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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23444 Date JANUARY 5, 1995
THIS CERTIFIES that the building ADDITIONS
Location of Property 580 BROADWATERS ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 10 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 2, 1993 pursuant to which
Building Permit No. 21317-Z dated APRIL 7, 1993
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 ADDITION & DECK ADDITIONS FRONT & REAR TO EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to LOUIS & SONIA SULICH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-336100 - DECEMBER 12, 1994
PLUMBERS CERTIFICATION DATED DECEMBER 22, 1994-K&K PLUMBING & HEATING
X.,l 14~
Bui ding Inspector
Rev. 1/81
i
"RXNO.s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
ft
R .
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLE~I TV10,F :THEE
.
N°° 21317 Z Dare 19.9.
Permission is hereby granted to:
.........?.......::......aP...............................
to 4 kS 4 ..-It ~cYrYl sQ4-}
.
at premises located at ....a~+. 4 ~!j°... u
County Tax Map No. 1000 Section ....I Block I Lot No...
pursuant to application dated (~/~41 j .....z- 19Q.3 , and approved by the
Building Inspector. ~J
Fee S..n~./. b.:
5 SfV..... zr~ 91~....
Building Inspector
Rev. 6/30/80
SEW YORK STATE DFP\RTMFVr OF E`AIRONN%I TAL CONSLR\'+TIO\
DEC PERMIT NU.MIOR ® EFFE E DATE
v
1-4738-00527/00001-0 '"W Oct. 13, 1992
FAUUTY!PROCRAM NUMBERIsi PERMIT EKPIRATlO~ DATE
Under the Environmental Conservation Law (ECL) C
Oct. 31, 1994
TYPE OF PERMIT (Check All Applicable Boxes)
El New ?Renewal ?MOdifkation ? Permit to Construct C Permit to Operate
Article 15, Protection of Title Watr C~ SPDES 17, Titles 7, 8: HArticle 27, Title 9; 6NYCRR azardous Waste Management
3
Pr
Article 15. Title 15: Article 19: Article 34:
Water Supply C~ Air Pollution Control Coastal Erosion Management
a Article Transport 15. C~ Mined Land Title Water Reclamation C~ F oodpla n Management
Title Article 15, 15: Article 24: Articles
Long Island Wells C~ Freshwater Wetlands C~ 6NYCRR t380: Radiation Control
Wild,O Sc15, enic Title Recreational C= Tidal Wetlands Other:
Rivers Article 27, a Title RR 360:
08. C~ Solid Waste Management
WNa`CRORua Certification
PERMIT ISSUED TO TELEPHONE NUMBER
Louis'F. Sulich, P.E. t )
ADDRESS OF PERMITTEE
14-05 156 St., Beechhurst, NY 11357
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
( 1
NAME AND ADDRESS OF PROIECTiFACILITY
Sulich Property
N.S Broadwaters Rd., Cutcho ue
LOCATION OF PROIECT/FACILITY
SCTM 111000-104-10-3
COUNTY TOWNIClTX@rjtWE WATE RCOURSEIWETLANI NO. NYTM COORDINATES
Suffolk Southold B E: - N4 - -
DESCRIPTION OF AUTHORIZED ACTIVITY
Place approximately 80 cubic yards of upland fill to raise the grade of the property
around an existing house. Raise house by adding concrete block to existing foundation.
Construct 2 new additions to attach to the south side of house and g new deck on
north side. All work shall be in accordance with NYSDEC approved plans attached.
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance
with the ECL, all applicable regulations, the Genera) Conditions specified (See Reverse Side) and any Special
Conditions included as part of this permit.
Deputy Regional ^ ' 'EG0'tra
PERMIT ADMINISTRATOR ADDRESS a;npt OSl f + TMA5. 40 3 T.1 F$ it
aatvD-%.1~6
eor a Ha rth rz"'Iy idrocLt rt. V.
AU RIZED SIC"T v OnrE
10/ 13/92 Page 1 of 5
~I r(
GENERAL CONDITIONS
Inspections
1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours
and intervals by an authorized representative of the Department of Environmental Conservation (the
Department) to determine whether the permittee is complying with this permit and the ECL. Such
representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of
this permit, Including all referenced maps, drawings and special conditions, must be available for
inspection by the Department at all times at the project site. Failure to produce a copy of the permit
upon request by a Department representative is a violation of this permit.
