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HomeMy WebLinkAbout32497-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32722 Date: 11/13/07 THIS CERTIFIES that the building ADDITIONS Location of Property: 374 NORTH (HOUSE NO.) county Tax Map No. 473889 Section 106 DR (STREET) Block 6 MATTITUCK (HAMLET) Lot 28.4 SUbdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 2, 2006 pursuant to which Building Permit No. 32497-Z dated NOVEMBER 15, 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 ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5892 DATED 6/8/06. The certificate is issued to FRANCIS & NANCY DEEGAN (OWNER) of the aforesaid building. N/A SUFl'OLK COUl'I'l'Y DKPAR'l14KHT OF HEALTH APPROVAL 03/28/07 ELECTRICAL CERTIFICATE Il1O_ 3023975 N/A PLOMBERS CERTIFICATION DATED ~b!f!!::- Rev. 1/81 , Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 \ I \ \ , NOY 1; '7 ~ ~,....-- APPLICATION FOR CERTIFICATE OF OCCUPANC~ This application mu~t be filled in by typewriter or i* 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 2/10 of I % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certitic~te 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 Building Inspector shall state the reasons tlferefor in writing to the applicant. C. Fees -# 2.S- dJ. ..~~ fiJ~. I. 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 New Construction: Old or Pre-existing Building: 7' /1~ij~O) (check one) 1-1/9 7T / T 1/ el\ Hamlet Localionofproperty: Sa d lVol2Jl-I D.e/ 1/ C House No. . Street Owner or Owners of Property: 4./1# t./5 ..,....1/I.f1Af~y J;;&:-. IS &'/1 rI .' IO/' ( Suffolk County Tax Map No 1000, Section 0 Block C> 0 0 .c Subdivision .s f{ () If re- A L~ F. S" Filed Map. .#S1/ PennitNo.3~~?7 Z Date of Pen nil. (//lsl06 Applicant: OWAl.E:/C Health Dept. Approval: N A Underwriters Approval: 4- .3 C>2... ~ 17.J /V/! Lot 02d'. () Oy ~/tJ r, L \\ . Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ =?' 5 IJ-.tJ Final Certificate: L (check one) ~,133'6rp c o~3;)1)...:J... .~il!Imffi! ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I Located at ~ Application Number: I Section: I ~ ~ ~ ~ ~ ~ ~ I ~ I ~ ~ Paddle Fan ~ ~ ~ ~ ~ ~ ~ ~ I ~I!l BY THIS CERTIFICATE OF COMPLIANCE THE Nt,. -(" ~2.'g.' ~ NEW YORK BOARD OF FIRE UNDERWRITERS ,~I BUREAU OF ELECTRICITY ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ I ~ ~ I I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~ I ~ I i I ~ ~ I ~ ~ I ~~~~ CERTIFIES THAT Upon the appl ication of upon premises owned by RJ, CORAZZINI ELECTRIC 320 RICHMOND LANE PECONIC, NY 11958, FRANCIS DEEGAN 500 NORTH DR MATTITUCK, 52, 500 NORTH DR MATTITUCK, NY 11952 3 2lfq 7 3023975 3023975 Certificate Number: Block: Building Permit: ns11 Lot: BDC: Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, Second Floor, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 28th Day of March,2007. Name OTY Rate Ratio. Circuit IY!ll; Miscellaneous 1st & 2nd floor addition Wiring and Devices Outlet Fixture Outlet Receptacle Switch Dimmers 20 0 20 0 25 0 19 0 7 0 3 0 I 0 Fixture Incandescent General Purpose General Purpose General Purpose seal I of I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 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. 