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HomeMy WebLinkAbout24972-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26309 Date: 03/02/99 THIS CERTIFIES that the building ADDITION Location of Property: 6400 INDIAN NECK LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 86 Block 7 Lot 2.2 Subdivision Filed Map No. __Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 9, 1998 pursuant to which Building Permit No. 24972-Z dated JUNE 23, 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER ZBA #4550. The certificate is issued to RUTH MILLER of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-480397 02/19/99 PLUMBERS CERTIFICATION DATED 02/23/99 DAWSON 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. 24972 Z Date JUNE 23 98 Permission is hereby granted to: R MILLER A/C EEI PO BOX 190 PECONIC~NY 11958 for : CONSTRUCT AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS PER ZBA(%4550 4/16/98) DEC AND TOWN TRUSTEES. at premises located at County Tax Map No. 473889 Section 086 pursuant to application dated JANUARY Building Inspector. 6400 INDIAN NECK LA PECONIC Block 0007 Lot No. 002.002 9 98 and approved by the Fee $ 38.00 · Building Insp~tor Rev. 2/19/98 ORIGINAL APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 yith accurate location of all buildlngs~ 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 Upre-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 ~asons therefor in writing to the applicant. C. Fees · 2. Certificate of Occupancy on Pre-~isting Buildinm - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Co~ercial $15.00 Date .......~ /~ ............................ ~ . .. New Construction ........... Old Or Pre-~isting Building ................. Location of Property..~ .....~~ ................ ..... ...... ........ House No. Street Ha~et Onwer O~ers of Property ~' ~ ~.l /.~ ' County T~ ~o lO00, Section .............. Sub division -5 ~.~.~.E i .~j jj .................. Fil2d Map ............ Lot ...................... .............. ~ ...... ~,4_' '~:D',&EL ....... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fca Submitted: ................. .............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- 40 FULTON NEW NY 10038 STREET, YORK, Date FEBRUARY 19,1999 Application No. on file 16507898/98 N 480397 THIS CERTIFIES THAT PEP~4IT NO. 24972 only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of RUTH HILLER, 6400 INDIAN NECKLA, POLE 1SA, PEC0}~IC, NY in the following location; [] Basement [] 1st Fl. [] 2nd FL OUT Section Block Lot was examined on '~]~BRUAR¥ 12 ~ 1999 and found to be in compliance with the National Electrical Code. FIXTURE OUTLETS 12 11 DRYERS FURNACE MOTORS FIXTURES RANGES FLUORESCENT OTHER FUTURE APPLIANCE FEEDERS ~PECIAL REC'PT. TIME CLOCKS OVENS DiSH WASHERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO OF CC COND. A W G. A W, G, A.W. G, PER (fl OF CC COND. NO, OF HI-LEG NO. OF NEUTRALS OF HI-LEG OF NEUTRAL i 2 1 WHIFL POOL BATH-1 PADDLE FAN--1 3 TON-AIR CONDITIONER-1 4 TON AIR CONDITIONER-1 .6OA DISCONNECTS.- 2 ELEC. ROOM HEATERS: I- 1.5 K.W. PANELBOARDS:I-18 CIR. 125 ELEC. WATER HEATERS:: 1-4.5 K.W. G.F.C.I:-i <<< Continued on Page 2 GENERAL MANAGER Per- This certificate taus! 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. THE NEW YORK BOARD.OF FIRE UNDERWRITERS loelo 3 BU.EAO OF ELECT.,C, Y ~ 40 FULTON STREET, NEW YORK, NY 10038 Date FEBRUARY 19,1999 Application No. onfite 16507898/98 }t 480397 THIS CERTIFIES THAT PERHIT NO. 24972 only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of RUTH }~ILLER, 6400 INDIAN NECKLA, POLE lSA, PECONXC, NY in the following location; [] Basement [] Is, Fl. [] 2nd Fl. OUT Section Block Lot was examined on P]~BRUARY 12,1999 and found to be in complianae with the National Electrical Code. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE RECEPTACLES SWITCHES OUTLETS FLUORESCENT OTHER DRYERS SYSTEMS NO. OF FEET E R C NO, OFCCCOND A.W G. A,W.G, A W G. PER ~ OF CC. COND. NO- OF HI-LEG OF HI-LEG NO, OF NEUTRALS OF NEUTRAL OTHER APPARATUS: TRACK LIGHTING: -16 DOROSKI ELEC. INC. LIC.