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HomeMy WebLinkAbout23322-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24774 Date DECEMBER 5, 1996 THIS CERTIFIES that the building ACCESSORY Location of Property 9202 BRIDGE LANE EXTENSION CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 73 Block 2 Lot 3.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 27, 1992 pursuant to which Building Permit No. 23322-Z dated MARCH 20, 1996 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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to SHARON LI & ROLAND NEUMANN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-280755 - JUNE 23, 1993 PLUMBERS CERTIFICATION DATED N/A B lding Inspector Rev. 1/81 I 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) 9 Date.............. ..............:.. .............. N-0 23322 Z Permisslon Is hereby gr ed to: ... ............................................. to .......... ... ' , rt ✓�.. . . ......... .. ...r.J i' ............ .............. ................ .. .............. ... ......... . „ at premises located at.........�/ ;�.�.............. J ! ` �?-•Pi. ................. .................................................................. T 2 County Tax Map No. 1000 Sectlon .............2.3... Block...............6..�Lot No. ..... .. ...PJ... pursuant to application dated .......................... .. .a..sT...., 19..<.... and approved by the Bullding Inspector Fee $... � ......... Ae� ............ . . ...........I............,...g......:.....,.... .................. P�-�-/�' Buildln Inspector Rev. 6/30/80 •� i FORM 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) N 21054 Z Date ......©..�.... ,...... .7.......... ., Permission is hereby granted to: ................................................................................ to .. t ... .... E . ....................`J�<re .. cc .1F.? ?C1 .......�........ ........................ ... 01 at premises located at 9,c�A.mN..... i...( !S+i... ..... County Tax Map No. 1000 Section .....0-12....... Block .....q...A ....... Lot No. ..... .,.�...t... pursuant to application dated ....sem. .t.?1-Q!-�+► ....z1.............. 19AA-1 and approved by the Building Inspector. Fee S• :. •••.•.• ,cc�Ut Building Inspector i Rev. 6/30/80 QerK ly9 Form No. 6 / 7 1�,621Yw✓J° 1 TOWN OF SOUTHOLD 07 S/ y BUILDING DEPARTMENT TOWN HALL 765-1802 f S 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. 3. t 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. 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 Building - $100.00 3. Copy of Certificate of Occupancy - .25C 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15. 0, Commercial $15.00 Date . . . . . . .I. !.�! ,! ,I. �. . . . . . . . . . . . . . :. . . . . . few Construction. . . Old Old Or P e-existing Building. . . . . . . . . . . . . . ,ocation of Property. . . 4 �C'2 . . . . Y. .. . . . . . . .:Aw... . . . . . . , ,.0 (C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. StreRet Hamlet! AINI )nwer or Owners of Property. . .�:1. ��. . ,Ll . . . . . ./�! . . , ,N... . . . . . . ./� :ounty Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot nn. . . . . . . . . . . . . . . . . . . . . . 'ermit No. �3 3Z2-...L.�..Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . �(� 'U� ` . . . . . . . . . . . . . . . lealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . TanningBoard Approval. . . . . . . . . . . . . . . . . . . . . . . . lequest for: Temporary CCertificate. . . . . . . . . . . Final Certicate. . X . . . . . . 'ee Submitted : $. . . . . .`.