Loading...
HomeMy WebLinkAbout20225-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20679 Date APRIL 27, 1992 THIS CERTIFIES that the building ADDITION & ALTERATIONS Location of Property 495 NORTH PARISH DRIVE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 71 Block 1 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 16, 1991 pursuant to which Building Permit No. 20225-Z dated OCTOBER 23, 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 ADDITIONS & ALTERATIONS TO EXISTING ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECRB AS APPLIED FOR. The certificate is issued to SHELDON & HELEN SAL2MAN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-232659 - APRIL 20 1942 PLUMBERS CERTIFICATION DATED MARCH 30 1992 - H.SMITH PLUMB.&HEAT.INC ~ ~ uilding Inspector Rev. 1/81 Y08Dt NO. f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST SE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF 7HE WORK AUTHORIZED) N 2 0 2 2 5 2 Date ~ 19..~~ Permission iQs,hpere~b~,.~granted,~o:j~ ~ s to ilcl~.. ..,,.:..~Ao:...~ ~Y . of premises located at ....1-~..7~...J~.`......~/~' .`~..l~.ct<:C~ County Tox Map No. 1000 Section Block Lot No....... pursuant to application doted ........,1~...~0...~ 19..<.s and approved by the Building Inspector., Fee 5..~~~••/J~yl'J g..n~.G.t.~t.................. Bui n I or Rev. 6/30/80 Form No. 6 = ' TOWN OF SOUTIIOLD ~ 3 G~""~ BUILDING DEPARTMENT ry ' R TOWN HALL APR ~;®~g~4 t(' 765-1802 r a~.. - ._.~'g~_~ F~t.Y7 u ~'~:;:w z~ ~a.. Y1)V+i~; €3F:ri'si:'f7~~;~:;i..47..#.~.~. APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OF, 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 Pire 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 buildin s and g i "pre-existing" land uses: i 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ,,,April 5, 1992 New Construction.. X........ Old Or Pre-existing Building 495 North Parish Drive Soufhold Location of Property „ House No. Street Hamlet Onwer or Owners of Property.,,, Sheldon and Helen SAlzman County Tax Map No 1000, Section.... 71........Block..~ .............Lot.S.................... Subdivision ....................................Filed Map............Lot...................... 202252 10/23/91 John Bertani Builder Inc. Permit No ................Date Of Permit................Applicant............................. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval....:-.- Request for: Temporary Certificate........... Final Certicate.......X... Fee Submitted: 2 5 00 " C4'L ^66~n APPLICANT H. SMITH PLUMBING & HEATING, INC. MAIN ROAD SOUTHOLD, N.Y. 11971 (516) 7653690 C E R T I F I C A T I O N Date March 30, 1992 Building Permit No. 202252 Owner Sheldon Salzman Plumber: H. Smith Plumbing & Heating, Inc. I certify that the solder used in the water supply system contains less than 2J10 of 1~ lead. enry P. Smith Sworn to before me this 30th day of March , 19~ Notary Public, Suffolk County ~./ii 2=~ O Notary Public 6ERNADETTE L. TAPLIN NOTARY PUBLIC A4844893 Stato of New York Residing in Suffolk County ~ommirsmn Expux; Sept 30, 19.2' I THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1001071 