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Home My WebLink About18896-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219028 Date MAY 8, 1990 THIS CERTIFIES that the building RENOVATE EXISTING PIZZA PARLOR Location of Property 13540 MAIN ROAD MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 114 Block Il Lot OS Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 8, 1990 pursuant to which Building Permit No. 188962 dated MARCH 20, 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 RENOVATION TO EXISTING PIZZA PARLOR. The certificate is issued to BETTY & SOSEPH HARDY (ROSY COTTONS TENANT) (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 5/4/90 I.D. 04963 UNDERWRITERS CERTIFICATE N0. PENDING SLIP 4/25/90 PLUMBERS CERTIFICATION DATED HARDY PLUMBING & HEATING 5/4/90 uil ing Inspector Rev. 1/81 rosai xo. s TOWN OF SOUTHOLD BU1LDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 18896 Z Date .......~..~:sg....~ 19..1.. Permission is hereby granted to: ....~....0.~~~gqyy ..`?r:::. ro ..~rn.!?~?;cSr~........Sirrz....~4~-~.~»^~~.~.4~fS,a.~...~t..4~ktR......44.....9~......... 1,,' , at premises located of ..~...~.~.4'Q...... ?.Y14~s:....~ .......................i~K~,.......................... County Tox Map No. 1000 Section ......~.~.7..../.~...... pBiock ........~.t!........... Lot No.... d pursuant to application dated ...~..Qi1,.,GA......Q 19.1.0.,, and approved by the Building Inspector. Fee ...~.c~t."w:z- ding Inspector Rev. 6/30/80 Form No. 6 ( TOWN OF SOUTHOLD BUILDTOWNDHALLTMENT PU'~Y r I~ 765-1802 PUt ~ TQWN O SOU74iOL17 APPLICATION FOR CERTIFICATE OF OCCUP A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 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. 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 Tnspector 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, Comc7mercial $15.00 Date .........~r._..~.. New Construction........... Old Or Pre-existing Building............ Location of Property..~35SC7•.•~~j.,i.1•~C~~.•••.••~/~`~"7-( TVC(:~•••~~~ ~,1„/,~~;,•.•, House No. Street (,Y{amlet Onwer or Owners of Property..<.J~(T`~.~.~,_,)~5~~.~...~"`4 t ~ County Tax Map No 1000, Section..~~:?........Block...~.j...•..••••.Lot...s Subdivision pp.~.GG..// ........................a.....Filed Map............Lot.... Permit No.l/.~R.I~O.~...Date Of Permit..~?:aO:R.J/...Applicant..~~'1Jj. .~~l.I.:4SL...... //f/ °S Health Dept. Approval ..........................Underwriters Approval......7.~....:........... Planning Board Approval.. / L// Request for: Temporary Certificate........... Final Certicate...... Fee Submitted: ~ /~f9o e o /ga a ~ ~~APPLICANT ~~FFOLk~, P ~ D ~ T LD ~ ~ S Y Southold, N.Y. 11971 (516) 765-1938 December 23, 1986 Mr. Victor Lessard Executive Administrator Building Department Town Hall Southold, NY 11971 Re: Site plan for Paula Clark and Joseph Taormina Dear Mr. Lessard: Please let this confirm the following action taken by the Southold Town Planning Board, Monday, December 22, 1986. RESOLVED that the Southold Town Planning Board approve the site plan for the renovation of the former