HomeMy WebLinkAbout19881-z
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22153 Date FEBRUARY 22, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 2669 MEADOW BEACH LANE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section I16 Block 4 Lot 16.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 12, 1991 pursuant to which
Building Permit No. 19881-Z dated MAY 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 GARAGE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to NEIL & AMY McGOLDRICK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-266050 - FEBRUARY 10, 1993
PLUMBERS CERTIFICATION DATED N/A
c-
~uilding
I` tar
Rev. 1/81
k.
rosa~s xo. #
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALT.
SOUTHOLD, N. Y.
BUILDING PERMIT
{THIS PERMIT MUST 13E KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereb nted~ ~ ¢ ~
~
~ ..3 ~
.........~..f
........~::.....~~~~~~a~,~~- o
~ _
at premises located at
..~s~~~f
..................~~~~..,r~..........
. ~:....~~:~..~:~~c~~,~!r1~........................................
County Tax Map No. 1000 Section Black .........T........... Lot No......~!~!...S.F:....
pursuant to application dated ~ 9.~1., and approved by tine
Building inspector. %
Fee s... .
~~Idtng Inspector
Rev. 6/30/80
_ _ ~ Form No. (
J M I (J.
• TOWN OF SOUTHOLD
"v>,
BUILDING DEPARTMENT ~"~`~r a-
• ~ TOWN HALL ;t,`~~~~„r J ~
765-1802 s~ ~,i'i
a
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 17 lead.
S. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
t responsible for the building. _
6. Submit Planning Board Approval of completed site plan requirements.
3.~ 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.
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 Euilding - $100.00
3. Copy of Certificate,of Occupancy - $5.00 over 5 years - $10.00
. 4. Updated Certificate of Occupancy - $50.00
S. Temporary Certificate of Occupancy - Residen//t~~ial $15.00, Commercial $15.00
Date .ll~~?4?C
V ' ,7~ • i a9?
ew Construction. Old Or Pre-existin Bu
C g ilding, , x.
'ccation of Property: rl(?~'C7, ~Lt.) St,t~-~p(.k. ~L',•
House ~N,o/. 1 Street Hamle
ewer or Owners of Property.L~(QJ ~''IC~O~C~,rI,C~,',..
aunty Tax Map No 1000, Section.....~j ~.....Block....~~,,........Lot..,~r,;~,,,,__..
•
,bdivision. ,Filed Map...........,Lot.,
~rmit No.. `I,Q~~S'I:~.....Date •Of ,Permit........... C . • • ...y...{......
.....Applicant.-?Q,M.(df~.~S. E. ,'°~~,(,~t.,A',Y)~...
al[h Dept. App roval........~,,~!/~,,,,,,,, „Underwriters Approval
anning Board Approval........:K/~...,,,,,,,, •
quest for: Temporary Certificate........... Final Certicate „
e Submitted:
CC ~.vZoIIS ~ APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS J.
io~0t:)7.43 BUREAU OF ELEGTRIC:ITV~
65 JOHN STREET, NEW YORK, NEW YOF2K 70038
Date ~~7JJ177713i°Z .~E9,.7~~~ Application No. on file ~i~~~l~T99~'9~3 ~ 25fit~51~7
THIS CERTIFIES THAT
only the electrical equipment as deacrlbed below and introduced 6y the applicant Homed on the oboue application number in the premiaea of
plr,(~p7,pftICECr Nk;$f7f}4f [IP;L'N J,RNkI, RtAT'~:1.1'i7l;R, N.Y,
? 1st Fl. ? 2nd FI, Section Block Lot
fn thP. fallawlnR llleatiOn' ? Ba.9enLe>L[ ~nJ~ ~C}~rA
uns examined on .1 f'E7<3UR.724 23,P99:4 and found to be in compliance ulth the requirements q/'this Roard.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIUORESCENi OTHER AMT. N.W. AMT. K W. M1i. KW AMi K W AMT, H P
2 b h
DRYERS FURNACE MOTORS FUTURE APPLIANCR FEEpERS SPECIAL REC'PT TIME CLOCKS ggLL UNIT HEATERS MULTI-OUTLET DIMMERS
AMC K. W. Oll H. P. GAS H. P. AMT NO. A. W. G. AMl AMP. AMT AMPS. TRANS, AMT, q p SYSTEMS pMT. WAi15
NO.OF FEET
Q
SERVICE DISCONNECT NO.OF S E R V I C E
AMi AMP. TYPE METER ~ ]W ~ ~ DW 3,9 3W 3,a 4W NO. OF Cf. COND. A W G NO. OF H4lEG A W r'' NO. OF NEUTRAIE p' W' G'
EQUIP. PER A" OF CC. COND OF HbLEG OF NEUTRAL
OTHER APPARATUS:
t?.I~,C. Cc-2
- _ AD
l
r.~Plr, rarnfJ~. ~Ixcrs~Ir~a~T rtac. Paxc.az~azz ~
27.R R7V~RfJPs'Al? YtD
W. BAHP1'OkJ 97A t~.C,Q ~`(I $7.9'79 GENERAL MANAGER
Per ~ P
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THtS COPY OF CERTlF7CATE MUSt NOT BE ALTERED IN ANY MANNER.