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Dote APRIL 20,1992 gpplicotianNo.onfile 76006892/92 N 232659 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 SHELDOiv} iALZMAN, 495 NORTH PARTSH DRIVE, SOUTHOLD, N.Y. in the Jo/lowing Grcation; ~ Basement ~ /xt Fl. ~ 2nd F'l. GAR / Oll i .Section Bloek Lot was exarrtinedon APRIL 13,1992 andfoundto be in comylianre uith the requirements q(U}is Board. iIXTURE ECEPTAClES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENL FLUORESCENT OTHER AMt K W AMT. K. W AMi K W qMi K W AMi H P 26 1 23 20 1 ~ F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gElt UNIT HEATERS MULTI-OUTLET DIMMERS MIL N. W. OIL H. P. GAS N P. AMT. NO. A W. G AMT. AMP, AMT. AMPS. TRANS, qM}. H P SYSTEMS AMi WATTS NO.OF FEET 3 F SERVICE DISCONNECT NO.OF 5 E R V 1 C E AM}. AMP. }YPE METER I ~ YW I a 3W J.e 3W 3.e' 4W NO. OF CC COND A W, G EQUIP. PER Of CC. COND. NO. OF HbIEG OF~HI LEG NO. OF NEUTPAIS Of NEVTXAt 1 200 CB 1 % 1 4(0 1 2/0 OTHER APPARATUS: G.F.C.I:-3 G F S COidTRACTOR LIC.#578-E C~ BO% 215 SOIfTHOLD, NY, 11971 GENERAL MANAGER 11 Per 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. INSPECTORS „u~: PrincipaltBuildtngInspector Sr®L`'~1,;i~(~~'U Curtis Horton r-~ ~ SCOTT L. HARRIS, Supervisor Senior Building Inspectar s"~a ~ Thomas Fisher ~ ~ Southold Town Hall ~ l ;=:,e~r n ~r°~ i a ' P.O. Box 1179, 53095 Main Road Building Irupector ~ ; Southold, New York 11971 Gary Fiah '"A!~t ~ ;s : S° Fax (516) 765-1823 Building Inspector Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspeaar OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD APRIL 1, 1992 SOHN BERTANI BUILDER, INC. 1380 OAKWOOD DRIVE SOUTHOLD, NY I1971 RE: SHELDON & HELEN SALZMAN To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file, (Enclosed) xxx No Underwriters Certificate on file. xxx The check is x(~~~Y~1r~xJnot on file. )$25.00 No Health Department Approval on file. No final inspection has been made. xxx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 20225-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: SHELDON & HELEN 5ALZMAN ' c:` J i;:S. _ .'_J;i i~J;.: ~ jl ~i::-(i•1LNT~ OUJIDATZ0:1 _(1st) _~~i H~ • FOU:IDATI011 (2nd) _ 2 . ` o ?OUCH FRki~fE & .PLUMBING • I ~ / ~ - y 3 . I, ~ 1 m n iNSULATZON PER N. Y. I H I~~ STATE Et1ERGY I~ CODs II a . 3 3~ v _ ~ m `II ~ _ FI;IAL • ADDITIOPIAL COMMENTS: ~ . M • x y '-1 ` •n ~ \A,\\ ' A F H ~i \W ' O . m • • o i ' m -a H • a 1 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ) ROUGH PLBG. [ ] FOUNDAT{ON 2ND (IrNSULATION [ ]FRAMING [ ]FINAL REMARKS: C~'~~~~ii DATE ~ ~i INSPECTOR t 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION ~RAMING [ ]FINAL REMAR : ~~~W s~ ~ ~ C~ DATE ! ~ ~ INSPECTOR ~ cc~~ c~~ c~~ ~ ~c~. FOR NON*ELECTRIC HEAT) DESIGN CRITERIA 6,OOa Degree Dale ( O,A, 10 l I,A. ~0°F _..r_ 4 fS~y(~ ~Cv/S ~ ~ __..__._..,___._.M_._..~_._....._._..._._....._ _ _ .,w.__w..._,~.,-____,_ -~S`U ~ S YS ~i AQE Aks~c~ °r`Jt~'Rtf~L R~M,~R e~ s • /tatrrG , _ ...-__,r~, . Exterier Walls (Opaque) i3 JJ ,oS~ t/ya Clasing J ~ Z.3~ - ~L7 ___.__.,..---_.w.__..........__..