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HomeMy WebLinkAbout20393-z ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUFANCY No Z-21018 Date SEPTEMBER 15, 1992 THIS CERTIFIES that the building ALTERATIONS Location of Property 375 FIRST ST.&2665 JACKSON ST. NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 4 Lot 31 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 10, 1992 pursuant to which Building Permit No. 20393-Z dated JANUARY 16, 1992 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 ALTERATIONS TO ROOF OF SEASONAL COTTAGE AS APPLIED FOR. The certificate is issued to GEORGE & LAURA MAUL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. H-029288 - JUNE 12 1992 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1j81 ]E"08M NO. 8 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 2 0 3 9 3 Z Dote 19.f..~ Permission is hereby/g'r~unted to: ...~1{..... ...p~!...1-...y..1~.. ~ - / . at premises located at ......C....~.r1..~~...Cd.~ s.... ~~1.~ County Tax Map No. 1000 Section ......../r~~~..... Block ,..........l......... Lot No....~/.......... pursuant to application dated ~../.....9..~--- 19........, and approved by tfie Building Inspector. Fee 3s:~U ~ ..k'. B ding I for Rev. 6/30/80 i FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-19974 Date JUNE 12, 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 375 FIRST STREET NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 9 Lot 31 Subdivision Filed Map No. Lot No. conforms substantially to the requirements for a Private One Family Dwelling built prior to: APRIL 9, 1957 Pursuant to which CERTIFICATE OF OCC. #Z-19974 dated JUNE 12, 1991 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 SEASONAL ONE FAMILY DWELLING WITH ACCESSORY GUEST COTTAGE & CEMENT STORAGE BUILDING. The certificate is issued to HUGH F. HURRAY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NJA UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. ui~Inspector Rev. 1/81 ~ ~ Form No. 6 ` M TOWN OF SOUTHOLD BUILDING DEPARTMENT ~y~~ ~ ~ TOWN HALL 765-1802 '~f`'~- ~ - _ .~~~ti... ~~~a a APPLICATION FOR.CERTIPICATE 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 17, 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~• B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and ~ pre-existing land uses: 1. •Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. • 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. • C. Fees 1. Certificate of Occupancy - Naw 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 Euilding - $100,00 3. Copy of Certificate,of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $1//5,,.00, Commercial $15.00 Date ........7.'.Q-..C1.~ few Construction........... Old Or Pre-existing Building......., vocation of Property: ~~s5•..~C'"St.s~'~•...t..a.~.~fl,~5~„~~C~P)s~~J';., , , ~-S~. .I !''e~ Hoase N^u. Strneent Hamlet ~nwer or Owners of Property. Ger?r~~i„;`; LQ,{{/,?~, J,/,1,¢C,,1.f 'ounty Tax Map No 1000, Section....~~~......Block...., q .,,,,,,,,Lot...,.-J,,,,,,,,,,,,,,, ubdivision ..Filed Map............Lot........... crmit No.~Q.~~.~,~.z,,.Date Of Permit....(~L(~s~.~r~..Applicant.~,eQ(/~P,,,~,•~.~~~/ ealth Dept, Approval ..........................Underwriters Approval.,Y fanning Board Approval , quest for: Temporary Certificate........... Final Certicate...Y,,,,,,, 'e Submitted: $.::~~:~.Q ~u~,~ K~g6 ' C~,O C.