North Fork Video to a take-out restaurant located at Main Road, Mattituck for Paula Clark and Joseph Taormina. Survey dated as amended October 31, 1986. If you have any questions, please don't hesitate to contact our office. Very truly yours, BENNETT ORLOWSKI~ RIJ~~_~/ SOUTHOLD TOWN PLANNING BOARD By Diane M. Schultze, Secretary ~ ~ .,.,.F-.. THE NEW YORK !lOARD OdF UNQ~RYYRIT~"R5 pA~a I a as 1 a 14 5 at~wu of rnn.scfrwctw e;a JOHH sTasear. NEw rURK. e/~W YiwNC IoG3! naY ~~>av9q 6aagg9eol~q w glbgea o.te ~,yP~911ice::on no. on~//fu/e THI! CEekTIF{ES THAT PERMIT Nq. 18856 Mdr tkrrlretritd equiplneRL Y deretibed I/IIOIC and Intrrdreed tks rewt MRt/dMtM rkeee ~ wuweberiw the prewAlMS ~ ANSEY_0 I'OSCANO, 1.554q MAIN Ri)AD, MATTTTaa£K, N. Y. in tke follrteinR location; ? 8rsement ® l At Fl. ? Ynd F1. Sertiun /trek Lat Aoas esaAniued on MAY I~, 1990 andfound to 6e in rolnpliance ritk tke reyuinementw ofekie Beard. IIIt1W T F l)t1Tiele LIIYITC.Ile6 INI:ANOtSCENT nUOtESCEM @7'N!R NAT. t. W. AMT. t. W. MIT. t.W R AMT. N.P. 4 3 & b `i= r eenii~s ~uelua keo~~oes iamlee 1M~leerr ~ eritceriNlee eiwkres AMT. R W. dl X. P. 0.Ab N. P. AMT. NQ A. W.0. AMT. ANY. AAH AMeR AMT. R I. MAT. WATTt 1 `bqo eeawas etecotlwecT ttaoY e e e v t c e AMr. AMr. TTYE I w tw A w sN a s tw t A Aw No. a~kcoNO. ~ A. w, . No. a NFIE6 a ~ . oPtsunuls gF NWtu~iAt: _ ` u i~ OTtIIR AIlAeATt/k ~ ~A~ AN6ELQ I05f,AN0 1354Q VAIN kD. - MATTITUCK, NY, x.1952 ~eleYe11N0e1! 11~ Per - lttRl tAW ba in RNMIat; mourn M f`t ofEiu of the ~ If . . k. EIR ~II,AIM' I ~ - THE NEW YORK BOARD OF FIRE UNDERWRITERS - zoox3ai BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date Mi1L'CYL 9 r 1987 APPlication No. on file gvJ9D~~87 wl 7 ~ ~ ~ ~ - THIS CERTIFIES THAT EV only the electrical equipment as deacrihed below and introduced 6y the applicant homed on the ofwve opplicotion number in the premiaea of Amicis Pizz®ria, Main Road, Mattituckt N.Y, in the following htcation• ? Raaement ~ lat F'l. ? 2nd F'l. .Section Block Lot - was exa.nined on MarC11 1987 = and found m be in cornplianre with the requiremears of Chia Qoard. FIXTURE ECEPTAGLE$ SWITCHES FIXTURES UU RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT vnPOV AMT K W. AMi K.W AMT. KW AMi K W. AMT. H P = 10 8 5 4 6 y F - DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS - PMT. K. W. OIL H. P GAS H P AMT NO. A W. G. AMT AMP, AMi AMPS TRANS. AMT H P SYSTEMS pMT WATTS - - NO. OF FEET _ ~ s i ~o SERVICE DISCONNECT NO.OF $ E R V I C E AMT. AMP. TYPE ~~Ep ~ %vw 1 ,e 3W 3.a JW 3,e" 4W NO. OF CC CONn A. W G NO OF HI~LEG A w G NO Of NEUTRALS A W G. PER % OF CG COND OF HbLEG OF NEUTRAL OTHER APPARATUS: 7 s Jody Pumillo ~ - Pat Lane MattittlCk, N.Y11952 LiC~29DOE OENERA4`r~ANAGER S:i~ i.r' Per 7es ' This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identiF"ied by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT.6E ALTERED IN ANY MANNER. • TEL. 76.