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HomeMy WebLinkAbout18020-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18647 Date DECEMBER 15, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 475 ROSEWOOD DRIVE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section lI3 Block 02 Lot 10 Subdivision ROSEWOOD ESTS. Filed Map No. 5240 Lot No. 7 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 7, 1989 pursuant to which Building Permit No. 18020-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 isONE FAMILY DWELLING WITH ATTACHED PORQi & GARAGE The certificate is issued to EDWARD & JANE MULRAIN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-159-DEC. 14, 1989 UNDERWRITERS CERTIFICATE N0. N-104158 - NOVEMBER 21, 1989 PLUMBERS CERTIFICATION DATED OCT. 30, 1989-K&K PLUMBING & HEATING ~L - Buildi.ng Inspector Rev. 1/81 lO~L NO. f 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 1.8 0 2 0 Z Date ~~v . 9. fJ..,r Permission is hereby granted to: er... / ....y...~~~.....~/~c7.G ~ at premises located at ....~":..~~ijr~j~..,,..~..f..~~i~MG'"_"_l"'.7 "....~.l.~G~I.:G ................................................7~C/r'r*r~ • ~GL~................................................................... . County Tox Map No 1000 Section Block .......Q~..... Lot No .............1~ pursuant to application doted ...r~.~~:.L~...l.~y~Q 19. and approved by the Building Inspector. Fee S.. ~ l"' s%?~... . B ding 1 or Rev 6/30/80 . _ D ~c-~v TONN OF SOUTHOLD ~7, BUILDING DEPART:fENT i ` .F y ~ ~ ~ ~ ~ TORN HALL SOUTIIOLD, NEG7 YORK 11971 BLDG DEPT 765 - 1802 70Wt~OFSOUTFiES>U.t~ ~ APPLICATION FOR CERTIFICATE OF OCCIIPANCY ~ Q DAT1;... II=.~:.~? ~ NE11 CONSTRUCTION ~~CS__(,..~OLD OR PRE-E%ISTING II\UIL\DING_.....oA~'}C~A,N,,T.I`'~L.A,N{.D..l._.... Locatioo o£ Property....t.~~....~~1~1J.~L6~1.JQJ?..R.d~I.~Q,.....l: K.ai,. t.l.ll.~S~~~... HOUSE NO. y'y~ STREET , - H~A/M~L/~~T Ovncr or Owners of Property...7..4~.:b'J!.I~~...~~~.1~7~-1~~.1.~.!.1~J1\.~.~,?t1,~ County Taz Map No. 1000 Section ~.1~. ]31ock ..~_~Lot Subdivisxan Fi(le'd Mya~~p ......_.Lot.f.}~.._..... Pccoi[ tio. ~~QDatc of Permit _'f:~.~V.':~i plican[,!L!~~r~~~.:.~une.~~~- IIealth Dept. Approval Underwriters Approval........_..... PLannznF board Approval Request Ior Temporary Certificate Final Certificate Fec Suk~nitted: . ~ APPLICANT rev. 10/I4/88 (~.ec•3&7s3 C~~ ~i$~y7 A L v . FORM NO. 6 TOWN OF SOUTIIOLD BIIILDING DEPARTMENT TOWN HALT 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings 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 of Health Dept. of eater supply and sewerage-disposal(S-9 form). ~3. Approval of electrical installation from Board of Fire Underwriters. ~4. Sworn statement from plumber certifying that solder used in system contains less than 2/10 of IZ lead. 