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HomeMy WebLinkAbout19145-z i ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20101 Date JULY 22, 1991 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 465 WEST ROAD CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 110 Block 7 Lot S Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 18, 1990 pursuant to which Building Permit No. 19145-Z dated JUNE 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 ADDITION 6 ALTERATION TO EXISTING ONE FAMILY DWELLING The certificate is issued to HERBERT 6 SUSAN YOUNG (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING - 7/22/91 PLUMBERS CERTIFICATION DATED JULY 2, 1991 - PERFECTION PLUMBING & HEAT. Building Inspector Rev. 1/B1 N®, s T01NN OP SOUTFIOLD BUiLDONG DEPARTMENT TOWN HALL SOUTHOLDa N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 7HE WORK AUTHORIZED) No `J ~ f4` z Dare .....~.4.!~y!;c-....~-1 19.9..0.. Permission is hereby granted to: ` .............5....~....~....................................................................................... of premises Ixated at 4:°........~.:.............~:.--,,,........................... ~ County Tox Map No. 1000 Section .~/..Q......... Block .....,.0..~....... Lot No...~.~,. Pursuant to application dated ..~.~r!.^.?r¢^....~..~ 19.~.~, and approved by the Buildingp Inspector. Fee s,.9.~.`~::7~.. i ~~yy-- Building Inspector Rev. b/30/80 l FORM NO. 6 Q~ ; ; TOWN OF SOUTHOLD Building Department ~ ~ Town Hall BLDG. Oep'r'""'"""'~' i Southold, N.Y. 11971 OF$DUTHOLD ~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ilr~ to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ I 0 . 0 0 4.Vacant Land C.O. $ 20.00 p,, S.Undated C.0. $ 50.00 Date ~ :...Z. ~ NewConstruction,,,,,, OldorPre-existing Building Vacant Land Location of Property .......1~.~25-~' 1~Q~C~%~ 1J'~C~V IC5 e ~ House No. 1,~ ~ Street . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 7/am/et Owner or Owners of Property ~~!J~!f~c~.-. ~j C~l' , , , , , , , , , V. County Tax Map No. 1000 Section . ~ Block ~ Q.:. ~ , , . Lot ~ . Subdivision .......................:.........Filed Map No. ..........Lot No. . /a I ` / , Permit No. , Date of Permit ..........Applicant , ~t'~~n~j,~.~ . . . . . Health Dept. Approval ........................Labor Dept. Approval . Underwriters Approval ........................Planning Board Approval . Request for Temporary Certificate .....................Final Certificate . Fee Submitted $ Construction on above described building and mit meets al applic~a~ble codes and regulations. Applicant. ..:;'~.`ti..:.4~' aa~. ~o-to-~s c~~,.yaa3~ ea ~~o! t s~ ev ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS PA1;F. 7 (101.071, z ~ EIUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 JULY 29 1.997 7047"990(90 N 19"J5ti1 Date ~ ~ Applicotian No. on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant named on [he abode application number in the premises of THING, A55 fiEST Rh„ Pi,.17., CU1'CItI?