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HomeMy WebLinkAbout18741-z-,1 FORM NO. 4 TOWN OF 50UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20437 Date JANUARY 2, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 802 MAIN ROAD LAUREL, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 129 Block 2, Lot 6.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit hereto€ore filed in this office dated JANUARY 12, 1990 pursuant to which Building Permit No. 18741-Z dated JANUARY 19, 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 ACCESSORY STORAGE TOOL SHED AS APPLIED FOR. The certificate is issued to CARMINE RUFRANO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NIA UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A .~e~ .~- Building Inspector Rev. 1/81 ~. FORM NO. 4 °" TOWN OF SOUTHOI,D BUILDING DEPARTMENT Offiee of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20438 Date JANUARY 2, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 802 MAIN ROAD LAUREL, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 129 Block 2 Lot 6.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 12, 1990 pursuant to which Building Permit No. 18741-2 dated JANUARY 19 1990 was issued, and conforms to all of the requirements o€ the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY TOOL SHED AS APPLIED FOR. The certificate is issued to CARMINE RUFRANO {owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OE' HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A _ ~ ~ ~'3~~ Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20439 Date JANUARY 2, 1992 THIS CERTIFIES that the building ALTERATION TO ACCESSORY hocation of Property 802 MAIN ROAD LAUREL N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 127 Block 2 Lot 6.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 12, 1990 pursuant to which Building Permit No. 18741-Z dated JANUARY 19, 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 ALTERATION TO EXISTING ACCESSORY GARAGE AS APPLIED FOR. The certificate is issued to CARMINE RUFRANO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNllERWRITERS CERTIFICATE N0. N-22286 - JANUARY 28 1992 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 roans 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 a ~. 8 7 41 Z Date ~~9 ....................................... 19.>n..6. Permission is hereby gmnted to: County Tox Map No. 1000 Section .....,,lr~...7...... Block .............fir.-... Lot No........!'~..!...1...... pursuant to application doted ......1/~2 :..................................... 19.9 and approved by the Building Inspector. ~j ~ a o Fee s.....?.~...X ~ Gbh .. ... . .. .......... ~.. .:P:4..r ................. Buil g Inspect r Rev. 6/30/80 jF:. *1 ~L\1~:~i~' '!`fit%~~~I~ ~ ~ ~ ~ ~' 2 01991 NOV ~I'~ ~ ' '~ E , EI ~ s ~ , ~ S e ° ~~.~ '1~~,,-~ - s: ~. , . ct . ` " ~ .., "et'. t f.~ 5'ta,.~tr~j Form No. 6 TOWN OF SOUTEIOLD BUILDING DEPARTMENT TOWN BALL 765-1802 APPLICATION POR CERTII'ICATE OF OCCUPANCY :~. This application must be filled in by typewriter OP, 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 Pire 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. :-. 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 applicanC. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00/, Commercial $15.00 Date ~4} U.? an. l:',rd F~:...2':c? ~. / ,fib,' ~d ~....... Sew Construction..,. ~.. Old Or Pre-existing Building ................. Location of Property.....c~~.C7L ............ a`.~'!J :~ ~rL!... ~-v,F3.1~-..........`?.$11./~ s~CC_.... House No. Street Hamlet .nr] O Onwer or Owners of Property....~°~.~J~..... . °:~:~ g?:~, ; ; ;'p;-~-, , , , , ,~,ld ~; ,/~`, ,~+ ;!~/ County Tax Map No 1000, Section...l ~....... B1ock tr~~ ......4:........Lot ..... ...~........... Subdivision.CC.//....../. ......................Filed Map............Lot...................... permit No.! 6.~.~/......Date Of Permit ................Applicant............................. klealth Dept. Approval ..........................Underwriters Approval,./dx.<.ttc.~.~ ............. I'l:~nning Board Approval ........................ Request for: Temporary Certificate........... Final Certicate..r........ Fee Submitted: $,....::~J, ~ .............. ~ ~~ APPLICANT .~~ j, yr/ ~. f. vhlz S Form No. 6 ,: *. 'TOWN OF SOUTIIOLll BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION POR CERTIFICATE OF OCCUPANCY 1. This application must be filled in by typewriter OP, 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 Pire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 19 lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings anc "pre-existing" land uses: 1, ,lc curate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1, Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. Z. 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 - Reside.n~t/ial $15.00, Commercial $15.00 Date /.?~:::'?:':'~. ~?:~~:... ~~: ~. / ~ ~7 t....... ::ew Construction.... ~..,.. Old Or Pre-existing Building ................. location of Property.....~~. ~.~:~ L ............ ~ .~3 iit/... ~ U R.~ .........~?.!A-4i~'a'~-; ... House No. Street Hamlet Unwer or Owners of Property.....'?P..... €~.. ; Y!I ;"??, ; ; ;f;~......~.~1 f'. (.`:.!~-~~~ , , , , , , , , ~ 77 ~ . c;ounty Tax Map No 1000, Section...~.j . ~....B1ock......Sr ........Lot..... ., ~........... ,--- :subdivision.... ~~..../~ ......................Filed Map...: f.....-Lot...................... PermLt No.'~ ~.`-l ......Date Of Permit ................Applicant............................, ilealtfi Dept. Approval ..........................Underwriters Approval......................... .'1;inning Board Approval ........................ :request for: Temporary Certificate........... Final Certicate........... :'ee Submitted: $,,,,;15 `~x..,,,_,_„,„ ~o ©~3~~ / APPLICANT ~-0 h p/ ~. / ~//7Q S Form No. 6 ' ~ TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN BALL 765-1802 APPLICATION POR CERTIFICATE OP OCCUPANCY '.. This. application must be filled in by typecariter OF, ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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. :S. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. .lc curate 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 cariting 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 - 510.00 G. Updated Certificate of Occupancy - $50.00 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial 515.00 Date f2G f:?::2. ~,-?s~a°-... ~ ~ r. l 4 °l P....... ::ew Construction.... ~..... Old Or Pre-existing Building ................. Location of Property.... ~Gy ~ :.............!~? :~ ii!/... ~ v F3. t, .........~?.~</./~''=.:~-r... House No. Street Hamlet /'~ Onwur or Owners of Property...:~~/?.~...4...!~:y. f-r't.:t"':~-......~".~.-. /t:~':.~.!~-/G~!~........ County Tax Map No 1000, Section...~.1.. 1....Block..... ~........Lot......r`.~.. ~........... ,r_ :;ubdivision.....,,..//..~.