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Home My WebLink About29140-ZFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29439 Date: 05/16/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 5028 NEW SUFFOLK AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 10 Lot 2 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 4~ 2003 pursuant to which Building Permit No. 29140-Z dated FEBRUARY 4, 2003 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 ACCESSORY TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to THOMAS P~AY MURRAY & GEERT MARTENS (OWNER) of the aforesaid building. SUFFOLK COUN~f DEPARTMENT OF HEALTH APPROVAL ELECTRICAL C~/~TIFICA~E NO. PLUMBERS CERTIFICATION DA'r~u N/A N/A N/A ~~t h~ i/z ed~ignat ure Rev. 1/81 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. 29140 Z Date FEBRUARY 4, 2003 Permission is hereby granted to: THOMAS RAY MURRAY 119 WEST 71ST ST APT 9C NEW YORK,NY 10023 for : CONSTRUCT ACCESSORY GAP~AGE W/NON-HABITABLE REC ROOM AS APPLIED FOR WITH NYSDEC & TRUSTEES. THIS PERMIT REPLACES BP#26896. FLOOD PERMIT INCLUDED. at premises located at County Tax Map No. 473889 Section 115 Block 0010 Lot No. 002 pursuant to application dated FEBRUARY 4, 2003 and approved by the Building Inspector to expire on AUGUST 4, 2005. 5028 NEW SUFFOLK AVE MATTITUCK Fee $ 270.00 v Aut h~r~m zed Signature COPY Rev. 5/8/02 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS PERMIT NO. BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OR THE WORK AUTHORIZED) 26896 Z Date NOVEMBER 1, 2000 Permission is hereby granted to: MURRAY/MARTENS 5028 NEW SUFFOLK AVE MATTITUCK, NY 11952 for : NEW CONSTRUCTION OF ACCESSORY GARAGE WITH NON HABITABLE REC ROOM AS APPLIED FOR WITH NYSDEC & TRUSTEES #5101 APPROVALS. FLOOD PMT. INCLUDED. at premises located at 5028 County Tax Map No. 473889 Section 115 pursuant to application dated OCTOBER Building Inspector. NEW SUFFOLK AVE MATTITUCK Block 0010 Lot No. 002 24, 2000 and approved by the Fee $ 225.00 COPY Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO'tN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This applicafion must be filled in by typewriter or ink and submitted to the Building DepaFLment with the following: A. For new building or new use: 1. Final smwey 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 fomi). 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 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 Plamm~g 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 consent to inspect sigmed 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, Swirmning 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 $15.00 New Construction: Location of Property: House No. Date. Old or Pre-existing Building: Street (check one) _ /7/'2rr/ Hamlet Owner or Owners of Property: 77~&/7/~q ,~/~/~,r /7/./.,e~,~).~,_~ Suflblk County Tax Map No 1000, Section //~ Block __ Subdivision Filed Map. Pemt No. ~/~O -Z Date of Permit. /~applicant: /~ff~_g Health Dept. Approval: ~nde~riters Approval: /Er') Lot ~ Lo!: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: ,$ ~_~,~ Final Certificate: ~,-~-'.