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HomeMy WebLinkAbout35288-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34163 Date: 01/13/10 THIS ~KTIFIES that the building "AS BUILT" DECK ADDITION Location of Property: 13650 SOUNDVIEW AVE SOUTEOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 3 Lot 7.1 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 22, 2009 purs,,ant to which Building Permit No. 35288-Z dated JANUARY 5, 2010 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LYNNE WENTWORTH (OWNER) of the aforesaid building. SUFFOLK COUN~"f DEPART~NT OF HEALTH APPROVAL Z.R~-rKICAL CERTIFICATE NO. PLD]~ERS C~KTIFICATION DA'r~ N/A N/A N/A '+/'~!(~ i z/e d~l ~ nat ur e Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application 1Tiust be filled in by typewriter or ink and submitted to the Building Department with the t For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusua' 3. 4. 5. topographic features. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). Approval of electrical installation fi'om Board of Fire Underwriters. o~ ng: nntllrnl q y~'~.~i Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. Commercial building, industrial building, multiple residences and sirmlar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. 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. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A/terations to dwelling $25.00, Swimnfing 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. 1/5/10 New Construction: Location of Property: Old or Pre-existing Building: X 13650 Soundview Avenue (checkone) (as bu±lt deck) Southold House No. Street Hamlet Owner or Owners of Property: Lynne Wentworth, as Executrix of the Estate of Mildred Boyce Suffolk County Tax Map No 1000, Section 054.00 Subdivision Map of Northwood Estates at Southold Permit No. Health Dept. Approval: Plarming Board Approval: Date of Permit. ~ - ~ -~ L) Block 03.00 Filed Map # 5675 Applicant: Owner Lot 006.000 & 007._0~L.7.x Lot~: 8 and 9 Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ 25.00 Final Certificate: X (check one) Applicant Signature ' Lynne Wentworth~ Executrix 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. 35288 Z Date JANUARY 5, 2010 Permission is hereby granted to: MILDRED BOYCE ESTATE 13650 SOUNDVIEW AVE SOUTHOLD,NY 11971 for : "AS BUILT" DECK ADDITION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 054 pursuant to application dated DECEMBER Building Inspector to exq~ire on JULY 13650 SOLTNDVIEW AVE SOUTHOLD Block 0003 Lot No. 007.001 22, 2009 and approved by the 5, 2011. Fee $ 400.00 ORIGINAL Rev. 5/8/02 owNER , FREET / ~-'25/~ 6(~, ~"~,/ "-'/ 's FAR~ -- 9o · ToWN OF SOUTHOLD PROPERI~Y"REcoRD CARD DATE VILLAGE E W I SEAs. /' · ~ VL ') .- RES.~ i_AND - IMP. TOTAL CB. MICS. M~, REMARKS DIST. jSUB. LOT ~ ,,~ - ! ACR ' "", I .,.,~." · TYPE OF BUILDING 'alue , ' Tillable· Woodland Me,',dnwloncl House Plot FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD ¢ Total · / ¢ Extension ~xtension // Porch BreeZeway Garage Patio Total 24 ,'(,Yd = Foundation j I~aa~e4 , Both Fire Place Type Roof Recreation Ro~m )ormer Heat Rooms 1st Floor ~aoms 2nd Floor )riveWay Hnette LR. FIN. B '~T_.OV~H OF SOUTHOLD PROPERTY--RECORD CARD OWNER STREET FORMER OWNER N F~',-~.~s S VI LLAGE E ~D,ST. SUB.LOT~ ? ' TYPE OF BUILDING RES. LAND iMP. - Woodland TOTAL FARM CO/V~M. CB, MICS. Mkt. Value DATE REMARKS Tillable FRONTAGE ON WATER FRONTAGE ON ROAD MeadOwland H ,OUse pl~ Total DEPTH BULKHEAD NOTICE COUNTY OF SUFFOLK Reol Property lax Service Agenc'/ SECTIO~ NO PROPERTY MAP CONSENT TO INSPECTION Estate of Mildred Boyce Lynne Wentworth, as Executrix of the -- , the undersigned, do(es) hereby state~ Owner(s) Nmne(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, locatedat 13650 Soundview Avenue, Southold, New York 11971 which is shown and designated on the Suffolk County Tax Map as District 1000, Section 54 ~ Block 3 , Lots 6 & 7 That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: c.o. application of "as built" deck · That the undersigned do(es) hereby give consent to ~he Building h~spectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, roles and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, roles or regulations of the Town of Southold. Dated: January 5, 2010 ~z" (Signature) Lynne Wentworth, Executrix (Print Name) (Signature) (Print Name) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork, net/Southold/. Examined. ., 20.