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Home My WebLink About25679-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26985 Date: 03/14/00 THIS CERTIFIES that the building ALTERATIONS & REPAIR Location of Property: OCEAN VIEW AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 9 Block ll Lot 6 Subdivision Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 15, 1998 pursuant to which Building Permit No. 25679-Z dated APRIL 19, 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 ALTERATIONS & RESTORATION OF FIRE DAMAGE FOR AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GUNTHER STROTHE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A PENDING 03/03/00 01/20/00 E.NEM~SKAY PLUMB.&HEATING 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. 25679 Z Date APRIL 19~ 1999 Permission is hereby granted to: GUNTHER STROTHE 108 EATON PLACE LONDON SWIX 8LR ENGLAND~ for : CONSTRUCTION OF ALTERATIONS AND RESTORATION OF FIRE DAMAGE FOR AN EXISTING SINGLE FAMILY DWFT.T.TNG AS APPLIED FOR. at premises located at OCEAN VIEW AVE FISHERS ISLAND County Tax Map No. 473889 Section 009 Block 0011 Lot No. 006 pursuant to application dated DECEMBER 15 1998 and approved by the Building Inspector. Fee $ 205.00 Author~ zed Signature Rev. 2/19/98 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL · :,,:sou 765- 1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTING EUILDING..~..VACANT LAND ........ Location of Property OCEAN VIEW AVENUE FISHERS ISLAND, NY HOUSE NO. STREET HAMLET Owner or Owners of Property GUNTHER STROTHE 473889 County Tax Map No. I000 Section .PP~.. Block 0011 Lot 006 Subdivision ....................... Filed Map ........ Lot .......... it ~J~ 4/19/99 H P BROOM HOUSEWRIGHT Perm No. . . Z...Date of Permit - ......... Applicant .............. . . . .. Health Dept. Approval .................. Underwriters Approval .............. ~ Planning Board Approval ................ XX Request for Temporary Certificate ....... Final Certificate ................ Fee Submitted: HARRY P BROOM, JR PRESIDENT H P BROOM HOUSEI~RIGHT rev. 10/{4/88 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit (please print) (please prlht) I certify that the 'solder used in the water supply system contains less' than 2/10 of 1% lead. ,.,., ,:. Sworn to before me this .o~.~ ~,u~c, ~[~ cou.~ 162 Ferry ROAD P.O. box 70 HADLYME, CONNECTICUT 06439-0070 TELEPHONE (860) 526-9836 FAX (860) 526-2647 March 9, 2000 Town of Southold Building Department P 0 Box 1179 Southold, NY 11971 Re: Herrick/Strothe Residence Enclosed is the Application for Certificate of Occupancy for the Herrick/Strothe residence on Ocean View Avenue, Fishers Island, NY. I hope that we have enclosed all the information you need. If you need any thing further, please let us know. Best Regards, Mariann Paskiewicz Enclosures January 19, 1999 H.P. Broom - Housewright, Inc. Attn.: Skip Broom PO Box 70 - 162 Ferry Road Hadlyme, Connecticut 06439 Re: Herrick / Strothe Residence ~ Fishers Island, New York Dear Mr. Broom, I have made a careful inspection of the stairs at the Herrick / Strothe Residence on Fishers Island following the fire. The first to second floor stair was built with a 7 inch rise and a 10 inch run. The restoration of the main stair including the removal