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Home My WebLink About25125-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25930 Date: 08/30/98 THIS CERTIFIES that the building ACCESSORY Location of Property: 550 WELLS AVE SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 61 Block 3 Lot 8.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 21, 1998 pursuant to which Building Permit No. 25125-Z dated AUGUST 21, 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 FENCE TO CODE AS APPLIED FOR. The certificate is issued to PLEDGED PROPERTY III, LLC. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N196232 07/16/98 PLUMBERS CERTIFICATION DATED N/A B -il ng In pector 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. 25125 Z Date AUGUST 21, 1998 Permission is hereby granted to: PLEDGED PROPERTY III, LLC. 5373 WEST ALABAMA AVE HOUSTON,TX 77056 for CONSTRUCTION OF AN INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#19696-Z . at premises located at 550 WELLS AVE SOUTHOLD County Tax Map No. 473889 Section 061 Block 0003 Lot No. 008 . 001 pursuant to application dated AUGUST 21 1998 and approved by the Building Inspector. Fee $ 150 . 00 Building Inspe or f ,9 ORIGINAL Rev. 2/19/98 FORK NO. f 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) W19696 2 Date ....474'.Aa— ..........6.................. 19.Y.1 Permission is hereby granted to: to ......... ..G1 .. . .. . ......... -� ... C.. ......... ..� ......:.......... at premises located at .............. -..t.. .. ..... . . ... .......................................................:- ................................... ..................................................................//......:.1..1....L/ ......................................... /�..................... County Tax Map No. 1000 Section ...(�...l........... Block ...2............ Lot No. .� ,,...../...... pursuant to application dated ........�� .~�.......... 19.1y,, and approved by the Building/ Inspector, Fee Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OF, 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 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 Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .2511,, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .Z . -.I I.9 . . . . . . . .. . . . . . . . . New Construction. . . . . . . . Old �� )O) r /Fre-ex isting uil�dgi�nyg, / r%. . �/ y Location of Property.. . ��. .110e S � ��^ :�� . ./.U.7 :.1.lL l.l. . . . . . . . . . . . . . . . House NoJJ/7 g/ Street // Hamlet Onwer or Owners of Property.. . ... . . . . . . ./. . . . . . . . . . . . . County Tax Map No 1000, Section. .u�/ <. . . . . ..Block. . . . ..� .. .. . . . . .Lot. . . .�i. [. . . . . . . . . . Subdivision. . . . . . l/. . . . . . . .. . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . .... . . . . . . Permit No. . ./?.�A . . . . .Date Of Permit. M/510/. . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Tempary Certificate. . . . . . . . . . . Final Certicate. . . . . . .Fee Submitted: Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . �y� U56�d J-APCZ�� co gas 9.30 ------------ THE NEW YORK BOARD OF FIRE UNDERWRITERS 11951.55 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,ltiliY (fi, r+°9 i 'I"1 43.1 jcT1 14 Date Application No.on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Flit, RAND, 550 W:F;IO S AV? fE, t in the following location; U Basement ❑ Ist Fl. ❑ 2nd Ff. Section Block Lot `TUNE 06'. 1.�i91, andfound to be in compliance liance with the req uire►nents q this Board. was examined on f 1 � FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEll UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL I H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. T. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP, TYPE METER A.2w 1,9 3W 3,B'3W 3,6'4W OF CC.COND. A.W.G. NO.OF HI-LEG A•W.G• NO.OF NEUTRALS A.W.G. TR EQUIP. PER B' OF CC.COND, OF HI•LEG OF NEUTRAL OTHER APPARATUS: SWIMM'fN0 POOL-1. $ bKW SPA HEAURS--i. SPEC'TAL REC. 20AMP �.