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Home My WebLink About15466-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Budding Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy September 18, 1987 No Z-16189 Date ONE FAMILY DWELLING WITH ATTACHED GARAGE THIS CERTIFIES tkat the budding L°catt°n°fPr°pertYHou1809'No ROW Off Rocky Point Rd. East Marion, N.Y. · se ....................... County Tax Map No. I000 Section 0 3 1 . .Block 0 3 .Lot 10 Subdxwsion ....................... Fried Map No ........ Lot No ............ conforms substantially to the Apphcahon for Budding Permit heretofore f'ded ~n tMs office dated November 3, 1986 pursuant to which Buriding Permit No. 15/,66 Z dated.... November..... .. ..........7' 1986 ... . was~ssued, andconformstoallofthereqmrements of the apphcable provm~ons of the law. The occupancy for which tlus certfficate m tssued ts ....... ONE FAMILY DWELLING WITH ATTACHED GARAGE,WOOD DECK & SECOND STORY WOOD DECK AS 'A]P~P'L' I'E~ '~O~ .' ................................................. The cerhficate ts tssued to NORMAN R, & KAREN RIECI~I ............... ~ ~e;, ¥~,~o~'~x .................. of the aforesmd braiding. Suffolk County Department of Health Approval 86- S O- 16/4 UNDERWRITERS CERTIFICATE NO. N 823869 July 2/4, 1987 PLUMBERS CERTIFICATION DATED: R~v 1t81 TOVVN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER,AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No I000 Sect,on C) .~..I. Block ..... .(:~..~. ...... Lot No...). D.., A .... ~.ont to o~p~,cot,o, dot.d . ~....~' .~"'~.....~. ....... . ~.'2 k'.. o.~ oppro~ ~ ,"~ Budding Inspector ~ee *..~-....' / Building Inspector Rev 6/30/B0 FORM NO. 6 TOWN Of SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 Instructions Th~s apphcat~on must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor w~th the following, for new buddings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical ~nstallat~on from Board of F~re Underwriters. 4. Commercial buildings, Industrml buddings, Mull{pie 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-ex,sting" [and uses: 1. Accurate survey of p~operty 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 buddings or premises, or other pertinent mforma- t~on required to prepare a cert{f~cate. C. Fees: 1. Cert~f[cate of occupancy $25 00 -- BOSI~TES$ $50.00 ACCESSORY $I0.00 2. Certificate of occupancy on pre-existing dwelhng $ 50.00 3, Copy of certlflcate of occupancv $ 5.00, over 5 7ears $I0.00 4.Vacant Land C.O. $ 20.00 .,~,~.~,~ NewConStruction ...... Old or Pre-ex~stmg Building ........... Vacant Land ............. Location of Property ~R r~ ~'2~] ~' ' ' 'J ....... 1 ............................. House No. ~treet ]Yam/et Owner or Owners of.roperty . AJ.C .¢.~:4~ .~..~'...~...~....~.~.~ .~..~. ~;..C~.. ................ CountyTax Map No. 1000Section .~.( ........... Block ............... Lot .... : ........ Subdlv.s~on ..................... Fded Map No ........ Lot No ............. Permit No ....... Date of Permit ...... Apphcant. ............................... , Health Dept. Approval ..................... Labor Dept. Approval ........................ Underwriters Approval ...................... Planmng Board Approval ..................... Request for Temporary CerDficate .................. Final Certificate ....................... Fee Submitted $ .... ' .................. Construction on above described building and permit meets all applicable codes and regulations Apphcant . ~I~.~.~/V'L. ~'~.¥[Z~ .......................... Rev I0 10 78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 CERTIFICATION Bullding Permit No. owner (please print) ~/ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me thms /~vT~ day of ~_f~57~ 19 ~7 Notary Publzc, ~./:~--~ A~/~ Notary Publ~ County kARE~q~W/BOE~C~ESSON QuaM~ed m SuUo/k C~n~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000708 BUREAU OF ELECTRICITY 0~.. July 30, 1987 ~t~.oh~t,o~o.o,,yd~ 483222/87 N THIS CE~IFIE~ THAT ~y t~ e~t~c~ ~u~pment ~ ~e~ be~w a~ tnt~uc~ by t~ apricot ~m~ on t~ ~ appl~at~ numar ~n t~ p~ of No,man R. Rei~, Rocky Point Road, Private Ro~ E/S, East ~r~on, N.Y. ~sexamm~on July 20, 1987 andfoundtobemcontphanceutththerequlre.zenrsofth~Boar~. ~XTU~ ~ I I RXTURES ~ RANGES {C~KING D;CK5 ~ OVENS DISH WASHERS EX~AU~T FANS 4-G.F.C.I. 3-S~ Detectors Prato Electr~caian Wmggins Lane Greenport, N.Y. 11944 Lic. 1049E OUNDATION { 1st) OUNDATION (2nd) OUGH F~ FLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIOt tL COMMEN 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ISULATION / FRAMING ~/] FINAL REMARKS: ~"~/~-~ ~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ~.ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~']'/~I.NAL ~ REMARKS: DATE [~/~ INSPE~OR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE [ ] FRAMING REMARKS.' 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FINAL DATE 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [//]'~OUGH PLBG. [.~FOUNDATION 2ND [~/] INSULATION FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~FRAMING [ ] FINAL / / / 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [~.AL REMARKS: DATE INSPECTOR~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL :.. ~ .~....~:2~'..~J~.~ PLEASE TAKE NOTICE that your apphcation dated ...... ~..././. ...... 19 .~.. ~' Location oI~'roper[y /t~se'Uo ..... ~ ......... OP.. r. ~t~J't '1' ~ ~ ..... ~ ~ ....... *' 'H~le~ County Tax Map No. 1000 Section .. ~..~ ..... Bloc. k .. ~.~ ..... ~t ~ . ~ ~ SubdiviMon~~. ~e~o. ~~ .. Lot No .... ~ ~. ~.-- ~ Is r~turn~d b~with and disapprowd o~ the fotlowmg grounds .~~~ .~ .... ~ .... ~. ~..~~ ..... .... G~.. ~ ~...~... ~ ..... /.e~..~.~ .......... Buzlding Inspector RV 1/80 FORM TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date .~.../. / .......... 19 .~..~. PLEASE TAKE NOTICE that your application dated ~: · ~..~ ..... ~...~./.~/,~//~,/,.~,//~,~, ....... ~cation di~mperty: · · ~.~ ?~. .................................... ~ ........... ~OUSe ~0. Stroe t Hamlet County Tax Map No. 1000 S~ction... ~..~ ....... B~ock ~.~ ...... ~t . ~/~.. ~ ~. is returned herewith a~~ the followmg grougd~. ~~ .... ~.. / a~...~... ~ ..... /.~..~.~/ ............. RV 1/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY B5 JOHN STREET, NEW YORK, NEW YORK T0038 THIS CE~IFIES THAT ~n R. Rei~, Rocky Point Road, Private Ro~ E/S, ~a~c ~r~on, ~.Y. m the following I~t,on, ~ B~ement ~ Ist fl ~ 2nd ~ S~t,on Bilk ~sexamtnedon .~U~ 20, ~87 andfoundtobetncotnphanteu~ththerequtrementsofth~sB~rd FIXTURE fiXTURES OUTt~T$ DRYERS FURNACE MOTORS FUTURE APPLIANCE I~ED~RS ~S COOKING D~CKS OVENS DISH WASHERS EXHAUST FANS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS SERVICE DISCONNECT S E R AI~ARATUS Xotor~: 1-F 4-C.F.C.I. 3-Smoke Detectors C NO OF Hi LEG 4/O Sal Praco Electricaian ~;i.~gins Lane Greenport. N,Y. 11944 Lic. 1049E MANAGER cerflf*cctte must not be altered ~n an), manner, return to the ofhce of the ~oord d incorrect Inspectors mo by their credenhals COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER Southo Town Board o£ Appeals ACTION OF THE ZONING BOARD OF APPEALS 3554 Appeal NO. Application Dated August 28, ]986 TO: Mr. and Mrs, Norman Reich 295 West Front Street Greenport, NY 11944 [Appellant (s) ] At a Meeting of the Zoning Board of Appeals held on 0ct0ber ]0~ 1986, the above appeal was considered, and the action indicated below was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request for Special Exception under the Zoning Ordinance Article , Section [×] Request for Variance to the Zoning Ordinance Article III , Section ]00-3l, Bulk Schedule [ ] Request ~or Application of NORMAN AND KAREN REICH for a Variance to the Zoning Ordinance, Ar'ticle III, 'Sect'i6'n'106-31 for permission to construct dwelling with an insufficient rearyard setback, at 1809 Right-of-way off the East Side of Rocky Point Road, East Marion, NY; District lO00, Section 31, Block 3, Part of Lot 10, K]mon and Retzos Minor Subdivision #81, Lot #2. WHEREAS, in the Matter No. 3554; and a public hearing was held and concluded on October 2, 1986 of the Application of NORMAN AND KAREN REICH under Appeal WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; and WHEREAS, the board has carefully considered all testimony and documentation submitted concerning this application; and WHEREAS, the board members have personally viewed and are familiar with the premises in question, its present zoning, and the surrounding areas; and WHEREAS, the board made the following findings of fact. 1. The premises in question is known and referred to as Lot #2, Minor Subdivision No. 81, approved by the Southold Town Planning Board during 1973, and contains a total lot area of 44,216 (inclusive of six-ft, wide right-of-way extending along the easterly property line). 