�. . . . . . . . . . . . . . . . q--Dc-° �a�a� - ` . . . . . . . . . . . . . . . . . . . . . . . . . . . co �� I'l�i6 APPLICANT �0Lf-) 3 )2- a1o5L -2 R THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 F BUREAU OF ELECTRICITY I 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date JUNE 23,19.93 Application No.onfile 0464OB91/93 N 280757 THIS CERTIFIES THAT Ionly the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of § ROLAND NEURAN , BRIDGE LANE , CUTCHOGUE , N. Y. d inthefollowinglocation• ❑ Baement GAR/OU'P t, ❑ /st Fl. ❑ 2nd F(. .Section Block Lot was examined on J UNt 18 ,19'93 and found to be in compliance with the requirements of this Board. FIXTURE ECEP7ACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCE Tj FLUORESCENT OTHER AMT. N W AMT K.W AMi NW. AMi K W PMi H P 3 19 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 PMT AMPS TRANS. AMT H.P. NO.OF FEET AMT WAiiS a SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER L�,4W ,S.3W 3 d�W 3,e'4W NO.OF CC.COND A.W G NO OF HI LEG A.W.C' NO OF NEUTRALS A.W.G. EQUIP. PER% OF CC.COND I OF HI LEG OF NEUTRAL OTHER APPARATUS: LL" LANDSCAPE LIGN1'ING-1. G.F.C.It-1 8 i ^ SABAT ELECTRIC LTC, ##209'E 50 PAT LANE HATrITUCK, NY, 11.952 GENERAL 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 1195197 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 4 Date JUNE 23,1.993 Application No.onfile 04640'793193 N 280155 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 r NEUMAN , BRIDGE LAME , CUTCHOGUE , N.Y. in thefollowinR location• ❑ Basement ❑ Ist Fl. 11 2nd F1. GAR/OUP .Section Block Lot a l ws examined on JUNE; 113 ,19 93 and found to be in compliance with the requirements of this Board. FIXTURE EGEPTAGLE$ SWS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ITCHE OUTLETS INCANDESCE Tj FLUORESCENT I OTHER AMT K.W. AMT. K.W T. K.W AMT. K.W. AMT. H P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTI TIME CLOCKS I BELL UNIT HEATER$ MULTI-OUTLET DIMMERS OIL I H.P. I GAS H.P. WT 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 I C E AMT. AMP TYPE METER 1 0 tW 1 0 3W 3 H 3W 3 S,AW NO.OF CC COND A.W G. NO OF HI LEG A.W.G. NO.OF NEUTRALS A.W�' EQUIP. PER.e OF CC.COND. OF HI LEG OF NEUTRAL OTHER APPARATUS: have frequent Centland or repairs made by a qualified person. "s 1 5AF3AT ELECTRIC LT.C .#4204 E 50 PAT LANE MATTITUCK, NY, 11952 GENERAL 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ✓� ' THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1195191 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 y Date JUNE 23r 1993 Application No,on file 04640'793193 N 280755 . r THIS CERTIFIES THAT 3 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of NEUMAN , BRIDGE LANE , CUTCHOGUE, N.Y. in thefollowing location; ❑ BasementGAVOUT ❑ Ist FL ❑ 2nd Fl. .Section Black Lot wasexaminedon JUNE 1.8,1993 andfound to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 't RECEPTACLES SWITCHES OUTLETS INCANDESCENT FLUORESCENT I OTHER MAT. K W. I AMT. K.W AMT I K.W PMT. K.W. AMT. H P 2 1 2 2 R }, DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS $r AMT. K.W. OIL H.P. GAS H.P. AMT NO. A.W.G. AMT AMP AMi AMPS TRANS. AMT H.P. NO. FEET qMT. whirs T g R SERVICE DISCONNECT NO,OF S E R V 1 C E AMT, AMP. TYPE METER 10 2W 1 0 3W 3%3W 3,0 4W NO OF CC COND A.W G NO OF MbLEG A'�`''G' NO OF NEUTRALS A'W.G. EQUIP. PER 0 OF CC.COND. OF HbLEG OF NEUTRAL a OTHER APPARATUS: K SWIMMING POOL -1. TIME CLOCKS-ARP.40--1 G.F.C, I-1 MOTOR8; 1--1.5 H.P. rl-F H.P. *(SWIMMING POOL) This certificate c-overs compliance at the date of inspection ouiy. Because of unusual environments it is advisable to <<< Continued on Page 2 ra> GENERAL MANAGER Per i 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. 1 C:di•iLNTC m 1• N4 .. W -a Pip OUNDATION ( 1st) N OUNDATION ( 2nd ) I o r OUCH FRAME Id •PLUMBING N En R. H� n q'' NSULATION PER N . Y. STATE ENERGY CODE .✓t-^ r FINAL w t ADDITIONAL COMMEN S : � • m IY x R� 9 • H O m o i t m ^V H �REcI.sT �T�' puMP { FIiTtQ COF'•4r6 A�,To,,,.ATI� ly:..F-,LT�o GENE-RAL NC) SURMCt SrIMMLY2' S R�.TVAL LIVE 1. P1PIL3C. 116 SMOWN �� ��nO�R Cop�AST a11hLL Ee P7LlGTN' SClib}q ATIGALIY AVO C ) fu L WISP.: L / O 1"l ET 2.RCI CS, OTHa K�Rk'JR-n C. OR E4'JAl PITnU 4'/='T�Q NFpRC1UC� SHnLL 9 _ CARS L`RI`^1`-DIATC E bDFORMto Z ALL BARS ISHALL LAP GRADC tSILLGT SIP 1 G'wG-TILE(\' A MIU- op C f�-W.lu CPJ.IU �I.