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HomeMy WebLinkAbout18987-z s' ~ w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20630 Date APRIL 7, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 60 HARBOR LIGHTS DRIVE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 71 Slock 2 Lot 11.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 23, 1990 pursuant to which Building Permit No. 18987-Z dated APRIL 26, 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 ONE FAMILY DWELLING WITH GARAGE UNDER & ATTACHED DECKS AS APPLIED FOR. The certificate is issued to NEIL & ROBERTA SIMON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 13-SO-166 - MARCH 18, 1992 UNDERWRITERS CERTIFICATE NO. N-083068-7/26/89 & H-027853-3/30/92 PLUMBERS CERTIFICATION DATED NOV. 12 1991 - MICHAEL DAWSON . N~ Bu lding Inspector Rev. 1f81 rows xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 1897 Z ~ ~c ~ Dote 19.g V Permission is hereby granted to: .C~... a:.P~ N: y.:...... il.~~.~:..... r ro..t:~......5if...S?:n4...~ ..,..4.J:s~.~'.~.Cft.A.,,...4~:N?..... UUU ~ ~..1..9.....:~ of premises located at ~9..Q......l:A.~4~'~-`^~ ~:911>!' County Tax Map No. 1000 Section ........5?.7.~...... Block lot No....11: 3 pursuant to application dated 19..g.f~, and approved by the Building,' IIlnspector, ~1 Fee $...'f Bui ng inspector Rev. 6/30/80 Form No. 6 ire TOWN OF SOUTIIOLD , BUILDING DLPARTMGNT TO[JN HALL 765-1802 APPLICATION FOR CERTIPICATB OF OCCUPANCY .1. 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 toith 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 1~ 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. 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. O. Fees t. 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 - $50.00 S. Temporary Certificate of Occupancy - Residential~1$ 55f [00, Commercial $15.00 Date ....,T~~/.11,~- ':cw Construction...~•~ O1 Or Pre-/exist{s g B{u~ildin~yg~............ C Location o£ Property.. L: ~...~al,l:~;)~ ~ : L:.l~P t'I~S .:t./.~!'~ t'.(. .............JS~~:~I'~ ~f.~ . House N~o/./ / c~ J } Street~/~ Hamlet Unwer or Owners of Property./.['L~~l.:".f.:~~.~a...~~~U:d ..............j....tJ.r............. County Tax Map No 1/000,~Secti~~on. U7J.........Block.~,..~././...J.....Lot.~~/1~,.(!'/ ubdivision~~.~.cc'~~~CjY;.(,'(~~.1:~~ ~1C1~~.~.~~t~/..~/dF}iled Map.:?"C~~1.....Lot.:k~~ Permit No`~.~U.7 ....Date Of Pe/rmit.~I"~/,rj'L'~1.......Applicant~:~t~~ 7~~~~~~..~~~~:7.. !iealth pept. Approval.~~..W.s-?~...J~~........Underwr.iters Approval.. !~'~'f•:`~~ Plannin Board A ®`~3~~~ g PProval.. ~~7 C~ i:equest for: Temporary Certificate........... Final Ce tica e .n~.. f9 ! :'ce Submitted: @,~c. X13.5 7..5 ~/.'dry":... ICANT Cn ~.aoG36 Neil M. Simon FIVE LUC[LLE LANE OLD BETHPAGE. NEW YORK 1180a April 2, 1992 Town of Southold Building Department Town Hall Sout}gold, New York 11971 re„ Building Permit 189877 60 }}arbor. Liqhts Drive, Southold, NY 11791 Enclosed please find the following documents: 1. Applir_ation for Certificate of Occupancy 2. Copies of Board of Fire Underwriter's Certificates N792647, N083068, H027853. 3. Plumbing solder Certification 4. r}.na1 Survey/Health Department Certification (showing siting of brick/sand patio as requested nn final inspection report) 5. Copy of final inspection report. 6. C}reck fox fee i amount of 525.00 Thank you f.or pro'e sing this application. Sin .e . 1 , Neil ~ on TEL. 7G5-1802 o~pc~~FFU(/~~O~ TOWN OF SOUTIIOLD :~G OFFICE OF BUILDING INSPECTOR c ~ P.O. BOX 728 TOWN HALL yO,y~O~ ~ ~~0{ SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date /f-/Z Building Permit No. ~1~~ Owner ~/f/~L S/~~?a (please print) Plumber Hj/o~/FFG~ D/~°v5o (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber's signature) Sworn to before me this = , i1 day of ~l, a r__ ~ ?~E~ 2 Notary Public Notary Public, FFo<-1~ County LINDA K. DAWSON Mor- ~ FubNq Stata of New York No. 4694686 Qualified in Suffai:; County Term Expi-ros Marafi $0, 19 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1' 1000414 BUREAU OF EL.ECTRIGITY E15 JOHN STREET, NEW YORK, NEW YORK 10038 ~ ~ ' - Uatr JULY 26,1989 gpplicationNo.onfile 62503659/89 N 083068 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the opplicont named on the above application number in the premises of NEIL M. SIMON, 60 HARBOR LIGHT DRIVE, SOUTHOLD, N.Y. in theJollutcing location; ? Basrntent ? Let Fl. ? 2nd F'l, OUT .Section Block .Lot uaa exftmined un JULY 18,1989 and found to be in rumplfanre with the Yvgairrntenfa q/this Board. FIXTURE KEPTACIES SWITCHES FIXTVRES RANGES COOKING OECKS OVENS D15H WASHERS EXHAUST FANS OUTLETS INCANDESCENT FWORESCENT OTHER AMT. K W. AMT. K W. AMT. K.W. AMT. K.W. AMt. H P., DRYERS RIRNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gEp UN17 HEATERS MULTI-OUfIET pIMMERS ' AMT. N. W. on H. P. GAS H. P AMT. NG. A W. G AMT AMP AMT. AMPS TRANS. AMT N P SYSTEMS q,•nT wAita NO.OF FEfT SERVICE DISCONNECT NO.OF S E R V 1 C E METER NO OF CC COND A w G. NO. OF HIAEG A W, G. NO. OF NEViRAlS A. W G• AML. AMP, TYPE EQUIP. Iq DW 1,e'9W 38 ~W 3g4W PER.9' OF CC.COND OF NbIEG OF NEUTRAL OTHER APPARATUS: ~ " DLC-A/C-1 HILARY H. HOLLBORN & SONS LIC.