-1802_ ~ ova=act; or B,ut~t,DU,ic: Lvst'~cz;o~t y0j, ~ SOi3'I'HULD,, I:.Y. 1,1~9Tfl_ ~ ; ~ M ' E ~ MAY - 71990 l ~w. C E R T I F I C A T~ Z O. Ld TCitiJfr ~ . - x~4~.. , _ Date MAY 4, 1990 Building Permit No. 18896 Owner VILLAGE PIZZA II (please print) Pl~trber HARDY PLUMBING & HEATING NORTH, INC. (please print) I certify that the solder used ~n the water supply system contains less than 2!10 of 1~ lead. _ " (plumber's signat re) Sworn to befor~J//~e this - ~day of 19~ Rotary I~ublic Nota_° Pc~h_iclx~G~~~- County . 1 f~a. ' ~S • 70.16 PLUMBING & HEATING NORTH, INC. JOBBING & ALTERATIONS LIC. NO. 1593P 298-9181 Day 298-5691 Nlght May 1, 1990 i TO WHOM ZT MAY CONCERN: Be advised that HARDY PLUMBING & HEATING NORTH, INC. performed all ~ plumbing work at: VILLAGE PIZZA II 13550 MAIN RD. MATTITUCK, NEW YORK 11952 If we can be of further assistance, please advise. Yours truly, HARRDY PLUMBING & HEATING NORTH, INC. I1 , ~ Richard A. Durand f Vice-President , RAD:es Gas work done by others. P.O. Box 1460, 13500 Main Rd., Mattituck, N.Y. 11952 ~a~;dry s PLUMBING & HEATING NORTH, INC. JOBBING & ALTERATIONS LIC. NO. 1593P 298-8181 Day 296-5691NIght May 1, 1990 j TO WHOM IT MAY CONCERN: ! Be advised that HARDY PLUMBING & HEATING NORTH, INC. performed all plumbing work at: VILLAGE PIZZA II 13550 MAIN RD. MATTITUCK, NEW YORK 11952 If we can be of further assistance, please advise. Yours truly, HARDY PLUMBING & HEATING NORTH, INC. i Richard A. Durand Vice-President RAD:es Gas work done by others. P.O. Box 1460, 13500 Main Rd., Mattituck, N.Y. 11952 „rf ; > PLUMBING & HEATING NORTH, INC. JOBBING & ALTERATIONS LIC. NO. 1593P 298-8181 Day 298-5691 Night May 1, 1990 TO WHOM IT MAY CONCERN: Be advised that HARDY PLUMBING & HEATING NORTH, INC. performed all plumbing work at: VILLAGE PIZZA II 13550 MAIN RD. MATTITUCK, NEW YORK 11952 If we can be of further assistance, please advise. Yours truly, HARDY PLUMBING & HEATING NORTH, INC. • Richard A. Durand Vice-President RAD:es Gas work done by others. P.O. Box 1460, 13500 Main Rd., Mattituck, N.Y. 11952 ~ r. - r r \ SENTRY Fire and Safety Equipment Corp. i ~ " ~ t~ ' , , ~ , . 16 BURNS AVENUE r MELVILLE, NEW YORK 11747 MAY " 7 0~9a 516-271-0159 - CONDITIONAL SALES AGREEMENT ' CONTRACT To:....1~~'.tz~.~fj,~?'lCl~....///.t,l.~~~,L..../.~~1 Z:ZI~i ate:.....,./.~0./ street:...l.3~:~.U......f~'~.h!..../~'i!~31~ Pnone:...~~r'.~~~'~3..::~?... ~/~a~~ City: ...J.''7~~tl~4CK....~'y> .........................:j....... ......:.......r . Fabricate and install hood duct work per NFPA Article 6 \ .t.~............./ ...~f ~ ~ . ~7~. ~ . Automatic Fire Extin wishing Systems ~ ~ 9 Furnish and install.. ....1:..... ~ /ru' ~df'/~(j~D/~/9~1~. !id~~5" S~7//.t.~-(J~/~ ~p~L s i>12c~"G9tt~ N~'LZLt:'S~ Thi~uotation may be accepted by buyer only by executing this quotation form and delivering same to seller within 30 days from the date of this quotation. Buyer agrees to pay all sales, excise, or other taxes which may be applicable to the sale of the quoted equipment All equipment and/or materials quoted by seller is sold installed in accordance with manufacturer's specifications. Equipment and/or material quoted carry only the manufacturer's standard written warranty in effect at date of ship- ' ment. Seller warrants articles to be free of defects in material and workmanship when used for the purpgse for which manufactured. Total For Above ~ F1 ~ . ~~~.a a ~ Sales Tax $ Nassau County Hood & Duct Permit $ Nassau County Fire Suppression Permit TOTAL $ ?