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Home My WebLink About20122-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20309 Date OCTOBER 29, 1991 THIS CERTIFIES that the building Location of Property 5025 ROUTE 25 House No. County Tax Map No. 1000 Section 35 Subdivision ALTERATION GREENPORT, N.Y. Street Hamlet Block 2 Lot Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 29, 1991 pursuant to which Building Permit No. 20122-Z dated SEPTEMBER 5~ 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 ALTERATION TO EXISTING COUNTRY CLUB AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FLOYD F. KING~ JR. N/A N/A Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20311 Date OCTOBER 29, 1991 THIS CERTIFIES that the building PUMPHOUSE Location of Property 4675 MAIN ROAD {ROUTE 25) House No. Street County Tax Map No. 1000 Section 35 Block 2 17.1 Subdivision Filed Map No. conforms substantially to the Application for Building Permit heretofore filed in this offic~ dated AUGUST 29, 1991 pursuant to which GREENPORT~ N.Y. Hamlet Lot Lot No. Building Permit No. 20122-Z dated SEPTEMBER 5~ 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 PUMPHOUSE The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MARY W. BI~ACKI~AN & ANO N/A N/A Rev. 1/81 TOWN OF $OUTHOLD 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_e 20122 Z Date Permission is hereby granted to: ............... G..~.~.~...~....~..: ...... I..I..~.~.~ .......... at premises located at ...~.~..,~,,.,.~,. ....... .~,~...~ ......... .,.~, .~~ .................. co..~ Tax Map No. 7000 Sect~o. ..... .~...~.~ ..... mock .... ..~..~ ....... Lot No ....... .~...~.~.... pursuant to application dated .... .~¢~..~.........~.....~ ............, 19..~.]..., and approved by the Building Inspector. ~g't'B~tor Rev. 6/30/80 TOWN OF SddT-flOLD For,1 No. 6 TOWN OF SOUTIIOLD BUILDINO DEPARTHENT TOWN ltALL 765-1802 APPLICATION FOR CERTIFICATE OFtoccuPANCY \- This application must be filled in by typewriter OR ~nl¢ and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and Unusual natural or topographic features. 2. Final Approval from tlealth Dept. of Water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Uederwriters. 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 C,4npliance from-archi'-'ect or engineer responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and 'pre-exist~ng land uses: 1. Accurate survey of property showieg all property lines, streets, building and ~ unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the ~ reasons therefor in writing to the applicant. '.. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. ' 2.Certificate of Occupancy on Pre-existing Building - $100.00 3.Copy of Certificate of OcCupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential{ $1~0, Commercial $15.OO Street I ' ' House No., , , Ha ml~e t nwer or Owners of Property... , . / .. ' (j..,ff~ . . .... runty Tax blap No 1000, Section...~ ...... Block ..... ~ ..... Lot.. . ...... ~bdivision ............................ , . . anning Board Approval quest for: Temporary Certificate.. . Final Certicate..~.. e Submitted: $. , ...... Form No. 6 TOWN OF SOUTIIOLD BUILDINC DEPARTHENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY \. This application must be filled in by typewriter OR ink and submitted to the building inspector with tile following: for uew building or new use:' 1. Final survey of property with accurate location of ali 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 -sed 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 C~.pliance from archiuect or engineer responsible for the building. 6.Submi( Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-confgrming uses, or buildings and pre-ex~stzng' 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 Occupaacy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ~ · Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwclliug $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy oD Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Cer~'~ficate of Occupancy - Residential! $15.~0, Commercial $15 OO ~n~l~o~sc _ ~te .lZ~//7~ 191 , ~ . \/ / - ' Y' z'~' T ............................. e'~ ~onstructlon../~.,:_~,w' ~ld ?,,,r Pre-exiating Building.. ... ~ '~ .' · i ~ .. . .......... ,~....~/..,~r. ....... ~.~ .......... ouse ~o.~treet Hamle~ .... ...... : ............... :: '":;':: ,unty Ta~ .ap ~o ~000, ~ectio. .~.~. .... ~lec,~..~..' .... ' ' ' ...... : ............... ............ ...... ;" · . · · .