__ (check one) Appncant S~natt7 ! o EDERAL EM RG .C MA.AG M .T AGE.CY NATIONAL FL. OOD'iNSUR"ANCE PROGRAM ELEVATION CERTIFICATE Important: Read the Instructions on pa~les I - 7. SECTION A ~ PROPERTY OWNER INFORMATION BUILDIN~ OWNER'S NAME BUILDING STREET ADDRESS (Including/~pl., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. PROPER~ DESCRI~ION (Lot ~d BIo~ Num~m, T~ Pardi Number, Legal Description, etc.) O.M.B. No. 3067-0077 Expires July 31, 2002 ZIP CODE I/ 9._q' BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments ares, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L-I GPS (Type): ( ~°-~wr-~.~" or ~.;;;;;;.:'"..'°) L_INAD~927 L_INAD1983 I__I USGS Quad Map I~lOther: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION r~o O n ~ .,..F,P OMMU.I NA.E, COMMU., .UMBER &' J "' ~ ~ ~ ~ 0~ 3 IB2. COUNw ~ME ~. ~P AND PANEL B5. SUFFIX B6. FIRM IND~ B7. FIRM PANEL [ BB. FLOOD Bg. ~SE FLOOD ELEVATION(S) NUMBER DATE EFFECTIV~REVISEO DA~~ ZONE(S) (Zone AO, use depth of flooding) B10. Indi~te the source of the Base FI~ Elevation (BFE) data or base flood depth entered in Bg. I~ FIS Profile ~[ FIRM I~ Communi~ Dete~ined I~ other (Describe): Blt. Indi~te the elevation datum used for the BFE in B9: ~J NGVD 1929 ~1 NAVD 1988 I~ Other (Des~be): B12. Is the building lo.ted in a Coastal Barder Re.urns System (CBRS) ama or Othe~ise Pmte~ed Ama (ePA)? I~1 Yes ~ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations am based on: ~lConstm~ion Drawings* ~Building Under Constru~ion* I~inished Constm~ion *A new Elevation Cedifi~te will be required when ~nstmction of the building is ~mplete. C2. Building Diagram Numar ~ (Sele~ the building diagram most similar to the building for which this ~difi~te is being ~mpleted - see pages 6 and 7. If no diagram a~urately represents the building, provide a sketch or photograph.) C3. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, A~A, A~AE, AR/Al-A30, AR/AH, A~AO Complete Items C3.a-i bel~ a~rding to the building diagram spoiled in Item C2. State the datum used. If the datum is different from the datum used for the BFE in SeXton B, ~nve~ the datum to that used for the BFE. Sh~ field measurements and datum ~nversion ~lculation. Use the spa~ provid~ or the Comments area of SeXton D or SeXton G, as appropdale, to d~ument the datum ~nversion. Datum ~ I ~ Z ~} Convemion/Comments Elevafionmfemn~markused Doestheelevationrefemn~markusedappearontheFIRM? I~Yes ~lNo ~ a) Top of ~om floor (Jn~uding basement or eRclosure)within 1 ff. a~ve ~/~ ' ~'(~ ~~~ ~ ~~ ~~~ ~ ~) lop Of n~ hiflh~r floor M [ ~ . ~ fl.(~ Q c) Boflom of lowest horizontal stru~ural member ~ zones only) ~[/~ . ~ fl.(~ ~ Q d) ~ garage (top of slab) ~ ~ . ~ fl.(~ ~ e) Lowest elevation of ma~ine~ and/or equipment - - , satiring ~e building (Des~ibe in a Commen~ area.) ~/~ .~ fl.(~ Q 0 Lowest adjacent (finished) grade (~G) ~/~ . ~ fl.(m) Q g) Highest adja~nt (finished) grade (HAG) ~/~ . ff.~) Q h) No. of pe~anent openings (flood vents) adja~nt grade ~ i) Total ama of all pe~anent openings (flo~ vents) in C3.h ~/~ sq. in. (sq. ~) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This ~Rifi~fion is to be signed and seal~ by a land su~eyor, engineer, or ar~ite~ authorized by law 1o ~di~ elevation info~ation. I ce~'~ thai the info~aflon in Sections A, B, and C on this ce~ificate represents my best effo~s to inte~mt the data available. I unde~tand ~at any false statement may be punishable by fine or impds~ment under 18 U.S. C~e, Sec~on 1001. CERTIFIER'S ~ME ~ LICENSE NUMBER .. ~-- -- TITLE - / ~ / ~ / COMPANY ~ME / ~ / ~ ADDRESS~ ~ I// CI~ . / / STA~E ZIP CO~ SlG~TURE /~ DATE TELEPHONE FEMA Form ~1-31, JUL~ SEE REVERSE SIDE FOR CONTINUATION REP~CES ALL PREVIOUS EDITIONS / · ' ' '~ ' I FOr Insuiance Comp?ny U~e; ,,,; I IMPORTANT: In these spaces, copy the corresponding ~nformatron~rom Section A. BUILDING STREET ADDRES~ .