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HomeMy WebLinkAbout18602-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219589 Date DECEMBER 17, 1990 THIS CERTIFIES that the building ACCESSORY STORAGE BUILDING Location of Property 75 CEDAR POINT DRIVE EAST SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 90 Block 03 Lot 08 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DEC. 8, 1987 pursuant to which Building Permit No. 186022 dated NOV. 28, 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 STORAGE BUILDING-BOARD OF TRUSTEES 4/28/88 The certificate is issued to ERNEST H. PAPPAS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N161063 NOV. 15, 1990 PLUMBERS CERTIFICATION DATED N/A Bui n In ector Rev. 1/81 i 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) ~g N ~ ~ $ G ~ ~ Z Date ~ 19.(F`,1.. ~ Permission is hereby granted to: .~..T~~::::~~~ at premises located of .'~t~ ~lf1i.. ..~~s~J...~. s,,~`.~,,,,,,,,,,,,,,,,,,,,,,,,, 4:P.S:................................................................................... County Tax Map No. 1000 Section Block Lot No ..............rJ.:........ ~~..lo y........... pursuant to application doted ~ ~ ~ 19........, and approved by the Building Inspector. /~f Fee ~•a sng Inspector Rev. b/30/80 0 ~ C~ r~ O M R ~ Form No. 6 ~7 L5 V 15 l TOWN OF SOUTHOLD D~`` ,'r ~ ~ BUILDING DEPARTMENT TOWN HALL B DEpT 765-1802 TO UTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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. 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 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. 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 New Construction........ .Old Or Pre-existing Building.. Location of Property.....~:~..C~rJr9-/2...~:~::UT..~2'.:~' ..............~'U.~.Lr~.......... House No. Street Hamlet Onwer or Owners of Property.... C.~:(/~S'F' t/: ~vp ~ 5 County Tax Map No 1000, Section ..............Block................Lot...................... Subdivision ....................................Filed Map............Lot...................... Permit No ................Date Of Permit................Applicant............................. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Cert_i/~ficate........... Final Certicate...`:....... Fee Submitted: $."'1$~0. lady... ylarlS ~~~~-'l~ rz~~~~4e CU Z 195~~ ~ APPLICANT .___._____..._.._.a....., _~_._.w._._~___~..._-____,.__-__._~._.___.,_.~.._~,~.~_.~....~_.....~.._~ p~~ G ~g~ i~o~~ ' t,r} 33 qg ~ ~t~ Y ~ ,;ti~i ~ ~ ~ t:~ ~ c~ ~ ~ ~ i J ± ,a;~ ~ ~ - ; ~ ~ J J ti i _ 1 P ) `V pr T~1~1 ~ V I I"k ~ °^~1, ' \1\\ v X~O.>~ cX xl. V 1 \ ~ ~ L~['1 fi ''I ' 'i ~ ~1j q~~ 1. ~ CCS1J ~N ~ _ ~ ~(J `Y~v ~~S) ~'~t. i. . 41 ~ OI i E "t~.._ (n ~ ~ ~ ~ i YYY ~ ~ y ~ ~ lu a ti` r ~ C ~ Cl . d ~U ~ ~ ,p e1 o e-, ~ ~ - , i EI. I i ' ` ~ c: ' a ~r~_ ~ ~r ~ - ~ Q.i~ ~~,1 o! ~1 ~a ~ ~ ~ ~ C, ~ S ~ 1 ~ ~ ~~1 , . _...__._r_..____...___.._._____.--_______________.