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HomeMy WebLinkAbout18019-z 4 , FORM N0. 4 TUWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20810 Date JUNE 19, 1992 THIS CERTIFIES that the building ADDITION Location of Property 710 MAPLE LANE GREENPORT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 35 Block 5 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 7, 1989 pursuant to which Building Permit No. 18019-Z dated APRIL 10, 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 ADDITION TO DECKING & ROOF TO AN EXISTING ONE FA~kILY DWELT-TNG The certificate is issued to JEAN MACKIEWICZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-238390 - JUNE 10, I99Z PLUMBERS CERTIFICATION DATED N/A Bui ding Inspector Rev. 1/81 rosx x~ s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUtLDlNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 1$019 Z Date ..........L.d 19g.1. Permission is hereby granted to: ~hh~ nn fir- ` ~p ~::^.R~S1'~.:~.:': ~...~4~ . of premises located at V.......~ .~-5,.... . County Tox Map No 1000 Section (.~..,O, 3DS , „Block ~ 5........pp. Lot No.... . . pursuant to application doted ( 19.Q..9., and approved by tfie B u d d i ng~~--I99nt~specto r Fee 5...•.T.K.:. Building Inspector Rev. 6!30/80 • Form No. G TOFTN OP SOUTI[OLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OP OCCUPANCY A. This application must be filled in by typewriter OP, ink and submitted to the building inspector with the fallowing: 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 Deft. 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 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. y 6. Submit Plauning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-cor.formirg 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 $1//5~~i~.00/,/gCommercial $15.00 Date .....~.l-i- J..{. ` . New Construction........... Old Or Pre-existing Building./' Location of Property..~t..r~'..~.~.'~t:~.L"~:':~~.....G.T,~:~.~'•U!~:`['T~/,,,~f..~~:!....... House No, Street F:amlet Onwer or Owners of Property.....:~...r'.'J!9.~-.~:~.~~J9,~;,~.,, County Tax Map No 1000, Section ..............Block................Lot...................... Subdivision.......C~ .............................Piled M.ip............Lot...................... Permit No.'~ ~.~.\......Date OI Permit ................Applicant........... Health Dupt. Approval ..........................U~iderwriters Approval......................... Planning Board Approval Request far: Temporary Certificate........... Final Certicate........... Fee Submitted: ~ ~ / APPLICANT 4~.• ~o~ aP~B>b INSPECTORS ~,,;,z,.,_ Victor Lessard ft% SVffO(~ Pnnctpul ButldrngInspector f~`~~Vo COC,~, Curtis Horton y~ S',, SCOTT L. HARRIS, Supervnsor Sentar Building Inspector a f - Thomas Fisher ! ~ x Southold Town Hall Buildmg Inspector d P.O. Box 1179, 53095 Main Road Crary Fish 'J'''~Oj .