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HomeMy WebLinkAbout8992-zNO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z78~) ...... Date ............... AUgUSt...~t~., lg. THIS CERTIFIES that the building located at Capt..l~.eld..Dr~.v® ......... Street Map No. Capt' K~Edd' F~°ck No ........... Lot No, .1.11~ ....... l~tt~tuck. · .I~,Y~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Nov' 22 '" 19. ~(~. pursuant to which Building Permit No. dated ......... Deg...2 ....... , 19.76, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pl'~,va.2e · one · l'ami].y, dwet[.:[ng ..................................... The certificate is issued to .. t~rl~le.~. -. P~i:LOs ..... 0wne~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. - Ju~y. · .~l. -$~. · -by. R, UNDERWRITERS CERTIFICATE No ..... N3~ ...... AUg..~...~' ........... HOUSE NUMBER ........ ~60 · · Street ..... Cap2-lii. ~d · 9rive ...... P~2tiiuek. · Building Inspector ~om~t ~.0. ~: T°W OF TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8992 Z Dote ......................... .~.O..q ....... ~ ............. , 19.~7.~.. Permission is hereby granted to: Cad,~a~. ,~ o~'~.~.t .h;~ ~...../~,/~-..- .k]~,~tt~&. ..~alios ......... 1'""~et'r~'l" ~d ............ 8o~zt h'gmp't on'" to ..~r, iLd.,~ea~.., o~e,..ta~Z~b~;,,,~,~.,.i~ .................................................................................... at premises located at .[LO~..~4,~ ....... ~a~..~.¢0.'~....~-~.t~ ................................................................... ............................................... (~p 4."~'J:&d'-'&"tt~i~ t'"~:z .......... ~at:t i't;uu'k .................................. pursuant to application dated .......................~Ia~......$~. ............... , 19..~6., and approved by the Building Inspector. Fee $~3.,.~:.0. ............ ',,,,~: ~:, :~.~THE NEW YORK, BOARD,,~OF FIEF iil~nFr~WPIT~i~q ~;. ' ; ;~[ ~ ; ? ~ F ; 85 JOHN ~R~E~' ~E~ORK'N W' ' ' ~ ,;;,~;, , r,'. ,, .. ..~. .... ~:= ~¢d~ ?~1~s ,~ ~w%~or.,:~gp~ ~ K~dd :Rd..: ~ ~Iniet~ ~d.~. Mattituck, L.I. FOlt~ NOo 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. -F~ I,~ -P 0 ~-- P ~ ~ Certi~icnte O~ Occupnncy No..7_.~ 71l .$.~t.,, rate ................ .-4..~..~.x., .~..-1., ~977.. THIS CERTIFIES that the building located at .~..D.O....C/{~.- .7...Vi D.b....-~..~.~.. Street Map No... t..'8.~. ~.. Block No ........... Lot No .... ./.g.~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~....~..D~.., 19.7.~.. pursuant to which Building Permit No..~.? ?..~. ? dated ......... .~)~C. .... .~...., 19.~,~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ./~...~..I.V. PtT.~...~)1~.£.. iZ .B.~{ .I .Ly...~..6H..~.L. L/.N...dry.. .................... The certificate is issued to . ~...M..~. ~.~..~. ~ ..... .?.~..L.I ?..~. ........................ (owner, ~t) of the aforesaid building. ~F~ b-.5o-o~o~. ,gu~7 2~. ~07'7 Suffolk County Department of Health Approval .~ ................... .~ ....? ....., .. U~D~,aWRIT~.RS CERTImCAT~ ~o .......... i~.l.x! j3.,..~...r..,w. .................. HOUSE NUMBER .... .,~i. ~.. Street ..... .~.~[~.T .... .15. !?? .... .~. :.~..~ 3./!S. ...... ................................................ ~/.~...m. !-' !..T..u..c. !? ............ ....... Building Inspector · OEM NO. S TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. ¥. 11971 APPLIGATiON FOR ¢£RTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusuaJ natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposals(S-9 form or equoI). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial. buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings end unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..................... ~ ....... New Building ~ Addition Old or Pre-existing Building Vacant Land - Location Of Property 5> C~ c) C/~' ' ~.../.>.?. Owner Or Owners Of Property .....~.'/?.'.7..~;(.~.i~.~.~. ......... ~ .z..~...~...~.