~1~O APPLICANT FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTiViENT T05VN CLERK'S OFFICE , SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL Date JANUARY.13,........., 199x... To . , GEORGE ati LAURA MAUL I11 HEWLETT AVENUE PATCHOGUE, NY 11772 ' PLEASE TAKE NOTICE that your application dated , , January i0, 19 9 i for permit to constrgSS alteratiotlSto , an accessory cottage . , , , , at Location of Property .~7.5. ,F.i,r,~t St;.,,, 2665 Jackson St..,. New. Suffolk, NY 1 1956 Street House No. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~hlam/et County Tax Map No. 1000 Section ,1,1,7, , , , , , , , Block 9........ Lot 3 . Subdivision Filed Map No. Lot No. is returned herewith and disapproved on the following grounds Under, Article, I% Hamlet, Business District, Section 100-91-C, an accessory cottage is not permitted, and under Article %RIV Section 100-241-A, alterations not permitted ACTION REQUIRED BY THE ZONING BOARD OF APPEALS i1d~Inspector RV 1/80 0393 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~(}cif: 1 s349:f32CiUr BUREAU OF ELECTRICITY EIS JOHN STREET, NEW YORK, NEW YORK 10038 °ttINF 1;',~~75)F iY/4~'fS~~jil2 H €~:47?Rfl Date Application No. on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant named on the obove oppiication number in the premises of Cif.:URCi: MAUI, '3iC5 !"T (75i'`3T.„ I'~ft4J `:Uf"t~nt,.Kn iV.1'. in thefollowinq locations AI("CCr'Ot.)I t~fl n1 ? Boaement L_7 /at Fl. ? 2rzd F'l. .Section Block Lot .t11h14' S)!i,ih3',1? was examined art and found to be in coneplianre with the requirerrtenLs q(this Board. FIXTURE FIXTURES RANGES COOKING DECKS OPENS DISHWASHERS EXHAUST FANS ECE4TAClES SWITCHES OUTLETS INCANDESCENT ftUORESCENi OTHER AMT K. W. AMT. N W. AMT. K W M1i. K. W AMT. H P. ~l, I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS AMT N. W OIL H. P GA$ M. P AMi NO. A. W G AMT AMP. AMT AMPS TRANS. AMT. H. P NO. OF FEET AMT. WAITS SERVICE DISCONNECT NO.OF S E R Y 1 C E METER NO. OF CC. COND A. W. G A. W G A. W G. AMT. AMP. TYPE EDUIF 1,e' ]W l,a 3W J.e 3W R,e' 4W pER Of CC COND NO Of HI-lEG OF MbLEG NO. OF NEVTRAlS OF NEUTRAL ggg OTHER APPARATUS: -P~ (itit)Rtr( MA111. .19.1 M£'411.A 1'1" m P>Ai~C:H~LdUlt, NS'Y F1%%7 ~ 6ENERAI MANAGER 1:1 r` Per ~ This certificate must not be altered in any manner; return to the office of tfie Board if incorrect. inspectors moy be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. i .'lELD 5;:.`'..I~:_.;:i ~~J:.:.. j~ :;J?4i~1E:NT~ 1. ~ w II ? (~1 , • i it ~ ~((W`~ ?OUI7DATION (1st) ~ H 1 , ?OUNDATI0;7 (2nd) c z ~ TOUGH FRAME & ~ ~ v .PLUMBING ~ ' ` 3. ~ Z I17SULATIOi1 PER N. Y. m`L STATE EIIERGY CODE _ i. ~ _~m s H FI;IAL I `7~ ~ ~ ~ ` ~ c ° ADDTTIOIIAL COMM . x~ • ~ X • ^v ~ H H Fi \ O ((V~~ W ~ _ m r H ~ ~ ' ~ m ,a a ~ INSPECTORS ~ Victor Lessard ~pFFD(~- Principal Building Inspector o~© d'~ ~ Curtis Horton h~' s SCOTT L. HARRIS Su ervisor Senior Building Inspector p ~ ~e ~ p Thomas Fisher ~ ' k ~ Southold Town Hall Building Inspector O ~ " ~ P.O. Box 1179, 53095 Main Road Gary Fish ~'~'`~0,(y .~`~4~ So Fax (516) 765-1823971 Building Inspector ~ Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD SEPTEMBER ]0, 1992 GEORGE 6 LAIIRA MAUL 111 HEWLETT AVENUE PATCHOGUE, NY 11772 PROPERTY LOCATED @ 375 FIRST ST./ 2665 JACKSON ST.~ NEW SUFFOLK To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: KRR An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 20393-Z Please contact our office on this matter. Thank you for cooperation. 50UTHOLD TOWN BUILDING DEPT. ~ , ~ J OMNIBUS FAX 233-4634 PAGE 9: FO1tM N0. f y~ 7~ r. 'a'flWN Qr SO'UTH01,1,1 ~ I3UII.T1lNG DF;PAIt'['MF,I~T ~ Town Clcrk`H Office , R~~D Soutl.u~lrl, N. Y. CBrtiflC8t8 ~CrU~7~t1Cy No, ,~tr34i, . , , . , Date . . . ...........August.. 