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HomeMy WebLinkAbout18699-z.~, FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20842 Date JULY 9, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 4298 ROW OFF WUNNEWETA RD. CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 111 Block 14 Lot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 8, 1984 pursuant to which Building Permit No. 18699-Z dated DECEMBER 18, 1989 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 BOAT HOUSE AS APPLIED FOR. The certificate is issued to RICHARD ANDERSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-138104 - JUNE 27, 1990 PLUMBERS CERTIFICATION DATED MAY 30, T990-MATTITUCR PLUMBING & HEATING ~ ~~ wilding Inspector Rev. 1/81 Foam 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) ~q .LO~J9 Z Date ... ~~~Gt .................................... 19.5!..1. Permission i~ereby granted t . ~~!,3~.Y. f.I..GY... y..!,/.1. ~. i.. .. ... v ..... ... ~(../~~Ji'.. fo!*.,'G~. Lr,Q~.r~~/1.~.. ...~... ..~~. .~c~......Za~.l~~...f~K.~..~.......~....... .. .L~ ~Q ........... ct premises lacated at ..~r~~.~~.~~....!.t,..0°!,~.....~(..~!'x~y?.~4...........!C~ ................... County Tax Map No. 1000 Section .......~~~......, Block ~.~j..'1.... Lot No.......s~~ pursuant to application dated ..../....~~~ .................................. 19.0.../.., and approved by the building Inspector. Oo Fee $...~'~.: ss~ . ...... ............. er Build! I ... ec2rsr ;~~~ Rev. b/30/80 YRY TOWN OF B[ILDING TOWN SOUTIIOLD 765 .A' sOUTIIOLD DEPARTMENT' HALL NEW YORK 11971 - L802 1' , APPLICATION FOR CERTIFICATE OF OCCIIPANCY ! ' DATE . stay: 3.~,,. X9.90 . , . NEW CONSTRUCTION K......OLD OR PRE-E$I,STING BUILDING....,-VACANT LAND,.,..... Location of Property...1~2.9~.A4G;i.Vdu~1'~B~P4tB.Ft43~ ..............c~?tCh~~tie .....'. HOUSE NO. STREET EIAMLI:T Richa>?d ~Ande~sbri Owner or Owners of Property. .,.. ... ......................... ... County Tax Map No. 1000 Section .Y'11.. $lpck ....ll-~., Lot .4~. ... Nassatia Point Pro~ortie~s ~ ~ 116 z~F~ Subdivision ....................... Filed .Map ........Lot.......... 7.£~699G ~ 12fti8~~~9 ~heironment,>^,'ast ~Znc Permit No. .. .....Date of Permit`. ... .Applicant ...,.? . i~or'6~rner" Health pept. Approval ....~/A.... ... Uaderwri,`tcrs Approval............ , Planning Board Approval ..1N,IG1.•, ..: yea >.'' jy Request for Temporary Certificate ,....„.Final (j~rtificate ~ ~~ Fee Submitted: $., ~J~.a~~ .............' ' ~ Pre s: APPLYCA r .. ..... ~l ~ i.ronment~~7ast,"Inc, A. .. Cam) J ~ ev. 10/14/88 Q,~,c ~ ~~a~~ e o ~~o~s~f ': f-'/tPDP~tUrittq die f Q,~~ A1KlCe ~a~ad~.a~~~,~e ~cl~iie a; ~) 1~~61~92 ~, ~__ ji9e$ i ''~y, r__ ~ ~d ~~~ ~~ f ,~< ~ ~ ~~~- ,. Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 516-7347474 ', ~ 1 }p pqp (sqy~ QS~FFOU, ~Ol~ T0~lN OF 50UT~Ob.D 0~; " ~ OFFICE OF BUILDING INSPECTOR ( ~ ~ P.O. E30X 728 O ~ T v'~~~` ~~"`' ..e TOWN HALL "O ~ ~ ~ SOUTHOLD, N.Y. 11971 "~~l ~ ~b0 C E R T I F I C A T I O N TEL. 7G5-1802 Date ~/~j(~~? Bui wing Permit No .) ~ p ~Q~ ~ . Owner ~ n7Ll2K.