~. ............................................. Subdivision ~TAI i'q I~l~ ~_~;~/~ TI S I~ No. ,.~.~:~..... Block No ............. House N~..... ........ ................................................................... /,-' _ Permit No. ,.~...:.~...~..-Z Date Of Permit:. .Applicant ~z~ l_,, .% ~ ................................... .... Hea*th ept. Approval Dapt. Approva ............ ....................... Underwriters Approval .............................. ..,.;::>..,..,Planning Board Approval ....... .,~./..!~ ....................... Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... Fee Submitted ...... :..:. ................... Construction on above described building and permit meets all applicabJ, e cedes and regulations. ~) ~ C~'~ -// Apphcant ...... ;~..... :~-.Z.:....~..~.~.i ........ ~' .~.... ......................................... ................ day of ............................................ (stamp or seal) Nota~ Public .................................... Coun~ ~c~ /~ ~ O TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N. Y. 765-2660 717�-/1 7 /-2,�KO�� a� , FORM NO. Y ��2v 77 �c%� ✓ Q /� TOWN OF SOUTHOLD �f�Z�77 s/,��ti,,. ao-t�+ BUILDING DEPARTMENT TOWN CLERK'S OFFICE, �f�- v `o K La- � r SOUTHOLD, N. Y. l CP Examined .......... .......................... ..., 19. .... A plication No. .. ..... Approved ...... �::"...�.. .... 192 ., Permit .. �'. `..... No. .. ,..... 1J��---- 1 S-17 7— . - Disapproved a/c ... .......... ........��.......�.�?............ ...... ........... .... .... � ....................................................�.....�...... .................. .. (' .......................... ...... .. .... (Building Inspector) �� .r. � .� ���� � � ► / APPLICATION FOR BUILDING PERMIT r e 6 /J/ C Date ......... / :... '� ..... 19! 1 - ,., (` INSTRUCTIONS 'This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building : Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b f b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets A � areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. G i APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to theL 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 too admit authorized inspectors on premises and in buildings for necessary inspections. .......................................................................... (Signature of applicant, or name, if a corporation) ....... ................................................................. (Address of applicant) /7�p7 0 )/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................................................................................................................................................. Name of owner of premises . ,//�ls�/, ...... Lj U-2; f — 2rj� .. ... .... .... ........ ,... ....... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ �. (Name and title ooff� corporate officer)B -se�-- a. �eE.. d h�/3 1'•X AC �c,�? Plumber's License No.�.... ��.c1:: ................ ,000 Electrician's License No. �J :: : Alm y2-vv// 3� ............................ � /Y/EEp�o�D mil.Other Trade's License No. ........................................1.l. (�_ //"7(��0 — 0 S ,�,,,� 1. Location of land on which proposed work will be done. Map No.: Z. . ........................ Lot No. Z.4. .......... Street and Number ...0 .��.,....N/ .......���T.!�l!-1�.:���'.�.�lY�? ...�/. .............................. Municipality 2. State existing use and occupancy of premi es and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........./�1� / ir/ G—� ...............................`.......................... / b. Intended use and occupancy ................ f..:.. .1•.... . .............. '.. h ! ........(..:.: .....:..C............ r _ � 3. Nature of work (check which applicable): New Building. ........... ..... Addition ------ Alteration .................. Remoir ---.--- Ronnovo| ....---.�� Dan�u|�ion---^--- Othur \�/o�k --.