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HomeMy WebLinkAbout19332-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19467 Date November 5, 1990 THIS CERTIFIES that the building ALTERATION Location of Property 46520 COUNTY ROAD #48 SOUTHOLD, N.Y, House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 5 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 21, 1994 pursuant to which Building Permit No. 19332-Z dated AUGUST 21, 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 BILLARD PARLOR IN EXISTING SHOPPING CENTER A5 APPROVED BY ZBA #3956. The certificate is issued to HI-QUE BILLIARDS, INC. (LLOYD GATE5,PRES.) (Leassee) of the aforesaid building. I SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. PENDING 11/5/1990 - ERNIE PAPPAS PLUMBERS CERTIFICATION DATED N/A ae.A- _ Bui din n pector Rev. 1/81 F08ffi NO. TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) a Date ~:1..........., )9..9u N- ~ ~°3:~~' Z Permission is hereby grouted . E to ..~f.:?.4F.1'.....1~.....~`~~.wr!?I?F.~!-Qk.....T.'.r~r~a.....~.2:1...~.~.'~."'"'..__"_'""""'"""1'U ~::.....c~:~ ..........~.Y~..!~.......~.9..~~......... Q... at premises located at ......7..~~~~.........4'r.......~.t....~~l-d.t'?f.....~.A.........~ ....`.`f .a..°~f ~ County Tox Map o. 1000 Section ©5......... Block ......~.5........ Lot No. pursuant to application doted 190.., and approved by the ' Building Inspector. Fee $..t! ,t. ~~j 3${~ Building Inspector { Rev.6/30/80 f _ _ _ { t'IELD I1:SPEC;iU.7 ~~UA:E ~ COMMENTS •o 1 . D ~ ^o ~W H ~ FOUtJDATION (1st) N to N b ~0 cn ri h' FOUNDATIOtJ (2nd) _ _ e ~ 2. xb tom., o P,OUGH FRAME & h PLUMBING _ y ti H 3. ~ ~ m ro IIJSULATIOM PER N. Y. • • STATE ENERGY CODE . xn 7~ y FIiJAL ' 'I/ q ..l'~~.....N A ~p ADDITIOtIAL COMMENTS: x l"' P o s . 2 ' M " . ".r H 9'~ Z N x m • A • r ' x 3 d H Form No. 6 _ t~~ ~y~yy BUILDING DEPARTMENT NV~ ~ ~ISi~V TOWN HALL 765-1802 6OFS f~' APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 accuzate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from azchitect or engineer responsible for the building. 6. Submit Planning Board Approval of comgleted 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 Che applicant. Tf a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificata 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./0/0~~--,^^Commercial $15.00 Date .......i~c?•/~~ lew Construction.... ,t.... Old Or Pre-existing Buildin /~G ,ocation of Property.'~`~.~.D.~~~:-~~t.....~.1~~..!.a House No. Street Hamlet nwer or Owners of Property..~~'?"':c?"•`••~~~~~•••••••••••••••••••••••••••••••• ~ ~ ounty Tax Map No 1000, Section...:'S.~.......Block.....a.a.......Lot..... abdivisionl ..................................pp..Filed Map............Lot...................... ~rmit No. I ~:~~~..~.Date Of Permit.~„r..°~ ~ /Applicant.... ((jj ~ f~. alth Dept. Approval...: ~-........Underwriters Approval.ll: ;.?':.°L~'::' ~ ~G~ arming Board Approval , quest for; Temporary Cexti4icate..~..-'. Final Certicate...~,~ - . Submitted: ~~~y' .G~~~ " Yo?y . etl }q~g~ LICANT s. - ~ n r. n]ryiFblaYYi a. /d.S 10®% OLEFIN 11 CONTINUOUS FILAMENT YARN SOIL AND STAIN RESISTANT . WEAR RESISTANT OUTSTANDINGnCOCLO/'R~FASTNESS/? T p~ LOW STATIC NON-ALLERGENIC SPECIF6CA 1 ~®IY~ ROCKY POINT 16 ROCKY POINT 20 ROCKY POINT 26 CONSTRUCTION . Level Loop Level Loop Level Loop YARN : 100% Olefin II 100% Olefin II 100°k Olefin II YARN SIZE & PLY : 3000 3000 3000 DYE METHOD : Solution Solution Solution GAUGE : 1/10 1/10 1/10 STITCHES PER INCH : 9.3 9.5 12.6 PILE HEIGHT : ........................:..............156 .156 .187 YARN WEIGHT (PER SO. YD.) : 16 Oz. 20 Oz. 26 Oz. PRIMARY BACK . Polypropylene Polypropylene Polypropylene SECONDARY BACK : ActionBac® ActionBac® ActionBac® TOTAL WEIGHT : 50.5 59 65 WEIGHT DENSITY FACTOR 59,076 92,307 130,139 CRITICAL RADIANT FLUX : . Type I Type I Type 1 TRAFFIC CLASSIFICATION : Moderate Moderate Heavy WEAR WARRANTY : 5 Yr. Commercial 10 Yr. Commercial 10 Yr. Commercial F.H.A. CLASSIFICATION : N/A Type I & II Class I Type I & II Class I & II FLAMMABILITY - ASTM E-84 Class A Class A Class A FLAME SPREAD : . . . 