid delay in prooossing the application, plcase provide ennug.h information to easily identify the project locaUOlL Provide the Weel address, lot number or legal description (aflam) and. outside urban areas, the distance to the nearest intersecting road or weU-k.oO\lm Lindmark. A sketch atLachcd to lh.i5 application sbowing (he project location wouJd be belpfuJ. 1'-1,1<;; ~('(l L fJryA/c! LA. ~teQivJ:Y""T 9ou';TY Miff#- IOoe] <;;{!Cr.c,/../ n'~.s;:' rbLD('lc (Jq I La! I / FDP(93 ) ,,, ;\ .---~~' ~ APPLlCA TIO'" f! PAGElOFd DESCRIPTION OF WORK (Check all appGCJblc boxcs) A.~STRlJCTU~ QEVELOPMENT ACTIVITY STRUCTURE TYPE ~ential (1-4 Family) o Residential (More lh3Jl 4 FamUy) o Non-residential (Aoodproofwg? 0 Yes) o Combined Use (Residential & Commercial) o Manufactured (Mobile) Home (In M3Jlu- factured Home Park? 0 Yes) o New Structure o A.J.dition ~lc.ralioo o Relocation o DewoUtioD o Replacement p ESTIMATED COST OF PROJECT S .5 5;dJ () C) B. OTHER DEVELOPMENT AcrJVlTlES: o Fill 0 Mining 0 Drilling 0 Grading o Excavation (Except for Structural Development Cbecked Above) o '0>tercourse Alteration (Including Drodging and ChanoellylodiJications) i'J'Drainage Improvements (Including Culvert Work) o Roa;!4 S~ect or Bridge Construction / o SU~VlSlon (New or ExpansIOn) / . o !.9ilividual Water or Sewer SYSI<yO}J" [j Otber (Please Specify) W.L.M..:#-~ '/.2.~pL/tct. .A/JG:V T AI.er completing SECTION 2, APPLICANT should submit form to Local Administrator for review. " SECTION 3; FLOODPLAIN DETERM[N,\TION [To be com Dieted bv LOCAL ADMINISTRATOR) The proposed dcvclopmenr i.s located all FIRM Panel No. . Dated The Proposed Development: o Is IiQI loated in . Special Flood Hazard Area (Notify the .ppUcant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT [S REQUIRED). o Is l0C3tcd in a Special Flood Hanrd Ana. ARM 1.Onc de.<;ignalion i.s loo-Year Rood elev.tion .t the sile is: Ft. NGVD (MSL) o Uo.vailablc o Tbe proposed deyelopment is loc;llcd to a. Ooodway. FBFM Pancl No~ Dated OSee SUIIOIl <1 for ,j(Jdiliofla! in~I(lJ({ion~ SIGNED DATE '.' ".' , . .r APPLlCA TION 'I PAGE] OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED 1T0 he comnlcted bv L.OCAL ADMINIST~^TOR) u~~enappUcant must submil Ihe doeumenls checked below before Ibe appUcauon can be processed: / / , o A site plan sbowing the location of all cmLlng structures, water bodies, adj~ccDt roads, 101 dimensions and proposed development. o Developmenl plans, drawn 10 scale, and speciUcatif,l15, including wbere applicable: details (or anchoring structures, proposed elevation of lowest noar (induding bascme[]l), types of water resistant materials used below (be rust noar, deta.ils of OoodprooflDg of uLi.ljties located below !he flfsl noor and delails of enclosures below Ibe flfsl Ooor. Also. o Subdivision or other development plans (Iltbe subdivision or otber development exceeds 50 10ls or 5 acres. wbichever is tbe lesser. the applicant must provide I()()..year nood elevations if they are not otberwise available). o Plans showing Ibe extent of watercourse relocation and/or landform alterations.. o Top o( new rill elevation Ft. NGVD (MSL). o Floodproofmg protection level (non-residential only) Ft: NOVO (MSL). For noodprooCed s(I1Jctures. appUcant must attach c<:rtificalion (rom r"-gUtered engineer or architect. / o CertifiCJ.tion [rom a registered engineer that the proposed activity in a regulatory fioodway wilJ nol result In .,illY increase in the. height o( the lOO~year {lood. A copy of all data and caJatJations supporting tiill rwding must also be submiUcd. o Other: SECTION 5: PERMIT DETERMINATION ITa be comDlclod bv LO..:AL ADMINISTRATOR) [ bave detennined that the proposed activity: A. 0 ls B.O I, nol in conformance with provisions o( Local Law rI . 