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HomeMy WebLinkAbout19476-z FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20707 Date MAY 8, 1992 THIS CERTIFIES that the building ADDITIONS & ALTERATION ' Location of Property I8O BEVERLY ROAD SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 52 Block Z Lot 38 Subdivision Filed Map No. Lot Na. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 22, 1990 pursuant to which Building Permit No. 19476-Z dated OCTOBER 22, 1990 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 DECK ADDITIONS & ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE SANTIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-230956 - APRIL 7 1992 PLUMBERS CERTIFICATION DATED MARCH 25 1992 - K&K PLUMBING ~ HEATING °d ~ `"~L B ilding Inspector Rev. 1/81 lOBM NO. D TOWN Of SOUTHOLD ' i~U11.DING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS' PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Dnte ....~a/ 199Q.. N°_ 1 947G Z a ~ Permission is hereby granted to: ...G~e~dttr~.. ..mss.. at premises located at ....,,l~f~.......r~, .........~/1..~ ~~~G2~~~%~7~................................................................................ County Tox Map No. 1000 Section? ....///.4~ .2-:.. Block .........2" :...QQ. Lot No.......~.Q.......... ' pursuant to application dated .,.1.~/~,..~~ 19,/..~., and approved by the Building Inspector. / • Fee 5.~:~F.~.i' ' ~~ccs~`•~••• .r.. .t~l.(.1 uildin for Rev. 6/30/80 Form No. 6 3~ awe-. D 1.~~:~~`,~'~i1 TOWN OF SOUTHOLD ~~,bh.~ "n„U t i BUILDING DEPARTMENT J 3 ~i~! ` i~~ 765N1B02L ~ ~3~ ~ ~i~~ BLDG. s~~k'Y. TOWN OF SUUTWULyCtu„,„„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 Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 19 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 - $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 New Construction...... Old Or Pre-existing Building Location of Property.l.~~t'... ~ Gt/fi~tli House No. SCreet Hamlet _ y- Onwer or Owners of Property..~%:--~'1:~~~.....~~.~VJ..~~ County Tax Map No 1000, Section...:-~~.....-B1ock.....~.........Lot.. Subdivision...//. ......................F-filed Map........../..Lot...//.,,.......r~. p..~.ry~./r Permit No. l~`Y. .Date Of Permit ...Applicant. L~'~.~'. ~4?~... ~i. i,/.~ ?..1. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Tempo~~7rary Certificate........... Final Certicate........... Fee Submitted: $.2::?. ~ ~ ~ r ~ , Y3 78"2 . LD ~ aO ~ Q APPLICANT , ;,,,....:a 'CAL, '1 GS•1802 ~ ,~~s. ,Y~ . `5 «TpcyN OF 5t)'LSTTLEILT) , pu~ir itasr~cron orricea~'rainox~2a ~ M= 4.ti T ~VN211eLL t9'}i ~ `t. " O n^~ ~~a1 r~, T X F~~_-~ ~ F~ C~,~-~----" ; 3 ~,r pate :ao ~ ~4.. ~ No ~-,-r''_ T,~ Building Persnl~ G~~~~~ ~ ~ t7 S ~ 1 ~~Q pwner iPleaye Pr in CJ'ti~- r~Cr°„ ~ ~ 1 c~'`l J~ "~~,-may bc~~ Plus"`aec' page pzi,ntl ~G~S'.S ,a§. l~ _._-_~__-n tt~e war°x '~uP'PlY oy°tom , , ~'j~~.: ~ Sn Ldox Ugtacl L s~~~, 19s 1e1d. s, Y earti.£Y that ~ LO oC 'd„ than 2! oonraina 1es~ r.: ~.t ~ ~ ~ ' ~ ~ .g si.gnaeuxei iE'LarabEx he£orn mG thlg ~ ub1i.~/~-" ~ 6 ` Sworn aY tlf `Y~~ ~~1-`~'"~", ~yptatY e 19~ ~ CnuntY ppotaNP No'gg513~8kG.~ Q~ .,rt publi~• ~seion~~M}eY~'°..