~__._.,.-._____._._.._.._._ Il~ern Ctilina/Roof (Opaque) • ° t' ,..._.__..~k~ _.~,d~'_ . $kYli¢htn L.~ 9b' L, p F~vndation Walla ~ - . T._______.__._. - _ Elab 1'neulatien TOTAL ~ ~ Nsteat ' Railding Eaaelepe Syetetttn t© Meet requireAente of 9~1,~,t HVAC'Equixneat to meet regrirextentn of 7a1y.11 ' HVAC S'yRtern to sect regifirenente of 7~15,]t , . Ditet S~eteua to Beet regniretwente of 7fb1S.13 VF.ntila.tienn $teteRa to meet require>aentn of ~R15.1b Ineulatien of Pipina 'Aymtewn to meet require7Rentts of 7g1'S.15 Service Water. ueatina Syetewrs And Eijvipuent to meet Regtaire9aents of 7415.11 Electrical an~1 LSahtinR Sytttetx~s and Egtti.patent to acct requlretnentts ®f ~A15.31 7'® tie btet of try Knexledae, K~0~ NEFg yo belief, and prafennional ~a NcEna. ~co 9,t, ,jtl~l¢e7Ment, these rlann are in y~Q¢ Tir co>wpliance with the code. 4 ~ ~ r w ~ w r ti' ~ ak J• 032254-7 F ~ dp'ioFESS1Dw*\. ~a B~ i ~ ~ 95-206 (9186)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE -x/738'-0039 00 ~ ~ = ~s r FACtLITYIPROGRAM NUMBER(1 PERMIT EXPIRAT N DATE(s) Under the Environmental Conservation Law oa/~'/9~ Article 15, Title 3; 6NYCRR 327, WaterROualOity~ Certification ~ Tid II Wetlands 328, 329. Aquatic Pesticides P oltecton ofltWater ~ SPDES 17, Titles 7, 8: ~ Solid W st TMa a~geme tRR 360: Wateles5ppiYtle 15: ~ ArtlPlollution Control* ~ Hazardous Walste~Management3~ Article 15, Title 15: ~ Article 23, Title 27: ~ Article 34: Water Transport Mined Land Reclamation Coastal Erosion Management Longelsland IWellsS. ~ Frelshwat r Wetlands ~ Floodpla n Management Article 15, Title 27: N-New, R-Renewal, M-Modification, Articles 1, 3, 17, 19, 27, 37; Wild, Scenic and Recreational C-Construct (`only), 0-Operate (*only) ~ 6NYCRR 380. Radiation Control Rivers PERMIT ISSUED TO i A RESS OF PERMI EE ,hl " ~ ) IS ~ AG NT FOR PER TTE EfCO TACT PERSON TELEPHONE NUMBER ~d f S/ .76~ _ S2 NAME AND ADDRFj6tS OFCPRO~IECTjFACILITY (If drfferent from Permittee) LOfA~I~Of PROOjE~TfFA LITY COJJN~(~/t a TOWN~TI~~LLAGE UTM COORDINATES -DESCRIPTION OF AUTHORIZED C IVITY GCJ• -Jf-J}.uT f 5 `Lf~t'_1 Construction ex ans on modification of a r an existin sin le-famil dwellin and more than 75 ft. landward from the tidal wetland boundar or restoration reconstruction of an exristiin functional facilit ~t7?l~ ~ a~ be +n QCCorc~Lc~, w i ~1n ~Le ~P,d NY~S d~`~ /o ~~fs GENERAL CONDITIONS By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli- ance with the ECL, all applicable regulations and the conditions specified herein or attached hereto. 1 The permittee shall file in the office of the appropriate regional permit admmistrotor,orother office designated mthe special conditions,anotice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him/her promptly in writing of the completion of the work 2 The permitted work shall be sublect to inspection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if the public interest so requites pursuant to ECL §71-0301 and SAPA §401(3). 