__ t 7 . s . II O 0U1JD_TIO!! / I - - y~ ~ 1 I I ?OUtJDATIO:J cC (2nd) <n ` j - - - m o` V .',OUCH FRAh1E~ I 4 PLUMBING H a I17SULATIOf1 PER N, Y, I n STATE Ef1ERGY I y a~~ CODE I ~ II' 4 J'z /e I ° FI;IAL I I ADDITIOfIAL COMMEt1TS: m x ro M 0, 9 H • m \ b m ^o H p ~ j ~ ~ im 0 I ~UF~O~ HENRY P. SMITH ~ .C JOHN M. BREDEMEYER, III, President °ps ' ~ TELEPxoNE John Bednoski, Jr. ~ ~ (516) 765.1892 ALBERT KRUPSKI, JR., Vice-President ~ BOARD OF TO~F'N TRLSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 _ _ _ March 28, 1988 i (~WF{ ~ ~ ~ : f~ ,m.=...-.... TOWf'JOPS6'U,t„ Mr. William D. Moore Attorney at Law Suite 3, Clause Commons Main Road Mattituck, New York 11952 ~ Re: 1000-090-03-08 ~ ~ q~jpQ, Dear Mr. Moore: The_following action was taken by the Board of Town Trustees during their regular meeting held on March 24, 1988 as follows: WHEREAS, William D. Moore, Esq. on behalf of Ernest & June Pappa pplied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 18, 1988, and WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a public hearing was held by the Town Trustees with respect to said application on March 24, 1988 .at which time all interested persons were given an opportunity to be heard, and WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW, THEREFORE, BE IT RESOLVED that William D. Moore, Esq. on behalf of Ernest & June Pappas BE AND HEREBY IS GRANTED PERMISSION UNDER THE PROVISIONS OF THE WETLAND ORDINANCE OF THE TOWN OF 50UTHOLD TO: Construct an accessory structure for storage on property located at 75 Cedar Point Drive East, Southold. The permit is approved with the provision that dry wells are to be installed on the property to contain run off and a sketch submitted to the office to be placed in the file. William D. Moore for Pappas Page 2. i This permit will expire on March 24, 1990 if work has not commenced by said date. There are two inspections required and the Trustees are to pe notified upon the completion of the work. Prior to the issuance of said permit by the Clerk, the applicant shall file with the Clerk a certificate that he has public liability insurance policies insuring against any liability which may arise in the performance of the operations pursuant to such permit in such amount as shall be fixed by the Trustees, which said policies shall name the Town as alname insured. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the sam$ or similar project. PLEASE BE ADVISED THAT THE APPLICATION FEE OF $150.00 and $10.00 for the Wetland Inspection fees are due at this time. Please remit to this office prior to the issuance, of your permit. PLEASE CONTACT THE BUILDING DEPT. FOR A DETERMINATION ON THE NEED OF ANY OTHE~2 PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT. Very truly yours, John M. Bredemeyer, III President Board of Town Trustees JMB:ip cc: Bldg. Dept. I Board of Appeals file I I i FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIIOLD, N.Y. NOTICE OF DISAPPR'O-V~AL File No . Date ~.aJ~.~F~:.~~ ..0~.0...., 19 ~ a. . PLEASE TAKE NOTICE that your application dated .^q~~~.~..SQ^:»~~:. 19 . fox permit to construct ...Q~n.. ~ J.~.. at Location of Property .7.5 , C.ecQa,,~crt.,,P,~~; ,.mod, Y- .S'Z? (~s c~a.:,~q,~,~~~,. ~Js,,~ House No. Street • ~ 1-1amJet County Tax Map No. 1000 Section ©.9 v..... Block .....Q Lot O. . Subdivision Filed Map No. Lot No. . is returned herewith and disapproved on the following grounds .:c.QA .'(~~?--..~P~ti.. ~ ~R • I c.