#2562 E 102-5 CARLE'CoN AVE. ~ T p~ SUITE E GENERAL MANAGER' ISLIP TERR., NY, 11752 il„ `~Q~ ' Per "G ,i" " This certificate must not be oltered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 ,8_@31579 BUREAU OF ELECTRICITY 1 85 JOHN STREET. NEW YORK, NEW YORK 10038 Uate MARCH 30,7992 npplicationNo.onfilc 41309786/86 H 0?,7853 THIS CERTIFIES THAT PERMIT N(7. 14086Z only the electrical equipment as descrihed helow and introduced by the opplicant named on the afrove applicotion numher in the premises of NEIL SIPtON, 60 HARBOR LIGHTS llI-RI. EJu, POLE#6, OLD BETtIPAGE, N.Y. in thefollouinq location; nX Basement n Let 61. ~ 2nd F'l• GAR/OUT .SerNon071 Bloek2 Lot 11,001 was examined ort MARCH 24,199? andfound to he in cmnplianre with the n•quireutents q(lhis fJoard. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FWORESCENI OTHER AMT. K W AMC. K. W AMl KW. AMI. K W AML. N. p. 97 72 %5 92 1 3.5 1 1.2 3 g DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME ClOCXS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K. W. OR H. P. GA$ N. P. AMT. NO A. W. G AMT. AMP. AMT. AF1P5 TRANS. AMT, H. P NO. OF FEET nMT. watts 3 g 1 30 1 8 600 SERVICE DISCONNECT NO.OF S E R V I C E METER NO. Of CC COND A W G. A. W. G A, W. G. AMT. AMP. TYPE EQUIP 1,9']W I,P 3W 3,0 RW 3q 4W pER .e OF CGCOND NO OF NbLEG Op HI LEG NO.OF NEUTRALS OF NEVTRAI OTNER APPARATUS: PANEL80ARAS:1-15 CTR. 100 G.g.C.I:-16 SMOKE DETECTOR:-2 *NOTE: This is a partial, not a complete cert.ificaY,e. NEIL SINON G/~~~ 5 LHCII~LE LANE OLD BETNPAGE, NY, 11804 GENERAL MANAOER~ 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentiols. -t ~Z'..CSl~>~. cTmcTmnmcrmmctmrstmccmrTmS>~V,~L~-I~S~S,.TCU~4~1~5?~TI,~U~.U@S~.V~S - -----~y.~c,i~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 10037$ BUREAV OF ELECTRICITY t rehg 85 JOHN STREET, NEW YORK, NEW YORK 10038 5 Drn<• Tebruary 06, 1987 ,'Lppficmiorr No, on flle ¢46192/$7 ~ `7 ~ ~ C ~ l ~ THIS CERTIFIES THAT - V only the e(ectr(caL equipment ox described befarn and introduced by Uee applicaet naneed nn the above opplicntion number in theprernises of ~ C s Niel Simon, Harbor Lights llrive, off Windjammer, Southold, NY ~~~~11 e in thefoLlnming Location; ~ Rnsoment L1 Ist 17. C~lnd h7. Srrtion IJlnrlc lot T teas auunined on nndfowul Ur be in conydiunee with the requin•ments qL this lluarrl. _ i~ebruaxy_ 02, 1_~87_Y FIXTURE FIXTURES _ RANGES COOKING DECRS OVENS DISH WASHERS ExF1AU5T FANS r RECEPTACLES SWITCHES n+cANDescENT PEUOaescENr ~ OUTLETS ~pppF- AMi. N. W. AMi. K. W M1i K,W, AMi, K. W. AMr H P, t 1 DRYERS FURNACE MOTORS FUTURE APPl1ANCE FEEDERS SPECIAL REC'Pi TIME CLOCXS gEtl UNIT HEATERS MULTI-OUTLET DIMMERS r SYSTEMS - ~ -AMT._ K. W. O1I _H. P GAS _11-P_ AMl NO. A. W. G. AMi pA1P. AMi AMPS TRANS. AMT H P. NO. OF FEET AML. WALLS t - ~ ~ r SEfl`lICE DISCONNECT No. OF _ _ S E R V 1 C E I ME1ER - t AMi. AMP TYPE EQUIP. I q ]W I ,e ~W 9 d JW J A' 4W NO. OPER%COND OF CC. CCOND • NO. OF HbLEG OF HI LEG NO. OF NEViRALS OFANEU e'AL 1 1 200 CS _1 X ~`1 _3f0~ - _ 1 3/0 _ OTHER APPARATUS; ~ j 1 1 c r - ~ ~ c I Steve's Electric, Inc. p.0. BoX 1268 ~ ~ GENERAL MANAGER Southold, NY 11971 Lic4E3494E , Per 11' , This certificate must not be altered in any manner; return io the office of'fhe Board ij~ iritorred~: ~"Inspector}' may 'fie Identified by }heir ~credentia~s. l 9 " ' ass-isoz r ~ ~ ~ BUILDING DEPT. ~ INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. i [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL ~ .REMARKS:L~.~t~~..fi~~- y=~~~ f~~~,,,. '~i .,n..,~_~ l;~ ~ ~ ~ ~ ~ ri ~`,~)1 x.•a..rc./`f .C;l.+. o~-t: tnt v: f~ / f Y J r DATE ~ ~ INSPECTOR \I^,',,~°,1'ECTIUN UATE COMf4LsNTS rot FOUNDATION (1st), ~ - ~ ?OUNDATION (2nd) _ ~ ~ ~ .1% zo e tGUGH FRAME & ~ PLUMBING :~.t ~ y ~ 3. ~ m m ~ H IWSULATION PER N, Y, /Y STATE ENERGY .3~ 0 CODE 1 _ / a d"R r e~ ~4 . H FINAL - ADDIT ONA OMME S: ~ Z ~ rn - x . ca P,J ~ i ' r y x ~ d ~ ~ ~ ~v y 6'° r~~ 1~~~~ T65-1802 UILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SULATION [ ]FRAMING [ FINAL 0 REMARKS: . t . ~k DATE ~ INSPECTORS 765-1802 BUILDING DEPT. 1 NSPE~T'ION [ ]FOUNDATION 1ST [~OUGW PLBG, [ ]FOUNDATION 2ND [ ]INSULATION [~RAMtNG [ ]FINAL ~ < REMARKS: ~ ~ DATE ~ INSPECTOR ~ ; ~ ~f- / 7 7to5-iSOZ BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [~OUGH PLBG. [ ]FOUNDATION 2ND [)INSULATION [ l FRAMING [ ]FINAL REM RKS: ~ ' o r DATE _~,~~~{NSPECTOR Y Neil M. Simon FIVE LUCILLE LANE OLD BETHPAGE, NEVN YORK 11804 Dloveruhor _l1, J_991 li~/~1 Town of Southold ;:~uiidirag Dei~a~rtment Town FIa1l. ~',t~ Southold, New York :1.1971 ~ ~ /a~ 7 Uear. klul'Lding llepartment, re: P1uil.ding Permit No. 15987 'L Please grant a six month extension to the subject permit. t Thank yoia. `i t Sinc rcl , ~ f 1 i ei1 n i ~ ~~6r'' NOV ~~3~Ji I2 E ~I. ~r_ xosas xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. L b~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 017198 Z Date 19..A.