~,.3+'J~ So Fax (516) 765-1823971 Butldmg Inspector _ Telephone (516) 765.1800 Vincent R. Wieczorek Ordenance Inspector Robert Fisher Assistant Frre Tnspectar OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOW1V OF SOUTHOLD MAY 4, 1992 STANLEY MACKIEWICZ 5 LOU COURT MELVILLE, NY 11747 RE: PROPERTY @ 710 MAPLE LANE, GREENPORT, NY To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xX}[ An application for Certificate of Occupancy is not on file. (Enclosed) xxx No Underwriters Certificate on file. xxX The check is $~iy~d7knot on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 18019-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. INSPECTORS Victor Lessard gUFFD(y ~ Principal Building Inspector d'~~ ~'p~ Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector co ~ ~ v~ f = Southold Town Hall Thomas Fisher } ~ Building Inspector O ~ ~ ;xbr t. P,O. Box 1179, 53095 Mom Road Gary Fish ~~`~Ol >s.~~~' So Fax (5 6) 765-1823971 Building Inspector Telephone (516) ?65-1800 Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD MAY 4, 1992 STANLEY MACKIEWICZ 5 LOU COURT MELVILLE, NY 11747 RE: PROPERTY @ 7I0 MAPLE LANE, GREENPORT, NY To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: %XX An application for Certificate of Occupancy is not on file. (Enclosed) XXx No Underwriters Certificate on file. xxx The check is ~xRx>$d>e7knot on file.)$25.00 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 # 18019-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Nr era t...~ r. ~ '%f ' ~ r~ I F .`j . - - ._Fi.~E Vis:-W J~~ ` 1 J_ .5 SSf fi ~t ~ o ~ r-~.-- , ~ :e ~ ~ ~ ~ ` ~ v I ~~i ~ - - - - - - - ,T - .Q _ ~3~S~t Nl'SCEC DATE~~• /C~ a /~s - ~P NrlTt-^ 1c:LD I;..`,::~.~..1)N ~(U„YE i;OMhfGNTS 1 . ~ c H H FOUtJDATION _ (1st) ~ > p' ~ POUNDATIO[J (2nd) I m~i z o aOUGH FRAME & PLUMBING d C N , H ~ 3. ~ m ~ IIJSULATIOPI PER N. Y. ' H ~ STATE ENERGY CODE ~ _ ~ a c _ 4 y ~ FI;JAL ADDITIOf1AL COMMENTS: x ~ e ' x ~o ~ ~ H - • a H H O ~ } r H c ' x a m ^o H ~ ~t~~ _ I~~ , _ u~... ~ v J ~ A~r~~G~i~'~?~- G~ WN OF 50uTHUU~" , ~ . ~ ~ o ~r~~~' ~ x31gEN° "5, i8a a, 'I~~E~'. 'N?'J' ^vt', v a~'`'X a'' „F~,` r` a I - x A t.,, k'H"g ~I. ' + '+~'.N~' °^n~ 1" i. ul% r t~,,. ',}11i °»d ~lt~"~':"' i'; e ,r ~?y'~rY,F M~`'~f ~'t TI'^t^, ~'1<. "I~t ,ra," , 1 ~ 'I ~Y" r''~w.~, Sa.~. "eg~.,`M'~N#` xh"~~L,~'/~c,~ n1 v! ~~'A Iti'„ ~ ~ ~ . 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X.i "~i 9. . J _ t{~ , t+ri X CAD ~ -p -a ~ ~ ~ ~ o Z D p~ o ~ ~ ~ ~ ~.ao^~ ~ ~ ~ m~ ~~'~r+-mgr' ~ • ~ c~io¢'mcQV~~im ~ ~ CD z n ~ a O o ~moCD~o< -,,z m ~ O Vii ~ N O m ~ m Z ~O~cn~p o ~ ~ ~ ~ CD Cn w ~ ~ ~ o. o o ~ l ~ ~~~c~~' ~ C7 v ~ ~p^ O ~cQO~~tpi'I ~ o m ~ C~ CD Q o ~ -~~o~~ ~ ~ ~ o ~ ~ ~ o m a C - w 'i~'LT•J FRANK A. KUJAWSKI, JR ,President ~ i. s TELEPHONE , ALBERT J. KRUPSKI, JR., Vice-Presrdent F"" G"'+ w; (5t8) 765-1892 JOHN M BREDEMEYER, [II d° '0~c'~t~ CC' ~r JOHN