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26102-z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-27049 Date: 04/20/00 THIS CERTIFIES that the building NEW DWELLING Location of Property: 475 OLE JULE LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 12 Lot 14.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 14, 1999 pursuant to which Building Permit No. 26102-Z dated OCTOBER 28, 1999 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 ONE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE & FRONT ROOFED OVER WOOD DECK AS APPLIED FOR. The certificate is issued to JOHN & PATRICIA PERRINO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-99-0179 04/19/00 ELECTRICAL CERTIFICATE NO. N-51995 03/31/00 PLUMBERS CERTIFICATION DATED 04/03/00 HI-TECH PLUMBING "14 zc� _ /Au orized 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. 26102 Z Date OCTOBER 28, 1999 Permission is hereby granted to: FRANCIS VAN MANEN 475 OLE JULE LA MATTITUCK,NY 11952 for CONSTUCTION OF A TWO STORY SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE. at premises located at 475 OLE JULE LA MATTITUCK County Tax Map No. 473889 Section 114 Block 0012 Lot No. 014 . 003 pursuant to application dated SEPTEMBER 14 1999 and approved by the Building Inspector. Fee $ 872 . 60 /u7or.red S gnature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUT40LD 1 e j; '= BUILDING DEPARTMENT TOWN HALL 61'V1, APR 19 2000 n< 765-1802 gg ELLid. F:�s'a. TWN CSFSOUiHOLD APPLICATION FOR CERTIFICATE OF OC PSN -"'"'"�'°""""""""" A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 17 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 a 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 P£e-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - _ .25¢. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $151, 00, ommercial $15.00 Date . . . . . .�/•;X�. . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Or Pre-existing Building. .. . . . . . . . . . . . . . . Location of Property. . . . . :J.?.d. . . . .�IL�T.. . . wv*. . CI u . . . . . . . . . .! House No. Street Hamlet Onwer or Owners of Property. . . . . // 2 County Tax Map No 1000, Section . �. J• . . . . . .Block. . . .` �`• • • • • • . •Lot. . . .< .7. .3 . . . . . . . . . . . Subdivision. . . . . y �P Fi1 d Map. . . . . . ap. . . a . . . . . . . . . . . Applicant. . • • •�� hl NJ Permit No. . . J. �p� �Q/i — • Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . .: Final Certicate. . .� • • • Fee Submitted: $. . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . Co �a�o�9 APPLI ,,;oSUF"rD(K�o •����, Gym `, Town Hall, 53095 Main Road ti Z Fax (516);765.1823 P. O. Box 1179 Telephone f616) 765-180'. Southold, New York 17971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE : ©O Building Permit No . 6 o Owner : -la n/ &616 ,j a (please print ) Plumber : 7EcW EWjWF/^i1— (please print ) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. 5uoniv lz� Mr lkt, 3r✓� �� u� ��M'1� aeon Plumbers Signs iii e�) ROSALIE SALEMME NOTPAtlpU8uC,State0fNeWYd ' NO'P.RYPUBLIC e0f 01-SA4800818 0 4800818 OualifedinSuBo*Counl �• �•rlinSutfelkCounty 1ka THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1045096 BUREAU OFELECTRICITY - 40 FULTON STREET, NEW YORK; NY 10038 MARCH 31,2000 19796400/00 N 519995 Date ARMTo 6.ar�M2 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of ZOU14AS HOMES, 475 TOLIID JULE LANE, MTTITUCX, NY �� in the following loca ' LJa�ettkept n Ist Fl. n 2nd Fl. GAR/OUT Section Block Lot CEi �, VJJOOCC was examined an and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT, K.W. AMT K.W. AMT. K.W. AMT. H.P. 41 52 50 41 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL I N.P. I GAS H.P. AMT. NO. A.W.G. AMT. AMP. 