23 , 19..71 THIS CF.l.t'i'Ii•I>;S that the building located at ,>!11'St~ .5t. ~ .J'ack~on. ?t.. Street Map No, ~ • • • dock No..X~, , . ~ , Lot No.xxXac New auf f talk N,Y . , , . , , confprmS Substantially to the Application for $uildiXYh 1•'ermit heretofore filed in this office dated - . Pc.t , . ,1.~ , 19.65 pursuant to whiCl~ F.~uilding P¢rmiC lLro• .?90~~ . dated , , , , . , , .Oct . ,1,~ , , z 1965 , ~ was 'issued, and conforms to all of the require- meril,n of the applicable provisions of the law, The nceupancy for which this certificatE is issued is .px.~,vate„q~e, f~m3.,1~',(SUP11.~%R) Cottage,.,,.(!'$",d;LSt),.,,,,,,,.,. The certificate is issua~d to .Hr~''.~MUTF.Ay.... ,OHT~.ox. , . (owner, lessee or tenant) of the aforesaid building. Sullolk County Department of Health Ariproval , )1.iS.~B. existittg.ws.ll&. Iaaols.). , , building Inspect r T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [)INSULATION [)FRAMING [ INAL REMARKS: ~ f DATE ~ ~ INSPECTOR I ~-o ~9~ rss-iso2 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T [ ) ROUGH PLBG. [ J FOU DATiON 2ND [ ]INSULATION [ FRAMING [ ~1 FiNAL REMARKS: .c ~ w- 4 f i i ,f DATE ~ ~ INSPECTOR .-G~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ NSULATION [ ]FRAMING [~J] FcI~NAL REMARKS: ~~.1%~i ~~~~i'7,G~h.~-F., G' f :t i ~ DATE f~ L INSPECTOR ~ , ~a ~ Page 5 - Appeal No. 3234 ~~~;1 ~~y~~"~'? ~~lt Matter of ARTHUR R. TRUCKEPlBRODT, ET A~. JAN Decision Rendered January 26, 1985 _ ,t~ _ ~ r t % v.~.~ occupied. They also presented evidence of the discontinuance of electric and gas services to th_e premises. The owners of the premises produced evidence from all of the previous owners of the premises from 1956 to 1983, all of whom stated that the premises and cottages thereon had been continuously used and occupied during their ov~nership of the property. Dr. Damianos, the owner of the property from 1973 to 1984, testified that the cottages on the property were used continuously during his ownership, as recrea- tional facilities for his nursing home and vineyard employees to spend vacations and weekends at the cottages during the summer months. He also testified that Burin some of the period of his ov~nership, the electric and gas facilities were discontinued and that the occupants of the cabins brought in drinking water in ferry cans; used sea water to flush the toilets, Coleman lanterns for illumination and charcoal grills for cooking purposes. q' U From a review of all of the evidence in the record, and visits to the premises on three occasions by Board members, the Board finds that there was no discontinuance of the existing uses of the QU1 premises for a period of more than two years during all of the lf,~' period from 1956 to and including the date of the acquisition of the premises by the present owners. By reason of the above findings, 9t is not necessary for the Board to make a determination as to whether the use of the cottages on the premises from 1956 to 1984 was a nonconforming use. However, it is the position of the Board that the "use" of the cottages ~i. for single-family occupancy is not a nonconforming use in the district in which located. The Board agrees with the interpreta- Cv ~ tion of the Building Inspector that the nonconformity exists by ~ reason of the existence of five residential structures on the ~i5 premises, and not the "use" of such buildings for seasonal resi- w^ dential purposes. On motion by Mr. Grigonis, seconded