__ Approved ,20.__ Disapproved PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Buildlng Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Expiration ,20__ b [(; ' 2 I[_~PLICATION BUILDING PERMIT ' I INsTRuCnONS December 14, ,2009 a. This application 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. e. 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 f~om 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, ho.~i~g code, and r~gtflations, and to admit authorized inspectors on premisas and in bui!ding for necessa~ inspeetions~~ / //(Signatm-e'of applicant or name, if a corporation~') P.O. Box 1424, gattitunk~ NY 11952 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Agent Name of owner of premises Lynne Wentworth, as Executrix of the Estate of Mildred Boyce (As on the tax ro~ 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: 13650 Soundvinw Avenue Southold House Number Street CountyTaxMapNo. 1000 Section 054.00 Subdivision p of Nor'~hwood Estates at [Name) Southold" Hamlet ;' ~' Block 03.00 ',Lot 006.000 ~ 007'.000 Filed Map No. 5675 Lots 8 and 9 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy "as built" wood deck b. Intended use and occupancy "as built" wood deck 3. Nature of work (check which applicable): New Building. Repair Removal Demolition 4. Estimated Cost /(n/ - eck 5. If dwelling, n?~m%er o~ dwelling units if garage, number of cars Fee Addition Alteration Other Work "as built" wood deck (Description) (To be paid on filing this application) Number of dwelling units on each floor (n/a - deck) . 6. If business/commerci~il or mixed occupancy, specify nature and extent of each type of use. (deck) 7. Dimensions of existing structure, if any: Front 18'-2" Rear 18'-2" Height Number of Stories n/a , (none) Dimensions of same structure with alterations or additions:'Front Depth. Height Number of Stories /n/a- existing 8. Dimensions of entire new construction. Front Height Number of Stories _Depth 7'-1" Rear 9. Size of lot: Front 25~.50' Rear 290 ' Rear Depth .Depth 317,30 10. Date of Purchase 8/23/74 Name of Former Owner W.H.D. Realty Corporation 11. Zone or use district in which premises arc situated R-40 12. Does proposed constmction violate any zoning law, ordinance or regulation? YES__ NO x 13. Will lot be re-graded? YES __ NO x Will excess fill be removed from premises? YES.__ NO X Lynne Wentworth, Exec. of ~oyce Southold, ~Y 14. Names of Owner ofprerrfises/Estate of Mildred~ddress 1135 0aklawn Ave .'~>hone No. 765-3005 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet 0fa tidal wetland or a freshwater wetland? *YES.__NO __ * IF YES, SoIYrHOLD TOWN TRUSTEES & D.B.C. PBPdViITS MAY BE RBQUIRBD. b. Is this property within 300 feet of a tidal wetland? * YES __ NO X * IF YES, D.E.C. PERMITS MAY BE REQUIP,.ED. X 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 SUFFOLK ) ABIGAIL A. WICKHAM being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Agent (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed thc said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in thc mann~ set forth in the application filed therewith. Swo~!l ~before me this ~/'it:_[_~__ day of Dec,ember 2009 NOt~ ~Hc DONNA McGAHAN Nota~ Public, 8tare of New ~or~ No, 01 MC4851459 Qua ified In Suffolk Coun~ Commission ~plres Aug. 18, ~ ~/0 James Deerkoski PE. 260 