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HomeMy WebLinkAbout21035-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25327 Date OCTOBER 21, 1997 THIS CERTIFIES that the building RENOVATION Location of Property 655 (a/k/a 518) BAILEY AVE. GREENPORT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 34 Block 4 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 3, 1992 pursuant to which Building Permit No. 21035-Z dated OCTOBER 21, 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 REPLACE FRONT PORCH & REAR DECK TO EXISTING ONE FAMILY DWELLING & CHANGE ROOF PITCH AS APPLIED FOR. The certificate is issued to DONALD WACHTEL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-057196 - OCTOBER 1, 1997 PLUMBERS CERTIFICATION DATED - N/A (L i;z;~6 Bu lding Ins ctor Rev. 1/81 "lax NO. s 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) ! NW04 21035 Z Date (Zt... 19.9:x j Permission is hereby grantedd tom: n r, . 1 -'(~1 Q .....4 n.............. ~~1 ......!U.... :..1.!.9... t0 .9s........ 4arf.....,.. O.'n .::..tl.. I . p...p..st.r.-p:.rr:.E~:.Y..~: t.... MOAJ...CU..J4 R!ti..l >i1~ 1? ZR......J.,~MwtU 931.x.... of premises located V rx,r~ . at . i County Tax Map No. 1000 Section ......Q Block ..d Lot No...t'.O pursuant to application dated ......QA.4~ 3 1992 and approved by the Building Inspector. Fee S.. . Building Inspector Rev. 6/30/80 Form No. 6 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT 00T i 410 TOWN HALL 765-1802„ 61DO.bE 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. 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 - 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 $15.00/, Commercial $15.00 Date g7. New Construction.... n. Old Or Pre-existing Building Location of Property.... LKA.~1$............ 17a1.f,f.y...?!U(~1U~........G?..??.A.......~. House No. Str t Hamlet Onwer or Owners of Property .....Do h 3I ` `I ~ W C, k f 2 County Tax Map No 1000, Section...-'A. Block Y........... Lot...1.a Subdivision Filed Map............ Lot.........'............I... Permit No...a0M. ~ ..Date Of Permit. ~-?/?,/.X2.... Applicant ....~.40.a.u.. Pg.4tA 1... Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate.. v....... Fee Submitted: $...d,5';oo n G ~3S a~'On.~ C~ APPLICANT co assa THE 'NEW YORK BOARD OF FIRE UNDERWRITERS 80681G.1? BUREAU OF ELECTRICITY - 85 JOHN STREET, NEW YORK, NY 10038 Date (WTOMIR 01,1.39'7 Application No. on file 14770097/97 11 05'7196 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 DONALD WACHTNT., 51.8 BAILEY AVENUE, CREPNPORT, NY in the following location; ® Basement ® ist Fl. IJ 2nd Fl. OUT Section Block Lot was examined on SEFTEW ER 25,1997 and found to be in compliance with the National Electrical Code. FIXTURE 11ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER T. K W. AMT K. W AMT K.W AMT K. W, AMT 4, P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIMECLOCK REII UNITNEATERS MULTI-OUTLET DIMMERS AMT. K. W. OIL H P GAS H. P AMT NO A W. G, AMT AMP AMT. "is TRANS. AMT -P SYSTEMS NO. OF FEET AMT. WATTS SERVICE DISCONNECT, No. OF S E R - V 1 C E TYP AMT, AMP, E METER 10 3W 1.9 3W13 9 3W 3,F AW NO OF CC COND A. W G NO. OF HIAEG A W G NO. OF NEUTRALS A. W. G. EQUIP. PER.C Of CC. CONp OF HI LEG OF NEUTIIAL I OTHER APPARATUS: ENTIRE PREMISES-1 *NO VI."SUAJ. DEFECT; "All ?leK;aric l survey has been made, of the exposed elecLric,al equipment in the premises indicated." "No obvious unsatisfactory condition was found. L L DONALD WAMTEL 518 BAILEY AVENUE GENERAL MANAGER GREENPORT, NY, 11944 §.=t, 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 8E ALTERED IN ANY MANNER. =1ELD II:SP=C;iON JJDATE COMMENTS H FOU14DATION (1st) V - ti o+ FOUNDATION (2nd) m 2. 0 ROUGH FRAME & PLUMBING ^ v w 3. x m INSULATION PER N. Y. STATE ENERGY CODE +~J x a FINAL o ADDITIONAL COMMENTS: x 6 1.15-A? f © 6 C.'~, ji-F i y m A r _ y T . ry m .b H FORK NO. 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) N2 18931 Z Date 193.0. Permission is hereby granted to: w~ s.!.$..... 0 R....... qwmy.. ro ..R -~v k...~..... -h ....~e....L°., x.... !?n... ' at premises located at .I;J.... Z....... v'R.........