-a,~, ,a,-~,~ca, w:~t7C~..l. S'-u. ~ wo~9.a,... !r+... W.v.~.~-~•.:.4~~~..?-.~(~ra,~..~t ti~ . U 4.~. ~ . s~--p.~ c~ . Building Inspector RV 1(80 a P~~t~ ~ ~ ix~~~~~h a F t 1 " T~ AY Y'f +5 S rP 1 ~ t N R CWt~T t Se ?Y4 $ . S. r a '4 ~.'i+t y, ti 1 i ~ A'FI F (~'ry. ¢ty. C l f+S• Al ~'fY 1~ ~ d + ~ , i e' t r~V # 7E•s~"'~ '~,t.~~~,'yy~ r'#'~~ 4, ~+y.+i£,~ ~3c. 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JS ~°Z ~ l~~ rL ~N'£. rt,'& ns S~ e K Ltx 1 r y a> ! o. xri r u a R 00 ~i r Y~.~W ra~tLL 7. r+~.t ,i,~`~y~ ai?t r~4f! ~r '~w M.r~:y ~x` £ y'a 'fby( ~ b ~t~ ~r'? Lf1 t w't`~6.° *.a~t ~a r'>~ Ir +t~r.s e`~~ ` yr'-ay<. 'AF C. ~v file ~ :~F^yr .8... r~ 1 New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 !a' li~~~Y I ~f ~P., ~~~~~f 9 j .i j ~ MAR 4199( # ,~~~7~.. il! e! Tktg s C. Jorling ~,..<y~„7~a`v~J'd ~'r ;M;~r,.,,Com lssioner NOTICE OF VIOLATION February 25,1991 Ernest H. Pappas 75 Cedar Point Drive East Southold, NY 11971 Date of Violation: 2/22/91 Location: 75 Cedar Point Drive East, Southold Permit Number (if applicable): None Dear Mr. Pappas: Records of this Department indicate that you are in violation of the Environmental Conservation Law (ECL): Article 15, Protection of Waters, Section 15-0505.1 x Article 25, Tidal Wetlands, Section 25-0401.1 in that you caused, or permitted to be caused: Construction of 18' X 20' building in the adjacent area to a regulated tidal wetland without required permit. Contravention of this/these Articles of ECL is a violation and/or a misdemeanor and is punishable by a fine of not more than $10,000 and/or $15,000 per day. You are, hereby, advised to cease your operation at the referenced location immediatley. Please contact this office at once so that we ntay attempt to resolve this matter at 516-751- 8468/7y900. A failure to contact this office within 30 days will result in this matter being referred to the Department's Regional Attorney for legal action. Very truly yours, Charles T. Hamilton Regional Manager - Marine Regulatory Unit , 90-69 cc: F. Panek ECO John Bredetneyer, Southold Trustees Victor Lessard, Southold Bui7.ding Dept. HUG G1 '71 1Y ~1 InYb tIYV. WIYS. N,~ New York State Department of Environmental Conservation Bulldfng 40-SUNY, Stony 9rook, New York Y17B0-2358 (516) 751-8468 Fax - (516) 751-3839 Thomas C. Jorling Commissioner August 21, 1991 Mr. Scott L. Harris Town supervisor Southold Town Hall 53095 Main Road 30uthOld, NY 11971 Re: Ernest Pappas Dear M;. Harris: I am requesting the following People be present at a wednesdaY~ Auguate28~~1991tat 11t00rA M,Ernest Pappas on Scott L. Harris - mown supervisor Harvey Arnoff - Town Attorney Victor Lessaro - Building Department John BredQmeyer Tawn Trustees The meeting will be held in our office at stony Hrook. Thank you for your attention to this matter. ver~y~)tru~ly You fr~ Charles T. Hamilton Regional Manager - Region One Marine Habitat Protection CTH:kw ~j E ~s >(I AUG2~1991 ~~~E to ;,S ~~n~.~~ I , ~,?txe:~~~r.~ , <<,,I THE NEW YORK BOARD OF FIRE UNDERWRITERS ~~•n~~n~ f ~1)f' izl ( BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 70038 Date NOV)•S,~fH;;$ 1!S, }T)~~~ APPlicatian No. on file '7lt,'~f2~K ~~7(,if@fJ if Tts1 {Y{; THIS CERTIFIES THAT only the elactrica! equipment as described 6abTV and introduced 6y the app[icont rwmed on the obova applicotion number in the premises of H:It(+lksi't N. f~'lel'lAAri, ib F;_C"h~it1{It u{)k~l"f ISIq.