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Home My WebLink About24576-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26244 Date: 01/28/99 THIS CERTIFIES that the building ALTERATION RENOVATION Location of Property: CENTRAL AVE FISHERS ISLAND (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 6 Block 4 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 19, 1997 pursuant to which Building Permit No. 24576-Z dated DECEMBER 23, 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 & RENOVATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DAVID C. & MARIA W. PATTERSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N474765 12/18/98 PLUMBERS CERTIFICATION DATED 07/03/98 ROBERT E. WALL 4 - -. ' 1 111B"111B "Xg Inspector 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) DECEMBER 23 47 Date.............................................................. 19... 24576 ........ Z Permission Is hereby granted to: HAROLD' S ...I.............................................................................. P.O.HOX 661 ........................................................... FISHERS ISLAND,NY 06390 ................. ............................ to ......T. .....O A.LTER. . . ...AND. . ...RENOVATE. . AN EXISTING SINGLE FAMILY DWELLING AS . .. . .. . .. .. . .. .. . .. . APPLIED FOR ...................................................................................................................................................... .................................................................................................................................................................. ............ ... ............................................................................................................................................ ............................... at premises located at...............................CENTRAL AVE FISHERS ISLAND ......................... ........... . ...... ............................... CpuntyTax Map No. ....473889 Section ..,006............. Block .....0004........ Lot No. .0.0.4............... pursuant to application dated ....NOVEMBER......1. .................. 9 ...... 19......97...., and approved by the . ... . .. Building Inspector. Fee 5........x.5.:��,.... .... ...,. ,. ....................................... Building Inspector Rev. 6/30/80 Form No. 6 .1AN 2 6 lr�q i.. �.�,,,� TOWN OF SOUTHOLD BlpO T._.� BUILDING DEPARTMENT TOWN OFGtDE HO 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: I. 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. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 lead. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer `qq responsible for the building, 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 Occu anc � - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwellin $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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . .�. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4ew Construction. . . . . .. . . . . Old Or Pre-existing Building.. . . . . . . . . vocation of Property. . . . . . . . . . . . . . . . . . . . . . .C�� . AVS: . . . . . . . . House No. n Street n Hamlet )nwer or Owners of Proper ty..M'e. .� IDMPS.•,JAVID f'�fl-��TIfFeSON ''rr� ;ounty Tax Map No 1000, Section. , d((p . . . . . .Block. .P QO 7. . . . . . .Lot. . . .CQ.7. . . . . . . . . . . . . ;ubdivision. . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . .Filed Map, . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 'ermit No.