Permit Changes and Rerhewais
2. The Department reserves the right to modify, suspend or revoke this permit when:
a) the scope of the permitted activity is exceeded or a violation of any condition of the permit
or provisions of the ECL and pertinent regulations is found;
b) the permit was obtained by misrepresentation or failure to disclose relevant facts;
c) new material Informatlon is discovered; or
d) environmental!, conditions, relevant technology, or applicable law or regulation have materially
changed since the permit was Issued.
3. The permittee must) submit a separate written application to the Department for renewal, modificl-
tion or transfer of this permit. Such application must Include any forms, fees or supplemental infor-
mation the Department requires. Any renewal, modification or transfer granted by the Department
must be In writing.]
4. The permittee must submit a renewal application at least:
a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES),
Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid
Waste Management Facilities (SWMF); and
b) 30 days before expiration of all other permit types.
5. Unless expressly provided for by the Department, Issuance of this permit does not modify, supersede
or rescind any order or determination previously issued'by the Department or any of the terms, con-
ditions or requirerrlents contained in such order or determination.
Other Legal Obligations of Permittee
6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili-
ty for all damages,!, direct or Indirect, of whatever nature and by whomever suffered, arising out of
the project described in this permit and has agreed to indemnify and save harmless the State from
suits, actions, damages and costs of every name and description resulting from this project.
7. This permit does n;ot convey to the permittee any right to trespass upon the lands or interfere with
the riparian rights of others in order to perform the permitted work nor does it authorize the Impair-
ment of any rights,',title, or Interest in real or personal property held or vested in a person not a party
to the permit. i
8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-
of-way that may be required for this project.
I
Page 2 of S
SUPPLEMENTARY SPECIAL CWNU1'1'LONS
tThe following conditions apply to all permits:
A: LE any of the permit conditions are unclear,the permittee shall con-
tact the Division of Regulatory Affairs at the address and telephone
noted below.
B. A copy of this permit with supplementary conditions and approved
plans shall be available at the project site whenever authorized
work is in progress.
C. The permit sign enclosed with the permit or a copy of letter of
approval shall be protected from the weather and posted in a con-
spicuous location at the work site until completion of authorized work.
D. ,At least 49 hoiltg prior to commencement of the projectj the permittee
shall complet6 Acid f6tofh the top portion of the enclosed receipt form
certitying.thAt hdA,4.fUlly aware of and understands all provisions and
~conditione of this perMlt. Within one week of completion of the
permitted work, the bottom portion of that form shall also be com-
pleted and returned.
E. For projects involving activities to be accompllshed over a peri.od of
more than one year, the permittee shall notify the Regional. Permit
Administrator in writing at least 48 hours prior to the commencement
of resumption of work each year.
F. If project design modifications take place after permit issuance, the
permittee shall submit the appropriate plan changes for approval. by
the Regional Permit Administrator prior to undertaking any such modi-
fications. The permittee is advised that substantial modification
may require submission of a new application for permit.
G. All necessary precautions shall be taken to preclude contamination of
any wetlands or waterway by suspended solids, sediment., fuels,
solvents, lubricants, epoxy coatings, paints, concrete, leachate or
any other environmentally deleterious materials associated with the
project work.
i
H. Any failure to comply precisely with all of the terms and conditions
of this permit, unless authorized in writing, shall be treated as a
violation of the Environmental Conservation Law.
1. The permittee is advised to obtain any permits-or approvals that may
be required from the U.S. Department of Army Corps of Engineers, NY
District, 26 Federal Plaza, New York, NY 10278, (Attention: Regulatory
Functions branch), prior to commencement of work authorized herein.
J. The granting of this permit does not relieve the permittee of the
responsibility of obtaining a grant, easement, or other necessary
approval from the Division of Land Utilization, Office of General
Services, Tower Building, Empire State Plaza, Albany, NY 12242, which
may be required for any encroachment upon State-owned lands underwater.
Regional Permit Administrator
NYS Dept. of Environmental Conservation
Bldg. 40, SUNY-Room 219
Stony Brook, Uy 11'190-235A
(516) 751-089
- Page 2
f SEOR Negative Declaration
Reasons Supporting This Determination:
(See 617.6(g) for requirements of this determination; see 617.6(h) for Conditioned Negative Declaration)
- The project is well designed to meet the applicant's need to raise the grade of
property and elevation of house to protect against flood waters associated with
storm tides without causing undue adverse impacts to the adjacent tidal wetlands.
