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HomeMy WebLinkAbout24172-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25172 Date JULY 31, 1997 THIS CERTIFIES that the building ALTERATION Location of Property 2705 BAY SHORE ROAD GREENPORT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 53 Block 6 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 25, 1997 pursuant to which Building Permit No. 24172-Z dated JUNE 5, 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 ALTERATION TO PORCH ON THE REAR OF AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS TO CONDITIONS OF TOWN TRUSTEES The certificate is issued to WALTER A. WAPPAUS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING - JULY 22, 1997 PLUMBERS CERTIFICATION DATED N/A " Buil ing Inspector Rev. 1/81 YORK 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° 24172 Z Date ............. ................ir................... Permission is hereby granted t///fff111''' //ffes� .....1/........ .. �...... ..�... .:....... ro ,cCt✓. . . . ..... at4.... . .., y .... .......... V...... ...................................................................... .. . ........ .............. ....................... . .. .. at premises located at..... 1.. ..1... ..... .. ................... .... ...LQ /..... .......... County Tax Map No. 1000 Section .... . ...... .... Block ....... ......... Lot No. ....1................. pursuant to application dated ........ ... . . .........®'F.. ...., 19/... and approved by the Building Inspector. Fee $... ....... . ..... .. .. ... .. ... .. .a ..................... Building Inspect Rev. 6/30/80 Form No. 6 l5 TOWN OF SOUTHOLD BUILDING DEPARTMENT JUL2 81997 TOWN HALL 765-1802 B m D;_-PT. 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: 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. e 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 Buildin¢ - $100.00 3. Copy of Certificate of Occupancy - .25�,, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. .p2.7.4.r. . .�3/j�t/dt�„ o ,. _. , ��, (e/✓ /?o2 yam` „ House No. Street Hamlet Onwer or Owners of Property. . . . .i. . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . .5' . . .Block. . . �? . . . . . . . . . .Lot. . . . ./ . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . HealthDept. Approval. . . . . . . .. . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . .: . . . . . . . . . . . . . . . ho. . . . . . . . . . . . . . . . (R-� .53a-2-1 APPLICANT Co 2 d'5)?2- 11',1,11 Illi l'I;1;11111�_II I�1'llll l' IIA I'l: l:Vlll11:111'71 Ill 011lA I-It'll ( I!I'I') t �0 ..x 1111711 PII AI Nay',',A O ri.ul�i1.I nu - ` In •+nn----------nn..nwn nn,n •dn.n.rn nnr nnnnrt nu.nnw.r-.m..n.,r-m n,..rw,..,wr...,n.nv�r..mnnwewrnnr nna..n n.... ,i`�� U _ II wu.uin.• _ ; 1 .!;Ill.n'I'11111 I`Itll 11 , Y . I !I'1 A I I( 1'.111'.111 IY !.11111'. ....n...n.........nn.. ,.m�nnnn II �..,,-,n.�•nnn•.mnn,...,...n r...rn...m..n.n mn nn.. V I IIAI. Ann.... ----------------- -------------- -------------------------- ., --------------------------------- AI1111'PIONAI. .nnnnnn (;(11It 11!11'1'11 : n mnnn.--- .In -Inn...,----n_nnm, ---------nnn..,n-----nn....,------------------------------ �.I 1 -- ' i6•I THE NEW YORK BOARD OFFIRE UNDERWRITERS I' WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE OF COMPLIANCE FOR THE I ELECTRICAL INSTALLATION AS COVERED IN ANA PLICATI NN /�Df BELOW. - APPLICATION NO. G '�✓ / r LOCATION f' INSPECTOR IBD(REVI) kl1 q/� PP AS NOTE a P PAJ s R E 5/ QZAJ6 B.P.