- MC)TORS:1-1 H.P. PANKIsBOARDS::1-:3 CIV 1,00 *(8WTMM:rN(x P001.) `x'111 S oert. i ricate revers compliance at rhe r1-ate of inspection only. Ar,'atlsN of uollstla3 p environments it. -i s aely 1.,sa`r tt, <<< Continued e,n Parg«- 2 >>? GENERAL MANAGER i 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. THE NEW YORK BOARD OF FIRE UNDERWRITERS 115! I.55 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date JlI .IY )fi, 199:3 application No.on file 7'.A055G"I/91 Iii `I g6i:.)I THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MR. RANO, 550 kVFW1-P,, 011-`f{OW), N.Y. in the following location; 21 Basement l)ta'1 ❑ lst Fl. ❑ 2nd Fl. Section Block Lot was examined on `711NE. 06,1.991, and found to be in cornpliance with the requirements of this Board. FIXTURE EPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. I AMT. I K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP. TYPE METER 0 YW I B 3W 3 B 3W 3,0.4W NO.OF CC.COND. A.W.G. NO.OF HI•LEG , W G• NO.OF NEUTRALS A.W.G. EQUIP. PER,0' OF CC.COND. CIF MI-LEG OF NEUTRAL ai s OTHER APPARATUS: bave frequenttf-st: anal/(-)r• rppair• crude by a quaji.t i(id person. I• S. SANTO iI'.c;,#1077 } 16 PITCHAP3, PIACK NFSCONSf,'i', NY, 11767 GDOM 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. COOY,FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT 11 ALTERED IN ANY MAMER. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ATION [ ] FRAMING [ NAL [ ] FIREPLACE A CHIMNEY /Rr)jE�MA�RjKS: DATE INSPECTOR BUILDING DEPT. INSPECTION I FOUNDATION IST ROUGH PLBG. FOUNDATION 2ND I"ULATION FRAMING [6;/FINAL RKS: lo- ,2 r r DATE INSPECTOR / y oe � wo- i�� i AUG-26-98 10 :35 AM CENTURY 21—ALBERTSON 516 722 4449 P. 01 a cO*jVry �,�� z 6 � �� r� FAX ;. �® Albertson Realty www.contury2l-albertson.com �I 1146 Route 25, PO Box 2 ❑ 56215 Main Rd., PO Box 598 Jamesport NY 11947 Southold, NY 11971 Ph: 51 22-260 Ph: 516-765-3800 Fax: 516--70---4446 Fax: 516-765-3803 -- 7To: e.�..�� From a Re: !,5c) w�a�s (av �-i4mld Date: -ge-t�c e w u1; we4a�v.A..nc40 S 6-Y8 0-1u-�T�iry' ,,,./, _ q .A..y. c ..sK� l �L rI _A.v...o--� o,► .�ua,...�, n��e-��. c.C�.�n�� .V:� �-•� v�-� cJ�s.� "YIRtz� owe cti. ,A 14 X- Page lELD I :SPECTi �'N �JUATE COMMENTS -o m 1 . FOUNDATION ( 1st ) FOUNDATION) ( 2nd ) m � 2 . z o ROUGH FRAME & PLUMBING 3 3 . m m INSULATION PER N . Y. STATE ENERGY CODE 4 . FINAL Rep ® l' ADDITIONAL COMMENTS : x H(� 1 • m a • r H b . m b H UOARD OF DEitull ... .. . . .. ... . .. n D OORM NO. 1 3 SETS OF PLANS . ..... .. . .. . .... D t TpWN OF SOUTtIOI.D SUAVCY .....• . • • • •; ^•!"""" " ' UU1I,DINO DF,PAR'114ENT CNUCIC ......... . .•• • TOWN HALL SEPTIC PORN ... . . . . . . S91IT1101,1D, N.Y. 11971 NOTIFY: BLDG.DEPT. TEL; 765-I BO2 T WN FS U NOL CALL(./ �yyt/?('. . . .:e�r� Jz�u MAIL. TO:/, IDmnined...... . ... ........ 19.... ....1�Cur �>� 53 Al-4>r0vod...... ... . ......... 19,... penmlt No. ¢ ��-. ... ......... olsappruved a/c ...................:............... (lk:ilding Inspector) APPLICATION FOR BUILDING pEmin ,19. •Date.{�" INSTRUCTIONS a. 'Baa application moat be ca„pletely Pilled in by LypWriter or in Ink and sulwitted to the Duildiag Inspector wi 3 sets of plans,.accurate plot plan to scale. Fee according to sdWlule. to oini remises Or public h. Plot plan dowing location tlad description o 1sya3Clof nropertyreauatibe drawn on the dfaagram..4nid, is part of atrects or areas, and givi� this appllcaCioa. tirent. Such by this appllcaCion may not lxt crnmenced before issuance of Ifirilding Perndt. c. 'll,e work } d, Upon approval of this application, the llullding Tnapector Wilt 10" a Wilding Permit to the app permit shall be,kept an tl,e premises available far inspection UnrouglnouC the irk• whatever until a Certificate of e. No building d,all be occupied or used in 14tole or in part for any purpose Occupancy $1,811 leave been granted by the lknilding Inspector. APPI.IC/if1tN IS W= "6 Co tl,e Wilding Deportment for the issuance of a liuildiag Permit pursuant tito the or 1suilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lawa, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, herein reGM described. the applicant agrees Co comply with all applicable laws, ordinances. building code.inspections regulationa,,and to admit authorized inspectors On premises and in building'for necessary inspec ................................ ..................... (Signature of applicant, or nese, if a corporation) . ..................................... (Mailina address of applicant) lent, archl t, engineer, general contractor, electrician, pltnber orlxnil, State cul tier applicant is owner, ea p, lc /e . �. .. � ' .................. Naze of owner of premises ...... " (as on l!he tax roll or la eat deed) It applicant is a corporation, signature of duly outlxAzed officer. (Nano and title of corporate officer) Builders License No. ........................