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the 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: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural oz topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shalt show single and separate ownership of the entire lot prior to April 9, 1957. If a Certificate of Occupancy is denied, the Building Inspector shall stale the reasons therefor in writing [o the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior [o April 9, 1957 shall also accompany [he application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.06, Additions to Dwelling $25.D0, Alteration [o Duelling $25_00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25_00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing duelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over S years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential, $50.00 Commercial rev. 10/14/S8 TEL. 765-182 ~pc~VFFOC,~~pf~ TO'l~N OF SOYJTHOLD < OFFICE OF BUILDING INSPECTOR P O. BOX 728 u' T01VN HALL ~ f ~ SOUTIiOLD, N.Y. 11971 C E R T I F I C A T I O N ' ' Date ~©~~~~6~ Building Permit No. \~,~a,C~ Z Owner ~y~6oJ.C\ {please print) Plumber ~ ~~`VM~C~~ ~ (please print) ~ \ L~c~es5e ~ 2~''.~~ - ~ i I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ~ - I • (plumber's signature) ' Sworn to before me this A ~ f ?O day of ~~o'i~~~e e„ r _ 19 Notary Public Notary Public, Z G`~~ County ' rl ~ ~ ICY Mnr1Mk err. TEL. 7C,5-18~' Qt"~~0;~ To~rrr or sou~o~.~ y~ arl-icl~ ~Ir ~uILDINC INSercraa r=-, i~ 4"~St~~4 z I'.O. ISOX 1179 ~ t-'~;+`~' ~ TO`ViV [TALL ''"c',y a'~ fit- SOiIZItOLD,N.Y. 11971 ,d~~ o~y y 'to S4hcm This, May Concern, YIe are unable ro complete your Certificate of Occupancy because of the follo~•nng reason. An application for Certificate of Occupancy is not nn £ilc. No tJndcr~.~ratcrs Certificate on file. 'Clre clir_c:l; t:, (nutcl,lt'CCl/nut nn file.) $aS,40 /t!( No Ilia] tfi Dcpt. npproval on file. D7o final ~nsl~eut ion ha:: hecn made. Pleasr, contact our office on this matter. - Thank you for your cooperation. Iltttlcltr,d Pcrmi_Y ff / ~ ~ a. ~ Z EIuilQinq Duet, "*"/v/ tf~r Plumber Solder Certificate on file. ' 1 ! ( nl.l porrtit:; involy~ ncl pluml~lny briny / issued after llpril 1,198A ) -1cLD ILS:EC:IU;~ ,IUtii^ CvMMENT.S t. r - ~ - ~ H y FOUtJDATION (1st) ~ ~ C c fi ~ ~ R FOUNDATIOIJ (2nd) _ m ~ 2. ~ ~ o °,OUGH FRAME & PLUMBING ` ~ ~c.a~ y 3. ~ m m IIJSULATION PER N. Y. STATE ENERGY CODE x a 1_ y ^ ~ FI;JAL I D "'~1 o z ADDITIOPIAL COMMENTS: x~ _ ~ /i ~ 6 dU ~ Q` ~ d d do X 3 X S so d B a H O~^C x m a r H x v m •v H • ~ _ 765-1802 ~ a BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INS TION [ ]FRAMING [ FINAL REMARKS: DATE CJ ~ ~ INSPECTOR ? 