3 The permittee has accepted expressly, by the execution of the appbcanon, the full legal responsibility for all damages, director indeed of whatever nature, and by whomever suffered, arising out of the project described herein and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and descrip~ tron resulting from the said project. 4 The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when a) the scope of the prolect is exceeded or a violation of any condrtwn of the permit or promvons of the ECL and pertinent regulations are found; or b) the permd was obtained by misrepresentation or failure to disclose relevent facts; or c) newly discovered information or significant physical changes are discovered since the permit was issued 5 The permittee is responsible for keeping the permit active by submitting a renewal appbcatwn, mduding any forms, fees or supplemental information which may be requited by the Department, no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date 6 This permit shall not be construed as conveying [o the applicant any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work or as authorizing the impaumen[ of any rights, title or interest m real or personal property held or vested in a person not a party to the permit 7 The permittee is responsible for obtaining any other permits, approvals, lands; easements and tights-of-way which may be requ ved for this prolect 8 Issuance of this permit by the Department does not, unless expressly provided for, modrfy, supersede or rescind an order on content or determination by the Commresioner issued heretofore by the Department or any of the terms, conditions, or regwrements contained in such order or determination 9 Any modrf¢ation of this permit granted by the Department must be in venting and attached hereto PERMIT ISS ANCE DATE PER T ADMINISTRATOR ADDRES~®~.®~ ffi ~ 87Ei$.• r$® ty'Z7 P98' /O i~ avid DeRid AUTHORIZED SIGNATURE , n //f p. /f// ~E~7(/~e3~ Page 1 of oaas~ • co ~ ~o - THE NEW YORK BOARD OF FIRE UNDERWRITERS eACr 1 1Ni~i1071 BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 70038 Du eP AI'~TL `l~ir1992 APPliration No. on file ~I~~Q~F592 ~ ?32brJ9 THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant Homed on the above application number in the premises of $MEt1IlON $AG`I,MAM, 49'a M~RTtS 1"ARI.~iF[ U[2IVF, a01JTHGLiI, M.Y. ~ in thefoliowinq hrcationg ®Rasement ~ Ist FY. ~ 2nd F1. r*A~(Q~~ 3ertlon Block Lot ~ uas examined un AI? ti T fa 1.3 + 19 ~ 2 and found to be in coutplianPe with the reyuirernents q(this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS ~ OUTLETS ECEPTACIE$ SWITCHES INCANpESCENi FlU00.E5CENt OTHER PMT K W. PMT K.W PMi KW. PMT K.W. AMT. H P. Zb ~1 l~ l~ 1 DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'PT TIME CLOCKS FELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W. Oll ry H. P. GAS H. P. PMi NO. A W. G. AMT. PMP. MAT. AMPS TRANS. PMi H P NO. OF FEET AMT WATTS L SERV^.CE DISCONNECT NO.OF S E R V I C E METER No.OF CC CONp A. W, G A W G. A. W G PMi AMP. LYPE EON7 1%2W 1,H 5W 3%SW 3%4W PER% OF CC.COND. NO. OF HbLFG OF HbLEG NO OF NEUlRAlS OF NEUTflAL I ao~ cu a x 1 11(2>a ~ z,/~ OTHER APPARATUS: c, e.c,r.l..3 G~~~ ' G & 5 C~MTRACTMlt LTC.