of the landing detail and continuation of a straight flight to the first floor involves the first five treads in the staircase, and will extend approximately 45 inches past its current location. Relocation of the existing newel post, extension of the rake rail and installation of new balusters will be necessary to complete the flight. I have examined the cost of replacing all of the major components of the main staircase verses the restoration of the existing stairs. Replacement cost is estimated at Seven Thousand Nine Hundred and Eighty Dollars while restoration will cost approximately Three Thousand Five Hundred Dollars. With regard to the stairs from the second floor to the third floor, the entire flight must be replaced. The floor to floor height and the pre-existing run dictates that the old stair was constructed with a 8 1/8 inch rise and a 9 inch run. Replacement cost of this staircase is estimated at Seven Thousand Three Hundred and Ninety Dollars. The cost associated with the restoration and reconstruction of the stairs in this house are based on matching the existing stair elements and details as they were originally installed. In order to execute the cons/ruction of the new stair parts, it will be necessary to dismantle part of the existing stair on site and transport it to my shop location. Please contact me to further discuss this project. Brian Faucher 23 Westbrook Industrial Park Road ~ PO Box 1089 ~ Westbrook, Connecticut 06498 Phone 860-399-6001 ", Fax 860-399-6002 H.P. Broom - Housewright, Inc. Attn.: Skip Broom PO Box 70 ~ 162 Ferry Road Hadlyme, Connecticut 06439 Herrlek I Strothe Residence ~- Fishers Islam], New York Staircase 1: First to second floor Existing landing to be removed. Relocate existing newel post, extend rake rail, replace balusters to match existing. Replace risers ~1 - 5 (7 inch risers) ~- Replace Treads 1 - 4 ( t I 1/4 inch treads). · 23 Westbrook Industrial Park Road ~ PO Box 1089 - Westbrook, Connecticut 06498 Phone 860-399-6001 ~ Fax 860-399-6002 H,P, Broom - Housewright, Inc. Attn.: Skip Broom PO Box 70 ~ 162 Ferry Road Hadlyme, Connecticut 06439 Herrick I Strothe Residence - Fishers Staircase 2: Second floor to Third Floor Construct 13 rise staircase to fit pre-existing location to match first floor stair detail, 13 risers at 8 1/8 inches, 12 treads at 10 1/4 inches (9 inch run per tread), 162 FERRY ROAD P.O. BOX 70 HADLYME, CONNECtiCUT O6439-OO70 TELEPHONE (860) 526-9836 Fax (860) 526-2647 LUCINDA HERRICK AND GUNTHER STROTHE Description of Proposed Work: Repair Fire and Water Damage 1. Reinforce dormer roof (see "Fire Damage Partial Plan - East Dormer Structure" by Gibble Norden Champion). 2. Rewire where necessary. 3. Replace damaged bathroom. 4. Insulate entire house. 5. Re-sheetrock all ceilings and damaged walls. 6. Re-trim damaged woodwork. 7. Replace damaged flooring. 8. Replace and finish third floor stairs. New Work 1. Partially enclose existing porch. 2. Rework first to second floor stairs eliminating platforms. 3. Create cathedral ceiling in third floor hall (see Cathedral Ceiling Structural Renovation by Gibble Norden Champion.) 4. Relocate exterior door on west side of house. 