(:UF., N.Y. in theJollowinp loc gg ent ~ /st FI. CJ Pnd FI. f>AR/'A'1"~ 1 C/OtYT ,r~.tion Block Lot ~ uar exomined on and found Lu 6e in compliance with the reyuiremenfs of this Buard. h-[ RxiUEE RXTURES RANOK t:OOInNO oEt:lcs OVENS qSN WASHERS EXHAUST FANS g ~1~TS ACAS SWI7CIIE5 INCANDESCEM PIUdIFSCFMT OTHER ,WT. K. W. AMT. K, w. AMT. K.W. AMT. K. W. AMT. N. P. 85 3 74 77 1 ].2 d t c gtYERS RIRNACE MOTORS RITERE AMIIANQ EEEOERS SFEgAI RECFT 111AE POCKS EEII UNIT MATERS -MULTFOEIIIET gMMERS - AMT. K. W. Oll N. P. GAS H. P. AMT. NO. A. W. G AMT. AMP. NAT. AMPS. TRANS. AMT. N. P. SYSTEMS AMT. WAiTK NO.OF RRT 6 F 1. ].2 5)i0 SERVICE gSCONNLCT NO.OF S E R V 1 C E AMT. AMP. TYPE ~ 1 / [w I / JW J D JW ] R ~W NO.OP CC. CONU. A. W. 6. NO.OF NI-U:G A, w. G. NO.Oi NFUTRAUi A. W. G. PER / OF CC. C 0. OF IN~IEG OP NEU1141 _ i zti0 c~ x t n/o ~ ,io OTHER ARAl1ATU5: 3T()N AIC UNiT-1 ~ 2TON A/C UNIT-), MOTUH5:2-0.75 N.P. PAN};),HOARDS:1-5R CIR. :)00 ~.r.i.~r;-6 TRACK ),7GHTING•-56 a t;« & S CQN'l'RACTOR 1,7C.y57$-P: ~ »~x z15 SQUTH0110, NY, 11.971. oNtEEU MANAOR.,' / )1 ~ Per d - this nrtificaM must not be aMerod in any manner; return to tM office of kw Eoord if incorrad. Inspectors be identified by their credentioh. S CAPY POR BUILDING DEPARTMENT. THIS COPY OF C[IITNMCAT! MAST NOT BE ALTERED IN ANY MAMIER. ~ I TEL. 765-1802 S~FFOU; C p Ole, TO'44~1V OI' SQJ'~F30b.D o . r. ~ < OFFICE OF BUILDING INSPECTOR ~ C c~°n ` ~-ti1 P.O. BOX 728 IVf ~ ~ -C TOWN HALL O~~ ~DY SOUTHOLD, N.Y. 11971 ~ 2 Ol ~ ~ BLDG. DEPT. TOWfV OF SOlSTF90L0 C E R T I F I C A T I O N , Date Building Permit ''N//o. _(q/yam Owner Ypuue (plea en n/t) Plusher G~,ef+~Tioro )"'/vm b~ry/ '~~ii~ (please prin ) I certify that the solder used in the water supply system contains less than 2/10 of to lead. (plumber's signature) Sworn to before me this day of~. U1.Y r' Rotary Public, ~.r~~k ,County ROBERT L SCOTT, JR. , NOTARY PUBLIC, State ai N.Y T~1 y31.1~9 I j ~ TEL.,,7G5-1802 o~~FF~Ck~ o~ , O~ TOW1V OF SOUTIIOLD ~;,+,,~k'~~(, < OFFICE Or IlUILDINC INSPECTOR o y~.; y.q~ .z , ~ P.O. BOX 728 ~ I"' TOWN f{ALL " ,yy01 ~ ~ao~ SOUTIIOLp, N.Y. 1 1971 June 28, 1991 Samuels & Steelmann 25235 Main Road Cutchogue, N.Y. 11935 RE: YOUNG, HERBERT fi SUSAN To Whom This May Concern, We are unable to complete your Certificate oL- Occupancy because of the following reasons. % An application for Certificate of Occupancy is not on file. (ENCLOSED) o IJnderwritera Certificate on file. Ttie check is (~E~~a~.~./not on file.) X25.00 No flcalth Dept. Approval on file. No tinal inspection has been made. Please contact our office an this matter. Thank you for your cooperation. Building Permit i! 1 9 1 4 5 Z Build Dept. r / No Plumber Sc~lcler Certificate on file. -4~~~J'~°a-tu"~ ~~~~f~~ ( all permits involving plumbing being .i:sucd after April 1,1984 ) lELD II:S:'~C:iU27 ~~UA;H ~ COMMENT° H , } FOUIJDATION-._. (1st) ~ U'~ FOUNDATIOtJ (2nd) _ - m~ f z . ~ - o~ ROUGH FRAME & ~ ~ PLUMBING ^ C' -~~d G /z ~ 9 3. ~ ~ ~ 0. IlJSULATION PER N. Y. STATE ENERGY D~j CODE }~d"F x a r 4 . ~ -a 1 FI;JAL s,~~ o 7. ADDITIOPJAL COM ENTS: 4- f x b~ H ~ y N H 0 ~ 2 / \ m ~ a ~ r ~ .a x e -c H TOWN OF SOUTi TOLD BUILDING DEPARTMENT ' SOUTHOLD,NEW Y02K STOP WORK ORDER TO: THOMAS SAMUELS Owner, Owner's Agent or Person Pertorm~ng 1Vorx) 25235 MAIN ROAD, CUTCHOGUE, N.Y. 11935 Aaaress of above-namea person) YOU ARE HERESY NOTIFIED TO SUSPEND ALL WORK AT: 465 WEST ROAD, CUTCHOGUE (Aaaress wnere work is to be stoppea) TAX ~tAP NUMBER 110-7-8 Pursuant to section 100--283 of the Cade