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Home My WebLink About34178-z · o~ NO. o TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .~...~...../..~~ ....... ~ .... .~.~..~......~.~.~[~ ~o .............. ~ ......~..~ ~2 ........................ cou~ r~ ~o, ,o. ~000 Se~,,o~ .../.~G ....... ~ ....... ~ .......... ~o~ ,o ...... ~ ............ Building Inspector. Rev. 6130/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ***TEMPORARY*** No. Z 15896 Date July I , 1987 THIS CERTIFIES that the building R e s t a u r a n t Location of Property 5765 MILL Road Mattituck House No. Street Hamlet County Tax Map No. 1000 Section 106 .Block 6 .... Lot 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated F e b. 1 2, l 9 8 7 pursuant to which Building Permit No. 1 6 0 9 2 z dated.... J un ..... e 1 8 ,.........' 1 9 8 7 ...... ... . was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... Alteration of restaurant. The certificate is issued to DAV I D RO S E N B ERG ..................... it .................. of the aforesaid building, Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO .............. .P.e.n.d. ~,.ng ............................ PLUMBERS CERTIFICATION DATED: N/A This temporary C.O. expires Sept. 1, 1987 Building Inspector Rev. 1/81 FQRM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted -- ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, 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 pZoperty showing all property lines, streets, buildings and 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 informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1 Certiflcateofoceupancy New Dwelling $25,Q0, Accessory!$]0.O0 Business $50.00 J~,ertificate of occupancy on pre-existing dwe))ing $ 50.00 ~. Copy of certificate of occupancy $ 5 00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 & ~.O ~ 5.Updated C.O. $ 50.00 Date ...... .~ ...... ~. ........... New C on s t r uc % i on ...... O~d or P re-existing Building ..... ~ .... Vacant hand ............. Location of Property . .~--~ D..O.i~'... M.'~..L.....~.../~. ......... ~ jO~..~..~.~, .~.~..~. ........ House No. Street Ham/et Owner or Owners of Property .~.~d,~.~.... ~.~...~. -~.~ .k~.~J~-~.-.~ ...................... County Tax Map No. 1000 Section .... ~.0.~ ...... Block .......-- ~ ...... Lot ..... ~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... A p p lica n t .~'~.. ~1. ~..~.. ~-.,J~ ~'~ .~.~ .... Health Dept. ApprovaJ. ~.~L.~.. ~.-~.....'T'J~..~. C.,. Labor Dept. Approval ........................ ~ ~; er s tr ~_~mP ~°r:: ly '~ :r~i'f~ t~e ' Q~ ..... P Jan ningF ~r;e~f~; ' :: ......... :'"[ Fee Submitted $ ~ .... I.~ ~. ..... Construction on ~bove described building a~mit~ a~licable e~des and regulations. ~. ~o-~o-v8 . Applicant .. ~~..~~~ ............. FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TO DAVID ROSENBERG (owner or authorized agent of owner) P.O. BOX 998, MATTITUCK, N.Y. 11952 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance CH lO0 Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that ..... ~..e..b..u.~.~.~.d.~?-~?..~.~..b.~.u..~.~..d..~..n..~..:....?..~..~b.u..~.!~d.~.~.~`~t t, (state character of violation) operating bar no Certificate of Occupancy. 100-14 I--100-144 in violation of ............................................................................................................................. : .......... (State section or paragraph of applicable Jaw, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the 19 th June of ...................................................... , ,9....8Z. The premisesto which this ORDER TO REMEDY VIOLATION refersoresituoted at 5765 MILL ROAD ................................................................................. Coumty of Suffolk, New York. MATTITUCK, N.Y. I1952 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law "STOP ALL WORK" ROSEN & ROSENBERG 662 MAIN STREET PORT JEFFERSON, N.Y. moy constitutean offense punishable by fine orimprisonmentorboth. "STOP ALL WORK" i 777 CURTIS W. HORTON FOKM NO. 5 TOWN OF SO,UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATIOt,4 Dote March 10, 1988 19 ........ Old Mill Inn of Mattituck, Inc. David Rosenberg ~_ (owner or authorized agent of owner) Mill Road, P.O. Box 998, Mattituck, N.Y. 11952 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists o violation of: Zoning Ordinance ............................................ Other Applicable Laws, Ordinances'or Regulations ....C...h.,a.,p.:....4...5. ...................... at premises hereinafter described in that A business is being operated without a (state character of violation) certificate of occhpancy, doing alteration work without a Building Permit and creating a hazardous condition with a heating unit. Chap. 45-8, Chap. 45-~5 Jn violation of ............................................................. ' ........................................................................... (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Jaw and to remedy the conditions above mentioned forthwith on or before the .....