~..Applicant ......... .. alth Dept Approval ' · ' ........ ' Underwriters Approval 2nning Board Approval ................. ~ ....... luest for: Temporary Certificate ........... ~ Submit ted: $. t ................ Final Certicat~ ..... FOUNDATION_~ (l~t) FOUNDATION (2nd) 2. ROUGH FRAME & .PLUMBING ® INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: TOWN OF 5OUTHOLD OFFICE OF BUILDING IN~'PECI'OR P.O. BOX 728 TOWN tlALL SOUTItOLD, N.Y. 11971 OCTOBER 23, 1991 GENEMAZZAFERRO TSLANI)'S END GOLF COURSE & COUNTRY CLUB 5025 HAIN ROAD (RTE 25) OREERPORT, NY 11944 TEL..,765-1802 To Whom This May Co.ncern, We are unable ko complete your Certificate of Occupancy because .of the following reasons. ~'-/~/_ An application for Certificate of Occupancy is not on file. (ENCLOSED) 2 REQUIRED: 1. PUMPHOUSE /_~/No Underwriters Certificate on file.2' ALTERATIONS ~ /~--/'=rile check is(~/not on file..) $50.00 ($25.00 each) /~/ No lIe.alth Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit Il 2 0 ! 2 2 Z Buildinq Dept. ***/_--/ No Plumber Sol. der Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) dL INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supewisot Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: JULY 22, 1991 TO: MR. GENE MAZZAFERRO ISLAND'S END GOLF COURSE & COUNTRY CLUB 5025 HAIN ROAD (RTE 25) GREENPORT, N.Y. 11944 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance - CHAP. 100 Other Applicable Laws, Ordinanoes or Regulations at premises hereinafter described in that ALTERATIONS HAVE BEEN MADE TO THE CLUB HOUSE & PRO SHOP WITHOUT OBTAINING THE NECESSARY BUILDING PERMITS. In violation of ARTICLE EX, III CHAP. 100-281 YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 5025 HAIN ROAD (RTE 25), GREENPORT, COUNTY OF SUFFOLK, NEW YORK, SUFFOLK COUNTY TAX MAP ~1000~35-02-11. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. 5tt ~ ! // I ////'/ / T~G I F'oo~ INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD ORDER TO REMEDY VIOLATION Date: JULY 22, 1991 TO: MR. GENE MAZZAFERRO ISLAND'S END GOLF COURSE & COUNTRY CLUB 5025 MAIN ROAD (RTE 25) GREENPORT, N.Y. 11944 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance - CHAP. 100 Other Applicable Laws, ordinances or Regulations at premises hereinafter described in that ALTERATIONS HAVE BEEN MADE TO THE CLUB HOUSE & PRO SHOP WITHOUT OBTAINING THE NECESSARY BUILDING PEP~ITS. In violation of ARTICLE XXVIII CHAP. 100-281 YOU ARE THEREFORE DIRECTED AND ORDERED TO comply with the law and remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at: 5025 MAIN ROAD (RTE 25), GREENPORT, COUNTY OF SUFFOLK, NEW YORK, SUFFOLK COUNTY TAX MAP %1000-35-02-11. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. VINCENT R. WIECZOREK° ORDINANCE INSPECTOR TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWNHALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 July 19, 1991 Mr. Gene Mazzeferro Island's End Golf Course and Country Club Main Road Greenport, NY 11944 Dear Mr. Mazzeferro: Thank you for the cooperation during the fire inspection of Island's End Golf Course on July 16, 1991. The Occupancy Certificate indicating the maximum number of people allowed inside the room, space, or building shall be posted in a public location so as to be visible to the public, the police, the fire inspector, or any inspecting agency. During the inspection the following were noted and should be corrected immediately. Flammability certificates are necessary for all awnings. There shall' be kept on file and a copy forwarded to this office. Ali emergency lights must be in proper operating condition at all times. The west door from the bag room shall have a classroom lock set that is lockable from the outside but not the inside. The west exit light in. the dining room shall be moved to be over the exit door in the north wall. ~The~wire on the 2 door refrigerator shall be properly repaired. The condensers over maintained. the broiler shall be properly cleaned and Second Floor ~z/All exit signs must be illuminated any time that the establishment is open to the public. The electrical panels upstairs are not accessible. No -1- 035-02-011 TEL. 765-1802 ,,material may be stored within three feet of the panels. All outlets are to have proper covers. All exits and exit paths must be proper for the rated occupancy load of 80 people on the second floor. The second floor shall not be used for public assembly until the necessary changes are completed. The necessary changes are below. The primary exit that is lockable inside. door may have a passage lock set from the outside but not the The west exit door to the outside shall have the proper exiting crash bar hardware. The door at the top of the stairs shall have the dead bolt removed and shall be another exit. The light in the stairwell shall remain on at all times. This light shall be a proper fixture. The stairwell shall have emergency lighting for illumination in case of power interruption. The exit path down the exterior stairs shall be illuminated. o 7. ,g~he exterior stairs shall be constructed of non ~ycombustible materials and shall be of prope~ width ...... 