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HomeMy WebLinkAbout29478-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29628 Date: 08/08/03 THIS CERTIFIES that the building ADDITION Location of Property: 570 THIRD ST NEW SUFFOLK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 9 Lot 21 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 10, 2003 pursuant to which Building Permit No_ 29478-Z dated JUNE 10, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS PER ZBA #3104 DATED 4/20/83 . The certificate is issued to JOSEPH POLASHOCK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 77112H 06/25/03 PLUMBERS CERTIFICATION DATED N/A u o� zed Signature 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. 29478 Z Date JUNE 10, 2003 Permission is hereby granted to: JOSEPH POLASHOCK 86 FRANKLIN STREET NORTHPORT,NY 11768 for CONSTRUCT ADDITION TO EXISTING DWELLING. REPLACES BP 12282-Z at premises located at 570 THIRD ST NEW SUFFOLK County Tax Map No. 473889 Section 117 Block 0009 Lot No. 021 pursuant to application dated JUNE 10, 2003 and approved by the Building Inspector to expire on DECEMBER 10, 2004 . Fee $ 150 . 00 Autho ized Sig ature COPY Rev. 5/8/02 WOM X06 f 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 AUI' fCAIZEb) r N° 12282 Z Date ....... ................. 19. ew Permission is hereby granted to: • .... % ............:,,........ to .... . .. . "",.... sell.'"":. ...' .....+ c1,► ' .41(90 ......... ' 41( 441cz"— oil IZ ........4 .::...........41 ... .. ....................................................... at premises located at ....4h � ......... „ice it`ii '": ..... .................. .... ............ .. ....... ....................................................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ....& .......... Block .. .. ..... Lot' No. Zk .......... pursuant to application dated .....1..![.11 .vA....4111W.............. 1940;& and approved by the Building Inspector. Fee s.. ......... ; Building Inspector Rev. 6/30/80 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical 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 Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling $25.00, Additions to dwelling$25.00, Alterations to dwelling$25.00, Swimming pool $25.00, Accessory building$25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 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 Date. O zl /Q3 New Construction: '1 Old or Pre-existing Building: (check one) Location of Property: S 7D r X j�OePr ) fK0/ House No. Street Hamlet Owner or Owners of Property: F—Z;g 0,100 _P 6 's a N Suffolk County Tax Map No 1000, Section j l Block Q Q Q q Lot t�oz l Subdivision Filed Map. �7 /afiLott: / Permit No. (9 ��,!'� Dale ofPermit. /�a/!2_s Applicanyz� P!1 /"!� % orr Lc- Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: tl (check one) Fee Submitted: $ �� � Applicant Signature - FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL 1� �� File No. . . . . . . . . . . . . . . : . . . . . . . . . . . . . : . . Date . /.��r.C/. : . .Z?�. . . . . . ., 19 . . . a: To t,�1GC/tnr. . ..u...`f. ... . . . . . . . . . X' -y. PLEASE TAKE NOTICE that your application dated . . . . z� . . . . . .. 19 .,?;� for permit to construct .x/ cit 1.1�1�. . Cl. .�u!6ll/« . . . . . . . . . . . . . ./. . . at (� Location of Property . 4/.5 . . . . . . . . . . .. . . . . . . . . . . ..... . . Nousw No. Street Hamlet County Tax Map No. 1000 Section . //7.. . . . . . . . Block . . .L7 7. . . . . . . Lot .aWl . . . . . . . Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . . is returned herewith and disapproved on the following pp g Srounds'—?. .�/.,�X,�E. . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector RV 1180 MWA Electrical Inspection Certificate Issue Date Electrical Inspection Service, Inc. Application Number 06/25/2003 375 Dunton Avenue 77112H East Patchogue, New York 11772 (631)286.6642 Issued To: Joseph Polashock Street: 570 3rd Street Village: New Suffolk Zip: 11956 Town: Southold Section: Block: Lot: Contractor: Lic. # Was examined and found to be in compliance with the National Electrical Code. ❑ Commercial ❑ NV Defects ❑ Pool ❑ 1st Floor Q Indoor ❑ Basement ❑ Hot Tub �< X❑ Residential ❑ Det.Garage ❑ Attic ❑ 2nd Floor X❑ Outdoor ❑X Addition ❑X Survey Switches Receptacles Fixtures GFI Heaters A/C Fans .� r � 3 4 2 1 `' NM Dishwasher WasherlAmps DryerlAmps Oven Range/Amps Microwaves Furnace oil Gas Circulators Smoke Detector Bell Transformer q M�vF d Meter Amps Phase UG/OH Jacuzzi Television CO Detector Bldg. Permit: Other Equipment fGF' Hugo S. Surdi President Rough Inspection: 06/24/2003 >� Inspector: Ed Scavelli >� Final Inspection: 06/24/2003 Inspector: Ed Scavelli This certificate must not be altered in any manner. 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Co, cAtyFh;cld `54L�' Q . 1 3 �st � u'� vincrs Rur+A�`to� SµYre�ercA MoWii� �9G,'. �Y ,, I "z` .� � s , a Qt•tn W, VCA" '�"u Ly z a1pE _ ✓ Y,- o-� ' Y'� yrs. V •.3 ;l:,iccrs�-cl; l.ctrtcl .�uYVBwjR`Cs ' 1 ... d3. .. ...«.... ...�,.....�,�5�.. ry �..��....�..�..�..��.�. LYS ...�,.......� ..�.. �..�......,... ..... .... ..,... i �; T�. .a,M 4 ,GYCP_N v,70Y 1. r s Dute: WEDNESDAY, APRIL 20 , 1983 "ers A bser.t , if any: 0/0 '71 _"Ida item/dater of: CZ- -- Llt, c of Variance or Appeal : Charles S,eroe ROhert Gerard �Fosep Grlgocus oyen Douglass Goenrtnger/ awlc -i ,:;elution made =,y: ( ) ( ) ( ) ( V1 ( ) ,,,,o n ded by: ( ) ( ) ( ( ) ( ) cn: -A� pe as applied for ( ) Approve with the following conditions : ( ) 1) as applied for ( ) Decy . ( ) i:'.'_ny without prejudice ( ) Withal-awn without ( ) Subiect to Coucty Planning referral Prejudice ( ) Suclectto Plannina Board approval ( ) ( ) Subie= to D-E.C. reau?aticnS ( ) Other: ;zf tc^ Eoarf, are as fcdlows: _ Ot \ot t:itilin t!:e Character of the A'eighgcrF'rod ( ) Granting the Relief Requested is wii Cariance is Substantial in Relation to Code spirit of the zoning code acs=s of the C. de ( ) Relief is not substantial ii.:r:lshiP not s,tflic:ent ( } Burden of hardship or difficulty shc N'et Unique ( ) Circumstances are unique precedent in the nei htarhood g ( ) Variance will not change charac-e_r a is z:iready very congested the neichborhood or-�sts of justice served 'bv denying ( ) Interests Of Justice served by gran ( )�OthcL for Special Exceptions o )4-TD ( (44-,S Nav: ( ) ( ? O ( J O M-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ) INSU ION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE l d 3 INSPECTOR . 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ;`FINAL1 ULATION FRAMING [ [ ] FIREPLACE & CHIMNEY REMARKS: IfZ4!�z � DATE INSPECTOR �71e- FIELD INSPECTION �DATE �� COMMENTS ro 3 a _ H _ FOUNDATION ( 13t ) n FOUNDATION ( 2nd ) C 2 . zG ^� o ROUGH FRAME & C PLUMBING 3 G 3 . m C m INSULATION PER N . Y. 13 G -4- STATE ENERGY CODE Z x a 3 © i m Ci L ' FINAL 6 © CDA z � A TIONAL COMMENTS ro „ ro S �. a H � O Z x C+7 a r H x c7 rh ro H FORM NO. 1 TOWN OF SOUTHOLD ' BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined c��? .,.,?+Y. ., 19 e-3 Application No. .L?.? . . . . . . . Approve. ,-/. .fib. . . ., Ie--!?p e r r n i t No. f7.Q.?! Disapproved a/c . . . . Ste✓ r` 4( u g n Inspector) APPLICATION FOR BUILDING PERMIT / p Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with . 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi 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 Occupant; 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 t( admit authorized inspectors on premises and in building for necessary inspectio /J (Signature of applicant, or name, if�ja corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . � �P ../. . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . Ff ( n�A5hoci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . Electrician's License No. . . L tom, . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J�7c). . . 3P.GC . . .. . .. fw 5/Ffo�f� House Number Street Hamlet County Tax Map No. 1000 Section . .,. ��.7. . . . . . . . . . Block . . . . 0,,,q. , . . . . . . . . Lot . d . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . , . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy f. -IC4, i(//h. . . . �7CiJEl(iN lr b. Intended use and occupancy . . �p� . . . . . S U . . .'ren - . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . Alteration . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . j vo. — • • • . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid 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 business, commercial or mixed occupancy, specify na ure and extent of each type of use . . . . . . SF 2 . . . . . . . . . . . 7. Dimensions of Existing structures, if any: Front . . �. . . . . . . . . . . Rear , ./.�. . . . . . . . . . Depth .�. . . . . . . . . . . . . Height .W. . . . . . . . . . Number of Stories . . . . .jyY. . . . . . . 5... . . . . . . . . . . Dimensions of s me structure with alterations or additions: Front . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . .2{v. . . . . . . . . . . . . . . Height . .2 U. . . . . . . . . . . . . . Number of Stories �A . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . �S/ Rear . S. . . . . . . . . . Depth ? . . . . . . . . . . . Height . . . . : . ('. . . . . . . Number of Stories . . . . . /. . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . 9. Size of lot: Front . . . �a.4�p . . . . . . . . . . . Rear . . , f5; 03. . . . . . . . . . . . . Depth . . .LO,) . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . />/.f. . .?.q Ffgl 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction vi ate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . P. . . . . ., . . . Will excess fill beJremoved from remises: Yes Cc 14. Name of Owner of premises l�N. !�f .d., PF. (°�qJ�°6�'Address Phone No. . . . . . . . . . . . . . . Name of Architect . . / Address . . . . . . Phone No. Name of Contractor . -� u F .�Vi I�iq�u F . . . . . Address Er/tgoa . . . . . . . . Phone No.7S• 300 ?bs- ai . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property fines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. UTE OF NEW iC„ � S S (Name•of individual signing • . . . ' ' ' ' � • being duly sworn, deposes and says tha�he is the appl�ant contract) above named. �He is the . . . . . . . .�� !?•�74 c 11_ agent, t Q . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . r/�(Contractor, 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 all statements contained in this application are true to the best of k4is-knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . . . . . .day of. . . . . . . C Not Public, . . . ,;� County k �L Euzaa x sNn NEVI (Signature of applicant) flNew PUBLIC, State of New YMk No. 528225850, Sufrnik Cau Ny Term Ix�-;errs 1 7 FORM NO. 1 � C� �? �uu`tt. ✓ civ � ,,,' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ; "i'i a. SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined!! �'`'. .�?'. ., 19 �3• Application No. ./.2.?! . . . . Approv .4 4-V. .0?6. . . ., 1 W(- Permit No. Z.1 e;?. Z Disapproved a/c q?$5i '. . < . . . . . . . . . . . . . . . . . . . . . . . . . . 'u ding Inspector) . . . . . . . . APPLICATION ICOR BUILDING PERMIT /J/J 'Q / Date l/.// �!"� . .Z Z. . 19�.= IQs / �l6Qi �"4I^ '' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issued a Building Permit to the applicant. Such permi 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 Occupanc, 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 thf Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws,Ordinances o: 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 tc admit authorized inspectors on premises and in building for necessary inspectio :. .