(.Including Apt., Unit, Suite, and/or Bldg. Nb.) OR P.O. ROUTE AND BOX NO. I Policy Number ;! I I BEOTION D - ~U~VEYO~, ENGINEEr, O~ A~OHITEOT OE~TIFIOATION {OONTINUED} Oopy ~lh sides of lhis Elevntion Oe~ifion~e for (1) oommuni~ o~ainl, (2) insurance ngen~compnny, nnd (2) building owner. COMMENTS I_1 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Z(~'AO and Zone A (without BFE), complete Items El. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is LLI fl.(m) Ll__lin.(cm) I_1 above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I_LI ..(m) Ll__lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain mana~lement ordinance? I__1 Yes I_1 No Ll Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are con'ect to the best of my know/edge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I--I Check here if attachments SECTION G - COMMUNITY INFORMATION {OPTIONAL) The local official who is authorized by law or ordinance to administer the communily's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Gl. I_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or amhitect who is authorized by state or local law to certify elevation information. (Indicate the soume and date of the elevation data in the Comments area below.) G2. I__1A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. LI The following information (Items G4-G9) is provided for community floodplain management purposes. LG4. PERMIT NUMBER lGS' DATE PERMIT ISSUED lG6. DATE cERTIFICATE OF cOMPL'ANcE/OccuPANcYISSUED G7. This permit has been issued for: I__1 New Construction L_l Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: ff.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: ff.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachments FEMA Form 81-31, JUL 00 REPLACES ALL PREVIOUS EDITIONS ~ 0.~/02/00 14:09 FAX 212 963 8845 DEPUTY SECRETARY GENERAl. [~]002 Albert J, Krupoki, President James King, Vice-President Henry Smith Artie Footer Ken Poliwoda Town Hall 53095 Main Road P.O, Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 27, 2000 Eh-Consultants Inc. Rob Herrmann 1329 North Sea Road Southampton NY 11968 Re: GEERT MARTENS & THOMAS R. MURRAY SCTM #115-10-2 Dear Mr. Herramnn, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on January 26, 2000, regarding the above matter: WHEREAS, GEERT MARTENS & THOMAS R. MURRAY, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated November 15, 1999 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on January 26, 2000, at Which time all interested persons were given an opportunity to be heard, a nd, WHEREAS, the Hoard members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of GEERT MARTENS & THOMAS R. MURRAY to construct a single family dwelling with pool, cabana and garage with condition that haybales be drawn on survey and that the haybales be placed along the top of bank and down the south part of slope. Located: 5028 New Suffolk Ave., Mattituck. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have a~ application pending for the same or similar project. Permit to construct and complete project will expire 'two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification ~ Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None V~ry truly yours, Albert J. Krupskl, -Jr. President, Board of Trustees aJK/dJh cc. DEC Dept. of State Bldg. Dept. .... Dept.-Of Health ...... ,~ew York State Department of Environmental Conservation Based, on the info~-mation you have Thomas C. Jodlng Commissioner submitted, the New York State Department,df Environmental Conservation has determined that: Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part g6l) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a per, it. It is your responsibility to enskLre that all necessary precautions are taken to prevent any sedimentation or other alteration or dist~trbance to thegroud~d surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, ~arrier, or hay bale b~rm. Please be further advised that t-his letter does ~ot relieve you of tke responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional Per, it Administrator BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: DATE REVIEWED: DATE SUBMITTED: PROJECT LOCATION STREET: ~'O~ CITY: ,/v/'"'~-o~a: SUBDIV. NAME: ARCHITECT / ENGiNEER: FAST TRACK: YES oRNO SCTM#--- DISTRICT: 1,000 SECTION: ?/~' BLOCK: /o LOT: ZONING: ZONING DISTRICT~ R80, AC, CONFORMiNG: YES oR NO REQUIRED LOT SIZE: '~O,~ .SQFT. WHERE ACTUAL LOT SIZE F. RCkM? 7'~,~ ~ c,,,-J !,'/,2-,~r~ ACTUAL LOT SIZE: ~ ~/2~ SQFT. REQ. t//o' Se,-,/g*~,2.~ REQ. REQ. FRONT: ' PROP'USED:__' SIDE YD: '/ _ ' ~PROPOSED: I~' PROPOSED: ,~'Nx LOT COVERAGE: LOWED: 20 % / % TOT^LX; - CORNER?~i~o~---'~ WAT ER FRONT? (Y(Y(Y(~,~R NO DESCRIPTION:- ~'"r~'~-,:-~,..,r SiNGLE & SEPARATE CERTIFICATION-REQUIRED: YES o~__~NOTES: Z/,2/~rn- ~ _ LOTS 40,000SF --100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger. (A nonconforming at any time after July 1, 1983.) PROJECT DESCRIPTION: ^DP ,^[T,~OR-- ~/D: /~'..~/~-- ~/e0 / AGENCY PERMITS REQUIRED FOR REVIEW TOWN SPETIC PERMIT: YES or~ SUFFOLK COUNTY HEALTH DEPT: YES or~)(BED NEW YORK STATE DEC: (~r NO SOUTHOLD TOWN TRUSTEES: ~,,S~or N,,.~ TOWN ZONING BOARD APPROVAL: YES or~[, TOWN PLAN. BOARD APPROVAL: YES or~,) FLOOD COMPLIANCE ZONE: FEMA PRE-FIRM OF SOUTHOLD 3/18/80 NYS ENERGY: YES 0t~: __ NOTES: PANEL #: ,~,R-2 ~RESS: DTE: / / PERMIT #:RI0- FbOOD ZONE: ,,4,¢:-,¢ ,/pqo ~ __ VENT: LIGHT: ~ ,o/~._ FEESTRUCTURE: FOUNDATION: ~ ~' SF FIRST FLOOR : ~ SF SECOND FLR : "~ >~' SF TOTAL: ~..~) SF iNIT OTHER TOTAL FEE FEE FEE TOT( ~ SF)-( ~'O6 SF)= '/t...~-O SFX$ .,2d =$ ~ .- +$ 5g~'"'-'+$ /e:~ =$ ~ ~ 765-1802 BUILDING DEPT. [ ~FOUNDATION 1ST [ ] PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECTOR 7654802 BUILDING DEPT. INSPECTION [ ] FOU~NDATION 1ST [ ] ROUGH PLBG. [ ~OUNDATION 2ND [ ]~ULATION [ ~/] FRAMING [~] FINAL [ ] FIREP~LA(~E & CHIMNEY DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. TM [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FIREPLACE & CHIMNEY DATE INSPECTOR · LD INSPECTION P,~PORT DATE )UNDAT ION ( IST) )UNDATION FINAL II ,~--.'i TO~I OF SOUTIIOLD ........ ~c !l BUILDING DEPARTMENT · ~:,~d~T. { TO~ H~L ~'"" ~'~ -~OLD SOU~OLD, M.Y. 1197 ~L: 765- 1802 Disapproved a/c .................................. (l~ildi~ Inspector) BOARD OF BEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK SEPTIC FORN ................... TRUSI~ES ...................... NOTIFY: ~ ._ . MAIL TO: ................... APPLICATION FOR BUILDING PEP, HIT INSTRUCTIONS a. This applicati~ mst he c~mpletely filled in by t-ype~riter or in i~ ~ ~itt~ to ~ ~fildi~ I~tor w 3 ~ts of pl~, ~te plot pl~ ~ ~le. F~ ~i~ to ~le. b. Mot plm ~ ~tim of lot ~ of ~ildi~ m ~s, mlati~ip to Mjoini~ p~s or ~lie stmt~ or m~, ~ giM~ a ~tailM ~Mim of l~t of ~ ~t ~ dr~ ~ ~ diem ~i~ ia ~rt of ~is ~li~tim. c. ~ ~& ~ ~ ~is ~liotim ~ mt ~ ~ ~fore i~ of ~ildi~ ~t. d. ~ ~ of ~is ~liotim, ~ ~ildi~ ~tor ~11 i~ a ~ildi~ ~t ~1 ~ ~ m ~ p,~s ~il~le ~r i~ti~ ~t ~ ~. e. ~ ~ildi~ ~11 ~ ~i~ ~ ~ in ~le or in ~ for ~ ~ ~t~r ~til a ~rtiflcate of ~ ~11 ~ ~ ~ ~ ~ ~ildi~ ~tor. aI~ IS ~ ~ to ~ ~ildi~ ~,t for ~ is~ of a ~ildi~ ~ildi~ ~ ~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~r ~li~le ~, ~i~es or ~ati~, for ~ mati~ of MiMic, ~iti~ or alterati~, or for ~1 or ~ri~. ~ ~limt ~ ~ ~ly ~ il ~li~le l~, o~s, ~ildi~, ~i~ ................. (Si~e of ~li ~ratim) State ~hether applieaut is ~mer, lessee, agent, architect, engineer, general contractor, electrician, plmber or builde Architect (as o~ the tax roll or latest deed) If al~lie:mt is a ~rporation, signature of duly authorized officer. (N~ and title of corporate officer) Other Tra~'s Linerme No ..................... I. l~catiou of land ou ~i~ ~,~ ~ ~11 ~ ~ .............................................................. Off of New Suffolk Ave. on ~p Hole ~eek, ~ttituck ~,~ ~r S~t ~let ~ivisi~ ...................................... Fil~ ~ ~. ............... ~t ............... (~) 2. S~te ~sti~ ~ ~ ~ of ~s ~ int~ ~ ~ ~ ¢.~~t~ti~: b. ~t~ ~ ~ ~ ...... ~¢. ~d. ~2u~O ................................. :;'.7. :2 Y: :d. .... %t.,re oe ~_P< (d~c', '.~,;d, apo' ~bYe): ~ ~fildi~ ..' '. ...... ~itim .......... ~teratim ....... (~ripti~) (to ~ ~id ~ fili~ this a~li~tJ~) I~ ~11i~..~r cf (~lli~ ,~its ............ ~r of ~lli~ ~i~s ~ e~ fl~r ................ If ~r~, ~r of ~rs ...... ~'.~ ............................ If ~i~ss, ~mial or ,~ ~, ~i~ ~mre ~ ~tent o~ e~ ~ o~ ~ ...................... 24' ~r of ~ories 2+ Di~i~ o~ ~ s[~l~e vi[h alterati~ or ~i~i~s: F~ ............... ~ar ............... ~ptl~ ................... t~i~ .................... ~r of ~tories ............... Dim~i~ of entire r~ ~,st~ti~: ~t 25' ~ar 25' ~p~ 19' ~r o~ Stories si~ o~ ~o~, ~,: .~.~?_ .......... ~,~ ..l!~:)2l ......... ~pt, ............ ~t~ o~ ~,~ ....~ ?~gP ......... ~ ot ~,o~ ~ ......... :~rp~, ~xv~;. ............... Residential ~ or ~ district in ~i~ pr~i~s a~ si~t~ .............................................................. ~s ~ ~mt~tia~ violate ~ ~i~ 1~. o~i~e or r~lati~: .... ~ ............... ~ill lot ~ ~ ....... ~ .......... ~ill ~ss fill ~ ~ ~ ~s: ~ ~s of ~r of ~, ~Z .~q~Y- /.~qg~..~r~ss . ~19. ~,7~. tiC. ~C, ~.. ~ ~. ~2~.~6~83 ~ o[ ~fit~t ~ll!~.~!9~Y ................ ~ress5~..E$~O~4.~.~....10023 ........ ~C, ~ 10013 ~ of ~tr~tor ................................... ~ress ............................... ~ ~ .............. Is ~ds p~r~dain ~ f~t o~ a till ~tl~? * ~ ...~ ...... ~ .......... PLOT DIAGRAM l~cate clearly and distinctly all boildin~s, ~4~eti~r existit~ or proposed, and indicate all set-back dixr~nsio~s r~n proper~y lines. Give street and block ttn/~er or description accordin~ to deed, and ~ street n~ms and indicate ,ether interior or comer lot. (~tr~tor, ~.t, co.rate officer, etc.) ~m to ~fore ~ this ~E~I~A~ ~D ~ N~ YORK