~,r.T ......................Filed Map...:'f.....Lot...................... Permit No.r~ ~ Y /..../..Date Of Permit ................Applicant............................. health Dept. Approval ..........................Underwriters Approval......................... I'l:~nning Board Approval ........................ e quest for: Temporary Certificate........... Final Certicate........... i; `•'ce Submitted: $....::ZJ..~X ............... VW'~' X1315! .... /. APPLICANT SG /~ n/ /~• /-/~i~s ~c~ ~~10y3~ INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector 'Thomas Fisher Building Inspector Gary Fish Building Inspectrn Vincent R. Wieczorek Orditutnce Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 ~~Y~l~p,~Y ~'p~~2 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD NOVEMBER 8, 1991 CARMINE RUFRANO 51-29 65th PLACE WOODSIDE, NY 11377 To Whom This May Concern: SCOTT L. HARRIS, Supervisrn Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 We are unable to complete your Certificate of Occupancy because of the following reasons: xRx An application for Certificate of Occupancy is not on file. (Enclosed) (3 Co's REQUIRED, ONE FOR EACH ACCESSORY BUILDING) 7{~7( No Underwriters Certificate on file.( FOR GARAGE-LIRE STRUCTURE) xifx The check is ( not on file.}$25.00 FoR EACH No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 18741-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. ,y~~ J' ~~~~ .xi+~ -ii • ~d' .~j ' r'* ftOPOSED 'B' LIGHT SiNESS~a~,~oE - ZONING USED ICT :~ 19T0 RY ~ BRICK BUILDING ..;~, ..;f.. ~ _ ., ~. I ,, G~S'~ 9ae J~~~RF'~ a;l. - vpJ z.ra, .Mn ,i _ ` i' ;. ~~e~ ~v i ~P/ // _< 1 ti `~8 .... K,,..x-~sr.:~r' 'yw w X, v N 9 0 d .-. n\ ~ ~ y~R ~ ~ y.r f' uA ° a• -_ r ;y wt y ;,, ~: s." y ' In 'l~ ~ '•Y1 ~o ~ r~~ ° O I•.f m N ~LL ~ C O N ~w m 0 0 2 ~ i m 3 o. ~a o. 0 ~ r.. 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A 7 ~.. ^ ~' C £ ~ w ~ N A.. m ~ _.r "' m r~ £ ~ ~ F' s '~ a ' > c ~• 3 N O 0 T i N v ~ N ~' y ~ ~ •o 1 . H __._ H FOUI7DATT_0"7 (1st) - - - - a c ti FOUtIDATT0;1 (2nd) m _ 2. ~ z ~ 0 OUGH FRkilE & ° .. , •PI.UMBING y 3. m m II7SULRTZO.I PER N. Y. •' y STATE Ei1ERGY CODE 5 4 . •~ • ! gS- /J F-:7AL • ~ - oC .. C ADDITTOIIAL CO:~!MENTS: / :.~ ' m ~ x • ~v H 9 • y H O m . } • ~ r y . b m ~v H ~f ii; ~ ?(;'~ ~~~~f T65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [)FOUNDATION 2ND [)INSULATION [ ]FRAMING INAL DATE INSPECTOR ~® REMARKS: ~)-s2 C~ 765-1802 BUILDING DEPT. f NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [)INSULATION [ ]FRAMING [ fNAL ~~'~~~ REMARKS: / O ~O~ V~~~ _~ ~~ ~ 1 N ~~, N ~~~ ~~ ~~ W W. +~ ~ rn OPOSED 'B' LIGHT SINESS ~e~,~o~ ~, R ZONING USED ICT 'ix ' 1 OTORY 8R1CK BUiLDINO ~ ~ !_^ . ~ __. __ '. .~~.'~~. - ~~~ - .,.. .~ ~ .i _ - __ .. } "~ ~ n ' .P ,W.'~ ~ ~ O ^'i,~~~,'~iif pia ~',~~~ Q- ~' ~ ~~~ ;,y~ - ~; ~.o ~~ "~ x `~~' ,~ • Q- E ~.~. _ ~ ~~ ~ i 4Q ~~~u v `. ~~57 ~~ ~a ti ~~~ ; s o ~ 4~_~~~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 7G5-1802 EXanllnl • • • ........, Approved ...~~.~ ......, 19~n.6 Permit No. 1.~.,~. ~/~ BOARD OF HEALTH ......... 3 SETS OF PL.1H5 .~ ....... SURVEY L2 e: ~~ ....... . CHECi` .i/. ~ /~ ~ ............ . SEPTIC FORCf NOTIFY o ~ ~7 7 CALL ~.~..,1~~/.,,,, MAIL T0: Disapproved ^/c .. ...... .......................... ~ ~ ~~ ~~ LI~J ~~=.'>!,; _. AP ROV ~D AS NOTED ..ba`1'S:'~ 'Fa'P.~.~/{'~'L4.... .......;,/vyl.'G~' au.~._.,,m~~..-.... o .. Jt~ 12 ~~ NOTIFY 8111 NG DEPA 4E T AT ~(B~ no Inspector) F3(~!?