765-1802 U BUILDING DEPT. tNSPECTt4N [ ]FOUNDATION 1ST [~GH PLBG. [ ]FOUNDATION 2ND ~ ]INSULATION [ ]FRAMING ~ ]FINAL REMARKS • ~--~~.V~~_~~~ DATE 1 NSPECTO ~ , ~ 765-1802 BUILDING DEPT. INSPECTl4N [ ]FOUNDATION i5T ( ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ FINAL REMARKS: v~°~-~ _ _ ' ~ C 4eT~. • „I t J 4s~~~ l~ ' j _ L~ ' f . ' I L J n r ? DATE~~ ~ INSPECTOR ~ir ~(~D~ ass-isoZ BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ )INSULATION [ ]FRAMING /f [ ]FINAL REMARKS: ~N d' ~~C,LO DATE ~ ~ INSPECTOR i~~ _ C ~oy~ rss-iso2 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ j ROUGH PLBG. [ ]FOUNDATION 2ND [ ~ INSULATION [ ]FRAMING [ ]FINAL REMARKS: i' G-- a- DATE ~~3 INSPECTOR ~D L U 765-1802 BUILDING DEPT. tNS~ECTION [ ]FOUNDATION 1ST [ t.~000H PLBG. ~(/p FOUNDATION 2ND ( ]INSULATION [ ~RAMING [ ~ FINAL REMARKS: DATE ~ ~ INSPECTOR ~sS-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST ( I ROUGH PLBG. FOUNDATION 2ND ~ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: - DATE t¢ INSPECTOR i ~ - - - - e ~ li ~ ~ ~ Vi) _ - _ ~ - _ _ - - - _ - a - - ~ - - - - - ~ - lam', ~r - ~i. Iy+ i5 ~ ? flCT 2'f i999 - - - -I - ,~,..~gtj - ~ r~IDG DEPT - _ _ , 70hNtYDFSaUTHQLD - - - ~ - - I ~ ` - - - 3 c~5 - --1-- - - - - - I _ _ _ _ - - - - - - - - _ . r r-r _ _ _ _ a THE NEW YORK BOARD OF FIRE UNDERWRITERS a>ACr: 1 1175003 BUREAU OF ELECTRICITY / 83 JOHN STREET, NEW YORK,:NEW ORK 1003® N01%$NBER 21,1984 ~ppjctt@~ ~tJi{~ 63152089189 N 104158 TMlS CERTIFIES TXAT PSR7Tlt1'o lif~o oL80.d() only tM aleetrkal puiptrtent a. deecrihed 6eloto and introduced~hy the appdcarat named on the akeoeapp/ictton nutnhsr to the ltrarrtisas of SDMARD/TfANE NULRAIN, 475 ROSBMtlOD DR., LIL 1{4, NATTI'PUCK, N.Y. rk thefolbteinR kmeNon• ~ry t Ist Fl. GAR/C1UT `~tB~#n~? ~ U Ynd FL ~eation Block .Lot mas exagrIned un NQY~6NB a 1.3 , 1 X89 and found to be in complia~rcr milk tha ~ayuirementK of this Board. ~ Ipfl{IM : ACYS fW1TC116 RX RANGES COOKING DECKS OVENS W EIfNAUST FMK OUTIETE INCANDttCEM P1U011lSQN7 OTHER AMT. K. W. AMT. K. W. AMT. ' W. AMT. K. W. NAT. N. P. 54 - 5 35 54 ~ I' DRYERS f1lRNACE MOTORS IUTIIM ANIl1ANq REDERS SRX:IAI Nt: fi TIM! CLOCKS EYl YNIi NMTERE Mt YS AMT. K. W. Qll N. P. GAS N. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS.. TRANS. AMT. N. P. NO.OF 1@i AMT. WA1T5 ,F 1 2 12 to EUO `I MO.Ot S E R V 1 C E NO. OF CC. COND. A. W.O. A. W.O. A W. G. NtP. iMN! I,e tV/ 1 / tW t 13W I1 tW NR / OP CC. D. NO' ~ OP N41E0 NO. p NFV111A1t OP Nt111KA1 1 2DO ca 1 x 1 z/n 1 x/o Oi1NR M?AMTUS: r,,e.c.2:-a SKOKE DETECTOR?-2 Q,C. ELECTRIC 1N('. LIC.N35'23 E N.o.BOx 518 w LAUREL, NY, 11448 EIEMRAI MMIAOQ 1.1 Psr Thit artifkaN mutt M~ be alNred in any manmr; tWurR to 1M office of 1M bard if incorrect. I rs may be~idsMified by Moir cademak. UILDING DEPART S C OF CE 1 TE ItNlST E ALTERED IN ANY AIAl1iER. P~ ~~I~- I ~ oao t ~r ~ / ~4'' r~ cq N ~ ~ 6To3 C~T l) r o ~d 3 i0 "e 9 Q f . ' J ~ , ~ F ~ ~ o; _ ~ / Q ~ / v ~ zs°, 2 Off, v ~O m° ~ . N mo O 2 N ' ° ~'B a , ~ ~ s 4~. r 02' Q s sTo33 ~ 0 i b• O yy m' - .h 3. 