32497 Z Date NOVEMBER 15, 2006 permission is hereby granted to: FRANCIS & NANCY DEEGAN 500 NORTH DR MATTITUCK,NY 11952 for : ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR PER ZBA DECISION #5892 at premises located at 374 NORTH DR MATTI TUCK County Tax Map No. 473889 Section 106 Block 0006 Lot No. 028.004 Building Inspector to expire on MAY 2, 2006 and approved by the 15, 2008. pursuant to application dated NOVEMBER Fee $ 224.10 I~A~ Qf)[ I Authorized Signature ORIGINAL Rev. 5/8/02 APPEALS BOARD MEMBERS Ruth D. Oliva, Chairwoman Gerard P. Goehringer James Dinizio, Jr. Michael A. Simon Leslie Kanes Weisman http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809. Fax (631) 765-9064 Mailin~ Address: Southold Town Hall 53095 Main Road. P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex /First Floor, North Fork Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF JUNE 8, 2006 ZB File No. 5892 - Francis and Nancy Deegan Property Location: 500 North Drive, Mattituck CTM 106-6-28.4 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned. PROPERTY FACTS/DESCRIPTION: The applicant's 28,750 square foot parcel is improved with a one and two-story dwelling with garage as shown on the February 24, 2006, site plan prepared by Matthew L. Moed, P. E. BASIS OF APPLICATION: Building Department's March 14, 2006 Notice of Disapproval, citing Section 100- 242, in its denial of an application for a building permit to construct additions to an existing single family dwelling. The reason slated by the Building Inspector in the denial is that such additions and alternations will constitute an increase in the degree of nonconformance. The proposed side yard setback is 5' 7" and Section 100-244 requires 15'. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on May 25, 2006, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED:, The applicants wish to construct an addition to the front of their dwelling, which has a non-conforming side yard of 5' 7". 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 variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The terrain of most of the land is sloped, varying between I 0 feet to the easterly lot line (creek) to 40 feet or more at the opposite westerly lot line. The existing one and two-story home follows the line of the bank at the east side and is not square on the lot. The home has a 5.7 ft. nonconforming side setback that existed for many years, and the new two-story construction will replace a section of the one-story portion, without reducing the nonconforming 5.7 ft. side yard at the north yard. The neighboring houses are behind the bank, staggered along the bank rather than being along side each other. Page 2 - June 8,2006 ZB File No. 5892 - Mr. & Mrs. Francis Deegan eTM No. 106-6-28.4 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. The home has been existing for many years. 3. The variance granted herein is substantial because the code requires 15 feet on a single side yard, and the new construction will be 5.7 feet at is closest point. 4. The difficulty has been self-created having knowledge that the home has existed with the northerly nonconforming side setback. 5. No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. 6. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an addition, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Goehringer, seconded by Members Dinizio and Weisman, and duly carried, to GRANT the variance as applied for, as shown on the 2/28/06 revised site plan prepared by Matthew L. Moed, P.E. 4/2/06 floor and elevation diagrams prepared by Matthew L. Moed, P. E., with ZBA date stamped April 13, 2006, subject to the following condition: That the two story addition have large (oversized) roof gutters with leaders into dry wells for the purpose of catching water run off. Any deviation from the variance given such as extensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, are not authorized under this application when involving nonconformities under the zoning code. 