25 25 25 FUEL CONTRIBUTION . 35 30 35 SMOKE DENSITY . . 90 75 100 AATCC 134 KV : . 0.2 0.7 - 1.1 Chair Qads are recommended for use under chairs with roller casters to preserve appearance and to help avoid delamination and excessive wear. The manufacturer will not be responsible for damages 4o carpet arising from the failure to use such pads. Color may vary from dye lot to dye lot and/or yarn lot to yarn lot. LIMITED 5 YR. COMMERCIAL WEAR WARRANTY LIMITED 10 YR. COMMERCIAL WEAR WARRANTY Tne menulscturer warrants tole carpet for normal commercal use after vrooer The manufacturer warrants thla carpet for normal commercial use after proper commercial lnatallellon In erase recommended by the menulscturer, lore penotl of flue commerciallnatelletionin°rasa recommended by the menulscturer, fore permtl of ten (5)yeare. Thle werrenty eztende only to the ongg nal purchaser and commences upon (10) ears. Thiswerrenty extends onlyto theoriginal purcheaerantl commences upon the data of propper Inatelletlon Ii, wllhin Ilve (5) years after proper Inatellehon, the the date of proper Inatelletlon. If, within ten )10) years after proper inetelletion, me surface pile al the carpet (not Including Inel on elalrsl, wears ebrearvaly, ao that one surface pile of the carpet (not including that on ataual, wears ebraalvaly, ao mat one equsre Inch or more o1 pile fiber la worn to the mrpet ecking, iho menulscturer, will square inch or more of pile Ilber la worn to the carpet ecking, the manulecturer, will Ivrnlah replacement carpet of equlvelent quality for the effected room or eras at no furnlah replacement carpet of equlvelant quality for Ua effected room or ame et no charge. Tnl6 warranty does not Inclutle the Inatelletlon coat of soy such replacement charge Thla warranty dose not Include the inatalletion coat o1 any such replacement carppet fumished by the manulecturer. Thb werrenty tloea not cowrteare, pulls, cuts, carpet furnished by the menulscturer TMs werrenty does not cowrteere, pulls, cuts, plllln>), bums, melting, cruaMRB, or damage due to Vmpropar cleenlnp aganis or puling, burns, mattlnp, cruaning, or damage due to improper elaenmg agents or clean ngmethada, orleck olprotectlon under rallercestercnalro. Thlawerrantyeppllea cleaning methods, or lack ofprotection underroller casterchaire Thla werrentyapplies solely to the orlpplnel purchaser, entl dose not cover irregular carpel, or remnants, or solely to the origginal purchaser, and tloea not cover Irregular carpet, or remnants, or carpet sold "as is". To obteln performance of ibis werrenty obligation, the customer carpel sold "ea le" To obtain parformenee ql thla warranty obllgetlon, the evatomer must send proof of purcnsae and date Inereof, showing the name of the dealer/ moat tend proof of purchase end tlate Iheroot, snowing the name of the dealer/ coniractor,thecerpel style, entllnetlale itwaslnatelle4 TO Tha Claim Dept.. of dealer, contractor,the carpet style, antltne tlete it wasmetelled. TO: The Claim Dept, ofdeslar, disirlbutor or manufacturer. The manulecturer must be allowed to teat the carpet In tliatributgr or manulecturer. Tne manulecturer must be allowed to teat the carpet In question upon request to the customer. If the warranty clelm la a valid one, question upon request to the customer If the werrenty claim Is a valitl one, menulscturer will lumlan the replacement carpel wdhln six 8) montne of receipt of manufacturer will furnish the replacement carpet within six /S) months of recelpl of customer's notlllcatlon. WHEN THIS CARPET IS USED S~ A CONSUMER FOR customer's notllicahon. WHEN THIS CARPET IS USED BY A CONSUMER FOR COMMERCIAL PURPOSES, ALL IMPLIED WARRANTIES, INCLUDING WARRAN- COMMERCIAL PURPOSES, ALL lMPL1ED WARRANTIES. 