7 :" · maximum of 80 people. The flue for the outside hot water heater shall be properly installed with the correct clearances. The above violation is considered hazardous and shall be corrected immediately. Failure to do so may result in the commencement of legal action. No combustible liquids may be stored in the basement. The open duct through the floor ~rom the basement shall be /ooperly sealed or removed and repaired. th exit lights in the pro shop were out. /Open electrical boxes in the cart barn shall be properly covered. The electrical panels in the barn shall be accessible at times. all -2- 035-02-011 TEL. 765-1802 I could not find the proper building permits for the changes to the existing building. Please contact the Building Department immediately. If you have any questions or the required modifications are completed, please contact me at the above office. Yours truly, Robert Fisher Fire Inspector -3- TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWNHALL SOUTHOLD, N.Y. 11971 July 19, 1991 Mr. Gene Mazzeferro Island's End Golf Course and Country Club Main Road Greenport, NY 11944 Dear Mr. Mazzeferro: Thank you for the cooperation during the fire inspection of Island's End Golf Course on July 16, 1991. The Occupancy Certificate indicating the maximum number of people allowed inside the room, space, or building shall be .posted in a public location so as to be visible to the pub]~~ ~-- fire inspector, or any inspecting following were noted and should be are necessary for all awnings. 'ile and a copy forwarded to this be in proper operating condition at ag room shall have a classroom from the outside but not the he dining room shall be moved to be north wall. ~rigerator shall be properly )roller shall be properly cleaned and Second Floor All exit signs must be illuminated any time that the establishment is open to the public. The electrical panels upstairs are not accessible. No -1- 035-02-011 TEL. 765-1802 material may be stored within three feet of the panels, All outlets are to have proper covers. All exits and exit paths must be proper for the rated occupancy load of 80 people on the second floor, The second floor shall not be used for public assembly until the necessary changes are completed. The necessary changes are below. The primary exit door may have a passage lock Set that is lockable from the outside but not the inside. 2. The west exit door to the outside shall have the proper exiting crash bar hardware. 3. The door at the top of the stairs shall have the dead bolt removed and shall be another exit. 4. The light in the stairwell shall remain on at all times. This light shall be a proper fixture. 5. The stairwell shall have emergency lighting for illumination in case of power interruption. 6. The exit path down the exterior stairs shall be illuminated. The exterior stairs shall be constructed of non combustible materials and shall be of proper width. When finished, the occupancy for the upstairs will be a maximum of 80 people. The flue for the outside hot water heater shall be properly installed with the correct clearances. The above violation is considered hazardous and shall be corrected immediately. Failure to do so may result in the commencement of legal action. No combustible liquids may be stored in the basement. The open duct through the floor from the basement shall be properly sealed or removed and repaired· Both exit lights in the pro shop were out. Open electrical boxes in the cart barn shall be properly covered. The electrical panels in the barn shall be accessible at all times, -2- 035-02-011 TEL. 765-1802 I could not find the proper building permits for the changes to the existing building. Please contact the Building Department immediately. If you have any questions or the required modifications are completed, please contact me at the above office. Yours truly, Robert Fisher Fire Inspector 055-02-011 FOR~! NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TO ......................... = .................................... (owner or authorized qge~nt of_owner) ...C.q..8. ~.?..F.L. Ee..E .:[::~...h..L:..