~t5`!S-C C~j~9~ EtgX 215 9ftUTt[OY,I) L MY, 119'73 GENERAL MANAGER 11 Per y This certificate mLlst 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 BE ALTERED IN ANY MANNER. `l' 'rr~ f ; r ~ .-r' t i ~ ~ ~ 6` ~('j~~ . tr•~ gi: m w ~ J~ r.~ ~ 8 , <`'~I ~ u m ~d.cu ~ y 2 ~ ~I~, cw o I Wf tl = O i W 0 ~I 4 fit mm M Q.`~i~z ~.i CJ; I G b+;W wyW ~ Ni w• I J~ z~ ~ ~ ~ mr~ a ~i ~I ~ r.~ n' w F LL~~ ~ 8 n~ ~ ~I z. oI ~ a' W7 ~ d W a o, OII Q ~I F. n, C_~I I. ~i _.._J W.W J ~-1 i' =1 W w z 0 . v~ ~ w J 4' / ,1y 1139 i ~ 4 ~ ~~F O'S6Z m - M Ol i0~~1'S p °p m m e ~ ~ ~ . ~ 94z x ~ a. is y IMj yl'IYM ( {~V~ ~ PAILO TBM v T PA,.p 4 ~[j 77 ~ )~LJ~. . ~ o N lii5 r ~ L , .jµ.aq. '..so a `r p jii'•oQ~a i. Pswo.a O in D I- t' N i L rte, "~f,~~. t• ~j O~ Y~'~Y9it.A r.GG{~„ryyLG¢OO.i~ ?r Z ,GI r) :-0-- ; m 0871 m M (s w/ Y r O'SZ£ - '3,0150, I'N J ti Z'9 . ~ O . li (301Y3Q)5.7~21j ~ Q N 0 3'IVq SVOJO ~ ~ z ~ 3 z. ~~-~J O W W • Y ~j' N ~ . N oIF'~i Q,~,, 1 wlz~.`0~ f' B0,1RD OF HEALTH ~yC~~~~,~~~ r'p:~:`ty ANO.1 3 SETS OF PL.A:1S FORt SURVEY 1 - , ~ ~ TOWN OF SOUTHOLD CHECK ~+r~ ' I' BUILDINGDFPARTMENT SEPTIC FoRrt Qt+' I6I:~~I ~ TOWN HALL ~~m $OUTHOLD,N.Y.11971 NOTIFY; _ C~ i k3lhr ~r _;:i°• TEL..7G5.1B02 C LL ~~l•~ xa TO~J~~~~"/t l~~r~ nom. ~ r A L 'C0: . Appravcd f~~ 1~l~Pcrmit No.. w ~ Z- .j ~ . ..3. Disapproved a/c _ . (Bt•ding pector) APPLICATION FOR BUILDING PERPr11T . Date I... i I5g ` INSTRUC'T'IONS a. Tltis application must be completely filled in by typewriter or jn ink and submitted to the Buildi tI, ;ets of plans, accurate plot plan to scale. Fce according to schedule. inspector, with b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public strce or areas, and giving a detailed description of layout of property must be drawn on the diagram which ispart of this app 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 appliant. Such perm shall be kept on the premises available far inspection throu;ltout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a CertiL~ of Occupant shall have been granted by Ute Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or Cor removal or demolition, as !sr-_in describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ti admit authorized inspectors on premises and in building for necessary inspections. • •(Signature of applicant, or name, if a corporat:on) • ' • ('~&O • Crj~E~t3Jp~tj S6v`E{wCl~ (Mailing address of app icant) 1•l~t • State whether applicant is owner lessee a~ 7( . vent, architect, engineer, general contractor, electrician, plumber or butlder. .......~~c•o~......... Name of ownerofpremises ...~~.,~1~;~.~~?!-t,,,~,~;c,`z;y~+'1~ (as on the tax roll or latest deed) • ~ • ~ ~ • • !f applicant is a corporation, signature of duly authorized officer. .a~~:~-:...:.. (Name and title of cotpora[et oftccr) Builder's Liccnsc No. , , ;L ~ ~R , j{ .y. Plumber's Liccnsc No. . ~~,,~;t~/h^(~~'~. Elcc2rician's Liccnsc No. , A~ ,~!rtR.nnl. ,.l/l,c~, ,C; , Other Trade's Liccnsc No. ,~/~,,Q~ :/L~l~ • Locatio`nrnof land on which proposed wor~k~„will/bt: done; flouseN ~bcr .Nllt~d'~.~~17i'r~:E.~..~~(~~.......