Deer Drive Mattimck, NY. 11952 631-298 -7116 December 10, 2009 To: Town of Southold Building Departn~ \ \ Reference: Mildred Boyce 13650 Soundview Avenue Southold, NY. 11971 Building Permit # SCTM # 100-54-03-06 & 07 To Whom it may Concern, ~ The following existing deck construction and footings, locat~at 13650 Soundview Ave., Southold, NY. 11971, conforms to Residential Code of New ~ork State. Sincerely, James Deerkoski PE. AVENUE AVENUE t55.C ¢L'J~ON elPE_ / / / / ./ LAW. I~0D_E E'fCI4.. YRN TUYL,!:?.C. GROUND WIND SNOW LOAD SPEED (mph) Cb Ibs/sqft 120 (mph) SEISMIC DESIGN CATEGORY CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA DAMAGE FROM SUBJECTFRoST LINETO MODERATE TO HEAVY SLIGHT TO MODERATE WEATHERINGSEVERE DEPTH S'-O" TERMITE DECAY WINTER ICE SHIELD TEMP, REQUIRED 11 degrees YES FLOOD HAZARDS 1984/1998 LUMBER SPECIES AND GRADE ALL EXT, DECK FRAMING MATERIAL ACQ NC PINE #2 AND BE~ER DECKING MATERIAL ~"x 4" MAHOGANY DECKING AREAS OF STRUCTURE CRAWL SPACE NA 3ASEMENT NA HRST FLOOR NA SECOND FLOOR NA THIRD FLOOR NA 3ALCONY NA _OFT NA ATTIC (HOUSE)to) NA ATTIC (HOUSE)th) NA GARAGE NA ATTIC (GARAGE)to) NA BONUS ROOM NA SCREENED PORCHES NA SUNROOM NA 3ECKS 115 sq. 30VERED PORCHES NA COVERED ENTRANCE NA =OOL HOUSE/ CABANA NA ACCESSORY STRUCTURE NA (a) WITHOUT STORAGE (b) WITH STORAGE MINIMUM UNIFORM DISTRIBUTED LIVE LOADS (in pounds per square foot) USE LIVE LOAD DEAD LOAD EX~:RIOR BALCONIES 60 10 BECKS (f) 40 10 PASSENGER VEHICLE GARAGES (a) 50 (a) 10 ATTICS WITHOUT STORAOE (b,e) 10 10 ATTICS WITH STORAGE (b.e) 20 10 ROOMS OTHER TNAN SLEEPING ROOMS 40 10 SLEEPING ROOMS 30 10 STAIRS 40 (¢) 10 GUARDRAIL AND HANDRAILS (d) 200 (c) 10 ROOF SO 10 a) ELEVATED GARAGE FLOORS SHALL BE CAPABLE OF SUPPORTING A 2,000- POUND LOAD APPLIED OVER A 20-SQUARE-INCH AREA b) NO STORAGE WITH ROOF SLOPE NOT OVER 3 UNITS IN 12 UNITS. c) INDI~BUAL STAIR TREADS SHALL BE DESIGNED FOR TNE UNIFORMLY DISTRIBUTED WVE LOAD OR A 300-POUND CONCENTRATED LOAD ACTING OVER AN AREA OF 4 SQUARE INCHES, WHICHEVER PRODUCES THE GREATER STRESSES d) A SINGLE CONCENTRATION WITH WOOD TRUSSES SHALL BE DESIGNED IN ACCORDANCE WITH SECTION R802.10.1, e) SEE SECTION R502,21 FOR BECKS ATTACHED TO EXTERIOR WALLS LLVING ROOM SCALE: 1/4" = 1'-©" NOTE: ALL SIMPSON HANGERS HAVE BEEN CERTIFIED BY AN REQUIRED AMOUNT CALCULATED FOR EACH CASE. ENGINEER TO HAVE A CAPACITY EQUAL TO OR GREATER THAN THE NOTE: PROVIDE SOLID BLOCKING IN ALL FLOOR JOISTS AND RAFTERS AS REQUIRED BY THE BUILDING CODE OF THE STATE AND THE AMERICAN FOREST & PAPER ASSOCIATION (AF & PA) WOOD FRAME CONSTRUCTION MANUAL (WFCM) FOR FAMILY DWELLINGS, 2001 BBC HIGH WIND EDITION. OF NEW YORK, ONE AND TWO NOTE: EAST END DESIGN ASSOCIATES, LLC. AND ITS ASSOCIATED ENGINEER HAVE NOT BEEN RETAINED TO INSURE PROPER INSTALLATION OF ANY MATERIAL OR WORKMANSHIP PROVIDED TO THIS JOB SITE, LAN SCALE: 1/4" = 1'-0" 4"x4" CEDAR POST IL SCALE: 1/4" - 1'-0' r,~, FL'i ',lq 'FI Al L CODES OF NE:',"/Y L)F,h' ST/',~ L & TOWN CODES A~"~ -~EO(iiREF¢ ANn CONDITIONS OF ................... S~8~kSb3ffO~L~A~ , x6 TOP RAIL 2"x4" CEDAR SUB-RAIL AU_ CONSTR~!(:I iO.q SHALL ¢,~I'i, 'T ]!i~ REOU ItEl//[-E-01,1 o O, THE 2"x2" CEDAR POST 4"x4" CEDAR POST b CERTIFICATION NAILING & CONNECTIONS REQUIRED. -2"x4" CEDAR SUB RAIL ALL CONSTRUCTION SHALL ~EET THE REQ JiREMEI',iTS OF THE ' lx10 MAHOGANY 2x8 ACQ BOX SIMPSON TYDOWN JR 2x10 ACD GIRDER ~" GALV CARRIAGE BOLTS STAGGERED 2'-0" ac. (~) 2xB ACQ GIRDER ~x6 ACO POST ~"x4" MAHOGANY DECKING 2x8 ACQ FJ 16"oc TECO POST ANCMOR 10" BONA TUBE FILLED WITH CONCRETE BASE OF COLUMN IS TO BE BELOW FINAL GRADE SCALE COPYRIGHT 2009 EAST END DESIGN ASSOCIATES, LLC. ALL FLOOR PLANS AND ELEVATIONS ARE PROTECTED UNDER FEDERAL COPYRIGHT LAW. PLANS MAY NOT BE REPRODUCED WITHOUT WRITTEN AUTHORIZATION. ALL PLANS AND DESIGNS ARE THE SOLE PROPERTY OF EAST END DESIGN ASSOCIATES, LLC. THE RIGHT TO BUILD ONLY ONE STRUCTURE FROM THESE PLANS