-i .....................................................................................................``..LL..................................................... County Tax Map No. 1000 Section ....Q..w A........ Block .....Q.q......... Lot No... 1.0 pursuant to application dated ..............C3A,CLh.... 19.9.42., and approved by the Building Inspector. Fee 5...`Sl C y Gti .........................Qldi;n;g~ Inspect or Rev. 6/30/80 7,oeate •cleariy and distinctly all builaingS, wile titer existing or proposer, axm. uw+~•+••- property lines. Give street and block number or description according to deed,and show street names and indicate ~YhetheJ interior or corner lot. i(O i f UED AS NOTED DATE: a B.P. # 8 9 ~,.L FEE: BY. SCI G(t 7J Y. /a ( ~0ar- ~ise 7 to NOTIFY BUILDING DEPARTMENT AT w 765-1802 9 AM TO 4 PM FOR THE Vsrn/G a x S ~T S~`~ l b ~H/Ge~ r/~~ FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED I FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING -1CC )i'AiYC R 3. INSULATION IS l~~~9 ~$~~SL 4. FINAL - CONSTRUCTION MUST USE BE COMPLETE FOR C.O. UJIT T CERTIMATE ALL CONSTRUCTION SHALL MEET - ....a anx. THE REQUIREMENTS OF THE N.X INSPECTORS (516) 765-1802 o~~SyfFO(kea Gy SCOTT L. HARRIS, Supervisor VICTOR LESSARD, Principal CURTIS HORTON, Senior r°n Z Southold Town Hall VINCENT R. WIECZOREK, Ordinance P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire Southold, New York 11971 Building Inspectors Fax (516) 765-1823 THOMAS FISHER Telephone (516) 765-1800 GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD September 28, 1992 Mr. Donald E. Wachtel 518 Bailey Avenue Greenport, N.Y. 11944 Re: Building Permit #18931-Z (ALTER ROOF) Premises: 518 Bailey Ave. Greenport, N.Y. Suff. Co. Tax Map #1000-34-4-10 Dear Mr. Wachtel: 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 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures or new dwellings, and it is unlawful to occupy or use said 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. Victor Lessard, Principal Building Inspector VGL:gar (Cert. Mail) M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: c DATE r2~ INSPECTOR r 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 214 [ NSULATION [ ] FRAMING [ ] FINAL REMARKS: - DATE 11INSPECTOR r J 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ZINSALATION FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] j14SULATION [ ] FRAMING [ VI FINAL [ ] FIREPLACE & CHIMNEY REMARKS: c Z/9 /YZ v cam, 011 DATE INSPECTOR r ~~o~~gOFFOlkco Gyp co ca x Town Hall, 53095 Main Road W- 0 S Fax (516) 765-1823 y~©1 Telephone (516) 765-1802 P. 0. Box New York 9 11971 Southold, N OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 28, 1996 Mr. Donald Wachtel 802 Main Street Greenport, NY 11944 Re: Building Permit #21035-Z - (roof change) Premises: 655 Bailey Avenue, Greenport Suff. Co. Tax Map #1000-34-4-10 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. INSPECTORS (516) 765-1802 VICTOR LESSARD,Principal ~ SCOTT L. HARRIS, Supervisor CURTIS HORTON, Senior Southold Town Hall VINCENT R. WIECZOREK, Ordinance,? P.O. Box 1179, 53095 Main Road ROBERT FISHER Assistant Fire +B+ ! Southold, New York 11971 Building Inspectors =ar Fax (516) 765-1823 Telephone (516) 765-1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD September 28, 1992 Mr. Donald E. Wachtel 518 Bailey Avenue Greenport, N.Y. 11944 Re: Building Permit #18931-Z (ALTER ROOF) Premises: 518 Bailey Ave. Greenport, N.Y. Suff. Co. Tax Map #1000-34-4-10 Dear Mr. Wachtel: 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 100-281 and 100-284 a building permit is needed for any construction of additions, accessory structures or new dwellings, and it is unlawful to occupy or use said 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. Victor Lessard, Principal Building Inspector VGL:gar (Cert. Mail) BOARD OF HEALTH 3 SETS OF PLANS toarhNOtri SURVEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORT( 4p TOWN HALL V Q' 11 /~q~ SOUTHOLD, N.Y. 11971 NOTIFY: 7 TEL.: 765.1802 CALL Examined . / 04.! q- MAIL TO: M Approve 19 Permit No'? Disapproved a/c (Building Inspector) - APPLICATION FOR BUILDING PERMIT Da te((!C....., 15~I1J INSTRUCTIONS a. This application must be completely filled in by typewri ter 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 pan 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 =hall 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;vor for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and reg•Shticns, and w admit authorized inspectors on premises'and in bWidi.,g for neces3s3a~ry f~n~sp~e(/cr~onsJ~. ~ } 1~.