~~d~•-~ (please print} J/ Plumber~-~~ ~ v •~ ~ ~('~;h~ ~-oval. (please print) ~ ~ y I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. (plumber's ture} Swor~n~ to before me this ~~/~~7.~`~'~YlLday of ~~9~T~19~,~it°r~ ., ~/~, /~ Notaryub 'c Notary Public ¢ 'C~ County ~ EU"Nt{FJaG7CSON Notary Pupic, 5aalo ai Netr York No, 4S2f175t1 CNall6ed in Suffolk Couory Tettn Fzpkes Feb. 18,19 ..E~....E.E THE NEW YORK BOARD OF FIRE UNDERWRITERS ('~`'~~ ° - 1'OY)T~) ~'I 9UREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 70038 6'7U70t)9C1 (')O ~Pd '~-'Y i?1. f}Q. 1z1 ~1 (1 `)tTIVT~L•T , APPlicotion No on file Date THIS CERTIF{ES THAT on.iy the electrical equipment as described below and introduced by the opp/icant named on the above applicntion number in the premiE hlrrHakzt aml~r;tcs~za, ~a;t~n^~'~~ tarr~;I~ar>rTN~FxiT~7°N: xn., ~It~~~. ~ttf~_~,/~, c.Yrrr,.lr~>c;Yl~, ~v.u~ in thefollawinq 4mati9n; ^ y s ent ^ 1st F'!. ^ 2nd FL ('~~ 3ertion Blnck Lot i ~ ~ ,7lY~Sh; 1,4, 2 3'~ was examined on arzd found to 6e in caneplianre uifh the rer{uireraenfs q(this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAU51 OUTLETS ECEPTACLES SWITCHES INCANDESCENT fIUORESCENt OTHER AMT K W. AMi. K.W. AMi. KW AMi. K W PMi, Iz t 's DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT M IME CLOCKS ggLL UNIT HEATERS MULTI.OUTIET SYSTEMS DIM M AMT K. W. Oll H. P GAS N. P PMT. NO. A. W. G AMi AMP AMT. AMPS TRANS. AMT H P NO. OF FEET AMi SERVICE DISCONNECT NO.Of S E R V I C E AMi AMP, TYPE METER EQUIP. I ~,1W 1 %3W 3.e' 3W 8 A' 4W NO OF CC COND. A W. G PER .B" OF CC COND NO OF NbLEG A W' G NO OF NEUTRAIa OF HI-LEG A V OF NI OTHER APPARATUS: ~?ITti.7~Y~ ~C~R 1;7+Na,t4k; tIN11°7~1. z~a~~ir.,nc,.;3xns:T.~-~ l~rx, lol~ ~~~E=ec-r~-~ .E ~ f,,g1tY Ui)kf7SK~ r_ra,f.#1.1~t41-~. ~~~ 425 h1UN:>EhI, I,ANT'; ~ t;YY'PC,{il)tClk„ CtY, 11`_'+943 GENERAL MANAGER la .. %J~ 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 c: COPY FOR BUILDING DEPARTMENT. HIS CO Y OF CERTI KATE MUST NOT BE ALTEREp IN ANY MANNER. ', ~a 0£G I i New York State Departmw!?t of Environmental Buflding 40-SONY, Stony brook, New York 11784 L~7?/pN-LU2/~Lr~ `~- ~ "1,~~ DATE: ~yC, ~ J " ~U ~J ~~ /CG~K ~. Re: Dear ~ - X73 ~ -Ooa3~; ~ ~~,,.: ~ GQ,~ _ /, ''.!Thomas C. Jor /'~' o,, ~// (%~ CJ t;Commissioner ~`J"~~f izC'~1 %~ /- .~, 1 A review has been made of your proposal to: ~~a.~~/ ~.~1~ SGT/ r`-~ /ono - ~/ -i~-a ,. Based on the information you have submitted, t e New York State Department of~E~v}'~ronmental Conservation has determined that the parcel ~C project is: ~I I~ ,~ I~1~ !'; greater than 300' from inventoried tidal wetlands,, _ i~andward c~i' a substantial man~mads at~ut'tuce ++~~,,,,--greater. than 100' in length which was construcked prior to 9 20 77. ~t~andward of the 10' above mean sea level elevation contour~n gradual, natural slope. Gtr .~cc- ~? ~/Q GC _ Landward of the topographic crest of a ba b/~ff/~r~~n@ 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 I.aw). 