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Home My WebLink About22132-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Bouthold, N.Y. CERTIFICATE OF OC=uuANCY No Z-23401 Date DECEMBER 12, 1994 THIS CERTIFIES'that the building. Location of Property 944 YOUNGS ROAD County Tax Map No. 1000 Section 18 Subdivision ACCESSORY ORIENT, NEW YORK Street Hamlet Block 2 Lot 14 Filed Map Ho. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated J~NE 1, 1994 .p~rsuant to which Building Permit No. 22132-Z dated JUNE 16, 1994 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 STORAGE SHED "AS BUILT" & AS PER ZBA ~4285. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 ELHERT E. & CAROLE LUCE N/A N/A Building InSpector / FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the' Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23402 Date DECEMBER 12, 1994 THIS CERTIFIES that the building Location of Property 944 YOUNGS ROAD House No. County Tax Map No. 1000 Section 18 Subdivision ADDITION ORIENT, NEW YORK Block Filed Map No. Street Hamlet Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 1, 1994 .pursuant to which Building Permit No. 22132-Z dated JUNE 16, 1994 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 OPEN DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to "AS BUILT" & AS PER ZBA #4285. ELBERT E. & CAROLE LUCE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspec~r ~RM TOWN OF SOUTHOLD BUILDING DEPARTMENT IOWN HAU. $OUTHOLD, N,Y. N£ 22132 Z BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted-- Z~/~~/' ~t°: / ~ ~ ~. ........ .~......~.~.~ ....... £~.,, .............. ~.~.~.~.......~....~:..~. ............. .~,,,o~. ......... ~..~.~...~,~......~..~..~....,. ............. ..,.~:...,~.,./..~..:: ....................... .................................................................. ~......~....~....Z... ........................................................... CountyTaxMapNo, lO00 Seotlon....,~...Z .......... Block .......... ~ .......... LotNo ..... (,.~,,. ................ b~r~,,o ob~l,oot,o, dated.... ........ ~.~ ............ ~ ......... ~...~.... ond a~ro~ed ~y~e Building Insp~ctc~. - ~ ~e ~..,~..~.. ............ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 BLDG. DEPT. TOWN OF 8OUTHO£D APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 I% 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. 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 - $20.00 /' 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 December 12, 1994 Date ......................................... New Constt~ction ........... Old Or Pre-existing Building .... U~q~ ......... Location of Property 944 YOUNCS ROAD ORIENT. NBW YORK House No. Street Hamlet Onwer or Owners of Property ELBERT E. & CAROLR LUCE County Tax Map No 1000, Section .... 18 ~ ~ .......... Block ............... Lot .................... Subdivision ............... Filed Map . Lot .. / . 6/16 94 A licant ELBERT E LUCE Permit No.....22132-Z...........Date Of Permit ............ ... pp .......... : .................. Health Dept. Approval .......................... Underwriters Approval ...................... Planning Board Approval ........................ Request for: Temporary Certificate .... · ~~E~ ...... Fina Certicat .'; ........ Fee Submitted: $ ....... 25. DD ..........' .-,CO 3gO I APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWNHALL 765-1802 This application must be filled in by typewriter OR ink and submitted to the building inspector with the followihg: 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 bui%ding, 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. 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 ~tate 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date December 12, ~94 ACCY SHED New Const~uetiom.' .......... Old Or Pre-existing Building ................. Location of Property ...... ~44 YOUNGS ROAD ORIENT, NEW YORK House No. Street Hamlet ELBERT E. & CAROLE LUCE Onwer or Owners of Property ................................... County Tax Map No 1000, Section ..... J~ ..... Block. 2 ..... Lot. ]4 Subdivision ................................ ... . Filed Map ............ Lot ................ .... .. Permit No.. .22132-Z...Date Of Permit...6/.].6./?.4 .Applicant. ~LBERT E. LUCE Health Dept Approval · Underwriters Approval Planning Board Approval ........................ Request for: .Temporary Certificate ........... ~ __~Final Cei~t~Icate .......... .... .......................................... ' ' Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 13, 1994 To Whom It May Concern: Re: Premises @ 944 Youngs Road, Orient, N.Y. Suff. Co. Tax Map #1000-18-2-14 Please be advised that the correct address for the above premises owned by Elbert E. & Carole Luce is 944 Youngs Road, Orient, New York 11957. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector GJF:gar 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ AL Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Richard C. Wilton BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Ha{I 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1809 ACTION OF THE BOARD OF 2~PPEALS DATE OF ACTION: December 7, 1994 APPL. '#4285.~ APPLICANT: ELBERT E. LUCE, JR. (Edward J. Boyd V, Esq.) LOCATION OF PROPERTY: Private Right-of-way off the easterly side of Youngs Road, Orient. COUNTY TAX MAP DISTRICT 1000, SECTION 18, BLOCK 2, LOT 14. BASIS OF APPEAL: Two separate Notices of Disapproval issued by the Building Inspector, each dated November 7 ~ 1994: "Accessory building, as built, shall be located in the required rear yard," and "deck addition, as built, with insufficient rear yard setback." PROVISIONS APPEALED FROM: Article III~ Sections 100-32 and 100-33. RELIEF REQUESTED: 10' x 12' accessory shed located previously in the rear yard, and now situated in a side yard, 35'9" from the southerly property line and more than 60 feet to the easterly side property line. Subject deck addition is. shown 33 feet from the rear property line instead of the required 35 feet. MOTION MADE BY: Richard C. Wilton, Member SECONDED BY: Serge Doyen, Jr., Member ACTION/RESOLUTION ADOPTED: Granted side yard location of 10' x 12' accessory, shed, as built~ and granted open deck addition with a rear yard setback of 33 feet, as located, and all as shown on survey dated November 2, 1994 prepared by Roderick VanTuyl ~ P.C. REASONS/FINDINGS: Prior to location of deck, accessory shed was located in a required rear yard. Amount of deck subject to variance consideration ia two feet. The variance is not unreasonable and is minimal, under the circumstances. VOTE OF THE BOARD: Ayes: Serge J. Doyen, Member James Dinizio, Jr., Member Robert A. Villa, Member Richard A. Wilton, Member Gerard P. Goehringer, Chairman-Member lk t ERA D P. GOEHI{INGt~R, CHAIRMj~N ./ OU1;DATION (1st) OUNDATIOU (2nd) OUGH FRAME & -PLUMBING H~SULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONA'L ~ENTS. ~ FORM NO, 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL 944 YOl~ICS ROAD ORIEI~, 'W/ 11957 NOVEMBER 7, PLEASE TAKE NOTICE that your application dated .. ~ 1, ., 19..9.~. for permit to ... CONSTRUCT ACCESSORY SNED 946 YOUNGS ROAD, ORIENT Location o f Property ~l[~s'~ '~o~ ....................... 'S't/e${ ....................... fl~/e~' County Tax Map No. 1000 Section 18 Block 2 Lot 14 Subdivision ................. Filed Map No. ................ Lot No .................. is returned herewith and disapproved on the following grounds SOUTHOLI) ZONING CODE ARTICLE III, SECTION 100-33 - ACCESSORY BUILDINGS AND STRUCTURES, OR OTItI~R ACCESSORY USES S]~L BE LOCATED IN ~ P, EQUIRED P, EAR YARD - ACTION EEQUIRED BY THE ZONING BOARD OF APPEALS. Building In'specto~/ - RV 1/80 : 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ] ROUGH PLBG. [jFOUNDATION ZND [ ] INSULATION []FRAMING ~'~INAL FORM NO. 3 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL · . ,,at, ...... ~z ......... ,~?,/'. · ..... Co,,,~ra,~,~o.]00OS,~,~o~ .... /.~...~o~ ...~: ..~o~ ../~e~... ' Subdivision ................. Filed Map No. r ............... lot No ................. .~ ....... ~. ....... ~~..~.~~~ .. ~~- .~ ,~ ~ /J --~'~ ....... ~ ...... RV 1/80 FORM NO. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL for pe~it to .............................. ............ ~ ....... at Hamlat County Tax Map No. I000 Section · ~..~. ...... Block .... ....... Lot '/'r .......... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on t~e follow~g grounds~~~O ~ ..... ~.~. ~...~.~... ~ ...... ~...~ .............. RV 1/80 TOIVN OF SOUTIIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ~o ~ ~ ,~ i..._~ .... ~ .... ~...~ ..... ...... · ~.. ~~,../.V.,..~... · · 19 for ~:~ ~ o~.. ~e~.~~. ' . ~_ . . . . .... . .... Subdivision ................. Filed Map No. : ............... Lot No .................. is returned herewith and disapproved on the followin~ groun~ .... ~7~' ' ....... )7'~~':'~'"~'~'~~ . . .~~ ........... .................. .......................... . RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined .......... Approved .