�RG WO J.t bRA1�SIGu 1i GA6tD OIJ A 4A"UV hp FG DIVIUG .i3on1e.0 ® GRouuD WA IL WITM LOSS THAu 101. GILT. I Tte SHALL L-xIST WI .__--_ COPTIONAl) coj G.r�peST <M ,.+ LIMITg Op r At EXGVAT O TFIw THE- ___, Cour. eouo ygµl 4 No SURCHAR[;E CUtr TO ) N. t -'Ft! MLRBLt --- ALL ARpwo - --SHLLL -ETUST-WI ADDITIouAI LOAD p�p7 b.nbT FIu15N� Tltp 12• o.0 OR `,O• THIU " _-p OF TNt ,HALL04 ,WALK .�l %e " THL-- DCtP o<T,a Ay I J� aHnu owD S FRc�zuG musm MTHtrt SPT wv xy Rub PLAT t C YYPYCl�L) { � 4' bC P)�u0 C>SO'C G.NALKS TO 66 sMODtTI 1 OM•.IC. Tb-+ACP FRt_r= O.C. T`(PE aLOPL-o AWAYti1PCRVIouS, unu- ' 1/4 IUCH Pftp- ��^ FROM rAL POOL AT � R OVTAL S CoPr�ouAL) FITTUG s )rw e ro 7 ALLMHM� h �+AT RlftM Co CRtTr_(GuulTc) �- bct 3421.'t'O,C. THAu a c�EVT N tm.'A, SYJMMM P�O (>3=0• Ya GAL%. PL-Q OT GRtnTb 6 rt 34!6"o.C. ) MIK To IS@ Put• F'ACTrTO 4` C THE Fo?R. uUOGRW R Rnaw VPRIpubes`-'Al To 1RRIGAT\�r,� coati'nwC-D LILHT 4^To 24' out�Q SLAa U C)WL P4cp��TY. (.'i�TIOWy MA... SNAILow EW12"O.C. 9 WATL�R Xf SAN 25^ To S=o• ou+ o{_McAH WAy PPLY liY oW't�s GAQa bi.CP Evb C=wulu ADTA.OtuT s kkU. 15.4c E CRADe OR V O uR.t3 A3 RED. PILL GQ—M EAC.E6D5 0=0" Putu ATCALLY WALL 5_ ECS TIC�1J �pPLlcn co�ceerc SMALL k- nc usaa ao 3<Alt• 12.TH6 R-n 1, CAPAsl6 OF t>t TYPICAL S -noW STP{ 1tUl GAI ACITY WITHIL�j2 % ,o 1 C SIRE A C C D E F G ARH. fAwc.ITY O I C.� � - TUQI.)Wt�l+ RATE �- FLOURS <—fILTt1;, PUMP P�UR'.cU�TIUN RATE� GA.I�b{I/]. ( TiJMP FILTRATION RATE -� GAL�MIU '/c• �UTCHIM F-IITtrR AREA .� IY+L F-T.�_—_.__.._.____ � rECT Hons-Joochim Dottke (516)288-4267 President MAy ➢RAv.. POOLS BY HANS, INC. MGMER POOLS AND SPAS em " - 96 North quarter Road N11,11 _ Westhompton,N.Y.11977 ii INNER ;im A -�sss.r H Z Town Hall, 53095 Main Road `gyp Fax (516) 765-1823 Southold, New York 911971 y�o� ���� Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD February 6 , 1996 Mr. Roland Neumann & Sharon Li P.O. Box 149 Clinton Corners, NY 12514 Re: Building Permit #21054-Z Premises : 9202 Bridge Lane, Cutchogue Suff. Co. Tax Map #1000-73-2-3 . 1 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284 , it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. 0-1802 UILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUL [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: _R4 �. DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE S CHIMNEY REMARKS: DATE INSPECTOR. TSS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [ ] // FRAMING [,1NAL REMARKS: - I DATE I t 19 INSPECTOR FORMN0. 1 BOARD OF HEALTH . . . . . . . . . SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CIIECK . .'. . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORK . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t76T1FY Examined CALL . . . . . . . . . . . . . . . . . . . NAIL TO : '%PProved .4?�r�vQls`- d 19R4 . Permit No. . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . ... 3.2-2 . . . . . . . . . . . . . . . . . . . . (Building Inspector) 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, with 3 ats 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appH- ation. 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 `tall 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 :call 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code; and regulations, and to imit authorized inspectors on premises and in building for necessary inspections. -- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . 9-/n n C� u-V �4t\t-)C� . c l' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;ame of owner of premises . . . �?