- The area of fill will be contained far enough from the high marsh area along the
shoreline to prevent filling and sedimentation impacts to the wetland. Appropriate
fill containment measures will be employed throughout the construction phase of
project and maintained until the fill area is vegetatively stabilized.
- Proposal is compatible with the existing waterfront residential character of the
surrounding area and should not effect the adjacent properties.
- No endangered, threatened or special concern plant or animal species are known
to inhabit the site.
if Conditioned Negative Declaration, provide on attachment the specific mitigation measures imposed.
For Further Information:
Contact Person: George Nammarth
NYSDEC
Address: Region 'I Regulatory Affairs
Bldg. 40, SUNY, Rm. 219, Stony Brook, NY 11790-2356
Telephone Number: (516) 751-1389
For Type I Actions and Conditioned Negative Declarations, a Copy of this Notice Sent to:
Commissioner, Department of Environmental Conservation, 50 Wolf Road, Albany, New York 12233-0001
Appropriate Regional Office of the Department of Environmental Conservation
Office of the Chief Executive Officer of the political subdivision in which the action will be principally
located. Supv., T/Southold
Applicant (if any) Louis F. Sulich
Other Involved agencies (if any)
14-12a j2nM-9c 3E'OR,
b17.21 1
Appendix F
State Environmental Quality Review
NEGATIVE DECLARATION
Notice of Determination of Non-Significance
Project Number 1-473', 00527/00001-0 Date Oct. 13, 1992
f
This notice is Issued',pursuant to Part 817 of the implementing regulations pertaining to Article
8 (State Environmental Quality Review Act) of the Environmental Conservation Law,
The N.Y.S. Dept. of Environmental Conservation as lead agency,
has determined that the proposed action described below will not have a significant effect on the
environment and a Draft Environmental Impact Statement will not be prepared.
Name of Action: Sulich House Improvements
SEAR Status: TypeI ? - Unlisted Action icoated in Peconic Bay CEA
Unlisted ?
Conditioned Negative Declaration: ? Yes
®No
Description of Action: Placement of approximately 80 cubic yards of fill in the area
around an exisitng single family dwelling to raise grade by approximately 1.5 feet.
Raise house by approximately 2 feet in elevation by adding several courses of
concrete block to the. existing foundation. Construct two additions and a deck to
attach to the existing structure.
Location: (Include street address and the name of the municiPalitY/countY. A location map of appropriate
scale is also recommended.)
North side of BroadwTters Road Cutchogue
Broadwaters Cove; Town of Southold, Suffolk County
SCTM #1000-104-10-3
95~06f (7/87)-25c ` NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
For Article 25 f Tidal Wetlands
5. All fill shall consist of "clean" gravel and soil (not
asphalt, slag, flyash, broken concrete or demolition debris).
Supplementary Special Conditions (A) thru (J) attached.
DEC PERMIT NUMBER
1-4738-00527/00001-0
FACILITY ID NUMBER PROGRAM NUMBER 4 5
Page of
-A Form No. 6 BYIJL~ Q7 2~idJC ~3y,
6, d TOWN OF SOUTHOLD
(1 4, BUILDING DEPARTMENT
,f "~iV 4 ~9~5 TOWN HALL
765-1802
BLDG. DEPT.
TOWN OFSOOTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be. filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. 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 in,starllation from Board of Fire Underwriters.
4. Sworn statement from plumber certifyin"hat the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building,'industrial building, multiple residences and.similar buildings
and installations, a certificate 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:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
.
C. Fees
1. 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 - $100.60
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .3 .....1:97.5
New Construction........... Old rOar Pre-existing Building
Location of Property........... B)2o~P w4-rtGts ...?.Oi4 L UTC;ffo6UC......
.1 House No. Street Hamlet
Onwer or Owners of Property..(7joU.... S W c; r C._./-/
County Tax Map No 1000, Section ...1 6 q ......Block...... 0 ........Lot......`
Subdivision ...................................Filed Map............ Lot......................
Permit No. al 6 1.7 Date Of Permit ................Applicant........ .
Health Dept. Approval ..........................Underwriters Approval...................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $
e'f~97~........
