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HomeMy WebLinkAbout24315-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25393 Date: 11/26/97 THIS CERTIFIES that the building ADDITION Location of Property: 765 PEQUASH AVE CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 103 Block 7 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 18, 1997 pursuant to which Building Permit No. 24315-Z dated AUGUST 19, 1997 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. The certificate is issued to CARMELO & RITA LAZZARO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 11/19/97 PLUMBERS CERTIFICATION DATED N/A Bui ing I pector Rev. 1/81 FORM NO. $ 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) N° 24315 Z Date ......�-,/9..................................... 1917 Permission is hereby granted to: IAr��f.....f9?✓. ....��f. 415 fz.�rj�. ! :...!yt�.. IAz-Z A f- ............................... to .. 5 (C,f:.........'mr..✓........... //.7..�''�.......... ..... t' !�.... rf 1. if '���.... �/. .l......... %.... .............. ..�1�%-1% ....... IT..........�'�r-�...cam............. .............�,X..........................�...............................�............................................................... ....................................................`............................ '..................... ....................................................... at premises located at.......7�4r..... eej-.M 4:01...../ E........... ✓.�6��t�Q.��`9��.............. County Tax Map No. 1000 Section ....Ia..I........ Block ......4?,.7...... Lot No. ....?�... ....... ....... pursuant to application dated .........10 tM6.........1 ...:................... 19..191and approved by the Building Inspector. 1 Fee $...f•�.......... Idi Inspector Rev. 6/30/80 VU1111 LIU. U TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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: L. 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 sewer age-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. Ce 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 - .251�. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residentiia/1J $15.00, Commercial $15.000 Date . P.:'. fJ` . . 1.9. .)�.�•% .�. .-. . . . . New Construction.`,� Old Ar Pre-existing Build'ng. . . . . . . . . . . . �7 r Location of Property. . '.5 . . . . .. . Cka . .�17 . . . . C �GGI L . . . . . . . . . . . . . . . . House No. Street f Street �y ,�.�� Hamlet Onwer or Owners of Property. ` ' � /rn��� ` � . . . . Z`-YYI .t.!. . . . . . . . . . . . .. . . . . . . . . . . . . . . County Tax Map No 1000, Section. j. .V� . . . .Block. . .7 . . . . . . . . . .Lot. . .`. .. . . . . . . . . . . . . Subdivisionq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. y �2� . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . .... . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval..,(. . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Corticate . . . . . r Fee Submitted: $. �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �c' S 36'78 / APP c� 2-as 3 y3 THE NEW YORK BOARD OF FIRE UNDERWRITERSf, ; 1 1t1351PO BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 Date NOI,TEI113ER 24,1997 Application No.on fife 1�"" .`-"-a7(c'7 N 438746 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 LAZZANO, 765 PEQUA.SH AVENUE, CUTCHOGUE, NY in thefollowing location: ❑ Banernent ❑ Int Fl. ❑ 2nd Ft. 'Ii.IT .Section Black Lot teas examined on NC?1 EHRER 20,1997 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES I RANGES COOKING DECKS I OVENS IIHSHWASHERS EXHAUST FANS OUTLETS ICI►TACLES SWI7CHE5 INCANDESCENT FLUORESCENT OTHER IMT K W. AML N.W AMT. R.W. MIT, K.W. AMT, I Hr DRYERS FURNACE MOTORS FUTURE APPLIANCE RIDERS S►ECIAL RECTI TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS_ - SYSTEMS AMT. K.W. OIL H.P. GA5 H.r IJAT. NO. A.W.G. AMi. AMP. UAi. AMTS TRANS. ANi H.P NO,OF RET 'U'ST. WAiiS SERVICE DISCONNECT NO.Of S E R V 1 C E METERNO Oi CC COND A.W.G. A W.G. - A,W.G. MT. ANP' TYPF EQUIP. F-12- I/]W ]R 3W ]X IW ffR/ f D. NO.Of Hb LEG HHE NO.OF NFUTRAR Of NLBiML OTHER APPARATUS: G.F.C.I;-1 SMKE DETECTOR: -1 CALL HE ELECTRIC LIC.