2. The subject premises is presently vacant and ]s more particularly shown and identified on the Suffolk County Tax Maps as District lO00, Section 31, Block 2, Lot lO. 3. By this application, appellants request permission to locate a new single-family dwelling with attached garage with an insufficient setback from the rear property line at 37 feet. (CONTINUED ON PAGE TWO/ DATED: October 10, 1986. Form ZB4 (rmv. 12/ CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS .?age 2 - Appeal No. 3554 Matter of NORMAN AND KAREN REICH Decision Rendered October 10, 1986 4. Column "A-40" of the Bulk Schedule of the Zoning Code requires a minimum rearyard setback at 50 feet. Article III, Section 100-32 permits accessory buildings in the rear yard area with setbacks at three feet from all property l~nes. The depth of the subject parcel is 135 feet, which ~s substandard. 5. For the record, it is noted that improvements of this private right-of-way from the easterly side of Rocky Point Road to within the first 25 feet of the subject parcel were accepted as conditioned by Appeal No. 3337 rendered June 13, 1985 pursuant to New York Town Law, Section 280-a~ on October 2, 1986. In considering this appeal, the board also finds and deter- mines: (a) the circumstances of the property are unique and lend to the practical difficulties; (b) the variance w~ll not in turn cause a substantial effect of ~ncreased population density or be adverse to the safety, health, welfare, comfort, convenience, order of the town; (c) there w~ll be no substantial detriment to adjoining properties; (d) the relief requested is not substantial in relation to the requirements; (e) in view of the above factors, the ~nterests of justice w~ll be served by granting the variance applied. Accordingly, on motion by Mr. Saw~cki, seconded by Mr. Grigonis, it was , RESOLVED, that the relief requested under Appeal No. 3554 in the Matter of the Application of NORMAN AND KAREN REICH of an insufficient rearyard setback at not closer than 37 feet as shown by survey of August 5, 1986, prepared by Pecon~c Surveyors and Engineers, P.C., BE AND HEREBY IS APPROVED. Vote of the Board: Douglass and Sawicki. due to illness.) Th~s Ayes: Messrs. Goehnnger, Gr~gonls, (Member Doyen, Fishers Island, was absent resolution was duly adopted. lk GERARD P. GOEHRINGER, C~AIRMAN October 13, 1986 ,--., > LOT NUMBERS REFER TO \ MINOR SUBDIVISION FOR KIMON 8~ WOODENE RETZOS \~ \ NOTE LOT ~ ,. ~ 4REA 82o$5,40. ( Vqconf ) N/O/F KIMoN F~ETZo$ 61 WOODENE RETzos LOT 3 ' WIDE ~IGH T OF ~ WAy ~ ~ / o.~ r~sT ~ / ~ h~vYl / 5URVE~ FOR NORMAN R . REICH KAREN REICH / TOWN OF SOUTHOLD /SUFFOLK COUNT~, N.Y, ~mJ~0O - 3J - o~ - P/o Prepared m eccordence with the st~a~rd~ ~or htle su~eys ~s estebhshed by SC AL ~ ~" = 50* the L I.A. LS. ~nd ~pproved end ~opte~ JULY ~7, ~986 for such use by The New York Stale LanO AO~ ~ ~ /~ ~ Title Association. N Y S LIC NO 49668 SURVEYORS (516 ) 765 - 5020 P 0 BOX 909 MAIN ROAD .SOUTHOLD , N Y 1197'1 ENGINEERS , P C ELEVATIONS ARE TO AN ASSUMED CERTIFIED TO TITLE U S A INSURANCE CORPORATION OS NEW YORK NORMAN R REICH KAREN REICH 295 West Front Street GreenDort. New York 11944 516 477-2332 REFERENCED DATUM Z LOT NUMBERS REFER TO MINOR SUBDivisIoN FOR KIMON 81 WOODENE RETZOS alo1~ - ~ 41~EA SURVEYORS (516 ) 765 - 5020 P 0 BOX 909 MAIN ROAD $OUTHOLD , N Y 11971 LOT 2 '~1 $2035,~i0 ,, W 135 ( v,~o~, ~ / SURVEY FOR ~ETzo3 ~ LOT 3. Prepered in accordance with the mimmum SCALE j, = 50' ~tandards for htJe su~eys ~s est~bhshed b) the L.I A.L.S. and approved and adopte~ JULY for such use by The New York State Lan~ A~ ~ ~ /~ T~tle Ass~ation. C~ ~IFI~O Y S LIC NO, 49668 TITLE U S.A, INSURANCE CORPORATION O~ NEW ~RK NORMAN R. REICH KAREN REICH ENGINEERS ~ P C ~h~ water supply & towage d~sposal sys- te?s f~ th~s residence Wll) conform to the ~stdnd~ of the Suffolk County Depart- O~nt ~ Health ~ B Y OTHERS ~ TEST HOLE % ~r~ve/ 5' ~ ~rove/ ELEVATIONS ARE TO AN ASSUMED REFERENCED DA TUM 86.