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TR-333 Amend
Albert J. Krupski,President p�► OG Town Hall John Holzapfel, Vice President 53095 Main Road r Jim Kin P.O. Box 1179 cc Martin H. Garrell Southold, New York 11971 Peter Wenzel Telephone (516) 765-1892 1 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 25, 19-96 Costello Marine Contracting P.O. Box 212.4 Greenport NY 11944 RE: MONIQUE MORRIS SCTM #47-2-29 The following action was taken by the Board of Trustees at their regular meeting of November 22, 1996: RESOLVED that the Southold Town Board of Trustees approve the request for an Amendment to Permit #333 to add a 20' ramp in place of 'the 10' ramp and three 2-pile dolphins to float. Located: 1555 Shore Drive, Greenport.. I€ you have any questions, please call our office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC ACE Dept. of State o Town Hall, 53095 Main Road LO T P.O. Box 1179 Telephone Q Southold, New York 11971 (516) 765-1801 9 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the Southold Town Conservation Advisory Council meeting held Wednesday, ' November 13, 1996 the following recommendation was made: A-77 Moved by Scott Hilary, seconded by Bruce Loucka, it was RESOLVED. to recommend DISAPPROVAL of the request to amend permit by MONIQUE MORRIS 47-2-29 to reconstruct dock facility: install 4' x 55' fixed dock, 3' x 20' ramp, reinstall 6' x 20' float secured with three 2-pile dolphins. 1555 Shore Drive, Creenport The Council recommends disapproval due to the passage of time since the original permit was issued. A wetland permit should be required for this project. Vote of Council: Ayes: All Motion carried. TOWN OF SOUTHOLD BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK WETLANDS PERMIT This Wetlands Permit No. ..3.3.3............. has been granted by the Town Trustees according to information furnished in Application No. ..413.........,,. filed by Applicant Douglas.Morris .............. ........................................ on „June ,12............. 19 86..... A map of the proposed work-will be kept on file in the Trustee Office under the application number given. Permit granted to do the following'work To add a ramp 3' x 10' .and a 6' x 20' float at the end of an existing dock:. ......................................... ................................................................................................... ................................................................................................................................................................. Location of property on which work to be done ....Silvermere„Roads,,Greengor .........................................................................................................................................•_...................... ................................................................................................................................................................. Creek, Bay or Harbor fronting property ....Pipes..Cove ......................................................................... ................................................................................................................................................................. Size of work: Length ....3:..x..10: ramp and..6'.,x 20' float . ......... ........ ............................................................................. Width ............... ........................................................................................................... HeightAbove High Water ............................................................................................. DepthBelow Low Water ..............................................................................:.................. Yards to be Excavated ..................................................... Yardsto be Filled ......................................................................................................... Manner in which material is to be removed or deposited ......................................................................... ................................................................................................................................................................. Intended use of property Residential ...........................................................................................:............................. ................................................................................................................................................................. ------------------- Conditionsif any ..................................................................................................................................... ............................................................................................................................................ ..................... Expiration Date ,August„28�„1987„ „�igk,.haa..naZ..Cautute�.ced.by..said..data•........................ Number of Inspections Required ...3:Trustees..are..to..b.e...notif. . ied, gpA„comp tiAn..af........... ...... ...... .... . . ... . the work. $5.00 paid ,,,,,,,,,,,,,,,,,,,,,,, InspectionFees ..... .......... ......................................................................... .................. LiabilityPolicies in the Amount of ......................................................................................................... The validity of this permit is or may be subject to the approval of other governmental or municipal authorities. The Town accepts no responsibility in applying for or obtaining such approval. In the event that such approval is necessary, the holder of this permit shall not commence operations here- under until such approval has been obtained in writing. The failure to obtain such other approval when required shall subject this permit to immediate revocation by the Trustees upon receipt by the Trustees- of written notice from such other governmental or municipal authorities of its refusal or disapproval. The applicant does by the acceptance of this permit, assume all responsibility for operations under- taken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons and property resulting from such operations. By such acceptance, the applicant also agrees to indemni- fy and save harmless the Town, and its officers, agents and employees from any and all claims arising from operations under this permit and any and all acts or omissions of applicant, his agent and employees. The applicant and the owner and occupants of the premises upon which the operations authorized by this permit are being conducted, do, by the acceptance of this permit, give consent to the Town, and its officers and employees to enter upon the premises where such operations are being conducted to make such inspections as the Town may deem necessary to insure that such operations are being con- ducted in conformity with this permit. This operation will not substantially: A. Adversely affect the wetlands of the town. B. Cause damage from erosion, turbidity or siltation. C. Cause saltwater intrusion into the fresh water resources of the town. D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife and vege- tation or the natural habitat thereof. E. Increase the danger of flood and storm-tide damage. F. Adversely affect navigation on tidal waters or the tidal flow of the tidal waters of the town. G. Change the course of any channel or the natural movement or flow of any waters. H. Weaken or undermine the lateral support of other lands in the vicinity. I. Otherwise adversely affect the health, safety and general welfare of the people of the town. Signed L............... ...�.. .,.�L .. President Board of�'Southold Town Trustees f Date..... Oc�c.:... :,�...1/.