C
765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ INSUL{lTION
O
[ ]FRAMING [ ]FINAL
' REMARKS:
C~~~~
i
l
G
DATE l/ INSPECTOR
gU~FDLe~
TRUSTEES ~p ~ SUPERVISOR
John M. Bredemeyer, III, President r.'~®f SCOTT L. HARRIS
Albert J. I{rupski, Jr., Vice President ~ t ~
Henry P. Smith ~ nai Town Hall
John B. Tuthilt a ~ 53095 Main Road
William G. Albertson ~~~Ol ~ P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
t -.~~j,_.r y_
November 23, 1992 i ~ ~ ~ ~ ~ ° ~ -
No~ z ~ 19~z
"p. E}$
Roy Haje i'i ~3;; _ .
En-Consultants, Inc. P'Ju1+~IC~F~„t~EjTN
1329 North Sea Road ~g
Southampton, NY 11968
RE: Neil McGoldrick
SCTM #1000-116-4-16.4
Dear Mr. Haje:
The following action was taken by the Southold, Town Board of
Trustees on Friday, November 20, 1992:
RESOLVED that the Southold Town Board of Trustees grants a
waiver to construct a swimming pool and deck landward of
existing bulkheads.
If you have any questions, please do not hesitate to contact
this office.
Very truly yours,
~ Q
John M. Bredeme~I
President, Board of Trustees
JMB:jmd
cc: Bldg. Dept.
INSPECTORS
Victor Lessard ,,yy~~~`-~+JFFi)(,~',
Principal Building Inspector f~~~.. ~~I,
Curtis Horton ti~ :A~ SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~ ~ Southold Town Hall
Thomas Fisher ' r'Y t "~'t
~ ~ `~"m+~° ~ ' P.O. Box 1179, 53095 Main Road
Building Inspector O ~ r :y
Gary Fish f
~ Southold, New York 11971
1 ,~y Fax (516) 765-1823
Building Inspector uyv'
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
OCTOBER 26, 1992
NEIL McGOLDRICR
1669 MEADOW BEACH LANE
MATTITUCR, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
~ffi[ No Underwriters Certificate on file.
The check is (outdated/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 # 19881_Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
9'~-20-6 (10190)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER ~ EFFECTIVE DATE
1-4738-00265/00001-0 ~ May 7, 1991
FACILITYIPROCRAM NUMeE R(s) ~PERt~AIT EXPIRATION DATE
Under the Environmental Conservation Law (ECL)
May 7, 1994
TYPE OF PERMIT (Check All Applicable Boxes)
®New ?Renewal ?Modrf¢ahon ?Permit to Construct ?Permit to Opera[e
Preltection~ofltWat r ~ SPDESI7, Titles 7, 8: ~ Hazardous Walste~Management3
Article 15, Title 15: ~ Article 19: ~ Article 34:
Water Supply Air Pollution Control Coastal Erosion Management
Article 15, Title 15: ~ Article 23, Title 27: ~ Article 36:
Water Transport Mined Land Reclamation Floodplain Management
Lotngelsland IWelisS ~ Frelshwater Wetlands ~ 6NYCRR1380: Radation Control
Article 15, Title 27: Article 25: ~ Other:
Wild, Scenic and Recreational ~ Tidal Wetlands
Rivers Article 27, Title 7; 6NYCRR 360:
6NYCRR 608: ~ Solid Waste Management
Water Quality Certification
PERMIT ISSUED TO TELEPHONE NUMBER
Neil McGold ik 1516)748-2429
ADDRESS OF PERMITTEE
86 Se d S ee G rden Ci NY 11530
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
T S -25235 M in Rd C h ue NY 11935 15161734-6405
NAME AND ADDRESS OF PROIECTIFACILITV
7690 52
LOCATION OF PNOIECTIFACILITY
I
COUNTY TOWNICITYIVILLACE WATE RCOURSEIWETLAND NO NYTM COORDINATES
E:~ _ N'4
DESCRIPTION OF AUTHORIZED ACTIVITY
by Thomas C. Samuels dated February 24, 1989 last revised 3/15/91
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance
with the ECL, all applicable regulations, the Generp~J~ Conditions specified (See Reverse Side) and any Special
Conditions included as part of this permit. a
iz,~,>rc~r -
• -
PERMITA MINIS RATOR ADDRESS s-T`~1Lr xT;~-;;; _ -
AUTHORIZED SI' ATUR~` ~ '~/DATE 't•'=-s~=:^c~
Page 1 of `f'
GENERAL CONDITIONS
Inspections
1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours
and intervals by an aut}~orized representative of the Department of Environmental Conservation (the
Department) to determine whether the permittee is complying with this permit and the ECL. Such
representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of
this permit, including III referenced maps, drawings and special conditions, must be available for
inspection by the Department at all times at the project site. Failure to produce a copy of the permit
upon request by a Department representative is a violation of this permit.