~.rF1, s Payments to be matle as follows: 50% down $.....'.`f.~~l.~Q balance upon completion $ i~~~~t.~.~/.. Any alteration or deviation from the specifications herein agreed upon involving extra cost of labor and material will be executed only by a written order for same, and will become an extra charge over the sum mentioned in this contract. We will furnish alt labor and material under terms and conditions described herein. Title to all material and equipment retained by SENTRY until paid for in full. " Semi-Annual Inspections as Required by Insurance Services Office of New York. r°' Per Inspection $ ....,,/.f?:`.".~ Recharge Fee $ ..../,,~7„j,.t?¢ ACC TED E ACCEPTED andAP~P~ROVED By:...... a..~.:.~, Name of irm: ..~7.T`'.TUC~.U.!.~~.-9~.,.~??:d-..~~C'. u`'th~orized ignature and Title PrintName:..l.~-.~~-1,~~~.~~"c~i..../.F~~...... Print Name:...!?~`.'~.r~..~.?:Y. ~?i2/~' THIS PROPOSAL IS VOID IF NOT ACCEPTED WITHIN 30 DAYS. r _ ~ ~ - ,-r - ION - iSUFFY7LK CQUNCY'-DEPAecrmcrrA• OF HEALTH SERVICES" .,'f - PAGE CONi!` CHGE 0, ~ FOOD ESTABLISHMENP INSPECTION REPORT ~ OF - NLTA ` DEC,T ~ - - - - - - a ESTAB~. -LD. , / SANIT. ESTAB.' - ESTAB /j~ - NUMBER AREA CLASS ~ ~ NAME ' / ~ 1" /T' ' Z J.~ . &SPAH'. n~~- / ~ ,~U ~C) A n/ ~ ~ .COD. DTE~ ~Ya` ~ .REER~~T ~ OGINER'S - CORP.. ~ ESTAB. ' NAME ~ ~ Q i ! 'r" NAME PHOME f AD~~,~ ..3 - ZIP ~ ~ h4AT8R: SEWAGE FROZEN 7 ~ U ~ ~ E .CODE ~ / ,SUPPLY DISP... ~ DESSERT ACTS TY / MGRS .CERT. INS ION. .ysl' ~POF'_ AM ~Y~TERp ~ SAMpI,E ~ I'A. ~ DAY YR. CSIGN' YES ;Q~ NO ~ ~ ~OO~II~ YES 0,-N0. ~ CtiASSIFICATIONI .0 Z- 3~ .p I~EISPECtION ~ PART 1:. RED CRITICALITEMS " - VIS 0 ,~A'PIOONS NO ' . . ITEM - & DESCRIPTION OF` VI(~IATION ~ ~ ~ pp1~ - ' NO• THESE`; ITEMS REISATE DIRECTLY. TO "FACTORS'WHICH LEAD`TO FCZODBORNE ILLNESS; AND MUST~~RECEIVS. IMpffiDLAPE':ATTENPION CORRECTID 1 , . a.- ~ - 714 J' ~t~f x~ i~ .F-. - - - ' ~ ; PART 2: BLUE ~2+8SNTE~IANCE' ITEMS, - - SU,~R' OF ITEM " VI.OLATIONS N0. = - - . ; , , ITECI = DESCRIPTION OF'VIO7~1"~~ppN " ~ CORRECP NO ~-THESE'I'PEN1,5- TO MATNPENANCE OF-THE FOOD.SERVICS,OPERATION °AND CLEANGI'i]ESS CORRE;CP'AS SCHEDULED... gy'~ . ~ s r ' .r' - - - - _ - :3- ~ ~ ~ j ~ ~ g ~ . ~ ? st 'e ` ' _ ~ ~ ~ _ i RHE MARICED`ITE'MS ABO BARE VIOLATIONS FOUND DURING AN INSPECPIUN OR' OPERATION OF' FACII;ITIE,S IN THIS ESTABLISfII~IQP WHICH MUST BE `CO 4=AS INDICA Di F ~ 'ROC LY'MAY RE~rW.1P ;IT~ INI~1'IATIOI~ 0, ECAL ACTSON AGAINST 4'HZS ESTABLISHMENT-'AS PRO DED FOR I ~ THE SUF~LIC~G6 SCAN dPARY COpE N(xLUDSNG:A HEARING) POSSIBLE-. - y50SPEN5TON OE YOUR DOPE ~ PUBLICATION OF THE-, T,~~N,AJ~U FINES - SIGNATURE OFr.PER50 T SAN ~ i l RECEIVING REPORT - p I~~~'' INSS~ ISN~ v > V " ~ _ J ~ * ~ ? ~ M ~ q~ + _ - Se Yic f F. «p. eyj'. 