�.:....................... 1i ~1 Albert J. Krupski, President Town Hall John Holzapfel, Vice President 40� 21 53095 Main Road r„ _ P.O. Box 1179 Jim King p Southold, New York 11971 Martin H. Garrell e Peter Wenczel 41- �.a Telephone (516) 765-1892 . Fax (516) 765-1823 BOARD OF TOWN TttUSTEES TOWN OF SOUTHOLD 0 R I G I N-A Office Use Only a Coastal Erosion Permit Application Wetland Permit Application FT 3 I 1996 Waandfather rmit Application ive Amendment h ng r- ceived App ica ion: � at N f-6- _ __ k ' N � t'ceived Fee: $ v " Completed Application la i Incomplete SEQRA Classification: Type I Type II. Unlisted Coordination: (date se t) C C Referral Sent: / ate of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: NOV - sublic Hearing Held: Resolution: Name of Applicant M 0 N,l O U E Mb RR Q Address I'M LAUREL H6LL.OL 120AD LAU EL HOLI.OUJI ( U 117 11 Phone Number: (Sl4 ) 3 h?- l & y Co Suffolk County Tax Map Number:, 1000 Property Location: SHORE D R U REj==hI APO RT N q l l9qq (pro ide LILCO Pole # , distance to cross streets, and location) AGENT: OOSTELU ARIt3E_ CONTRACTING CORP. . ( If applicable) Address : BhX al aq C ICE-E-I'APbRT N �Z _ Phone: ! - FAX# : - ©©n 1 1 . r Bo"' -- of Trustees Application j GENERAL DATA Land Area (in square feet) : /a _T 7p 6 +- Area Zoning: R F 5 1 1)p N TI A L Previous use of property:_BULKHEADED SINGOL EAMILy DWEL.LN(; Intended use of property: N p iL1 /4,A tJ G F - X 1=CDNST"2 UC T- LX N �7aC Prior permits/approvals for site improvements: Agency Date `['ate -rPOFI .ES I � ff�O ? DGlJ6l l� S MDRRISGE(DEMf4N No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Nla Project Description (use attachments if necessary) : PECON-S1KOCT JOCK FAC)L lTq : KSTA-I-L �Xs15 FIXFb ,DOCK . �, x oZ0 &AM,P. 21<IINSTALL �A a0 � F-I.OAT S1=C.0 P Eb W IT -1 TAKEE. a - P1�.E_ •DOLPHINS 2 • i , Bo-- , -'[ of Trustees Application WETLAND/TRUSTEE. LANDS APPLICATION DATA Purpose of the proposed operations: M A I ICI-rA l tJ F F-MEAT I a NA L T 1-- 6 O C Area of wetlands on lot: /y1/� square feet Percent coverage of lot: r o BVLkt-f CA D Eb Closest distance between nearest existing structure and upland edge of wetlands: /�(�f}. feet NO W i5-7-/-^MD VE6 L-"TA T16N Closest distance between nearest proposed structure and upland edge of wetlands: A feet N6 (A)(4-Tl-A)\J-D UEGr--TATf J Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? - 0- cubic yards How much material will be filled? — O - cubic yards Depth of which material will be removed or .deposited: - feet Proposed slope throughout the area of operations: alL,4 Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate) : K0 ter F E.cT o w r--r j- m T) v cG F TA-T 10 t A - YR6:P0SAL =.S —'p ��tiSTP. UC`C EX,( s �W,r EACI L IT U 1/1"-12ia1)—text 12 PROJECt I.D. NUMBEn 6117.21 S I✓Q a Appendix C Slate PnVltOnmonlal OunIlly llevleW > SHORT MlnoNMENTAL ASSESSMENT FOFIM Pot UNLISTpU ACTIONS OhIj PART 1-0110JF-CT INWOaMATION (To bo completed by Applicant or Project Sponsor) 1. APPLICANt•ISPONSOn 2. PROJECT NAME Costello Marine Contracting Corp. N1gl) F— tA o-Le'F, J. PROJECT LOCATION: MUnIclpAllly -tjT Lj) "TpW1� �g� �J _02r_counly Suffolk A. PRECISE LOCATION (Street address and road Inle secllons, prominent landmarks.etc.,or provide map) See Attached area map. , S. 19 PROPOSED ACTION: ❑NevY ❑Expansion odlllcatlon/allerallon RECONSTRUCT 'P OC k FAC-I L- l Tv e. DESCniae PROJECT enIEFLY: NSTAt- y `x5s"r FIXEb 16ck J 13aII•X ad f RRM P, PF-I N STALL CDIfXab " F/~oAT 5ECURE-b W cr N "Cf-fRE-F. d- PILE UbL-ph/IDS 7. AMOUNT OF LAN17 AFFECTED: O Inlllally U Acres Utllrnately Acres e. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING On OTt1En EXISTING LAND USE nFSTnICTIONS7 IN Yes ❑No It No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PnO.JECT7 ® tt--II Elm Eltr-J -1� Resldenllal IJ Induslrlal comercial Agriculture l ParklForeslJOpen space ❑Olhdr Describe: WATERFRONT 10, DOES ACTION INVOLVE A PERMIT APPROVAL,On FUNDING, NOW On ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL. STATE OR LOCAL)?