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HomeMy WebLinkAbout23237-z 4 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-24589 Date August 26, 1996 THIS CERTIFIES that the building addition and alteration Location of Property 500 North Drive, Mattituck House No. Street Hamlet County Tax Map No. 1000 Section 106 Block 6 Lot 28.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated January 22, 1996 pursuant to which Building Permit No. 23237—Z dated February 2, 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 a two story addition and alteration to an existing one family dwelling as applied for. The certificate is issued to Francis and Nancy Deegan (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. pending July 30, 1996 PLUMBERS CERTIFICATION DATED N/A uil3ing 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) NG 23237 Z Date .......................:jV ............................ 1914.. .. Permission Is hereby granted to; °.... .Wm.....�q&....................................... ......:...... .......(..x.95.. ....... to .,,�tln!17?�5�,e ............�....,.,...�r^�.........�??... <.......... .y,ltzlh�........!!�''!!�....... ��CTII� } '... X � ..... 7.�4...... `. .. .......... .......... / . ................................................................................................................................................... ............................................................ E ............................................................................. c—oo A ......1.A .Vr.............................................................. at premises located at............... ................../.L/. (:t. . . ............................................................ ..................................................................... County Tax Map No. 1000 Section ..l k............. Block....O�P.............. Lot No. ..... ...r...... pursuant to application dated ........ "!k ti ....A,) ................ 19...44!....... and approved by the Building Inspector. Fee S......T� `.......... .... ... .:... ... ........................................ 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 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. Q. 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 Buildins - $100.00 3. Copy of Certificate of Occupancy - .25C 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $115.000,, commercial $15.00 / Date . . . . . .t�.+. .p(. <.�. . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . ... . . . Old Or Pre-existin Buildi.ng. . . . . . . . . . . . . . . Location of Property. . . . ti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . (1 t..G� . . . . . . . . . . . House No. /J ,G�,� Street Hamlet Onwer or Owners of Property r/') 'i 5 �d4' cy Ql"��YJ� P5' . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. / . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No J1000, Sectionn. . . . . (. . . .Block. . . K . . . . . . . . . .Lot. . . ./1 .1: y Subdivision. . . . . . +cS .! '- � G . . . . . . . . .Piled Map . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . . . . / 9 . . . . . Permit No. .L. 3 2.3.� Z. . .Date Of Permit. . . ././.'2-/!6 . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . .: . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . . . . . . . . . . . . I . . . . . . . . . . ,. . PlanningBoard Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . TT. . . . . Fee Submitted: $ . . . `r. . . . . . . . . . . . . . . . . . . . . �.- rec . 