-- ~y noaarl ~ ~mm ~ , r;;, ~9 ;i, INSPECTORS t. Victor Lessard ,~~~FfO(,r~G' Principal Building Inspector ~c~,'i. f pG Curtis Horton u ' ~ SCOTT L. HARRIS, Supervisor Senior Building Inspector y ' 'i~;,, Ft's,' ~ Southold Town Hall Thomas Fisher w • y )'r" ~ P.O. Box 1179, 53095 Main Road Building Inspector ~ d~A a~ ~ r Gary Fish `°•°ll ~ j'J`',4, Southold, New York 11971 Building Inspector d Fax (516) 765-1823 Telephone (516) 765-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD APRIL 27, 1992 GEORGE SANTIS 41-11 28th AVENUE ASTORIA, NY 11103 RE: PROPERTY LOCATED @ 180 BEVERLY ROAD 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) %xx 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 # 19476-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. i l 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INS TION FRAMING FINAL [ REMARKS: i 4 r an.. DATE Z L- INSPECTOR s ~ ; . c 1cLD L;: S: _ ~~J„; n it ~;U:'•[i•itNi,^, t. ~ l( C D ~ V i 1 H r0U17DATI0N ,(1st) `-I - - _ _ rOUNDATI0IJ (2nd) _ 2. 'r ~y o ROUGH FRAi~1E & iC,G ~ p PLUMBING ~ / 3v ` 3. ~ m n T1ISULATIDII PER N. Y. STATE EPIERGY I k,~p CODs ~~-'7 . } . 3 ~ Ja~ a . "~v FI;IAL o ADDITIOPIAL COMME S: . ' ~ ~ lT} • x 'v / ~ H h~ ~ O L y~- x m a - H . S \pN ' b ~ m -o y - ~ i 1~~~~e 765.1802 BUILDING DEPT. t NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [)FOUNDATION 2ND [ ] INSU ION [ ]FRAMING [ INAL REMARKS: A~.c_..~ - Y _ ~ DATE ~ NSPECTOR ~j `k - - ~ - BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] R GN PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ c _ DATE ~ ~ INSPECTOR T65-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T ROUG PLBG. ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~-e-~ r ~ 9 ,4 DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGN PLBG. [ ]FOUNDATION 2ND [ NSULATION [ ]FRAMING [ ]FINAL REMARKS: ~J~~.; DATE ~ ~ INSPECTOR .~lq k F f a - ? _ 765.1802 BUILDING DEPT. t NSPECTION [ ]FOUNDATION i5T [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION MING [ ]FINAL c'"µ`` ~ ~ RE A~tKS: 7` ~ x ~ y ~ ~ DATE l~ INSPECTOR ~ ~ 765.1802 BUILDING DEPT. t NSPECTION [ FOUNDATION i5T ROUGH PLBG. [)FOUNDATION 2ND [)INSULATION [ ]FRAMING [)FINAL R6MARK5: E E l G _ DATE INSPECTOR I C~ l ~ / 765-1802 ~ BUILDING DEPT. INSPECTION [ ]FOUNDATION iST~ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION " FRAMING [ ]FINAL REMA S: -~-a~._--- ~~.v~ DATE INSPECTOR iZ~ FC-8669.4-55 k'OHM NU. 11 xOWN OF SOVPIiOLA BI7ILDINC3 DEPARTMk.NT mowN 1iA1b 50A'1'?TOLD, i1X DEVELOPMi:TJT YF:RMI'P !Jo /~G I' Date /0~~..3 ly~~. Perxniaaioy ie kioreby grrrntod bo: to~a2~.1~;~i~j, at premioet~ located nt /~,r6 County Tnx Mnp No. 1000 9ootiorr Bloclc Teat 3 ~ purauunt to c+Apllaation da,t®d _~/O 19~_, and ripprovpd by the Huilding Inapoctor. iuildini, Peaxait Pia< Du di ~ Tnspoctor ~v~~,w 4/f~0 r .\~7 o/ h e. s pool r j~ tlusfp !2'wfmarr i•~ rnv Ebn~.i~ y 4~q/ limn. / Pl 7~_ 5~--r1~7, _ ~ 1 q'. SEP7r~ in~a Inv.B~ TAnK H~$~ 2'm rl1 .'L a Goo'" rnY. @l.+S.tJ .J-~ ( wcfe~ B/.. L2; PLAN OF pROPO~~Q . SFpTiC SYSTEM ~ ~ 3 a o NORTH ROAD l C.R. 8 ~ ~ s ~ ~a ~ 3 W M Gf-'W~°/~~n '-~-3 ~ NlO/F GEORGE & MARY SANTtS ~ N 61. 59' !O' E 75.00' o+'r FE 12'N WOOD POST F ~i}t S OGf~ PIPE 9+ al AJE. Zp' `F. `o ~t /7Pw /o,GCr-?~io~ n ^'"Ni` • Hrr e w Rio P.