#2941-E 425 HONSELL LANE CUTCHOGUE, NY, 11935 This certificate must not be altered In any manner; return to the office of t~e 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. APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman James Dinizio, Jr. Lydia A. Tortora Lora S. Collins George Horning BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION REGULAR MEETING OF APRIL 30, 1998 Appl. No. 4550 - RUTH MILLER PARCEL 1000-86-7-2.2 STREET & LOCALITY: 6400 Indian Neck Road, Peconie DATE OF PUBLIC HEARING: March 23, 1998 and April 16, 1998 Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 ZBA Fax (516) 765-9064 Telephone (516) 765-1809 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The above-identified property consists of a total land area of 2.507 acres situated on the southerly side of Indian Neck Road, Peconic. The March 6, 1998 survey submitted under this application shows that the property is improved with an one-story, single-family frame dwelling which is the subject of this application for a new addition, and three other accessory buildings in the front yard. BASIS OF APPEAL: Building Inspector's Action of Disapproval dated January 26, 1998, which reads as follows: "...Please take notice that your application dated January 9, 1998 for permit to construct an addition to an existing single family dwelling ...is disapproved on the following grounds: the proposed addition being located in an R-80 Zone is required to have a side yard setback of 20 feet minimum and a combined side yard setback of 45 feet. Pursuant to Article III, 100-32 .... " AREA VARIANCE ]{F, LIEF REQUESTED BY APPLICANT: The request made by applieallt is to locate a proposed 20' x 26.2' dwelling addition with an easterly side yard at 18 feet and westerly side yard at 14.9 to the existing foundation, or at 8.5 to the top of the step area. The total side yards to the foundation walls at the sides would equal 32.9 feet, and to the top of the step area (larger than 5' x 6' code exemption) would equal 26.5 feet. The code requirement is 45 ft. total both side yards. REASONS FOR BOARD ACTION~ DESCRIBED BELOW: (1) The granting of the area variance will not produce an undesirable change in character of neighborhood or a detriment to nearby properties because the prOperty is a heavily wooded waterfront lot and a row of evergreens screens the addition frOm view by adjoining properties to the east. Page 2 - Appl. No.i4550 (R. Miller) 1000-86-7-2.2 at Pe¢omc Board of Appeals Ai~ril 30, 1998 (2) The benefit Sought by the applicant cannot be achieved by some method, feasible for applicant to pursue, other than an area variance because the proper~y is unusually long approximately 1250 feet, but its narrow 87-foot width prohibits expansion of the dwelling without a variance. ' (3) The requested area variance is not substantial in considering the modest 20 ft. by 76.2 ft. size of the addition and limited width ~of the lot area. (4) The proposed i variance will not liave an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because the addition is of minimal size, and it will be an improvement to the house and near~y properties. (5) The situation ihas not been self-created and is due to the unusually long and narrow cop_figuration of the property. In considering thi~ application, the Board deems this action to be the minimum necessary land adequate, and at the same time preserves and protects the char~cte, r of the neighborhood, and the health, safety, welfare of the comm~mty. RESOLUTION/ACTION: On motion by Member Tortora, seconded by Member Collins, it was RESOLVED, to!I GRANT the relief as applied. VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO, TORTORA, HORNING, AND~n was adopted by unanimous vote (5-~). ~. GERARD _P: GO~.HRI ~/' Approved for l~llng 5/4/98 X~~'A~ SCUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Feburary 25, 1999 Building Permit No. Owner Ruth Miller 24972-z (please print) Plumber Dawson Plumbing & Heating (please print) I certify that the solder used in the water contains less than 2/10 of 1% lead. supply system (plumber's signature) Sworn to before me this , ay of ,,, Notary Public, ~_/c~ //~. County Notary Public ~ JUNFANN O. 