162 Ferry road P.O. Box 70 haDLYME, CONNECtiCUt 06439-0070 TELePhONE (860) 526-9836 FaX (860) 526-2647 Decer~ber 18, 1998 Mr Gary Fish Fishers-I~iand~uildi~ Town of Southold P 0 Box 1179 Southold, NY 11971 Dear Mr Fish: I am responding to your request regarding our $450,000 estimate for work on the Herrick/Strothe residence on Fishers Island and it's relationship to the replacement cost of the entire house. .Within the past three years, we have constructed two new residences on Fishers Island. The square foot cost for these houses were $261/sq ft and $324/sq ft. The level of detail and quality of the 6,000 square foot Herrick/Strothe residence is somewhere between the two aforementioned houses. Even at the lower cost of $261/sq ft, the replacement cost of the Herrick/Strothe house would be $1,566,000. This is considerably more than twice the $450,000 estimate we have submitted on our building permit application for repair and renovation. I would be more than happy to discuss this with you Please feel free to call. HPB/mp further. Best regards, ~ Harry P "Skip" Broom, Jr President 162 FErry ROAD P.O. BOX 70 HADLYME, CONNECTICUT 06439-0070 TELEPHONE (860) 526-9836 FAX (860) 526-2647 January 21, 1999 Mr Gary Fish Fishers Island Building Dept Town of Southold P 0 Box 1179 Southold, NY 11971 Dear Mr Fish: In response to your request for additional information required for the Herrick/Strothe building permit application, I am sending the following: Engineered structural drawings - Jim Norden of Gibble Norden Champion Consulting Engineers, has been retained to visit the site, prepare the drawings and to inspect their implementation. 2. Letter regarding replacement cost of Herrick/Strothe residence by Jim Norden of Gibble Norden Champion. Stair builders proposal a. First to second floor. b. Second to third floor. If you have further questions, please call. Thank you for your cooperation. Best regard.~~~ ~, Harry P "Skip" Broom, Jr President HPB/mp Enclosures TO H.P. Broom - Housewright, Inc 162 Ferry Rd. P. O. Box 70 Hadlyme, CT 06439 Telephone (860) 526-9836 FAX (86O) ~26-2647 Mr Gary Fish ~'isners lslan~ Building Dept Town of Southold P O Box 1179, Main Road Southold, NY 11971 3/3/99 {~°' ~°' Lamborn Residence Section 9. Block Iff Lot 6 Supplemental to material send on 12/9/98, Dec 18, 1998 and Jan 21, 1999 WE ARE SENDING YOU [:] Attached [] Under separate cover via [] Shop drawings [] Prints [] Plans [] Copy of letter [] Change order [] the following items: [] Samples [] Specifications PAX[ NO. DESCRIP?,ON 1/7/99 Additional copy of Structural Plans S-1. S-2 and S-q 1/7/99 Additional copy of Engineer's letter Re: Prnim~t ~nmtm 1/17/99 ~dd~t~on~] ~n~ ~ ~ Contractor'~ Estimatc and plans. THESE ARE TRANSMIT[ED as checked below: [] For approval [] For your use I~l As requested [] For review and comment [] FOR BIDS DUE [] Approved as submitted [] Approved as noted [] Returned for corrections .19 [3 Resubmit [3 Submit [] Return copies for approval copies for distribution corrected prints REMARKS Per conversation with your office of 3/3/99, additional copies requested. [] PRINTS RETU~RNED AFTER LOAN TO US we are sendinq the Please let ns know asap of any fnr~h~r need for processing of this pe~it. Respectfn l Harry P BUILDING DEPT. INSPECTION ]FOUNDATION 1ST [ ] ROUGH PLBG. J FOUNDATION ZND [ ] INSULATION ] FRAMING [/~'~A L tN SPECTOR~~~___~,~/ DEC t 5 ,t998 BLDG, DEPT ~.