~°.,Y. ` o~. T. .1f1 fiorrn4 c, P >•S rq V b o~ _~rnv CV~v, 5 to , ~ Q ~ ~ 3}° ~ t / j~W ~ m in ~ f.~ of f-~ rl N ~ h ~ ~ hti hh ~ ~ ~ ~ ~ ~ Q ~ h ~ l7 N ~ ~ bn p ~ !d , , p to ~~b ~ ~ b ~ ~ ~ ~ ~ ~ ~~M~~ ~ ~ ~ ~ ~ ~ ~C> i< ' io .i.f ~q ~ ~ ~ ~ ~ ~ N~ J ~ {~~d7} ? ~ C7 W ~ ~ O ~ p~7 rw m + ~ ~ ~ ~'j u ~ ~ ~ b ~ a c ~ ~ ~ ~ ~ < U p ..ti ~ , d I C ~ ~ ~ ~ U ~ ~ ~ O d b b O C1 C ~ d , ~ ~ V ~ Ca ~ ~ l,, ~ ~ ~ Cr+ ~ ~ j~ o ~~H G o v` v ~ c~~ o ~ ~ e~~~ i ~ z° ~ o Nq~il ~ ~ ~ ao~`° ~qw 2q~`n ~ ~ 0 -I o Z ~ NYC ~ Ib A n~ Sao ~ of t Fyn/NBER ~ ~ ~ z FORM NO. 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. Box 728 Town Hall Southold, N.Y. 11971 Main Road Southold,N.Y. jIPPT.T (`ATTf1N F(1R T1F.TJF. T,(1PMF,NT nFj?prtTT " Instructions: The application to the Building Inspector includes (each in duplicate) 1. Form No. 10 filled out"in ink, or.typewritten, 2. Sur- vey of premises with elevations above mean sea level, 3. Drawings of pro- . posed work. The application must give complete information to show that ' the proposed can comply to the Local Law No. 1-198,0, Chapter 46 of the Code of the Town of Southold known as "Flood Damage Prevention Law" of the Town of Southold. The applicant must submit approvals that any other agency requires. c General Standards as required in Section 46-17 of the law to minimize flood damage: A. Anchoring of structures, including tanks and mobile homes B. Use of construction material and methods C. Design and location of utilities D. Subdivision proposal with drainage, public utilities design and base flood elevations Specific Standards as required in Section 46-18: A. Residential construction B. Non-residential construction C. Mobile homes ' The applicant must submit plans and specifications as well as any other information requested by the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the base flood level the structure is water tight with walls substantially and impermeable to the passage of water, 2. that structural components are capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3. applicant must submit certification by a registered professional engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard.. area (V Zone) 46-19. Applicant shall submit plans, specifications including the required certifications and such other in- formation as the Building Inspector may require in that the provisions of 46-19 are complied with. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation with all space below open except breakaway walls. Sand Dunes. If sand dunes exist on the premises and the applicant pro- poses to alter same, plans and specification must be shown in detailed nature of any alteration submitted. Building Permit. A Building Permit is also required for any structure. Both a Development and a Building Permit must be issued before any work can start in a special flood hazard zone. A written disapproval or a permit must be issued within ten (10) working days. During construction, the inspector shall be notified in time so he may make the required inspections. Upon completion, the required certification of the final elevations and work must be submitted before the approval to use or occupy can be approved. (Fill out the form,on the back of this sheet) ~ f 11/85 a l ~ ~ ~.ter,.