1NCLllDING WARRAN- TIES OF MERCHANTABILITY AND FITNES(S FOR A PARTICULAR PURPOSE, ARE TIES OF MERCHANTABILITY AND FITNE//SS))FOR A PARTICULAR PURPOSE ARE WARRANTY. WHENTUSED OFOR ANY OTH~R PURPOSE~OR M ANY SETTING WARRANTY. WHENT 9ED OFOR ANV OTHERYPURPOSE, GROIN ANY SETTNG OTHEfl THAN A COMMERCIAL SETTING, ALL IMPLIED WARRANTIES, INCLUD- OTHER THAN A COMMERCIAL SETTING, ALL IMPLIED WARRANTIES, INCLUD- ING ANV WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR INO ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE,ARE HEREBY EXCLUDED. THEABOVE WARRANTVAND REMEDY ARE PURPOSE,ARE HEREBY EXCLUDED THEABOVE WARRANTYAND REMEDY ARE IN PLACE OFANYREMEDIES FORINCIDENTALOR CONSEQUENTIAL DAMAGES, IN PLACE OFANYREMEDIES FORINCIDENTAL OR CONSEQUENTIALDAMAOES, AND THESE DAMAGES ARE HEREBY E%CLUDED. Same statue do not allow AND THESE DAMAGES ARE HEREBY EXCLUDED. Some states do not allow Ilmitetlons on now loop en Implletl warronry testa or the eX°IVSIOn or Iimltatlon o1 Ilmitetlone on now long en Implied weReny testa or the exclusion or Ilmitstlon of Incidental end coneepuentlel damages, ao the ebow Ilmitstlon or exclusion may not Incidental and conaequentlel tlemaBea, so the above Iimltatlon or eXCluMOn may MK apply to ou. Thla werrenty gives you apecltlC legal rlgMe, and you may Mve other eppply to you. TMa werrenty gives you epeCnlc legal rlphts, end you may hew other ripnts which very imm stets to stets. rl hIS which vary Iron state to state. ROCKY POINT 16 OZ. ROCKY POINT 20 OZ. 8. 26 OZ. ~..A'', , . • ~ ~ r `C APPEALS BOARD MEMBERS ~ ~ ~ SCOTT L. HARRIS Gerazd P. Goehringer, Chairman t~ ` Supervisor Chazles Grigonis, Jr. ~ ~ e ~ Town Hall, 53095 Main Road Serge Doyen, Jr. Joseph H. Sawicki P.O. Box 1179 Southold, New York 11971 James Dinizio, Jr. BOARD OF APPEALS Fax (516) 765-1823 Telephone (516) 765-1809 TOWN OF SOUTHOLD Telephone (516) 765-1800 D ~ ..~r~r3c~~~a - auc ~ ~ f9~a a TOWN~oG' dEpr"°"~~. of sotrrriQtd.. ACPION OF THE BOARD OF APPEALS Appl. No. 3956 Matter of L10YD GATES. Special Exception to the Zoning Ordinance, Article X, Section 100-1O1B, for permission to occupy and use as a Billiard Parlor for commercial recreation. Property Location: 46240 County Road 48, Southold, County Tax Map No. 1000, Section 55, Block 5, Lot 7. WHEREAS, a public hearing was held and concluded on July 25, 1990 in the matter of the Application of LLOYD GATES under Appeal No. 3956; and WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question, its present zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. The premises in question is located along the southwest side of Route 48, Town of Southold, and is identified on the County Tax Maps as District 1000, Section 55, Block 5, Lot 7. 2. This is an application for Special Exception from the Zoning Code Article X, Section 100-1O1B, for permission to occupy and use as a billiard parlor for commercial recreation. l image 2 - Appl. No. 3956 Matter of L10YD GATES Decision rendered July 25, 1990 3. Article X, Section 100-1O1B, Uses permitted by special exception by the Board of Appeals. The following uses are permitted as a special exception by the Board of Appeals, as herinafter provided, subject to site plan approval by the Planning Board. i6) fully enclosed commercial recreation facilities, including but not limited to tennis clubs, skating rinks, paddle tennis, handball and squash facilities, dance hall, billiard parlors, bowling alleys, health, spas and clubs and uses normally accessory and incidental to commercial recreation such as locker rooms, eating and drinking facilities and retail sale of goods associated with particular activity. 