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: Members Oliva (Chairwoman), Goehringer, Dinizio, Simon, and Weisman. This Resolution was duly adopted (5-0). ~ t) _ ~ Ruth D. Oliva 7/ c:.o/06 Approved for Filing .--'--' , ~ I '-1n' } -----' ]AMES]. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-5506 v :1 ') c. ~()I 5 ~ . .j\1 . .J . 0',,\ To: Town of Southold Re: First and Second Foundation Inspections Deegan 500 North Dr. Mattituck, NY 11952 Permit# 32497z To Whom It May Concern: This letter certifies that a first foundation inspection and dampproffmg inspection was preformed on the above mentioned property and was all done correctly and meets all state and local codes. Any questions please feel free to call. ]ame ] Deerkoski P.E. ]AMES]. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-5506 r i 'j :\ r/ 7 ~- rH _......~! ~~' .. "',', J ,) ,.~---..,_.- .....~. To: Town of Southold l T'::__. Re: First and Second Foundation Inspections Deegan 500 North Dr. Mattituck, NY 11952 Pennit# 32497z To Whom It May Concern: 1bis letter certifies that a first foundation inspection and dampproffing inspection was preformed on the above mentioned property and was all done correctly and meets all state and local codes. Any questions please feel free to call. es]. Deerkoski P.E. JAMES J. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 To: Town of South old Building Dept. Date: February 15,2007 Re: Insulation Inspection Deegan 500 North Dr. Mattituck, NY I 1952 Permit #32497 To Whom It May Concern: After an Insulation inspection was performed on the above property, it is deemed that all Insulation was installed correctly, and meets all building codes. Any other questions please call. FEB I 5 20G7 JAMES J. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 .3 I 20CI d _J T(" To: Town of South old Building Dept. Re: Framing! Strapping Inspection Deegan 500 North Dr. Mattituck, NY 11952 Permit#32497 To Whom It May Concern: After a Framing, and Strapping inspection was preformed on the above mentioned property, it is deemed that all work performed was completed to plans and meets all state and local codes. Any other questions please call. ... ~ ; ?-Lf~ 7 'Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [~FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPEC'nON [ ] RRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRATION REMARKS: N'~ 1:1;, trr- ~ ~ tf-.r- !-,~~ ~ ~-, ~t)k ~~~ /1-)0- 01 DATE INSPECTOR ~~ " . FIELD INSPECTION REPORT DATE COMMENTS ~ ~ 'U~ ji NJ"" ~d (jr:i Z \}.J~ .J -L- '" 2~ ol"l 'P'" ;1., 0 iO -- <. (1\ ! l"l .., 1-31-01 C'M.~ fe Jv. L: v -,.. ~-jS--o 7 r~/lt .-J.. . ft:. ).e; . - v FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL 7&.: \~ f/ n;\"o . r ~----f--~" -,,---- -..... A A \ v.. " l' ~ ~.L ../'I" ....... I ./ -- -...... -- ---.... -..--_..--..-.....~ qL..~ .. -\--~-~-- 1-------- "fl- 3M Ij ~ ~ AI ~, JJ . ~ '11t-- -L.~ \ _11 l! I V J..-...JL..-..... ~ ~_:H" , l<l/ ~ (. ./L./..... fTJ \ v"..... ADDITIONAL COMMENTS -- r-:7'- ~ .-+r-- '\ de:;yr 'h I: /' - """ ~~ . ~I' ~ /..// ~ ;u ~ ~ ' [~ \ A . (7 , . U\ l"l \ ~ (/\~ , .., o ... O('~ ~ .., = I:i ~ ~ SURVEY OF PART OF LOT L MAP OF SHORE ACRES FILED JANUARY 3, IQl4, MAP No. 41 51l1JA TE: MA TTI11JC,K TO.,...: 5OUTl-IOLD SUFFOLK COUNlY, NY SURVEYED 12-14-2006 SUFFOLK COUNTY TAX II 1000 - 106 - 6 - 2E>.4 U5K11I'IISU TO: I'RANCIS DIlBGAN NANCYDIlBGAN I L.ot M , I 889042' lO"E 332.90' , c;.haln link 4 stoc;.kQde fenc.e gate , ----- , , . '- , ~ , / - +/? ~ t'-: I/,f! 00 Yd~ 00 II ~ ~v "i f.lJ rfG ~v t-. P /0 L.ot L. , ~ .J 0 ""TIo !l1 - , 0 is .......--~,. ~, ::l - w 0 , l= rn , .