-1 U IN Yes No II yes, Ilst agency(s) and perrnlilapprovals NYS DEC, ACOE TOW N of 573UT L.b It. r-1 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? U Yes rfwo It yes,1191 agency name and permiltapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yee IN No r I CERTIFY THAT THE INFOnMATION PnOVIDEO A130VF IS TRUE TO THE BEST OF MY KNOWLEDGE AppllcanlJsponsor name: COSTELLO MARINE CONTRACTING Dale: �o Signature: 11 Ilib nellon Is III Ilia Conslal Aron, and you are a stale ngerlcy, complete Ilia Coastal Assessitterit Form before proceedlnq wIll0l11s assessment OvEn • 1 PART Its--ENVIRONMENTAL ASS VENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYcnn, PART 617.127 11 yes. coordlriJte 111e review process and use the FULL EAF. ❑Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED Poll UNLISTED ACIIONS IN 6 NYCRn.PART,617.67 It No,a negative declaration may be superseded by another Involved agency. ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECIS ASSOCIATED WITII THE FOLLOWING:fAnswers may be handwrllten,If legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid wade production or disposal, potential for erosion, drainage or flooding problems? Explain bristly: C2. Aesthetic, agricultural,archaeological, historic, or other natural or cultural resources;or community or neighborhood character? Explain briefly: r C3. Vegetation or launa, fish. slrenlisir or wildllls species. signlllcant habitats,or threatened or endangered species? Explain bristly: C4. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or outer natural resources?Explain briefly r CS. Growth, subsequent development,or related activities likely to be Induced by the proposed action? Explain bristly. CO. Long term, short term,cumulative.or other effects not Identified In CI•C57 Explain bristly. C7. Other Impacts(including changes In use of either quantity or type of energy)? Explain briefly. D. 18 THERE,On IS THERE LIKELY TO eE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes U No If Yes, explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above,determine whether It Is substantial,large,Important or otherwise significant. tach effect should be assessed In connection with Its (a) selling (Le. urban or rural); (b) probability of occurring; (c) duration; (d) Irreverslblllty; (e) geographic scope; and (1) magnitude. It necessary, add attachments or reference supporting materials. Ensure that bxplanallons contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF andlor prepare a positive declaration. ❑ Check this box If You 'have determined, based on the Information and analysis above and any.supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Narne o Ueait-XQencv Flint or Tvup_TarveyooT iesponn6ie U1Tfcer pn lead Ajencv ----Tr7WU-1;sponiiWe of Icer Signature or Ae+pp.+ir6in(')f)cei i In lea-U—Agencv --Slynature-oo reparer 1 dllferent from respomi e o cell Date 2 County of Suffolk ) State of New York ) :TO N DST E -1-0 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS• AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(§) OR REPRESENTATIVE(s) , TO ENTER ONTO MY PROPERTY TO- INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SIGNATURE SWORN TO BEFORE ME THIS DAY OF Q CT Q b'E P , 19� SUSAN E.LONG NutryNo 01 L044958343w York Qualified in Suffolk County NOTARY PUBLIC won moires November 6,1 Suggested space for location Map THIS IS NOT A PERMIT 7 �-- -w - - — 5rCl-L6 MARINE CoNTP., :rN5TALL y �X SSA DOCK, p.0, 5 A 'If 3a X c20 RAMP, Cv Xa0 FI-OAT IR5EMP��`-�i N Il qq SECURrl) `NITI4 THR1=E uZ-PIL- l Tlep 477- 1 q DOLFRINS -510RE P l V E PREPARED FOF- MoN I quE MbRK►S FRf►M� I q RB L.A O RCt_ R6LLpw RD- �� �-A U R FL HaLLauJ� N�/ (1791 �5.55 SHORE DRIvF =\J GRFCIv PaF S H oL I sou T' Dq� O f T ovv N to 3 s7. s rTM - I4-OA-y7I IL - 1 CO. �xlsrrN BLK, 100� g nYa o a0f 2N STA L L `]� x SS t• i j t ' na"�..D t. E-TIMBER bQCk 25 .