~ Permission is hereby granted to: ,1 ~ ~!J to ....~s.~'...QIa...P..?u-..~ ...1~J.,.t.......~..bth-.~R..!.,?744: ....,...Q-A•?..... a . ~ : ~ . . , . . , , . p..~ . . . . . . . . . . . . . . . of premises located of ..lD..~.... Hart,~,~..c. ~~F.~t.~.~.~. ~!~"-A!!~~i~!l.T^:K~- ...A..,. .r............ ...............................................r.............,,......................r...r....,..................................,.................,,........... .........r ...................................................................................................r............r,.................................... County Tox Map No. 1000 Section ......~~~..jjjD.~.In...-...... Block ©~^....p.. pLot No.......~,~-..~.+~........ pursuant to application dated ...........~n~I~.KA.q••~ 19.d..A,,, and approved by the Building Inspector. 1 / Fee $.`~7.d:../.. ,~~e-t.. . . Building Inspector Rev. 6/30/80 ro8at xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N ® 14 0 8 6 Z Date ...~..ls.Q .~....1 19.? Permission is hereby granted to: .`~.a K....t. ~.!.z ............................................D.................................... ...s. j...~ I _ , at premises located ot ...l,S?..........E.:!.a:1..1~7.,... ...~..~.~:..'~~...~...~w County Tox Map No. 1000 Section ......Q...7~....... Block Lot No........I1t~1. pursuant to application doted .....~.~-!'!A:$e...~.~ 19.~.~~ and approved by the Building Inspector. Fee 5... ~ R2.D.' ~ D Bw ding Inspector Rev. 6/30/80 r~~:~(! ~ ~ , i ~ d C) ~ i (ii ~ ~ i c) ~ r a.. r A i;' - ~ `o ~ ~ ~ ~ i~' ---dd to ` ka ~ _ x ~ 1 I ~ ~ 7. ~ ~ I u ~ ~ ~ ~ 1 i 1 t 8 ; i. , K• ~ ;i ~ - F` 1 r,~USe ;r; y h, 1 41~ 1 ~ ~O r~n l ~I/c+~~l~ ~q' C?G.W~ ~ ~ b ~ i. ~ Y (.l /qj r ~ ~ a Q, :gel i ~ i'y'ai 1 I s. ~ .r ~ ,.~,an ~ ~ o~ ~ , ,a . ~ ~ r ~ ,r ~ ~ r~.~.~:r~~~~ .4 rI U n I' ~ ? $ ~ I . ~ lJe~-fe: f='r~rMisc~s arv~ o ~iwrr o~ e_ ' ~hotvn on '•dti1a~ of~` f-f~cr^F~er l.rgfr; ~ .~i~gf^io+n Tins" f'r(~+r1 irr -ffr~, ::`a~.N,r~'! i m, i4 Gf~?i~'S c>ffricer ag Mai .Nt~. 410i?BD ~ c~~FF~(1~~®~ ~ ~o~ 1 ~ TELEPHONE ~ (6I6) 765-1892 BOARD OF TOWN TRtiSTEES `TOWN OF SOITI'HOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 June 26, 1985 Mr. Garrett A. Strang, Architect P. O. Box 1412 Southold, New York 11971 Re: Neil & Roberta Simon Harbor Lights Drive, Southold Dear Mr. Strang: As per your request for a determination on the need of a Wetland Permit regarding the above referenced matter, please be advised that the Trustees have reviewed your plan on June 20, 1985. The Board has determined that no permit will be needed for the construction of the house being it will be built behind an existing bulkhead, but would like you to take the following measures during construction: 1. Roof ruri off shall be discharged to dry wells. 2. Driveways and parking areas within 75 ft. of the wetlands shall be of porous construction. Blacktop shall not be used on this site. 3. Care shall be taken so as to preclude the entry of any construction material into adjacent waters. 4. Immediately following construction, all areas of exposed soil shall be properly protected with suitable erosion control devices and/or vegetated to prevent entry of eroded soil into nearby waters. You must secure an application for a wetland permit for the construction of the stairway and float before you commence construction on same. Thank you for your cooperation in regard to this matter. Very truly yours, Henry P. Smith, President Board of Town Trustees HPS:ip Attachment • ~ , - NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ~~.5276-037~ f ' PERf~I~" UNDER Tf1E ENVIRONMENTA4 CONSERVATION EAW ARTICEE 95, (Protection of Water) ARTICLE 1S, (Tidal Wetlands) ARTIfiLE 24, (Freshwater wetlands) ®ARTI(a.E 36, (Consteuctton in flood Hazard Areas) iRNiT ISSUED TO- - - - - _....._.v...