# FFF.: ._ .LAY: NIG'I'Ii Y BUIL.,F)ING MPART N'L• T 766-1802 9 AM TO 4 PM FOR THE rOL.LOWING INSPECTIONS: 7. FOUNDATION - TlAfO REQUIRED 0p`'U PA R r.Y 0R FOR POUREI)CONCRETE2. ak •UGH � IS R�Rt�� � UL 3. NLS LATIONIA INC9 S E�LUNI€tlNta °F�'i OUT CERTIFICATE UNDERWRITERS CERTIFICATE 4, F4NAL - CONSTRUCTION MUST OT OCCUPANCY REQUIRED BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALE. MEET HE REQUIREMENTS OF THE NX, >Irr • e — r:i,SGi'T. NOT Fdt:«`ro°39C)NSIBL[ FOR FExIIr.IU OR COI ISTRUCTION ERRORS 4 F7 C 4FD41Z 5 0.4lie i T Fl - ctG an12 5ynkrs � � — 2 ? sck42e=1 1/4 '1 _ '�O .e ,_ _ 1: I NpV�SF ' I ' l 1 1 I UN14r-4Tr- a MICRO IoM �-+ PORCR . 0Erp to erz s \ I ' S�-c) i I i i---------- 27' 4"---------- ------- \/VAPPAus P JQO PO SES tv OR f� s i) Q6nrovG t—Xtsti.vcl 1,0iNDow5 AND tuA1-45 DE P&AcH 2> 1QEPL.gfE w/N/JOw S' e¢N p W*Gt 5 ® +C P® RC N utt7'tf NB4� �(' ILC N13 u� w t nJ 8 0�v S z ' K 4 o��gUFFO�,�Co Albert J. Krupski, President hy. Gy Town Hall John Holzapiel, Vice President o '� 53095 Main Road Jim King W P.O. Box 1179 Martin H. Carrell 41, Southold, New York 11971 Peter Wenzel Telephone Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 30, 1997 Bob Kehl 28595 Main Road Orient, NY 11957 RE: Walter Wappus SCTM x{53-6-1 Dear Mr. . Kehl: The following action was taken by the Southold Town Board of Trustees on Wednesday, May 28, 1997 : RESOLVED that the Southold Town Board of Trustees grants a waiver to reconstruct a 10' X 28' porch using the existing gutter system running into existing drywell system. Located 3995 Kerwin Blvd. , Greenport. Please note the Board of Trustees would like you to cap and close the pipe that is coming out from your bulkhead. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:jmd } W4*,16. zq o c.s 177 �- C� © s;d y,9 t• �t z�, Q LOT 46 ,.. 94 COM- -LIS Y 2�_ _ 100A fine of o / � n 2 the Nrw YorL I'w- L f OT -f7 `� evo:)a> mn c"his survey map not h 3•.',.T + nd surveyor's inseal or not r� � .seed seat shall not be consieeree t a validc aced -:� t !eos ind-�cated hereon shut-, f ( t� V the person for w iom tie s - i [7t4P O / b?O and cit v .4L-T 4 Or > 6�4-0V04,OK5 show" 48, /997- i A�i- 4WK)M, f "Ievy"I sect, Tc v%w or `" 9-T7-,Kx o, N.Y. ZY t S :CIM �� I' vG�J `yt LEIq' 0 °oma 5:fo* Cb6 7aK,t#*Pib 000-05-5 6-f- ear Lot rjptMwv-.5 IAP"Awe"ded9r� 3gee + hi trfnr °� Hew Y° Uwe- �` I" to _. �+ '411" _ 4 o�OSUFFO(,f-�O CO2 x Town Hall, 53095 Main Road p . Fax (516) 765-1823 9y�lpl �� Telephone (516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 11,1997 Walter A. Wappaus 17729 Tree Lawn Dr. Ashton Maryland 20861-3342 Dear Mr. Wappaus: With regard to your inquiry of property improvement we advise the following: 1. Replacement of windows and walls on all three sides of existing enclosed porch. A permit is required. Application fee $75. 2. Replacement of windows in frame house. If you are not changing the structural design (framing) of the window, a permit is not required. If changing the egress window in the bedroom, you are to meet the requirements of emergency egress ( 18" minimum height or width and 4 sq. ft. total) . 