#34941 � �. L L �a't 1341. (IH2CAC,() AVENUE BAY SR)R.E, NY, 11796 GENERAL MANAGER 11 j A 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. 1llli l'bL11U11 1I 1,1'Ulfl' I,611:-„- ...._... .. _._. .__._-I:Utllll:II P” I {In1IIIn'I1IIf1 (1!;t �. I'VUinly'I'I UII ( 2111) 1111111 III I'IlA 11C F ' I'I.I II 111 111(, ..._---- .-----_n.----.._..--- 'Jmr. k ....mnrr-,mm....:----- ----------.-_------------- wr 11!,III.A'I'11111 I'I•:It 11 . Y.. (:111111 ' S re.__ r.�____r _r fr m.._.,.. _-. ..__.,-------m..__,-_..----------------r-- - I 1' 11IAI. __rrrn_rr_.._,.____mn nr __ ____r ____---.rr__,___m__-____---------------------------------------- .. nunl-I'IUnnl. t;Unw;n'I'ue ..__.... .........___-rrr__m__.,r,.____rm..:;,.__nr-_r-.m_..r..rmr..r_m.,_mrmr-.mmrm_____r_r__r_r.._.,rr_rrrr - I. • o >7 , 41.. y. NI — l"1 1,� M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ AL [ ] FIREPLACE A CHIMNEY REMARKS: DATE /.l INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ ] ROU LBG. [ ] FOUNDATION 2ND [ INSULATION ( ] FRAMING ( ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: r 4 `t- q- L DATE11y4' 7INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FO ATION 2ND [ ) INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE ! INSPECTOR t 2� 3I5� 765-1802 BUILDING DEPT. INSPECTION [ /FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHI/MONEY REMARKS. K5; DATE 9 � /n7 INSPECTOR2L6 G/ f{ L ` - "Nadi :a•1: •••Ca.+ fli y.. .( �' z Ac ' '7 ° •.• .mai StIT.D`I,J s-.} / AREA: :�?,1�J - i ' _ OF NF{y - MAP OF Pft PFDTY �•�w. y,, 'o, .twt lsVln! �� /'r' �-"s.�{( . ��t � � � ,'•' r�Yli �� :,�, Kn; iapF YO al1ND low now AT .: . .�. .6,m"rune - to ,.; �. z�.• '.'C?WN rf 5--�JTH0 "V, NY. T6�Mr GAN •^ IM5U�wIiI+ti CVEQ Co. � A-f03-7-25 _ ".�cPOP rasa. 1 ^ _ `4#A T'�YL, s 4 : E:Z COCVS� `t ,'' I .I.0'r'i J _ J ,i.. \ .. -�•- � ` '' / - "Of � I :�+c:. ,•.2cua •{.'-_asst 1 '��, :•v: •• C_,i y�. l—! •R sit ii 3CAL CIS j it 1 MAP lilt i�:��V Iz �ior -� v awe r.M k .._-r--------- ... ..-.•+•l \ �(�`t.:� F ,LQ �"�e �p Saw y,ts�6 rx ecn 's b "'�'�' bAT --- %x% 7,.N 7 � — 4 S±;zcn.:,+� I *,:�AL•�i•kla.�.Kr:s..]ez..—..•z arsz.�mm.tn-n � — - /tN �EO7WN � 50 �TNY & •_4�T �C x:a5FE � E , rmIUN i 1 s _ l r –A1( MAP TATA: t 1 A �_4� 7 25 ;..:. _ EQ!C / JA.N ''J�: t> ., Yom?–��Q_ ,s: . J •' 1 4 Y•Af f AREA: i0,0.' t o a t`OFµF{3 - --- - IAF r;� c�� FFTY tiQ� y{: i Qv 6- beenk+rK •.. �. � r �I Y :I..! =.\ s l.� r's'�./`•_.i' ..�i t o +4 13266 AT wF.:s C3fjCHOG'j!E z't'P-G rho. tat- - „I i.a.nsaL'• MWN e F SOUT.1-Q��, tJ.Y• Fl1.5T r ICAN •"'+TLE ;Ff. e v r /V I' � . ., t.P GAZA t 1t;o to3- 7 25 t EQKV `/oAN 7-Pf �11Ar- 'sr � vp'-VA '� � ✓ .. 4 tWIE ' $� '�?��,�.XN»a,�i'L $ ���Y� fe` »-' A�YV�'a�/.�• �3 �- �P' XF'L� w:T. - iw ^ SUFFOLK COUNTY This is to certify tt - Dennis katevatxs x 4, , .4i- 4 w . r ..•.. . . .:. • . . . . . ), doing business as ,,`.Sha17&4P � %R Su€folk, Inc k .. r ^v .,'a . . roti.+.; Cieer �Ste. t to a _t . P to having furnished the Tfourthjin acco'rdancp Mth afld subject to the irovisU3s.gf applicable `. l Fg- 4 laws, rules and re ttons of t e Counjy f Suffolk, Stats 4f NeVork, is h*' ebWic4nq 41Wnduct Q � t ��S°�{) � bu81ne88 as N.�1�S"•fes"' � k ! THIS LICVEM$ER y� i a t •-* , i! ' �i' 1 " COMMISSIOjdER Ol CONSUMER AFFAIRS NOT V ALID WITHOUT DEPARTMENTAL SEAh> , Lfnd 14fv.s - 1-22 36.120--4!!cs By+r� ■A- ' 1BI+�. �{wr wK t .�. 