--....,....._.,...._....._ - Nei1 Simon, c% ESL-Consultantst Tnc.t 64 North 1Kain Streets Southam ton N. Y. 12yEti DOP.ESS OF PERMIT f EE 55 Incille Janet Old Bethpage, N. Y. 7CATiON OF PROTECT (Section of stream, tidal wetland, dam, building) .Dug canal off Shelter Island Sound -end of Harbor Li his Drive ESCR)PTION OP PftOJECi Construct 200± lineax feet of timber bulkl9ead backfill with k75f cubic yards of clean f311 and construct single fatrli],v home with associated septic system OMMUNITY NAME (City, Tnwn, Village) TOWN Bayview Southold OUNTY FIA COMMUNITY NO. DAM N0, PF,RMIT EXPIRATION DATE Suffolk Dscember 1 1 8 GENERAL CONDHYlONS t. The permittee shall fife in the office of the appropriate Regional 8. That the State of New York shall in no case Oe liable for any damage nnit Administrator, a notice of intention to tommente work at least 4g or injury to the structure or work Derein authorized which maybe caused by or urs in advance of the time of commencement and shall also notify Dim result from future operations undertaken by the Slate for the conservation or >rnptly in writing of the completion of the work. improvement of navigation, or for other purposes, and no claim or rlgM to 2. The permitted work shall 6e subject to inspection by an authorized compensation shall accrue from any such damage. uesentative of the Department of Environmental Conservation who may 9. That if the display of lights and signals on any work hereby authorized ter the work suspended If the public interest so requires. is not otherwise provided for by law, such lights aM signals as may be pre- 3. As a wndition of the issuance of this permit, the applicant has as scribed by the United States Coast Guard shall be installed and maintained pled expressly, by the execution of the application, the full legal respon• by and at the expense of the owner. aility for all damages, direct or indirect, of whatever nature, and by whom 10. All work carried out under this perrtiit shat! be performed in accor- er suffered, arising out of the project described herein and has agreed to dance with established engineering practice and in a~workmanlike manner. temniiy and save harmless the State from suits, actions, damages and sts of every name and description resulting from the said project. t t. If granted under Articles 24 or 25, the Department reserves the right to reconsider this approval at any time and after due notice and hearing to 4. Any material dredged in the prosecution of the wok herein permitted continue, rescind or modify this permit in such a manner as may be found to all be removed evenly, without leaving large refuse piles, ridges across the be just and equitable. If upon the expiration or revocation of this permit, the d of the waterway or flood plain or deep holes that may have a tendency io modification of the wetland hereby authorized has not been completed, the use injury to navigable channels or to the banks of the waterway. applicant shall, without expense to the Starr, and to such extent and in such 5. An material to be de osited or dumped under this time and manner as the Department of Environmental Conservation may require, Y p permit, either In remove all or any portion of the uncompleted structure or till and restore the e waterway or on shore above high-water mark, shall be deposited or dumped site to its former condition. No claim shall be made against the State of New the locality shown on the drawing hereto attached, and, if so prescribed York on account of any such removal or alteration. anon, within or behind a good and substantial bulkhead or bulkheads, such will prevent escape of the material into the waterway. t2. This permit shaft not be construed as conveying to fhr applicant any 6. There shall be no unreasonable interference with navigation by the rrght to trespass upon the IarMS or interfere wttD the riparian rights of others xk herein authorized. to perform the permitted work or as authorizing the impairment of nny rights, title or interest In real or personal property held or vested in a person not a 7. that If future operations by the State of New York require an alteration party to the permit. the position of the structure or work herein authorized, or it, in the opinion 13. The permittee is responsible for obtaining any other permits, ap- the Department of Environmental Conservation it shall cause unreasonable provals, lands, easements and rights-ol-way which may De required for this tstruction to the free navigation of said waters or flood flows or endanger project. e health, safety or welfare of the people of the State, er toss or destruction the natural resources of the State, the owner may be ordered by the Depart- 14. If granted under Arlicte 36, this permit is Branted sorely an the basis ant iq remove .or alter the structural work, obstructions, or hazards caused of the requirements of Article 36 of the Environmental Conservation Law and ereDV withouE expense to the State; and if, upon the ezpiranan or revocation Part S00 of 6 NYCRR lConstrurtion is Flood Plain Areas having Special Flood this permit, the structure, till, excavation, or other modification of the Hazards -Building Prrmns) and in no way siggifies that fhr project will be atercourse hereby authorized shat) not be completed, the owners shall, Tree from flooding, ithout expense to the State, and to such extent and in sorb time and manner 15. Ry acceptance o/ this