~..m..m...e..c]...i..a...~.e.~.~. ........................................ March day of ...................................................... , m....8..8.. Suffolk Co. Tax #I000-]06-6-3 The premises to which this ORDER TO REMEDY VIOLATION refers ore situated at 5765 w. Mill Rd.,Mattitu.c..k County of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the opplicable provisions of Iow may constitute an offense punishable by fine or imprisonment or both. Work can continue when all applicable permits are issued. ............ Vincent R. Wieczorek STEVE G. TSONTAKIS ASSOCIATES Consulting Engineers, P.C. STRUCTURAL RE-INSPECTION (4/20/88) Old Mill Restauraut Mattituck, New York The structure was found in essentially the same condition that was reported on February 25, 1987, except for the following items: The corner piling and girder at the two story partition that is over the water. The corner piling, which should be a multiple dolphin, and a section of girder is marginally stable and needs immediate attention. (see photo #4 of original report) Two of the steel "I" beams in supporting the dining room floor are structurally unsound be- cause of corrosion. Portions of the beam web is rusted out. These need to be augmented with angle iron which would strap the top flange to the web. The second and third beam need this modification where there are rust holes. SGT/bp Steve G. Tsontakls, P.E. BOX 1190, 632 ROANOKE AVENUE, RIVERHEAD, NEW YORK 11901 (516) 72~7411 ROSEN May 20, 1988 Mr. Victor Imssard Building Inspector Town of Southold Southold, New York RE: The Old Mill Inn of Mattituck, Inc. Please be advised the undersigned represents The Old Mill of Mattituck, Inc. My client has done everything possible to cc~ply with the request of your Depaz ~e-nt. The Old Mill Inn of Mattituck has been improved both aesthetically and structurally over the past year and a half. I am aware of your Department's request that still more work be done, specifically that certain pilings be driven underneath the kitchen portion of the hnl . ~ you know, you signed a certificate of occupancy on September 20, 1984 for this premises. It is clear that The Old Mill Inn is in much better condition now than it was at the time you issued the Certificate of Occupancy. Nonetheless my client has agreed to further improve the structure. Within the past two weeks the steel girders in the dining room were re-inforced in accordance with Mr. Horton's request. Although the engineers agree that the buildir~ is at least as structurally sound as it was last year, we agreed to perform the work required on the steel girder. Additionally, my client has agreed to undertake to drive the piles above raentioned. You sh~,~ld be Fade aware that this work will be accomplished as soon as possible. My client spoke to several mar/ne contractors and is engaging the services of the contractor who can first perform the work. I must again, however, re-state cur position that the Certificate of Occupancy signed by yourself on Septe~cber of 1984 is still valid and in effect. Should you require any further information, feel free to contact me. ~MR-Db nclosure HAND DELIVERED cc: Supervisor Francis Murphy Very truly yours, ROSEN & ROS~QS. BY: TEDMo ROSENBERG l~ay 20, 1988 Mr. victor Lessard Building Inspector Town of Southold Southold, New York RE: The Old Mill Inn of Mattituck, Inc. Please be advised the undersigned represents The Old Mill of Mattituck, Inc. My client has done everything possible to comply with the request of your Department. The Old Mill Inn of Mattituck has been improved both aesthetically and structurally over the past year and a half. I am aware of your Department,s request that still more work be done, specifically that certain pilings be driven underneath the kitchen portion of the building. As you know, you signed a Certificate of Occupancy on September 20, 1984 for this premises. It is clear that The Old Mill Inn is in much better condition now than it was at the time you issued the Certificate of Occupancy. Nonetheless my client has agreed to further improve the structure. Within the past two weeks the steel girders in the dining room were re-inforced in accordance with Mr. Horton's request. Although the engineers agree that the building is at least as structth--ally sound as it was last year, we agreed to perform the work required on the steel girder. Additionally, my client has agreed to undertake to drive the piles above ~entioned. You sh~a!d be made aware ~-hat this work will be accca~lished as soon as possible. My client spoke to several marine contractors and is engaging the services of the contractor who can first perform the work. I must