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W311 Holu'aatie ~Frla~rvtl ann~a .tsnw - SA*3S,I maolslao aaa I A r o0 1 . .D _ y FOUIJDATION (1st) '0 FOUNDATIOIJ ( 2nd ) _ a~ ~ d v/ z ~ 2, o ~ ~J ROUGH FRAME & /~CGESs ~ PLUMBING ~g• . - H _ m 3 . • ~ ~ INSULATIOPJ PER N. Y. ` STATE ENERGY x m CODE ~ 4 . ~ /~.S/ .a b FINAL ~ , o l F ~ ADDITIONAL COMME TS; ~ • x .9 •w H 4.. ~ N a b H H ~ O 2 , • > • r 5 . - ~ m . ,v H o~rr. [ ] ~~01~AT1~M LM®[ ] Mifi1LAT10N [ 7 FRS f'1#1AL ~ i << n t f i { ~7 1 i r j , rss-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [)INSULATION [ ]FRAMING [)FINAL REMARKS: DATE ~ INSPECTOR l BOARD OF HEALTH 3 SETS OF PL.1NS I.~....... FORM NO. 1 SURVEY I~ . TOWN OFSOUTHOLD CHECK t~~ BUILDING DEPARTMENT SEPTIC FORPI TOWN HALL $OUTHOLD,N.Y.11971 NOTIPY~.Jkt.(.~ ~,3p'/~•'•"•'.. t~ TEL.:765-1802 CALL - .l. "C Examincd..~.4~?-4+1?-d..,19q~. MAIL T0: Approved ..~.WMf-,A. Via.., 199 ~ Permit No. ~ ~o,'~',.. . Disapproved a/c w.. „-t ~ c„~::~y ~ ~Mt - e ~o (Building Inspector) APPLICATION FOR BUILDING PERMIT ~6p~Vxt7'~''Y.} TO (7F sS1lJ1 Ft€~i. h.7 w Date ./....~C'/f _ ,~J„ 15 INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or jn ink and submitted to the Building, Inupector, with ~ 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 pan 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 CertiSeate 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, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe - s. z, (Signature applicant, or name, if a corporatton) (Mailing address of applicant) f l'~fb ~ State whether applicant is owner, Lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. _ ...........QW.VI. ~ K . x Name of owner of premises ....:~~~?1=:Pf'~.... ~g.'`~Y~ . (as n the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. ~ /,y (Name and title of corporate officer) Builder's License No. . Plumber's License No. C1~JC/~.~///•?~,~/......... . Electrician's License No. J:~f.: , q~e y OthcrTradc's License No.Uh~~~R~ S~?/~R~y.~~'~'~ u60 ~AUQ'~~Y ~~~i~~0 G~77o"~, 1. Location of land on which proposed work tvill be done; 13-'.`.~.1.1,1Ai/v.R.d:~.~Yl~~:rrTV~:r,:./.`ly,.l.l.9~ a v Elouse Number $treet. Hamlet County Tax \tap No. 1000 Section ~~~y Block .....L~, . Lot . . Subdivision Filed A1ap No. Lot •(Nvnej ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: 0 a. Existing use and occupancy ~R.rCI ~'R ~ ~/••Z Z~'~r ~l~ . b. Intended use and occupancy .......~~Q~~s.~ s22C~V'/'9 . 3. Nature of wort. (check which appli Addition Alteration n /X!/~~. cable): New Building • • ~t~~ Repair Removal , Demolition ..........Swimming pool S..... . Tennis Court Accessory Building.........,Fence .......Other Work........... 4. Estimated Cost .......~i ~.QO.`"# . Fee 5. If dwellin nurnbcr of dwcllin u (to be paid on filing this applications g rjits Number of dwelling units on each floor /r:~"~ If garage, nurnbcr of cars : ~`l.~./.~:............................ , 6. If business, commercial or mixed Occupancy, specify nature and extent of each type of use .....!`Fh.......... , . 7. Dimensions of existing structures,,if any: Front . car Depth . . Height Number of Stories !1 . . Dimensions of same structure witl} alterations or additions: Front Rear , pepth Fleight ....Number of Stories . 