�. �,U. . . . . �. . . . . . . . . . . (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 builder. Name of owner of premises . . . ! i�Ff l o��A 5h o C-.k. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . 1.) . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . Electrician's License No. . .d '`" . . . . . . . . . . . , Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will/be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section 7. . . . . . . . . . Block . . . . 011. . . . . . . . . . Lot . O . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . ,/. .t :'L`7. . . p �ll!N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy .FOo,4ac_ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . .✓. . . . . . . Alteration . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . .� 4� . . 0-W (Description) 4. Estimated Cost . . . . . . . . . . �i SOo � , -. . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid 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 business,commercial or mixed occupancy,specify sure and extent of each type of use . . . . . r%1 - - - , " 7. Dimensions of Existing structures,if any: Front . . a . . . . . . . Rear . ./.6.. . . . . . . . . Depth 5 . . . . . . . . . . Height . . . . . . . . . . Number of Stories . . . . . �� . . . . . . . : .,: . . . . . . . . . . . . . . . . ....I. . . . . . . . . . . . Dimensions of saipe structure with alterations or additions: Front . . . . . . . . . . . . . . Rear p� . . . . . . . . . . . . Depth . . . . .�a? . . . . . . . . . . . . . . Height . 2-4) . . . . . . . . . . . . Number of Stories . . /1 . . . . . . . . . . . . 8. Dimensions of eptirp new construction: Front . . . . . . . . . . . . . Rear . O.Z:S:. . . . . . . . . Depth .9.`. . . . . . . . . . . . Height . . . M'.t:. . . . Number of Stories . �. . . . . . . . . . . . . 9. Size of lot: Front . . . vfq . . . . . . . . . . . Rear . . .-fS 03. . . . . . . . . . . . . Depth . . J 102. . . . . . . . . . . . . . . 10. Date of Purchase �N/�e of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . /.4-E !„S v F& k 12. Does proposed construction vi ate any zoning law,ordinance or regulation: 13. Will lot be regraded . . . . . . . P. Will excess fill be em ved from premises: Yes CNc 14. Name of Owner of premises A* �aF. P�g3�4�Address 3a�ST. /Y+�w :�Y .D/t�. .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . .Address . . . . . . . . . . .Phone No. . . . . . . . Name of Contractor i.fl!A . . . . . . . . . Address S.E :4a'. . . . . .Phone No.? .:300 X65- 38at 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 K, S.S ��/ U� -� �L'. . . . . . . _. . being duly sworn,deposes and says tha>�e is the applicant (Name of individual signing contract) above named. LL / SHeis the . . . . . . . .CO.'7hce. . c�O�L. . . .{ . . . . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Con a ent co orate officer,etc. ( g � rP ) 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 all statements contained in this application are true to the best°=f�v'�wledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . �v. �i . . . . .day of. . . . . . . <��. . . ., 14�s w , Not Public, . . GL`L�. . . . . . County -� ELIZAB H ANN NEVILLE . (Signature Of applicant) MARY PUBLIC, State of New York No. 52.8125850, Suffolk County Term Expires ►. gr APPROVED AS NOTED _ PATE: 6 _ '� B.P. #�2 . ...... .:.. ..:,.. FEE. , 2 =:BY : _ , NOTIFY BUILDING DEPART _NY AT V 765-1802 9 AM TO 4 PM FOR THE FOLLOWING I^'S^ECTIONS: J. FOUNDATV)N - TWO RF('UtRED FOR P^UR^!) CONCRETE ��8 r 2. ROUGH - FRAMING � PLUMWNG 3. INSULATION --s x 2 4. FINAL - C^?.'STRt�t'�; ^Ifs MUST----- x-u BE GOMPI_FTE FOR C, 0. ALL CONSTRUCTS'.'N SP/ALL ME T t THE REQUIREMENTS OF TK": 14.,Y, STATE CONSTRUCTION & E1P MY/ i CODES. NOT RESPONSIBLE l DESIGN OR CONSTRUCTIOiN! ERROAS. �Vti"Y![ JILf f r Jr ' !'1 kX /^ ov a i B FIN t _ r