L. SEDNOSKI, JR ~~,"1'II('J~ t~ ~`G~,'~ HENRY P. SMITH ~x-tr,=`e:.s~ t' Bf?ARD OF TOWN TR~'I9TEES TOWN OFSOUTHOLD ~,~4 Town Halt, 53095 Main Road ~`F , P O Box 728 Southold, New York 11971 + a November 22, 1988 , Y~ Mr. Stanley Mackiewicz 710 Maple Lane Greenport, N.Y. 11944 . , Dear Mr. Ma~~kiewicz: t The following ac,:ion was taken by Yne Board of Town Trustees during their- regular meeting held on November, 17, 2988 on the ~ above referenced property: WHEREAS Stanley Mack>_ewicz applied to the Town Trustees for a waiver to enlarge a deck and construct a roof over same on property located at 710 Maple Lane, Greenport, N.Y. Property is identified on the Suffolk County Tax Map as 1000-35-5-24. a~ WHEREAS the Town Trustees have conducted an on site 1;,,, inspection of the subject property, and NOW THEREFORE BE IT RESOLVED that tha; Southold Town Trustees approve the request a'~'; for WAIVER for Stanley Mack>.ewicz to enlarge deck and construct roof over same on property located at 710 Maple Ave., Greenport, N.Y. ~t Please be advised that this determination is not a n determination for any other agency or department which may have r'$~> jurisdiction in this matter. Very truly yours, ~1 Frank A. Kujawsk>., Jr. President Board of Town Trustees r ' FAK:7as cc: Bldg. Dept. ` ~ file , r' ~x~, ti~"< R- +,~sf _ ~ 765_1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE V INSPECTOR loo 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [)FOUNDATION 2ND tNSULATtON [ ]FRAMING FINAL REMARKS: DATE INSPECTOR n _ - . THE NEW YORK BOARD OF FIRE UNDERWRITERS @AG6 1 11115003 BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 peep JUEE 10,1992 ApplicotionNo.onfile 77190492/92 R 238390 THIS CERTIFIES THAT - only the a4atrical equipment ar dsscrifted 6ebto end introduced 6y eke applicant named on [he above application numher in the premises qJ MR & MR8 KACKIEEICE, 710 MA@L6 LAEB, GRBBB@OR4, N. Y. in thefollominp location; ? Basement ~ /st Ff. ? Pnd Fl. Section Block Lot tans examined un 70EE 01 , 199 2 and found to 6e in compliance mirk the reyuirernen is of tkia Board. NXTURE R%TUREf RANWf COOKIYW tNCKS OVENS DISH WASHERS EXHAUST FANS OUTIlTS BTACtES SVYITCNlS INCANDESCINT. t1U011E5ClM OTHER AMT. K. W. AMT. K. W. AMT. K.W. AMi. K. W. AMT. X. fi 3 3 _ its _ DRYERS WRNACE MOTORS lUTUR! AMLANCR IHMRf SMOAI INC'M 71ME ClOCK4 Rll UNIT HEATERS MUITI.OUTIET DIMMERS AMT. N. W. dl N.I. GAS R. t. AMT. NO. A. W. G. AMT. AMI. AMT. AMTS. TRANS. ANT. R. I. SYSTEMS AMT. WATTS x NO.OF iMi p Me = SERVICE DISCONNECT NO.OF f ! R V 1 t E 1__ AMi. AAV. IMPE E~, 1,e tW 1 / 7W 3 / JW 7/ AW NO' NR 8CON0. CC. OND. N0. d NI-lEG D, M l G ~.Oi NFUTKAtS Oi ~NEUTMI - OTHER AMARATUS: - 1~ Q.C. ELBC4RIC INC. LLC,i3823-6 @.O.BOI 518 LAURBL, pY, 11948 fi1MNAE MANAWR 37 Prr This eertRicgM mIM not be altered in any manner; rNurn to dla offita of the Board if incorrect. Impactors may be identified by their crodantiah. GEftTIFIGTE: GE1S7' NOT'$E !tL F - r\- ~ - _ - y Y--_ _ _ - Ol1rIN~[rR~: r~vr~~~~' 4'~]~s~..fp_~~.