—.---------.—_ ,_ ' (Description) zL Estimated Cost `..^����+�/�l��.':_—.---'.--.�ee ��'..�--_-----_--------_--_---_.__—__ ' . . (to be paid on filing this application) 5. R dwelling, number of dwelling units — . --.Nun`ber of dwelling units on each floor .�..��---- {� ^�1^�� .If garage, nunnborofc�r --'�,�/�.��._—�.�./�:��—_!�����.�.�.�.—__-----.,--..-----_---_—__ ' 6. If business, commercial or mixed occupancy, specify nature and 'extent of each type of use --.------- 7. Dimensions ofexsting.'st,u uras ifony: Front -------.--- .Rear ................................. Depth ..... Height ........................ Number of Stories ---------------------.---.---'_---------' ' Dimensions of yone structure with alterations or additions:_ Front . , Rear ............................ i ' Depth- c .......................... Height -------- Number of Stories .� . .. � �.—� l_ .'— � --�ron� '� — � �'—'�--.— Oeoth — .8. Oinansions of entire now construction: F --- -_ y / �% ��-74 Heig�� �.. �: Number of Stories ..��- � . -� 'L----------- ........................' �> ~ —_—_ C 9� - Size of |o*: Front ----..~y — - --------' Rear --.."—;]C)—y—.. ...` D ES- � lO. Purchase -------.-----------.Nonno of Former Ownor ����..�'.'���.��----~='����..��.. " Zo'ne or use district i `which premises are 'situated ................................................. --------------- 12. Does construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will fill be nynovadfronprenoe�o:,(r1_w0 yaa ) :No 3 ..lzL No of Owner of i --- mdUressz�. - �-Pnone,r*» ��. ,.. e of Architect. . ~ .. �—^~~------ ' ~~.-�-~ -~ ,_—_- - .-------._-_ None of Contractor ........... / ddr9 V.5-E/K RR-' Phone ���x �����...����'� � PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existingproposed, and' indicate all set-back dimensions from property lines. Give street and block- number or description occor6ing'to deed, and show street non`as and indicate whether interior urcorner lot'. _ ` ' . ` - ' | . i ` - . STATE' OF E\� i ^ ^ '� ' S�� COUNTY OF, —`.,. ' . Vassilia balobrias _.----------------..--_.------_----boing duly swoon, deposes and says -that he is the oppUcon/ (Nome of�indk'idun| signing contract) above non�ed. ' �- / agent for` Call-os Contracting Co.', Inc. ` Heis the ....................................................... ntroctor, agent, corporate officer, etc.) _ of said owner or owners, and is duly authorized to per6o,m or have per6nrme6' tho said work and to� make and 6|e this application; d,o� all statements contained in this application are true to the best of his knowledge.and belief; and thor the work vvi|| be'performed in the nnonmar sot forth in the application therewith. Sworn to before me this ' ^ ` . ������� November ���� df .............., 19........ Suffolk Public ^ — ....�... ... nty .,.,'—...-,^.^^'..,.—.-_~...^,. --~-_.----' (Signature of applicant) � ELIZABETH.ANN N pwucNOTARY PUBOC, Sate of New York ( - No. 52-8125850. S~.0, ,�', mnn Expires wonh 30. m__ 7 1?1 · 'O~ ~Oo ]. TOWN OF SOUTHOLD BUILDING DEPARTMIrNT TOWN CLERK'S OFFICE SOUTHOLD, N. Ye Exam,ned ......... ..... .......... Approved ...........tsp~t..C.....~ ...... , 19.Z.~. Permit No..~..~.Z...~....~ .... D,sapprovod.% .. ................................................................ I ........ (Buil~ng Inspector) APPLICATION FOR BUILDING PERMIT Date ........ ................ INSTRUCTIONS 0. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 o Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. 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 buildings for necessary inspections. wi 1 .. /,;, / (Address of applicant) / ~ . .~/~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~Jl~.~. Name o¢ owner of premises. , .......................%; ............... :.; ...... '...=-. .................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /' / .~ </,.. /':' Plumbegs License No., ................. ,~, ............................ Electrician's License No. '~.d...¢:..¢d ...... ,T. ...... Other Trade's License No ................................................. 1. Location of land on which proposed work will be done. Map No.: ~.,,...~...;: ........................ Lot No....;z..z.~ ........... Municipali~ 2. Slate existing use and occupancy o¢ premises and intended use and occupancy o¢ proposed construction: o. Exisiting use and occupancy b. intended use and occupancy ................... ~ ........... .................................. :..~, ............ <.....~*...:.....; ......... ;-4 ............. I 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost ..;..L.)~-.J.,..LL?..'CZ...:: ............................. Fee ......................................................................................... (Io be paid on filing this application) '~)t / L~ , .... : ........................ 5. If dwelling, number of dwelling units ............ :....~ ........ Numbcr al dwelling units on each floor If garage, number of cars ? 1'/ ~' ~ /' z~, /, / ~ ~ ' 6. If business, commercial or mixed eccupQncy, specify nature and extent of each type of use ............................ 7. Dimensions of existing sh'uctures, if tiny: Front ............................ Rear ................................Depth .................... Height ........................ Number of Sfor~es ............................................................................................................. Dimensions of same structure with alterations or addttions: F~ont .................................... Rear ............................ Depth ................................Height ............................Number of Slories ............. , ................... 8/" Dimensions of entire new construction: Fron~ ~ ~ Rear ............................ Depth Height .... :~:t.~..~'~/,.. Numbe~ of Stories //" /' ~' ~:/~ 9. Size of lob Front / ~J ~ ' [Le~n' / ' ~ Depth / 10. Date of Purchase ................ : ....................................... Name at Former Owner ':...C.&.~.~..r.:;t..:._~:...'..:..:.'..:..::..:. 11. Zone or use district in which premises are situated ............................................... .)~...~ ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ~Yes ( ) N~ 14. Name of Owner of premises .:-,:zz,~z'.z,/.a~..;,,..Z.¢'.'.~:.: ................. Address L....~....~.~..J;(.:.....~.~ Phone No; .~:. ........... Name of A~d~itect ..... ~(.....~,Z.~..~.C::.:'.; ........................... Address'~..t~ ............. "':...:.:.:,- Phone No.'C:.':..:.~.::.::.Z( ~/ ~ , / ' ... Nome of Contractor ~ /'/ , 4 . ,,.::....-:.,..,~, .~c ....... ~,, /; / /) ; , . /,,,. .......................... z~adress ....: ........................... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exisling or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whetlner interior or corner lot STATE OF NEW YORI( COUNTY O~ ............................... ~.~.~..~.9~.~a.~ ..................... beh~g d,,ly sworn, deposes and soys tb~t he is the applicon, (Name of individual signing contracf) above named. He is the ~n~ (Contractor, agent, corporato officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all, statements contained in ibis application are true ~o the bes~ of his knowledge and belief; and that the work ~ill be performed in the manner set fo~h in the applicgtiop.filed therewith. Swo n b fo e me q y/ . , .......................... · Suffolk , 'o r ~.. Nota~ Pubhc, . ............................................... C u ~ ................................................................................... ) ........... ~{~2 ' /~ ~ '~ z~ /7 (Signature of applicant) Yolft![ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... c ... ..... 1926 Application No. ..9.42 .......... MProved pjC....,�...... 19k � Permit No. ��! a Z"� .................... Disapproveda/c ..................................................................'