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HomeMy WebLinkAbout25324-z FORM No. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27011 Date: 03/31/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 250 SOUND BEACH DR MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 99 Block 1 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 9, 1998 pursuant to which Building Permit No. 25324-Z dated NOVEMBER 13, 1998 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 INGROUND SWIMMING POOL WITH DECK AS APPLIED FOR. The certificate is issued to RICHARD A & CHRISTINE RIVERA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 21336A 11/25/98 PLUMBERS CERTIFICATION DATED N/A 4 f 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. 25324 Z Date NOVEMBER 13, 1998 Permission is hereby granted to: RICHARD A RIVERA 22 WILLETTS COURT ROCKVILLE CENTRE,NY 11570 for INSTALL AN INGROUND" POOL AS APPLIED FOR. THIS /�PERMIT DOES yNOT � INCLUDE DECK. �/YN//1 ceetX 3�l�OO X 4e Z 66,, 12 . * _ZS'� ` — S7 at premises located at 250 SOUND BEACH DR MATTITUCK County Tax Map No. 473889 Section 099 Block 0001 Lot No. 016 pursuant to application dated JUNE 9 1998 and approved by the Building Inspector. Fee $ 150 .00 B 1 ingAnspsrftor ORIGINAL Rev. 2/19/98 ANY ALTERATION OR ADDITION TO THIS SURVEY/S A VIOLATION - - OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, ' AS PER CONATIONS HERON RE b FOR TOf MAP ANO STHER OALY F % SAID MAP OR COPIES BEAR THE NFRESSEO SEAL OF THE SURVEYOR O WHOSE SIGNATURE APPEARS HEREON, AOMTIONALLY TO COMPLY MIN SAID LAW THE TERM ALTERED BY' - - MUST BE USED BY ANY AND ALL SWVEYORS Un LffJ*A COPY .. OF ANOThER SLOVEYORS MAP. TERMS SW.H AS WWECTW'AAV BROUSYT•TO-MTE'ARE NOT W CCWN.IANCE WITH THE LAW. o o � % I am thioNar with the STANDARDS FOR APPROVAL AND CONSTRUCT/ON OF SUBSURFACE SEWAGEON {k DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ei io,+ - and #111'abide by the oondlHons sal forth therek; and on the er q r r Fimnhed y;«ea e/ 8.3' - permit to construct. Im,� . �. O �y 'in tz>a <en rocY� 9al ,r ,€ ° n�pew TY. ma wafer T 9 o, GRADING, PLAN SEPTIC SYSTEM r EXI.S'T1NG SEPTIC SYSTEM TO BE FILLED IN OR REMOVED SURVEY OF LOTS 61 , 60 & P/O L O T 59 O MAP OF, � " CAPTAIN K/DD ESTATES " V % a FILE NO. 1672, FILED JAN. 19, 1949 qaa �0 ' E AT MATTITUCK TOWN OF SOUTHOLD Ji' a11N SUFFOLK COUNTY, N. Y. \ a' 1000 - 99 - 01 - 16 ` Co` n m� O :KALE : 1" = 20' y�P nE" �° JAN. 9, 1995 d �Elot 4 Dec. 28, 1995 (TOPOGRAPHICAL INFO) \ 16 1 ?D II L mar 25, 199(x(prop- aaot.Yion� of • el p June /l, 1996 (SEPTIC SYSTEM LOT 6/ Jan. /O, 1997 (Revisions], Jan, 14, 1997 (additions) ° Feb. 19, /997 (revisions) 0o Ap2 V �� j \ feb 25, I99� C3/iower rem=✓eo�� U' Mar. 11,1997 IRevlslons) •\ Q 1 \ `� ,^ 1 ' b June 19 /999Qewsc \ = J­ 9i /998�i-^moo \ 40 II \ m E LOT e l► eaao�' 4 � oh's0I CCRTIFICATE . \ of OCCUPAI'EKY AREA HOUSE - 2880 s Jl. _ Ldq Lln �G N = DECK = 925' sgfl. \ F/O 59 N _ •\ r 1.G 'NN POOL a�`�y .. r:fi.�P�,1� �., o �o- — 1 .13 `04 Paoc.�C.i�.'r5 y3r",,. I� (Ds';' — v n At AEN F/O 59 �'h _�i d e "' w; — 5 3 a DATE: 3 BA M The locations of wells and cesspools p shalvn hereon are from field observations o' / r �� _- - - NOTIFY BUILDING DEPARTKNIIIII AT and or from data obtained from others. y (. n^ — ' , ly'� 1 ,./ N FOLLOWING S AM EC 4 S: FOR THE ILh FOLLOWING INSPECTIONS: 1 FOUNDATION - TWO REQUIRED 7• �N- _ 1 �" 6 FOR POURED CONCRETE 81 2. ROUGH - FRAMING & PLUMBING - LOT 1° 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O: ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.V. STATE CONSTRUCTION & ENERGY \ / I +�� s g �• Q I'P mN DESIGN OR NOT ERRORS ro yep' JUN 1010 AREA PER DEED', 29,513 sq.1;. L $' DEED COURSES AND DISTANCES FROM DEED LIBER 7908 CP. 294 DSA TED J �1'. -� , \ P dJ5•j�/'J 0a`cj } .SEPT. Io, 1975 \ �\ Pty fIc 033 Test Boring D .1. 