+• 1961 .S h q Plumbers License lb. Electricians License No. Other Trade's License Na. e�f SC �GC C..... .. I, lc�eaticx, of land on which proposed work will be done � !, �./.......................................... louse N.ni,er SCreeC�+ / liaale (� l...... mock. ... ......... Tot ... .... County Tax 11ap No. logo sectio, ..... .. Filed Map No. ..... .:...... lot ............... Subdivision (Name) of construction'cu 2. Scace existing use and occupancy, 09 premises and intended use and occup proposed tnf".3fF J eCing use and occupancy ..............................5",;eif.+'"}L1 Y" a. C�ci. , ••••••• . ;wamY�klsY4 rPnt.u.._LIaSi aal!aE ....................•.•........i.•.. .i`i� i4• i ,......... b. Intended use and occupancy .. ... ' Mntura of work (dark Mildl appliopbla)s flew paild(ng ........A. Acklltlon .......... Alteration .......... Ilclair ..........., ltrznovat ......1....., t1>PJmlititxt ,............ Other Work ..... ............... (Nacriptlon) •' Lathmted Coat ...........1 ...., fes, ....'.......................................... (to be peid, dxt elllna tills application) It c1,ra11Ina, sxnlar of MIltna traits ............ I�xiber of e><aalling units on each fupor ....:. .. �., .... Ifgurage, rxniar of care ...................................... L if lxrehleas, ca nareial or mlmr occulaney, bpaeify naturo and extent of arch type Illmennloos of existing sttuctureaj If anyt lrront................. Rear ............... Npth .. .......,.....,. ' Might .......................4. li stbar of Stories .. ....... ........ ..... Uinenalam of anm structure withllaltarattons or'aclitiones !wont ............... hear ........, ...... Uaplh ................i... lleiglttll ................... limbar of Stories ............... I. I)6nensiorn of entire new conatructiont lrront ................ hear ............... oepth ... .... .. . .... 11a101t ........................ 4nlar of Stories' ................. . 1. Size of lora Ihnnt .............i....... 11esr .................... Dapth ................... . 10. Ml•e of purdrbee .............. ... Ham of 1}onnsr Owner .....,.,........................... .... . II. lora or use district In thidt preptsea are situated .........................:..................... . ......... . . ... 12. Ikae proposed axatruction viola�'e any zailng law, ordinance or regulations ........................ Il. Will lot be regraded I..........�........ Hill excess fill be removed Fran premisest Yves NO 14. tiaras of O.ner of pmedaes .....i.................:... Wress ...............:.............. I9rorxe No. ......,.,,.. Ilan of Ardsitect ..............1.......r............. Address .............................. More lb. Num of Contractor .............i w.................. AfMmas ............... ............11loca 110. ............ 15. Is this property within 300 fee of a tidal wetland? * YRS .......... tl0 .. ...... *lR YPS, SQIIU LD TOIIN man 1'Lrl3IRr MY M 11ltCl illttm. PLOT MOM.- locate clearly and distinctly all buildings, Amdar existing or proposed, and indicate all bet-lads dirmnsions Mom property lines. Oive street and Itlo* mbar or description according to Meed, and allow street 'nnma and ialteote iketllor Interior or corner lot. II r SIMIl r W " III LV4"-.GJ. (r�.�l.I/W:.✓.YI D......bLirig duly swrn, delx>sea and nays Lint be in U,e appl.1cone (Nnrn of lodivlchal signing contract)' nixwe luxted, lie In the ...... .......... (Cattractn• altenC,• I rpornte oEClcer., etc.) of Mnid (Mxtr or cxnxtrs, next is duly �ulllorized to pertonn or line perfonind the said work aux) to nuke aril file this alntilcntirxr; Lhnt 11.11 statereuts contained in title npilllcaticm are true to the beat of his knowledge mel Willef; nrxi that the w+urk will he perfom l In Ltre nnnner net forLh in We npplicntidn Cited therewidl. 1T.ilrn Ln ix fu}e Lhia <ny ..d. .. 19. votary Pl li .. . t... .... . /� // MCFWRPR! (Siltrnturp of Applicant)rty—!"^"°� �' (fR�' BOARD OF HEALTH . . . . . . . . . . . . _ 3 SETS OF ="af�fSj FORM �! � i SURVEY TOWN OF SOUTHOLD CHECK . . . . . A tAk . . . . . . . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL HI-DG. ar-_Pz: SOUTHOLD. N.Y. 11971 NOTIFY E TOWN OF SOUTHOL0 TEL.: 765.1802 CALL . . . . . �T Examined . . . . ... . ,,„. . X19 . . MAIL TO : Tom. Approved`1'21eto,t. .lGl/�. . ., 19f/Permit No. .l.% � °" .. . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . 2 �Z y . . .> 19�f INSTRUCTIONS a. This application must be completely filled in b ° P y typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans,accurate plot plan to scale. Fee e 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. 