C®ta3gv AP LICANT
FOL4,
t
Town Hall, 53095 Main Road Fax (516) 765-1823
P. 0. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 22, 1994
Mr. Louis Sulich
P.O. Box 1091
Cutchogue, NY 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
XX The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.z,--~
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21317-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
01
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
10016/71 BUREAU OF ELECTRICITY
F 88 JOHN STREET, NEW YORK, NEW YORK 10038
Date DECEMBER 12,1994 85882:394/94 N 335100
Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
LOUTS SULICH, BRO~AryDWATERS ROAD, CUTCHOGUE, N.Y.
in thefollowing location- LJ Basement A ist Ff. ? 2nd Fl. ATTIC/OUT Section Block Lot
was examined on DEfCEMBER 05,1994 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES+ COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT, K. W. AMi. K W M1i K W AMi (W AMT. HP
18 22 20 16 2 1 E
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W OIL H. F. OAS H P AMT. NO A. W. G. AMT AMP "T. AMPS. TRANS. AMT H. P. SYSTEMS
1 30 NO. Of FEET AMT WATTS
1 E
a
SERVICE DISCONNECT NO. OF S E R V I C E
, METER 1 q ]W 1 g 3W ~,B" 3W p IW NO OF CC. COND .
"I. AMP TYPE NO OF NEUTRALS Oj NEUTORAI
EQUIP- PER a OFA CG W. C G OND. NO. Of H4LEG O F H IEC
1 200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS:
SHED-1
30 AMP.TRANSEER SWITCH-1
MOTORSc2-E H.E.
E1,13C. WATER HEATERSti1-4.5 K.W.
G.E.C.It-2
SMOKE DETECTOR:-1
G & S CONTRACTOR LIC.#578-E
BOX 215 GENERAL MANAGER'
SOUTHOI,D, NY, 11971,
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
CONY FOR BUILDING DEPARTMENT. THIS CORY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
~T
,
(20
TELI
O Ol$ TOWN OC SO[T HOLD ,
orriCGor• BUILDING INSPCCTott !
P.O. BOX 728 •
TOWN HALL '
rd0~ SOUTHOLD, N.Y. 11971
,
f y
C tt T I F I C A T I O N
.g ,
Building permit No.~~
Owner
p ease pr ntl
Plumber
i• Ip oase print) f"41
'i
Z aortily that the eotdnir usnc1 in the water supply sYstem N ~
~5 contning 1099 t
} han 2/10 of It lead.
~i a ails ~ 1
1 ~ e ! rxx.
(plumber's signature)
Sworn to beforh this
c t°
19
otary Public
ffolary t+ubild~ count."•``~'
P, 4
JOYCE M. WILKINS 'A'I M
Notary Public, State of New York z . .
No. 4952246, Suffolk Coin
CTerm.ExpiresJunel2, i ~ , ' + ~;,h,
9
IELD I!;SP CTiON JJDkTE COMMENTS
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INSULATION PER N. Y.
STATE ENERGY
CODE
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ADDITIONAL COMMENTS: x
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JUDITH T. TERRY I i d H;
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tJ i < Southold, New York 11971
;c.
' MARRIAGE OFFICER Fax (516) 765-1823
Telephone (516) 765-1801
I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
fuly-6--7993 JULY 16, 1993
SECOND REQUEST
Thomas Fisher, Building Inspector
To: 6txrt+s-W:-+7owton,-~enioi BuiFc77rg Fnspeetol~
From: Judith Terry, Town Clerk
Re: Request of Michael Zuhoski
Attached is a letter from Michael Zuhoski requesting an adjustment of a
.Building Permit fee.
Please advise the amount of the refund due to Mr. Zuhoski so I may
prepare a resolution for the Town Board authorizing said refund.
Thank you.
Attachment
,
pq i
r
William M. Beebe Builders
A Division of S & Z Builders
P.O. Box 722 • Cutchogue, New York 11935
(516) 734-6681
July 2, 1993
RECEIVED
JUL 61993
Southold Town clerk
Dear Mrs. Terry,
On April 2,1993, I submitted plans for a permit. These plans
included additions, alterations and two decks. I explained at the
time that only the decks would be built. However, a mistake was
made and I was charged for the additions and alterations instead
of just the decks.
Would you please review the plans and adjust the permit fee
accordingly and send the relffuhd to the address above? I would
appreciate any help you could give me concerning this matter. The
permit number is 213172. Thank you.