111►�,E+/y�' f �y`■fit_Barr AOORD CgR7IFI,CATE O{ I..IABILIXY M� ISURANC „CSR B'G DATE IMMA)O/YY) aIIHxi 2� . . ' 06/17!97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bo & Borg, Inc. f ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Borg g I HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 148 East Main Street `� (//^�j� (((� ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Huntington NY 11743- ... �`...J�!f . COMPANIES AFFORDING COVERAGE L1 COMPANY PIarr No. 516-673-7600 Fax No. - A Maryland Casualty URED COMPANY B State Insurance Fund COMPANY Shells only of Suffolk Inc. C 680 Sunrise Highway COMPANY Went Babylon NY 11704 D G01/ERAGES :; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE fMMMDNY) DATE(MM/DD/YY) GENERAL UA91LITY GENERAL AGGREGATE i 2,000,000 A X COMMERCIAL GENERAL LIABILITY RGP28455948 04/29/97 04/29/98 PRODUCTS-COMP1OP AGO i2,000,000 CLAIMS MADE FX] OCCUR PERSONAL S ADV INJURY $1,000,000 OWNER'S B CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000 FIRE DAMAGE IAny ane fire) It 50,000 _ ^ MED EXP Ww person/ S 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 0 ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ NON OWNED AUTOS W ' IPer eccldoMU r, PROPERTY DAMAGE 1 GARAW LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT t AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE 1 OTHER THAN UMBRELLA FORM 0 WORKERS COMPENSATION AND X WC STATU- OTH- I EMPLOYERS'LIABILITY EL EACH ACCIDENT $100,000 B THE PROPRIETOR/ INCL 978 701-1 06/30/97 06/30/98 &DISEASE-POLICY LIMIT $ 500,000 PAMWERS7EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE 0100,000 OTHER DESCRIPTIO OF OPERATIONSILOCATIONSNEHICMISPECIAL rTEMS Workers Compensation for evidence purpose only, \ cep e G�R'!'1FCCRY'E HgGI}fR : � DNCEI:fATION '' •{,• ial SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCIEU ED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Street 3 O DAYS WRITTEN NOTICE TO THE CERTIROATE HOLDER NAMED TO THE LEFT. Mafia St Town Southold BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Southold NY 11971 OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. AUTHORIZE EPRESENTATIVE `.'�pRp 28•�iTt4481 .... '; ,.? `: _ -.ee-.---� -, �? , ®gCORD CD(;t�RAT10M.198H. --------�.•_ BOARD OF HEALTH 3 SETS OF PLANS . rl�ll FORM NO. 1 SURVEY . . . . . . . . . . . . . . . . . . . . TOWN OFSOUTHOLD CHECK . . . . . . . . . . . . . . . . . . . . . ' g BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . TOWN HALL °OUTHOLD, N.Y. 11071 NOTIFY 1 . TEL.: 765-1802 CALL yv;q MAIL TO : Examined . . . . . p . . . . ., 19Approved . . . . . . . . . „ 19//Permit Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l (Build• g pec r) `' APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 19 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,witi 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 stye: or areas, and giving a detailed description of Iayout of property must be drawn on the diagram which is part of this app. 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 peiir 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 Occupan, 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 ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all ap is bile jaws, ordinances, building code, housing code, and regulations, and i admit authorized inspectors on premises andWild �gecessary inspections. � � _ �� _� • .o-�i C (Sigtlature of aQp/li' n nor name, if a corporation) (Mailin addres . .1-?�.V. . . . . . . . . . .' .5�2 p wzylLl,-?G ,��,11.�fiF s of a licant 1 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises �Z ZC3 t1 (as on the tax roll or latest deed) If a ant is a car oration,si nat e of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . --�� (Name and title of corporate officer) Builder's License No. . . .KL. . . . . . . . Plumber's License No. . . . . . . . . . . . . . . I . . . . . . . . . Electrician's License No. . . . . �>f:L. . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .!. �. . . . . . .`.e. l.�_�li,�, . . . . . ''... . . . . . . . . . . . . . . . . . . Yi �Y1O.\A! . . . . . . . . . . . . . . . . . . . . House Number V Streets Iti\Inlet County Tax Map No. 1000 Section . . . . . .. . . . . . . . . . . . Bieck . . . . . . . . . . . . . . . . . . Lot . . '. . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Nlap 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 . . C �! . wti . .