~ ;}t)IJ9'7Y<Atlfl, N.Y, in thefollowinS'lowtimTT ? Basement © lst F'I. ~ 2nd F7. tilff .Section Block Lot u~os examined an h11rJl~'Ptlif;'l2 OSi ,'I ~f artdfouredto be in corrtplianee with the requirernen[s q/'this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FIUOREJCENi OTHEH PMi K.W. AMi K W. AMi KW AMi K W. AMi. H P I i i .l. ~ ITS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCXS ggLL UNIT HEATERS MULTI-OUTLET DIMMERS AMT K. W. Oll H P GAS N. P. AMi NO A. W G qMT. AMP qM1. AMPS. TRANS. AMT. H P NOYOF FEET MAi WAiiR x SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP, TYPE METER I YW I%3W 3%JW 3,e'4W NO. OF CC.COND A.WG EQUIP. ~ PER % OF CG COND NO. OF HbLEG Of ~MI--LEG NO OF NFUiRglS OF NEUfR~AL OTHER APPARATUS: y{7R1°~VCi/FFdtlLtiSA:TF ft{n.l'ff i'ftNi~. L4 t~CC'~„~-i F:hrili', Itts~yM SNf~;A7`)ik.Ss7~ ?,fi K>4d,."s°~'r; H W.,'!-."??, ~„'g7_ F'F,,~TH'~fiP.7iSR1?":1•-.I t? t"flt, 'iGq ~ U.:e'.t;.:S 1-~l. s ~7(81Y F`C7Prz,"[l.l(,li t,ir`.~p:.3C~€i~' puf'f' l~~Etit; l'tk"I'•f'i'PU{:K~ 3~9'Y, f79h?. GENERAL MANAGER 1i 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 credentials. C®PY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. i ~ ~ ~ ~J ~~~OVE C'~P~ a i ~ r i _ r _ _ _ ~ _ ~ _ _ ~ ~ ~ r i ' i i ~ i ~ - _ J _ ~ , 1~ ~ ! ~,xr'i ~S• p - pn p arse nr r ~ G~ ,19Y~ ~J 1®®TGU p .e yu/e NN nsW$ ~/~~'~iC ATE: /a ~ e.F' ~~6~2 (ycr(.t EE:~~~° sv: OTIFY BUILDING OEP MEN ~X~a 765-1$0'1 a AM.TO n PM FOR ~OLL()WiNG INSPEC7iC:N5: ~I. FOUNDATiC1N TWO REQ ED FOR POUREDCON,CRETE Rr3 i _ y ax3 a.x~ 2. ROUGH -FRAMING Rs PLUM NG c ~ .°3h2,D 3: INSULATION c1i~o ao.¢s Cad FINAL - CONSTRUCTION ST l3E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ET THE REQUIREMENTS OF THE .Y. STATE CONSTRUCTION & EN Y CODES. NOT RESPpNSIBL'E OR DESIGN OR CONSTRUCTION ER 3r dEteW I ~ SDU"1' N 7~-1/ ~~u. c¢YrnJ 4 _ dP1~'~. 1. '7 I /~y0h9G? ${lC/II~LES 7b MATC/f use a~~ iyp spa TyO µLOC. uT"~+.~dv ara8 w~..vew axag s,raf ~3~~ -Ta,s wa..e? •u~ ~ E1JQQ $'/11U ~jGFjr a'rJ' To 8u3 CRfe I»~'sts< Gast uf+p~ a aCo .Uw.SE Gt-+S5 . Dq>Fb i ~ ' ~ ~ ~ WEST . C,LB? ~'C'c'~S'!aa?Y ~7'd ~~7fi t3CaCv. ~ i. _ ~ - ~ ~ ~ , ~ i ~ Ipt'rH~ i ~ ~ ~ ~ I F ~ -i t ~ a.r3do ~ ~ ~ ai~~ 40 a ~ - ~ ~ ~ ~ ~ - i ~x~ ax 3 do 40 J`To.2{?-Grc ~EQ cymoD Jem2 $ CeugT °,psN ot~T Yu'~~+` ~=,vsr ~"~~q8 ~auae~ CONC. i ew3 dvB dv Ao o7-3~Pxb~ waoa d~o-e.~ .-~omQ'S ~Zx3 axa Cr~srineur G%emevr ~o.tJ r'F~ w. . ~ a.- s~~y ° GG I _ . ~ ~ - j {~'e- ; -sTo ~~E' _ .Cvq,.~i r r%yu ~e~ y.x+?4~:Ek-~-~S'»~:ea~~~J . . . J/1~ 765-1802 BUILDING DEPT. i NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: i~~t. DATE`S INSPECTOR ,G~, Y K" ~g ~ ©v 765-1802 BUILDING DEPT. 1 NSPECTION [ FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL REMARKS: Ou- d-u.~-- DATE ~ ~ INSPECTOR 7"~zr.~i. BOARD OF HEALTH , 3 SETS OF PLANS FORM N0.1 SURVEY TOWN OF SOUTHOLD CHECx ~t'-I`~4 BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY f,OUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 MAIL T0: Examined ..