of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescirded_ BASIS OF STOP WORK ORDER: NOT FOLLOWING PROVISIONS OF PLANS, NO DEMOLITION PERMIT. CONDITIONS UNDER WHICH \VORn MAY BE RESU,LIED: TELL US IN DETAIL WHAT YOU ARE PLANNING TO D0, TARE ODT A DEMOLITION PERMIT. Failure to remedy the ctinditians aforesaid and to comply with the applicable provisions of law may constitute an offerue punishabic by fine or imprisonment or both. DATED:812219D L/ ~~~~//~.rJ'~-~/_~. BUILDING INSPECTOR /CODE ENFORCES NT OFFICER CURTIS W. HORTON TOWN OF SOUTIfOLD BUILDING DEPART~b1ENT SOUTEIOLD, NGW YORK STOP WORK ORDER TO: ~ i//`Yr, 6~ -(O[~, Uwner's Agen or erson Pertormmg ~Vorx) . ~ °l //935 ZAaa ss of^'above-named p~on) ~ ~ ~ YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: (Address where work rs to be stoppe~d)~/ ~ TAX ~1AP NUMBER ~ / Pursuant to section ~D-+ e~-?7 ~ of the Gode of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescinded. - ~ BASIS OF STOP WORK ORDER: • CONDITIONS UNDER WHICH WORK MAY BE RESU~b1ED: ,~Z~%r/O /~''rJ Failure to remedy the ctinditions aforesaid and [o comply wi[h [he applicable provisions of law may constitute an offense punishable by fine or imprisonmcn[ or both. DATCD: ~ D BUILDfNC INSPECTOR /CODE ENPORCEIIENT OF [CER 1 765.1802 BUILDING DEPT. INSPECTION E ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [)FRAMING [ ' INAL REIIiIARKS: f ~ i DATE ~C' INSPECTOR . _ ~ j~.~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ~GH PLBG. FOUNDATION 2ND [ INSULATION L] [ ]FRAMING [ ]FINAL REMARKS: ,ti-e~ f i i i r DATE /(a ~ INSPECTOR ~~r~~ 765-1802 ILDING DEPT. SPECTION [ ]FOUNDATION i5T [ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [)FINAL REMARKS: -dv ~ DATE ~ IN8PECTOR 765.1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [fjJ~RAMING [ ]FINAL Q..~-~.c..~ REMARKS: DATE ~ INSPECTOR ~ r~ ' /~~G~ 7fr5-1862 BUILDING DEPT. INSPECTION [ FOUNDATION i5T (vi1 ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: A~ _u.,..a.~ -A~ DATE INSPECTOR, 765-1802 BUILDING DEPT. [ ]FOUNDATION i5T [ ] !ROUGH PLBG. ( FOUNDATION 2ND (]INSULATION [ ]FRAMING [ ]FINAL REMA K5: DATE r INSPECTOR L ~ ;~r~` ~~~Yq Ss `C s ~~S vial , ~~'aVm`~ T i tx~>.~2 z h~ POF7ER~~OF~~ATTORNSY Know all men by these presents that I, Herbert Arthur Young, a citizen of k,`,~ the United States of America, resident at "34 Clabon Mews, London; England, do hereby make, constitute and appoint Tom Samuels, iay „~r architect, a citizen of the United States with the professional address a^''~= of Samuel & Steelman, Architects; 25235 Main Road; Cutchogue, NY 11935, f` as my true and lawful attorney-in-fact for me and in my name, place-and ''r. stead, to do any and every act and "exercise any and every power that I might or could do or exercise through any other person in connection with the execution, submission and management of contracts for the provision , of materials, labor and construction of, or the application for building , construction or zoning permits required for, the"improvements to be built,°•,;; on the following described property (hereinafter referred to as the " "Property"): 465 West Road; Fleets Neck; Cutchogue, New York „ J`x'^~'" intending hereby to vest in him a full power of attorney in connection with the contracting for materials and labor, or the obtaining of building, construction or zoning permits associated with the construction - ~3':a_ of said Improvements, giving and granting unto my said attorney-in-fact `'J' full power and authority to do and perform all and every act and thing ,rya ~ whatsoever requisite and necessary to be'd'one in connection with the ~ - construction of said Improvements, as fully, to all intents and purposes as I might or could do if personally present; and I agree and represent to those dealing with my said attorney-in-fact that this power of""` attorney shall become effective upon its execution and shall terminate and forever come to an end as of 5 p.m. (Eastern Daylight "Time), on Friday the thirty-first day of May, 1991. ~ IN WITNESS WHEREOF, I have hereunto set` my .hand this ~ day of 'June, • " ~ 1990. ^ ,:r' yl. Y k53 r , S'" Her rY- .t r Young g~ , Pvi "r'. Great Britain and Northern Ireland ) London, England ) , Embassy of the United States of America ) Before me, a Vice Consul, on this the Ficstday of June, 1990, personally appeared Herbert Arthur Young, who having established his identity to my f`` satisfaction, personally executed the foregoing Power of Attorney in my ~'~5' - resence and acknowled ed to me that he executed the same as his free and hr,; P g p.,+ voluntary act and deed for the uses and purposes therein set forth. ~ ~ Oill Uf1dE9'WOOd - Vico Consul of ~ ~ the Unit¢d Sfatos of Amodca ' r ~ ti<...~ A.%' , London, England i'"' ~ t r y ~ "r E~ i; ' ~i5 New York State Department of Environmental Conservation ~J ~ ~ ~-~B-ui/l~din~g)40-SUNY~,j^Sto~ny, Brook, New York 11794 / /V~~"r lT~ 71°'~ D1~(1''!l~/~ DATE: ~/~ri~~Il7 LG,1~ l Po o~ R~ a~ ao l p Thomas C. Jorling / 1 • x.« ~ S~ I ' Commissioner Dear U ?J Q~(~Z.~ -~I~ '/%~~~J~; T~j CCCCG~~.c~~A11 ~ Ci.l~~7,'yK~ ' A review has been made of your propos l to:~~>l Based on the information you have submitted, the New York State Department , o~f,Epvironmental Conservation has determined that the parcel X Y, project is: Greater than 300' from inventoried tidal wetlands~.~-~~~~Q~~1~~ Landward of a substantial man-made structure """"~~Q~( greater than 100' in length which was constructed prior to 9/20/77. _ Landward of the 10' above mean sea level elevation contour on a gradual, natural slope. ' Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 , of the Environmental Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the 10' contour or topographic crest without a permit. It is your responsibility.r.o ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a 15' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please contact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. , i i Very truly yours, i Deputy Regional ~rmit Admin strator JJ i S~w~ SAMUELS & STEELMAN ARCHITECTS [~[~4`~~Gj QO ~ 4~Q[i\]~~~~f'~f'Q~ 25235 Main Road CUTCHOGUE, NEW YORK 11935 (516) 734-6405 HATE ,oa NO. .rte 9O gTTENT~ON _~j Tin ~C ~y~7~ y~ `e/'y'~/~//, / - TO /CY~'~(J/nC! ~Wn/•uK/ P~GG/.