~,_WN OF $OUTHO~.~r~, ~BO0%RD OF H£ALTtl ......... FORMNO. I 3 SliTS OF , SURVEY ............... ooo.o. TOWN OF SOUTHOLO ClIECE ............. BUlLDNGDEPARTMENT ZSEPTIC FORH ..... TOWN HALL ' ' ' $OUTI-IOLD. N.Y. 11971 NOT[FY = Examined ..... ./._ ......~..., 19... Approved ~- )O 19~. Permit . .~...~. ...... ................ , Disapproved a/c .................................. /. / tm.ldmg Inspector) (:~LICATION FOR BUILDING PERMIT HAIL Date December 9 .~8 ........ : ......... ,1~ · Eicctrician's Liccnsc No. 2455 E - Oilier Tradc's License No I. Location of land on which proposed work ~vill bc done: Former Lamborn Residence, Ocean Av~ and Beach Ave, Fishers Island, N~ House Number StrccC Hamlet yT ~ 9 ' Count ax M.,p No 1000 Section .................. . BlOck .... 11 6 ............ ** Lot**,********** Ia' N/A ' * ~'; ' Subdivision .................................... F. ilcd Map No. t' (Name) ' . ............. Lot ........... · · · · · Slate c.x/st/ng u~ and occupancy or' premises and intended use and occupancy of proposed construction: · -- Residence .~L~!.e. Family a. Exit[in?. use and occupancy ............ , . Reside.n.c.e. Single Family b. Intended Usc and occupancy ......... Buildcr's Liceaue No 13061 HI Plumber's Lkcnsc No. 2563 P INSTRUCTIONS .. a. Tiffs'application mu~t be completely filled in by typewriter or in ink and submitted to the Build/n~ Inspector, with sets of plans, accurate plot plan to scale· Fcc according to schedule. b. Plot plan shmving location of lot and of buildings on premises, relationship to adjoining prcmis~ or pubt/c or areas, and giving a detailed description of layout of property must be drawn on the diagram whichispan of ~ appti- cation. c. Thc work covered by this application may not be commenced before issuance of Building ?ermit. . ' d. Upon approval of this appilcation, the Building Inspector will issued a Duilding Permit to the appib=mL 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 what~ver until a Cfriifica~ of Occupant- shall have been granted by rite Building Inspector. ' APPLICATION IS HEREBY FIADE to the Building Department for the issuance of a Building Permit pursuant to the Building [Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or T~u.la_t.~;,~_s, .for the e. onstruct:on .of buildings., ad. dmons or alterations, or for l;emoval or demolition her=' ' ...,~ ap~,cant agrees [o comply with all appt~cab e laws. ordinances, buildin, c~,a,, h....; .... ,,~s . m dcscnb, cd. P O Bo× 70. Hadlyme~ CT 06439 Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiIelor. general eoneract, or Name o£ownerofpremises Lucinda Herrick and Gunther Strothe (as on thc tax roll or l-~tfst deed) Il" applicant %7;ati~s;%e of duly ~thorlzed oflicer. ~,l~amcamt.litlc of corporate offic/:r) Harry P. Broom, Jr, President xx Interior 3. Naturoo£work(¢hcckwhichappHc~blc):NewBuilding ......... AdditiGn .......... Alter:ti°n ~"',.'~,'~ .... R. p~ ~ g~ al~ D~ olition : ' ' ~ po01.' · ennxs court ......... Acc~essory Bui[~[~S .......... ~ence ..... Ocher %4ork ............ 4. E~timatcdCost.. $ 400,000.~00 F ~ ~ { (to bo paid on ~hn~ [his applicanon) 5. If dwcllin=, number o~ dwelling units ..... ~.. ;... Nnmbut o f dwulliug units on each floor. ,. .. Ir ~ara~:, numbcr or cars ........ , ......... :: .... : ................................. 6. Ir business, commercial or mixed occupancy, spcciry~gtore and extent or e~ ty~c or use ...... ........ ,. ~ .......................... D~pth ..., .... H~i=ht ..... ~.~ ....... Numbcr[o~ Stories .................. rron~ .............. ~ear SAh~ ........... . . · ...... ~ ................... Number o~ Stones .................... 8. D~mcnstons of entire new construction Front ..... ~. ~... Rear ............... Depth ........ 10. Date of Purchase *P~q. ~99W .. Nam fFo~er Oxvncr ~ ............. 1 I, Zone or use d~stnct in wtuch prcmis[es ar~ situated .... ; ~U .......................................... ~ no il. Does proposed consiruction violate ny zonin~ law, ordinance or rc~ulation: ................................. 13. WHI lot be re=rudud .; .qq... { ........ Will excess ~11 bc removed from~remises: Yes .... Na -, 14. N~e ofOwnerofpremis~s ~. HeT~xck [~ O St~h~ ~08 Eaton P1 Lo~e ~ro0~44~7~2~56~59 N~ of Architect ............ ~ .............. Address ~ .~. .......... Phone No. N~e of Con:factor . ~P. Broom! Housewr[ght---- 70 Hadl~.C~o '~b~t~'~ 15.Is "his propert~ locace~ within {00 feec of a ,tidal ~ec[audl ~X[S .... · If ~es, SouchoId Toun T~ruscees Permit may he required. PLOT DIAG~M Locate clearly and distL~ctty att buI property lines. Give street and block nun interior or comer lot. [dings, whether existing or proposed, and. indicato alt set-back dimensions from tber or description according to deed, and show street names and indicate whether STATE 0 F~2~[~'~'(Z, CT o ~ COUNTYiOF..~e.v..L.O. ~.d.o.n. (. ,CrtD' i Harry P Broom, Jr ............................... , ................. being duly sworn, deposes mad says that he is thc applicant · (No,ne of individual signing!contract) aboyc named. He .... Contractor , . . I (Contractor, agent, corporate officer, crc.) of said o~vner or owners, and is duly :lathorizcd to pc,florin or have performed thc said %york and to make and file this application; that all statements contaim,d in tltis application are true to the best of his kno%vlcdgc and belief; and that the Work will be perforated in Utc manner s~ fortl~ in thc application qlcd therewith. ,,. ¢ w w i � r�os ``"-. 2 2wwLLW5)0 J V v ' „ mil aLLzoC ^4 c~i°NozzppppCp� O � � C3 \ rn ri YULLiaO zJr0-2 VV' J LJU Qo � OOwj-- 7 % 00LL O oa ? zo N mNg �OOZO OI V? o � Z �C� ZWVzU141 7 Wf7 OON WFO0ZLLm :MQoW Ucp1 . CZ J _ — ayo � 6 Z G x m m ,fl 1 a NEW NONNALL o84yyy �o � � y WINNOW HALL G Y G. W yd� Y O I LO i m C x x d OF N m 2-EXI5TING fv 3" PIA STEEL GOLUMN5 'TO REMAIN z I A--- _- A----- I - EXISTING 2-2x10+2-3/* I!h" EXISTING c -I r y I - ,'I� 1.1 L. SI5TEFZ ONE EACH SIDE L-.--- - - — I 2-9 1/2'xu 1/2" - FROVIVE 2'-6"xh' O 10 BEAMS <I I f 'xl' < 1NG _ , FOOTING AT GENT -P POSTS 2-2x10 + �- 1-1 5/45 ER.h - i -i�Tf- SHORE JOIST TO INSTALL "v / I NEW M L.'S REINSTALL JOIST M. WI fH GALV JOIST HANGERS L PROVIDE MIN I I TYPIGAL 3-2xh P05T T"(PIIGAL > x I EXISTING 2-2x102-3/4"x'l 1/4" ML, 515fER ONE EACH SIDE -- ,2 I I I .l I NOTE: —__—_-----� PROVIDE MIN 2'-0" WIDE VIALL WITH 1/2" COX PLYVIOOD EACH ;31DE AT EACH END + MIDDLE I ?IERS. EACH WALL TO HAVE 2-51WIF50N H05A HOLD DOVIN ANGHOR5, I EACH END TOTAL REQUIRED) 11 MCK STROTIE