'ZARZEC, KI Notary PuDlic, St~e oi New Yen% No, 4961037 Q,~ati/ied in Suffd~ Coun~ My ~r,vm~sifl~ Ex~ir~ Jan, 8~ ~ 0 · Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (516) 765-1823 Telephone (516) 765-1802 February 22, 1999 Environment East Inc. P.O. Box 190 Pecontc, NY 11948 RE: Ruth Miller, 6400 Indian Neck Lane, Peconic, 1000-86-7-2.2. To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file.)$25.00 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 # 24972-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Environment East, Inc. 2885 Indian Neck Lane P.O. Box 190 Peconic, New York 11958-0190 516-734-7474 Fax: 516-734-5812 February 25, 1999 Southold Town Building Department P. O. Box 1179 Southold, NY 11971 Dear Sirs, Enclosed is the Plumber Solder Certificate for Permit # 24972Z. The Underwriters Certificate has been issued and will be sent to you directly from the Underwriters. If anything other information is needed please let me know. Sincerely, Judy McAfee Office Manager / FOUNDATION ( FOUNDATION ROUGH FRAME & .FLUMBING' INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ]~N~,~JLATION [ ~] FINAL~/~~,~ REMARKS: Henry Smith Artie Foster Ken Poliwoda Southold, New York 11971 Telephone (516) 76§-1882 Fax (516) 765-1823 BOARD OF TOWN T~USTEES TOV~N OF SOUTHOLD February 26, 1998 Environment East Inc., Joan Wilson P.O. Box 190 Peconic NY 11958 RE: RUTH MILLER SCTM ~86-7-2.2 Dear Ms. Wilson, The following action was taken at the Southold Town Board of Trustees meeting on February 25, 1998: RESOLVED, that the Southold Town Board of Trustees approve the request for an Waiver to construct an addition to an existing house as per survey dated and received February 6, 1998, with stipulation that a row of staked haybales be placed along top of bluff during construction. Located: 6400 Indian Neck Road, Southold. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Building Dept. Environment East, Inc. 2555 Indian Neck Lane P.O. Box 190 P¢conic, New York 11958-0190 516-734-7474 Fax: 516-734-5812 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: ~'~ ~ [ ] ROUGH PLBG. []INSULATION New York State Department of Environmental Conservation Building 40 -SUNY, Stony Brook, New York 11790-2356 Telephone ($16) ~.x.~.-0365 Facsimile (516) ~.~.~.-0360 LETTER OF NONJURISDICTION -TIDAL WETLANDS Ms. Ruth Miller 6400 Indian Neck Lafie Peconic, New York 11958 Date: March ~3, 1998 RE: 1-4738-01859/0001 Mfller'~roperty 6400 Indian Neck Lane, SCTNI No. 1000-86-07-2.2 John P. Comml~oner ~Peconlc Dear Ms. Miller: Based on the information you have submitted, the New Yo~k State Department of Environmental Conservation has determined that the property landward of the topographical top of the bank as shown on the survey prepared by John T. Metzger, last revised 3/6/98, is beyond Article 25 jurisdiction. 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. / cc: Ms. Joan Wilson, Environment East, Inc./ Bureau of Marine Habitat Protection, NYSDEC File DMG Very truly yours, Permit Administrator Albert J, Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P,O, Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 26, 1998 Environment East Inc., Joan Wilson P.O. Box 190 Peconic NY 11958 RE: RUTH MILLER SCTM #86-7-2.2 Dear Ms. Wilson, The following action was taken at the Southold Town Board of Trustees meeting on February 25, 1998: RESOLVED, that the Southold Town Board of.Trustees approve the request for an Waiver to construct an addition to an existing house as per survey dated and received February 6, 1998, with stipulation that a row of staked haybales be placed alon~ top of ~/~ba-uff..~onstruc~'~on. Locatea~ ~400 indian Neck R~ ~ ~outhold. ~ - '' However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Building Dept. FOI~'H[ NO. 3 TOWN OF SOHT]tOLD BUILD:NG DEPARTMENT SOUTBOLD, N.Y. NOTICE OF DISAFPROVAJ, HATE: ~uvo~.20,.l$~ ............ 3075 Indian Neck La. ~econic Ny J19~ .... PLEASE TAKE NOTICE that your application dated ~D~rY.P~ .......... ~gP~ .... Location of Property . 6400 Indian Neck Rd. Peconic House No. Street Hamlet County'Tax Map No. 1000 - Section 86 BLOCK 07 LOT 2.2 . Subdivision ............................ .. . Filed Map No .......... Lot No ........ grounds ...P..P ...................... is returned herewith and disapproved on the following the ro osed addition . being located in a~ ~-80 Zone is required to have a side yard setback of 20 feet minimum a~ a combine~ side yard setback of 45 feet. Puysuant to Articl? III {p0-32: ~P ~9~ by the Zoning Board of Appeals.- B~LDING~INSPECTOR RV 1/80 Environment East,!nc. 2885 Indian Neck Lane P.O. Box 190 Peconlc, New York 11958-0190 516-734-7474 Fax: 516-734-5812 Mr. Gary Fish Southold Town Building Dept. P. O. Box 1179 Southold, NY 11971 RE: Permit # 24972Z, Miller Residence Dear Gary, Enclosed are photos of Miller's welded and bolted columns as well as cemented fuel lines as required for fin~-----~, Please,~call if there~ ~uestions. Sincerely, [X~~ Peter R. Stoutenbur / President ~ Environment Ea~ Encl. ~ PRS:jm 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING [ ] ROUG~.BG. [ ] INS~ATION [/~NAL [ ] FIREPLACE & CHIMNEY INSPECTOR DATE 765-J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ]~UGH PLBG. [ ,,~ INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: INSPECTOR 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ L~ROUGH PLBG. [ ] FOUNDATION 2ND [ [ ~FRAMING [ ] INSULATION ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE :~¢~ ,NSPE~OR Environment East, Inc. 2885 Indian Neck Lane P.O. Box 190 Peconic, New York 11958-0190 516-734-7474 Fax: 516-734-5812 MILLER RESIDENCE 6400 INDIAN NECK LANE PECONIC PERMIT # 24972Z MR. JOHN BOUFUS; July 13, 1998 PLEASE NOTE THE ATTACHED HEADER DETAIL AND AMEND THE PERMIT FOR THIS PROJECT TO INCLUDE REPLACING THE EXISTING 8'0" CELLAR DOOR WITH A NEW 9'0" DOOR. THANK-YOU, Yr='~'~ ~ F~ 1t ~V?'~ r-, ~' ' BOARD OF HEAbTH ......... IIE~F III1 TOWN OF SOUTHOLD , .,. ~,, ~'.-~,,. lU~/ JAN -9 ~ IE BUILDING DEPARTMENT CllgCK~.~7./.~ .~g.'g~ ... J . J J TOWN HALL SE~TZC FO~H ..... ~ ......... I AL , _ L:__ ",~ SOUTHOLD, N.Y. 11971 '~? . . , ~i'-~L CALL ................... E~aulnled .. Dias roveda//' ' ............. ' .... .... ~.~.~..~..~~.~,,.~,~/~..~...~--- - ., : , , '// ~ - ,,~~'~~/~ / ~ ..... ~ " .; , Inspector) ~ - ~ . '. ' ~NS~AUCTIONS a. TMs application must be completely'filled in by Wpewfiter or inink and submitted to the BuildMg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pl~ showing location of lot and of build~gs on premises, relationship to adjoining premises or public streets or areas, and givMg a dot,led description of layout of property must be drawn on the diagram which is pa~ pf this appH- atlon,- , , : ' ' .c. The work covered by tMs application may not bo commenced before issuance of Building Permit.' d2 Upon approval of this application, the Building Inspector will issued a BuHdMg Pe~it to the applicant. ;Such p¢~it ah~ bo kept on the premises avaHable for Mspection throughout the wdrk. ~. No building shall be occupied or used in whol0 or in p~t for any purpose whatever until a Ce~ificate of Occup~cy ~hall have been granted by ~e Building Inspector. APPLICATION IS HEREBY MADE to the BuildMg Dep~tment for the issuance of a BMtding Pe~it pursuit t0 th~ Building Zone Ordnance of the Town of Southold, Suffolk County, New York, ~d other applicable ~wa, OrdM~ces or Regulations, for th~ const~ction of buHdMgs, additions or alterations, or for removal or demolition, as hereM described. The applicant agrees to comply with all applicable laws, ordinances, buRdMg code, housing code, and regulations, and to admit authorized Mspecto~ on premises and M buildMg for necessa~ inspections. .. ~ 9. ;~o.~ ~x...~.. J.e 9.:.. ~ ' (Signature of applicant or aa~e if a c0~p~raQ$0) · . ;.a (Mailing address of applicant) : State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises .... .~. p.~_L-'~ (as on the tax roll or latest deed) If app ' 's a rp~ rat'on, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No....~.~.~..~.....~..~-~ ....... Plumber's License No ........................ Electric. lan License No ' Other Trade's License No ...................... 1. Location of land on which proposed work will be'done. ' House Number Street Hamlet : B~ ¢..7. 7~ E. ' ' Coun.ty Tax Map No. 1000 Secti(m .................. Block ................ Lot ................... 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 .... ~ .......... b, Intended use and occupancy .......... : ....... 3. Nature of work (check which applicable): New Building .......... Addition ..... .... ;' !Al'~'eration ·., ......... Repair .............. Removali .............. Demolition ............. Other Work ............... ~? ~e~ .. i: ;~ ':~:(Desc~r, iption)~ 4. (to be paid o~ 5. If dwelling number of dwelling unilq ........ I ....... Number of dwelling units on If garage, number of cars, ....... ~& ............................................................... 6. If business, commercial or mixed occupancy, specify nalure~and extent o f eacl~ ty~e o[ nsc ... ~ ~ .............. 5. Dimensions of qxis~ing structures, i{ any: Front .... ~5'.~ ...... Rear . .~ q~.~ ...... Depth...~ ~.'. ~ ..... Hmght . . .~ ......... N nber[ofStones ...~ .................................. ~ ...... .. · · Dhnensions of same structure with ~lterations o[ a~iti~s: Front ... ~ ~ .~ ....... Rear . . .~.,.~ ......... Depth . ~' ~ Hei~t ~+~ -~. Number of Stodes 8. D~mens~ons of entire new constmctmn: Front .... ~ 7~ ...... Rear .. ~O.. ~ ...... Depth . .~...~ ...... Height . .~e~...Numbe~ofStories . ~ ......... ' .... ~ '2 .... ~ .......... ~ -~ 9. Size of lot: Front ..~-t,&O .... ~ ........ ltear ....... ~.-~ ............ ~epm [..~ ......... ~ ........ ~0. mt~ ofP,~h,,~ ...[q.g.~ ..... ~, ...... . ......... ~,m~ of Fomer Ow,~r .~¢~..~ ........ ]~ Z .... hp '~ ' ~rflg: , CBC or uso district m whit reml es arc situated .................................. 12. Does proposed construction vJolate~any zoning law, ordinance or regulation: .......................... 13. Will lot be regraded ..... ~... ~ ................ Will excess fill be removed from prem~ses. 14. Nm* o~Owner o~ premises ~..~t.~... Address ~. :OP.~N~:Phone No. 7~..Z~.~ .~. Nme of Architect ..... ~...~ .............. Address ................... Phone No ......... ' ....... N~e or Contractor ~ .~P~T.~ ~. Xd~ress ~: tqg.g4 ~P.n (9... ~hone No ~. ~7~ ~'... · 5. Is chis properCy w~Chtn 30~ feeC of a ctdal wetland? ~Yes ........ No ......... ·If yes, Southold To~n Trustees Permt~ may be requlred. ' PLOT DIAG~ Locate clearly and distinctly ~1 b~lld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensJo~s from property lines. Give street ~d block nul abet or desc~ptJon accord~g to deed, and show street nines and indicate whether inte~or or corner lot. STATE OF NF:~r'5~ORK['7~ [ I. o ~ COUkrrY OF. _.~..1-~..~[7~.O. 1..~ ~ (Name of individual sig~nl' contract) above named. [~e is the ....................... >f said owner or owners, and is duly application; that all statements contain work will be performed in the manner s ·. being duly sworn, deposes and says that he is the applicant tuthorized to perform or have performed the said work and to make and file this · ~d in this application are true to the best of his knowledge and belief; and that the forth in the application filed therewith. Sworn to Before me ~}~ ' -- :392 .,I ..... ' -- 't~ ;,~£,£~o09 '$ .......