�" L)o '14 c.w PLAN L A 1�1 LjSr t' 25 H Lhil}eie `: p 2NSTALL.3 X db a . U p rcl• 0E Q E-- RA P i . ( U'P. Q� REINSTALL EXi.5T(Nr LOCAT16N a0 FL OAT c PIPES COVE s CCU RED WITH �S �• 3-a-PII E DOLPHINS r t � 1 DOCK kR- Mo FI-ofAT- XI 3 f I N 6 w— — 0 —. — �- �A tl lht 1314V 11MD W� — — AtW 5.0' pTT.OM CRo SS V[ E-vA/ Q TES MORR1S FAMILY PARTNCRSHIP NC>'rE MktEMAA -S Cc.A-PRATED "TrMBFpz 1y1219 LAUREL HOI.l.6W ROAD FIARD\AJARE HOT- bRPE.D GALVANIZED LAUREL lJoLLOW1 W1 117?1 ® JosEPH BARQARA DAI g I - ?$ a STRFE'f BRookI,YN 1 N y Iraq -SHEET 10f i ©c-TORE I' 17, 17% 1ii 4fyr /i� filly)`' 1:7:n - r. iffl—..�.r 00, -t- v n�2 6 X o' r J r- Ic7 +/•(� � 4✓ rd�c'' � _ LAG lC, ' rv'.' -5 "�.:%jZ,,i �� ��)<�'rr �%'�%i'� _/OU�: �xPs 0, �.Y�/ �Y•\\.i � !'x 20 `i'�;� „J y jl�CJ�L �/�./J� - �=•�F�:L�✓�'`�i?•�'� /J�;�'`s.� -SCALE: "- D BY DATE: tom , ° o�c 16 e,fWel o p v�K LL rJ fI C' CCU f �. NEW 3q Flo f F! es- 4 7f/.s• !L1°L'I N. G`%�...... ....» .. DR INCa NUMBER � Y. Skate Lic. Land Surveyor -t'� CHARR£TTE PRO-FORM 920pr PRINTED ON 920H CHARPRINT VELLUM 2- Q — `Z �G SURVEYED FOR:-MD/(//QUE /tilD�e�/s LOCATED AT�je,�EiC//OIJ��- , TOWN OF �pc,,o�,o I SUFFOLK COUNTY N.Y. LOT Z4 2S �U.vE MAP OF CO. CLK. NO. I7J�.9 FILED 1/1156 SCALE 1" =30 ,vyF G,eEa� .eF� /wc- SUFFOLK CO. TAX MAP DATA: Map C��E DIST./c2� , SEC. OW7-CO 5p BLK. 02.GZ5' LOT vl ?0.2 ¢/-1 N w Delve 0 OFFSETS FPOM STRUCTURES TO kELATIVE riOUNDRY LINES 0 � ON SUR` VI,- .ARf FOR A: � �� S � to SPECIFIC USE. ONLY. AND &ROULD NOT BE JSE:r, IDR ;TH1FK ti`?,aw vjRES_ R+ N a7Q, p 70 �ti1c>�rovE itaaeeis � �"`� FiesT,4.yEeic.�.v TTLE 53,9'2IZ50". /2�a0 _ g T7zE rt/ct /3/-S-�987 �Z �EI/iSEO �QPol c Z2, /9-?/ SURVEYED�(/pV 19.:PC BY WILLIAM R..SIMMONS JR. P10 BOX 377 JAMESPORT, L. I., N. Y. 11947 Y12Ctc� FILE NO. f2 7¢t5 PAGEOLo GRID�¢¢ �� DRAWN BY<7/.f' �n COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING •JETTIES • BULKHEADING • STEEL & WOOD PILING • FLOATS 423 FIFTH STREET, P.O. BOX 2124 GREENPORT, NEW YORK 11944 (516)477-1199/477-1393/477-0682 FAX - (516)477-0005 AUTHORIZATION FORM Date: sowner of 0('/''/.� �,�C Business Prope ty ame located at ', - do hereby give Costello Marine Coeracting Corp, the authority to act as agent in my behalf in applying for all of the necessary permits in order for work to be done on my property described above. ignat re J COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING JETTIES • BULKNEADING STEEL & 'NOOD PILING • FOUNDATIONS ago i �:s _ - COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING •JETTIES• BULKHEADING • STEEL & WOOD PILING • FLOATS 423 FIFTH STREET, P.O. BOX 2124 GREENPORT, NEW YORK 11944 (516)477-1199/477-1393/477-0682 October 31, 1996 Albert J. Krupski, Jr. , President Board of Trustees P.O. Box 1179 Southold, NY 11971 � Re: Monique Morris Previous Dock Permit 1986 (Douglas Morris) SCTM #1000-47-2-29 Dear Mr. Krupski: Pursuant to the above referenced dock permit that was issued by the Town of Southold in 1986, please be advised that Costello Marine Contracting would like to undertake the reconstruction of the permitted dock due to normal wear and tear and the recent storm damage it sustained. The original dock consisted of a 4' x 55' fixed dock, 32" x 10' ramp and a 6' x 20' float which will be secured with three 2-pile dolphins. We would like to request an amendment to install a 20' ramp in place of the 10' ramp. Please note that although the original float was secured with pilings, more recently it was secured with pipes. In addition to lengthing the float, we propose to secure the float with dolphins as indicated in the aforementioned paragraph. I have enclosed the application fee in the amount of $40. 00. Please advise if you require additional information. Thank you for your review and assistance. Very truly yours, Susan E. Long Permit Manager Enc. FGt TRUSTEES � .