IS LICENSED EXCLUSIVELY TO THE BUYER, PROJECT TITLE & LOCATION: BOYCE RESIDENCE 136 ;0 SOUND AVE. SOUTHOLD, NY, 11971 SCTM # 1000-54-3-06 & 07 WORKNOTES: I(Notes shall be considered typmol for items identified ond sholl opply to oll some ond similor conditions or Iocotions; oil Iocotions moy not be noted ) Acceptance of these drawings does not authorize the right to build without the authoNzation of local governing agencies, such as Suffolk County Dept, of Health Services, Town Building Depart- ments, DEC, FEMA, otc, Verify all conditions, codes and requirements with such agencies prior to constructlon. 2. ROUGH - FRAHING & p[ur,ABING 3, ]NSU[.AT[ON 4. FINAL - cor,'LH'RUCf~ON IViUST EAST END DESIGN ASSOCIATES, PO Box 1675 5130 Main Sayvlew Road Soufhold, NewYork 11971 phone: (6311 755 - 1862 fax 1631) 755-6820 SHEET NAME: DECK FLOOR PLAN AND CROSS SECTIONS ENGINEER: JAMES DEERKOSKI, PE Professiond Engineer 260 Deer Ddve Mattituck. NY ~1952 631-298-7116 GINEER'S SEAL: OWNERSHIP AND USE OF DRAWINGS: These drawings and speclficabons including the ~deas, design and arrangements represented therein, are the property of East End Design Associates, LLC. No part thereof shall be copied, dlsclosed to others or used in connection with any work or project other than for which they have been prepared without written consent of East End Design Associates, LLC, PROJECT NO: 908-2009 }RAWN BY: BDK SCALE: AS NOTED DATE: 11-27 09 SHEET INDEX: A101 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35292 Z Date JANUARY 6, 2010 Permission is hereby granted to: LLOYD C & JOAN K KALIN PO BOX 246 ORIENT,NY 11957 for : DEMOLITION OF COTTAGE AS APPLIED FOR. at premises located at County Tax Map NO. 473889 Section 018 pursuant to application dated JANUARY Building Inspector to expire on JULY 24065 MAIN RD ORIENT Block 0002 Lot No. 028 6, 2010 and approved by the 6, 2011. Fee $ 124.00 Authorized Signature Rev. 5/8/02 ORIGINAL YOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net PERMIT NO. Examined ,20 Approved Disapproved a/c ,20 Expiration ,20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector ,ICATION FOR BUILDING PERMIT Date ~ ©q: ,20 IO INSTRUCTIONS ¥ ,rely 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 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, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofowner ofpremises !..~--'~, DC~ ~.~._. ~c~ [! ,\ (~Z~/d (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: House Number Street Hamlet County Tax Map No. 1000 Section I ~'( Block 09,. Lot o3,~' Subdivision Filed Map No. Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~,~ ~. t'~ ~,~_ b. Intendeduseand occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars /" Addition V/' Other Work Fee Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height_ Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth. Height. Number of Stories Dimensions of entire new construction: Front Height Number of Stories Rear Size of lot: Front Rear Depth Rear _Depth 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 NO__Will excess fill be removed from premises? YES NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. ! 5 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 cfa 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. 18. Are there any covenants and restrictions with respect tQ this property? * YES · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: ~~~._r being duly sworn, deposes and says that (s)he is the applicant (N~of individual signing contract) above named, CONNIE D. BbhCH Notary Public, State of New Yor~ (S)He is the ~ A~ '~/~ No. 018U618505N (Contractor, Agent, Corporate Officer, etc.) &ualified in Suffolk County . Commission Expires April 14 20~ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /r:> mLCr~ day of~,~6"~ 20~ Notary Public ~L~4CE COI~. /? i 4 ;, 3 \ . PP~OPOS.ED 5E~:.OFE ¢-.~VlsEP M~A',( tz,198~