7.0 0MVIto Pda Brown 2 \ \ c yEr Very Coarse Ioz Or ve p Itlafx N p OO e t� r M Brown MArL'Ra \ .1 ! f. Vwy Cax.. Sand �.._ . _ , 5• b with Ioz EXISTING SEPTIC SYSTEM TO REMOVED \ O IPJ �1P ���. n+erzcF `➢�/ OR FILLED IN •\ q I2' -- a r NO, 496/6 CONTOUR LINES 8 ELEVATIONS ARE REFERENCED TO N.G.V.D. �f e p f�' P cONCN- 2 AREA =39996 sq. ft. to tie line (5/6) 765 \ � COASTAL EROSION HAZARD LINE FROM rP. O. 'BOAq6 , COASTAL EROSION HAZARD AREA MAPMAIN ROALAND �, - PHOTO 59.533-83. SOUTHOLD, N. I 94-381 F'x •'k"�'.1� IT;Sr+r•--•,.,r' '`"'F'a -'�:TV T`r. �7" '.i„'n�3M`- a„"'''"p �rt?''�r ' ,: �i"`GF„'nC' ,r *,n<wi'r^"vr .:x.\*,*F�Yat r:4c r, 'Na ,- ,.r,�� r: .n-+H^v'l:,m. s,nT "mt-�nrU�^' .,fir,-;, ,remm, ,re I t” r !i' , .:i 't. ., ',s �, ah ,If, i s '(;'F,',' .'>? '.' a ,."4 r-,#1 14�il�" E iCR:%G., '� ' rx, t .�'--t*, S, .,-W, R,-7,,. _ v (: ,�,. F �,,t •r;'�'p, 7 , Er,I,A s a�; f.ki w. r7l w J�"F^"',.', �' ,` "r .�. „i;M, ..n h .,." ,, x-. .:rv' b. ,u: , rs. �,:,i€='• v .;rt• w ,s .e :ir , �,v�'I i : r: a.. I .� in... „ -. . a4 ,, r. 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K v , <4 %/s S4F T 41 w dw I / ��p� ��VA� � PM1I -Cs(r{ E'.e d,t Grw-PRt I ., r I §k R� BI M�+n' -AH oy,� n `;i I,iYT iJ - • , - - - - a,� � . 1 "" r"(`iI�V 11 m . I �,. - - - - . I „ + n5§..t , G' 3 � � � [ � `p� D ���4,�JJJI ! � � 1 ',MAR &1999 : !� 1 ' � y1 EILDG,p TH .x 1,. W -,ir r p oI r , s i E ,l i I �y} P'/V SGNMr T1000Liy InC " [ '1r� 1 Y,: 4 t6 ,Y-. jI al 'la b nr "i:. 1.l - `, _ w q r1. r a , n la i (; ' V; ,4,°fi .',n, 4 a, r A,r M, , - 111, $nn '+ q e t 1 .''�: s r 5+ Jv ,d f,I gym, {' . . I ,L .r3. , ., - T'. ,r ., . : ., w..,.. ...6. »_�.:., ,aa�, x - !.. . _ _ �d�,'r it _r : ., . ,_ '.b:- Le, Ga l'�'(:, � -. L .�__ .. ,,. . . J F. ,,.:� a„a.r'" >F_. :mtnldtSq .....:. , x. 4h' ' ��nJ. ,. l " ,,, JM., �' I: y, e Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT Pr11''I f; )9,09 �� TOWN HALL �u ✓ 765-2802 YtyJ WOLDAPPLICATION FOR CERTIFICATE OF OCCUPANCY 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar building: 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. i 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. y If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C.4 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 - .29C 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . ./�:��- .�eo�. . . . . . . . . . . . . . . . . . . . . . . New Construction. . .. . . . . Old Or Pre-e 'sting Building. Location of Property.c;�Isa. . -ep. d f<r� . �: . ./ �r'/!? �. �4. . . . . . . . . . . . . . . . . . . . House No/ L Street Hamlet Onwer or Owners of PropertyC4,fs "! , ,CC,,, ,S <u /, /, � �� . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 10010,, Section.... .? . . . . . .Block. . . . .C. . . . . . . . . .Lot. . .lCJ . . . . . . . . . . . . . Subdivision. T. . ./.t'.��. . . . . � S�.t� .0 . . .Filed Map. . . . . . . . . . . . Lot. . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant�r.� !f��� . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . ..Underwriters Approval. . . l. . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . /D G . . . . . . . . . . . . . . APP ANT co t��?o l l s73z - M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING [ FINAL [ ) FIREPLACE & CHIMNEY REMARKS: AA DATE � -INSPECTOR ep o orL m 6jL _ LL { RICAL INSPECTION SERVICE INC. 375 DUNTONAVENUE EAST PATCHOGUENEW YORK 11772 (516) 286-6642 21336 DATE: 11125198 APPLICATION No.ON FILE VILLAGE. Matfituck TOWN.- Southold ADDRESS: 950 Sound Beach Drive ISSUED TO: Chris Richard Rivara INTRODUCEDBY Aztec Electric LICNo: 4173E was examaied on 11125198 and found to be in compliance with the National Electrtcal Code LOCATION: Base.. 1st xx 2nd 3rd Attic Det.Garage Hot Tub Pool SWITCHES RECEPTACLES FIXTURES HEATERS FANS G.FL AIR,COND. 60 62 76 1 2-exhaust 10 DISHWASHER DRYER CLOTHES WASH. GAR.DIST. RANGE OVEN SMOKEDETECTOR 1.2 kw 30 Amp. 20 Amp. 6 FURNACE OIL GAS CIR MOTORS BELL TRAN. SERVICE DISCONNECT 4—f 1 METER AMPS PHASE 1 200 OH OTHER EQUIPMENT Outside,Res. 7-paddle, 3-1/2 hp garage door opener, 1-microwave 20 Amp. I-whirlpoo120Amp., 1-steam generator30Amp., 1-200Amp. sub panel, 1-200Amp. disconnect, 1-hood 2-a.c. compressors 40 Amp. each 2-air handlers 20Amp. each HUGO S. SURDI PRESIDENT BUILDINGPERMIT No. sur«temp mbea«donmymm� bupe ommeybeidemifiedbythweeedeM BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE o,S13FFO(/-c Town Hall,53095 Main Road o Fax(516)765-1823 P.O. Box 1179 W Telephone(516)765-1802 Southold,New York 11971-0959 nor � Sao BUILDING DEPARTMENT TOWN OF SOUTHOLD NOV. 9, 1999 CHRISTINE RIVERA 250 SOUND BEACH DR. MATTITUCK, N.Y. 11952 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) XX No Underwriters Certificate on file. XX The check is (not on file. ) $25 . 00* No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 25324-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. * $75 . 00 DUE FOR AMENDED FEE (DECK AROUND POOL) TOTAL DUE $100 . 00 . r=iin•Il.ti;iri 1_�:i dun-n1 ;�nrl»» unre (:uuuCnT(1 Pt)II MATI Of ( 1691) 1 la% _z ---------------- Illll)f tll Pil Alli: R 1'1.111 111 1 110 W �1 III:;IILA'1'lllll PIUI 11• Y . (;I 6'1'ATIt. IMRI11:Y » «..-»-------------- ` «« .. -« --------- »««------ ---«--«-----_-»- I�I IIA I. AIMITIOMAL 3 3 i66 - Q16 v qllho Y _ fr� Ik 6VI II 11,111;1 I Illllllln l lul+ ( I!:I ) � -"_--._• � - •�I RC 4r .— O U^ t I!IIILA'1 11111 i'I'.Il Ii, y "" s •. l' s rJ n _yJ s �/'�y�,�-Pte__-y—✓.J�. _ ���i GC�-l? .vim �� ,,.^ n11U11 IIIIIA I. (;prll❑r111 Ii1 �} �,D •-- — s --- - � � w ikxlse Pknixxr Street ! llanlet New York State Department of Environmental Conservation Buadinq 40 -SUNY, Stony Brook, New York 11790-2356 Telephone (516) 4440365 Facsimae (5161444-0373 Mr. Richard Rivera ukh" 0.z8gau 250 South Beach Drive CanrnWsImm Mattituck, NY 11952 Date: April 11, 1996 Re: 1-4738-01297/00001 Rivera Property SCTM 1000-99-1-16 Dear Mr. Rivera: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: the property landward of the ten foot elevation contour as shown on the survey prepared by John T. Metzger dated January 9 , 1995 and revised for topography on December 28, 1995 is beyond the jurisdiction of Article 25 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15 ' to 20 ' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, Deputy Regional Permit Administrator cc: Pasquale J. Castellano BMHP File o�osuFFock� Albert J. Krupski,President may. GGy Town Hall Jvhn Holzapfel, Vice President o 53095 Main Road P.O. Box 1179 O Martin H. Garrell y �� Southold, New York 11971 Peter Wenczel ��( �`�� Telephone (516) 765-1892 Fax (516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 7, 1997 Christine Rivera 250 Sound Beach Dr. Mattituck, NY 11952 RE: SCTM #99-1-16 Dear Ms. Rivera: The above referenced property was reviewed. As per the site plan dated 3/4/96, the proposed renovations are out of the Trustees Jurisdiction. This dose not constitute any approvals from any other agency. If you have further questions, please do not hesitate to contact this office. Sincerely, �� `n/ Albert J. Kieski Jr'. President, Board of Trustees AJK: jmd cc: Bldg. Dept � ;Y 661V BOARD OF NEALTN . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . .. . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . .. . .'r'. . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: / Q CALL . . . . . . P.xanined....... /.�3...., 19 �[!y yy���//; MAIL. TO: . . .. . . . . . . . . . . . . Approved......1� ...., 19..1. Penni l: No. ............1. .................................... Disapproved a/c .................................. ......................... ............................................... (11:i1tyt Yn.. .Cor) APPLICATTON FOR BUILDING PERMIT INSTRUCTIONS a. 'Nils application must be completely filled in by typewriter or in ink and submitted to the Building Tnapector wi 3 seta of plana, accurate plot plan to scale. Fee according to schedule. b. Plot plan shoving location of lot and of buildings on premises, relationship to adjoining premises or ptdrlic streets or areas, and giving a detailed description of layout of property :met be drawn on the diagram which is part or chis applfeet ion. c. 'Ibe work covered by this application may not be cam enced before issuance of Building Permit. fi� Upon approval of this application, the Building Inspector wilt issue a Building Permit to the applicant. Such mit shall be kept on the prenisee available for inspection throughout the work. No building shell be occupied or used in thole or in part for any purpose whatever until a Certificate of Oc ncy shall have been granted by the hAlding Inspector. APPLICNam IS HEREBY MADE to tlo Wilding Department for the issuance of a Building Permit pursuant to the Wilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to codply with all applicable laws, ordinan:ee building code, housing code, and regal at ions,,and to admit authorized inspectors on premises and in buiillddsl �7Lnecessary-ins ons. (Signature of appli t, or none, if a corporation) ......................I............................ (Mailing address of applicant) State whether applicant is owner, leasee, agent, architect, engineer, general contractor, electrician, pludier or Wilde, ........................... . .................................. ...................................... Name of d finer of prenisea � ..F..�`:• lS.l; i U (as on t1w tax roll or latest deed If applicant is a corporation, signature of duly authorized officer. ....,..................................................... (Now and title of corporate officer) Builders License No. ......................... Pludbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. location of land on which proposed work will be done�.SU J . vim LK ......... (louse tkmber..............r:/./. Street lunifet ......................... JJ County Tax Map Nn. 1000 Section .......!..�.... El.dxk ......l........ Lot ..�. �� ........ Subdivision ......................................vl ,✓ s Filed Map Ub. .......... .. Lot . ............. (Nacos) 2. State existing use and occupancy of premises and inters use and occupancy of proposed construction: a. r%isting use and occupancy ..... ra�2 ? .... ... �..................... .............. b. inter" ties and occupancy ..............