~Q~CY~:~ . . Street Nanilet " County Tax ,,\faN No. 1000 Sec ,7,~, lion BI'ock _ ~ • r' Subdivision Lot , ~:r Tiled Afap No. State • (Name) Lot `~tsting use and occupancy of premises and intended use and veto a p. n:Y of proposed constrttc[ion: - ~ - a. Existing I e ' use and occupancy ...©ll~~..~tA? ..[7,'t~/'z'l.c.~tdJee ' /1 .......l. b. Intended use an tt tt 61 d occupancy _ . . . I i , 3. Nature oCwork (cheek which app'licable): New Ouilding , , Addition ,V(etabon Repair , , , , , , , RFmoJal . Demolition ,Sai:anin ; pool. Tennis Ceurt~ 'ccessor ~ ~ ~ " ' _ ~ y Building. .Fence .Other lJork`. 4. EztimatcdCost...,~, •pOt~, _l.,tf 601. .Fee ............f . (to be paid on filing this application) 5. If dwelling, number of dtvclling units , , , , , , , , , , ; , , , , Number of dwelling units on each floor . ICgaragc. number oC cars 6, if business, commercial or mixed'occupancy, specify nature and extent.of each type of use . • • 7, Dimensions of existing structures' if any: Front . , . ; , , , , , , Rcar ..it}.9~ , , Depth . ~ • Hcisht ,'7.P.t..... , , Number of Stories . . J„ • • . • . Dimensions of same structure with alterations or additions, Pront ,Rcar . ~ ~ ~ ~ ~ ~ ~ ~ • Depth ~ (A~ . . IIcight ....?r~.. . Nucccbcr of Stocks .....v'(.__... S. Dimensions of entire new constnt'Iction: Front , : ~ : , , , , , , , Rcar . . (ot~ Depth ...L'1.. • • Hciaht (Jumb,cr of . 9. Size of Iat:~Front l00 Stories . 10. Date of Pu . ~.I~~S~. Rcar .'.IA.~ Dcptft ....~:.1~.._.......... . rchase ~ , Namc of Former Owner _ _ 11. Zone or use district in which premises arc situated . , p4 , , _ Does proposed construction violate any zoning law, ordinance or regulation, (l,~.C~.. 13, Will lot be regraded , ,b,0,O ~ , , , \Vill excess Gll be removed Crom premises:. ~ Ycs , .X, No l•{, Name of Owner of premises .~$,$~'L!u~t! , ,Address , , Pltonc No. . Name of Architect , ,Address . Phone No... • . • Name of Contractor .)B~lf, , , (~(l~,pgf,~..y~ Address t'~vljJ~t 1. ®!Z..~ne No...7~4'~.: C~F!j 1S.Is this property locaC~ed within 100 feet of a tidal wetland? *YSS. HO.... *If yes, Southold~Town',Trustees Permit may be required, PLOT DIAGRAI~i Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back d'unensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ~~1l.~.~ , STATC OF \E1V `~,OR1:, S S • , • • • • • • .(N m(+ oC indvi~dua~! s~nit~l ~ ~ ~ ~ ~ ' ' ' ' • being duly sworn, deposes and says that he is the applican • ( g g contract) above named. r He is the . e~1?•e~:..'c~t~ (Can tractor, agent, corporate officer, etc.) . ~ • • of said owner or owners, and is duly ~',authorizcd to perform or have performed the said work and to make and file tlti: application; that all s[atecnents contaiiccd in this application arc true to the best oChis knowledge and belief;and that tht `work will be perl'ok?tted in the manner ~ct forth in the application filed therewith. Sworn to bciorc me this ~ ....day of . .........L%( .t.... 19 1.~ • ~btary Public,•",•¢~t, Q,~~.,~.. ~l'!~County • r HELENE D: HORNE • ~ • ~~u~~~~ • Notary Public, State of New York • • • • No.49613R4 Y ~ ~ (Si;na[ure oC applicant: qualified in Suffolk Count Commission Expires Mav 22, t _ _ i