~`!JE!';~ ~°° 765-1802 8 AM TO 4 PM FOR THE TOWN t.1~ UC7UY~':)I-r~ FOLLOWINGlNSPECTIONS^ APPLICATION FOFi BUILDING PE11N1iT P"~" `"` ".°" `"""°'°'°' 1. FOUNDATION - TWO REOWRED FOR POURE6 CONCRETE Date ................... 19 .. . 2. ROt1GH - FRAMfNG & PLUMBING 9. INSULATION INSTRUCTIONS 0..F.(NAL - CONSTRLt~CT10N MUST ~ - a. 1~~~7TA@~i@#~RFjf~B~§ be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ sets ~(' LP ~'f'F1f/ttilp~Qt f31ilYLV.o yp~lE7 Fee according to schedule. ftNFP1R~,~(~gta}~aKgT~r, Ip~¢atiRp{E of~lYt and of buildings on premises, relationship to adjoining premises or public streets or area~Ttan~'~f~O41O~A~NOTilot~~n of layout of property must be drawn on the diagram which is part of this appli- ~. ,_... catio n;OT RES r t "..E FOR q. ~~C.T ;~~ idE~'on may not be commenced before issuance of Building Permit. dFExJpnn aonrov,l ogyl~i~ apptisation the Building Inspector will issued a Building Permit to the applicant. Such permit shall 19~I~p~f ~M4tS(AEG~~fdyTinspection throughout the work. e.7b1$dI~(l~id~nr?~'ha1141b'b BQ~tF¢3~'dT6EEused in whole or in part for any purpose whatever until a Certificate of Occupancy shall I~rSUe3~raM1k~HHS'vTh~@!$uildine Insnector- ,. ~.,wvvw,vrv IvvV rlCl(VIRCu APP;`g~~~j~~ MADE to the Building Department for the issuance of a Building Permit pursuant to the Buildi~gp~+p~fQrdpR~gp~'~hpL'~' Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulgti}NgU~cgtlt~ construction of buildings, additions or alterations, or removal or demolition, as herein described. The ayp~ip~p~pE agreeBfjpg~~(p~~applicatile laws, ordinances, build'i5a~code, hou ' ~ code, n regulations, and to admit attg~grO~~~e¢1~sCo0.premises and in building for necessary in e~tions. ALL CONSTRUCTION SHALL MEET ~~ THE' REQUIREMENTS OF THE N.K ~~ ( ignature of a pie name, if a cor orauon) STATE CONSTRUC'flON "- ENERGY ``~ p p CODES. NOt RESPONSI'>LE FOR 'r ... ~Q2.. ~ jNDf~, _ ~;r~,iV~• . ~~~';z-'.......... . DESIGN OR CONSTRUCTION ERRORS (Mailing address of applicant) State whether applicant is owner, Jesse agent azchitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .! ~.1.:S .•.. `~~5. ~~~ r?... IC .~/,~~~:~' a ................................ . (as on the tax roll or latest deed) - !f applicant is a corporation, signature of duly authorized officer. .............................................. (Name and title of corporate officer) Builder's License No. ... ~!:~!1(~1~~.......... Plumber's License No. .....!1~~?:'/ E........ . Electrician's License No. .....N. ~~}......... . Other Trade's License No. ... !UG}: `~ ~ ...... . 1. Location of land on which proposed work will be done; / -, Elouse Nunt ber Street. ~ " " " " " ^-~ •~ Ha filet County Tax Map No. 1000 Section ..... /. ~• /.: • . • • . Blbuk .......4-- • • , , , , , , Lot .... ~....!'.... '' , • Subdivision ............... ............... Filed >\fap No. .............. Lot ........... . •(Nmnc) .. . -. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use an °~ ~ d occupancy .. ~`n~~.~~.. ..>~~.. `Y. ~ >.~~ .................. ~ it/Ga,~~ . t . 3 Tfl t b. Intended .~iJs?>trF-~JAE a~~r~.. use and occupancy ..~-!!.. ..... .. // y ................ •.. e,F$, ~ tlltud Y ...• 3. Nature of work(check which applicable): New Uuilding .... , , .Addition .......... Alteration .... . Repair . C/~.. , ...... Removal! .............. Demoliti ............Swimming pool........... . .. ~ ~9~+ Tennis Court ... ..... Accessory Building. ).Felice .......Other Work............ s5.~- Bti Lo x9 4. Estimated Cost ....