permit the permittee agrees that the permit the Department of Environmental Conservation may require, remove all or is contingent upon suit) eomplrance wi[A Ihp special conditions on the tY Wrtion of the uncompleted structure or fill and restore to its former reverse side. mdnion the navigable and flood capacity of the water[ourse. No claim shall r mtde against the State of New York on account of any such removal or lerdilbn. , i.20-t (9/75) ~ • (SEE REVERSE SIDE) 'til ONDITIONS 7 ~ ' lb. The Applicant shall provide for subsurface flow of groundwater through the bulkhead by appropriate means including but Twt ]united to weep holes, perforated sheathings gravel backfill and drain pipes. Detailed plans for the entire Project shall be submitted for review and approval by Department Staff prior to the start of any construction on the Site. 17• Hoof runoof shall be discharged to dry wells. 16. Driveways and parking areas within 75 fc:€~t of the wetlands shall be of porous construction. Blacktop sha]1 not be used on this Site. 19. The Project shall not cover more than 3,000 square feet of the Site rrith impermeable structures. 20. Care shall be taken so as to•preclude the entry of any construction material into adjacent waters. 21. Immediately following construction, all areas of exposed soil shall be properly protected with suitable erosion control devices and/or vegetated to prevent entry of eroded soil into nearby waters. STATE ENVIRONMENTAL QUALITY REVIEW The Department has•determined that pursuant to the State Environmental Quality Review Act, the action is an unlisted action and will not have a significant effect on the environment. No optional coordinating procedures were followed. ERNIT ISSUE DATC PE I OR ADDRESS New York State Department dv vember 2 , 19 81 of Fhv3 ronmental Cons • RALPH MANP7A, JR. 50 Wolf Road Chief Permit Administrator Albany, Nety York 12233-0001 QNCIIT{ONS 16. The Applicant shall provide for subsurface flow of groundwater thxougb ~ the bulkhead by apprapriate means including but not 1im3.ted to weep holds, perforated sheathing, gravel backfi]1 and drain pipes. Detailed plans for the entire Project shall be submitted for review and approval by Department Staff prior to the star4 of . any construction on the Site. 17. Roof runoof sha17. be discharged to dry weals. 16. D~r3.veways and parking areas within 75 Peet of the wetlands shall be of porous construction. Blacktop shall not be used on this Sate. 19• The Project shall not cover more than 3,~0 square feet of the Site with 3.mpermeable structures. S 20. Care shall be taken so as to preclude the entry of any construction material into adjacent waters. 2l. Immediately following constxuction,'all areas of exposed soil shall be properly protected with suitable erosion control devices and/or vegetated to prevent entry of eroded sail into nearby waters. STATE ENVIRONMENTAL QUALITY REVZ$w The Department has•determined that pursuant to the State Environmental Quality Review Act, the action is an unlisted action and will not have a significant effect on the environment. No optional coordinating procedures were followed. ,~wtt ISSUE DATC PE ~ ~ OR ADDRESS New York Stato Department .,,.umber 2, 1981 of lhvironmental Cons inn RALPH MANNA, JR. 5 Wolf Road Chief Permit AdmirE9.strator Albany, New York 12233-0001 • 'J r NEW YORX STATE OEPARTMEPTT OF ENVIRONMENTAL CONSERVATION TNF•15276-0373 1 i PER~i~' rrr^^^~~r UNDER THE ENVIRONMENTA4 CONSERVATION lAW ARTICLE 15, (Protection of wafer) ®ARTICLE 25, (Tidal wetlands) ' ARTICLE 24, (Freshwater Wetlards) ARTICLE 36, (Cortsnuction In Flood Nazar4 Arras) 'KNIT ISSUED TO Neil Simon, c% FAT-Consultants, InC., 64 North Ma.S.TL Stxeet, Southampton, N. Y. 1lgi,ts JOP.ESS OF PERnffTfEE 55 Luci3le Lane, Oid Bethpage, R. Y. ]CATION DF PROJECT (Section of stream, tidal vretland, dam, building) Dug canal off Shelter Island Sound -end of Harbor Lights Drive ESCRIP[t0P/ OF PROJECT Construct 200± linear feet of timber bulkhead, backfill with 475¢ cubic yards of clean fill- and construct s- lt3-f home with ssociated se tic s stem. ~ I OMMUNITY NAME (City, Town, Village) ~ TOWN Ba,Wiew Southold UUNTY FIA COMMUNITY NO. OAM N0. PERMIT EXPIRATION DATE Suffolk Dscember 1 I S GENERAL CONDITIONS t. The permiitee shall file In the ofNce of the appropriate Regional 8. That the State of New Yoek shall in no case be liable for any damage unit Administrator, a notice of Intention to commence work at least 4g or lnlury to the structuro or work herein authorized which may bb caused by or urs in advance of the ttme of comnxancement and shall also notify him result from futwe operations undertaken by the Slate for the conservation or xnptiy in writing bf the completibn o1 the work. Improvement of navlgalloM or for ether purposes, and no claim ar right to The permitted work shall