-1, 520' 889046'()()"E I 335.70' ~ L.ot K ~ NOTES. . Me*lJMENT FOUND FLOOD ZONE ANNOTATED FROM FEMA FIRM MAP NJMBER 36100c0143 6 AREA = 2Q,114 S.F. or ObE>21 Ac.re GRAPHIC. 5c.AL.E ~ 1"= 40' I \w '--J N w4-E S ~ ~ ~ L \) ~ \) J ...w .- ...w ...w " L -----"",,-- ....iC~..:......:=-~::;:c:"T'..:. .:. _'!'"""'-~~.. ~~=;T:":'~ .........____to___ -" ~-----~-- ~..r=t1_-,""",IIIIl_- ~_"'ar..";:~~~ ~~......---::=:;:""~ ~..;.:;~..:.:.,......::.....-=t::': """'~d_-,,__ ~ __IlM~IO__ JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREBT N.Y.S. UC. NO. 50202 RIVERHBAD,N.Y.11901 369-8288 Fax 369-8287 REF. \\CompIqserve1\pro8\06'4l6-248.pro l/:lW \"o-rK ;)lale uepanrnelll UI envrrOnmen131 \,.,onservauon Suilding 4O-SUNY. Slony Brook, New York 11790-2356 FraMJs W' D~-ejqn SOD l\)()d'-1 .b"'I'~ J-{q+tituGk,jJ~W~Dje.k /IU2 OAT:::: it- fr / ( ,) /'1"1,), REi: 1-."7?:Ji-ODl./b<;/OOOO'-()~ bc.~ Pr6f<'.J?-fy atl ...... .......,. . Thomas C. Jorllng Commissioner Dear HR. Dee..Jqn: A review has been made of. your fr-cfeR.+i itJc"lf-<d.. lLC S-OO lJ,n..,./. !JI'''~ Jvlqtf(tuc..k, !Je.w Y()lCl::j St!.Tfi ,'000- to!:.-" -PjO.:!i"'. ;}~",,,,'cf./ll'j +e ~ S\)f{tJe.'( fr-Lf(H'e.C( "'I, R"clU'.c.k VWK I Lit II J'l-f"ct :;JQ.,UClI-'1 ..;!ij 'Cj7~ -fJ,ls frofJ;'<:'~ o..c.-f,l)lt'j QI,.( 0."'/ fc'tt.u'(.. <lef/v, ft {q,.e/War.[ "f 9-1, C/"t:..s+ c-f +-f.-o.. IJ/t,d'.f ;:S Dl.-t q-f (H'..,. J "(lllsCP/t:.f/ON, Based on the information you have submitted, the New York State Department of E~vironmental Conservation has determined that the parcel ' ~ project is: Greater than 300' from inventoried tidal wetlands. Landward of a substantial man-made structure greater than 100' in length which was constructed prior to 9/20/77. Landward of the 10' above mean sea level elevation contour on a gradual, natural slope, ~ Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level, Therefore~ no permit is required under the Tidal wetlands Act (Article 25 of the Environmental.Conservation Law). Please be advised, however, that no construction" sedimentation or disturbance of any kind may take place seaward of the 10' 'contour or tOP09raphic~ crest withC?u,t p pe,:mit. It is _ your resporisibility to ensure that all'necessary precautions .are taken'to.- prevent'any sedimeqtation or other alteration-or- di:sturbance to the ground surface or vegetation in this area as a result of your project.. Such precautions may 'include providing adequate work area between the . 10' contour or top09~aphic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale b.erm. " . . . Please note that any additional work,~or~~dification to the project as. described, may require authorization by th~~ Department. Please contact this office if such are contemplated. Please be further advised that .this letter does not relieve vou or the responsibility~of. obtaining any necessary permits or approvais from other agencies. . . Very truly your?, #UMt ~ Deputy Regic~al Permit Administrator :"fi ill fw(t. t......--' INr .JAN 2 2 1996 . l!LOG, DEPT. ':r-",.,!~ QF SOUr"lCl'.Q..... TRUSTEFS 1ohnM. BmIemeyer, m. President Henry P. &uilh, Vice Presidetat Albert 1. Krupski, 1r. 10bn L. Bedoooii.1r. 1ohnB. Tuthill Te\ephon.. (516) 765-1892 Fax (516)765-1823 February 20, 1992 SUPERVISOR SC01T L. HARRIS Town Hall 53095 Main Road P.O. Boll 1179 SouIhoId, New Yark 11971 BOARDOlJ'TOWNTRUSTEES TOWN OF SOlITHOlD Francis W. Deegan 500 North Drive Mattituck, NY 11952 RE: SCTM 11000-106-6-28.1, 28.4 Dear Mr.. Deegan: After an onsite inspection of the above mentioned property, the Board of Trustees finds your proposed addition to be out of Trustee Jurisdiction. If you have any further questions, please do not hesitate to contact this office. " ~tru::' ~Z John M. Bredemeyer.. III president, Board of Trustees JMB:jmt cc: Bldg. Dept. . 