`~~~.~E~~J ~ C ~ SUFF. CO HEALTH DErT. ArPROVAL , ' r _s• Tb`°-~ 20 Y~~ f t~laivr`Ko:-i~ ~ S~{7FFOLK COUNTY HEALTH DhPARTASENTI~ •~'.u ~~fOi • L MAPLE LANE SAT C~g~iA. D. REF. ~ ~ j~rt; ~ GQ~EcNf~OfZT, N.Y. 119 TEL 4Z7-Z4"i4~ 2hrt se'na^s disposal and Zter supply " r- fa^ 1L?SAS for,tliis ~O~~n'.:aveibu d/,~ r AREAL 13.2.95.{+ l~vr~sin 7,ild rMdta iinea) ,ins e. ,ed by this de ar` ~-r a~~ Le' 7)`, ' .i1,%.~ !o a satisfactory. ~ DECD: iJ~A - f3iliet` oP General Enginearia~ 4I1 •~n. •.•1. t• +ilY r_ • • w... : » ...Y•,,R S w ~WYI " _ I • ' 1• i.{iy:• .w.,t ,fir •a J• r•~` ~ 4n V yVVN .99_1°°:h~~t~~ _ _r .i'(~i ^~e: rT,av ~~2 1-~,~~ TeYf •'Q _ d?~ jr1'+ NY."+a. = •j. ^~44~.y ri r nY- ~n.•r~ ` `Y iy'ti •~_r r•~ n yV' 1~~^Jw~Y. •.-e 4.4-. . ..n. . raj `KC^; -w y_ b• L.i. _ .i~ c. r - "r 'w wia t. ",4• sl Ct.-~ ~ 4_ s~ •F'Y 'q. 4 .A.~~Y<` •/4 ~'-i ~~Y,-{r•,+~, .._Y .y. - •r .s• -r~ ~y_: ^.4~.r;~r.i`h~"~~i^ 1. '4~ L t~'Y I. 1, _~y~rij'.i r~:., n'a4 - , ' ~.r p~ ~ Y t ryV . 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' 5.~3'30'1Y. • . {~a.^= ~ - ::v: cwrs or'frtfs sielvr N,vnwr,fwu+o~. - 's i • ~ ~ ~ _ ~ , F 7H[ tuo 54..VFY01's MT.S S[Al oR ~ ' Q 4 1 - - _ r ~ . • - - - i ; . _ ~ ~ wwss;a s.w+ sr.AU n :i a c;wulofuo - ,•I I _s 7 - LOT 6Z wC~;r'~, TOf1ArA1mrwlac^rr+s_ 1 _ ralAfAertf~ {rS {:Ai e•C1Y,_WSIIAIL turf ~ ~ 1 ; ~ ` Y aCa ft't'~ = ~ Oran To iru .~soei r- r:,•; r., 9a Su1r fs fwA:fn. A.v r,. 1{.s cl...r ro ff¢ , V ~(DiVMT, WV{.tSl '+A. AGfNCA' A rpS~rG 1'Si`.i~~+di /1T0~ TfTLi - ~ GCRT3 F. r le ~ wS.strFS ca re m~wc uufr - lucory cwtAr+~swi IOi aA.sru ' -MAP O~ 1...~JT ~ ~3 }f = .4 5.'-._:' . a,,,~ °r"-"~"-'__°-sT~u~ +MAP OP~~C/yL~EAVES fODINT - SEGT.~~~ :l u!'•'°."' - = t-:= .,~;.:.r.., BCAL 4_',~i: 4. - `.iL1~~Ol Y.. `Viir+RaV N1C~f~Fbl.°~O~ Y. 4~+F^'r •r"~ '.i'~ !~'i.~~•"tom.+..+]~so-» _ '•i-'i~T. 'rt 'C 't _ .A~, Y'Y .1>::'':Scirvey~f Au' - 3.K3'i~-,:_r-;,.. ~.?~;~";.»,vF.- ~VV~~,~~j'~~" ,,'tt yi.:.r• _ ~ -s_~:r rrillODERIGKY#F( TUYL T. C.~-9.,,c+;" _'F ~ w,:~~'Y4-'- .2 •~H~ -;S kii.'ww`0``f• ~r•,s. ur' < v '~~•~~YL~,~'Y -'~_01~1h4~-C3F .``34t.~t'~"1'!i?LD,hE:~ ;,•,~:~:~~~.?.-i.` yd-~,~•Y,: ^~:*i:~ - ^2~.r'•'> ..,,~;,.a. yf;.: `r „"1-oj'.`,L.~"~~ ""LC. LAND SURVCYORS2iREEN_ .'N ~.~+'Y~$.cTr_~_,:S; ~L.. :i l.hSC. _ J',T~-~4i .,:Fi rS~'',y~4~ As.y'~'t'•Tt,.zy;~~;+n3 ~{,'•3~, V,sy,~ -+;y~,F..~ '~,e+••_ T"~ _ .'SUFF. CO. i7EPT.OF HEALTH SiJtVlCES . _ STA'f'lLtENT OF itli'ZrIT• =r•^~•4`_' S r 1-,r =1''' 1•'::' •$r-~~a;^r .1ti R. .•r y~-' _y: itrr.. i -:p~, r ~v1rv ~u~• w .r. :;~s: • j. _•f~'<'^q k1.~ tau yf'~{.~~'F.'~ h~~t°rir{y ,~•~"~~:~=L .'-r,.`"+ T-~.i ~'".?F' aC'~ ,;w,ti ..~~i::'~.':'s~~.'4M-.Tp;i-~"^t.?;K'Y+'~,, _ r~~»t.~ ~±.''