-I John M.Bredemeyer,III,President ® -� SUPERVISOR Henry P. Smith,Vice President ". SCOTT L.HARRIS z� Albert J.Krupski,Jr. John L.Bednoski,Jr. �d ��® Town Hall John B.Tuthill 53095 Main Road P.O.Box 1179 Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971 Fax(516)765-1823' TOWN OF SOUTHOLD June 11, 1991 Richter Home Improvement Co. 515 Seventh Street Greenport, NY 11944 RE: Monique Morris SCTM 41000-47-2-30 Dear Mr. Richter: The following actions were taken by the Board of Town Trustees during its regular meeting held- on June 6, 1991: RESOLVED that the Town Trustees APPROVE the request for a waiver for the following: To construct a deck onto existing house located at Shore Drive, Greenport. The Trustees request that no fertilizers be used on the lawn and that roof runoff be contained on site. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. Very truly yours, John M. Bredemeyer, III President, Board of Town Trustees JMB: jt cc: Bldg. Dept. File RICHTER HOME IMPROVEMENT CO., INC. 515 Seventh Street • Greenport, New.York 11944 • Phone 516 477-0998 TO t/ O C//✓ /JiQ�I� 22 DATE SUBJECT --72asS s M _ TOWN OF SOUTHO� .-Z- /5/yJ /ZC a,E-J //1/G 1 GrJ19il�G/2 /o �LGi.GQ /,g r' xL `Form ML8 N72&The Drawing Board Inc,Box 505.Dallas.Teias Y - - BOARD - OF HEALTH. . . . FORM NO. 1 3 SETS OF PLAUS • TOWN OF SOUTHOLD SURVEY . . . . . .. .. ... ,,,, t. . . CI1EC1; ,, . ... . • • . .N+Ly.�-, ,>Aa••.:�.' ;,.; ;4, SUILOING DEPARTMENT . .. . . . SEPTIC FORM, - � ••`• • . - TOW .. . •' N HALL . . . ... . . . . . . $OUTHQLII.L\L.Y_11271 ?:Oc I F7 • TEL.: 705.1802 ` CALL MAIL TO: APProvcd.. ...... . :. . •�, - . . . . . 19 . . . Permit No. . . ..•.,. ' . . Pisapprovcd a c . (Building.Inspector) - - . . . . s APPLICATION FOR BUILDING PERNJIT Date NSTRUCTIONS a• T. application must be completel seis'of Pl* accurate plot plan to scale. 1'y filled in by typewriter or in ink and submitted to the Building. b.. Plot plan showing location of lot and of buildin�schedule. InsRectar,'tuit or.areas, and giving a detailed description of Ia out of ooerPremises, relationship to adjoining cation. P y premises or public strc property y must be drawn on the diaZram.which is P,. a• _The;work covered by this application may ^ parr of this ap �.. Upon;approval.ofthia application the Build�n be commenced before issuance of Building shall be kept on the premises available for inspection thraug Permit: . .Inspector will issued a Building e• No building _hout the work. _ Permit to the applicant_ Such pen shall.be occupied or used in whole or in part for any purpose whatever until a Certificate Shall have been- ,granted by the Building Inspector- APPLICATION IS HEREBY MADE to. Building �c�te of Occupar. BuiIding.Zone Ordinance of the Town.of Southold, Suffolk Count Regulations. for:the construction of build' s ad Department for the issuance of a Building Pezzrrit pursuant to t The applicant agrees to comply with all applicable laws, ordinances County. York, and other applicable Laws, Ordinances dilaws or alterations, or for and or demolition, as herein describe admit authorized inspectors on premises and in building ' builduig ' for necessa code, housing code, and regulations ry code, ( > , and (Sig natu ,. ,�i , re of �ant, or name.if a corporation)- ' (Mailing address of a 1 ... . . .... . State whether`applicant is\owner applicant) • -! , lessee, gagent, architect, engineer general contract r fad bor, electrician, plumber or builder ; j, . .. . . , .. .. . . .. . . . . Name of owner of premises '. , M✓ /� .!� • - . • •/1�J - - ---• -f applicant is a corporation,signature of duly authorized officer.(2s On the tax roll or latest deed- • • • • - • -- •• .