3. Construction of shed behind garage. A permit is required. Application fee $35. The enclosed permit application (1) should be completed and notarized by a N.Y. notary. You should provide us with an elevation survey and a drawing of all plans. The expected turnaround for the Building Permit to be issued is approximately three weeks. If you have any further questions, please do not hestitate to call me at 516-765-1802. Sincerly, Southold Building Department Gar7i. F/� ish Building Inspector March 07, 1997 ; 1` MAR 1 1 1997 k BLDG. DEPT. Town of Southold rt�wra of sou'r,ge!cr_- Building Department Town Hall Southold, N.Y. 11971 Re: Information exchange between W. Wappaus and Mr. Fish over procedure for filing building permits. Dear Mr. Fish, In response to our telecon earlier this week I am sending you a recent map of my surveyed property. With regard to your inquiry about the elevation of my property, the survey map does not contain this information. From information contained in my flood policy declaration, my property lies within risk zone A04. As previously stated, I desire to improve my property in three ways. 1. Replacement of deteriorate windows and walls on all three sides•of existing enclosed porch.? 2. Replacement of deteriorated windows in frame house. -- 3. Construction of shed on existing 10' x 12' concrete pad behind existing garage to be attached to existing garage'3.3 Please advise me on how to proceed with the application for the required building permits. I would like to begin the improvement project in late spring 1997. Please advise if this is a realistic expectation in view of your anticipated workload. I can be contacted by telephone on 301-774-7888 or by fax on 301-570-8682. Thank you for your assistance. Sincerely, Walter A. Wappaus 17729 Tree Lawn Drive Ashton, Maryland 20861-3342 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE INSPECTOR \ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FF UNDATION 2ND [ INSULATION [✓] FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY REMARKS: _ IL41z -ri� ok, Lu h . 49k oleo 4C-,t� DATE - G(l 4 INSPECTOR / THE NEW YORK BOARD OF FIRE UNDERWRITERS PArz j. 8066993 BUREAU OF, ELECTRICITY 85 JOHN,STREET, NEW YORK, NY 10038 Date AUCiUIT 05,1997 Application No.on file 1430899719'7 H OSf 3€32 THIS CERTIFIES THAT only the electrical equipment"described below and introduced by the applicant named on the above application number in the premises of WALTER A. WAPPAUS, 2.705 BAYSHORE ROAD GiREENPORT,,'N.Y. in lhefollowinq location; ❑ Basement ® Ist FI. tj 2nd Fl. .Section Block Lot was examined on JULY 31,1997 and found to be in compliance with the National Electrical Code. FIXTURE KEPTACUIS SWITCHES RXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FAN OUTLETS INCANDESCENT FLUCRIESCENi OTHER AMI K W. AMT. K W. AMT KW AMT K.W AMT. H P. 10 4 3 10 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCKS FELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi K.W. OIL ] M.P. "T.GAS H.P AMT NO. A.W.G i. AMP "TAMpS TRANS. AMT N.P NSYSTEMS O.OF FEET AMi WATTS 4 600 SERVICE DISCONNECT NO.OF 1 S E R V I C E AML AMP, Type METER 1 A,tW 1 0 3W 3 R 3W 3l AW NO.OF CC.COND A.W G. NO OF HI-LEG A W C' NO OF NEUiRAlS A.W.G EQUIP. PER a Of CC.CO,, OF HIAEG Of NEUTRAL OTHER APPARATUS: PADDLE FANS-'2 110TORS%2_F H•C' ' WALTER A. WAPPAUS L L 17729 TREE LAWN DRIVE ASHTON, 110, 20861 GENERAL MANAGER 11 Nilb� 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. LINE COPY FOR •BUILDING DEPARTMENT. THIS COPY, 'OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.?e,.,'-, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Daty I:Y1sCF:1'9f31' i +'A!i,1<+"?`/ Application No,on file 111.36n:=t`-?