by Mr. Douglass, by reason of ~ the foregoing, the interpretation urged by Appellants on the issue np~ of nonconforming use is rejected and Certificate of Occupancy No. 211736 issued by the Building Inspector on June 21, 1983 is „~d'"~' piyl deemed valid; and the appeal with respect thereto i s dismissed. ~""(/l/i•"gc,~W } Vote of the Board: Ayes: Messrs. Goehringer, Grigonis and Douglass. (Members Sawicki and Doyen were absent.) This resolution was duly adopted with a quorum of the members. * /~f9* /.P~~f ,pl "Fig w?~~i'f -,~.;iP,Yb!c,.4o ' GERA D P. GOEHRI'NGER, C~ RMAN j lk January 28, 1985 ._..e..J s. ~ • , f r, r. G. _..:.i 1 i.. . (i e• w- ,ti N/F VICTORIA S 83°5/'E 50.7/' cM Fd. N 0 h 0 ns ~ . s. z srucco STRUCTURE 13.5 25.6 2 J 1 ~ Q 26.2 74»~ 67.1 y WOOD FRAME Y BUNGALOW lV V (ELEVATEII ON 23.2 W Z ~ BLOCN9) ~ ~ ~+-17.4 VS a ~ 2 o ~ z m ~ la.o _ ~z•T Is.2 3 e~ 52 2 STORY N-~ ~ ~ ~ WOOD FRAME v, e o ~ RESIDENCE r~ O 30.3 6.2 ~ ? CELLAR ~ - ENTRANCE - lp Fd. N 83° 5/ W 50.66 GiiaraMees indicated here on ahafl run only b the person for whom the surrey k proparod, and on his behalf to the ?<ICKSON STREET title company, Eoverrrentcl Agency, lending instihtion, if lisfPd hereon, cnd to the assignees of th-~ lending irsfitVfi0/1. Guarantees are not transfe r:. t,le b addiywnal isstihdions or s„bsaquenf owners. T~AA 1000'117-09-31 MAP OF 'SURVEYED 27 APRIL,1991 SCALE ~ I~~ = 20~ CM Fd. ° Concre,e MbMiment DE'S CR I B E~D P'R~~PE RTY Found 1. P. Fd.=Iron Pipe Found. $ITUATE Mepla dfSurveyorseembopssedtseal shat not be considered to be a valid true Hi4MLET OF NEW SUFFOLK ~pr• TOWN OF SOl1T'N~LD.; SU~'~~bC.K COUNTY, N.Y. uFa,~,arr:aa olb,~,,, ar ad f survey is a vk+lation of Section 72 S SURVEYED FOR' GEOR`GGE LAURA MAUL Me, New YoAlr State F.dueation la GUAi?fiNTEEb TO ','t' ~ SUL~i><3'E0~ BP_~ - . 6EOROE ~ LAUR~,~'MAUL ~ b~~ l ` 4 C . ~ ~ ~ -STANLEY J 1SAkSEN, JR. TiCOR TITLE OYJARANTEE CO P, 9. BOX 29d ' -7bWN OF SO'((TNOLD n NEW SUFFOL .Y., 11956 ~ ~ ~ ~~R" ~ Yl : - ~ 5,18 ` 9A 8 5 i yg tl ~ 3 ~ - LICENS ATJ RV OR ' ~ ~ r NY.S IC NO 49273 . i A. . .~3`~~'.6'~~.&~' ° ,K , i?.' - •'•M'a%i+~WN^wu.e»~;awkx~. r~~3`i. u:.,.,ww~ . ~,~a,;, „v;~,. ~ _i3 r:.,,,_. ~-E . X91 R_a56 . B0.\RO OF HEALTIi FORMNO.t 3 SETS OF PL1:7S ,.V ~ ~ ~~~q~+ TOWN OFSOUTHOLD SURVEY yii'!I BUILDING DEPARTMENT C11CC[; ~ JAN 1 0 ; ~ ~ TOWN HALL serr>:c Fort:1 SOUTHOLD, N.Y. 11971 ) -7 ~7 L ' TEL.: 765-1802 -,r:..,.. , , 9q ~C~A L~ Exan11'iic'd".~~~cl~. , 19~!+.q~ /~~~IM~YL T0: :approved ../l~/,~!/.... , 19!H, Permit No..~;~~~..~~ / . . Disapproved a/c . . ~(Bui g 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 ets 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 1r~areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- .ation. ' c. T11e 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 •}1x11 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 flallltave been granted by the Building Inspector. APPLICATION IS HEREBY Iv1ADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ille applicant agrees to comp]y with all applicable taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins pe~ctions. ~ ~ h (Si~glnature of applicant,('o~r name, if a corporation) .lll.t?tfa-!~~e~.~Y~.:r~CY~ ~1~~.~~.1~? (Mailing address of appli nt) State wttettler applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. dame of owner of premises .G~~4~e.tl~(~ l:1-'(~.d, . A~W},Ci~ ,,,v ~~5~~ (as on the tarx roll or latest deed) !f applicant is a corporation, signature of duly authorized officer. ' (5161475-4773 (Name and title of co(rp~orate officer) Builder's License No.....