~::. ~i~. »kd'w`4.~.41 jF$~•' ~e:;.; ;'~a. >i. , Ex'~~,~ "y ~i. `aV ~ was l~f•`lktb'Y.+~'^t`a''4 ,.,,~ieh£l~' .e,e-F y r Application Received Disapproval Issued Permit # ~ _Ga Y 3 _ 19 9~ 19 _ /p_~2 3 19~ ' FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT ' IN THE TOWN OF SOUTHOLD i _Lp/s--,~ 19~D i. 'Pype os Oevetopme~}t Proposed: New Structure (including storage-tanxs Addition and/or Alteration Flood Proof Below Base Flood Elevation! Other (specify) ~ 2. Elevation Data in~,relation to above mean sea level of: _w (a) Lowest floor e,levaticn, including basement /o feet __!L inches (b) Tn a V Zone, bottom of lowest structural member ,feet ~ inches cq 3. FIRM--Flood Insurance Rate Map, Zone designations ,~f~ ~yg 4. Owner of Premises ~~S~-CaG/~~ 5. Location of Property: ~o / ~a ~D~~°A~ ~~T~s~~ House # eet - Hamlet' i County Tax Map No.~~,, Dist. 1000, Section ~'d2 Block 2 Lot(s) ~~8 Subdivision Filed Map# Lot(s) 6. Permission to be granted: Owner as above _ New Owner • Under Contract; Lessee _ Contractor _ Phone # Name if not given;above Mailing ad ss ' 7. Approval from othe;r(s) before Permit is issued: I DEC /d A + Wetlands (Town Board) ~?/r2 Health S r ices I ZBA R/J~ Buildi g emit i Planning Board 8. I,~ , the applicant, am the Owner , Co-Owner ~ New Owner , Under Contract Lessee _ Agent , Contractor and agree to compl,~ with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises authorized to perform or have performed the said work and to make and file this'; application, that all statements contained in this application are trice to the.best of my nowledge and belief and that the work will be performed in the manner s t forth in e appl'c tion filed therewith. I STATE OF NEW Y RK ~ ~ COUNTY OF ~ S$~ i ignat e i SWORN TO THIS ~1, DAY OF O'a~ 1g I: ~2 IUD 1#].EN K DE ICE Notar Public N6gRYPU9LIC,ShtaotNewYeA1 y T Tx~m•Erp ~~Mer~ch~30~ 1A [ Applicant's mailing ~ ~ ~ ~ ~ ~ - address and phone i,# if not given~above~ ~ ~ ~ ~ M 11/85 ~ tT ~ ~ ~fi."~ t ~ ~ ~ d -•~.n#.: z.r ,.y.r 't.cr .nn~~r d... kr{'A~vF~: :c~++p"R. :.,.T - ~ .v.w ~T BOARD OF HEALTH (1 ia~ ~ 3 SETS OF-PL.1^IS •t-~•-•'•.-.•- U FORM NO. 1 $t1RV EY • • . . , TOWN OF SOUTHOLD crseta: W! I O~~O ,;i BUILDINGDEPARTMENT SEPTIC FORrt },.''r' TOWN HALL LDG. DEPT. ~ s $OUTHOLD. N.Y. 11971 HO ~r~ TOWNUFSOiSTHt5f17 TEL.:7G5.1d02 CALL J. .u? `D~~ 2 , , 19 40 ~--J h I T 0 ~Pprovcd ~O,/„v?;2 199QPcrmit No..~~!.!f? ~ . )isapproveda/c ................................~_l~~l...~.. (B cling Spector) APPLICATION FOR BUILDING PERMIT Date 15 . • INSTRUCTIONS . a. Tius application must be completely filled in by typewriter or in ink and submitted to the Building inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shoving location of lot and of buildings on premises, relationship to adjoinin3 Premises or public streets tr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this appiication 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 appticant_ Such permit .hall be kept on the premises available for inspection throughout the work. e. No buildin; 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 3uildiny Zone Ordinance of the Torvn of Southold, Suffolk County, Nety York, and other applicable Laws, Ordinances or 2e;ulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described. Clte applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rcoutations, and to idmit authorized inspectors on premises and in bu[Iriin_^ far ~Pressary inspcctior,>. r (Signature of applicant, or name, if a corporatton) (Mailing address of applicant) irate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, piumbet or builder. ....1 ~'NC~?