Permit Changes and Renev~als
2. The Department reserves the right to modify, suspend or revoke this permit when:
a) the scope of the',permitted activity is exceeded or a violation of any condition of the permit
or provisions of the ECL and pertinent regulations is found;
b} the permit was obtained by misrepresentation or failure to disclose relevant facts;
c) new material information is discovered; or
d) environmental conditions, relevant technology, or applicable law or regulation have materially
changed since tF~e permit was issued.
3. The permittee must submit a separate written application to the Department for renewal, modifica-
tion or transfer of this permit. Such application must include any forms, fees or supplemental infor-
mation the Department requires. Any renewal, modification or transfer granted by the Department
must be in writing.
4. The permittee must submit a renewal application at least:
a) i80 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES),
Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid
Waste Management Facilities (SWMF); and
b) 30 days before expiration of all other permit types.
5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede
or rescind any order or,'determination previously issued by the Department or any of the terms, con-
ditions or requirement's contained in such order or determination.
Other Legal Obligations of'IPermittee
6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili-
ty for all damages, dirf;ct or indirect, of whatever nature and by whomever suffered, arising out of
the project described in this permit and has agreed to indemnify and save harmless the State from
suits, actions, damages and costs of every name and description resulting from this project.
7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with
the riparian rights of others in order to perform the permitted work nor does It authorize the impair•
ment of any rights, titl2, or interest in real or personal property held or vested in a person not a party
to the permit.
8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-
of-way that may 6e re'~quired for this project.
I
Page 2 of
95-20-6a (10)90)-25c '
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Pak 608 ( )
9 That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the
teration in the position of the structure or work herein authorized, or project.
if, in the opinion of the Department of Environmental Conservation 13, Any material dredged in the prosecution of the work herein permitted
it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across
waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a
the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of
resources of the State, the owner may be ordered by [he Department to a waterway.
remove or alter the structural work, obstructions, or hazards caused 14. There shall be no unreasonable interference with navigation by the work
thereby without expense to the State, and if, upon the expiration or herein authorized.
revocation of this permit, the structure, fill, excavation, or other 15 If upon the expiration or revocation of this permit, the protect hereby
modification Of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense
pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the
extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require, remove all or
Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site
structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of
and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration.
the State of New York on account of any such removal or alteration 16 If granted under Article 36, this permit does not signify in any way
10 That the State of New York shall in no case be liable for any damage that the project will be free from flooding
or injury to the structure or work herein authorized which may be caused 17 If granted under 6 NYCRR Part 608, the NYS Department of Environ-
by or result from future operations undertaken by [he State for the mental Conservation hereby certifies that the subject project will not
conservation or improvement of navigation, or for other purposes, and contravene effluent lrmitations or other lrmrtations or standards under
no claim or right [o compensation shall accrue from any such damage Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977
11 . Granting of this permit does not relieve the applicant of the response- (PL 95-217) provided that all of the conditions listed herein are met
bility of obtaining any other permission, consent or approval from 18 All activitees authorized by thes permit must be en strict conformance
the U S. Army Corps of Engineers, U.S. Coast Cuard, New York State weth the approved plans submitted by the applicant or his agent as part
Office of General Services or local government which maybe required. of the permit applicateon.