4. In considering this application, the Board finds and determines: (a) that there is no other method for appellants to pursue; and opening a billiard parlor for commercial recreation on the premises will require a special exception; ;b) that the area chosen for the billiard parlor is not unreasonably located; (c) that the special exception will not in turn cause a substantial effect on the safety, health, welfare, comfort, convenience and/or order of the Town; (d) that in carefully considering the record and all the above factors, t7ie interests of justice will be served by granting the special exception, as applied conditionally noted below. Accordingly, on motion by Mr. Dinizio, seconded Mr. Doyen, it was "~yR{~s' `~i~i"~a~~c~~ ~t 1. ~ ~ Ada- of A)1p~ ~ "~+~r '~"1~~ . a~ R[i2`Y` A'ppe~i NO. 3y5b, 1. That the hours of the billiard parlor be from 9:30 a.m. till 12:00 a.m. (midnight) during the weekdays and from 9:30 a.m. and 2:00 a.m. on Friday, Saturday and Sunday with this special exception. ?age 3 - Appl. No. 3955 Matter of L10YD GATES Decision rendered July 25, 199Q 2. That there shall be no playing of pool or the use of video machines while public or private school is in session for patrons under the age of eighteen (18). 3. That there be no alcoholic beverages on the premises and that there only be prepackaged food and no cooking facilities (except for a (1) heating appliance used for warming prepackaged food). 4. That the building contain air conditioning and heating to prevent the doors from being opened and reduce the noise level. 5. That the playing of music shall be reduced to a level that cannot be heard €rom the exterior of the building. 6. That the Special Exception goes along with the property and to all subsequent owners o€ the lease while the billiard parlor is an active business on these premises. dote of the Board: Ayes: Messrs. Goehringer, Doyen and Sawicki (Absent Charles Grigonis and Joseph Sawicki due to illness). This resolution was duly adogted. df Li~ . GERARD P. GOEHR NGER,/ HAIRMAN THE NEW YORK BOARD OF FiRE UNDERWRITERS 'I ~ 1f7!JO(ll BUREAU OF ELEGTRICITV 85 JOHN STREET, NEW YORK, NEW YORK 10039 Date N'CJS7F;I~F'ha2 fl'L,"}9=f f! Appli¢otionNo.onfile 1.tati7C1)Q1'1C! tl '44>$"1{i(1 THIS CERTIFIES THAT only the electrical equipment os deacrihed belat¢ and introduced by the applicant Homed on the above application number in the premises of fl'E-~ifR I~T9,1;tAR:DS, 1.NC, i 7d4i'.i2,~ r~}7,f1`l`I'R,4 R17x.17 ¢f3, ,,riCf['19t7t,1), It1 V. in lhefollouinK location; ? Basement ~ lot F'l. ? 2nd Fl. Section 87oek Lot ~i ~I"l"CAf31~k 199CY ums examined mt and found m 6e in cornplimrve with the reyuiremeats qj this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECK$ OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT fWOREJCENT OTHEfl AMi K W. AMi. K W. AMi. KW. AMi. K W AMT H P ~1 I tf ~ t? DR',"~Et" FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULiI-OUTLET DIMMERS PMT T 6 W Oll N.P GAS H.P AMl NO A W G. AMT AMP AMi AMPS TRANS. qMi H P SYSTEMS AMi WAiiS NO.OF FEET SERVICE DISCONNECT NO.OF 5 E R Y 1 C E AMi AMP, TYPE METER 1,9' EW 1 ,6' JW 3 9 JW 3,a 4W NO. OF CC COND A W. G. NO. OF HIAEG A W, G NO OF NEUTRALS A. W G. EQUIP, PER ,e' OF CC COND Of HbtEG OF NEUTRAL OTHER APPARATUS: ' L~ S"[tl ;AT~CNt,ka~.f;lC1M~tJh F,~,t31.' 1,1'C.#~6'E9~`, 7 ak:b1.TN(71,F; 11f2.1Vk~ CClFlA'[A^K~ IdY~ 11"f 25 GENERAL MANAGER _ 1.:I Per " it This certificate must not be altered in any manner; return to the office of the Board if incorrec}, Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BOARD OF HEALTH . D 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK g ~~tyy~~ fta®u 6UILDING DEPARTMENT SEPTIC FORM ' TOWN HALL BI~,pEP7. SOUTHOLD,N.Y.11971 NOTIFY tOWNOFSOUTHOLD TEL.: 765-1802 CALL Examined~ArtY~.~:~., 190 MAIL TOGi~~_'I~/d.,~C//J``~•~'~O/ Approved~!~!