`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . , t` t ort w._ . . . . . . . . Utcra�ion . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition " . : . . . . . Other work . . . . . . . . . . . It (Descriptio 4. Estimated Cost .�. t 5 J L) , , Fee . . . . . . . . . . . . . . . . . . . . . . . . (t,o,be paid on Fling this application) 5. If dwelling,number of dwelling units . . C)0, . . . . . . . . Number of tfwclling units on each floor . . . . . . . . . . . . If garage, number of cars . . . . . . . . . . . 6. If business,commercial or mixed occupancy,specify nature and extent of tach type of use . .hS! pE`ffCl{rL 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . , Rear . ..,1,2. . . . . . . . . Depth . Sf3. . . . . . . Height . . .Q. .(P. . . . . . . . Number of Stories . . . . .9 0.C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . .I? .�. . . . . Rear . . -Z a tn_.i. . . Depth . . . . . . .S7. Tom: . . . . . . . Height t t4.'. . . 0 3. ,4 . !kV" Numbcr of Stories . . . .Pule. . . . . . . . . . . 8. Dimensions of entire new construction: Front . . IV. . . ... . . . . . Rear . .( ?. . . . . . . Depth .aey Ot'.4 r r. . . , Height .C ia.4. . . . . . . . . Number of Stories . . . .©N . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . �"�: . . P'l , , . . . . , . Rear . . . . .�~�: . . . . . . . . . . . . . . . Depth gyp . . . • . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . �nI`N" am(e�,of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . .\�/c].. l !. YJ Pi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: .:'.0p .'. . . . . . . . . . . . . . . . . . . . . 13. wIIl lot be regraded . . . � . . . . . . . . will excel fill be re ovctdif�r0 premises: Yep c 14. NameofOwnerofprcmisesC;; 'r:r' .o. �?.�(Y. . . Address b.�i Qjt,c, Z Tone No a..ldoy Name of Architect(-P.J.gh:4W.S, . . . . Address'>1&. k1 _< ai k hone No. . ���.IiSlrl��� f.4.*tl.0 . . . . Address L'` Q� C S_i. rx one Noy 2 l v, . , Name of Contractor . 15 .1s this property lona d within 300 feet of a tidal wetland? *YES . . . .NOY *If yes , Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions fry property lines. Give street and block number or description according to deed, and show street names and indicate whet} interior or corner lot. ST TE O N \V YORK, S.S C TY F . . . . . . . . . . . . . . C t�OC' �� �• . . . . being duly sworn, deposes and says that lie is the applica (Name of individual signing contract) above named. Ile is the . . C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u 2C � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ti application; that all statements contained in this application are true to the best of his knowledge and belief;and that t: work will be performed in the manner set forth in the application filed therewith. Sworn to before me [tris L., . . . . . . . . . . . . . . .���. . . .day of... . . .L 191. Votary Public, . . . . • - . k :�`. t.{ Y1. ✓. . .�: : .: County DENNIS M.DRU"�::9 NOTARY FCaLIC.STyA�T['OF NNW YORK .k'.' . . . . . . . . . . . . . . . . . . . . . . . . No.45C3Laa'�"[ (signature of applicar TERM EYNO.41;._.—d— T. j C) "l( 17.1 co Lou ll� 'cloc-Ij��l N li�: ROM- G El _cx�kYQ'� Y !�l J�ll -XEL­ -TI IT P ?YL -77------ iSIT I tlus� AT;0 - k 5� 0 T MW , A D - kTAD`N `"-JVq, -1 S 9 � �,- -. _ . _. 10112SM UWE AS REQUIRED BY OAIM 714 OF T Ly,STATE guimis co I De. L OCCUPANCY OR USE IS UNLAWF 'WITHOUT CE IFICAM eX "WIN INYOF OCCUPAN ON DOW ptA 7114 IT T 'f �f vein IT I.Vs 6LI , PER "-4 Lgi= #a ft 410111 w 'grg, p" 2. mom. Z' 4 FINAL i T BE ALL CONOTRUCT11011 IT, T, 42, 1 THE REQUIREMENTS OF aN.Y C STKrE CONSTUCTION Na y CODES, NOTRR rz Y, t2 DESIGN On CONSTRUCTION RS CTIO tT ij �Ou%;m um '�A rqf�t ji—�Ai%mLF Tzz� Till A i 11�. .1, �X--,TR 'JM T� T IT q ty ", - ,,,r .. , d., � � '.�: ,� r , . '_ . ' � •_-_-_ �..: : , _: �,...:.�.._ .._. ..._k. a. �_ __ L +P' ����=� � r ' L��: . a. to - � �,u+'t i'i''. s LX T'l 4.1 V,l 7 Tr Is -71 0 TV UA f-w? —co T 1 . 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