_'TMw' r.s < . ~ J, µFOR APrROVAI O +r,~uir±kr;,r-,. ' F OONS7TIUGT(ON ONLY'. A,`: ar44r i+K~~~,,~+°.a~~•*. •~4~~ • r . ~v4 •;,.,i •,y`,~,, -e { .tu , '~'w.',~4 ~:~5 WASER .SUT~Y•.x "7ry'r~.. :~H t - ` .Stdi'•ry: `i.: rbo-= 3~:~+«. ~ J': PC Y `~~:'~+''}+r~i. ~t'Ry'i ~'•T:.~ : `'i ~r. %6y C+_.'rwyw ]:s d ~ .DATE: I~a "•4 - ~ ter' i ~ T DISPOBACt..SY'4TCM! 1pR 71•n. . , y' . f.- ~ t"' f.l a "NS .+fv i+wy'r s y.±~".F M!w- _ ' .it, 1.. „r ° `,DENCE „VYlLLr~~CONFORI[ TO . H. f. REF. NO.e ' ' STANDARDS OF fUFFOLJC Cb~. pitt'T _ ~ OF-HEALTH.•SERVFfas.''` r. •r 1.1 ' •r. cr c fit. 'w,.'E:s ii. G..,~Y...'.. A?PROYED• Y= .Vt~;,C, ra ~ `:.l.x~''-~':._~,•a.. . r'Y_ rnon9! • BOARD OF HE.ILTH 3 SETS OF Le1NS Y . FORM NO 7 SURVEY .4~ TOWN OF SOUTHOLD CHECK $ya . . . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N.Y. 11971 NOTI I'Y ~ a8~ _ ~ ?5.. . TEL.. 765-1802 CALL Examined ~ 198. MAIL T0: ~Myt e.1774 nJLG T /~/!~G'.C./ELeI/~ Approved .1 ~ . 19~~ . Pei7riit No ~ $o! 9 -~L. / Disapproved a/c O /Y~c~. v / c. c ~ N. Y- ®~Ty7 i r~ (Building Inspector) • • • • - ' p~t AP~ 1. APPLICATION FOR BUILDING PERMIT / `u„`ll ! Date f/.r~...., 15~. BLCG. DEF=T j TOWN OF SOUTHOLG INSTRUCTIONS a. i Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of pians,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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl 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 perm 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 Occupant 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 th Building Zone Ord~i~ti~f the:, of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Re,ulations, for the con~trtict~isfiuildings, additions or alterations, or for removal or dcmohtion, as herein descnbe~ The applicant agse~s,~b`bomply wit~i"i;~ apphcable laws, ordinances, buildin code, housing code, and~egulations, and t admit authorized uispegtp~ ozl premises and in building for necessary mspec ' ns ' w fea• i„ . f, ignature o4' Iicant~, or name, if a c ~ ration) • (Mailing address f applicant) State whether applicant is ewrer, lessee, agent, architect, eag:reer, gene.al contzactor, electric: plumbez or builde, Name of owner of premises ~ ~f^ri. ~ y., (as ~i#t~x.tt311 ~r latest deed) , +*R177 .a: i t If applicant is a corporation, signature of duly authorized office~f'~i!~ a McyfTlh,#ci{tt. t s x. (Name and title of corporate officer) T Builder's License No ~ ©.Q Plumber's License No . Electrician's License No . . Other Trade's License No . . 1. Location of land on winch proposed work will be done ~I ~I~',~f,L,t~, ,~jb~yt/~ , ~~i{J~GY~~ / House Numbcr 22 ~Street Hamlet County Tex hiap No 1000 Section oJS. ,JEST , Block 0 Lot Subdivision - Filcd Map No .oS,~.C..~ Lot (Name) State existing use and occupancy of~p/re//miles and intended use end occupancy of proposed constnichon a Existing tilt and occupancy ...~.~1!~'*~• `f~• . . ~ v r, b. Intended use and occupancy • • •U!~-/. 4~~c~~Cknf~rr~. k.