~t Q(~Qo C?C? ....... . ............ Fee ..................................... lto be oaid on ~lina this aonlication~ S. If dwelling, number of dwelling units ......I......... Number of dwelling units on each Cloor ...........:.... • ... If garage.numbcrofcars ...... .............................................................. 6. if business, commercial or mixed o, 7. Dimensions of existing structures, tccupancy, specify nature and extent of each type of use ........ . . ........... . 'f any: Front . ........... Rear ............. . Depth ....:......... . . Hci;ht ............... Numbek of Stories ............................................ ........ . . Dimensions of same structure withalterations or additions: Front .. ......... . .... Rear . ....... . Depth . ....................Height ......................Number of Storic~f~t~f L,A.t3#'t:ta'tr~:=:........ . 8. Dimensions of entire nc}v:constntction: Front ............... Rear .... .. ~G,~~h< ~.• .. ,-, .. .. . Height .... ~~ ...'. )<•Number of Stories ............................... •.....p..'.. .'~`.....~........ . 9. Size of lot: Front ........... !` .. , ..... Rear .......... . .........:~~°pC.p~;~;y,',°. Y~ .G ., .. ! 0. Date of Purchase . ..:.........! ... .:..' .ay. ~? .,~; • ' • ,..... . . .. .. Name ofFo rOwner~t,=,.._r~j',,r=°~•~•~...~~..~' .-• •,,• . 11. i;one or use district in which premises arc situated . K l=.g'!.ah!~~~~~. Lc ..........:::,,_,:.., ; • , .. , ......... . . I2, Does proposed construction violptc any zoning law, ordinance or regulation: .. ;'.-/;!~:;~,•, ••«• : • • • •_ ~ • •'•,• • • , • • • • • '• 13. Will lot be regraded ...... /V ~j ..... ......Will excess ill be moved Cro remises'. ~.., Yes ... , No . . 14. Name of Owner of prgmises ~rc~?!?~JN~• , ~Pl~T2/iii10. Address~J. ~~. ~i!.. • •~1~ Name of Architect •J+./.. (`~.r: • / , . ........ ,Address /.~ ~~:v~ L9^'~. ~f~• • Phone No. ~~.7 ~Gr.//.... . Name of Contractor ...~S/~C?J!/. ~ .. ....Address .. ......... :.. ..Phone No.. . • IS.Is this property located within 100 feet of a tidal wetland'? *Y>:5....NO./.r: *If yes, Southold Town'iTrustees 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. .5 (A) /.^~sT-i~.c,L-, c:c~,.re.. sL,r-i.6 ~L.®caiZ (t3~ /rosrn'~.~' 2. :3 °.3 ° drat e,,~,y~,L.;,.~ur,vaaws Tv .~c~t-~v~:r /_=X/~Ti•Jc, jlo7T~r~ _ Gvirv~owS „ .., Cam) ///8 i' I~ZL ! ~='X /// Ol/~,e ~k'rs'Ti•vG ~i2/9rvr~D icsr9L4g ~D,, /n/S7•%~>-.L rv~~n> .r=15pH~1-T /c~vv~ `'.~%~~nl~°L~s-± ~'iuE~' ; „- _ ,h 's '' XrS LNG k~C10~ ,~~l~iyJ/NG ~;z~ t"-g titia!`3~:f3:.'~~ ~ d~ lam? /ws7~iu. /v~-cv /=.4sc:,i/d a~ ,~C;,~?~.~~ ~o~~~~t/.;rvr~ <- ~F~ /rvs7"!~:-y- /vN ~ ~2r~ro~ i~nv.2 :n~t,P ~~ ~~-~. •f~=~. ~. , . (2 ~ N~cv j.' 9 ",~ i~ ~©" o ~ s~~-v ~7 ~~ c i-><o~~~..~ '7u 5r „ ~eq nPG ! ~ G/9 L~ G/2OCiw~p STATE OF N6W YORE, COUNTY OF ........ iS.S .... .... ..::.~SAw.~~~.. V...i~..~,vs~~,. . , , , . , being duly sworn, deposes and says that he is the applicant • (A'amc of individual signing contract) ., above named. /^~ , (Contracto agcnt,corporatc officcr,ctc.) •' of said owner or owners, and is du{y authorized to perform or have performed the said work and to make and Gle 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 fords in the application filed therewith. Sworn [o bclorc me this ,' ...........12-x... da • J M~ ~au~ ....., IS c~„ $~,~ . ~.. County ~` • • • (Signature'of applicant) Notary Public, , . . 1 t ~, r I~ \ ~' / d - -- f ~~+ f Y ---- _- ~1 ~~~ ~~ ~~~~ ~ ~~~ I.