¥., ............................. (address of owner or authorized agent of owner) 19..?..(. PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that ..~..L,..~?~..¢&. ~:i.T..¢.~.J .~'?......~Ttl..~..~...~'~....£~..~.~..~.f...,.~..~.~-~.~....?.~,¢. (state character of violation) ....................................... ............................................................................................. .............. ...... ........................................................................................................ (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at I,g ]~ tt f~¢('JZT ,2'2').~t;4CAC?Ok~% County of Suffolk, New York. SU~FO~ com~ TAX MA~ ~ /060 - ~-&~,-/1 Failure to remedy the conditions aforesoid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Inspector TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWNHALL SOUTHOLD, N.Y. 11971 July 19, 1991 Mr. Gene Mazzeferro Island's End Golf Course and Country Club Main Road Greenport, NY 11944 Dear Mr. Mazzeferro: Thank you for the cooperation during the fire inspection of Island's End Golf Course on July 16, 1991. The Occupancy Certificate indicating the maximum number of people allowed inside the room, space, or building shall be posted in a public location so as to be visible to the public, the police, the fire inspector, or any inspecting agency. During the inspection the following were noted and should be corrected immediately. Flammability certificates are necessary for all awnings. There shall be kept on file and a copy forwarded to this office. All emergency lights must be in proper operating condition at all times. The west lock set inside. door from the bag room shall have a classroom that is lookable from the outside but not the The west exit light in the dining room shall be moved to be over the exit door in the north wall. The,wire on the 2 door refrigerator shall be properly repaired. The condensers over the broiler shall be properly cleaned and maintained. Second Floor All exit signs must be illuminated any time that the establishment is open to the public. The electrical panels upstairs are not accessible. No -1- 035-02-011 TEL. 765-1802 material may be stored within three feet of the panels. All outlets are to have proper covers. All exits and exit paths must be proper for the rated occupancy load of 80 people on the second floor. The second floor shall not be used for public assembly until the necessary changes are completed. The necessary changes are below. The primary exit door may have a passage lock set that is lockable from the outside but not the inside. 2. The west exit door to the outside shall have the proper exiting crash bar hardware. 3. The door at the top of the stairs shall have the dead bolt removed and shall be another exit. 4. The light in the stairwell shall remain on at all times. This light shall be a proper fixture. 5. The stairwell shall have emergency lighting for illumination in case of power interruption. 6. The exit path down the exterior stairs shall be illuminated. 7. The exterior stairs shall be constructed of non combustible materials and shall be of proper width. When finished, the occupancy for the upstairs will be a maximum of 80 people. The flue for the outside hot water heater shall he properly installed with the correct clearances. The above violation is considered hazardous and shall be corrected immediately. Failure to do so may result in the commencement of legal action. No combustible liquids may be stored in the basement. The open duct through the floor from the basement shall be properly sealed or removed and repaired. Both exit lights in the pro shop were out. Open electrical boxes in the cart barn shall be properly covered. The electrical panels in the barn shall be accessible at all times. -2- 035-02-011 TEL. 765-1802 I could not find the proper building permits for the changes to the existing building. Please contact the Building Department immediately. If you have any questions or the required modifications are completed, please contact me at the above office. Yours truly, Robert Fisher Fire Inspector -3- 035-02-011 FORM NO. 1 '[.OWN OF SOUTHOLD ,BU'I LDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .... ........................ ....../,.¢"~ ............................... . ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FOR}! .............. CALL ................... HAIL TO: Date ... ~.u.ly..2.9,..19.9.I. ., 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 o~' 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 this application may not be cbmmenced 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 Wiaole 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 Ord:nance 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 9ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspes;ti6ns. '. Island.' s. End. Golf. &. Country. Club,. Inc ........ -- (Signature of applicant, or n~me, if a corporation) P.O. Box 2066, Greenport, NY 11944 (Mailing address of applicant) State whether applicant is owner, l'~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Applicant is lessee . Name of owner of premises ......... .FAo. y~. F... J/,J. ng.,. Jr ................................................. (as on the t,ax roll or latest deed) / If applijaa~/is a corporat~6n, signature of d/ul,y~aufl, hjorized officer. .. ....... (Na~an~t title of corporate' officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License NOproposed work will be done. ,, ...... .~,,,fl~,.¢~~-,~. '.~...,.~.. 1. Location of land on which ~.~.~. ~..~.....~ House Number Street I]t;;~'1;; County Tax Map No. 1000 Section .......... 35 ...... Block .. 2 ............... Lot .... 1~ ............ 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 ......... ~SS -eours~ .okuDhou~ ....................................... b- Intended use and occupancy ........ ~a~. ~ .~~ ............. ................... 3. Nature of work (check which applicable): New Bu'ilding .......... Addition .......... Alteratiofi R pal .... R ~ I D oliti e r .......... cmo a .............. em on .............. Other Work ' ' · 4. Estimated Cost .............. Fee / ~, - ' ' (}; be paid o~'" ;~'t:'~%;"' x~ ...... flhng this apphcat~on)j 5. If dwelling, number of dwelling t~nits ............... Number of dwelling units on each floor ........... 'i ..... If garage number of cars i · ' If business, commercial or m~xedl occupancy, extent o f each type, of use,. 6. ' ' ' ' specify nature and ....... of existing structures, it' any' Front ' ~t~h' ........ 7. Dimensions ~". ~ r ' "'.'..'. Height ... ~ ,. ...... ' .... ' ....Rear ....... ~.~ ......"De ......... ............ Number of Stories . ~ .................... Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth 'Height .................... ~, ....................... Number of Stories ...................... 8. Dimensions of entire new construction. Front ........... ~ · ·. Rear . ..., ............ Depth ............... Height Number of Stories ' ' 9. Size of lot: Front ............ i..; ....... Re'ar.. ' ' Depth .............. I0. Date of Purchase i .................... · ....... .................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................... ' ........... -' · ............. Does proposed construction vJola,!te any zoning law, ordinance or regulation: . ·, . . 13. Will lot be regraded ....... ' ' ';';. ........................ ......... , .................. '3'111 excess lin De removeu ~rom premises: Yes No 14. Name of Owner of premises .... l ................ Address ............. ; ..... Phone No .......... .~ ..... Name of Architect ........... i ................ Address ................... Phone No ................ Name of Contractor ......... ~ ................ Address ................... Phone No ........ Is this property within 3 0 feet of a tidal wetland? *Yes ........ xx ........ · If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Lo ate clearly and d~st~nctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nl~mber or descriptioh according to deed, and show street names and indicate whether~ interior or corner lot. STATE OF NEW YORK, COUNTY OF S.$ ............................... ; .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) tbove named. te 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 tpplication; that all statements contained h~ this application are true to the best of his knowledge and belief; and that the ork w/Il be performed in.the manner sot forth ~n the applicatign flied therewith. ;worn to before me thi~, ! /'~ ......... ..day op~,, I o fora ry eublic, ~...~.'~ ,f~~~-~ :~',~ .... ~-'~2~ ........ ~ ~,/'~"~,~fT,~,~/-Y' ,~.~_-.. ~--,-,C ,~-,~... county. (Signature of applicant) ,,i