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 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. 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 all applicable laws, ordinances, building code, housi cod , and Rulations, and to admit authorized inspectors on premises and in building for necessary i ions: (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . owt'`.'. ... . . . . . . . ... . .. . . . ._. . . . . . . . . . . . . . . . . Name of owner of premises / L! S „ 0,/� ,��Xa9- (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. P , �4e ,e,•, Other Tradc's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done; U. . . . . . . . . .1Z)e_115 . Xt1e. . . . . . : . . S01 House Number / Street. Hamlet . . . . . • County Tax Map No. 1000 Section . . . . . . . . . . . . . . . Block . . .�? , , , , , Lot . . . :.�: Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .. . State existing use and Occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .` y• • •%� S... b. Intended use cc . . . . and occupancy % . . 3. Nature of work (check which appli;cable): New Building • . . . . . . . . . Addition . . . • . . . . . . Alteration . . . . . . . . . Repair . . R�movalil . . . . . I . . . . . . . . Demolition . . . . . . . . . . . . . .Swimming pool. . . . . . . . . . . • Tennis Court ice aeii cc<ld� �+ls i L:� t Wee Othl . . 16'r32- _z. p&c44w' ��n sry p s�!' Fee . 4. Estimated Cost-��6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on tiling this application) 5, If dwelling, number of dwelling units . . .(. . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . . If garage, number of cars • 6. If business, commercial or mixed occupancy, specify n turn and extent of each t pe of use . . . . . . . . . . . . . . Depth . . . . . 7. Dimensions of existing structures, if any: Front . .r t. . . . . . . . . Rear . ...,�. . . . . . . . P Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . j Height . . . . . . .. . . . . . . . . . . . . ... Number of Stories . . . . . . . . . . , . . . , • 8. Dimensions of entire new construct Front . . . .3..'2n . . . . . . Rear . . � Z :. . . . . . . Depth . . . ��. . . . . . . . . Height . . . . . . . . Numb�r of Stories'. . . . . • • • • • • • • • • • • • • • • . . . . . . . . .. . . . .7 . . . . . . . . . . . 9. Size of lot: Front ? '.�Z .. . . . . . . . . . . . Rear . .� e?O ". . . . . . . . . . . . . . Depth �. . . . . . . . . . . . 10. Date of PurchaseName of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which pre ises are situated . . . . .4-.�.r. . . . . . . . . . . . . . . . • • • • • • • • 12, Docs proposed construction violate any zoning law, ordinance or regulation: . . . .u�.�• 13, Will lot be regraded . . . . . . .Will excess rill be Tpmoved from premises: es No . 14, Name of Owner of premiseAddress.SS-G�0IFs ef0e_ . . . Phone No. Name of Architect . . . .Address . . .Phone No. Name of Contractor/,.m!OT:rs?. . . .. . Address �54� u'�e . . Phone No. �'- 777 ": . rr. . 15.Is this property located within 100 feet of iKa'tland? *YE S. . . :No.-1 *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinT.:`' qlI, buildings, whether existing or proposed, and.indicate all set-back dimensions from property lines. Give street an<;` ,urnber or description according to deed, and show street names and indicate whether interior or corner lot. +' '� — - - --- Pr,a •.,t;1"I I1VIAf' _ (.111112 CII - - 'D I 1; Ln � 1 '� I •11 �t4:�, N LI IfJi IP VIIICP 1 ,_ n I'7F°601?`l 117 P1) P, i> h) ii to J ±.�. fl ?. Sr, r1e2.0 70 PLAIN�QQAD_ . Ii r _ I i� it W STATE OF NEW YORE, COUNTY OF . .`aU(�f OSIS , , . I . . . . . . . . . . . . . . . . . . . . . . . . . being duty sworn,deposes and says that he is the applicant (Name of individual signi;rg contract) 'above named. Heistile . .6 wt).-S r. . . . . . . . . . . i . . . . . . . . . . . . . I . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) ;,' owneiv op=a,,.fle-.Q, and is duly authorized to perform or have performed the said work and to make and file this application; that 311 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. Swam to before me this . . . . . . . . . . aq�. . . . . . . .day of ,. / � ,� . . . . . .. Notary Public, SoVounty dri,^.rAr'n mPdLTTb Notary 'Rubik, 5few of New York Nn. 30-665.674 _ . . . . . . . . . . . .r. . . . . . . . . . . . . . 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