~W~~ N'/-?' RE TC~F~V ! ~ ~ `~J~ . WE ARE SENDING YOU ~ Attached ? Under separate cover via the following items: ? Shop drawings ? Prints Plans ? Samples ? Specifications ? Copy of letter ? Change order ? COPIES BATE NO. DESCRIPTION ~ zz•~ ® v ~ / - / • pa ~ 77 i ~ • 9a J r~Z •7 ~ , Y. ' 7 r y3 • ~s' /Ll? o ~~~7. i! 1 1 THESE ARE TRANSMITTED as checked below: ~ '~9; For approval ? Approved as submitted ? Resubmit copies for approval G ? For your use ? Approved as noted ? Submit copies for distribution i! > ? As requested ? Returned for corrections ? Return corrected prints I ? For review and comment ? fffi ? FOR BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US i I REMARKS tf I I I { i i 1 i I COPY TO SIGNED: PAOWtttdu4 ~mF, Cmwn, Mm omn 1l enclosures aro not as noted, kindly notify us at once. - - - ' i ~ - _ r~. B0.1RD OF NEALTN 3 SETS OF PL.1NS FORM NO.1 SURVEY ~ q TOWN OFSOUTHOLD CHECK .?~aC~~~ • 6UILDING DEPARTMENT SEPTIC FORM TOWN HALL $OUTHOLD. N.Y. 11971 NOTIFY ; 2~ r ~~0~. • • • • TEL.:7G5.1II02 CALL ~1 , Examined ~,(~'W,. l9 ~Q PIAIL T0 Approved N.:-!Yi. 3~ 19~Q .Permit No. - • . Disapproved ale ti . ~ o~~~,i t a Leo (uiWing Inspector) l' ...fit-' i APPLICATION FOR BUILDING PERMIT B(.OG. DEPT: TQWP~ OF 50UTHUtU ) Date 15... INSTRUCTIONS f:' a. Tlus application must be completely 511ed in by typewriket or in ink and submitted to the Buildinslisspector, 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 strcezs or areas, and giving a detailed description of layout of property must be drawn on the diagram whichss part of this appli- cation. C. The work covered by this application may nat be commenced before issuance of Building Permit d. Upon approval of this application, the Building Inspector will issued a Building Permit to the appl~mt. 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 Lams, Ordinances or i Regulatio.ns, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. i The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and r~ulations, and to admit authorized inspectors on premises and in building for necessary inspecti ~ . ~~~~r/rrr.R.v- C. <)~!~/11!1!l~t,lrl~l . . •(Signature of applicant, or name, ifacorporaiwn)~ - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. SCR Ht~Gi...- . sA~l~?u.?~.~ ~-r~ w~~trJ Name of owner of premises :~k ~~t~-~~ ~t-i ~ C7... _ . (as on the tax roll or latest deed) - If applicant is a corporation, signature of duly authorized o(Fcer. • • • • . • ~ • (Name and title of corporate ofFcer) - ~ Builder's Liccnsc No. ~ ~ . Plumber's Liccnsc No. ~A . Electrician's License No. ~ ~ . Otfter Trade's License No. , . • 1• Location of land on which proposed work will be done; - 4taf~ ~vT R~~........... ~-clTe.t-(QCy L! Etouse Number ~ Street. Hatttlct • • • • • • ~ County Tax i\tap No. L 000 Section BI'uck • J, , , , , , , , , , , , , , Lot ~ , , , f" Subdivision r- F,ilcd Atap No. . ~(Namcj Lot...: • State existing use and occupancy o(pre'm^tises and intended use and occupancy of proposed construction. - ` 1 a. Existing use and occupancy ...•~.~t~~ • • F~~t~Y ~ ~C.~ b. Intended use and occupancy ..vr.1N~~:'.~• .C,~4{Y•~!t-`~„~Pp~~~ 3 3. Nature of work (check which applicable): New OuiWing Addition • • • AItC71U0n • • . Repair RFmovaJ Demolition ...Swi:anin; pool............ Tennis Court Accessory Building.........,Eence .......Other lJork.. ~ OC'7~ . 4. Estimated Cost ...r, Fcc d (to be paid on tiling this application) 5, If dwellirig, number oC dwcllin~ unlfts ~ , , , , , , , , . Number of dwelling units on each floor . ICgaragc.numbcrafcars 6. If business, commercial or mixed occupancy, specify ~ttt r and extent of cacft_,t~~c oC use . 