~.wti.~v-' COVE CONSTRUCTION MGMT. Plunlbcr's License No. Electrician's License No . J ' 105 Hewlett Ave. Other Trade's License No. George Main Patchogue, NY 11772 ' Location of land on which proposed work will be done . . !louse Number Street HamlCt County Tax biap No. 1000 Section .1:7. , . , , , , , , , , Block Lot .....-j I....... . Subdivision Filed 1<4ap No. Lot . (Name) Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Cxisting use and occupancy ...~Um~~ ..h (~.~1~er. , . , , , , , , .'rr,'rYie''~r.:, _ 1 '.rr•'~i b. Intended use and occupancy ..~19.t'f1MS',1:... r~~5~ . 11~y~`(~ rQ0"t"`..~'. a.. err, , • i 3. Retaic of work (check which applicable): New Building Addition Alteration P • . Removal Demolition ' ' ' ~ ' ' Other Work . 4. Estimated Cost . , ~ , (Description) Fee 5. If dwelling (to be paid on tiling this application) 'units ....1, , , , , , , , , , , Number of dwelling units on each floor . . . . . . ' b'~ If ara e number of carswelhn^d occupancy, specify nature and extent of each t e f ~ ~ • 6. Heb~usiness, conunerc~al or mixc s if any: Front . ra'?3 r a!, YP o use . . . . . . 7, Dimenstons of extstm~ structure nht /t~....., ~ Rear ~ .Depth ~ r n Nut ber of Stories ChnG , , , , ' ' ' ' ' ' Dimensions of same structure tv;ith alterations or additions: Front , , ~f}„rr~, , , , , , , , Rear . , . SQ.JYI:P , , , , , 8. Dimensions o]re new coast' ' Ilcight ..."..~,n.')~',,, , , , , , , , , , , , Nttmbcr of Stories fi~(~~, , , , , , , , , , , • tYtctian: Front . Rear . Hetght . Number of Stories Depth . 9. Size of lot: Front . , ,ISO: ,"Z ~ ~ . 10. Date of Purchase ~-,4~, I ._e~}" " " • • Rear J S.a •„77 ~ , Depth , ...,~.Q.~: ? 1' . p ••••••••••••,...NameofFontterOwner .l-~ur.~h.,~.,;1'Y\Sxi'f one or use [strict in whtch rc P P miles are situated ,Id: R67R1,~,,}. QUS~r1G'.SS . 13-. Does ro ose~d construction violate any zoning law, ordinance or regulation: , (l~ , , , , , , , • . , 13, 1Vi11 lot be regraded fl,Q, ••••••..Willexcessfillberemov 14. Name of Owner of remtses ~9; , p ~ • ~ ~ ~ ~ ~ ' ~ ~ ' ' ed from premises: Yes N/a No Hama of Architect Address 11.1,l~ecufeN,4g Pai-~it4c~~hone No. !-1.7,5, ;47 Address . " ..............Address Name of Ifnyes orSout~old T ~l_akr~ l`l2uLl~ ..................Phone No...... . 15. Is [his ro ert withzn 00 feet of a tidal watland? ~ " " " " " •Phone No, * ,own Trustees Permit may be required. No.,..,, " ' PLOT DIAGRAM Locate clearly and distinctly al[ 'buildings, whether existing or proposed, and. indicate all set-back dimensions from property Gnes. Give street and block ryumber or description according to deed, and show street names and indicate whether interior or corner lot. fee, a~a~l~~c~ Su.rv~y I TATE OF NE YO1 ~'/S:S ,C~.~Qr'~' ' ' ' t • • • • • • • , being duly sworn, deposes mtd says that he is the applicant amt of i dividual si nin ,contract) ~ovc named. _isthc - (Con tractor, ag nt, corporate officer, etc.) ~ " " " " " " " said owner ar owners, and is duly aptho ' orm or have performed the said work and to make and file this plication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the irk will be performed in the manncrsct forth in the application filed therewith. om to before me this tary robot, . ~~-,1~~~,~,,Q!~ • . . . .county ~ CIAIRE L OI,EW . C-.'.~~._1. . Notary Pub1lc, Stste of NeW Yak No.487960B1 ........................pp....) QuetiftedlnSuffolktjouMy ~Z~ (Signatureofa licant Commiseion Expires Deoett~b6r 6.19...