+!Q.. 199Q. Permit No. J.9.~,3Z.`l2.. ~-39~`"e~, Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT mss,, Date /Yl~.~-,~ 19 .~.G INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part For any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal o demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code ou ~ d n ulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Siguature t" applicant, or name, if a corporanon) • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. c /l r/G=~ . Name of owner of premises ~~'~`.j•'~/.?~~/s~.~®ftlL~ . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...............N,~.......................... (Name and title of corpDorapte officer) Builder's License No. ....~/-?~/..~I. • Plumber's License No. ..../Y/~:~• • • • • Electrician's License No. • • Other Trade's License No. /.~`~.~Z~• • 1. Location of land on which proposed work will be done . . House Number Street Hamlet County Tax Map No. 1000 Section Block .....Q:~~~......... Lot . Subdivision Filed Map No. . g7- . Lot . (Name) 2. State existing use and occupancy of premises and intended/'use and occupancy of proposed construction: a. Existing use and occupancy ~~~/~~T.,/ ~~~'G'~/~~ b. Intended use and occupancy ....'~lG~~~~~•~~`®~ ~ ~ ®~~~p/9'~4,~ .............:^~e'.~ .;.,,w..,,,,.~ 3. Nature of work check which a ` hcable New Buildin Addition ( pP ~ g A~terab~ion° Repair Removal Demolition Other Work ~N . tike 1 ~n~~ `fit) 4. Estimated Cost ~~O~ Fee ,...t.. ..;..r..~...,...,-..~...., . (to be paid on filing th'i~;it~ilg~tt~+}pn) g g ,units . Number of dwelling units on each floor . 5. If darallennumba of ~dwelling'~• • , • • . • • . ' • • . r • • . . 6. If business, commercial or mixed occupancy, specify nature and extent of each t pe of use ,~1~~•~ Pis>lo.~ 7. Dimensions of exiting structurgs, if any: Front ~ . , , ,Rear . , ,Z~, Depth ,lp.Q,`, , , , , , . Height , Number of Storics , , ,d,N~ , • • . , Dimensions of same structure kith alterations or additions: Front ~LS . Rear . epth S HemhYsions of entire new c Nutl Height „ " " " " • • • • • • Number of Stories , , , , , , , , , , , , , , }action: Front , . Rear Depth . g berofStories....,.,.... ~y~, 9. Size of lot: Front ...,X.Jla.•~~. , Rear ......~l~~'¢r~Jn•~j Depth ..Z~'Qc47. ~ ytO, :d, ~ 10. Date of Purchase . , , , , , , , ,Name of Former Owner .~~!>~-Y*!.~'~F~!~ ~,/~C,~Lj%~ 1 1. Zone or use district in which premises are situated . ................O......... , . 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded ......Will exce s fill be removed f om premises: N,iD, Yes No 14. Name of Owner of premises ~~/YcF:4i~a~ . , , , ,Address a~O,'~Ye ~'`,rc_~° .Phone No...~'~~:~',~`,G~v, , , Name of Architect ..~~r3c~?lypJ,YE~,z~fUVA Per , , , ,Address F!'i9oX r~~°. cc°Y?'7/?~~X. Phone No...~~~:~:?7Q Name of Contractor ~~!~~?G'.°,• .Address . .Phone No . IS*Is ihis ro ert located within 300 feet of a tidal wetland? *YES....NO.... P P Y If es Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all bulldings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block!~number or description according to deed, and show street names and indicate whether interior or corner lot. ,(/D c.'i~J6'~~ ~il%birr~~G duiG~.rti/4' ~~/vx>.s.~xls. i ~II' i i STATE OF NEW YORK, COUNTY OF $'S (Name of individual sign~~~~~~ ~ ' being duly sworn, deposes and says that he is the applicant ng contract) above named. He is the !FNfSiir~~~~. . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conta}ned in this application are true to the best of kris knowledge and belief; and that the - work will be performed in the manner, set forth in the application filed therewith. Sworn to before me this a.~ ...day of; . 19 Notary Public, z/,`~J'~-!?, , ,~I~', County ~ HEtENK.0EY0E . (16TARYPUBIIC.~edlt+rrlcMM Si na PP Tee 4~~Muc ~ ( g tare of a licant) - r