+id~~ ~wt~~ ' ~.4FF}... . 3. Nature of work (cheek which applicable). New Building .AddiUOn . • Alteratton . Regair . . . . . Removal , . Demolition .Other 1Vark . ~ ~ (Dcscnption; 4. Estimated Cost .....~/p'~~ JG© Fee •~ca . (to be paid on filing this application) 5. If dwelling, number of dwelling units . Number of dwelling units on each floor . . If garage. number of cars . . 6. If business, commercial or mieed occupancy, specify nature and extent oC each type of use . 7. Dimensions of existing structures, if any Front Rear . Depth , Height Number of Stones . Dimensions of same structure with alterations or additions Front Rear . . Depth lIcight Number o Stones . Dimensions of enure new construction Front ~?i : .Rear . Depth , r. , , , , , , Hciglit . Number of Stones . . 9 Stze of lot: Front J..3.+Gl.~. L~ . , Rcar Depth . ~ G J.. , 10. Date of Purchase ~ ....Name of Former Owner ~p.i3y uf>^T- • .~:~?:'~e:.A~T.~... . 11. Zone or use distract m which premises are situated . . . 12. Does proposed construction violate any zoning law, ordinance or regulation• . . 13. Will lot be regraded Will excess fill be removed from premises: Yes 1` 14 Name of Owner of premises ,~../7?.^?.~.'r-.! L"~./,~ ikddr~cs 7. ~ , ~,r; , , , , P;~oit~ ivo?j/.~~.- 6 s~~~l'. Name of Architect ...........Address ...................Phone No............. . _ , Name of Contractor .rl. rt.*'7t~!.S.i~!!`~ddress ~~t.~~=z~ .`f 1~. G^'.t~ Phone No ''~7.~.- ~!'.:~r! 15.Is this property located within q00 feet of a tidal wetland? *YES.~.NO.... *Zf yes, Southold Town Trustees Permit may be required. PLOT DSAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all setback dunensions fro property lines. Give street and block number or descnption according to deed, and show street names and indicate wheth• tntenor or comer lot. OCCUPANCY OR USE !S UNIAWF~L ~,QQ~ vEO as NoT~:o wiTH4UT CERTIFICATE riATE ~•P ~ Qf t}GCl1PANGY r~, t. lfY 61In ptiv r, gFPA RT141 t5T nAT t4r1a { Air `t7 n F^A FS)R THE 5111 ~)dv;',~C t~i'.FFt'1::1'4~ t t;)UNDATiON TWORE(lU1RED FOR POURED CONCRETE • 2 ROUGH FRAMING & PLUMBING 3 INSULATION 4 FltvAl CONSTRUCTION MUST BE COMPLETE FOR C O. ALL CONSTRUCTION 5H ~ N THE REfriSIREMF.NT13 OF STATE CONSTflUCT~ ~ ENERGY CODES. NOT F~SPON' FOR DESIGN OR CON~'~tRORS STATE OF NE~V YORK, S S COUNTY OF .,,,~/.!9N. ~A, ~.~j~~l, C, ~ , , , , , , being duly sworn, deposes and says that he is the applicai (Name of mdrnduai signing contract) above named (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 th apphcauon, Chat all statements contained in this application are true to the best of his knowledge and belief; and [ha[ tl work wdl be perfoi-med m ih~ manner set forth to the application Filed therewith Sworn to before me this c Y f c,~.~/~..... , 1~ , Notary Public, f/~~~j~j.._ /~f( .County ~ , ~1t pubiw, State of Naw York _ 9rMM~~~^h'I~`1 ~ (Signature of applican