- ,583 LOT NUMBERS REFER TO MINOR SUBDIVISION FOR KIMON 8~ WOODENE RETZOS / The = pply facll~es for this Iocatm~ by this Department and/o~ / _ :;L ": ",, /'1:', ~J ~/o/~ ~ ) ~ ,' SURVEY FOR ~ IMoN RE ~ b~J ~oo~ ~_ ~o~ ~ ..I /NORMAN R. REICH ~~...:~~~ /~/,/ K~R~ ~E~C~ for such um by ~ New Yo~ 5~ Land JULY 17 , 1986 CERTIFIE~ OORPORATION O~ NEW YORK , ,; ~',* , ~ NORMAN R REICH "'~'~ ~ KAREN REICH SOUTHOLD , N Y 11971 TO AN ASSUMED DATUM FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOL9, N.Y. 11971 TEL.. 765-1802 Examined ~0.~ ~. , 19 ~ 9 Approved . .~)o~.~ '~., 19 ~(* Permit No D~sapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcataon must be completely filled m by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing IocaUon of lot and of bmldmgs on premmes, relationship to adjoining premises or pubhc streets lot areas, and g~vmg a detmled description of layout of property must be drawn on the dmgmm whmh ~s part of tbas apph- cation. c. The work covered by tkas application may not be commenced before issuance of Budding Permit. d. Upon approval of this apphcatmn, the Bmldmg Inspector will msued a Building Permit to the applicant Such permit · shall be kept on the pre, raises avadable for inspection throughout the work. e. No braiding shall be occupied or used in whole or in part for any purpose whatever untda Certificate of Occupancy shall have been granted by the Braiding Inspector. APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Braiding Permit pursuant to the Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additaons or alteratmns, or for removal or demohtaon, as herem described. The apphcant agrees to comply with all apphcable laws, ordinances, bmldmg c~de, hous~g coc~, and regulations, and to admit authorized hlspectors on premises and m bmldmg for necessarymspel;?~f~:x~/O (Signature of aplTli,~ant, ¢ ~ if a corporation) / (Mathng ess or apphcant) / / State whether applicant is owner, lessee, agent, architect, enganeer, general contractor, electnman, plumber or builder. .... O.Ud.a e f .......... ........................ Name of owner of premises ....................... (as on the tax roll or latest deed) If apphcant is a corporatmn, signature of duly authorized officer · ' <' (Name'an~ t~tle of corporate officer) Builder's License No /~ . .-°-A"l, ce-~ Plumber's L~cense No ~ .... Electrtctan's License No /~-:../'O~ . Location of land on which proposed work will be, done Ho s Nu nber Street County Tax Map No I000 Section '~ ( .. Hamlet Block ...3 .. Lot /O .... Subdlws~on.. Fded Map No ........ Lot ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction' a. Exist~ng use and occupancy b. Intended use and occupancy ....... ~ .... FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.. 765-1802 Examined ......... 19 Approved . , 19 Disapproved a/c ......... Permit No l:(ece ~.ve d ........... ,19. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... 19 INSTRUCTIONS a Ttus application must be completely filled in by typewriter or m ink and submitted to the Buildmg Inspector, w~t] sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showmg location of lot and of bmldmgs on premises, relationslup to adjoining premises or pubhc stre or a~eas, and giving a detmled description of layout of property must be drawn on the dmgram which is part of this ap cation. c. The work covered by flus apphcat~on may not be commenced before issuance of Bmldmg Permit d. Upon approval of th~s applicatmn, the Building Inspector wdl ~ssued a Budding Permit to the applicant Such pen shall be kept on the premises avadable for inspectton throughout the work. e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certfficate of Occupm shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Buddmg Department for the issuance of a Bmldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance- Regulations, for the construction of buddings, additmns or alterations, or for removal or demolition, as herein describ The apphcant agrees to comply vath all applicable laws, ordinances, budding code, housing code, and regulations, and admit authorized mspectors on premises and m building for necessary inspections. (Signature of apphcant, or name, ff a corporation) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull, Name of owner of premises lc- ~/ I. ........ (as on the tax roll or latest deed) If applicant ~s a corporahon, signature of duly authorized officer (Name and title of corporate officer) Budder's License No Plumber's License No .......... Electnman's License No .. Other Trade's License No. 1. Location of land on which proposed work will be done House Number Street (Name) .... State ex~ting use and occupancy of premises and ~ntended use and occupancy of proposed construction Hamlet / .. . . .Lot.g/(-,-'~_l~o/,t a Existing use and occupancy b Intended use and occupancy 3. Nature of work (check which apphcable) New Building ..~,< .. Addition ...... Alteration . .. Repmr ....... Removal ............ Demolltmn .......... Other Work ......... (Descnphon) 4 EstunatedCost . ~...~, ../~ff~...f, .~,.~.c_~z. ........ Fee ............................... (to be pad on filing this application) 5. If dwelling, number of dwelling units .... ,/ ....... Number of dwelling units on each floor .............. If garage, number of cars ...................................................... 6. If bumness, commercml or mixed occupancy, specify nature and extent of each type of use .............. 7. D~menmons of existing structures, ff any Front ........... Rear ........... Depth ........... Height .......... Number of Stones .......................................... D~mensions of same structure with alterations or additmns' Front ............. Rear Depth .............. Height .............. Number of Stones .............. 8. Dlmenmons of entire new construchon Front ........... Rear .............. Depth ........... Height ............ Number of Stones ............................................ 9. Size oflot. Front .............. Rear .................. Depth ................ 10. Date of Purchase ............... Nmne of Former Owner .................... 1 1 Zone or use district in which premises are situated ...................................... 12 Does proposed construction violate any zomng law, ordinance or regulation ................... 13. Will lot be regraded ..................... Will excess fill be removed from premises Yes I, 14 Name of Owner of premises .......... Address ................ Phone No ......... Name of Architect ............. Address ............ Phone No ........ Name of Contractor ................... Address ............... Phone No ...... 15. Is this property located wlthinl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Tovm Trustees Permit may be required. PLOT DIAGRAM Locate clearly and dmtmcfly all braidings, whether existing or proposed, and. indicate all set-back dn-nensions fro, property hnes. Give street and block number or descnptmn according to deed, and show street names and indicate wheth. interior or corner lot STATE OF NEW YORK, $ S COUNTY OF ....... (Name of individual slgnlng contract) above named bmng duly sworn, deposes and says that he is the apphca~ He is the .................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and ~e th apphcation; that all statements contmned m thru apphcatlon are true to the best oflus knowledge and belief, and that fl work wdl be performed ~n the manner set forth m the application filed therewith Sworn to before me thts ............................ / motaryPubhc, f.l.~'A<...d:~...~..t<..~f~.~.?.. Count:~ .~.~..,.. ..................... i~f~ a~~_/ (Signature of apphcan .1 Phone 477-0400 PLAN NO Main Road GREENPORY, N.Y. 11944 :-,~' - ~ ," '. ~' ' ,: ~-:.,,.,,.o., .. ,..""~,,,. . ','soLoER UsE , ' O'~LE*o'CO~rENT~O*~ ~ ,1 Phone 47%0400