't , -"'. L~~~rW~ .- J/IN 2. 2. 1996 . i BLDG. DEPT. O! D Tl"WN OF SOUTH . -~ . TO~ OF SO:X: BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southoldl f '.:;) ,., PERMIT NO. 3~ L/ti7 b I;' II BUILDING PERMIT APPLICA nON CHECKLIST I l Do you have or need the following, before applying? , ., . --' Board of Health 4 sets of Building Plans -- Planning Board approval Survey ~ Check -::If [0.2 '-I Septic Form N.Y.S.D.E.C. Trustees Contact: -n,.... ..1' I L re' "'___'m .._...J . ;,,_;. C~:-::'T. ~..2'~j)THOl!) Examined Approved Disapproved ale ,20k ,20~ Mail to: Expiration 5';'5' ,20JJL , Phoneb2 1/9; - D 30 L{ I~ I Building Inspector APPLICATION FOR BUILDING PERMIT ,20_ Date INSTRUCTIONS . a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets 0f 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 arells, 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. I 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature ...j;o M~TI1 ))~;JIE, MflTT1Tllt.k, NY 111 S 2...... (Mailing address of applicant)' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder owt/.el( Name of owner of premises Ft'I'INO'> W. Qt;;~t:..;:jrJ '>f- /triNE.;' J>;;;:E.tfrAN (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. Eleitricians License No. Other Trade's License No. I. Location of land on which proposed work will be done: ,-5-00 NOR.TH ,])/C/I/$" House Number Street Ml'itr'r/)~k Hamlet County Tax Map No, 1000 Subdivision .5Ho.te.E (Name) Section / () C:, /-?~;eliS Block b Filed Map No. 1"-:"\":'-"- ... , . ,- I v' , _Il.'~, ",,"'w'Lot Lot dj1f. . ..-41. "L ~; ,'r;J .-Y' ~T 2. State existing use and occupancy of premises and intended use Wd occupancy of proposed IXlnstruction: a. Existing use and occupancy / r/lMIL y J W/;,L.Lt AI 6-- I b. Intendeduseandoccupancy / h'tMILY .J)WE,L.L./III&- I Addition Other Work /' Alteration 3. Nature of work (check which applicable): New Building Repair Removal Demolition (Description) 4. Estimated Cost ~o 000 ) 5. If dwelling, number of dwelling units If garage, number of cars Fee / (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. 7. Dimensions of existing structures, if any: Front .5'0. 'J Height Number of Stories Rear 2- ..30. 7 Depth 01'1. 'I Dimensions of same structure with alterations or additions: Front Depth 'i tf. / Height Number of Stories Rear f;~. 2...... 8. Dimensions of entire new construction: Front c.5"O. 9 Height Number of Stories ' Rear 2...... .50.9 Depth ~'I, / 9. Size oflot: Front 10 Rear 10 Depth .;< r? 3 . 10. Date of Purchase / '1 .P 5' Name of Former Owner I'\ofl' , 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_ * 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: COUNTY OF Sf/Ho't-Ie ) ~MNC.IS W' .J)€J5! C;/iN being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the 0 tv p ere. (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. rn to before me t~Yv\ ' day of PJrv\.-. . 20~ ~~ Signature of Applicant ---- MELANIE DOROSKI NOTARY PUBlICbState of New'lHll No. 010 4634870 Co . Qualified in Suffolk County \J'\/V nunlssion expires Septemb8l3ll.~c> -- . - . ""I1l/~fNCt. ~iH~EY ! -'-nTf]. . . ~. ......J'1IJtj,f.t # ',11"r j r,cONf) 7-/JE O(J' fM?~ ~.~"ui- (}Jv.A 1 ~ ~f~ ~ rh ~, ;v . i ..., ,,,,~'!~n Mil 1 3 2006 r~~ ?-. NQ 80A 0 .J:e" , ..-' !to ~ ltN'w-.Jr:f. ~CLL.lY.Ii.~ Al'l1iTR."" t._. Ac. ~ ~1n:ltJ'l1l.Dt'l7T~YltJ:JfEl. #1 , (/I-' .' / . I I I t I ~. ~ .-~ , . I I I , D~.",.} '0 ~",' _~I!P!K - .Ib:t,,,. 'k~.1J!L ::itA.' L' I S.1' . 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