�y.Jr. 76. .4 . .Date Of Permit.41.Q.3Ig4 . . . .Applicant:?pg•)N,.5/,f1'(..Y_ fealth Dept. Approval . . . . ./. . . . . . . . . . . . . . . .Underwriters Approval. . . . . ? . .Z.(f.� lr . . . . . . . . . 'lanning Board Approval. . . . . ��. . . . . . . . . . . . . . request for: Temporary Certificate. . . . . . . . . . . Final Certicate.. . . . . . 'ee Submitted: $. . . . .. . . . . . . . . . . . . . . . . . aoA,5�7 . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . • Abm tn..«.. INSPECTORS � gOrfi3(� G SCOTT L. HARRIS, Supervisor : . -4 CM Thomas Fisher W ' '' Southold Town Hall BuildingIns �, �` P.O.Box 1179,53095 Main Road Inspector ca`o Southold, New York 11971 Gary Fish, !IS a''t Fax (516) 765-1823 Building Inspector Telephone(516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I O N / DATE: 1-319, J Building Permit No. o?1 576 Z- Owner:M/M �AVib J?Aup'soff (please Plumber: � 6��;- (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1X lead. (Plumbers Signature) Sworn to before me this day of 19 Notary Public, County \ Notary Public E!LEEN G. WALL NOTARY PUBLIC, NEW YORK STATE NO. 01 W A9509135 QUALIFIED IN 8W:r'):-K COUNTY 1kRVi, FXPIRr':. „ r 1000918 THE NEW YORK BOARD O;F FIRE UNDERWRITERS r ��G °1: ` BUIjEAU OF ELECTRICITY I ` AO FULTON STREET, NEW Y�O�RK,`NY't10033 nate DECEkT6ER'..18,1998 Apphcadion Yo on fide 16355398/9$ .X74765 THIS CERTIFIES THAT', only,the electrical equipment as described below and dnryoduaed by dhe appJFcant nam8rd on the apye application numbpr�s m tjae,premeses Pf DAVID PATTERSON, PATTERSON', FISHERS ISLAND, in the following location; ElBasement ®.est F& `, ti ' Section'- Bdock' Loi was esamined on DECEMBER„15,1998 aP!dfoupd to be,in compliptice wittyeh Nattonbl Electric 1 Code ., g FIXTURERECEPTACLF9 SWITCHES "FI TURES .. RANGES COOKING OECKS is O ENS 1z DISH WASHERS EXHAUST FANS' ” OUTLETS, INCANDESCENT FLUORESCENT OTNER•. :AMT, 1, I AMT. 1'"AMT.-, ..:K-V✓'..i,AMT,.III:.-K.W ;, ,.AMT:' ,,,HR.' DRYERS FURNACE VOTORS: I FUTUR0`APPLIANCE Fk DERS SPECIITL��{E41PT TIME CLACKS BELL UNIT REATERs MULTI•CUTLET DIM BYSTEM3 ,AMT, K.W. OIL H.P. 6A9' H,P. AMi ; .: NOji 9.W Pr AMi. „AMP AMiAMPS TRANS AMT P NO;:OFFEET, „AMi WAiTe, --SERVICE DISCONNECT MEi e S `. p E '' R '„V , . 'l, :, AMT. AMP. TYPE EQUIP. 10 EW Iviw J02W 00 eW NOi OPERY ND„0'.OF CC 6 B” N0t0F,k1 Q OiN Ea ” N9 OFAEUi"u t`OA 1 M R; U OTHER APPARATUS;' : : G.F.C.I:-6 , SMO KEDETECTOR:-4 - ` i WALL ROBERT E:' ALPINE AVE ;. ` rL- FISHERS ISLAND, NY05390 0595LA”" MANA R ,; Per^ This certificate must not.be altered In•`pny manner; return to the'elRczi of the Spard li Inoo�rect Inspectors may be�[do I Oetl by Try Ir ctedent101s `.' From FISHERS ISLAND WATER WORKS 516 7887011 Dec.22. 1998 09:49 RM P02 T6!j-1802 BUILDING DEPT. INSPECTION 11 I FOUNDATION IST I &1ROUGH PLBQ. j FOUNDATION 2ND NMSULATION [ij�- RAMING [c� PIAL REMARKS: ,...[p./ DATE-.4 c,/O - -1NSPECTORA06& i; 0 w R D FEB 2 0 10 i 8406.DE PX of so � I I t ---------- it \ I Ij ------------------------------------- I, ------- ----- ---- ------------ ---- ----- -- - - - -- ---- i' l II�'I CY FSuC � Alh CL _ � �d � hALL f C COOK P.0 BOX 661 FISHERS ISLAND N.Y. 06390 igA%OIOLD'S 516-788-5550 FAX 516-788.5549 HAROLD'S E(�'14, 8MG �_PO BOX 661 FISHERS ISLAND,NY 06390 '% 1 0 1997516-788-550FAX 516-788-5549 WDEPT CELL 860-908-2296 "j MR. GARY FISH December 8, 1997 BUILDING DEPARTMENT TOWN OF SOUTHOLD DEAR GARY; IN RESPONSE TO THE PATTERSON JOB, I HOPE THESE ARE SATISFACTORY. SINCERELY, HAROLD Y.S. Ll�L LL F"-O Loi O LOMP 1-I4'0d' COPC "n HAROLD'S 516-788-5550 FAX 516-788-5549 p h Flet PC Tz-00 A/'I A 'L j..., LV.