Sincerely,
~.~1
Michael Zuhoski
MZ ` ".x
1t ' ~d 1~~71'-i'~
Partner
S+Z Builders)
$1 r
JUL
ooc~~FFOIk
JUDITH T. TERRY = = Town Hall, 53095 Main Road
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER yQ O~' Fax (516) 765-1823
Telephone (516) 765-1801
~77
I ~4 OFFICE OF THE TOWN CLERK
Ju. ~I TOWN OF SOUTHOLD
DG. TT1°IOka
July 6, 1993
To: Curtis W. Horton, Senior Building Inspector
From: Judith Terry, Town Clerk
Re: Request of Michael Zuhoski
Attached is a letter from Michael Zuhoski requesting an adjustment of a
Building Permit fee.
Please advise the amount of the refund due to Mr. Zuhoski so I may
prepare a resolution for the Town Board authorizing said refund.
Thank you.
Attachment
}
William M. Beebe Builders
A Division of S & Z Builders
P. O. Box 722 • Cutchogue, New York 11935
(516) 734-6681
~>L1trl .5~~ July 2, 1993
~ JUL 7 1993
RECEIVED
TOWN OFI,SQU P 10;t
JUL 61993
Southold Town Clerk
Dear Mrs. Terry,
On April 2,1993, I submitted plans for a permit. These plans
included additions, alterations and two decks. I explained at the
time that only the decks would be built. However, a mistake was
made and I was charged for the additions and alterations instead
of just the decks.
Would you please review the plans and adjust the permit fee
accordingly and send the e'fuhd to the address above? I would
appreciate any help you could give me concerning this matter. The
permit number is 213172. Thank you.
Sincerely,
Michael Zuhoski
MZ
Partner
S+Z Builders
x(31 7~
E
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
REMARKS: 6~-~
~r
i
DATE l L ;11/INSPECTOR
E
f
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ] ROU PLBG.
FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
i
DATE D INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
[ ) FOUNDATION 1ST [ ROUGH PLBG.
FOUNDATION 2ND [ ) INSULATION
[ "FRAMING [ ) FINAL
REMARKS:
DATE INSPECTOR y
NOW,
M-1802
BUILDING DEPT.
INSPECTION
[ VJ FOUNDATION 1ST ( I ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: l`z9u UyC
DATE d-3 INSPECTOR
131
765.1802
BUILDING DEPT.
INSPECTION
[ FO DATION 1ST [ J ROUGH PLBG.
[ FOUNDATION 2ND [ J INSULATION
[041RAMING [ J FINAL
REMARKS: d~
GO
r
DATE INSPECTOR
TRUSTEES
John M. Bredemeyer, III, President SUPERVISOR
Henry P. Smith, Vice President SCOTT L. HARRIS
Albert J. Krupski, Jr.
John L. Bednoski, Jr. 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
March 6, 1992
Louis Sulich A R
14-05 156 Street
Beechhurst, NY 11357 SLDG.DEPT.
SOWN OF 541tIi49C9LY7
RE: SCTM #1000-104-10-3
Dear Mr. Sulich:
The following action was taken by the Southold Town Board of
Trustees on February 27, 1992:
RESOLVED that the Southold Town Board of Trustees approves the
request for a waiver to construct an addition to existing
dwelling as per survey submitted.
Please note that permits from other agencies may be necessary,
as the Trustees approval does not constitute approvals from
other agencies.
If you have any questions, please do not hesitate to contact
this office.
A V ry truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmt
cc: Bldg. Dept.
CAC
II i uv, uvn ,vw~iucrc
y(ATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
i0INT APPLICATION FOR PERMIT .U.S.ARMY CORPS OF ENGINEERS APPLICATION NO.
ALL instructions on back before completing this application. Please type or. print clearly -m.ink. Attach additional information as needed.
Will
rfCLE 9, TITLE 1, ARTICLE 43 6NYCRR 646 (LAKE GEORGE RECREATION ZONE) ' ' - -
riCLE 15, TITLE 3 (AQUATIC PESTICIDES CONTROL) ?6NYCRR 327 (AQUATIC VEGETATION) ?6NYCRR 328 (FISH) ?6NYCRR 329(INSECTS)
ARi1CLE tb, TITLE 5 6NY60.R 600 (PROTECTION OF WATERS) . - ,y : . ;1~,
r ~OFor the construction, reconstruction, or repair of a DAM or other impoundment structure.