RESIDENCE,- -G 1 i 13 t. E AF rw�cr G PLAN ttsIIERs ISLAND, NY.IARTIAL AV OkD __ — C HAMMON L-F - r,l ' m E C ORIPN AT U, ..IE .' �(} - - ---- - --- -- - '<. , uvflnl staee r: "'YO . "I `0O N^ 51' 6 Insronu[anv aoe .IPN A90 Gr NuvinKuiu Vry e_ __—_— � N o,ao�;a„ ff.1) BROOM HOUSEWRIGHT 8 - I - > • - - - OF PfA1tJ NOUiE 'r i $ - -1 FLUSH EEAHS FLU^I{ DLA15 INDICATES FIIN I 1 ECLID POF BELON r ,- - .x N 1 1 . l - h, - - --r-i- 2_-1 3/4"xq 1/4" ML FLUSH BEAt-15 { i 1 1 I I. I ItJDATE5 NAL1-5 AI' i SECOND FLOOR FELON . 1 , 1 1 { v. 1 - - ---- - -- - - -- - -- -a r rxR Ecr - PARTIAL ATTIC FLOOR RAING PLAN No�n1 FM of NEtvk G i B B L F HERRICK�- STROTHE RESIDENCEry SCALE, 1/4•.P O• DPP SF Na °9� N o rt O t N s R FISHERS. ISLAND NY. C HAMPION m P. Cyan t] Z CONSULTING - m �] ENGINEERS F = Ir C()RPI)RA$EC) E$. ILIP BROOM HUUSFI/RIGHT I , " ( INDICATES EDGE OF HAIN HOU5E ' LU r — _ _ _ _ __ _ - - _ - - _I' - - - -- - - - - - - - -1 , I I I I I 1 I I I i ADD. 51I'iF50N A35 0ALV FRAt11116 CLIP RAFTER TO III I I I t i RI0(5ET5TA60ERED) I i . i GANT'L 4 r 2x6 RAFTER I, .^. _._ 2x6 RAFTER_ A-f 16'o6 cANr'L MAIN RAFTERS TE SJ1 '�� AND AT rACH TO VALLEY u — J i 2-2x8 &C-AF I t—_ _ --- INDICATES 1/2" CDX � 7 =1 4'-O' HIGN PLYNIOOD GANtIL� - - CR.OS6 SEAM IN ATTIC ' Y INDICATES MIN I I N ADD( t-I 3/4"x 1 1/2' BL3GK ALL EDOE5 I d 2x4 COLUMN I , M,L. 515TER AM d I. - IINNA��LL 5TUB COLUMN I + + TO PLYWOOD —- - - - _2x8 RIDOE _ _ _ I n d / — CRO_5S.BEAM _ HALLYIAYLL BELO _ — —-- N 1 MAIN , - z rL -- -- -- - - .� -- - I �_ . . FEIUGE ' Q � Y � (-- `( I > " ff- II )) w NDrGArESt-1rT Az a t xI t<» II 1 I II I 2x6 RAFTE 2x6 RAFTERA . , AT 16"oc —_--, — ———— AT 16"or, it ADD 2x(o HIGH: COLLAR'. TIE , 1 ` . - I - I 1 I A60VE ARCH I ' - -.- - 71 I toP - I . I iT it I L; ;j�cr PARTIAL ROOF FRAMING PLAN oe eer) G I t3 B L e HERRICK - STROTHE RESIDENCE do?� N o R, DEN xµe FISHERS ISLANA. NY: C HrIMPIGN F � w s y �� A EN4-IN EEI29 )Mv cry -' INCORPORATED Cv5,, UFN _p Nn 515 13V 1M srpre( u''v N -. __ lccnnn$A 11 osoi I. oneeoa,eeuxa H.P. BROOM HOUSEWHIGH'I S-"•3 v � pppsiMpsaN�,�35GA�U�"` I I 2x cP eAFT �� ►- 2,< co ek�7, G� ILa oc 1 I `¢�, O V I VAI1 E Cfi�Afr'L I-JAW �u ,��r� 3 _2 - S; a at INO(c4as MIA) I /- /� xr 2 . sis��2 i — F NE p NE �y � ,�y� �—lAq - E4S� .WRM 9O LL 1. _ _� NORDEN CHAMPION ._.oon6u 30 of sb kxxxporabd N � STR�TUrz>r . y4I1_ hod ,30.box 602 p.o.box 802 — old aeyMook,own.05475 Job Dag. No. � Y-,j �GAtu !XJo� Au,�sr s 6E(,Ocda sr00 Jill ` v/ 11"Ung e N5 G V � ESSI0 130 elm sheett ��Y� �), Td 9AL I II 1 old;ayb 0 box 802�75 - f VAT aj - /4 1 'o 880 38842nn 24 oar ^ I � � � BUILDING PERMIT REVIEW CHECK LIST ►t� Applicant/ Date Owners Name: �i)MBC RN. Reviewed. zi�`I'' = �� Architect/ f Date Engineer: 46 1)en Submitted: /z 9 SCTM #: District: 1 000 Section: Block: Lot: Project A,�, Subdivision Location: �� 14r� '1 Name: Single&separate Requi�d�— certtfication: (Yes(No) Req. Req. Zoning District: [Lot size`: e Actual: ] (Lot coverage Proposed: ] Req J �q / Req. [Front Yard Proposed: ] [Side Yard Proposed: ] [Rear Yard Proposed: ] j� Project Description: TLt &, r L.G �'1 f 11V G 46 AGENCY PERMITS Permit REQUIRED 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: i Flood Plane Elevation ??? Flood Zone: Notes: pet I m ► 2 / 36 c