3`" M~ r ry ~ o ~o ti ~ r owFCC KGs ~Ta s8 ~ ~O d f fps ~ z 7 Q SURVEY OF ~ '"`u L 0 T 7 3es MAP OF ROSEWOOD ESTATES ss' FILED JAN 24 , 1969 FILE NO .5240 AT MA TTITUCK R=28.83 TOWN OF SOUTHOLD L=3987 SUFFOLK COUNTY, N. Y. 1000 - 113 - 02 - 10 ~Q' SCALE I 40t ~ NOV I9 1986 ~G MAY 22 , 1989 (u c) G~ CERTIFfED TO AMERICAN TITLE INSURANCE COMPANY SOUTHOLD SAVINGS BANK EDWARD MULRAIN JANE MULRAIN y~~ t AM.v ~~9 • ,~'~'oy~Q't` L~~ AREA 20,007 SQ.FT. r' gto °x Prapnrad in accnrr!7nce whit tE;a rt••,~ n N N' S LIC NO 49668 r,. c`a as for `i''o surve,, ~s~ •r u 49s8 t. 1. t.F_L5. a:~d op 1 ~ E C O p $ R S 9 ENGINEERS , P C fior stx3~ ux by The P~s;v Yor:. Ssota L },d ( 5 16) - 0 YAis A>aaeiaAio* P O BOX 909 MAIN ROAD • . SOUTHOLD , N Y 11971 ro-r7_g6 8 o•f/ as - 72s c fi 'SUFFOLK CQUN P11sn G ac) NMOl DAiF 94~C P,EF tb~ ~C.S..a.~_,S~f i ~ , b ~ '1~O jha 52 rYr: L11Stlrtc;si Z"' ~ `O i I IC 3f.r 1, hi' ~ r ~ ~ ~ +r fil~ltlr ~I~ i;~ t'1~ ~Cd(„r ; C'Q CAN i tar:z;,e~~~ e r e n J ~ ~ F WELL ~ o; J s`?, m ~ /T2 ~ Q ~ roe `r3 ~zsr• qAk ? 02• ~ r ~S O \ a 410 M m 4 ~ ~ ^ rM c \f = ti \ y~ b lL~d . ` "'~%F ~ ~ r we r 4`;fiS '3~J ~~w~4' ~ Q ~ ~9D Oq~_ 3,3 ,/p ~ a O O J /I ` Ir ~r~ g L,P CO 0 ' `ti Cp ti r owecc NGe /?a s8 \e ~ ~ Q SURVEY OF ~P '"`u L 0 T 7 3as MAP OF ROSE WOOD ESTATES ss. FILED JAN 24 1969 FILE NO .5240 AT MATTI TUCK F=25.53 TOWN OF SOUTHOLD `~357~ SUFFOLK COUNTY, N. Y. 10 OQ - 11 3 - 0 2 - I 0 ~Q' SCALE I = 40~ ~ NOV 19 1986 ~G ~ ~~F MAY 22 1989 I u c) Sept. 22, f989 (final) Q'~' , ' G A ~ ' , BUG ti4 CERTIFIED TO ~y. AMERICAN TITLE INSURANCE d~ANl~do t SOUTHOLD SAVINGS BANK ~~Gpe+ 8,~ f'4 # 88 - SO - l59 EDWARD MULR AIN JANE MULRAIN r ANOc G~~ + ~`''~05 F~.~~"< AREA s 20,007 SQ.FT. v °O , ~ * S LIC NO 49668 ~ECONI ~ RS f516) 76 20 ~ P O BOX 909 MAIN ROAR SOUTHOLD N Y 11971 io-i>_B6 8.o•N. 86- 72SD ' 9n ~ ,?4,N 33 ~u'~.~,;~„ tb(y,,Y: ~y 'r~E;~ssf ~ A e y ~ ~ rTC p \ l.. ~ \S' • ~ rah O . O o ~ 2 ti ~ ~ r ~ ` ` t Z' ~ ~ .\fS ~ j Q r sTo co .<v Q , v oti . L~°' . N , J 9 r t ~I \ ~ IvU~ a .,~>z SURVEY O F ~P ,~„~r, ~r,,. a LOT 7 ~ es ~t MAP OF ROSEWOOD ESTATES r~ w~` ss' FILED JAN 24 , 1969 FILE NO .5240 lr, 9 ' A T M A TT I T U C K r~```',`~~ TOWN OF SOUTHOLD ~-R-~~ L=3937' ~UFFOLK COUNTY, N. Y. ~~rr f00`l'~, - Ili - 02 - 10 ~ Q~ SCALE I ° 40~ r-- ~ NOV 19 1986 ~v ~ ~ ' P 1 } r V Cn ~ .w. EXPIRES TWO Y~i-~I,o Y-I-L~(+~~ ~!'((-.~~7~ C~ .asp' . 0~;; ~ ~ S ;FP+?t,t CV+'rti'£ ssp;^'•4ah"T GF HtkLTt4 SEt2VECE5 ~ ~ 31S~Y LJ ~ C"1 FCn A' rr rr'st'°T~L.C:'~4 ~;t Ct*LY Q"1 ~ ~ f~ m ~ ir< `a r,- ;;~F, ta~~ ~0 S TIFIED TO MERICAN TITLE INSURAN E COMPA Y ' PRGVED OUTHOLD SAVINGS BANK DWARD MULRAIN JANE MULRAIN rtes water supply & sewage disposal sys- tems for this residence wlll conform to the yo standards of the Suffolk County Deport meni of Health Serv~cea y~o ~ AND SCo ~~o5~e" ~"~~'9 ~ AREA 20 , 007 SQ.FT. 00 { / ~ iMf L(CA110N Df NELLS AND CESSPODLS SNDWN NEREDN ARE FX9M FIEE9 LPG S L