be subject to Inspection by an authorized eom~nsatfon shalt accrue from any such damage. xesentative of the Department dt Environmental Conservation who may 4. That if the display of tights and signals on any work hereby authorized ter the work suspended it the public Interest so requ(res. is not otherwise provided for by law, such lights and signals as may be pre- 3. As a condition o1 the Issuance of this permit, the applicant has ac- scribed by floe United States Coast Guard shaft be installed and maintained pled expressly, by the execution of 4he application, the full legal respon• by and at the expense o1 the owner. rility for all damages, direct or indirect, of whatever nature, and by whom 10. Alr work tarried out under this permit shalt be performed in actor- rr suffered, arising out o1 the protect described herein and has agreed to dance wilA established engineering practice and in a workmanlike manner. !emmiy and save harmless the Slate from sails, actions, damages and sis of every name and description resulting from the said project. 11. If granted under Articles 24 pr 25, the Department reserves the right to reconsider this aDProval at any time and alter due notice and Rearing to 4, Any material dredged in the prosecution o/ the work herein permitted continue, rescind or modify this permit In such a manner as may be found to ztl 6e removed evenly, without leaving large refuse plies, ridges across the be just and equitable. it upon the expiration or revocation of this permit, the d of the waterway or flood plain or deep holes that may have a tendency to medification of the wetland hereby authorized Ras not been completed, eht use injury to navigable channels or to the banks of the waterway- applicant shalt, without expense to the Stmr, and to such extent and in such 5. Any material to be deposited or dumped under this permit, either in ttme and manner:s the Department of EnvUonmental Conservation may require, r waterway or on snore above high-water mark, shall be depositedor dumpetl remove ail or any portion of the untompteted structure br fit) and restore the the locality shown on the drawing hereto attached, ard, it so prescribed site to its former condition. No Claim shall br made against the Slate of New mean, within or behind a good and substantial bulkhead or bulkheads, such yolk on account of any such removal or alteration. will prevent escape of the material into tfce waterway, t2. This permit shalt not be construed as conveying to Iho applicant any 6. There shall be no unreasonable interference with navigation by the right to trgspass upon the lands or interfere with the riparian rights of others Nk herein authorized, to perform the permitted work oz as authorizing the impairment of any rights, ' title pr Interest In real or personal property held or vested in a person not a 7. Thai ft future operations by the State of New York require an aPteratlon party to the permit, the position of the structure or work herein authorized, or If, in the opinion 73. The permittee is tesponSible for obtaining any other permits, ap- the Department of Environmental Conservation rt stroll cause unreasonable provals, lands, easements and rights-af-way which may De eequired for this .;traction to the tree navigation of said waters or flood (lows or endanger protect, . e health, safety or welfare of the people of the Stale, or loss or dostrucl{on the natural resources of the Stale, the owner may be ordered by the Depart- 14. If granted under Arllcre 36, this permit is granted solely on the pasts ant to remove or alter the structural work, obsiruclions, or hazards caused of the requirements of Article 36 of tAe Environmental Conservation Law and rrebr without expense to the State; and il, upon She ezpfraiton or revocation Part 500 of b NYCRR lConsirurNOn in Flood Plain Areas having Special Fiood this permit, the structure, fill, excavation, or other modification of the Hazards -Building Vermits) and in no way signifies that the project wits 6e atercomse hereby authorized shall not be completed, the owners she!!, free tram flooding. .shout expense to the Stale, and to such extent and in such time and manner t , the Depmfinehi o1 Environmental Conservation may requre, remove ail or 15. 8y acceptance o! this permit the permttlee agrees t1+ai the permit :w purUOn of the uncompleted siruclbre ar Pill and restore to its former is contrngent upon strict compliance with the specie) Conditions on the \ ,ndn,on the navrgable and flood capaoty o1 9he watercourse. No claim shall reverse side. mrde against the Stare of New York on account of any such removal or aeration. , .10«1 (9/]S) • (SEE REVERSE SIDE) ~t FoRt~ No. 11 TOWN OF SOUTHOLD BUILDING Dk;PAIiTMENT TOWN HALL SOUTHOLD, NY q DEVELOPMENT PERMIT P1a 1 ~ F Data _..~~11 , ~_.._..._...