again, however, re-state our position that the Certificate of Occupancy signed by yourself on September of 1984 is still valid and in effect. Should you require any further information, feel free to contact me. MR- ~ncI~ure HAND DELIVERED cc: Supervisor Francis Murphy Very truly yours, STEVE G. TSONTAKIS ASSOCIATES Consulting Engineers, P.C. STRUCTURAL RE-INSPECTION (4/20/88) Old Mill Restaurant Mattituck, New York The structure was found in essentially the same condition that was reported on February 25, 1987, except for the following i terns: The corner piling and girder at the two story partition that is over the water. The corner piling, which should be a multiple dolphin, and a section of girder is marginally stable and needs immediate attention. (see photo #4 of original report) 2e TWO of the steel "I" beams in supporting the dining room floor are structurally unsound be- cause of corrosion. Portions of the beam web is rusted out. These need to be augmented with angle iron which would strap the top flange to the web. The second and third beam need this modification where there are rust holes. SGT/bp Steve G. T~ont%a~is, P.E. P.O. BOX lf80, 632 ROANOKE AVENUE, RIVERHEAD, NLtW YORK 11901 (516) 727-74,11 STEVE G. TSONTAKIS ASSOCIATES Consuld,ng Engineers BOX 1180, 65~ ROANOKE AVENUE RIVERHEAD. N.Y. I1901 (516) 727-7411 Mr. David Rosenberg P.O. Box 998 Mattituck, New York Dear Mr. Rosenberg, March 4,. 1987 11952 RE: FILE COPY Old Mill Restaurant' Mattltuck, N.Y. · Enclosed please find the structural inspection report of the referenced building, as ordered by Mr. James Michele, together with my bill for services rendered. Should you have any questions regarding the report, please do not hesitate to call. Thank you for the opportunity to serve you. SGT/ac Enos. cc: Kurt Horton, Yours truly, ,, Steve G. Building Inspector w~ STEVE G. TSONTAKIS ASSOCIATES Consukiog Engineers BOX 1180, 632 ROANOKE AVENUE 1781 KING EDWARD DRIVE RIVERHEAD. N.Y. 11901 , ~,, ~ KISSIMMEE FL 32741 · (516) 727-7411 STRUCTURAL INSPECTION (2/2~/87) Old Mill Restaurant Mattituck, N.Y. INTRODUCTION The original structure was a three story wood frame.bui!.ding, which is built at the shoreline. The support of this'structure is partially a concrete pendement, with the remainder being on wood pilings under a system of girders and floor joists. There is a partial poured concrete section which is cracked and undermined. The other portion of the building, which houses'~: the dining room, is a single story structure which is supported on steel "I" beam girders connected to wood piling type columns. One end of these girders was founded on concrete..pads 'which are within a bulkhead, however, with the high tide this entire bulkhead is under water, and the water has undermined, the footings, therefore there is a severe deflection alongthe line. This line is the point in which the dining room connects with the three story section of the building. There is also a bulkhead at the shoreline which is the front face of the dining room (street side). The sheathing of this bulkhead is completely rotted out and there The dining room is completely wood pilings. There is also a ported 'on pilings. This section condition and structurally sound. -1- is undermining of the surface. supported on steel girders,i and dock and gangway which is .sup- is of a later date,,in good" DISCUSSION At the point where the single story section intersects with the three story section, there is a severe deflection {settling) which is due to the undermining of the footing and collapsed foundation. Although this settling has taken several years, it appears that the amount of deflection is at a somewhat critical point at this time. It is therefore recommended that this section be jacked into a level position and a girder be placed fastened tQ the steel single story section as founded on a high load under the original building. A ledge beam can be installed to support the well. This girder would have to be bearing foundation, this will probably be a dolphin (group of pilings) on the creek side. The other side can be supported on a concrete footing.which can be poured in place. The steelgirders supporting the dining room have ,~xperienced severe corrosion, particularly the top flange which is weak at this point in time (see photo #1). It is therefore recom- mended that a repair angle be welded to the top flange and web of each girder to supplement the existing structure. The girders then mush be cleaned and painted to prevent further' corrosion. The floor system of joists and beams in the lounge and kitchen section are adequate to support a ~00 pounds per square foot load. This is also true for the dining room section, assuming that the main girder is repaired as previou.