- - - ....... ... . ; (t\<'me and title of corporate officer) • - - Builder's License No. Plumber's Liccrisc No. -- • • . • . - . Electrician's.License No. . . • . • . OcJicr;Tradc-s.Liccrisc No.' ,�,; , . - • z, Location ofland on.'which proposed work will be done; ; I Iousc Nuni ber . . . . . . .. . . . .. • . Street: . . . Cr. .. . ►2 County Tare %lap No. 1000 Sect J. Hatnlct. • ••••.. ion �y,+9 subdivision . . . . Blo • • . • • • L ,a;v,�;S,�ayr.�-. . . . . . of , .CS-3._v�,' • . . . . . Filed 111a 7�' •• • •' Stttc c,•• (N:unc . . F. /. Lot �istino USe and occupancy of premises and intended use and occu • • •©'g-Q•s � A. Existinuse-'and y P P sc tr ti Banc � . //�� of ro o d cons uc 'on:. .: s use and occupancy. . . ...�/,w'e�i�. . . . . � ,• ••B. Intended. use nd . . .. .. :: -....... . . .. .y ... '.. qccupanc .. 3. .Nature ofwork'(checic which'applicablc): New Building . . . . . . . . . . Additicn . . . . .Uterdtion' .. . ... . . Repair' ':' :'�..'.' . . RFmOval Demolition . . . . . .Swi:nnin" o T • .. .Tennis Court : ' : . . . . . . - p_P . . . . . . Ceassory Building. • • . . . Fence . . . . . • .Other Woorrk;.o2ckc S 5 . . •4. •Estimated Cosi . . f P • • Fee • • • • , (La he Paid on'filing this"applicaIion) 5. If dwcllin„nutnbcr of dwelling"units . ; • • , , , . Number of dwelling units on cacti floor• m nubce of cars . . If garage. . .. .`'•'.':' :`. . 6. If business. commerciaCar mixed occupancy• specify nature.and extent of each•t. pc•oC,use...'�•' y :• - 7: :D nicnsions of cx tino structures,if any: Front . �`2',! , / Dcpth.:',2 71r • Z 3 Rcar Hei !tt • NumberofStories . • f�?-; � • • • � . ... . . . . . . . . . _ • Dimensions of same structure with alterations or additions: Front. •.� • • • • •. • • • • . •. • . Depth ......r; Height . . . . . . . . . . . . . Rear • .... - :' 8.,'Dimensions of entire new constntction: Front • •• ' ' ' • • • • Number of Stories . .�: '•".' .'• , Hci;ttt .'';' Nu . . .. . . .. . . . . . . Rcar . . . .. . . . . . . . . . . Depth . . . • • Number of Stories ' 9. Size of let: Front ;, . :.'.� . . . . . . . . : . . . :... . .! 7 . .. . . .. .10. Date of Purchsse I'.ca: . . ..l.Q.Q,. . . . . . . . .. :. . •Depth . . . .:Z . . .. . • . . . . . 11 Zone or use,district in �vlticlt.premiscs•are situated , •Name of Fo cr O% ncr' • . 7f:z.yP.�n . ., . l2. .Does proposed consiructio violate any zoning law, ordinance or regulation: . . .'•%�. . . • • • . • . 13 Will,lot b • ``regraded . . •Will excess fill be removed from premises:. •Ycs .. • 'tl t Nam w e of,Owner of pre s ov_Q�p,� lo r?V -..Address - Name ofArchitect-;, --.......... ....Phone No. ....:. •Address Narne-of Contracto � ?✓..�f C • • •7Y-, •. -Phone No. IS.Zs - this. property:- ' � • •Addressj���, Phone No.. I3 P y: located within 300 feet of a tidal `wetland?:,�Y1:S..�®tiO . .i,. . *If:_.-yes;; 'SouthoId Town Trustees Permit may be required. PLOT DIAGRAM clearly and.:distinctly all buildings,. .whether existing or proposed, and•indicate all set-bac1. dieters o . :: Property lines..,Give street and block number or description according to deed, and show streei names and"dicate ��; c::. interior or corner lot , . ,... eo ��l ,' r.;. ail,, O c••a � .. Xe- 'Tit n,....Qys y xli)CCri Y�6 fw* 3 3�a�an : STATE OF NEW YOR1:, COUNTY OF. . . . . . . . . S.S •.'• `' ` ' ' ' ' ' ' ' ' ' ' ' ' ' • • being duly sworn;deposes and says that he r • (Name of individual signing contract) • • • • • • • • is tlic appli; above named. :se is tile . ... .:'.:. .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . .. . . . . . . . . .'�.:. . . .. ..: (Contractor, agent, corporate officer' etc.). r 3C said owner or owncis, and is'duly .tutltorizcd,to perform or have performed the said work and to make and file,tl: =Pplication: that'all statements eontaitled in this application are true to the best.of his knowledp and belief;grid that t: +work will be performed in the manner set forth in thc,application filed therewith. 'wom to:.lictorc me this° .. •• :�._, �,. • .day of: • , - , , . . . . . . . . .. 4bt3ry Public. . ... .... . . . . . . . .. . ... . .. . . .. . . . .. . County (Si.,nzture of appliczn: