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HomeMy WebLinkAbout25056-zFORM 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. 25056 Z Date JULY 24~ 1998 Permission is hereby granted to: for : PETER I AEBISHER 15 OLD NORTHPORT RD HUNTINGTON~NY 11743 CONSTRUCTION OF A ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#20892-Z. at premises located at 30160 County Tax Map No. 473889 Section 073 pursuant to application dated N/A Building Inspector. CABOTS WOOD RD PECONIC Block 0004 Lot No. 002.001 19 and approved by the Fee $ 815.60 Rev. 2/19/98 ORIGINAL FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sonthold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27421 Date: 11/22/00 THIS CERTIFIES that the hnildlng NEW DWELLING Location of Property: 30160 CABOTS WOOD RD PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 73 Block 4 Lot 2.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to Which Building Peri, it No. 25056-Z dated JULY 24, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & WOOD DECK AS APPLIED FOR. The certificate is issued to PETER & MILDRED AEBISHER (OWNER) of the aforesaid building. SUFFOLK COUN=fY DEPARTMENT OF ~L~LTH APPROVAL 92-S0-67 ELECTRICAL CERTIFICATE NO. H066195 PLt~BERS CERTIFICATION DATED 08/05/99 GERARD STEWART ri/09/00 11/05/99 Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ o?~ A. Thi~ application must be filled in by typewriter OR ink and submitted to the buildin 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 buildi and installations, a certificate of Code Compliance from architect or engineer responsible for the building. '^mt~;~--~J"o.6' Submit Plapqing Board Approval~of completed ,~i~ plan require~entsl ..... B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings a Vpre-existing" land uses: i. 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 applican 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 bui%~ing $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate 'of Occupancy on Pre-existing Buildinm - $i00.00 ~-'3. Copy of Certificate of Occupancy - ~ .25~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $}5/0~, ~Commercial $15.00 Date ' · · · -.~ .... ~.~ .................... New Construction ........... Old Or Pre-existing Building ............. ..~.~ ~ocation of ~ro err ...~..P.l & C~ ~r5 /0oo~.$ p y ....O. ............................ ~.. r.~.oi.C ....... County Tax Map No 1000, Section...7.~. ....... Block....~. ........... Lot....~.~./ .......... ·. Map ........ Subdivision ................................. ! Filed ......... Lot ............. ~.//.~/?. ~. Appli Permit No.~.O.J~&.:~,.Date Of ~ermit.. .. . cant ............. ........ .. · · Health Dept Approval . .. ......Underwriters Approval · · Planning Board Approval ..................... PETER AEBISHER ADDRESS ~ORT ROAD, HUNTINGTON · PRIVATE ROAD OFF ROUTE 48, PECONIC -OEFIH DE WELL BELOW SURI:ACE ,BUFFOT,K COUNTY~ DEPARTMENT OF IlEAL'i'll SERVICES REF, NO. COUPLETION REPORT - LONG. ISLAND WELL 90 DEPTH FO GROUND WATER FROM SURFACE ft, 44 It. CASINGS LENGTH -- 85 fl. [ Il, CASINGS R~MOVED SEALING .. J ft. "6Eel ~o ~oP FRO~q0P oK CASmD -b-'~xiloN OF r(s)~ · SIATIC LEVEL PRIOR II. ) TO Z ST _ SUBMERSIBLE , ELECTRIC PUMPING TEST TEST ~ PE~-4ANENT PUMPI F4' ',~-:~ 'J M U M DISCHARGE hours Ballon$ per mln, In below LEVEL DURING MAX MUM PUMPING . In. belgw to~o[caslns ft. J top of caslns "' MYERS J-1020 -- kE N,P. 24 ];T~'~ER BOWLS O,t S~CES g.p,m, against J ft. ~ dlscharse head 1 1/4" PVC 60' 07-21-93 In, DIAMETER LENGTH USE OF WATER COMPLETED It. o( lotal head SUCTION LINE DOMESTIC 07-30-93 DATE J [~RILLfR LICENSE NO, 0R-03-?_9 L KREIGER WELL & PUMP CORP. 10 'NOIE'. Show log of well - materials encou~lered, with depth below ground surface, In, water hearing beds and water levels In each, casings, screens, pump, addili~al pumping tests and other matters Gl Interest. Describe re;mir job. See Insiruclions as to Well Drillers' Licenses and Reporls. Pages S · 7. S102943 Well No, 20 ' 2" 10' 30'2" 10' 40'2" 10' 50'2" SAND G]~AVEL S% ,10' 60'2" i011/2' 70'2½" SAND S~ DNE HAV /CLAY B~ LLS 10' ½" B0' 3" SAND ~TONE 10'0" ~0t3'' SAND & TO i0' [00' 3" SAND & TO 10' ½" L10'3~" ~TOPPED AT. 60 L0' ~" 120'~" ~'0" [25'4" HARD PAN ~OARSE )NE CLAY COARSE ~Y MUD COARSE VERY FINE ED. SAND VERY FINE ED. SAND " "'SALT ROPS SAME lof2, Well Yield: 24 9.p.m. BLACK IRON Casing: Type of Materia Drop Line: Type of Matelrtal Pvc If plastic, l was torque ~rrestor used? YES 3/16" S.S. iable installed? NO Sanitary Seal: lype Used PITLESS ADAPTER Storage Tanks: Size #251 gals.; Type Inside lMaterial BUTYL Type o~ Tank Drain BOILER DI~IN Pressure Gauge Installed YES Shut-O~f Valve Prior to Tank YES Samplilng Tap Provided YES Shut-gff Valve With Bleeder Line Installed on Outflow of Tank Method of Disinfection: CHLORINATION Well Lateral: Depth Below Grade 5 Materi!al POLY Water Treatment Equipment Installed For Treatment Make CAPTIVE AIR Type Model Humber Well Driller's SignAture' Print Name Print Company Name ROBERT G. LAURIGUET KREIOER WFtL & Pi lh~ RO, Box 101 - Main Road Hailing Address Telephone Number Ma~ituc~ N.Y. 11952 (516) 298-4141 2of2 Z8.~359 ://86 Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit NO & _~O~ ' (please print) Plumber: ~_~j~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to befor%"~e this day o~ Notary Publio, County DOMINJCA NATO~ Notary Public, State of New York Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (516~ 765-1823 Telephone (516) 765-1802 May 4, 2000 Mr. & Mrs. Peter Aebisher 15 Old Northport Rd. Huntington, NY 11743 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 Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 25056-Z Please contact our office on this matter. Thank you for cooperation. $OUTHOLD TOWN BUILDING DEPT. OUND^TION (2nd) ,OUGH FRAME & .FLUMBING ]NSULATION PER N. Y. STATE ENERGY CODE FI~AL /9/DDITIONA'L COMMENTS: H.S. Reference No. ~ f '~ ~'6 ~'~ Purpose/Date ~f Insp. Requested By Phone Number Received By/Date ~"7L. ~)."} ~ ~//'~ ~/' / N0~'ib~3 F iNSPECTION C~}MPLETION :'r'~ B Ins~cllon Not Gomp eled: ,L~"ater Supp y nepeotlon Com~ r'l Inspeotion Not MOSHIER BACKHOE SERVICE 101 SOUND AVENUE RIVERHEAD, NY. 11901 TEL: (516) 722-3924 A p p i, ca n ,O.~r~'~.& , <~'~-"-~ Address Type System Installed:~7_.F;~ f~' Manufacturer: ~:~.) ~-'lcOC..~~ 2~_~ /~''-- Health Dept. # Phone # Proper t~,-~cation. (Township, Sub. Div., Lot / O oo I hereby certify that the private subsurface Sewage Disposal System described above has been installed according to current criteria of the Suffolk County Dept. of Health. Date /~/' %[/~'~ Installer~--~~ ~-' System Locator: INSPECTORS Victor Lessard Principal Building Inspector Curds Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wleezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD August 19, 1993 SCOTT L. HARRIS, Supe~viso't Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Mr. & Mrs. Peter Aebisher 15 Old Northport Road Huntington, N.Y. 11743 Re: BP ~20892-z Premises @ 30160 Pvt. Road ~28, Peconic, Suff. Co. Tax Map 91000-73-4-2.1 NoYo Dear Mr. & Mrs. Aebisher: In reference to your letter dated August 16, 1993 and our telephone conversation today, please be advised that the above building permit has expired and we cannot extend it for 6 months. According to the code of the Town of Southold, a Building Permit expires in 18 months from date of issue, but you have to begin work within a 12 month period or the permit becomes void. Your building permit was issued on August 17, 1992. An inspection of the premises yesterday shows no evidence of any building construction. The fee to renew your permit is $815.60. Please send in your check in that amount and a new building permit will be issued. If you have any further questions, please do not hesitate to contact this office. Very truly yours, SOUT,~OLD TOWN BUILDING DEPT. Bui]fdfng Inspector GJF:gar TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO-No. 2089BZ Permission is hereby granted to: ..... .~...~....~.:.....~.~ ........ .... ~..~...~....~.~..e..~..~ ............. ' .'T/~ , , · .~~...,.,.~....V. ................................ ,o ........... at premises located at.. . .(e. ................................. County Tax Map No. 1000 Section ...... ..~...~.,,~ ....... Block ..... .O....~ ......... Lot No ..... .~....D~.~../.. ...... pursuant to application dated ....~I.~.~.......t..~ ................... , 19.~..~f..., and approved by the Building Inspectc~r. .... -Building Inspecto;;'''r' .................... Rev. 6/30/80 FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNI1L FULL COMPLETION OF THE WORK AUTHORIZED) Date ........................................................... 21801 Z Permission Is hereby granted to: ,o ............... . .~--~,. ,~,~. . ~ ........ m. . . . . . ~ . . . ~ ~ ~. . . . . . ~~, ...... ...... ~ ........ ~ ~ : ...... ~ . .. ........ ~ ~ . . . . . ~ ~ . . . . ~ ~ ~ ~ .............. Coun~yTax Map No. 1000 Section ...2~... .............. Block ......... ..~....~.. ....... Lot No ........ ..~....:i..'~.. ......... pursuant to application dated ......... ~...~...@.:....,~...?.. ........................ 1 g......~....'~¢~., and approved by the Building Inspector. Fee Building Inspector Rev. 6/30/80 TRUSTEES John M. Bredemeyer, III, President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthill William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 July 9, 1992 Peter & Mildred Aebisher 15 Old Northport Road Huntington, NY 11743 RE: SCTM ~1000-73-4-2.1 Dear Mr. & Mrs. Aebisher: After an office review of the above referenced property, it has been found that the proposed house construction is out of the Board of Trustees jurisdiction, under. Chapters.37 and 97 of the Town Code, as per map dated as a~ended June 15, 1992. If you have any other questions, please do not hesitate to call. t~uly Yours~ .Q~'ohn M.. Bred~eyer, III ':'.President,: BO~rd;Of Trustees JMB: jmt Town Hall, 53095 Main Road P, O, Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 5, 1996 Mr. Peter Aebisher 15 Old Northport Road Huntington, NY 11743 Re: Building Permit #21801-Z Premises: 30160 Cabots Wood Road, Peconic Suff. Co. Tax Map #1000-73-4-2.1 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284, it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. THE NEW YORK BOARD OF FIRE UNDERWRITERS 8077672 BUREAU OF ELECTRIC'i'TY, ~ 40 FULTON STREET, NEW YORI(~ NY ~J0038 · Date NOVEMBER O5,1999 Application No on file 3.9291999/99 H 066195 THiS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant name~on the above:applicatlot~ number is in the premises of PETER ~ M.K. /9~']BISHER, CABOTS WOOD ROAD, TAXMAP-100~i73-O4-2.~, CUT~HOGUE~ NY in the following location; [] Basement [] 1st Fl. [] 2nd Fl. GAB/ATTIC/OUT Section Block Lot 2 was examined on OCTOBER 29,1999 and found to be i~t compliance with the National Electrical Code.. FIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHEI EXHAUST FANS OU~';.E'rS FLUORESCEN1 OTHER 3 FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS 70 35 52 67 DRYERS FURNACE MOTORS ~NIT HEATERS DIMMERS SYSTEMS SERVICE DISCONNECT S E R V I ,' C OTHER APPARATUS: WELL PUMP WIRLPOOL BATH- PADDLE FANS-6 G.F.C.I:-7 SMOKE DETECTOR: -5 NO. OF CC COND, A. W, G. PER ~ OF CC. COND. A,W.G. AWG OF HI-LEG NO OF NEUTRALS OF NEUTRAL *NOTE, This is a partial, not a ~omplete certificate. PETER AEBISHER ~ GENER~L 15 OLD NORTHPORT ROAD ~ HUNTINGTON, NY, 11743 Per This eedlflcQfe mu~t not be ~ltered In Qny monner; return fo the office of the 6oQrd If IncQr~ect. Inspectors mQy be i~tifled by their credegti~ls. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE AL~'ERED IN ANY MANNER. INSPECTION - PLBG. ,[ ] F.~.Ni~TIONIST [ ] ROUGH I//J-~OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE~ INSPECTO~ BUILDING DEPT. ~ ,o~..~ISPECTION ION 1ST [ ~ ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL 76S-1802 / -/~/~ , ~ [/,~ FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: DATE 76~-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [/~OUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL DATF. INSP 765-1.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]/~NDATION 2ND [ ]INSULATION [ ~]~ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: .~'~ DATE ~ INSPECT~ ~ 76S..1802 ~ BUILDING DEPT. ~__~2~/~~~ INSPECTION ~ ~,~..~ FOUNDATION 1ST [ ] ROUGH PLBG.'""-"*'*-'*' .]//~JNDATION 2ND [ ]INSULATION FRAMING [ ] FINAL FIREPLACE & CHIMNEY ~ ~_/~/ 7G5-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNOATION2NO [ ] INSULATION [ ] FRAMING [~'/FINAL~. [ . ] FIREPLACE & CHIMNEY DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [,~'I~NAL [ ] FIREPLACE & CHIMNEY DATE~/ff INSPECT~ 7/'' /- - 1- 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~[ ]~ULATION [ ] FRAMING '~," ] FINAL [ ] FIREPLACE & CHIM~NEY R E MAR K S: ~ ~, ~ ~~~ ~ _~ DATE' ~.~/.~,~' . .,NSPECTOR~ ¸iI }'65 J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ~INSULATION [ ]/~JJNDATION 2ND [~ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~~'~ DATE 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]R~OUGH PLBG. [ ]F/F/F~NDATION 2ND [ ~JINSULATION [~/]FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ ~--~--. DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. [ ] FOUNDATION 1ST [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY INSPECTION [ R~~OUGH PLBG. DATE ~///~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ R~~OUGH PLBG. [ ~JNDATION 2ND [ ] INSULATION [ ~] FRAMING [ ] FINAL [ ] FIREPLACE & CHI_MNEY~_ /.~~ ~ 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ []FIREPLACE&CHIMNEY '~/ ' '-7 ' [ ] INSULATION ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ~FINAL (,'~~_,,,~ FIREPLACE & CHIMNEY REMAR, KS: ~ ..~r DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INSULATION [/~FINAL [ ] FIREPLACE & CHIMNEY ,INSPECTOR bU~ , i~i ~11~ w Og~ ,,i ~ ~TOWN OF SOUTHOLD ~'t\~ ~'1' -I ,'~ i : ~'i BUILDING DEPARTMENT ........................ ::: r ' TOWN HALL ~l,[:~. ~ .... TOWN ~: 6;'~L~';~o~ ~,) ~ SOUTHOLD, N.Y. 11971 .............................. TEL.: 765-1803 Approv~ ~., 19 ~ ~ Pe~it~O.~ Disapproved a/c .... . .......................... .....~ , , ....... (Building Inspector) APPLICATION F~R. BUILDING PERMIT t, OtzF¥ HAIL TO; Date . .J.u.l.y...1.4. ......... 19.9.2. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 appli- cation: ' ,, c. The work covered by this application may not be commenced before issuance of Building Permit. d. i Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shail be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shail have been granted by the Building Inspector. APPLICATION IS HEREBY MADE 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. the applicant agrees to comply with ali applicable laws, ordinances, building cfl4e, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necess~y i~sp~lct~n~./ % ~ _ ~ ~. ~ 1,5 · OLd .Nor.t2flpor.% .~oacl.r .Hur~t o,. N...Y.. :L2L743 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engifieer, general contractor, electrician, plumber or builder. Owner Name of owner of premises . ~.e. to¥..I., .A.e.b.%s..t39.~' .aB.d' .~J:..1.d.~.e.d...K....A.e..b.i.s.1).e. ~ ....................... (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 .......................... -Plumber's License No ......................... ' Electrician's License No ....................... Other Trade's License No ...................... Location of land - which proposed work ~.~ 0 I f* 0 Q~T~ ~.~/2 will be done. Oal~oOs .woo~s .Ro~d,. lo.t .~2. ~E. th~..Greenfield , minor subdivision in 1985, Peconic~ N.~.. House Number Street Hamlet ounty Tax Map No. 1000 Section .. 9.~ ........... Block . ~ ............ Lot 2 ~division. l'B. abo~ .~oo&s, .......... ........ Filed Map Ne.l/g4/~ 85. .. Lot .., ~ .......... (N~me) ......... ~ existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy . ded use and occup~cy .... ~0~n~w~P~9 ¢~7:~~ ~' ,a ,~.% ,~;~ . , :,% ¥ of Work (check which ap!c .r .............. Remo~ 4. Estimated Cost ...... ]icable): New Building .... ~ .... Addition .......... Alteration .......... al Demolition Other Work ~- ................................ · ' I '.%~ ..... .... (Deicription) · o .................... Fee . . ~ .......................... ~ ......... (to be phid on filing this application) 5. If dwelling, number of dwelling u fits ....O.rl~ ........ Number of dwelling units on each floor ................ · If garage, number of cars ...... ~ .......T.w.q ........................................................ 6. If business, commercial or mixed >ccupancy, specify nature and extent of ~ach type of use .......... ' ........... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ........ ' ....... Height ............... Numl ;r of Stories ......................................................... Dimensions of same structure wit]~ alterations or addition~: Front ................. Rear .................. Depth ...................... Height .......... i ........... Number of Stories .......... ~ ............ 8. Dimensions of entire new constru :tion: Front... 48~ ...... Rear ..4.8.* .......... De th 22 to 30~ Height 19 ~. Numb ~r of Stones ...... Txqo 9. Size oflot: Front ... 186.,7~ ..... Rear. .' Depth .600!... .................... 10. Date of Purchase .................... . ......... Name of Former Owner ..Norgb.:~ovk..Veug~..es ...... 11. Zone or use district in which pre~ ises are situated ..... Y.4U .-. ~.~,/a.g~ ................................ 12. Does proposed construction violat~ any zoning law, ordinance or regulation' .. N.Q .... 13. Will lot be re reded Ye ' ' ........... i ........... ,. ~ g ...... ~ ................. Will excess fill be removed from premises._ Yes N~ 14. ~ame oi Owner of premise.q~....S, lar~e..' ....... Address ..... Phone No Name of Contractor ' ~?. t' a~ ...... ' ....... 15. IS this property within 309 feet of a tidal wetland? *Yes, .X. ..... No ......... *If yes, Southold Town Trustees Permit may be required. (Letter is included.) ' Locate clearly and distinctly all b property lines. Give street and block n~ interior or comer lot. Ple~ PLOT DIAGRAM dldings, whether existing or proposed, and. indicate all set-back dimensions from tuber or description according to deed, and show street names and indid'ate whether tse see surveys attached to this application. , I ,TATE OF NI~'W-Y'OR~,O /]o~1 ;OUNr[7Y.OF~.~(.~''~. · .~'ol ~1111 .... /~[[OZe~ ¢,.~ :; ~. {1~. ........ being duly sworn, deposes ~d says that he is the applicant (Name o[ inaiviauai signing contract) bore named. leis the ...................... O'~r~ ;g;nt,~;;~;raie o~fi~er,'et~.~ . ' " '. ..... ." '. ..... f said owner or owners, ~d is duly a~t~ofized to perfom or have perfomed the said work and to m~e ~a file this pplication; that all statements containe~ m this application are true to the best of his ~owledge and belief, and that the ,ork will be perfomed in the m~ner setl forth ~ the application filed therewith. .' Worn to before me this I 'ora P~ hc . _ '.: ' ' a~llf