~ly dis- cussed. -2- The bulkhead sheathing at %he front face of the dining room needs to be replaced. OTHER CONSIDERATIONS Since the building is undergoing a complete it must be brought up to part B of the N.Y.S. Code. The floor system must be insulated and enclosed. No mechanical systems or wiring is permitted renovation, below the base flood plane level. The floor system must be at or above the base flood plane level. The building walls, ceilings, glaz'ing, and doors must be brought to code. Facilities and access for the handicapped must be provided. The kitchen must have a 2 hour separation from the dining room/lounge. If the upper level is to be used for a residence, a 2 hour separation from the restaurant is required. Also, a second means of travelable egress must be provided from the second floor. The third f'loor may not be used as habitable space since this is a type 5 (wood frame) structure. SGT/ac '. Steve G. ~sontakis, P.E. -3- JUDITIt T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF $OUTHOLD Town Hall, 53095 Main Road P.O. Boxl179 Southold, NewYork 1971 TELEPHONE (516) 765-1801 April 29, 1987 David Rosenberg Old Mill Inn of Mattituck, Inc. P.O. Box 998 Mattituck, New York 11952 Dear Mr. Rosenberg: To confirm our conversation of today, April 29, 1987, your application for ALTERATION OR MODIFICATION PERMIT for CESSPOOL/SEPTIC TANK is being held until this office is in receipt of the following: 1. Type written response from the Suffolk County Health Department. 2. Written approval from the Southold Town Superintendent of Highways (possible Highway Excavation Permit required). 3. Department of Environmental Conservation approval. 4. Southold Town Trustees' approval. 5. Indication of water location on neighboring property. After the requested has been received, your application and accompanying papers will be submitted to the Southold Town Building Department for final approval. Should you have any questions, please do not hesitate to contact this office. We will try to assist you in any way we are able. Very truly yours, Linda J. Cooper Office of the Town Clerk FORM NO. 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ti. Y. ORDER TO REMEDY VIOLATION Old Mill Inn of Mattituck, Inc. David Rosenberg (owner or authorized agent of owner) Mill Road, P.O. Box 998, Mattituck, N.Y. 11952 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ............................................ Other Applicable Laws, Ordinances'or Regulations ....C...h.~.p.:....~..5. ...................... at premises hereina~'ter described in that A business is being operated without a (state character of violation) certificate of occhpancy, doing alteration work without a Building Permit and creating a hazardous condition with a heating unit in violation of Chap. 45-8, Chap. 45-15. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the Zmmediatel~ March day of ....................................................... 19....8..8.. Suffolk Co. Tax #]000-106-6-3 The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ..5...7.~..5...?..:...,,~.L..1...I.....~..d..:.z~.~.~...c.,L..c..?..q,.k. ................. County of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Work can continue when all applicable permits are issued. Building Inspecto~ "' Vincent R. Wieczorek ROSLYN HEIGHTS, NEW YORK 11577 (516) 621-7170 (212) 432-5508 ELI J. HOCHMAN FtRE SUPPRESSANT · FLAME pROOFING * AIR PURIFICA~tOI't NAL SALES Zip Cmie No. AGREEMENI' / / GENTLEMEN: We will install the following AREAISI TO BE PROTECTED: [] Grease exhaust system(s), NUMBER OF HOODS [] Olher: ,fire extinguishing equipment on your premises reedy for use. SYSTEM(S) MODEL NO. ; ~r J ~ ' '~ AUTOMATIC FUEL SHUT-OFF(S) $_(_~ ,,. ~,~ MULTIPLE ACTUATION $ , ,, TYPE SIZE / LINK ASSEMBLY(S) $ (,,~ MICROSWITCH ASSEMBLY(S) $ ( , // CUTTING $ ,,/l. cONTACTORS (ELECTRICAL) $ ,' ALTERATIONS TOTAL FOR ADDITIONAL COMPONENTS TOTAL COST FOR THIS INSTALLATION SENI-ANNUAL INSPECTIONS AS REQUIRED BY FIRE INSURANCE RATING ORGANIZATION S /,k / per inspection, FIRST YEAR $. PLANS SUBJECT TO APPROVAL BY FIRE TOTAL WITH INSPECTIONS INSURANCE RATING ORGANIZATION SALES TAX We will f uml*h ' tt m) c~st ~° 's~u ' la~anetll¢ sketches Ol °~JH~e'lla[~ (~ ~"s~ ~ze ~r~'~li~t °~ Nx Y°~ TOTAL '" ' / ' t DEPOSIT. ~B~ DUE UPON INSTAL~TION, or TERMS: $ TITLE TO ALL MATERIAL AND EQUIPMENT ~ETAINED BY VENDOR UNTIL PAID FOE IN FULL ACCEPTED A~CEPTED AND APPROVED ULNIVERSA~LiFIRE SAFETY CORP. "' l/'/" (,,- BY: SIGN AND RETUR~I ONE COPY WITH YOUR DEPOSIT IN ORDER TO HA'dE THIS INSTALLATION SCHEDULED TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HgAnTH ...... 3 SETS OF PLANS 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: Examined ................ , 19... ........................ . ~ %OWN OF SOUTi (BuildJn~ APPLICATION FOR BUILDING PERMIT ~ F~ ~ ~~T S an ~Ths application ~ust be completely fille~ in b~ewriter or in ink d subnfitted to the Building Inspector, wit sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and o~ bulldogs on premises, relationship to adjoining premises or public stre or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap~ cation. c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this application, ~he Building Inspector will issued a Build~g Pe~it tothe applicant. Such pen shall be kept on the premises available for inspection throughout the work, e. No buildiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Building Dep~tment for the issuance of a Btfilding Pe~it pursnant to ' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws~ Ordinances Regulations, [or the construction of bulldogs, additions or alterations, or for removal or demolition, as here~ describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and h~ build~g for necessa~ inspections. (Signature of applicant, or name, if a corporation) ~: (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner ofpremises . .~&~./.O.. ~,.3.~ .~~ ................... O~ (as on the tax roll or latest deed) t ~(- · If...aP~ ~, ~a t ~>is a~ ~: pora.... ~ u, sig~ m~re ~'~' '°f duly authodzed~.~ .~'~°fficer' (Name and ti? of corporate ~) ALI. CONTRACTOR S M~T BE S~F~OI, K COUNTY LICE~SEB Builder's License No... ~f?~C2 ~.~ ........... Plumber's License No ......................... Electrician's License No ....................... Other Tradc's License No .............. ! ........ ~ 7 ~ ~-- 1. Location of hind on which proposed work will be clone..E~ .~..~...O.I~... ~..~D.~ .............. ............................ .............. Itouse Number ~~~. Street Hamlet , 3 County Tax Map No. 1000Sectio, 1.0.~ ............ Block ...... ~'..~ ..... Lot...~ ......... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and inteuded use and occupancy of proposed construction: o . ancy . .............................................. Nature of work (check which applicable): New Building ' Addition .......... Alteration ...,,,'~.. .... Repair ..... . .v~Q.. ..... Removal .............. Demolition ...__~ ........ Other Work ............... ' ~ (Description Estimated Cost .......................... Fee .... ~ .................... 5. (to. be paid on filing this application) If dwelling, ,lumber of dwelling un'its ............... Number of dwelling units on each floor ................ If garage number of cars If business, commercial or mixed 6ccupancy, specify nature and extent of each type of use Dimensions of existing structures, If any: Fro,~t ............... .'7.~E .'¢~L.~ t.Z'd~--~e~ ............ Depth ............... Height ~14~! ........ Number of Stories ~ ............. ' ...... Dimensions of same structure withI alterations or additions: Front . .c-'~.:~2 ~.,.L} ~.~..~.7~. Rear .................. Depth 'Height Num her of Stories Dimensions of entire new construction: Front .... ~/.&; .C/6...<-:. Rear ............... Depth ............... Height ............... Numbelr of Stories ......................................... , .............. Size of lot: Front ...c~. ~, '~.~.A...: ......... Rear ..... .c.~.~.: .o>.q~. ........Depth ... ~ [ ~ .............. Date of Pnrchase . i'~ '..90.i .,.~..¢) ................ Name of Former Owner .L.~. ~, ¢~... ~,~..~.~.(~' r.2 t..- ../75. ....... Zone or use district in which prem!ses are situated .................................................... Does proposed construction violate any zoning law, ordinance or regulation: ... t-~N.C~ ......................... Will lot be regraded ..... z__. ·. 1~).~, ............... Will excess ill[be removed from premise~: Yes Name of Owner of premises~.?Pt.03 ~ .V-~35..~-.~Q ~'~.%g'~. ddress .~.O...~.c] ~. I~.PrT.T.I~[9~ rhone No~'. ::~. <.~. ~..~. Name of Architect ............ ~ ............... ~ddress .... .... ........... Phone No ................ Name of Contractor ........... .... Address ........ "h' .......... xP,h°ne' N0 ................ Is this property located within 300 feet of a tidal wetland? *Ye's .~/P~, _No ..... · If yes, Southold Town Trust!ets Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly all b{i c i lgs whether existing or proposed, and. indicate all set-back dimensions fro,n )perty lines. Give street and block nuinber or description according to deed, and show street names and indicate whether crier or corner'lot. being duly sworn, deposes and says that he is tile applicant is the ........................ ................................................................. i (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this dieation; that all statements contain'ed in this application are true to the best of his knowledge and belief; and that the rk will be performed m the manner s~t forth in the apphcatmn filed therewith. orn to before me this ........... /. 2 ........ day of.. ........... , ....... County HR£N It DI~ VO~ (Signature [$'f,0pplicant ) NOTARy ~ntlC,. Stm of New York . No..4707878, Suffolk County ~ '~ ~ ,err. ~res ~rch130,1~ ,'~,/