~T . 19 ~ G Approved 19~ Permit No..~0~ x'12 Disapproved a/c a; 7t ;',e; C11 ~ 1. ~ ~ ~ ~ ''IGWN OF ........t.. ~..m.: wilding Inspector) w'h APPL~~ATION FOR BUILDING PERMIT . ]O6 /o/ Date 19... 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- catian. 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 constnrctioi. 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 c and regulations, and to. admit authorized inspectors on premises and in building for necessary inspe ns. (Sign ture of applicant, or name, if a corporation) ~S ~~oae g" 7J2 E. ~av~d/c-Gp (Mailing address of applicant) ~i4 ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Q? \1?M~/L Name of owner of premises ...EeNEST"N,../~,w~Ogs,,,~W/~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALBLUiIdeNS Lcense No. MU$T~BN~rU~FFOLK COUNTY LICENSED Plumber's License No . Electrician's License No . ~ Other Trade's License No . 1. Location of land on which proposed work will be done. . N~~/~, . C~~a~¢ DAN r ,~,2 d ~~...C'~a',ae ~ouur T~~e,E rS'°efT~o~.7 House Number Street Hamlet County Tax Map No. 1000 Section ...U.~ Block Lot . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....dom. ~'?~EL~'!~.1 ~,Q b. Intended use and occupancy ...J.~.t~~~RC~. $~h ~ . 3. Nature of work (check which applicable): New Building Addition Alteration . Repair Removal Demolition ..............Other 1Vork . ' (Description) 4. Estimated Cost ~m mU0 Fee . ' (to be paid on filing this application) 5. If dwelling, number of dwelling units !V~.9':...... Number of dwelling units on each floor ...'~1i4 , If garage, number of cars n!l':" ~ . 6. If bu i cupancy, specify nature and extent of each type of use ~~A . 7. Dim any: Front . ......Rear Depth'tit?; . Heigl};t~ of Stories . Dimensio~s'of~s~ s ]terations or additions: Front Rear . _ De th Dimensions of eight Number of Stories . entire new con ion: Front 1 ~ .r...... Rear 1.g....... Depth ^?s.~........ . Height , ~':'.'d, mb of Stories . l z~- • • • • • • • • • • • .i. .'f~~tS'" Rear;:.. o?oo•,•oa......... Depth ...lv?d:3 ' 10. Date oflPnrchaset Name of Former Owner . ~ /.1Co2n.y, , , , , , , , , , , , , , , , , , 1 1. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded ~.~!'w'. J!~5 . ........Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~'guterN • P~~,,s , , , Address ~stEO+;e.?r o?; E ,~,wx!~e~hone No. ?-4 ~ !a a.°...... . _ Name of Architect ~ ~ Address ........:'..........Phone No.... . e~''` .......Address .....Phone No. 15. Is thisCproperty located within 300 feet of a tigidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO~DIAGKAMed. I Locate clearly and distinctly alb 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. i , it i a1~t~rc+le~ s/~eTS I STATE OF NEW YORK, ~ S. S COUNTY OF ~(Nadividual sig As • • ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant ning contract) above named. He is the.........( ) ....C3tirtJ~'~e!~.. (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 ........~.~............day of ..ltiM•~.Q,~-u........, 19 Notary Public . ..~ra.2.k../......... County I wr`4_ . LINDAOP6R v ~ . Notary Public, Stake of New York (igc~of applicant) No. 4822683, S4ffolk County Term Expires December 31, 19~