'AMT. , AMPS, TRANS. AMT. I N.P. NO.OF FEET AMT WATTS 2 F 1 1 D/W 12/ 2. II - 1 600 SERVICE DISCONNECT NO.OF S E R .,V I" - C E METER NO.OF CC COND. A.W.G. A.W G A.W G. AMT. AMP. TYPE EQUIP. 1 0 RW 1 D 3W J D 3W 3 0 4W PER 0 OF CC.CO D. .NO.OF HI-LFG' OF HILEG NO.OF NEUTRALS OF NEUTRAL 1 200 CB 1 X 1 2/0 1 2/0 OTHER APPARATUS: PADDLE FANS-5 G.F.C.It-4 S140YE DETECTOR:-7 DOUBLE-POLE ELECTRIC LIC.#391.3-E L L PO BOX 147 PA.TCHOGUE, NY, 11772-0147 GENERAL MANAGER 11 Per This certificate must not be altered In any manner;return to the office of the Board If incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.' Town Hall,53095 Main Road p Fax(516)765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 00 April 12, 2000 CAL, (- Mr. & Mrs . John Perino 74 N. Howells Pt. Rd. Zp � ,,� /lam n P1 G� 1- D Bellport, NY 11713 RE: 475 Ole JuLe Lane, Mattituck e' cD 1000-114-12-14 . 3 . A -!Zo ff"I To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 26102-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. o�'gpFF04e OGy� Town Hall,53095 Main Road p Fax(516)765-1823 P.O. Box 1179 Telephone(516)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD April 12 , 2000 Mr. & Mrs . John Perino 74 N. Howells Pt. Rd. Bellport, NY 11713 RE : 475 Ole JuLe Lane, Mattituck 1000-114-12-14 . 3 . To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 26102-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 765-1002 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR s M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: C 1 DATE�� ®© INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [wl' FRAMING [ ] FINAL [ REPLACE & CHIMNEY REMARKS: DATE INSPECTOR r 7W-1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMA 5: DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FO ATION 1ST [ ] ROUGH PLBG. [� FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE INSPECTOR �t 1.0 INSPECTION REPORT /D1 TECOME --- MN—S__________________ -- ----- DATE--- DADA —DADA-- ___�____*.—__--- ---�—DADA--- - -- --- ----- fl-- O — --DADA-- -- INDATION ( IST) p -- DADA-- -ll_ - - -------- — t -- Z -- --- DADA— --- - ---- , f _ - - rc- m - it DADA-- --- - -- INDATION (2ND) ___________ __ ----- j_ - - - - JGR FRAME 5 tt-------it - PLUMBING ii 11 Ij DADA it d II JI �i SULATION PER N. Y. Ili �KK It y u----II STATE ENERGY CODE If I� p� DADA---DADA-- n==== II ��I � � H � it p c II II —4I It II ,' N----;t C FINAL 11 It it ADDITIONAL-COWENTS_====___-_______________= 7y 0 C. �) H H (j ' O z � r ------ ---------------- ---------------------------------- Q0 - V BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . .. . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: 9 CALL . . . . . . . . . Examined.....1�19.7., 19 [ MAIL TO . . . . . . . .. . . . . . . . Approved.... 19. . Permit No. G/o o� .................................... Disapproveda/c .................................. .................................... ...................................................... 419(-9 / L APPLICATION FOR BUILDING PERMIT Date iLOG DPTCrr.11i1T . . . . . . . 19. .� D INSTRUCTIONS a. Ibis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wii 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 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. APPLICMCN IS BEEM MATE 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 applicableeo nance or Regulations, for the construction of buildings, additions or alterations, or for removal or demn described. The applicant agrees to comply with all applicable laws o finances, ilding code, and regulations, and to admdt authorized inspectors on premises and in i •ng_for scary ins.. ........ . .......Signature of applican ccorporation) . .... ........... (t ilir address ofrlli/cant) / State whether applican is owner, lessee, agent, architect, engineer, general contractor, elect fician, (plumber or builder ..........� o� ..... /.�.r......�... .: Y�. .pp.....c ............................................. Name of owner of premises .... a.... T6�"`... n................................................ T6 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .....:..................................•................ (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... /� n� �l�•I 1. Location of lard on which proposed work will be done../�....................l..ti.`.......... ...... ..... ..... 7 ............................................................ a (`�C{e�,. �.:. � ` 1 � ............ House Number Street 77�� et I� County Tax Map No. 1000 Section ...lv.... Block ...I.I.1......... Lot ... Y......... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 1 2. State existing use and occupancy of n i*es and intg9ded use and occupancy of proposed construction: a. Existing use and occupancy ... .. ...!� .... ...... ..j................... b. Intended use and occupancy ... •..••••.•. lmm1;^.�S'ihzf;tY',i`=S,S":;b: S.... 3. N•iture of work (check which applicable): New Building ..1/...... Addition .......... Alteration .......... Repair ............ Rehwal .....!........ Demolition ............ Other Work .................................. h.� (Description') 4. Estimated Cost ... ...... fee ............................. ..............I •fto be paid on filing this application) 5. If dwelling, mucor of dwelli un,i1ts�.��•NJ�i�re...... Nuaber of dwelling units on each floor 401 If garage, amber of care ... '' IIl.:v..:^..:"�:..:.. .......... . .I y� G. If lxhairress, co m ercial or mixed pccupanccy, specify nature and extent of each type of use... 6!�............ 7. Dimensions of existing structures if any: Front................ Rear ............... Depth ................. Neight ......................... Nunber of Stories .... Dimensions of same structure wlthlalterations or additions: Front ............... Rear ............... Depth .... g) .................... amber of Stories ............... 8. Dimensions of entire new construcL'ion: Front !! Rear � FTDepth �a — .............. Dei64it .aY 71 ......... ....r ofiStories .. 21 9. Size of to �l �..... ..ice' j.. Rear :� . p�Depth .•� \/��I-:'.^.'./':y.;�p � �'r""°"' 10. Date of Purchase 9 .i!.!.( Nate of Former Owner .1.!4 . II. Zone or use district in which premises are situated ........... 13. Will lot be regraded .. .�................. 12. Does proposed constructs vholaCany zoning law, ordinance or regulation: � ��J ui.. .. 1W1ill as fill be removed from premises: OYES t 6 14. Names of Owner of premises A19 1�1. :"".� AddresaT� (/ rr `.fRhore No(�� N.•rre of Architect .�' T"J /L�!............... Address ... Phone No. .............. Name of Contractor ........ ..................... Address ........ ........ ........Phare No. .............. 15. Is Lhis property within 300 feet of a tidal wetland? * YES .......... No .. .. *IF YRS, soIN1a n 7OwN 'lId1SlFl s mumrr my BE RRQmm. PLOT DIAGRAM locate clearly and distinctly alll 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. IPDA^i /-NTTACHF-b II� � Suss Or tall Y(Aac, OOl1Nll� 'L` ...... ss ...�^ " . �u � /.............being duly sworn, deposes and says that he is the applicant (Nano of individual signing contract) i above n aTed, Ik is Lhe ........ do ?!ltd (Contractor, agent, coYporaLe 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 his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn Lo before me this .....day o[ i!! e Notary Public JISHpp ..... ..... BET1Y8 �'' ° Siture of Ajpplicant) NOTARY PUBLIC.Step of Now lwk ft 4926278,SuHogt Cw* Tom fixpMno 411!!10`1 �P Z7 ..�- -%'� '11, "" '�'mz A�V& W7, U MAP oxr-�'- FILED: F�8 X6..1993 J p" -42. "27 -,A UtPT. 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'e^ s n. ..c,?+. $ » .,> „4+ a,.M1.a. e,. �,' r�.,t :qr k, .,�. �`� .<' "f °3 a,a`s t. - Y >F u .. �. .".`�' �$"^a<. ” Ff�OLK O)c' LK Avg- •+ wgtra.IdMw.r.eearR�9eruir SURV6Ym" 0/�/ P or/-07 *AftlAci 14 Arm wcSwo spodmic porro,, /G,, 1903 1,10- 9327 f It -orm- wroamm"W'n, - AT -74-FT/7 UCA Su J�JgW 4 Z 'e a" o 31�5.az 5. C. T/-1. : 1000 - 114 - /Z - 14.3 0 E71Z-r r F I E-D -M + 10 I -30Hm % 5 U i`'P-C:;,L. l< C o u N3 7-,q N VACAt-47- KJA-r 1 0 NAL- in -T-I -r L-E- -S�E:lZ-,4 M ZO 22-5. 00' 61 + 6 CD Sul-'FOL-K LO COUNTY DEPA RTMP,�4T OF HEALTH SERVICES APPROVAL OF CGNSTR-SCTTD V�npMq poR 00 A SINGI-p-, FAM' Ln ;a ti —Affi�200011.S.Ref Wo. IL 0 J 'j diSPOSP) a-ad v,ra,!er SUppSV 3 .01 'lav em iad Ly this Depart- r0the' �zZePc=rmdwundto w "nte 'Sia- ry FOR Pft.A XIM U, K;DROOj) + m OF LA Chief > S I Uh-"A C�c!z�t�qp F�_ Z� GAR, 13"7* Office Of Water and Wag 24.2: ewater Management STATg lot Z' 0; PROFII�sr-r> 4j yo t q55 n T14 vv( AJ- i5Z*2720"K/- 3;00- 00 G. C( FOR -rF-:S-r �Aou-= LISA W^0WILKIN LAAJZ:> SURVE-YIA16 SES Fitly MAP h=>2- MAW 'S77RF—F--r %k/ SAYVILLE, "Y 1179& 0�p63l - 5l03 -49vr2 Lj"D' Ai>D PRoi, rte, 6116199 -SCALE-* P'-40' -7/Z-7jqqDA-re-: 1UvC:. 45, 1-9.9 ADD Q-WJ2'r5-- 9 aI� T F r J PROVIDE SMOKE-DETECTING , If copper tubing b ujad AUM DEVICES for waW dIsI r/alm piping dall be AS TO PARE 72LI of ILYS BUILDING COM PLUMBER CERTIFICATION ONLEADCONTENTSEFORE CERTIFICATE OF OCCUPANCY SOLDER USEDIN WATER PROVIDE OPENINGS FOR SUPPLY SYSTEM CANNOT EMERGENCY ESCAPE AS II EXCEED 2110 OF 1%LEAD. REQUIRED BY PART.714 OF N.Y. STATE BUILDING CODE. . ' PLUMBING ALL PLUMBING WASTE &WATER LINES NEED TESTING BEFORE COVERING PROVIDE Yi HR. FIRE RATED SEPARATIONTO PROVIDE ANT14MLD AND/011 PART. 717.3(f)(1)OF ..... THERMAL SHOCK PREVENTING N.Y STATE BUILDING CODE DEVICES AS TO PI 902.6(K) ILY STATE BUILDING CODE. L �7 `7 T j f Z-1 APPROVED AS NOTED DOW PROCEED INITIf DA .7/7604H) 4 8 P L4 LIM FOUNDAToac&I f IN EIV I": IUIMN13 DEPAk*ENT AT �FIWTII -7ap4ton 9 Am TO 4 PM FOR THE R, 77 ObtWINING#lSPECTfONS-•, tf(UNDA1700 4 TWO REQUIRSO ED CONCRETE r'E" MR"U" 2.,RW ON -FRAMING & PLIA011111110 IF77 225 ;'o -OCCUPANCTOR MON 1 INSUEA 4 X FINAL 'TION must�I: CONSTRUC AWFUL BECOMPEFTEFICIRC.Q., NIL ff, AE -CO. STRUC L N rION 'SHALL NI t N'.Y,.I WITH T IF] I THE' REQUIREMENTS TEr ''ST# -CO N STFiV&I ON ENERGY A MO -$MLE d In oN,,EFi RIDIFte' M4 YkIIII L .... ... --- .... ........ L V'L _ , _ 1"r 7r .............. �Elil TIb- FT-T 1:20- -c 'e„,w ^r.e"'cg. H "R- _{%'Y'•±+, -'.-^. , :Fkr"'rx 'n' ,:a `v ,n.. C, :r-A �'. k4:vr "v.'t�:. `. i �c,-rty#'„ r.S rd `'r ' , c. , z 1 I'm.9 " R5'I.. .. :d `.1. 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Al BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name: ./LC.WS Reviewed: l �-7 Architect/ / Date � ,�„ Engineer: u1[ Submitted: � /�` SCTM #: (/ 2 District: 1.000 Section: /f Block: 1p Lot: T J Project —�' Subdivision Location: Single&separate La certification: Yes No Req. Req. ,, Zoning District:�� [Lot size: �O� �� Actual: VOL �� ] [Lot coverage 1 y�0/a Proposed: ] Req. p Req. Req. / [Front Yard Proposed:_ Q Q 1 [Side Yard 01L0 Proposed: 1 [Rear Yard Proposed: _] Project Description: i AGENCY PERMITS 500 Permit REZUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: tes0