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. St is your responsibility to 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 ~.~~o_*k 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. ~j r' Please note that any additional work, or modif~~ation to the project as described, may require authorization by this Department. Please contack this office if such are contemplated. Please be further advised that khis letter does nok relieve you of the responsibility of obtaining any necessary permits or approvals front other agencies. Very truly yours, Deputy Regional rmit Administrator ' ~ ~~FFOU~~o~~ FRANK A. KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President ~ JOHN M. BREDEMEYER, I11 y0 O~- JUHN L.,BEDNUSKI, JR. .1 HENRY P. SMITH O't ~ '`~ BUARD OF 7'UVi'N 7'RUS7'EES TOWN OFSOUTHOLD Town Hall, 53095 Main Rood P.O. Box 728 Southold, New York 11971 October 23, 1989 TELEPHONE (5161 765-1882 Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, NY 11958 Re: Waiver for Richard Anderson to construct accessory building 75' from Wunneweta Pond. Dear Mr. 5toutenburgh: The following action was taken by the Board of Town Trustees during their regular meeting held on October 19, 1989 as follows: WTiEREAS the Town Trustees have conducted an subject property, RESOLVED that the Town Trustees approve the Environment East„ Inc. in behalf of. Richard construct accessory building 75' from Wunne~ condition that there will be no excavation. at 8298 ROW Wunneweta Road, Cutchogue, NY. on site inspection of the request made by Ande^~son for a waiver to aeta Pond, with the The property is located Plda~ig r~tuffin to tSxd >3u5.1da,ng bt~paatm~l~t €~z a ~otiexm~,nata~on en the need for any other permits which may he requir~a3 ~a~ t~tj5 p~0~@Ct. Very truly yours, ~ ~ Frank A. Kujawski, Jr. President Board of Town Trustees FAK:jb cc: Sldg. Dept. Board of Appeals file CAC "+ ;.':i i'~ :~ ~ ~7~~t ~o~ad~~a~r~~ ~e ~cc~t+rte Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 516-7347474 ~. i ~ -- - r~ July 11, 1990 Southold Town Building Dept. Town Aa11 Main Road Southold, NY 11971 Dear Sirs, Enclosed are copies of two Underwriters Certificates pertaining to permits # 18883 fpr Robert Schreiber and # 186992 for Richard Anderson. Please add these to their files. Thank you. Sincerely, Peter R. St President Environment Enc. PRS:jm ~C) ~ast, Inc. LJ I:..,. . ice.. i . 1 ^ v OUtlDATIOt1 i 7st) ~ ~ ._ ~ _. .~. ~ I ,~ c m OUtlDATIO:! (2nd) ~ O IDUGH FRAME & '4 .PLUMBING ti H 3. n , a N. Y. IIISULATIOt1 PER , . RGY STATE E2lE ~ ~~ CODE • = y 0 '~~ r -~ 4. i ~~ ' /// a I FI)lAL d • ~ ` O i .e U ADDITION L OMME11T5: x yr' v ?/ d ~ GO '~ ~ r ~~ ' H ~ _ , n H ~1 ~~ } H` / . ~~ m b .-a ~' a ,~1 > \ 7BJ-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION DATE ~~ [ ]FRAMING AL %~~~~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] F ING ~ [ INAL ~o G~ RED RKS:~_~ r ~/_ DATE ~ Y INSPECTOR ~. `~ ~j~ l 765-1802 L BUI4DING DEPT. INSPECTION [ ]FOUNDATION i5T [ ] ROUGH P4BG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [1,~'~'INAL Environment East, Inc. R, g, No. 3 - 30751ndlan Neck Lane Peconic, New York 11958 516-734-7474 ~ ~'j''~ ~Cs~~ac~--- . ~ .