19 The permit is issued subject to the conditions attached (0 and made part or this ~rmiL -- SIGNED , DATE If BOX A is chec,ed, tbe LoGJJ Admin.istrator may lssue a Devdopmeot Perm;1 upoo payment a( designated fee. If ~OX B is chcck~d, tbe Local Admirustrator will provide a 'HIil(CO summary 01 dc[jcicncics. Applicanl may reVIse and rcsubmll an application 10 the LDcal Administrator or may request a bearing (rom {be Board or Appe:Js ." . .' " " APPLICATION N PAGE40F4 APPEALS Appealed 10 Baud or Appeals' 0 Yel 0 No Hearing dale: ---Appeals 'Burrd-Elecisioo"".Approved" 0 Y u 0 -1'1&---- Coodilions SE:CflON 6: AS.DU1LT ELE:VATlONS rTo be submilled bv APPLICANT before CertifIcate or Comoliancc is issued) The [oUowing iniormatioD must be provide.d [or projecl slruclures. This sectioD mUSl be completed ~y a registered professional engineer or a lieensed land surveyor (or attach a certiIicatinn to this application). Complete 1 or 2 below. 1. Aetual (As-Built) Elevation of the lop of ihe lowest Ooor, including basement (in Coastal Hi2h Haza'rd Areas. bottom of lowest structural member of tbe lowest noor, excluding piling and columns) is: Fr. NGVO (MSL). ~ 2.' Actual (As-Built) Elevation of noodproofmg protection is Fr. NGVO (MSL). , . . . , ' NOTE: Any work perrormed prior to submittal .of the above information is at tbe risk ,6r the Appl.:canl. ! ! ! ) I .' SECTION 7: COMPLIANCE ACTION ITa be comulcted bv LOCAL ADMINISTRATOR) The LOCAL AD~llNlSTRATOR will complete tbis section as applicable based 00 inspectioD of the project to ensure compliance witb the commllllity's local law for nood damage prevention. INSPECTIONS: DATE DATE DATE DEFlCfENCIES? 0 YES 0 NO DEFlCIENCCES? 0 YES 0 NO DEFICIENCIES' 0 YES 0 NO BY BY BY SI::CTION 8: CERTIFICATE OF COMPLlANCl::fTo be eomnleted bv LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: " .. , , " . " " ! j Attaclunent B / Bl\H~GE CERTIfrCATEj-1F COKPLIAlICE for Development in a special Flood Hazard Area ", I., . , #, ~" . . , II .. .' TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT [N A SPECIAL FLOOD HA.Z.ARD AREA -fQWNER MTIST RETA TN mIS CERTlFKATEL -- ". PREMISES LOCATED AT: OWNERS NAME AND ADDRESS: " / I .' PERMIT NO. PERMIT DATE CHECK ONE: o NEW BUILDING o EXISTING' BUILDING o VACANT LAND '.. THE LOCAL ADMINISTRATOR [S TO COMPLETE ~ OR B, BELOW: A. COMPLlAl'lCE IS HEREBY CERTIFIED WITH HIE REQUIREMENTS OF LOCAL LAW # ,19 SIGNED: - DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH HIE REQUIREMENTS OF LOCAL LAW # ,19_. AS MODlFIED BY VARIANCE # DATED SIGNED: DATED: C I C (93) BUILDING PERMIT APPLICATION CHECKLIS' Do you have or need the following, before applying' Board of Health 4 sets of Building Plans Planning Board approval Survey Cheek Septie Form N.Y.S.D.E.C. Trustees Contact: TOWN OF SOUTH OLD BUILDING OOPARTMENT TOWN IJALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southold/ 3~ ~37 PERMIT NO. 3OS'56~ Approved Disapproved ale 9/?~ ,20~ 9/~;::; ,20--.!:L Examined CIrfT C/itk-L,'I!. - (2, {A___ 6/6- "lit 9- 2..3.;t { 2 0 2004 APPLICATION FOR BUILDING PERMIT Mail to: Expiration I ~eiJ: ,20 c... Phone: \,. Date ,20_ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 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 of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, 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 regu..1id"d to admit authorized inspectors on premises and in building for necessary inspections. V / ,/75/2...7 lS/f !<.OC/.(L/ ftJ/jl/~ IV.! / /778 J (Mailing address of ap lieanl) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder OWNer<- Name of owner of premises }/Iff 1<.1"-. &- ( i3fll St II (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. tj~0g!:l -p 1. County Tax M~ No. 1000 Section (33 S Subdivision /--tJ!<..DI-f/fNllTc.Pr-5Jc-C-!,/ (Name) Block 0 t-f Lot Filed Map No. 30'1 LLot II. p / C!> L-'(!JF IS- o I. 