` ^`� yqk- �•'�' t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. -� PFS . •CCCfX11 KJ�.! . . . . . . . . . . . . .L ?I (Name and title of corporate Officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. ./I� f� . . . . . . . . . frfti-S Location of land on which proposed work will be done. . . . . . K'`t ° . .` . . &� , . . . . �Qd .finP-e- .tc . . . .� �. . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . . Block . . .c... . . . . . . . . . . . Lot . . .,. . .{. . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . (N.ame. . .). . . . . . . . . . . . . . . . Filed Nlap'No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . State existing use and occupancy of pretfises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . -mL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . . . . Arv!t�lnh!? 7. , • , �� , 3• Nature of workcheck which applicable):pplicable): New Building . . . . . . . . , . Addition . ; . . . . . . . . � teration Repair 11 • • • • • • • • . . . . . . Removal . . . . . . . . . . . . . . Demolition i . . . Other 4. Estimated Cost . . .� (Description) .� LSF • paid on filing this application) 5• If dwelling, number of dwelling units • , , , , , , • , If garage, number of cars . . . . , , Number of dwelling units on each floor . . . . . . . . . . . . . . . . 6, If business` commercial or mixed occupancy, specify nature and extent of each t. .. of use . . 7. Dimensions'of existing structures, if any: Front . . . . • ' • • ' ' ' ' ' ' ' ' ' ' ' ' ' Height . . . . . .. . . . . . . Numbcr of Stories . . . . Rear Depth . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of samc'structure with alterations or additions: Front . . , , Depth . . . . . . . . . . . . . ,. . . . . . Height . . . Rear . . . . . . . . . . . . . . . . . . . . • . . . • • • . • . • • . . . . Number of!:Stories . . . . . . . 8. Dimensions of entire new construction: Front . . . . . ' • Height . . . . . . . . Numbbr of Stories . Depth . . . . . . . . . . . . . . . 9. Size of lot: Front : . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . : . . . . . . . . . . , . . . . . . . . . . 0. Date of Purchase L Zone or use district in which premises are situate Namc of Former Owner 2. Does proposed construction violate any zoning law, ordm r\cc or regulation: . 3. Will lot be regraded Will cxc s fill be removed . . • . • • . . . . . • • 4. Name of Owner of premises . . . . . . . . , from premises: Yes No Name of Architect Address . . . . . . . . . . . . . . . . . Phone No. Name of Contractor . Address . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Address . . . . . . . Phone No. 5. Is this property within 300 feet of a tidal wetland? *Yes• � � � • � 1 • " " " " " " " ' *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 roperty lines. Give street and block number or description according to deed, and show I,street names and indicate whether iterior or corner lot. �� Ams �� m t t�17 •TE OF NEW YK,��— JNTY OF . .` ?f S.S 'rte �I^ •^"'^'• r-. . . . . . bcin; duly sworn, deposes land says that lie is the applicant (Name of individual signing contract) re named. sthe . . , . . . . . . . . . ontractor gent, corporate officer, etc.) lid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this cation; that all statements contained in this application are true to the best of his knowledge and belief;and that the will be performed in the manner set forth in the application filed therewith. n to before�`me this� . . . . . . . ,/. �/ . . .day of. . . .1�/ )V a/ /. . . . . ., 19 ryPublic. !! .// . . . County ELL.ARETH ANNN LLE . . • ' Idotar;Public,State of "w York (Signature of applicant) Pic,. 52-812ULIS0,Suff IV County �"��m EXDIrP4 nMnhn�•�1 �r•Q 'i � i +�1 R , j Ce A i CK 14 u t+0 (raw- , / f _ - q - t) Cu LAIti4A V ifG{f. . r C6N - 375_ ;Z I _ {rt I r �!2 Is � gI sd 2p � 1 1 I 0. a IF. 4 �Y Sao "o= r�mZ7 - d OT •� 1 � -OWN 5cw-ruor_n. tsf.y. I it :rl�l. 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