5/g3Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (2.,„1 -e J 27r�X� APPLI(: NT ;Aug=21-96 09 _ 30A Crowe & DGlegan 516-759-3419 P.O1 CFzowE & DEEGAN ATTORNEYS AT LAW rnElO•DOL b'rROFr OL.Ew COVE,NEW VORR tll 2 TML:45101674-1421 r X. 45101764- I6 FRANCIS W.DEEGAN ROLAND A.CROWE(1014-1%711 DAMSEL P.DEEGAN' HATHLEEN OREGAN D.CRSON" ..r _ �a QWYMQ 1rITKs Nr•R6 01 uuf / JULIUS E.TENHE �•p11TIm RT 1RR LT MR! Pr TELECOPIIER 'CU38MITTAL LETTER" DATE: TO: FAX NO: � 7 S— �Z'� �/o 'z3137 MATTERc,. r-7 /a FROM: d- ' NUMBER OF PAGES TRANSMITTED (INCLUDING COVER.) : OUR TELECOPTER NIMMER: (516) 759-3419 PLEASE CALL TO CONFIRM: (516) 676-1121 TM orlOinti of the trwoottaf domment riSl be 6717 W-. I 'f ®WART MAtL I :. MESSENGER ilUVMIW MIL ruis DOG wff LILL BE THE OId.Y I= OF BELLVERT MESSACs THE INFORHRION CDMTAINED IN THIS FACSIMILE MESSAGE ISkJORNE7•PRIVILEM AND CONFIDENTIAL INFORMATION INTENDED ONLY FOR VIE USE OF THE INDIVIDUAL OR ENTITY HARED ABOVE. If THE REI,DER OF THIS MESSAGE IS NOT THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, OISTRIBMION OR COPYING Of THIS CLWMMICATION I$ STRICTLY "IONIBITED. IF TW HAVE RECEIVED THIS @BJUICATION IN ERROR, PLEASE IMMEDIATELY NOTIFY US BY _.. qug"-21-96 O9: 3OA Crowe 8 Daogan 516-759-3419 P-02 Ld�ZJiyyf NEY r ompd� i�i/a.ta�+ •O.Llr7 w•.t�rn�a 'T�" na.asw , 'iro SlfoetdrldV.�w amali,there utaStlWlk wctalbeatot tiliatney dyoram tosult ever,)need or spplisnrt.The fellow• told att intended as a pid r to prate partrActim dtatttaA vw,dhimnry Instalfat'NOW.. p m inln0 that 2. ' t�Mw7outGhimntYpatta.k7e�ezaer suopinerethe lna c C0Oblifaaftop "�'" •w•_•»_ aw.Mwevec by tilwaarins M►•ider wnuy ofmmW«t Furnace and dYrsnaY systema,while ode primsaye ntphaals m rJu did Want Hear"on Vit. n on soUd•fuel spill anw.the type of appttance o0e chimney. R Maa»lal � sekcoed mutt neer a7ez the inaaasoeut of the t the Chimney><imlial:yumirmttdt0ato.oil,or ,+000-0utllinrapp1411M.the pa:is uttd uN dearartets to ambumss ate ato"the Same Rementat:lyt at some pire ililll.It1a Nfrs tililllitty may aehe i ttped littTaR• dkstartadomwith8asoral MMY RtdR pOesiEt7itki to rhimM si,d li adst om • attow4l heed.Whether or netyea 5ndyout educt o f Wait"e0 rNmrtey warlgtnkn:here.temetnaer Neat bat,c } , an also emphasised tin the lnstallstso 1. WlpaperWpportand branrg-6,slie CMM system. 1 2.Malituln Qteit�ttunum ivnth AIII SMUckarance:e wrn«: wmbuWAN s and to any msulattort. 3.Stir pent aecutlty—dna Lowns lands a strews for the \ sr elilintwy and lis tonnactir u+..... r 4.Enclose or prated the chimney to av&A cosnact.damast l orbatatdstofumislunp. 3. !f.Ute only ail stance!which havt been seated."Listed" Wood Heater.with ....~� (oragp and lrupectedi.and follow dwir instruc- its od He r Udim In eWty detail(Cry;wr:xn rKNtcuw. chimney hfofl d�.w. PorYour Chlraney Installation t. Id rue[Appliance--with a rLwrtuaTchimmy. MIX tt d � 4. rktdwA Roue with A.tric �+.t"..... �\a�.rr•aM raw M� . 1 I }1 �wa»aa»r 11� I I aaw•r . men. � .i M•M 7r� !Msr: 3atsnwutpMWIofNeft0*31140a am•oklyroresaftatua tillitilpillaigm UO"121:1114:01showacretem shoae mdeato the Metre soWinenn tnwactim forsea-isl and asaa seu� oia ecma PW IS and:f lhaw Model SSI,ChiINIh aye• 1s++r<u •1 enudateffmuSe0tirlt Mefalatlws doualt.all lgvks pye US At . 1leteedd0{OtimtsynotANPatran:tapadetsl•ttaielNtt atarsnMYtemnravdterNkwnm.ep�.aigdte _ - .. Wet f»�h�..Nru•.�IfN..�•"• a. t'd �ll�f t'�91i�H1.y1�d 3n�» bPi�Y�96. d; t<l'tl lz s PH:kll IN:i P11C1IOIi RIi P(1111 DAlV CUIf19fiNiti FONNDA] ION ( Is'I') If I FOUNDATION (2141)) II rf i ROUGH Flt Arai 6 1'I.IINIII N(1 INSULATIOII PER N. Y . � Of S'I'Alli ENERGY w � I"I IIAI. 1 I ADD Of AL I.OM WN'YS ; i »=a------ .»_»»>®»Q»:>>=»___» »___>------------------>»__� ..___-...- THENEWYORKBOAROOF WE ARE IN THE PAOCFSS OFISSLIINGA .. _-__--_—_____-._v_.__,.___._______—�__. CERTIFICATE OF COMPLIANCE FOA THE -.- ____._... IN AN APPLICATIOELECTRICAL INSTLATION N NOTED BELOW.AS _..._-.._._ AMIGRiON/NNO'. I- 5O6 _. . ._. -. LOGQION c c DATE- -----_-- - 2 . INSPECTOR IBD(REV 8196Y/'�Y/OA� C 7 n Town Hall, 53095 Main Road ¢ Fax (516) 765-1623 P. O. Box 1179 Telephone (516) 765-1602 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: ( ��P� Building Permit No . 2 3 23 ? Z Owner: �j��C-(s Y A�li� cy D��" please print) Plumber: rgs!