~. CI V t? . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises S, (as on the tax roll or latest deed) If applicant is a corpo,catjon, signaturd bf duly authoriz ' WAI$ r (Nam eandititle, ofcorpor teofficer) "*6`~ y( t'g}#g q~ 6+y4 yi~<i,3gd}yi 9 ! @a{g.~yg14 B II~,dC 4S•rLIC.,CQSCLQ~iRx S '.NS , l;1} -7'a 31TB 1i DOD 40 Pltim bcr t k 1t }t' ` ,3: 41Ai ' it>xl 1: r E'lectrician's License No. Other Trade's License No . I- Location of land on which proposed work will be done: House Number Street Hairnet County Tax ,flap No. 1000 Section . 4 Block / ~ ...'7.' Lot. /P ~Subdivision Filed Map No. . (Name) Lot State existing use and occupancy of premises and i ended use and Occupancy of proposed construction: ~ a. Existing use and occupancy : .....CAT.I_~Q~ b. Intended use and occupancy 1 Y~ it 3. Nature of wor •(check which applicable): New Building , Addition .Uteration ..[ff....... . Repair . Removal Demolition ..........Swirhnin; pool............ Tennis Court: Accessory Building . . . . . . . . . . Fence .......Other Work. 4. Estimated Cost ~F.0000.Us7 Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . • , . , , Number of dwelling units on each floor 1.......... . If garage. number of cars 6. If business, commercial or mixed occupancy, spec .11 r}atuie and extent of each type of use a . , . , i •F , , , . 7. Dimensions of. existing structures; if any: Front , Rear Depth z~? Height . , . q... Number of Stories t • DimenG]1~i9,rns~ (^o7PQ•/~/s,a/me stfr'u ture with alterations or additi ns: ront , • Rear . S ~ gE , Depth VYrSYJ(1(r 1G({~......1. Height . . ~lun cr of torics S. Dimensions of tire'new construction: Front p, (k Cfca :.I p qP.Depth ...t?, Height Numbi'er of Stories . 1'1 , . .n. ,4................. . 9, Size of lot: Front Rear ...(00 pth Aq . . 10. Date of Purchase , , ,~1~~f°t• </.Q . Narn of F lCR fi Owner C ( t!P...l ( . . 11. Zone or use district in which Prcunises are situated try, i fY -i y~. 12. Does proposed construcliicin violafc any zoning law, ordinance or regulation: N6 • • • • • • • • • • • • • • • - • • • • 13. Will lot be regraded /U r(~ t Will exce,~,{,t 1 b~J~emoved from premises: Yes No~ 14, Name of Owner of prgrpist7( 1Ct lt?~, {LL Ad ,dress . C!.` r!5~ n'. Phone No..~ .~.(Q:: , . Name of Architect 1 , , , , • , , , , , , , Address .................A. Phone No.. Name of Contractor Address Phone No. . l 15.Is this property locatied within 100 feet of a tidal wetland? *YES NO.~G.. *If yes, Southold TownlTrustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. I AP_ PROVED B. NOTED DATE: B.P. FEE: A • BY: ~ax r ~ndF ise7 tO ( NOTIFY BUILDING DEPARTMENT AT 785.1802 9 AM TO 4 PM FOR THE 0JCeM Ye-R-+OLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED /j ~/Jb~ /LA~} FOR POURED CONCRETE tl' l / 2. ROUGH - FRAMING & PLUMBING OCCUPANCY OR S. INSULATION USE IS UNLAWFUL 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. WITHOUT CERTIFICATE ALL CONSTRUCTION rkHALL MEET OF OCCUPANCY STATE ~cQOUN81rRU$ OW THE NX r!, ENERGY S'VATP C.) F NEW YORK, COdIIS. NOC NSII 3LE FOR COUNTY OF S CTION ERRORS • • • • • • • • • • • • • • • • • • • • • • • • • • being duly swom, deposes and Says that he is the applicant (Name of individual°signiing contract) above named. r . i He is the 1.... (Contractor, agent, corporate officer, etc.) • Of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conta}tied in this application are true to the best of his knowledge and belief; and that the work will be perforated in the manned set forth in the application filed therewith. Sworn to before me this ....dayoo~f//l•~~/°~ s.Q...........1970. Notary Public Count NO ARY PUBLICNSte~te of, w York • . . • • No, 4707878,Su0clkCounty ( nature of applicant) Term Expires March 30, l9.. Qktat~uJ FII~ IgR31-7- BOARD OF HEALTH FORM NO.1 4-,SETS OF PLANS SURVEY TOWN OF SOUTHOLD BUILDING DEPARTMENT e-<ffREcr 16 55 9 TOWN HALL SEPTIC FORK . . b SOUTHOLD, N.Y. 11971 TEL.: 765-1802 nin-L FY Exaniiried CALL ~7.7 : 20Gy 19... MAIL TO: Approved 19 Permit No............ _ . Disapproved a/c _ . (Building Inspector) rLIC-TI APIN-4i IQIV -01' iV lLD1~Ul] PLi14111 Date 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to'adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ca9ion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or 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 neces ry ~mspect s. (Signature of applicant, or name, if a corporation) OZ..aF...'r. C~~..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. QWN~2.......... Name of owner of premises . f)q.q:(.I ~ 1E~. (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 . I. Location of land on which proposed work will be done . . House Number Street Hamlet II, County Tax Map No. 1000 Section Block .4 Lot..1 Y.............. . Subdivision ......................................Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy (2? ~T./,tA ~!u t-o . b. Intended use and occupancy (Z f I (Nt Cam, T1 3. Nature of work (check which applicable): New Building Addition Alter on Repair Removal Demolition Other Work (Description) 4, Estimated Cost ...~QOo "00 , Fee..................................... (to be paid on filing this application) 5. If dwelling, a mnumber number r of f dwelling u i ` Number of dwelling units on each floor If of cars € g 6. If business, commercial or mixed occupancy, specify ature and extent of each Ype ype of of use 7. DimensiOllS Of' ,,existing structures, if any, Front Rear Hei ht 1P23 Depth g Num ber of Stories 7i Dimensions of same structure w',ith alteratiops oradditions: F~j ont . Tt ~ Re r .e!.; ensionLof ent'r new construction: 'Height .li~l~$,Ot, , , , , , . Nu ber ^ofr$~tptH?ries ~t!. , , , , , , , • • • , . 8. Di/, jFront . Rear . Q .G{~" * Depth . ~D , t`f, Hei ht OK,rt ber of Stories . 1,2r. 9. Size of lot: Front . Rear //~OY...... D th 4R .F`~. chase er 10 . Date which Premises Name Qf F'oKr~; er Own. 111. or use di tract in f~ j , are situated. '.~.i.~1.:P3!kd^1Q4 Doesone proposed or d on u'ep~6gn violate any zoning law, ordinance or regulation: No , , , , , , , , , , , , , 13. Will lot be regraded , N.N.. ' Will excess fill be remove} from premises: Yes No 14. Name of Owner of p PC s : I I-/14~,". , ~l~l 'pddress . D2r,)AA Phone No. . T DP!Q L~ 4..7~.:3..f.. . Name of Architect , . . . Address Phone No... , . Name of Contractor . . Address . . Phone No. , 15. Is this property within X00 feet of a tidal wetland? *Yes„ No *If Yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. n~ ~i s o~ Doti 'rz z 6~ t STATE OF NEW Y R COUNTY OF... . c9 ~l~ S.S 10 nAL . (Name of individual signing G~ . . . ' ' ' ' ' ' • being duly sworn, deposes and says that he is the applicant contract) above named. d e~ , Y.l e~ He is the (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly 'uthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the Hork will be performed in the manner s~t forth in the application filed therewith. iwom to before in this flay o 1 fi i~_ Votary Public, t~ County ROBEffr 1.1 COTT of NOTARY PUBLIC . KY. k~"!` . C ~ . (Signature of applicant) o.4 81. 19 I g s .~~N ~My °tF On 4~ hl F' ~4 N Cl L 7 6 $~~k ta B-yKPcN l~ l/1 I~YIa I' •h`RJ~e ~'h XB O'~YA.'kRF"FS rr I 1 I W rr 7 ~~K + a¢~ ( to Ail 1VVl LLI Q L L Q Ltj LLJ d ' C.1 l J Lu N C'O V LL (JI l~ 00 y0.0 O _I N LJ LJ + ' I 1-• _ _ i Af) 9 I i ;z >I , u. AO M4, o plv ur I 6Yyy Df w i +N I m ! V ~ sT c L~ ro L4rn > w O LU <r J 0 l l ' R J V ~g Q h L) w ul Q W N LIJ W W c0 V Cv N Ul 6 j Ck. v ~I _ CV - r ~'r r 4• _'-T 3.. ~y "low- CIS 7.0 a V ? F ~a }<t 1. .:.c.-a_~.•s ~ CIO I ~ s_ a •F r.++s 2 ~ ~ls I G " o v~ (alrty 2,1q z-xs~ Led S~ ~,IreJ C er7 to \ I i t ' 6160 ~`tib~rF~