[3For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. 0401 WATER QUALITY CERTIFICATION
[]ARTICLE 15, TITLE 15 ?6NYCRR 601 (WATER SUPPLY) ?6NYCRR 602 (LONG ISLAND WELL).
[]ARTICLE 15, TITLE 27 6NYCRR 666 (WILD, SCENIC AND RECREATIONAL RIVERS) _
?ARTICLE 24 6NYCRR 662, 663 (FRESHWATER WETLANDS)
?ARTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ?ARTICLE 34 6NYCRR 505 (COASTAL EROSION) ^ .
- - -
F [SECTION 10 (RIVER AND HARBOR ACT OF 1899) for structures and work in navigable waters of the U.S. [COASTAL CONSISTENCY CERTIFICATION.
E [SECTION 404 (CLEAN WATER ACT OF 1977) for disposal of dredged or fill material in waters of the U.S.
D
[SECTION 103 (MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT) for the transportation of dredged materials for dumping into ocean waters
1. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES (If any) s
p~G 'M IT Wca1 1041-024o 3/59 -7.
2 APPLICANT IS A/AN
Lld'Owner [Operator [Lessee [Municipality/Governmental Agency (Check as many as apply)
3. NAME OF APPLICANT (Use Full Name)
L0 L) 'F- . UL C,l~
MAILING ADDRESS
1 ^ 0 IS TELEPHONE (Where can 6e reached during day)
POST OFFICE STATE ZIP CODE
3k~ca~U-~R~~f N kt~s
4. NAME OF LsSOwoer []Agen Contaccterson (Check one) '
0 U1 5 UL C. , 1
MAILING ADDgpSS a
Ip I ` n' TELEPHONE (Where can be reached during day)
14 i0 ~V.
POST OFFICE ; 1 . TArE ZIP CODE
h( k\~~ APR 2
5. PROJECT/FACILITY LOCATION / (Mark location or, map, see Number la on reverse side)
Sa> >-0 T e
County U L{~•- I -Town or city Village
y f
STREET ADDRESS (If drfferent from applicant) f
~~vATJW FZrD ,
POST OFFICE STATE ZIP CODE
60 L~ N
6. NAME OF STREAM OR BODY OF WATER
7. HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work without permit, includ dates. 8. WILL PROJECT UTILIZE STATE LAND?
[Yes CRNo Show work on map and/or drawings / 0 Yes
Yes o
9. PROPOSED USE: LM'Privato 10 PROPOSED STARTING DATE: t,11. APPROXIMATE COMPLETION DATE: I2. FEE OF (NYS Permit Only)
? Public ? Commercial AL~Cre ~~{-V Na~/L kq~2 $ , n~•~Enclbsed' 'I
13 PROJECT DESCRIPTION: (e.g. quantity and type of material to be excavated, dredged or used for fill or rip rap, location of disposal sites; type of
structure to be installe/d, Neigh f dam; size of impoundenq caps bets o 5r p se ate L s uSC'~e t4nt of dtstr,bTttt . tem; etc) O
SZAISk AA h4 `1( 0e-7.5 2 S z n Gn REV! f y C U g I..;414 ~
717t ~ qv+a R :)I F110. 6s czVt~lnn 0
1~ x sFV a~~c~~4lrlDrc~C47
14. WILL THIS PROJECT REQ IRE ADDITIONAL FEDERAL, ATE AND/OR LOCAL PERMI S? Yes ? No If yes, please list:
TOWtA OF SOU1'401.D J!W)LV N4 fECiMt?
15. CERTIFICATION: ,
I hereby affirm that under penality of perjury that information provided on this form and all attachments submitted herewith is true to the best of my knowledge
and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 21045 of the Penal Law.
Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project
described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said
project. In addition, Federal Law, 18 U.S C. Section 1001 provides for a fine of not more than 810,000 or imprisonment for not more than five years, or both,
where an applicant knowingly and willfully falsifies, conceals, or covers up a material fact; or knowingly makes or uses a false, fictitous or fraudulent statement
?1 1, b authorize the agent named in Number 4, a ve to submi this appl' anon on my behalf.
DATE / SI N T R E ~
TI LE
PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE
CORPSpF ENGINEERS
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BOARD OF HEALTH
APR-,21 93 FORM NO.1 ?3 SETS OF PLANS
TOWN OF SOUTHOLD ?SURVEY _ _ _ .