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiOli: a. Existing use and occupancy , )} 1// Vi L IE:- F4.NII L Y f</U II? Gw' cE b. Intended use and occupancy ""lilt/' VI L /~ /-::- /j /Y( I L 'f r</J / 0 E /i/ L E.. 3. Nature ofworkJcheck which applicable): New Building Repair L Removal Demolition -$f .' 4. Estimated Cost 3 S. (J Cl C> J Addition Other Work Alteration ~ (Description) Fee 5. If dwelling, number of dwelling units If garage, number of cars / (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. ;v'/rt 7. Dimensions of existing structures, if any: Front I tj, '7 Rear?.3 , il- Height / if Number of Stories ! Dimensions of same structure with alterations 9r additions: Front if, 7 Depth 0"-5: &:, Height / 'L Number of Stories Depth oS. fLJ Rear 13. i!- f 9. Size oflot: Front 8. Dimensions of entire new construction: Front' 0 Height 0 Number of Stories (') ( / J {)'/. :)7 r Rear /02.2-3 (Depth /93. 0 ;. Z-lf.:r: 7 . 10. Date of Purchase i /1.-3/0 t Name of Former Owner JV(')Ji?JfII1,i/ .j. rf LI3:-/~ 'D . I WIr-=PEtZ-.SUN 11. Zone or use district in which premises are situated _KP-.s" b P-07( 11 L- Rear () Depth () 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO V 13. Will lot be re-graded? YES NO . II'Will excess fill be removed from premises? YES NO / - - '/7JRTz.'Ji1 - 14. Names of Owner of premises Mltrt-IL Blfr.5LIiddress (.2{;C-r~ PT; II Z Phone No. t-3/ -7'11-.5706 Name of Architect R(';/3E.t2-7tJI c;t"tllJ Address () etI. If1 f>q Phone No f'r~;;; / '- z-oB -3.3SI Name of Contractor - Ow ~ ~ Address rllll7. 1"'-'V,-l1LPhoneNo. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES VNO_ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMIT~ Y 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. Ifelevation at any point on property is at 10 feet or below, must provide topographical data on survey. being duly sworn, deposes and says that (s)he is the applicant g contract) above named, S)He is the 0 W Aft::" tZ- (Contractor, Agent, Corporate Officer, etc.) Jf said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be Jerformed in the manner set forth in the application filed therewith. ;worn~ before me this C'> J..,. .. bv.r ~,"Yof a~ t;ary Public JENNIFER FIRD HERMANDEZ NOTARY PUlllC.STATt Of NEW '/ORK No.Ol.ft61114U6 QUQlIlled In Sulfolk County Commission ExpIres January 12. :lGOe -- -r N I.... FNC. 0.3S GULL pO~O ~1_ _l'~- Pia LOT 15 -- J (]) ~I BH 0.75 O,6E FRM. WALK OL NS O.BE BH, 9100 0.55 A'.O' 0.2W S "1' FRA E BULKHE/'oO FRAME 8 LANDING ~u & STEPS . iE ~ ~ 0,. '" K &. R/'oMP FRAME FLOA l1NG DOC '3' 02..2. \'IE"O E euU<: BH F"/'oW. 0.6W WALK 2.1 ~"LK <"w.. MON FND. 0.65 C.L.F. FNC. 0.35 0.75 ... ",' 17. FRAME LANDINGS 1,5' b ,... Lri -.t N ~~ w . u..1") ",en z.... ::J ;., !?j LOT 14 u z "- w o < '" () o ,.. UJ '" b 8 .. 8 o <D C.L.F.2: 0.3N z <( I () b .. 12.4' LOT 16 FNC. 0.15 F~~ME 23.2 4SPH4 . '" DRIVE: L T <ri FR4ME: '" '" G4R4GE:lI)' '" 23.2' 11.4' 3: ~I if 0::: o z: . o o b P o to (/) CERTIFIED TO: Mark E. Baisch Chicago Title Insurance Co. MON FND. GULL P OND p U.P. L1L #13 -- UN4UTHORlzm AL TERAnON OR ADDITION TO THIS SURIlEY IS A WOLA nON OF SE:CnON 7209 OF THE NEW YORK STA TE EDUC4 nON LA w. COPIES OF THIs SURVEY MAP NOT BEARING THt LAND SURVEYOR'S INKED SEAL OR EMBOSSED StAL SHALL NOT BE CONSIDERED TO BE A V4L1D TRUE COPY. GUARANTEES INDICA TED HEREON SHALL RUN ONL Y TO THt PERSON FOR WHOM THE SURIlEY IS PREPARED. AND ON HIS BEHALF TO THE nTLE COMPANy, GOVERNMENTAL AGENCY AND LENDING INSnn./nON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INsn- TUnON, GUARANTEES ARE NOT TRANSFERABLE. L.4Nt SU~VEY OF': P /0 LOT No. 15 MAP OF FORDHAM ACRES. SECT. ONE FILED MAR. 07, 1962 FILE No. 3519 KENNETH H. BECKMAN. L.S. Surveying and Land Planning 1814 Middle Cbuntry Road Suite D Ridge, N.Y. 11961 (631) 345-9427 FAX (631) 345-9429 SITUA TED IN: GREENPORT TOWN OF: SOUTHOLD SUFFOLK COUNTY. NEW YORK DATE: 04/13/04 JOB NO. 804-8211 SCALE: 1" - 30' S.C.t.M. NO. OIST. 1000 SEC. 035 BLK. 04 LOT 11