�a'7/ra j' 11' !C"11 :3ti'r,3 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 UA1,Tf-:r% A. VIAPPAO , "-/05 L'IV IftXT PLOIV), ,O1+RSAN'PORT, ffi' in the following location; ❑ Basement 12 1st Ff. ❑ 2nd Ft. .Section Block Lot was examined on °Tuy ''I I 1 1^��a f and found to be in compliance with the National Electrical Code. FIXTURE ECFPTAGLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W AMT K.W MMT. KW. AMT K.W. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMI. K W. Olt H.P. GAS H,P. AMT. NO A.W.G AMT. AMP AMT. AMPS, TRANS. AMT, H PNO.OF SYSTEMFET S AMT. WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E METER NO.OF CC COND A.W G A W.G. A.W G. AMI. AMB TYPE FoUIP 1.0 tW 1 a 3W 3%3W 13.0 AW pER.e' Of CC.COND NO.OF HbIEG Op HI lEG NO.OF NEUTRALS OF NE G. fI .1, 3lO 1 1/0 OTHER APPARATUS: wA,uC)'A, t'IyyAP^PXy.irt}�;�{�y^ ad.— 1... L 1'l"/?I"1 "I�1?Ilhl 6if➢rIRN I)i IVE A"'31-114014, ULA, 20861 GENERAL MANAGER 11 .. _ ib 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. RODERICK VAN TUYL, P.C. c 218 FRONT STREET MAY POET OFFICE BOX 8 GREENPORT, NEW YORK 1 19444 R TO GARY FISH DATE Apr. 28, 1997 SOUTHOLD TOWN BUILDING DEPT TOWN HALL SUBJECT Wappaus survey MAIN ROAD SOUTHOLD NY 11971 Dear Mr. Fish: Walter Wappaus asked me to forward these three prints of his property to you directly. Colin Van Tuyl Reorder Item NML5N72 The Drawing Board,P 0.Box 2944•Harford,CT 001042944 - FOLD AT I-)TO FIT DRAWING BOARD ENVELOPE H EW t OF ®EGI,1982,Printed in DS A. BOARD OF HEALTH �. . . . . . . . . . .: rr FORM NO. 1 3 SETS OF PLANS . . . . .. . . . . . r {{ TOWN OF SOUTHOL D SURV�Y . .�.p./ / BUILDING DEPARTMENT C •. . . . . . . . . . . . . . . . . (' APR Z'5 OT / TOWN HALL SEPTIC FORM . .. .:_2. . . . . . . . . . . . . 946tHOLD; N.Y. 11971 w TEL: 765-1902 . NOTIFY: BLD DE7 rr --JJ(� p a T(eWPf SO�JTiiO CALLA! .7(/. 19. ^nI Examined.. .. .. MAIL T0: JIM. 11tµ.I . . f `tl/t��` CA�,Q ticti,..Y?�.4�..020� 41....... Appnwed.,C� ......, 1 Permrt No. Disapproveda/a ....................:': ''.� a: .................................... t .n .. .......... .... ..� . . i ildiM Inspector) AP CATION FOR BUILDING PERMIT Date. INSTRUCTIONS a. This application must..,be'"yQnpletely 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 t' Mjoining premises or public stn Cs o ' Ras. am giuih " Gb�i{` dls q � .b"f'layout d€LWIRt b r c the diagram which is part of Atin ppl cAtion. `'... o, . 3' i�,^ " T� ', 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 issue 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. APPLICATICN IS IEW" MAZE 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..................................................... (Signature of applicant, or now, if a corporation) ................................................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Afh - . -Ca.ft ...0 5..... 4.w E/'.......................................................................... Name of owner of premises !.t) k c t E K.... .:...W.&P.P.A.0:5............................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. .�. ��.�..�.�..t`!•- Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Loca ti on of land on/which proposed work will be done—71PA*t P.......................e � uJe sYti.lY.:/.....13. ................. Horse Number Street Hamlet Canty Tax Map No. 1000 Section .$.,3......... Block .....4?......... Lot ....t.......... . Subdivisions?A A At !FA14:�"eP........... Filed Map No. . �(.Z ....... 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. Nhuure of work_(check wluiciu aa$icable): New IAuilding .......... Add ption .......... Alteration .......... Ikpwir ....