-r.111 W,,,law MD'J I Liv I IV G Rm- L n 1\4 d, �Sc,Al Z NEW HEADER 2(2•x 10'j W!112'PLY BWTN - FOR STAIR OPENING + 1 N x+'13.c MEW STAIRWAYPoe f f { x IQ / Ln k � OPEN TO BELOW -- _ `- -- --- - ` } IF • 3 - + MEW HEADERn y— 112-1 WIPLY 4r } BTWV FOR STAIR OPENWG I - f il i - � r-� i 11 I f {_��• �� I I � � � �-- = EXIST JOISTS I I t II I II II II t{ ; ; o I I , CL U\ u Ll Ll d Ll U [I L yt i 1 � -- -- DEMOLISH EXISTING WALL NOTE-EXIST CIBtJNG :- - JOISTS ARE fl&L 2"X 1c - tElll!tX)Mi&TNtMON -- ----- t ,= STAIR STI4JCTUW30 WMr 22M SITAff ro l(MC MY IM14 HEADER M,9 tP 7271223 • � FAX(212)675 59''9 - JOISTSCOWACM-A"TECT ALI WGWSMSEMED BOARD OF HEALTH . . . . • • . . . (� FORM NO. 1 3 SETS OF PLANS D U TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . 1A�� BUILDING DEPARTMENT CHECK NOV 9 qo( TOWN HALL SEPTIC • •FORIN _ . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 BLDG. DEPT TEL.: 765-1802 tt D I F Y ; TOWNOFSOUCALL • • • • • . . :xamine . . . . . . !! MAIL TO : 1pproved . . . . ��J�d�:3 . . . 191"..Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )isapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` . . . . . r. . . . . . . . . . ` ��'I pector)APPLICATBUILDING PERMIT ryry Date Na I� . . . . . . . ., 19�T INSTRUCTIONS isa. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 all 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 all 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 ;ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or -gulations, for the construction of buildings, additions or alterations, or for rem0v 1 n, as herein described. .e applicant agrees to comply with all applicable laws, ordinances, building cod s g e, nd regulations, and to mit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or n , if a corporation) ��1 a�'�� ► :�0,. .L�.4la('.�?�i�.l. . .�f5�f£�P..�s l5�klw/f n/ . . . . . (Mailing address of applicant) 1A 4A VAG ate whet ant*owner, lessee, t, Mt, engineer, general contractor, electrician, plumber or builder. LCdel 11�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . tas on the tax roll or latest deed) applicantqmwswlr&i ySuthorized officer.* Namnd . . . . e � tit t.'o (icer • Builder's`License 111o. _ • • • • . • . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . `. . ... Pr,-.., , , , , Location of land on which proposed work will be done. . House Number Street Hamlet County Tax Map No. 1000 Section . OCX�'W. . . . , . . Block . `I. . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . . . . Subdivision . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . Filed Map Nc. Lot (Name) � . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . State existing use and occupancy of premises and intended use and occupancy of proposed construction, l a. Existing use and occupancy b. Intended use and occupancy . . :. . . . . . :�/:'. . . . . . . . . . . . Repair , Removal New Building . . . . . . . . . . ton ;,t. 3. Nature of work (check which Addition . . . . . . . . .�t iklt�at�orl,]. , • • . • . . moval . . . . . . . . . . . . . Demolition . . . . . . . . , 'Other Work SEF �� 1 , .� 1 P.�. . . . . . . > i ! (Descripii' n 4. Estimated Cost . . . . , Fee . . . . . . . ... i (to be pai� onifilin&•this.applient4) g, r�g units . . . . . . . . , Number of dwelling units on each.f}oor' . .•: ; ; "7 S. If dwellin number of dwelli Ifgarage, number of cars . . .'L . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of-each type of use . . . . . , . . , • • • . , , , , , , , , 7. Dimensions of existing structures, if any: Front . .. . . . . . . . . . Rear . . . Depth . Height . . . . . . . . . . . . . . . Ntjmber of Stories . . . . . , . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Rear . Depth . . Height . Number of Stories , . • • • 8. Dimensions of entire new construction: Front . Rear . . . . . . . . . . . . . . . Depth Height . . . . . . . . . . . . . . . Number of Stories . . . . ; . . . . . . . . . . 9. Size of lot: Frdrt . . . . . . . . . . . . . . . . . . .,I . . Rear . . . . . . . .. . . . . . . . . . , . . . • ept4 . . . . . . . . . . . . . . , . . . . . . . 10. Data of Purchase ,', , • Name of Former Owner p/e, X?/,J/V.'5. . ..44e 4,.4 11. Zone or use district in which premises are situated . 12. Does proposed construction viplate any zoning law, ordinance or regulation: . ,/.VQ, , 13, Will lot be regraded ,. . . . . . Q . . . . . . . . . . . . . . . . . . Will excess f111Arc moved from premises: Yes No 14. Name of Owner of premises >�M,.�AAD. Fye5W.. Addressao t�7 r , Phone Noa!�. Name of Architect Q/L.1(Q CoP Q ,Address N r rY .'egprQ, , , , , Phone Name of Contractor fh?pLp,!!1~'tx�K _4 f o GG . . . . . . . . . . Address FmiAS,rIa4. Pfy, ,Phone No,5J&. . 15. Is this Ifrope ty withld ''300 feet 0`f.a, tidal 'wetland? *Yes. . . . . . . . No. . . . . . . . . Y :Town Trustees Permit may. be required. PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. �1A--fUV'-ff C)P woP-K 3 1NSj-,I LL 3 '/Vr_k! LX7-r-g402 kGSN�OIn/S .U,06ATF Fik AIAP—M 5\/S. E-� . 1N57??l L ! SN�w�ae ��xl�t 61V4 IN ek/S 7N6, 34 FI, , 6A--fXM' y A►110YEDAANO= !Z 1 E: �`V Noy" out"* 'Now f 70548a 0 AM V i"M No 11Nt OCCUPANCY OR ' + USE IS UNLAWFUL WITHOUT CERTIFICATE 4• FINAAL-CCONSMUCTION MUST'. OF OCCUPANCY ALL CONSTRUCTION ONST�RUCTONC$HALL MEET THE REQUIREMENTS .OF THE N.Y. STATE CONSTRUCTION dt ENERGY CODES. NOT RESPONSIBLE FOR COUNTY OF . . . . STATE OF NEW YORK, $ S DESIGN OR CONSTRUCTION ERRORS . . . . . . . . . . . . . • . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ie is the . . . . . . . . . . . . . . . . . . . 1�G7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly! authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the :ork will be performed in the manner set forth in the application filed therewith. ,worn to before an s G . . . . . . .. 19�� otary Pu . . . . '. . . . . . . . ... . . . . . County THOMAb F,15014k TY in ' Notary Public State of New York nat of No.4606559 (Signat applicant) ) 0uapfiea in Suffolk Co tyl. To Expires 12x31/ ! _ . BOARD OF HEALTH FORM 1 SETS OF PLANS TOWN OFSOUTHOLD SURVEY . . . . . . : : : : : : : : : : : nth BUILDING DEPARTMENT CIIECR An TOWN HALL serrlC Foaa . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 BLDG. DEPT. id " .. , TEL.: 765-1802 rraTIPY ; W FS UTH D CALL Examined . . . . . . . . . . . . . . . .. 1J . . . .. NAIL TO ; • . • . • . • • . Approved . . . . . . . . . . . . . . . .. 19 . . . Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT / Date : . .? . . . . . ., 19/.q � 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 stieets 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 demoh ' n, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cod de, a d regulations, and to admit authorized inspectors on premises and in building for necessary inspectio . . . . . . . . . . . . . . . . . . . . (Signa U a t name, i corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66w4 lid . i{��J�I7 f1c�77Z3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . Name of owner of premises . .l�i ... . �. .1�P '. � . . . iq?lJ PP�C)Q� . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . cpjg ,wl. . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . o . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C� n?��. A .rr� >�sH►F . .l.�t moo. . . . . . . . . .: House Number Street Hamlet County Tax Map No. 1000 Section . . . :d0�?f!�Q . . . . Block 7 • • , , , . ,, Lot ./. . . . . . . . . . . . . . . Subdivision . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . :. . . . . Filed Map No. 'Lot . . . . . . . . . . . . . . . (Name) 2: State existing use and occupancy of premises and intended use and occupancy 'o-f proposed construction: a. Existing use and occupancy . . . �!l:r . . . :�sSl/� ✓/v/C� . . .: ::: .. . . . . . . . .. :. . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . 5 ... . . . . . . . . . . . . . . .,' ; . . . . . . ( Re 'I l'; �,.,, . ` Repair applicable): New Building . . . . . . . . . . Addition . .§ . .;r .`' A{ate'ra ion 3. Nature of work check which oval . Demolition • , , , , �-'Ether Work . 4. Estimated Cost . . . . . . . . . ©;d0 Fee . . . . . . . . , �� lal>it I 6� (Description) :`. . . . . . . . . . . . . . . . . . . . . (to be al garage, . . . . . . Number of dwelling unit' n �n hlin n'�s appl cation): S. If dwelling,number of dwellin ' g units . . . . . . . �. „ °. , If ara a number of cars g $ door . . :. . . . . .. . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , , , , , , , , , , , , , , ,7. Height : .Dimensions of exis . . . . r to eS,if any: Front . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Dimensions of same structure �i h alterations or additio Rear of existing structures, ber of Depth . . . . . ns: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . Height . . . . . . . , . . . , . , . , Number of Stories . 8. Dimensions of entire new construction: Front . Rear . � . . . . . . . . . ' . . . . .Height . . . . . . . . . . . . . . . Nurpber of Stories . . . . ... . . . . . . . . . Depth . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . .. . . Rear . . . . . . . . . . . . . . . . . . . .Depth . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . * I ' . . . . . Name of Former Owner 5f,, >�rs,�.4'Al ' * . . . . * * ' 11. Zone or use district in which pmises are situate . . . . . . . . ' ' . ' ' ' • Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . .Will excess fill be removed from premises: Yes No 14. Name of Owner of premisesHlN'¢AUrr� e' 6FP,"W. . . Address14.1 6- t iAp Phone No.�L�';!{ �_ y�� Name of Architect 7.«,0.E( f'19 . . p . -3aw„aasr surre�w Name of Contractor . t7 `n;,CQeQ(L Address y��y, . ,t00-00. . . . Phone No.Wf .-jelf:Aah1T, 15. Is this • • • •Address . . . , ,Ssltu?s fsF9u0My Phone No.�(F:: } f; , property within 300 feet of a tidal wetland? *Yes, , , , , , , . No, . .✓. , , , , *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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 43 Amir �/5_76 � C-a.10VA-VOM 7o. 6 ""Fi-Odf. /3A-7XR-06M STATE OF NEW YORK, COUNTY OF . . . . S. • • • • • • • • • • • • ' . . .Cp.�IL . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. le is the . . ., . /�l7J�1�;e' ✓L (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ,fork will be performed in the manner sot forth in the application filed therewith. .worn to before me his . . . . . .day of./.,'`f�?: 1979 `otary Public, . w, Count EILEEN Q. WALL 'NOTARY PUBLIC, NEW YORK $TATE , NO. 01WA9509185 Y . . . . . . . . . . . . . pp. . . . . TERM EXPIRES OCTOBER. 01N19��' (Si ature of applicant)