~~ „~~ ~~~~~ ~~, ~> ~~ .r~";,; Fa P ~ / GWt .~iMb~~°fi - .~ ~r~-~~~~'j~~'+r ~ IteOP/ZbUI-t~ •1(~ ~'''-C YFJn r ' ~ e W-41~ ~i( ~ C~ f~ .A ~. V-^'YI ~. a tj. 'M~ir;l ~.' yY~u~.I,~ .1 j ,, ~ ~ ~ ~ ~~~_~ Environment East, Inc. -~ .~ R. R, No. 3 - 3075 Indian Neck Lane '~ Peconic, New York 11955 ~~ ~ 516-734-7474 ~~.., ~1 ~i-c~l~'~c'>~- "cam f C~' ri.~~~ . ~--~..~ '~ l ~.~-~(.~ 'V1Ll~J~t, . v v ~ ~~ t~wr~a.,~r~,f~~~ to/E ~~~~ t1 ~ / ~^'~ - ~ ~# ~ ~ ,,,. f ~+ . ; \5` ...1` t iT +J ~ ' ,'r, ~ p ~ n ~ ~ r ' ~.' ..r _ tb Tt R79 ?S _ i ~ i . c. k ~ r, r C i• .. ~.~~ }~., r }'~ ~ t", i ~ i r M• ~ ry "~• C" r. c ' .. 'ki , . ., ~o ~ r. ~'ft +~ .,, . . X ~ 1. • _ { N ~ ~ ` ~ i ~ . iLt TT V J ~ ~ o ~ ,, ~ ~o \ ~ v 4 , '' ~ ~~ ~~ ~ rm 1 - ~ , c75 'ate c ~~,.«........ w ~*oJ t'o f t`"1 it t ~ ~ `~ D ~P My ` 1 ' . .4~~ t 1 ~ t""`•" ~ 't ~s~ gym, t~< c? °a y :7 _ . f "„ .. ~ ~ t.., • ~ ~ _ ~ , , t .. ~ .~ -_. r.,,,, • =i ~ Yj ~• ~ ~n_,,, ~ i; _ ,. ^^^ ri~~ ~ ~ ~~~ ~ ~ • r 1 ~ r~~ ~' ...t ~f~ Y _ r: ~ .~ •`~ r. 3 ~ ,~.,.~ a1 ~..~ ~ ~ r. .. S ~ ~',~CC 1 ~ l '~5~:' y ` ~ ~ _~ r•: _ 1• _,_~ _ ~ 1~ ~ r ~~ y ~ r ~ R 1 i r .. g',' , a ~ ~ ~ ,~~ d . ~ ~ ,~ Ya ~ ~r•. ~ ~.,. N G , - ~~ ;~t r; ,T") ~~ M ~ ~ ,- ~' 1 i ", nl ~ < ti t~ , .~ ~ ~.-~- .~ x L7 ~ ,n C-, ~ ~ _ w~ ` ~ ~ r ~~ Ev _.-..--"` s ~ in , I - ` ~ c _ J J 1 ~~ _~~. ~~ ' ,. ~..- c T ~,:, ., r~ t ~. i 3 '~ y. ,,. s `'? s,i.. , is fr ^'Y' ~r*r ~~~» ~, r~ { "eh w:, ~" 1 'lfl ~ 1-" ~' ~ ~'o by p n ~ ,.ti~zf ~~ ~ ~ ~ ~" ~~ t.y X751 75 _- ~ ~~ ``s r ~' f ~~~ (K~'y,' ~1 ~ ~.~.~ L~ .,ti , ~ ,' 1 f I~ ~ y \~41'_ l ~ ~~ 8 ~ ~ ~ t `~~~ ~ ~~y- y. rs ( ~y .~ It ~ s py ,~ ..Y ~ • _ }j `~ .., ~~ ~ ~ 1~ t ~ ~~ . y ~.~_ ~. ~~ ~ ~ ;~ ~, 1 f > M+ '~ rya ~ _;.~--- 1`"t~ ~~ . 3 ~~.~v ~ `^~~d'a f_f~t ~~ ~.. 4 ~ ~4, l ~ ~ 4 ~~ ~, ~ ~ ti~; i, `~ ~~ a ~~ ~ '. y ~ ~ .. . .. x. ...-. _.._ r r, ~'f~ "~ ~ ? ~s ~ ~~ ..: ,~ , L"~ --,. C} - ~ to ~1 { ~ .~~ ~ . - ~ . ~ ~ "' ,~ ~ ~ ~ ~ ; a k M1 t~ ~ T"'4 1{ H h.s L„e ,1 h M ~ y l { ,~~ ~~ ~ ~ ~~„~ . _ s~ ~ 3 ~,,,.,~ ~ . ~ -p ~Zi qY :.1 ~ ~~ ~„..r __.. ~ °~ flit C~,7 '~ ~ U L_ U 1YI ~ ~ FORM NO. 1 SEP n p ~~ TOWN OF SOUTHOLD ,~~. ~.~~ _~,.~. ~~ BUILDING DEPARTMENT TOWN HALL '~ .._ EOUTHOLD, N.Y. 11971 ~~`°c'' a~~C ,TEL.: 765.1802 =_.~_a.zC~yi!tycar,:ot.~T,tOtra , Examined~.°~ ~.~G........, 19~ c/qq Approved . ~;1~~ ......., I ~ Permit No. ~Q (~ /. !.~ Disapproved a/c .................................... . BOARD OF HEALTH ..........., 3 SETS OF PLANS ............ SURVEY ... .. ........... CHECK ....~.!S, yar.. ... , . SEPTIC FORM ................ NOTIFY CALL ................... MAIL T0: uild' g Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ra I'; (' SEC " 8 1989 ~ IJUI~ Date ..`.; I )~..........., 15Q.