~. ..... 19~./Permit No ........... .~/ Disapproved a/c ..................................... I I ~ ~J~LICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORrl .............. t:O~IP¥l CALL ................... HAIL TO: Date ...~..o?..~.,..( ...... 19 J;..at/ INSTRUCTIONS a. Tiffs 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 streets 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 tiffs 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 appUcant. Such permit sl~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 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 demolition, as herein described. The appUcant 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 name, if a corporation) .. F..o., .'5.*..... ¢,.. z/.,t..s:7. ..... (Mailing addres~s of apt~licant) l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... o .o:4..~..~. ................................................................................ ,',;amc or owner of premises.. E'&Z~,e.T..z..,..4. ~.,¢~.....,/,.~.4:::.~ ......... I~ ................. (as on the tax roll or latest dcf~V¥~'.D A3 ~fOI[O / FEE: O~J ~--*, BY: .............................................. NOTIFlf BUILDING DEP~r'IVlENT AT (Name and title of corporate officer) 76fi-180;~ 9 AM TO 4 ~ FOR TIlE FOLLOWING INSPECTIONS: · Builder's License No .......................... 1 FOUNDATION TVVO REQUIRED F¢;;~ POURED CONCRETE Plumber's License No ......................... ;? ~:~.,:}(~'-i F~.t~,,'.ING & PLUMBING Electrician's License No ....................... < ; ,'.,"; CC,;,:STFI{.ICT~ON MUST ~3E COI?,PLETE FOR C O. ALI. CONSTR[!CT~ON SHALL MEET Other Trade's License No ...................... THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY Location of land on which proposed work will be done ................ I~tqDFS: ','NO7 · 'F~S~PON~rt~E- - FOR ...... House Number D o Hamlet Cot,nty Tax Map No. 1000 Section .....J.~. ........... Block .... & ............ Lot..j.7. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existiug use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ---~.E:d .~(..).T).&:.t .T.~.~ b. intended use and occupancy .................................. ' .................................. 3. Nature of work (check which Applicable): New Building .......... Addition . Alteration Repair .. ~ ........ Removal .... ' ........ ' ........ .a ..... · ........... l~emolJtion ......... Other Work .............. 4. Estimated Cost ~?.'.~../.~.._/~' tO/~'.~ ,~ /f- ' -- ~ · ! (to be paid on filing this application) 5. If dwelhng, number of dwellin~ units ............... Number of dwelling units on each floor ... · If garage, number of cars ~ ............ 6 Ifb ' m ' ' ~ ' ' ' · ................................ ,~. usm.ess, co.m .e~'.c I x~d y cify re and leach ty~ ofuse ................... 7' ,a or m, occupant ,spe natu extent o e · ~nnensmns oi existing structures, if any: Front ~'.O t /.~.e - . .............. H igt N inb ' . . ./..2.:... e at ..... Rear .......... n er of Stones ....~,~.~ ............. ' .... Dim sions ors c~ with alt ti additi Fro .......................... ' .......... D en amc stru ute era otis or ons: nt . ., ., ., ., ., ., ., ., ., .~'~ ~. ......... Rear ............... pth Hight .... e ................... i. · · e ...................... Number of Stories ............ ~ ......... Dimensions of entire new construction. Front ,:~s'-.~m~: Date of Purchase /.~7~/ . ,, · ~,~. .... ~. ..... Depth~~,. ..... Zone or use district in which premises are situated ~.,~.~/.2. a~ml .... ~:dg ' ' } ........ Does proposed Construc' ' ~ · · ,, tlon violate any zoning law, ordinance or regulation . . will lot bere~raded : ' ' ., . ~ . . ! · · ............ WQt excess fill be removed xname ol Uwner oI premmes .. i ...... ~ ........... Address ................. Name of Architect ......... i ....... Address · ~ ' ' ' ' Name of Contractor . I .... . · ' .................... Phon~ ................. ....... i .......... : · ·. Address ................... Phon/~ ............... 15. Is this property within :300 feet of a tidal wetland? *Yes ........ No ......... · If yea, Southold ~own 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 bloeklnt/mber or description according to deed, and show street names and indicate whether interior or corner lot. 9. 10. 11. 12. 13. 14. '.ff'/2~ /O'/cz'Z : ' I ....... ............ ~ ................... being duly sworn, deposes and says that he is the apphcant (Name of individual siga~g contract) above na~ed. He is the ~ ~ . (Contractor, agent, corporate officer, etc.) f smd owner or owners, and Js dnlyiauthorized to perform or have performed ti~e'said work and to ~nake and file this application; that all statements contained in this application are true ro the best of his 'knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith· Sworn to before me this ~ i ' 8 O'IOHJ.I"IOS :t0 N/V~O.; · '±cFtC] '9C19~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197~1 TEL.: 765-1802 ~;o?I PY J 19~rf. · · ~t^c^L":~ ~..;.;; ................ B~ARD'OF HEALTH ......... 3 $'ET$ OF PLA~$ SURVEY ................... CIIECK s~T~c';;~, ...:::.2:2:::': Approved ................. 19...,Permit N_o ..... ~ ...... .. " ' ' ~/~,LICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 sti'eets or areas, and giving a detailed description of layout of property mu~t 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 ~South~)Id, 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 name, if a corporation) .. P.o.,. ~. ..~ .... .~. r.~. ~ ~ .~:..¢~ .... /./. ?.~-~. .'... . . (Mailing address of~pplicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . .~, ~ ~..o. (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~ ......................... Plumber's License No ......................... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done..., ............................................... ........ '.q. .... 2. 4 · ........ ......... ..................... Itouse Nun¢ber Street ..... '..:.'Block .... a ........ :... Lot.....~./~.:/.~ .... County Tax Map No. 1000 Section Subdivision ........ , ............................. Filed Map No ............... Lot .... . .......... (Name) 2: State existing use and occupancy of premises and intended use and o~cupancy of proposed construction} . .--z). ~.c~.. ' a, Existing use and occupancy ........................................................... b. Intended use and occupancy ..................... ' ............................................... .3. Nature of work (check which aPphcable): New Building Addition ....... Alteration ..... ~.. 4. Estimated Cost t--~OF-~O : ' ' , (to be paid on filifig this fipplication) 5. If dwelling, number of dwelling units ....... Number of dwelling units on each floor ....... Ifs ......... · erase, number of cars .... ! .......... '... ' ........ ~d ify ......................................... .... 6. If business, commercial or mix occupancy, spec nature and extent of,each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... ig t N fsi i : ' e ............... U r O or es ......... , .......... mens onsos me structure er ns ora OhS rent ... Rear ' Nub of Stories 8 Dime ~i~ .................... e ................. ... m er ........ of entir onstru tie F ~5~ ~ Rea ............. · n ns enewc c n: rent... ....; r ............... Depth ..... Hight Numbe of St ri ' ' ' Date of Purchase .. '~ ' . . · ............... oepth o.~ · ' i ................. Name of Former Owner ...-:;.. ' ................. 11. Zone or use district in which premises are situated..~Y. Oa~ZNT~. "': :": .............. Does proposed construction vioiate any zoning law ordinance or regulation: ..... '...' ................... · o e regrade ....... '. ................... Will excess fill be removed from premises: Yes 14 N fP : Add . amc of Owner o remises.. ~ ............. tess Phone No .......... ;... Name of Architect ....... ~ ' ' ............ ............ .............. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ........ 15. I~ this property within B00 feet of a tidal wetland? *Yes ........ No..~ ........ · If yes, Southold Town Trustees Permit may be required, ''' I. 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 descnptmn according to deed, and show street names and indicate whether interior or corner lot. , STATE OF NEW YORK, COUNTY OF .S ............. ~..{2.T.....~:. ~{R.F-...~... .' ...... being duly sworn, deposes and says that he is the applicant .. , ......... (Name of lndwidual signifig contract) ' above named· . He is the , .~.... ............... i ........... . .................. , (Contractor agent, cori~orate officer etc ) of said owner or owners, and is duly!autl~orized to perform or have performed the said work and to make and file this application; that all statements contaiged in this application are true to tlie best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this Notary Public, ,~v~.,~,-, .............. , ............... County (Signature of applicant). 0 e'"-~'ett '