BUILDING DEPARTMENT ~IIECf _
. .
TOWN HALL SEPTIC FORA
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 Y.OTIF'f;
pp r~ CALL
L'xamined . yU 19?.ti PIAIL TO:
Npproved o . 199A Permit No.
Disapproved a/c .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
As 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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 issued a Building Permit to the applicant. Such permit
.call 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 whatever until a Certificate of Occupancy
call have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
CPWr9/9c.*
dame of owner of premises , , , ,
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .
Plumber's License No.
Electrician's License No .
Other Trade's License No .
Location of land on which proposed work will be done.
C?N9~YU1vJ/~ G G v
House Number Street Ham et
d L
County Tax Map No. 1000 Section .....I ....J Block f b.......... Lot...-
Subdivision Filed Map No. Lot...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy ..~l.~C('fl>CQ , y .
t
3. Nature of work eck which applicable): New Building , , Addit'pn
(~h y.......
. . Alteration
Repair emo
,
val . . Demolition , , • , , , Other Work
(Description) I Co 4. Estimated Cost al Ul. Fee 7 ~a: U .
g u (to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
garage, number 6. If business, commercial or mixed.i . . . .
occupancy, s'p'ec'if'y'
pecffy nature and extent of each type of use .
7. Dimensions of existing structures • • • ' ' ' • ' ' ' ' ' • ' •
,if any: Front Rear Depth...............
Height Numt er of stories .
Dimensions of same structure with alterations or additions: Front , , , , , , , , , , , , , , , , ,
Rear
Depth • • • • • • • • ..i. Height Number of Stories .
8. Dimensions of entire new construction: Front . Rear . , Depth . . . . . . . . . . . . . . .
Height Number of Stories
9, Size of lot: Front , , , , , • , , ,
Rear ...?J' Depth .
10. Date of Purchase
1 1 Zone or _s. di^tric in which re,l ~r . • ' • ' ' ' • • Name of Former Owner .
ing law, , ordinance , , ,dinan, .ce , . or . , , regulation: „
12. Does proposed ed construction ion violate any ny zoning :
13. Will lot be regraded . . • •
14. Name of Owner of remises P . • • • • • • • . • • ........Will excess 611 be removed from premises: Yes No
No
Name of Architect . ' ' ' • ' • ' • ' • • • • • Address Phone No............... .
Name of Contractor , . . • • ' ' Address Phone No . .
, Address • • • . • . Phone No.
L5. Is this ProPtY Souwithin thold To'0 feet of a tidal wetland? *yes,f/• „ No.........
*If
yes, Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interiur or corner lot.
i
i
N
TATS OF NE R
TA
OUNTY TS O O Gi. S.S'
(Name of individual signing ho. SA, • • • • being duly sworn, deposes and says that he is the applicant
contract)
)ove named.
e is the .
(CPagen;,corporate officer, etc.) said owner or owners, and is duly all orm or have performed the said work and to make and 61e this
placation; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the manner seta forth in the application filed therewith.
+om to before me this
5 day of ..G2 19
tary Public, County
CLAIRE L. GLEW
~ Notary Public, State of Navy York • _
No.4979606
Qualified in Suffolk Cou~ty (Signature of applicant)
Commission Expires December 8,18
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or.
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'rte"_ ~%C /I»C~ _ _
ord;=~----~~ _.i3...~._.__:-%=•"'• rmarK, i968~:r-^ MAP C7F ~i2a~4~r`~'7~)'.
ha.Y ,p,/ water 1
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9
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7 3 u C$~1T Oh~s__ `4 " N ~/u ~7rc1°~ v
nC'1 d !'r9 M' e' Map No, 1,56.
c Lot NO. 186
tr) C;J ~f. 1. fJ. /fy Y. M M~- No.. /000 - 109- 10--B,
'arfre/~dc~d Esc. 3'J, /°r-'~t
ti
o
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' o•-i ap/",0) S„ 6"'evaYG''1~`iy"G`''.~:ed 7'0 ' -1-hC r " ~fw
u Qti~fJ o~6 ! t
a!'1G7~,,.rvLlfe%7Y_;Cd6°1
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y ar
!8, 1968
Van 7Z,~f ai4 'Son
lJ ~fJ1~74/ 4-;,C 77'-
t :i Lrc.er~~. d Lard c'/,-Veeyor:v.
APR - 2 9993
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