~..Y 19 ~ Yerrnisaion is hereby granted to: (00 1~RrZ3ard. L.~(eS I.JKi Uti ..~s...~....~,....~...~-- .A.......,.. o U`7'~ o J ~ i. IV L`Za~ t o o N s V"K. u eP" 14 o N~ C' ~~4 m ~ 1 u J~ w~ 1 d t, ^',~C a,... at premises located at ~ N~~f3ox. .L.i CN-~s ~~.iu~~ a County Tax Map No, 1000 Section O'll Bl.nok O 2 Lot r~'1)I~J ~^a~ pursuant to application dated ! 1r„_„,,,, 19 ~S , and eppi~ovf>d by the Building Inspector. Building P®rmit No, 1 '-J O $ Co ~ Building Inspector 4/ao M ~~Application Received Disapproval Issued ~ Permit ~ ~ I 19_„_ { 19~ I 19_ ~ FORM N0. 10 APPLICATION FOR DEVELOPMENT PERMIT In th© Town of Southold ~He 1,],_ 19g~ 1. Type of Development Proposed: New Structure (including storage tank s Addition and/or AlterationQ Flood Proof Below Base Flood Elevation II Other (specify) 2. Elevation Data in relation to above mean sea level of:6'-0" at ,Gar e (a) Lowest floor elevation, including basement feet a -3nc~i~s (b) In a V Zone, bottom of lowest structural member feet ~ inches 3. FIRM--Flood Insurance Rat© Map, Zone designations A-4 iel. 8, 1}. Owner of Premises Neil & Roberta Simon 5• Locatio//n of Property: Lo d Harbor Lights Drive Southold HL'V:E T3 G7 hFt"I an ra r_c: County Tax Map No., District, 1000, Section 071 Block 2 Lot(s) 011.1 Subdivision Harbor Lights----lEstates Filed Map ~ 4681 Lot(s) 0_42 6. Permission to be ranted: ~tOwner as above New Owner - Under Contract ~Lesseo~~ Contractor 516-293-8031 _ ' PHONE nv.n Si Ef( M/M SS/imon 5 Lucille Lane Old_Bet~a~e N.w York 11804 NAME `fF NOT GIVER Ad~Vk AN 3] MHf LING ADDi215$ 7, Approval from other(s) before Permit is issued: DEC Permit # TW-15276-0373 WETLANDS (Town Board) N/A HEALTH SERVICE Approval # 1350166 ZBA N/A BUILDING PERMIT PLANNING BOARD 1 A 8, I, Garrett A. Strang , the applicant, am the Owner., Co- Owner , New Owner , Under Contract{~, Lessoe~{{, Agent{X Con- tractor C], and agree to comply with all applicable sections of the Code of the Town of Southold; County, and Stat© and to admit authorized in- spectors to premises authorized to perform or have performed tYie s~Lid work and to ma$e and file this application, that all statements contain- ed in this application are true to the best of my knowledge and belief and that the work will be performed in the mannerset forth in the application filed therewith, STATE OF NEW YORK COUNTY OF Suffolk ! SS ~ Sig lure HEtrrl N DE VOE SWORN TO TIIIS 1 1 th DAY OF June 1985 NOTRRY PUHLIC,. Stzte of New York p/~) No A701£76. Suliolk Count 7 / ~ 412- Tenn ExOires March 30, I9~ Notary Public Garrett A. Stranq, Architect Applicantfs mailin p,O.BOx 1412 address and phone if not given above: Southold, New York 11971 4'/80 516-765-5455 i 08/1 (gaegs sFuq 3o xosq eqq uo uzzo3 auq qno TtF3) eq use Gdnooo xo esn oq Tenoxdds e 'PaAoxdds pua suoFgenaTe,TtruF3 eqq o3 not so uq exo3oq paggFruqns eq gsncu xxoM q F3Fgxeo pexFnbex euq uoFgatduzoo uodn •suoFgoadsuF pexFnbex euq aKsui Gsu au os euzFq uF peF3Fgou eq TTsgs xogoedsuF auq `uoTgonxgsuoo HuFxna •sGap HuFxxoM (pT) ueq uFU4FM penssF eq gsnru gFwxad a xo TsnoxddssFp~uaggFxM,y •auoz pxBZZau PooT3 TsFoeds a uF gxsgs use ~xoM Gus axo3aq penssF aq genus ?tw.zad HuFptFng ~ pus quetudo enaQ a agog •exngonxgs Gus.xo3,paxFnbex osTs sF 4Futxea HuFptFng d 'gF~ad buFpTFng paTFsgap uF uMo see snuz uo •peggFu:qns uoFgaxegTs bus 3o cangsu u q q F4soF3Foads pus susTd eases xegTs oq sasod -oxd queoFTc~ds',auq.pus sesFuzaxd eqq uo gsFxe seunp pines 3I •saunp pueg •sTTsM GeMaxeexq ~deoxe uado MoTeq eosds TTs ugFM uoFgenete PooT3 essq eua ueuq xeMOT eq gouuso xooT3 gsaMOT euq 3o sxaquzeut Texngonxgs euq 30 uoFgxod gsaMOT eqy 'pegF0.FUoxd exa sausou eTFgoi~I 'ugFM peFTduzoo axe bt-9~i 3o suoFSFnoxd a~Qif; gsgq uF exFnbea Geui xogoadsul HuFptFng eqq sa uoFgeuazo3 -uF xeugo eons pua suoFgaoF3Fgxeo paxFnbex euq HuzpnTouF suorgaot3zoeds `susTd gFuzgns TTsus quaoFtddy '6T-9~1 (aua2 A) seas pxszzaH q~FH Tsgssop •paF3sFgss exe,apo0 PTougno5 auq 30 (Z) (T) ggT-9~1 uOFgoaS uF ugxo3 qes spxepusgs egq,gsuq goegFUoxs xo xeauFHua TeuoFSSe3oxd paxegsFHex s Gq uoFgsaF3Fgxeo gFiugns genus qusoFTdds `GousSonq 3o sgoa33e pus spaoT aFuzeuGpoxpGq pus oFgsgsoxpGU HuFgsFsax oq aTgedso exs squauoduzoo Texngonxgs gsuq •z `xagsM 3o eHessed euq oq etgaeurxeduzF pus GTTsFqusgsgns sTTeM ugFM ggHF4 xegeM sF exngonxgs auq Tenet PooT3 essq auq MoTeq gsuq xeuusut eons uF pe3oo,zd poaT3 sF exngonxgs uona •T :gsuq `uoFgatnHag Tsxepe3 auq Gq peggFuz.zad 3} :xo ucFgsnete PooT3 essq eqq anoge pegsnete `xeTTeo /quauzessq 9uFpnTpuF ~xoot3 gsaMOT ou4 ansu TTFM xo sgu axngonxgs euq gsgq sgos3 euq a?sF2upgsgtis oq xogoadsul HuFptFng euq Gq pagsenbax uoFgsurxo3ur xeugo Bus sa tZaM se suoFgaoF3Foeds pua susTd gFuzgns gsncu quaoFTdds aux seutou aTFgoW '0 uoFgonxgsuoo TaFquapFsex-uoN •g uoFgonxgsuoo TsFquapFsag •y :QT-qty uoFgoeg uF pexFnbex ss spxspusgs oF3F suoFgenete PooT3 essq pus uHFsap se?gFtF~n oFTgnd `eHauFe,zp ggFM Tasodoxd uoFSFaFpgng •a seFgFTFgn 3o uoFgsooT pus uHFsea •0 spougeuz pus TsFxegsuz uoFgonxgsuoo 3o esn •g saruou eTFgout,pus s~usq HuFpnTauF `sexngonxgs 3o SuFxouoTZ'd •tl eHsurep PooT3 azFuzFuFuz oq MsT auq 3o LT-9~1 uoFgoaS uF pexFnbex ss spxspusgg ts.