~ . lame of owner of premises ..C-~ ,~j~ . <as on the tax roll or latest deed) 'applicant is a corporation, signature of duly authorized officer. ' • ~ ~ (Name and title o,,^^f~~corporate officer) ~1~ Builder's Liccnsc No. 1~(A?t~.a~.~, ` Plumber's Liccnsc No. Electrician's Liccnsc No . ' Otltcr Trade's Liccnsc No . . Location of land on which proposed work will be done; , ' ' fiousc Number Street. ~Y~~ 9~,~ Hamlet • • County Tax Aiap No. 1000 Section 1ar1. • • • • . • • • • • Pock • . • • Lot .~R j,', Subdivision . Filed htap No. Lot . ~(Nam¢) State esisting rue and occupancy of premises and intended use and occupancy oC proposed construction' , i. Existing use and oc~:upancy (1 Lr',-~„ /1?,~6': , r. Intended .....f2~~,/„D.~:,? :GG~ ~ ? use and occupancy . I / k i a Nature oCwork (check which applicable): New Ouitding Addi 'cn ~ Alteration ".t~~,. Repair Removal : Demolition , ..Swimming poa,1~F ~ , i. Tennis Court Accgssury~Building.........,Fehee .......Other W i~,i;;. ork': . Estimated Cost ~~6.4Q4........!i Fee (to be paid on filing this application) ' I • If dwelling, nwnbcr oG dwc!ling unit; / Number of dwelling units on cacti floor . If gatace, number of cars , : , if business, commercial or mixed oc~upancy, specify nature and cxtcnt.of each type of use , , , . Dimensions of existing structures, if pny: prom Rear ..t'~R , , , Depth f{.'~ . . Hci:ht ...l.`L~~......... NumbcrafStorics ~ U y . . Dimensions of same structure with a?tcrations or additions: pront , Rear .~.8.. _ Depth t~~:~ . I~eight . az.8.~ Number of Stories ...rZ . Dimensians~f entire new constrnctipn: pront !.`~.~t. Rear ..Z.fi .Depth r;SQj , Hci;ht ~ Numbcrpf Stories SizcoClot:Front..~~./.1~~. Rcar.~~j~.~.®....:...'.... Dcp..~~.~.~~~/.°~p.. 1; Pate of Put•r!tase ./,9,73.. ~ . , ........Name oClronncr Oa•rcr ~J.~ • . • . ,Z.oz:: or use djstrict in whicli•premisCs arc situated y/ . . Does peaposed construciio~¢¢ violate dny zoning law, ardinanrc or regulation: . N. t? . Nill lot be rc;radcd ...il/.0. i, , ~ Nill excess Ctll be rcmov'cd from premises: Yes N~o S. Nantc of Owner of pr miser . S~6z't`.'fl,C. , Address ~ 3:~~/: ;?f ~1~~.x./1`~~. Phone No.~ ~5.. ~:z~~lSi./ , . Name of Architect ~R~~~ 11'. i ~~'/$,/.y.(: , , , ,Address ..Phone No........ Name of Contractor .C7SaN.43Z2.... ...Address 8+51/19?~:-I, .~.Z?.:.. • .Phone No.. . S.Is Cbis property located within .t 00 feet of a tidal wetland? *YGS..... ' *Tf yes, Southold Town Tiustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street and block number or description according to deed, and show street names and indicate whether ,tenor or corner lot. i • I ~ ' . • . i ' „ ' i I I~ ITATG OP \E1V YORK, S S~ :OifNT'Y UP' ................r • • • (Name of individ~~~/ino1 ~ ~ ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant • ~ ••'icontract) „ bove named. Er is the • . . . (Contractor, agent, corporate officer, ctcJ f said owner or owners, and is duly apthorizcd to perform or have pcr(ot•mcd tlrc said work and to make and file this Pplication: that all statements contained in this application arc true to the best of his knowledge and belief; and that the 'ork will be pcrCornud in the manner scat forth in tltc application filed tltero+vith. +vom to bciorc me [his ' ' 1 n`~'' .day of ©~R;~B~-.... 