12 All necessary precautions shall be taken to preclude contamination
of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by NYSDEC
solvents, lubricants, epoxy coatings, paents, concrete, leachate or any approved on 4/26/91
SPECIAL CONDITIONS
1. A71 roof runoff must be directed to drywel1s adjacent
Supplementary Special Conditions (a) thru (j) attached.
DEC PERMIT NUMBER
1-4738-00265/00001-0
PROGRAMjFACILITV NUMBER
Page of
.;i~~'r"
~f~1
VICTOR LESSARD ~ , ~y:~,~, Town Hall, 53095 Main Road
PRINCIPAL BUILDING INSPECTOR ~ `r;~:, f
cy; ~ ~ rn P.O. Box 1179
u ' ~ ~ Southold, New York 11971
(516)765-1802 y ~~:r:{~ ti
FAX (516) 765-1823 ""T'~ -
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
THOMAS SAMUELS
@ NEIL AND AMY MC GOLDRICIC
25235 MAIN ROAD
CU,~CHOGiIE ~ N ;Y ;1 1935 , , . ,
Qn order to issue a Building Permit for your
proposed construction for buildings located on lots ad-
jacent to tidal water bodies, we will need a waiver of
jurisdiction or a permit from the New York State Depart-
ment of Environmental Conservation.
Yours tS'`r ly,
Building Insp/ctor
1Phone Numbers:
D.E.C. 751-7900
Town Trustees 765-1892
- - ,
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rOUIJDATZON (1st)
FOUNDATIOtJ (2nd) -
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ROUGH FRAME & ~
PLUMBING
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IIJSULATIOPI PER N. Y.
STATE ENERGY
CODE
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FI;JAL
ADDITIOPIAL COMMENTS: x
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i~ ~~~~~[~Ll~lf.~F=:a
I~ - ~ ~ .
pp B0,\RD OF HEALTH
fOAMN0.1 3 SETS OF PLAYS Y,,,,~~~'
-m~..~~ .
~ TOWN OF SOUTHOLO ClfECkY. • ~/Q, ~ . • . .
BLDr, Gi;YT. BUILDING DEPARTMENT ~ ' '
TOWNUfa0U7Nt3i~~i'1 ~ SEPTIC FORPf
~ TOWN HALL .
SOUTHQLp,, C~1,Y_ 1tr171 t:OT I FY ~
TEL.: 7G5~1II02 CALL a3~! ; ~ e/ 0,~,~_ t .
Examincd.~,~~,,,,,. , l9 MAIL T0:
Approved 19GJ~ Permit No.. ~9~p .
Disapproved a/c . _ .
(utiildin~ ector)
. APPLICATION FOR BUILDING PERMIT .qj //!f q
Date. ti~.1F~~F~......IS.
• INSTRUCTIONS
a. This,application must be completely filled in by typewriter or in ink and submitted [o the Building Ins
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•strc:
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF
' 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 perry
shall be kept on [he premises available for inspection throuarout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certif)cate of Occupant
, shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pezrrrit pursuant to t:
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Reculations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec
The applicant a!trees to comply with all applicable laws, ordinances, building code, housin, code, and regulations, and t
admrt authorized inspectors on premises and in building for necessary inspections. ~ Q~
(Signature of applicant, or name, if a corporatton)
_.a5~'?5:vlaati,l~oa,~lx.~~clv,~~
(Alailing address of applicant) ~ ~ ~ '
State whether applicant is owner, lessee, agent, architect, engineer
~A,,,,,,/~ ~ ,general contractor, electrician, plumber or builder
Name of owner of premises ••..•••y"4~ll~it/4GV/",..••.....
1~:P~ . ~ i
If applicant is a corporation, signature of duly authorized officer, the tax roll or latest deed)
(Name and title of corporate officer)
Suildcr's Liccnsc No_ .f~,[)„
Plumber's License No. 7js^1?, , , ,
Electrician's License No. , , , , ,
Otltcr Trade's License No. .
1. Location of land on which proposed work will b ~ do g/~~
/6 ~ 9 A~~y~vu~ /3~~
flousc Nuntbcr .....Street
Hamlet ~
County Tax ,c\1upNo. 1000 Section ~/J ~
Block .
Subdivision it,~t • . • Lot
F.ilcd Alap No. t1.A. •
State cxistin~ (Name) • Lot ~a;
o use and occupancy of premises and intended use and occ+upanc///y of proposed construction:
A. );xisting use and occupancy..... ~~„f ~iI4'Ll~.. Y'G,dIO~P.D1,Ce.
B. Intended use and occupancy.'........... , ,TLC,~LLJ ~y/... • . • • . • •
00 ..aa ~ c'e .