7, Dimensions of existing structures, if any: front RT. , Rcar ....5~-S~. 1~:T... Depth FT, , , . Hci_Itt ALP.. r.:C.... Number of Stories . . . Dimensions of~am~~ structure with alterations or additions: Front . ,~~D.. FT.... Rear . ~ , . . Depth ,4Q,'~: ~ l~T. lIcight .....2,rJ~?.~. Number of Stories . iZ S. Dimcnsionsof'entlr~ncir3l~gtistmction: Front .....~+.~R.. ~T. Rear .....2~~'..FT.. Depth .,.,(R:`~}; Hci;ht ..:.2r?', N: , l . N'uinbar of Stories,... ^G~• o+y . 9. Sizcoflo~t#. ~~Q1.. Rca:....~".~- r©./.ti....... Dcp~th....r1-5~,~~ 10. Date of Purchase 1,-y", , 23{ lq~j.4 : ,,ss~~Name of Pormer Owner Jt J't r .~-~R~~~~(~ 11. Zone or use district in tvt~iclt` emises are situated ,tG: . R~,stp~.l.;).r)J}1-: , Q~~rS1.T'~ . ®`~K~,~~L~ . I Does proposed constru'eCtb vats an zonin • law, ordinance or rc ulatian: 13. 1Vi11 lot be re;raded '1 y b . Nill exc ss dl be r m veil©om premises: Yes. , No . 14. Name of Owner of premises .~.e~~`3..~©u!~~x`t , ..Address ate, ~Nty~ NC.? Phone No. P~ , Name of Architect ~4rrL4,k2~,~ ,57~{,Cvj,A~t; , , ,Address .'~:r~.?r3.~.M~,1!~~1~ .Phone No. `~s3'g:(O''~ar~'..... . Name of Contractor .Address ..Phone No.. ; P P y IS.Is this ro ert locat~d within 100 feet of a tidal wetland? ^YES.~.NO.... *Zf yes, Southold Town,Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all Buildings, 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. ! r S k ~ ~ T7ACiH ~ . ~ 12,r~t~•.9l t~ ~ ~ , . i~ I STATE Of \Ew Y~RI~,~-F- $ S COUNTY OF l-?'.c-~Q,.~G . • . ~ (Namc of individu~si,t~ ~ ~ ` ° ° ' ' • • being duly sworn, deposes and says that he is the applicant • ~ t; contract) , above named. FIc is the A'~~1~(~4tG'~' (Contractor, agent, corporate officer, etc.) ~ r oC said owner or owners, and is dul)1 authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applic~tton arc trtre to the best of his knowledge and belief; and that the work will be perforntcd in the mannerl~sct forth in the application filed therewith. Swom to bciorc me this ~ , v• ...............G~.F.~Q .dayofi ..~~?.Yl~........, 19 .Q U Notary Puhlic,, v . , County _ ~ - ~ F I ~i(/ 7 ~,Q~ I~b y Notarypul;c,5t„t3 ofNmsy ~ (Si;natureofapplicant) Pdo.4,ri~929d~ ~ tT,aGtlod ~ ~urfatk~ ~9z- Comm(sdce Exata, :6 ' ~ _x r, t" CG ~ ~ ~ ~•.~.-~..y7) ~~3 .,...-.--e-•-a.-r.-+-..-.~..~,..y-....~.ry.-•--i«+'~+ter<-^f*kt.,`-^".>.,--»....,...-... _ rw-..--~. y~.....-.w+-~... t e ~ e to ~ r ~ v - ~ ~~m ftD,r C p ~ n c a i ~ to J,n VY! - iI ~ F ~ 3 a c " ~ ~ n ~ o, lil C~ I V ~ ~ ? ~ ~ ~ p ~ ~ q ~ ~ n k ! ry " a rt,x ~1~ ~ ~ ~~a e¢~nc i 1~ jq~ i ~d ~-1 ~ ~ u r r~ ~ v h l h, d rta o r ~ o ~ `a~ y~~~~ aff'~ t3~ I n ~ r 4 _ )f{ la L ~ ~ Q ~ 0 L ) ~ ~@<., q hJ 9 ~O ~I 1 F ~ ,s i,l.} 1 ~ ~ . ~ ~ ~ "'a. ~ - ~ i I ~ ..a j (f~J ~ t ~ ~ t"' lLa I , r / ~ _ \ ;h ~ C~~ tn~ 1 ri w' ~ ~ ~ ~ \ ~ ~ ~ I ~ ~ ~ k){ ~L~ ~ X1.1 I ~ ~ s ~ ~.;I i ~ ; I ~ w4.i us 4 y 'k j ~ ( -tr ~ ~ of } ~i ~ ~._,f..~f ,l,t ~.11 { ~ I f Ems; r ~ ~ ~ o~ N' 37 I)I W k w f ~'t~ 'F sl I cis a1 ~ i .e ~ ti. ~ j aw .L~au~~ ~ 'i ~ AI m ~ c~, i d 4~ ~ F - 'r - ° a C}bs7-1~7i~n`r3 ,r a + _ Ci ~ ~ m ~ M 5 C.G1 u ~ U t ~v ~ O i_ - +~Y p ~ ~ ~ ~ ~ ~ ' ~ ~ ~ ~ M a ~fy~ hG. ~s~j ~ Q o ~ R~ ` ~,f~,tc2` I ~ a w ~ 1 - _ ~ s~ N 'V { ~ ~,o i