~auaQ •saxFnbax G~uaHs xeugo Gus gsuq sTenoxdda gFuzgns genus qusoFTdds eqy •ptoggnog 3o uMOy auq 30 „MaZ uoFquenaxa eHsuro a PooT3„ ss uMOUx ptoggnog 3o uMOy auq. 3o epo0 auq.3o gt~ xegdag0',`Og6T-t 'oN Ms'I TsooQ euq oq GTduzoo ueo pasodoxd eqq gsuq Mous oq uoFgeurzo3uF egetduzoo enFH genus uoFgsaFTdde euy •xxoM pesod -oxd 3o sHuFMSaa `Tenet eas uaeui enoge suoFgsnete ggFM sesFutexd 3o Gen -xnS •Z `uaggFxMed~fq xo stuF uF qno PatTF,I OT 'oN uuzo3 •T (egeo~~dnp uF nose) sepnTouF xogaadsul HuFptFng eq?. oq uoFgsoFTdda euy :suoFgonxgsul S~T.'.IN~d yDL'3Ldd0'I~AHa ~i03 NOTytlOIQdaV us `aaoxynos tL6Tt adoa NItr~I ]CN `a~zoxynos ~~vx tsrtoy gzL xog 'o'a zogT-S9L (9T5) yt~c~ya~axa aNlaaing a70Hd,[lOS 30 NMOy 0 ~ ' ON Y~I2i03 'FORM NO. 1 ~5~~ TOWN OF SOUTHOLD ~ ~ ~ ~ BUILDING DEPARTMENT 1 TOWN HALL ~ ~1~_ a SOUTHOLD, N.Y. 11971 1 "1" TEL.: 765-1802 ~-~~.m.~ M~.V` Examined .4~:~.~ 19~?~ 1 ~ 9 g7 ~ Received........... , 19.. . 19~~.PermitNo..j.~~~~°~ Approved . ~ Disapproved a/c e ~ . o (Building Inspector) ~ ~ ~ _ I APPLICATION FOR BUILDING PERMIIT Date .June,10,,,,,,,,,., 19$5. 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 or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, an regulations, and to admit authorized inspectors on premises and in building for necessary inspect' n . ' - .`as'p....' ( ignature of a licant or name, if a corporation) Garrett A. Strang, Architect ?.4..,~ox..1,4,12. S.QUtho.id,. N...Y..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Architect Name of owner of premises Neil, &„Roberta, Simon,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ,Not. Selected, , , , , , , , , Plumber's License No . . Electrician's License No . . Other Trade's License No . 1. Location of land on which proposed work will be done . . ~00 .,,,,Harbor,L.fights.,Drive,,,,,,,,,,,,,,Southold House Number Street Hamlet County Tax Map No. 1000 Section ~ ~ ~ Block ? . Lot Pl o, ,1 1 . 1 Subdivision Harbor ,Lights, Es,t~tes, , , , , , , .Filed Map No. 4,($~.. , , Lot g/.042....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , ,Vacant Lot b. intended use and occupancy ....Single, Family, ,Residence , , , , , , , , , , , , , , , , . 3. Nature of work (check which applicable): New Building , , , , , , , , , , X.'..... Addition Alteration Repair , . , .Removal . Demolition ..............Other Wgrk , , . (Description) 4. Estimated Cost 1 1,5 r 00,0 . . Fee . ~?3~.'.~.Q....... , , . (to be paid on filing this application) 5. If dwelling, number of dwelling units ~n?, , . , . , , Number of dwelling units on each floor . If garage, number Of cars 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use . Hei ht Nures, if any: Front ...............Rear ; Depth , . D gens>ons of existing structumber of Stories . Dimensions of same structure with alterations or additions: Front Rear . Depth .............:........Height ......................Number of Stories . , , . - 8. Dimensions of entire new construction: Front ...32 , Rear 32 ~ .......Depth . , ,56' • • . • . , • N_eight ..32 . Number of Stories ...Two.... . 9. Size of lot: Front . 100' Rear 100 r Depth .....19b:.'S~'' . . 10. Date of Purchase .....1,9$1;,,,,,,,,,,,,,,,,,,, Name of Former Owner 11. Zone or use district in which premises are situated A-Residential/Agricultural. . 12. Does proposed construction violate any zoning law, ordinance or regulation: ........~4 . . . 13. Will lot be regraded NQ . ...Will excess fill be removed from premises: X Yes No 14, Name of Owner of premises M,/.M. S.im4n......... Address~7-d. ~~~k~P.ag~.N.•.X Phone No.5,1.6-29.3,-$Q~,1. , Name of Architect ....G.A...Stx'a7ig , ...Address$9?r. 1,q) 2, Sq~t}iol,~hone No.5,1,6-7~,~-5,4,5,5, , Name of Contractor . ,Not, Selected.. • . , , , , ,Address . ...............Phone No............ , . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc(C number or description according to deed, and show street names and indicate whether, interior or corner lot. See Attached Plans STATE OF NEW YORK, S.S COUNTY OF. Suffolk Garrett A; ,Strang , , , , , being duly sworn, deposes and says that he is the applicant (Name of individ. ual sigping contract) above named. Heisthe .....Architect (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 contained in this application are true to the best of his 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 . 11 th.day of .June...... 19 85. Nptary Public, .........~-f?-N'... {~~-County F ' - HELEN IC OE VQE NOTRRV PUBLIC. Slai:; o! New }'ork • • ~ . 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