19 otary Public, . County P, • . • • . - , • • - . - e . - (Signature of applicant) - TITLE NO. 5-4611 rU i/ - l 0 R 2~ E RpA M~pp~ 0 .o merly now or fbs 3 ~ I 6~b W T r former Y ~ now~oleli° o merlY / m~n Ow °r fOrN°SS t" ~ SJ'k¢ Rio rn nNelmUf ~ NE. ~ ~ODpOfp~6G N.mi~ \a ~9. w , o w ' ~ ?F171' / o i 1 / L Z i f ~ ~r ~ ;v ~W\/~// i~// ~S~i Yes W_ E ~ p ~Si ~ / o gyp. ~ o ~ i A e , 3 0 SLOW, \ J ~ LW Y / YEA I o I~9 Ak \ v 0 formerly o Ha e P,v° 61°5y10 W now Helmet s S • Mel ssnest , Irene NOTE •=MONUMENT REVISFONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W.YOUNG LAND SURVEYOR PROFESSIONAL ENGINEER AND N.Y.S. LIC. NO. ?UB83 LAND SURVEYOR, N.Y.3. LI C. NO. 12 SAS UNAVTHORI2E0 ALTERATION OR ADDITION TO TNIS SURV[Y IS A VIOIAiION Of GEORGE RSANTIS Pie of ,YFy SECTION 7AD9 OG (MF N[W YORK 57ATE [DUCARON LAVI. 5~ JU. CORI[S CF iN15 SV.RVLY MAD NOT BEARING \ P'RD w iNE LAY•D 5U. V:Y'dk'S IN!np S: AL OR - ~ ~O cG EMSOSSID S~A StlMt NT Et CONSIDERED t0 BE A VALID I, UE COPY. G A ANTE F O GUA?AhTdE PIC I: ATLD MERCON SHALL RUN AT ARSHAMOMAQUE UT OLD ~ BANK ONLY TO TW A! SUN i0R VIHCM THE SURVE D IT GUAR ~ OD• IS G0.E:AAlU. A'•L O•. HK REh'AEF t0 /HE TOWN OF iliLf COMPANY, GOYLRNMEMAL AGkNCY AN SOUTHO LD G~ LENDING INSTIibib~H L.LL H.R:ON, A,~p TO THE ASSIGNEES OF iHF LENDING INST4 BY' TUTION. GUARANTLES ARE NOT iF.AnSGeLABIF SUFFOLK CO., N. Y• ~P 10 ADDITIONAL INS7ITUIIONS Ok SU65LQUENT 7 3~ 5 6 g OWNERS. SCALE: III = ~QI °are:dUNE 21,1973 ~ ~ E RpA M~pp~ 0 . . " \ now °r' fbsn'er~y 4b Rn fpfineri~ ~ L,tA n°w~ole~~o o °rmerlY m ow °r f Ness u' ~ "'k` n ,a ~ 4~~~~sPE"` N'm~ o~ GO~~ ~ N/ ~ W p o ~ :a sp, IL o, t G I i ~ 4 Z ~ l•4 ~i ~ u W~ i ' ~ ~ JfYYCS. W o ~ O V~ i A a.t C] SfGW. 1\ N ~ / i ~ 1 i Rw 1 ' ' `p d Ik9 AA \ v m f°rmeriy s P r° 6Io591o1w. n°W Ne~m~t H°s S ~ Y ~ . Me'ssnest , ~re~e NOTE< •=MONUMENT REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEA D, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LPND SURVEYOR LAND SUAV EY OR. N.Y.S. LIO~ NO, 12BA3 N.Y.S. L10. NO, ADBB3 UNAVTNORIZED ALTERATION OR ADDITION SURVEY FOR: 10 1rii5 SURVLY IS A VIOLATION OF SECYION J1040E iMt NEW YORK S7AiE GEORGE SANTtS p,'('w OF +rplY (DUCAiION lAV/, S~ CORILS Cf iH13 SVRYCY MAP NOT BEARING ~p,RD ~1{ ~ /U, iNE LA;:D SU V: YV k'E INOU S: AL O4 ~O (vG ~ EkEO351C YA 3:'Lll NVl EL WIV5IDERED to Bf A vA'.IC I, UL Capt. G A ANTE .'.y~y1E~j.,~.F 41 CUA"ANI.!' 4Y.1: Al1D Hf RLON SHALL qUN AT ARSHAMOMAQUE UT OLD BANK ~~[Z~~ ONLY W TN• IL SON EUR Y/NCM THE SURVF C IT - $GUAR MT CD• IS iqb AElL, A.D U? H,5 0L6AL: iV iME TOyyN OF SOUTHO LD ~O ililE COMPANY, GOV[RlddfNi AL AGcNCY AN ILNDiNG R.SI~I~SI VIa IS I,L N-R:ON, A,.p - TO iMf ASSIGNLcS VF Em tfnmNC INSn. SUFFOLK CO., N. Y• eY fUt10N. 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