..................... ................................................................................................... .. ..... .. (Buil nga Inspector) APPLICATION FOR BUILDING PERMIT Date ....... l ..y............... 19710.. INSTRUCTIONS a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate 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 giving a detailed description of layout of property must be drown on the diagram which is part of this application. 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 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 whatever until a Certificate of Occupancy shall 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 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 buildings for necessary inspections. .................................................................................................. (Signature of applicant, or name, if a corporation) // (Address of a �licant � �G� 0 u r r/A��/v r O n/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................................. ..................... Name of owner of premises L' o = .............. 4........................................................................................................ If applicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and tit Iecof corporate officer) R •ia i ---- F �Gvrn /NG' . `U.�i..x /L � .� �.................... Plumber's License No/ / Electrician's License No. h — .;•��.��ALZu.✓ i : 7 (n/Av4i t/ yrE Other Trade's License No. .............................................. 1. Location of land on which proposed wo/`k will be done. Map No.: 6.. ..4r... .. ...:............ Lot No. Street and Number ..CSL. .....Nyl � T: l !/JA.. ..E..r.....1!)!L!r.7.'....�iP....................... ............... . ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........�/q ...L.A.W.D. .. ....................�............................................. b. Intended use and occupancy FA �.1 �r �7...✓...........✓......................... .�...... .......... .w .. %N.... 3. Nature of work (check which applicable): New Building ...k< Addition .................. Alteration ..............,. Repair .................. Removal .................. Demolition.................... Other Work ................................................ .... 2 7 O (Description) 4. Estimated Cost ..3.Q./.&P.,;U...r..............................Fee .........: .... .-................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .... Z.:C.......Number of dwelling units on each floor G If garage, number of cars ......... ....C. � .............. ................................ ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ............�...,.............8. Z •'• entire new construction: Front .........74. ,................ Rear ............................ Depth ........ ............ P 9. Size of lot: Front[ Number of Stories /y/ .. A .✓C ............................... Dimensions o en Height ..............::..., ..............._.................................................. .. / Z c� �.......�... O!�............................. Rear ........I...�.� ................. Depth ................. 10. Date of Purchase .....................................Name of Former Owner �Af�T /ten 'Cj ' qTEJ ................................................. 11. Zone or use district in which premises are situated ............................................... v............. .......... .................. .. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( Yes ( YNo� _ yy i 14. Name of Owner of premises lY6r�LU.�tr.�ilF c.;1.5.......... Address/. ...f............?:�....:�0 Phone No�..�:......:j.��`J Name of Architect .....� i..67!? ../........................ Address .. tc:P_hone No.'�.J.��r. s Name of Contractor �7 .......... � . .... Phone No. kg' 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 interior or corner lot. STATE OF NEW Y R I S S COUNTY OP ........ .0 .#0. . .......f Vaasilia Calobriaf . .... .. .......... ...,*111*111**"I....*...being duly sworn, deposes and says that he is the applicant (Name ofrindividual signing contract) above named. He is the .............. .......agent !or Callon Contracting. Co,.,....Ina.............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that allt statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applica ' n filed therewith. Sworn to before me this 22.nd. day of ....#O��r....................1 1970...........r (��/ � Not ry Public. ............. ......Bu1't©lk County (Signature of applicant) ELIZBTH NILLE NOTARYPUCEIC, Safte of New York No. 52-8121,250, Suffolk County Term Expires March 3a IP_ • �� -�Fs.Ru. G ANUEL PAL145 159-ZZ ZOmi '20. tVHiTa rods N.Y. tit" (-rat. z12.4&s-o" *NMI It.864 091,ft. I �,.t, t '� d£tF{�aEV lity. l IRO. ({j I ` 1•t hF> . Soca. DS' y ' en fa b o + Z 1r sib tcwts 4040 1,1 tJotai Cammu*E144 veep Utrvkes all left. `F• 1� CAP + Alm op K100 Delve NOR ADDITION FO THIS SURVEY IS A VIOLATION OF , SECTION 1109 OF THE-NEW YORK STATE EDUCATION LAW, - EXCAVATiM, CG? rEC 6 ___ _ COPIES OF THIS SURVEY MAP NOT BEARING i THE LAND SUS;VEYOR'S INKED SEAL OR + _ EMBOSSED SEAL SHALL NOP BF CONSIDERED ,� TO BE A VALID TRUE COPY., { GUARANTEES INDICATED HEREON SHALL RUN �-� ONLY TO THE PEkSON FOR WHOM THE SURVE �E 15 PRE A ED, AND OTT HIS &HALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AN 1 {p„ LENDING INSTITUTION LISTED HEREON, AND i0 THE g55:GNEES OF THE LENDING INSTI- ��, TUTION. GUARANTEES ARE NOT TRANSF,RABLE TO ADWTIONAL INSTITUTIONS OR SUBSECIUE NI tA� OWNERS. P OF LOT 1-114 Cxwran+eed +o lirot � ss�tMP ,•'SAP oie"CAPTAI►t K100 gvrs. F �saurMaj Thin and faraaran ' 1te1e++�rwe� >ffclkt400"t4 Mop NO. Item) e3.4ury tii6u.L G► MAT T'trucK RODfRN''K, WA ru Ea. 'TOWN of 5ou'r'HO<_O , N .Y. resat MElL< su rr.Co.awr.or MSALTM !TA or woum ROR,APPROVAL OF COMa71!{�C��{}t dMlLY "a THX WAIRR WPPI.Y AM /tWA" Soam �� scnay PQR" MA. ro THE GtO .j' M. Rep, No.; 6 .SUS f'EAMpORDr Orr w.rdlwRMc -oo. DfPT. -rJ a !OE'1i11 fiM t/t+t{�MMIt>p. 4 4 ;ir ��-Q� OW . 6 OWNERS lUPP.CO. k P—MANUGi_ PAI_105 DAlS aft21 byz A. D. REF. # 51, t -ZZ Z� �O. The sewage disposal and water supply WHITa5T0N6 , N.Y. 11357 facilitlen for this location have been (Yet. Z12-463-0(79) to besad by this department and found-x rl ARd1:11,86G S4.f1. n Q Chief of General Eng?nite N DEED: 1..6Z73 , P.ZT7 c�rT lance 0 t� 1.43 �J Hz) (V OCo nt) 14 i for a'h�Pn - --- ��. AT IO Q HID F 3 J I , In I ' o freyme Meuse � M. SCALE: 40'mCAO 1 !tlnlC �r 4V N IM0 TnoruirKent — N,136'00'30"IV. -'►SA � Alf 4 ,.� No+e: Coo"ML N well ftrvfus all IotS. •. ^' C APTA 1 N \ JNAUTHORIZED ALTERATION OR ADDITION - Kloo DIZIV<rf SECTION 7209 OF THE NEW YOU STATE EDUCATION LAW. - _. T COPIES OF THIS SU:VCY MAP NOT BEARING THE LAND SUF.V0 �D %[AL OR EMBOSSED SEAL Snn,.L :�— uE C04SIUEREO TO BE A VALID T:UL C-,' . GUARANTEES iN✓":P.i L'J Es: ,-,SHALL RUN ONLY TO THE i-.SJ,: F:: tinOIA THE SURVEY IS PREFARED, A;,C OR, ft L-`.`JF TO THE TITLE COMPANY, G \ t A F AL AGENCY AND LENDING INSTITUTION L ST D H.F:ON, AND TO THE ASSIGNEES OF TEE LENDII•IG INSTI- T1TLE CERTIP T'JTION.GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. MAP OP LOT 1q4 STAMP Uuarart+eed i+n the SEAL MAP OF CAPTAIN Kloo EST"5.- Ser-or. ll -r.,+It and 6uavantR, eoFRTpeny (5offa k CoL" Mop No. h6T2) ag , Fweltsd July f8119T7. AT MATTiTUCK RODERICK VAN TUYL. P. C. -rowN OP 50uTHOLo , N .Y. T . y c ` / LIC.LAND sURVEYOR"REENPOIfY, N.Y. TEST HOLE BUFF.CO.DAPT.OF HEALTH SERVICES STATEMENT OF INTENT San y D b• FOR APPROVAL OF CONSTRUCTION ONLY 1a�dy THE WATER SUPPLY AND SEWAGE lOarry --- ------ '9/L DATE: DISPOSAL SYSTEMS Pon THIS REST. !array DANCE WILL CONPCRM TO THE C10 i' �. H.S. RAF. NO.: STANDARDS OF SUFFOLK CO. DEFT. Sand`, OF HEALTH. SERVICES. SC:xH�.Ya_J APPROVED: ' I'ot lt3 Isl 17' APPLICANT