I C N 0 4 9 6 6 8 DgSERVAfIDN4 AND OR IRDM DAiA DDSAINED FAOAt DiNEAL asss E C O O L R S & ENGINEERS , P C Prepare3 in accordaxe with }h9 msnnLwm 516) 7 O atandords for title surveys as established by P O BOX 9 0 9 the L.I.A. L. S. and approved and adopted MAIN R 0 A D ~ for such use by The New York State Larrd Title Association. SOUTHOLD , N Y 11971 io-/~_ea 8 o•f/ 8 6 - 729 BOARD OF HEALTH 3 SETS OF PLANS FORM N0.1 SURVEY ........V:........ TOWN OFSOUTHOLD CHECK BU1LDlNG DEPARTMENT SEPTIC FORri . ` TOWN HALL EOUTHOLD, N Y 11971 NOT ~ Q o. TEL..755-1802 CA~....... Examined T~~........ , 19~? p / MAIL T0. \pproved , 19~~ Permt[ No l0 ~1~ ~ / i~ ~ ~i~i l„ Disapproved a/c I , ~ APR - ~ a~ .~'t-•••"f"••••.... BLDG. DEPT. (Bw ng Inspector) TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT Date D lr INSTRUCTIONS a Tlus apphcahon must be completely filled m by tgpewnter or in ink and submitted to the Building Inspector, w sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot plan showing location of lot and of buildings on premtses, relationship [o adloinmg premtses or public st or areas, and gluing a detailed description of Iayout of property must be drawn on the diagram which Is part of this a cotton. c. The work covered 6y ttus apphcatton may not be commenced before issuance of Building Permit. d Upon approval of this apphcatton, the Budding Inspector will Issued a Building Permtt to the applicant. Such pe shall be kept on the premtses available For inspection throughout the work. e. No building shalt be occupied or used In whole or m part for any purpose whatever until a Certificate of Occup shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permtt pursuant tc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc: Regulations, for the construction of buildings. additions or alterations, or for removal or demolition, as herein descn The applicant acrces to comply with all applicable laws, ordinances, building code, housing code, and regulations, am admit authonzed inspectors on premtses and in building for necessary inspections- (Signature of applicant, or name, If a corporation) (Mailing address of applicant) State whether applicant zs owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or buil~ ......~.~-~.-~.~Q..~ . . Name of owner of premtses .~~J,.~~Q.\~`~.~ ..~.~~~r.Y.'~...."~-...-~.~?.,Y~!'?..... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) 44 Builder's License No L ...b r Plumber's License No . Electrician's License No . Otter Trade's License No . . 1 Location of land on which proposed work will be done . House Number Street Hamlet , r-, County Tai \I.ip No 1000 Section .~~e• • • • • ~•y Block ....'`1.^~._ . , , , , , Lot tri........ . Subdivtston ~U.'CVQ:`~.4Tr. L-!}}-~.~.i~E~V0.Cto~~l l~Q~-i(ad htap No. . Lot S~'lc~.p©F (2oScWoor,~ame)~STGt7e5 2 State e~uhng use and occupancy of premises and intended use an''dj~o' ccupancy of proposed constructwn a. Eristrng use and occupancy ~Q4R.'