✓....... Removal ..�!�...... Denrd Kion ............ Other Work .................................. (Description), r 4. EsCinlate<1 Cast m®!.p®...... fee ... .. a® 1 (to be paid on filing this application) 5. If rk!elliup,•, number of dwellirig units .....1...... Nlmber of doeiling units on each-floor ................ Ifgarage, amber of cars .... ,................................. 6. If business, comnercial or mixed occupancy, specify nature and extent of each type of use...................... 7. Uinuensuaus of existing sCnuclures, if any: Front....%s r/........ Rear ...". ' ....... Depth ...1*:Q.r......... licifilDepth G . .....�. timber of Stories .�.�1..Z............. / Dimensions of same structure with alterations or additions: Front ...Z?.�....... Rear ....�.?'....... Ilh .......,: ...... Ileiglrl' ... ?:Z.'........... Hnixr of Stories .. L-.... g. Dimensions of entire new construction: Dont ................ Rear ............... DepLh .............. llei Size of lot: LYrxuC -•�'it� i,,': niuer of Stories ..... 9. i............... r (� ..... ....... M IRear' .....3?..........GGDeptlu ....�7.rrrt......... 10. Rafe of Purchase //..a p.l .... Mme of Former Owner M".Y.:..��.'.4/3"FR?:�....4l�C�.'P..P.�N� S II. 7aie or use district in which premises are situated .............................................................. 12. Does proposed construction violre any zoning law, ordinance or regulation: .....N,t?............. g •.... `......... Will excess fill be removed frac premises: YES PD 13. Will lot' he regraded {�tl, G d7nd? 7"R� a41ftW CR• 3s / 14. Hanes of. Owner of premisea��'L� �..9�. �•��faf(�/. Ackireas ,Q.$.!i•:�,Alr I1�0-.'ZO•$•6vf• Prone No.7.14.r%788f,t• Mime of Architect ........ _. .. ... Address ....... Vane No. ...........1.. (.ar2ca i g...� property O� r/L.Lkt.L:d✓Yj..r.�tC Address .42/,111 711�..[1�. .....Phone Na. 3Z3-. ...... 15. s thHame is prope ty witbi 7� 71e4 of a tidal Yaetiand? * YRS .......... R) ...!!''... * ' S`IM9 PEAMrr N&Y RI: "it". r PLOT DIAGRAM I Locate clearly and distinctly a l bur (I ags, whether existing or proposed, sad indicate all set-back dimensions from properly lines. Give street and block ruduer or description according to deed, and show street names and indicate urhether interior or corner lot. I --r o w N op S o Li r j4-0 L iZ_--- hY PECo1VIG ( r N LUT 4¢ Iisr/ � h� Q I `� 18A y � N J {"krSY"11l/CI 7, A M� Q' Its_ (=7t15T/N _ — il`XIS-1�'IN1 I r'r Y. + r o A-Ra�E' ' loq.7.11a r-d' i. ro 1 _._..J � l• �- N S46° 09 ,tu Ru,i20kTt)Lr p7 4' ;iI'RIP. (Ar N1J Y(NtK, �'i ( XdL t •• .13 b ..................being duly sworn, deposes and says that he is the, applicant: (Hhue of individual. signing crntracl) above pined, t ,'.�l'. „n '�•.�;'�1 )�. I . , a*.l'•,. . � , ih•>�i.. lie is Lhle .. (Cintractor, agent;-triieliorate <officer,.el)ct)''�. , ,..'.'.�1'�...........ti�'.,.. ��'•�,. �.', y.�`;'� '1 of said ager or carers, aril is duly au�lhorized to Ix:rfonn or hale perforned the said work sad to make and file Lhis application; Lhat: all statements coAtaiind in this appl,ecation are !nue to Lli6 liYthL of his knowledge and Ix HeN, alxl that the work will be perf•Pnned in the 'numul aet,,forth in thea tication files,,41 rcwjdi.. r• .! h+ ' •t..y q. PR Sworn tobeforeme this o J ..day of .... I'....19.rZ�.... Pk Lary Public lQYBE M.WILK�N� (Sigruature of Applicant) , (/ Notary Public,State ofNeWYIp No. 4952246,Suffolk Cou�� Term Expir"June 12,78