� ............................I..........I............. 'kL 7 ifi??.1 Tut SOA ihoy web;to emll.aildu°l y161011 ytnu03 Av'" p ni b0btatu0 PtiOrV3' _wtY0.019 ; 1. Huura of work (dseck aAildt ar!liceble)t New Building .......... Addition ........ Alleratifo�nF Itelwir ............ Removal .. ........ Demolition . .......... Other Work /..:(Ikscrl 4. Hat invited Cost .�,ii. ....... fee ............................ (to be Ixid on filing this application) S. If (h:elling, naulxr of dmllLp.1�S anile ............ tAr:txr of. ch+elling im(te a: sad: floor .. .............. Ifgarage, (xnixr of Cara ... ..........................'....... A. If Ix(sloess, comtaercial or mlxonf occ:gxncy, specify nature and extent of ead: type of use...................... 7. Dimensions of existing structures, If any% Front................ Rear ............... Depth ................. Ikuillltt ....................... I ehnixr of Stories ........ Dinensioro of sane structure wjth alterations or 'a(kl{tlonst Front ............... Rear ............... Depth .................I.. llel0ht .................... N.ntxr of Stories .............. . 11. Dfinensions of entire new eohst�tuctiont Front ................ Rear ............... Deptlh .............. Iteiiju ....................... Mnixr of Stories ..................... 9. Size of lot•,t Front ......... ........ Rear .................... Depth .................... 10. llare of Purdinse'............. ....... Nam of Korner (Mier ........................................ II. tax or use district In nth{dh premises are situated .............................................................. 12. Does proposed construction violate any toting law, ordinance or regulations ........................ 13. Will lot be regraded .........f'.......... Will excess fill Ix removed from premises: YRS ND 14. Nares of O.sxr of promises ...}....................... A(klress .............................. liko a No. ............ Name of Arddtect ............h....................... Aadresa .............................. plane No. ...... Name of Contractor ...........:...................I... A(kdreas ...............................19hone No. ...^+........ 15. Is thin property within 300 fe4t,of a H&I wetland? * YRS .......... WO ,,,....... *IR YES, SOU I D 1UWN 1I1BSIF.IdS PRRMI'f MAY Wt Mi( JIRM. PLOT DIAGRAM Locate clearly and distinctlyXa11 buildings, A)ether existing or proposed, and indicate all set-back dimensions front property linen. Give street 84 block nnlxr or description according to Gleed, and slhot street nares ant inlicata ubether Interior or corner lot. r II II� SI'ME (Jit M:W Y(M (FAINIY (10 ................... SSI ' � (Manx. of Individual. si ori contract)\ ttMSs................befell duly swam, depxtses and says that be in the appl.ickant alxrve nailed, Slle is the ...... .................fir ^? ............................................................... (Cont rector, agent,-Sorpornte officer, etc.) of said (m)er or owners, nal Is (July i�suthorized to perform or have performed the said work atxl Co make and file thin airyul leati(nt; lint kill statements Cott fined in this application are tnx to the hest of his kaawledge attd Ixilief; nal that the vork will be performed In tlh nnntter set forth in the application filed therewith. 9.xhrn to Wore me tills r-� cl qp ."'y Notary Public . . s. i BERT 1.'SCOTT,IJR. (Signature of App. Cant) Not ry Public.State of New York Oualitied in Sullolk ounty No.OISC472 Term Expires mot 41,