`~ . a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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 street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which Is part of this appU 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 penni 9ha11 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. Llte 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 inspections. G' + (Signature of applicant, or name, if a corporattori) 3Q7,5. loc~'v~r,l~lec~41-AC,e . F~e.eart tt..H ~ :`~....... . (Mailing address of applicant) State whether applicant is owner, lessee, agent, ariichite1ct, engineer, general contractor, electrician, plumber or builder. Vame of owner of premises ......R:~.S~sA.~ t~ ... ~ Y:d 4 f ~4 r^ ........................................... . (as on the tax roll or latest deed) f ap tea t i si azure of duly authorized officer. (Name and title o rporate officer) Builder's License No. , , ,/f ~...~..Jr.r~.5 ~°....... Plumber's License No . ....................... . Electrician's License No . ................. . ... . Other Trade's License No . .................. . Location of land on which propose) work will be done. ..~`.... ' .X .,,..,.. r ,..r,,, , ,, ,,,,,,,,• House Number Street\ ~ ' Hamlet County Tax hlap No. 1000 Suction ... ~ODt?,-, I !,l, , , . Blpck .. , /.y...... .. Lot ....~~.......... , . Subdivision ~q,~cev.?a~n~lkb. 1?ca ~r~icS..1riC..,,. F;ledhlapNo. ...,l.~`"..ra...... Lot ..~.`.~~:..... (Name) State existing use grid occupancy of premise1s and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~5. i t~c~`E....~a-'n~~`Y..~~.e,`~~:n y~.......... .. ... ........... . \ ... ,.. b, Intended use and occupancy • • • S. ~ ^.a~`2 • • ~q`m 11y • .L?1^~ ~\~'~r~ . ,w'~A,c,S.g.S,S,U )`, iy...(~.,v)~d.i.nt~. -~ ?. 3. Nature of work (check which applicable): New Building ... /..... Addition . • • . • • • • Alteration ......... . Repair .... ....... Removal ..... . ........ Demolition ........ ... Other 1Vork .............. . tc^~~ ~ (Descriptiott) 4. Estimated Cost . t~ ~j U.C1.~ ......................... Fee , ........... , .~::':'................... . (to be paid on filing this application) 5, If dwelling, number oC dwelling units ............... Number of dwelling units on each floor .............. , , If garage,numbcrofcars ... ..... .................. ........................................ .. ... S. If business, eotnmereral or mixed occupancy, specify nature and extent of each type of use .................... . 1. Dimensions of existing structures, if any: Front . ........... Rear ......... . . . .. Depth .............. . Height ...............NumberofStories................,..............,......................., Dimensions of same structure with alterations or additions: Front ............. . ... Rear ................. . Depth ................. . . .. IIcight ..... .. ............. Number of Stories ...... .. , , , , ... . 3~ Dimensions of entire new epnsttttction: Front ... 01~. ..... Rear ...o"l~:........ Depth ... 1$:........ . Height ........... urthber of Stories ..... ~ ~~,"2-. .... ....... . . ......... . ........... y. ). Size o~'ilQt~~ ~i,ronb:}(~ .. o~;.~ . . ........... Rear , .....', ............... Depth .....$ ~?~ ...... .,... . )• Date of Purchase ....... . . .................. Name of For~n cr Owner ..................... , I ..... . ..... L Zone or use district in v~hic promises are situated ..... l~t:.5 i d.e.h9 i s,~ ............. ............... , , ?, h Does proposed construction violate any zoning law, ordinance or regulation: .......... ~ ° .................. . S, iybVill lot be regraded ........ .................. .Will excess 611 be removed from premises: Ycs 1. Name of Owner of premises 1LJdtiacd ,Ar`c)srgot*, ....Address ...................Phone No, ...... , . , ..... , Name of Architect ......... ! .. ..........Address .. ..............Phone No. , .. Name of Contractor ~ru)~4me~j.~~+..lr.>=.,, • .....Address , .pecvt"v t4.. ..Phone No. 73.''f. •7yi7!l.'... S.Is this property located within 300 °feet of a tidal wetland? *Y6S•~.I..NO.... *lf yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ally buildings, whether existing or proposed, and. indicate all setback dimensions from operty tines. GivC street and block'number or description according to deed, and show street names and indicate whether tcrior or corner lot. ' i s~ a~.k~ s~~v~.y ATE OF NE\V YORE, '$.S rUNTY OF ................. . . . . . . . . . . . ..............'.................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) rve named. rsthc ................. ( ontractor ` genf;:corporate officer, etcJ Bard owner or owners, and is duly authorize to pFrform or~havc performed the said work and to make and file this 4ica[ion; that all statements contained in this application arc true to the best of his knowledge and belief; apd that the k will be performed in the manner set forth in the application filed therewith. stn to bctore me this q ........... D! ~... ..,//dray of,'~/.~..m .............. 19°. !. ary Public, ........ -..~. ~~: ~~.... County , NELENK.OEyOti Si atuteofapplicantJ NOTRRY PUBLIC, Stxte of New Yuttr No. 4707R)R, Su9totk County Term l xpirex March ~9,19~;~ r•r a z v ~ r 9 ~k~" e f~ a q,~ yp~5~ z' a ° N' 3 iF i Y ~' ws i V ~ ~~y ~~~~y ~/U~F }~.j ~ ~ 'Y' "i ~ Pi'e` ~~~4 T { yD Yy IT y Y ~ '~ f f' Z ~] .E 1 t x '~ ~~ ~~~ ~~ ~ ~~~ Lt ~ ~ ~~" ~ x 4 ' w ~ ~ w ,~ ~~ rs Gk. ~ e~ , ~ o ~ ~ t'a'i ,ma}yyy ~~j +y4 ~ ~ x~ .'~ ~ ,~ w~-~ ~_ ~~ ~ vi u~..n ~ ~ ~ _~j -, ..~., ~r ~tY'f72I. ~13t,+i~t~!i'1-~'i 3-- ~ ,, ~~ ; r ~~-,,,, 1 ~ ~ ~ ~ ~~ ~,~ _,: ~, a( ~. ~ ~, ~ ~s ~ ~ ~ ~ ~ La ~ ~~~~ "' ~~ ' ~r ~' ~ ~.. ~°~ ~ . , t~ #~ {(!` ~~I e ~ . ~ yy++YY _i .~(6 L~ ~ ~' ~ mow".... ~ 1 ', '"!k' 11 ~ ~ ~ ~~t ~ ~~~~ .~~{ II , .t~ _ _ - ~.~ - Y y \ ~~ ~ ~z . k ,~g~'~,'.~` `~,,~ ~. ' ~ ~ , y~ :: } x 7 \ < i rtY t ~ tltl. ,.~ ~ ~ ~ ~ ,_ ~ v ,, ~ ~'' ~~} ~ ,~ ~ ~ ~ t' ~. .~~_ ~ ~ ~ ~ ~~ ~ ~~r 'a ~c r C ~ a C3 r~ ~Y ~ - '~~ w~ _ ~ < <~ a~,- ~S , v ~",~ .c y ~ ~ to ` ~ ~ ~a1' ~ . ~~G~. ... +n 0 !dam' G' Cd° L ~ ~ 4 0 ~,.. ~ a ~, .~, 1 ~: .LZr? t