8. Dimensions of entire new constnrt'aion: Front f' Rear Depth , Height r~ t~ . Number of Stories ,~Y l~''l:. . 9. Size of ld~tr Rear Depth , . 10. Date of Purchase . , ' .Name of Former Owner , , 'i G:tc G'. ii,.i; uiyiiit,f lr. t~,A ~iwl~liSeti are Sltuatrd . l2. Does proposed construction vlola~e any zoning law, ordinance or regulation : . . 13. Hill lot be regraded ...Will excess fill be removed from premises: Yes No . . 14. Name of Owner of premises ..~~.•6N~ . I.~:~~ay... Address'~~~:+'.~'S:~Q.f,~~~?~!L1":rPhone No. ~:4`~.-g... , 'Name of Architect ........Address .Phone No. . Name of Contractor 1~iY~'. ~~~~~~Y~'?~Y nP;'P:.... Address~64~a(!~h'.~Y~~ ~,9TfjYi: Phone No. 7P ~ :~.~~Q.... IS.Is this property located within J00 £eet o£ a tidal wetland? *YLrS....NO.... *If yes, Southold Town!Trustees Petmit may be required. PLOT DIAGRAM Locate, cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block r}umber or description according to deed, and show street names and indicate whether interior or corner lot. r STATE OF NE1V YORK, S.S COUNTY OF • • , , n! . being duly sworn, deposes and says that he is the applicant • (Name of individual si Wing contract) , about named. ~ Ffcistltc (Contractor, agent, corporate officer, etoJ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and Gle this application; that alt statements con;aired in tlris applicjtion arc true to the best of his knowledge and belief; and that the work will be performed in the manner set fortli in the application Ciled therewith. Sworn [o before me this . . .....................day o'f ....~'l fk1/-/~:Q~-:......., ]9.`7.4 Notary Public, , , , .!~`~t~! . 7J.-.. (/0er.... County ~ NEIEN K DE VOE L.:~ ~~~1 ~ . . NOTARY PUB11C, State of NewlYak • No. 4707878, SuftolkCauMy (Signature of applicant) Tarm Expires March 30,19...` ~ r o~ ~ ~W ~ # ~ ~ ~ ~ Q„ :.,iii V!~ ~ ~ tl fCL~~ ~ w ` ~ ~ 6~~~~ ~ ~ ~ ~ a1s 7 ~ II S'- _ I SS' Y~ yu, ~ `EQ„ ~ ~ ~ `t ~ ,p ~ ~ ~ o ' ,Wwg E s F~ ~ q4 ~ ~,-ry~~ ~rr~>4 s 4:k;' ~ ~ ~ 4 ~~~'f O ~ 4~ as ~ 'a ~ ~ ~ ~y _ .T selrtki X t If ~ „i ,w ~ ' t ~ ~ ~ r " ^ H a z x ~ w. O X~ F z~ a o a ~ ~ u p~ a o v ~ "r O t? a . Q ~ ~ ~ ~ ~ ~ ~ ~ g W W ~ ~4.;~ a ttiifS 4~~ ~ cUn ~ ass ~"v*"'_fl; o Wm~ct g~ ~ ~ iS ~ w1 - , q 1-Oad - W ~ 4. J ws y W ~ q4Q £ 'r nC C > sioakarlc 'k ~ San ~ x U U ~ z~ t y e k j41 ` ~'j Y. ~yri ~ ~ a O ~ ~ H ~~o & W CS ~~33``ss~~ ¢g W 4. Edtl ~ ~ "i ~ t s/pckad'~ ~~e 5'~d ~ W v ~ pQYMDNq F. NINE ~ ~ N l Ol f ~ W ~ ~ i; z ~ a ati~°~ ! f a a z;; r 'i r r S E" PROM 6E>S Y;nMEYEk RSSOC. 62.:1.1550 88:54 P. t r ~ c N/0IF .MAT,TITUCK ~ N c ASSOCI~w.-r ~iBRARY b a w 1~`f! ii S r F EUGENE GIA1'1,~`. . M N iO / r. ~ e . ~ d h „u....,. 41 _ . "i I O. wCr'GF ~ ~ ~ ~ wA1' ~ <u..; p.~ . ;a...'t d A~~ 7.5' 1 r ,gyp 1' '4 G~ o w f y 4 w I ~ ~ 'y0~ ii t? ~ i ~ n d Si ~ ~ : • ~ dry Z W ~ _i.. O, h qt K L k , h 1 ; i R° _ ' Y w 1 35. T' y ~pnc F~ ,Q o it _ K, N F ~ f M ~ fi' x 1 r~ t { d~~~F KgTNLEHN MARY KEM DALL l ~X ~ 07~~~ - 8 3 ao t k 02i 21/`30 0'0~: rJj 00'J Ca Fft9M BESSV~pMEYEk ASSOC. D2. 7f. 1958 68:48 p, i 'A. &; s IH