�(s (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signat ) Sworn{ to before me this 2/� day of % 19 Notary Public, S /o(/\ County DANIEL P DEEGAN Notary Public,State of New York x) No.4961764 Qualified in Nassau County qj Commission Expires February 2,19._ gOFFO(,pc TRUSTEES John M.Bredetneyer,III,President _ �� SUPERVISOR Henry P. Smith,Vice President ww = SCOTT L.HARRIS Albert J. Krupski,Jr. p John L. Bednoski,Jr. Town Hall John B.Tuthill �`� 53095 Main Road P.O.Box 1179 Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971 Fax(516)765-1823 TOWN OF SOUTHOLD February 20, 1992 Francis W. Deegan 500 North Drive Mattituck, NY 11952 RE: SCTM #1000-106-6-28. 1, 28. 4 Dear Mr. Deegan: After an onsite inspection of the above mentioned property, the Board of Trustees finds your proposed addition to be out of Trustee Jurisdiction. If you have any further questions, please do not hesitate to contact this office. V y truly yours//, //r •r � aw John M. Bredeme�_yVerr, (III�/I� President, Board of Trustees JMB:jmt cc: Bldg. Dept. )JI L ,JAN 2 2 19% ;1 SIDG.DEPT. VENN OF SOUTH0!0 _,_ rvew rorK oldie ueparirnefit ui izilYrroff emai l,on CfVau Clli Building 40—SUNY, Stony Brook, New York 11790-2356 rranc1 5 t,(J . 1�deJ�ln DATA: S/ID� A)oC+ti b.- uc. Re : /-`E73B-dOULy/ Llli ! I UG��i �eL_; �'Di�K � 15S2 OOfOi-Q_ Thomas onerilnq bCFg2M, �/-�y�,p�ty Commissioner Dear HR , DLt�'2n I A review has been made of your If r-e f' c,e41 �6c<, fe Mq-4lfucK ,Uel. Ycxki Se TM logo S �_) R_U2Y V �-Pc+ r ecQ � �f� �CcP ec .ri' k (,ICt,-x, —1t, Y l � c9Re Jhq vu !^�/ -tl} !'s fJ YC�dSeco ac'ftui' 7`/ 01160 ank/ fc -r &' k- C [-"(Gf,l'Vl �� � Glrr'e vek C P e L 4 c -f 'I"Jt-.'- b l U f-f' f 5 O l'-7 Ole 00k= .J Op- Based fKBased on the information you have submitted, the New York State Department of n3vironmental Conservation has determined that the parcel +/ project is : Greater than 300 ' from inventoried tidal wetlands . _ Landward of a substantial man-made structure greater than 100 ' in length which was constructed prior to 9/20/77 . _ Landward of the 10 ' above mean sea level elevation contour on a gradual, natural slope. L/' Landward of the topographic crest of a bluff, cliff or dune which is greater than 10 ' in elevation above mean sea level . Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law) . Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10 ' contour or topographic_ crest without a permit. It is your responsibility to ensure that all- necessary precautions are taken to prevent any sedimentation or other alteration -or- disturbance to the ground surface or vegetation in this area as a result of your project . Such precautions may 'include providing adequate work area between the 10 ' contour or topographic crest and the project (i .e. a 15 ' to 20 ' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this Department . Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies . Very truly yours, "O. ., J a63I�1 lig II IN1� Deputy Regic-al Permit Administrator JAN 2 21996 rt_ e PLDG. DEPT. "-;PIld C7F SOl1''�;0' 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY / REMARKS:- .�° :, �� ✓� DATE f2 !,_INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION i ST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: "Z,:5- ll DATE INSPECTOR I 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY REMARKS: DATE f� ` INSPECTOR 'r' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ZFINAL ULATION FRAMING [ [ ] FIREPLACES&}CHIMNEY REMARKS: i DATE �I '� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ OUGH PLBG. [ ] FOiAT1ON 2ND [ ] INSULATION [ F/RAMING [ ] FINAL ( ] FIREPLA�CEJ& CHIMNEY EMARKS:, e (LO✓� St' ADATE � INSPECTOR - c;23 3 7J� �. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ :NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: �Z . /iC,A elu 4 © `<— oxt DATE INSPECTOR 71 '�— L z 4G � - pFG T Q o5rz 25 BOARD OF HEALTH �/. . . . . . . FORM NO. 1 B SETS OK PLANS . . . . . . . . . . JAN 2 2.