.1\T . t~-J.ti • . b. Intended use and occupancy .~•1•~ e- ~ ~ V;GY` 1 • :V ~1,.A~.~? :L~ . 3. Nature of work (check which applicable) New Building ...Y...... Add[t[on Alteration , . Re air Removal Demolition Other 1Yotk . p (Descnpnon- 4. Estimated Cast , .((~iQ~ t?QO.v.J Fee . (to be pa[d on filing this apphcanon) r - 5. If dwelling, number of dwelhn uni/ts~ .ti?19..? ~':~PY"Yf.~~~ Number of dwelttng units on each floor , , If garage, number of cars ...~..l..Gl. C . . 6. If business, commerc[al or mixed occupancy, specify nature and extent of each type of use . 7. Dimenswns of existing structures, if any Front Rear Depth , , , , , Height ...............NumbcrofStoncs....,............................... Dimensions of same structure with alterations or additions: Front Rear . Depth IIcight _ ..........Numb/e~r of Stones , , , , , , , , , , 8, Dimensioi~s of entire new constniction• Front ~-0.!C. Rear (,~i rS!::~z~ Depth . Hciglit .....Number of Stones . 9. Size of lot. Front l ~ :7.op~ Rear . I, .].,a r~?.R Depth ,1. •7. , , , 10. Date of Purchase QlO.~l.~l-4CY.1..'~.~. 1.~ ~~f..... Names of Former Owner 17.4 ~S [ t7. ~8.(Y~tS~0.nf~ ~2.r. 11. Zone or use distract m which premises arc situated ......Li.C SfD.Q..n.~ctd.,-. 7~, gg . 12. Does proposed construct~~~ violate any zoning law, ordinance or regulation. J~! . . 13. Hill lot be regraded a~c:7 .....Will excess fill be removed from premises. Yes P 14. Name of Owner of premises .~L~+-i).A1'~ (nU,If~`i,T>, pddress 3G ~ .ti ~'41~~uclcPhone No. ao1~.:4s a~~ Name of Architect , ..Address .......Phone No..: . Name of Contractor ~4~fY~K'..Cl?Y.~aTctie~`~1a1 Address ~:l.J:tr~L~i~ ~.t~.. .Phone No..7. ~~-1.-radf.-7 15.Is this property located with in 300 feet of a tidaY wetland? *YES.-.NO.~ *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRr1M Locate clearly and dzstinctly all buildings, whether existing or proposed, and, indicate all set-back dunensions fro property fines. Give street and block number or descnption according to deed, and show street names and indicate wheth intenor or comer lot. u li1TL VA i\L FYI ~l'V l\A, COUNTY OFr~k~.~i4i%~II~. S S . • ~k"lt IVI f~-!f':Gt-?~~. being duly sworn, deposes and says that he is the applica (Name of mdmdual s[,nmg contract) above named. tic is the ~ . (Contractor, agent, corporate officer, etc ) of sa[d owner or owners, and is duly authonzed to perform or~have performed [he said work and to make and file tl apphcanon, that all statements contained in this application are true to the best of his Lnowlcdge and belief; and that t work will be performed m the manner set forth in the apphcanon filed therewith Swom tojbcforc,_me this l v ..day of ~l~~Q.l~~:.+..........., 19 .Q .7 i;otary Public, ~ ~TV 1.~ , . County C~, ~1 ~.1~ ' (Sicnature of applica: qd