I=.~w. ~
• ~ .
3. NaPurc oC worl. (chech.w'hiRhmt~plicable): IYcw building , Addition c t o . , , - - , ,
Re air' Qval Demolition ,Swimnin~ pool. ,
Tennis Court Accessory•IIuildin ~ ' " ~ "
4. Est m ~Al? g.......... Fence .......Other Work:........ .
i ated Cost..... F~~. Fee.....................................
(tn be oaid on filing this aDplication~
5. If dwelling, number of dwclling.lunits,,.l, QFt.ee Nttmbcr oC dwelling units on each floor , , , , , , , ,
ICgaracc. number oC cars , t'?:Q
6. IC business, commercial or mixed occupancy, specify n tuyc and extent of each t pe of use lte4
7. D ^i isions~~i~isOt~tg structur4s, iC any: Front . , , ~r?'. ~u , , , Rcar ...~6~0~~..... Depth ....,~„f ,lorr:: ,
Nunbcr of Stories , ~ ;'~SJI,Q, , g
Dimensions of sa c structure with alterations or addi ion Front , ,Fr,~~'
,•(Q!~ , , , , , , Rcar Q. rr
,~t~ n .y1 i
Q, . .
Depth ; Height .....ci1`~t'Q,~i ...Number f Stories . .~,Q. .
8, Dimensions of entire new constnmtion: Front , , ,a'~e?1-q~w, „a`212Ps5!~ , , , ,Depth o~~.~ Df' •
Height . , ~',3,t;-O M Nurrjber of Stories , , , , , .-f
yVp 2car . , , , , ,
4. Sizcoflct: Front .....'a~o~ .~E?~! .....................'A.~i:
P.car . Dc th ~t"r
10. Date of Purchase , ,•~~,%,%j$9, , ~ ~ ~ • , N~.1,me o Pogncr pwn r . ll~y/(? ~ ~p .2tHtf,rvi•
11. Zone or use district in which premises aresituated ....:!t,Qdl,~°Gt~"1 fL(' ~Q u
12. Does proposed construction viojate any zoning law, ordinance or regulation: . ~'1;Q .
13. \Vill lot be re;raded ~ , 1Vill e c ss t"Il be cm vcd from premiscs• Yr•
l4. Name of Owner of r ~ .tses . r ¢ ~ 2
p ~ •I -l-G. ~ . Address~k ~~s~('
•f~ Phone No.Z
Name of Architect . S~' , Address ap~~ n. D~,A.V Phone No.~~.rQ. ~a
Name of Contractor . , I ~fpl. , .{P1'!. Address I sQ: ~Q.~ CJ~ ...Phone No. ~.'.~/9 .
1S_Ls this property L~ca4ted within app feet of a tidal'vetland? ^Y7:S~..NO....
*If yes, Southold Towri Trustees Permit may be required,
PLOT DIAGRAtiI
Locate clearly and distinctly all, bui]dings, whether existing or proposed, and. indicate all set-back dime..^sior.: t:
property tines. Give street and biock;numbez or description according to deed, and show street names and indicate w;x:d.
interior or comer lot.
I
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(fwa)TI wGc+cGl ti`So .'~vew~ cJLz , ~joVtlf b w~G{•
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,
;
STATE OF NE1V YORK, 'S.S
COUNTY OF............~p~~,~,
'•fi1a C•
" " " " "'""U~`r: • • • • • • • • • • • bcin~ duly sworn, deposes and says that he is the appli:a:
(Name of individual signing contract)
about named. / J '
lie is the .....ItN'~ T,L~,~c... , •
~ (Contractor, agent, corporate officer, ctc.)• ~ ~ • ~ ~ ~ ~ ~ ~ ~ ~ ~
of said owner or owners, and is dul',v authorized to perform or have crformcd the said work and
application; that all statements contained m this application arc true to the best of his knowledge and belief; and tttat tlt:
work will be perl'orntcd in the manner set forth in the application filed therewith.
Sworn to beta/rc me this I,
,,°!~.-Z~ .....day of,.'.r.Y.l.~; ~c 19 ,fir/
Notary Public, ,/,~e~, ;,r~ . aunty
HEIENE D. HppN@ .
Rotary Public, State'of Newyork ~ ~ ~ ~ ' ' ' ' ~ ' ~ ' ' ' ~ ' ~ ~ ~ ~ ~ ~ ' ' ' ' ' '
No.49613IS4 (Signature oC appliean'
CommissioPn@[xpires MryY 2? f
9 •
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