� TOWN OF SOUTHOLD SURVEY c/ ttq ' BUILDING DEPARTMENT C1ICC[ J9l { . . . . . . . . . . . . . . p I "f(? TOWN HALL SEPTIC FORA . . . . . . . . . . . . . . sror D��-Ep. -_. SOUTHOLD, N.Y. 11971 - - WN"_"""' OF SOU�j-o .._ TEL.: 765-1802 DI F1 *1 CALL - • - Examined . . . . . > 02 . . . . 19q - NAIL TO : %pproved . . . . . � . . . . . ., 19!�. permit No. . &1-72-7 Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • '� ( u' ing nspector) APPLICATION FOR BUILDING PERMIT � p Date SION. . S::4 . . ., 19 .1 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 AS 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, :.nd giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 orin 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. lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Smit authorized inspectors on premises and in building for necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) _-Lf-e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. A . . . . . . . . . `. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,ie of owner of premises9! v'v�. . . . . . . .�`t` GA/✓ I . . . . . . . . . . . . . . . . . . . . . . . . . . .0 (as on the tax roll or latest deed) i applicant is a corporation,signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . 2/S�5 Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . Location of land on which proposed work will be done. . !i�acq , lt/Q? f. , 1�( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�. �.�. . . . . . . . . . . . .. (louse Number Street Hamlet ^ I-- ' 7 County Tax Map No. 1000 Section . . . . . . . .62. . . . . . Block . . . . .4 . . . . . . . . . . Lot . .tet:t . . . . . . . . . Subdivision . .Z./7/P Z.4- . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / /�fM/LLQ Z�G✓6Gc /N�r b. Intended use and occupancy . . . . . . . . . . . . . . . Z-Le 1jWE4 L-t,/V 6- 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . .!. . . . . Iteration . . `� • • • • - Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . ,y (Description) 4. Estimated Cost . . .?� 3oj A.QV. . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . 1. . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constriction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 0. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . 1. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 4. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . .,/. . Phone No. . . . . . . . . . . . . . . . 5. Is this 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 ,)perty lines. Give street and block number or description according to deed, and show street names and indicate whether -rior or comer lot. r l'ATE OF NEW YORK, S.S RUNTY OF . L-!4. . . . . . 1!koh(C.f$. . t�F rr!� I✓ . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ove named. isthe . . . .�{!1U$R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor,agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this ,lication; that all statements contained in this application are true to the best,of his knowledge and belief;and that the k will be performed in the manner set forth in the application filed therewith. im to before me this . . . . . . . . . .f Q . . . . .day of•� An/vgrzy. . . . . . . . .. 19 ��° ary Public, . . . . . � �1rn�K County l I' pMERt P.'ofililtlN t4otwy PJAC.&t o of Naw Yori No.4764554 (<_�� >�SN&+Ro��44 . . . . . . . . . . . . . . . . . . . . • . . . . . . atureofapplicant) 0. 40 0=9" � _ I FXl£j7NIr 4W8 4=8" 4'p ' _ lS�' PROVIDE OPENINGS FOR =rx 23'6" I z73 ,. 7-S' 8_8. 7-S . I i < b O _'CGOSEj1 IN /Xki 27�iC • � � �) o . EpR(JRA� � 9I b AW q o r�l Biu - •��'.raA' ' .3LK3YXd � �1 / - - 1 b � 16yew EY49A1,A5 6^1AVOW" e ; ' .8$2E�7✓�.ELGdwNf aFcosv- � �a I , I I a �te�ao�r�o Cl2? 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