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HomeMy WebLinkAbout18257-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18669 Date DECEMBER 21, 1989 THIS CERTIFIES that the building ADDITION Location of Property 495 BAYVIEW AVE. GREENPORT~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 052 Block OS Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 26, 1989 pursuant to which Building Permit No. 18257-Z dated JULY 5, 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to VENETIA A. McKEIGHAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NSA UNDERWRITERS CERTIFICATE NO. H-012958 - NOVEMBER 27, 1989 PLUMBERS CERTIFICATION DATED OCT. 23, 1989 (RAYMOND McKEIGHAN) B ilding Inspector Rev. 1/81 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) ~J ~ qq N ~ ~ 2 ~ ~ Z Dote `5 19.. g..l Permission is hereby granted to: , ....c.~.: a Wit. ~..1~:~ ......~d~...~~.. a -.nn. ..~A4:fPQlGK!~i{;/.lb....Y.f7......~lt./.J..F+v... .r- tc ..lW~~!~.}...Qla... y........... at premises located at ..T9.~?......l.Z........~dksn~~~l.~.~.1~4!.41!`~ County Tax Map No. 1000 Section ~..~5~..~--....rr Block ......Q.~~....... Lot No....~.~s,.......... pursuant to application doted a.y~ 19.~.~., and approved by the Building Inspector. Fee S.•1~~..:.~~..' Bui ing Inspector Rev. 6/30/80 K TOUN OP SOUTDOLD - BUILDING DEPART}(ENT u, \=J.6~,~„flj TOWN FIALL dy SOUTUOLD, NEW YORK 11971 ~ ~ d~~~ 765 - 1802 RI.O~;. OEN7. .U~J tti- SOUTHOLD ~ F.,~.,-,,,~... APPLICATION FOR CERTIFICATE OF OCCUPANCY / Q DATE.. LQ~.p~?l..d. q NEH CONSTRUCTION ~ ~K,~S~ny FeSiderlce --.....OI.D OR PRE-E%ISTIN'G'•//BUILDING......VACANT LAND.....r.'.. Location of Property....~~~,,,,_~~~~/.•i-~_~yY._,~~e:-.•~~-S.h~~m~.m~.e~u~ [LOUSE NO. J' STREET NAMLET e n Owner or Owners of Property.......~'ri,ff_~"!(~_ f~..~~°~~h.(~yJt,..,,,,_ County Tax Map No. 1000 Sectio? q Block ' V if0~. 6d... Lot' Subdivision Filed Map ........Lot.......... Ifermi[ No. /.QP(~./_, pate of Permit „.'l.(,, Iq~l 1~ Q V .~....A~iplicant ~~)~i°.`.I~~~~.~:~,t1I~Q.~~ ~ IIealth Dept. Approval Underwriters Approval...........~.//., Planning Board Approval Request for Temporary Certificate Final Certificate ~J 0 0 Pee Submitted: $-,(Jj ~ APPLICANT..~~ `eV• 10/tai/88 ,..3$~6p ~~,Co ~ ~~t,~q TEL. 7G5-I 602 S~FF[1i,1~~, ~ol~, - o,, ~rowrr or sourr~oa,a~ L`iY~'I! ~ OFFICE OF DUILDIPIG INSPECTOR u, ~ '.31~I ~ P.O. BOX 728 co - ~ ~ TOWN HALL r f~~.~=.~(J ~%Y SOUTHULD, N.Y. ] 1971 ~ "°°"4' l/ ~l>~' ~d ~ m i 1. IPf~Y ~Fb z ~ ~ ;'f1l' C E R T I F I C A T I O N ~ Date_~~ / X ~I Building Permlit No.~ Owner~C 1"; ~L ( (please print)' P l u e r~ /rxn.ti [D tvt ~ , / • ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. ~ ~7 0 ~ (L~~er"s si ature? Sworn to before me this `Z~' day of Uc '(o I?~~~: 19 d~' ( ~ ~l. otary Public Rotary Public, `~~-j County EUGENE M. A1.8EfiT Notary Pubib Stag of New ltOth No. 60032560 0vel16ed In Suffolk Cou Commission ExPItM,J ~ t'o 30, 1~ ' ri ~~~FO~C TEL. 765-1802 0~0 OG TOWN OI' SOUTgOLD ~ OFFICE OF BUILDING INSPECTOR . , P.O. BOX 728 TOWN HALL ,y~o~ SOUTFIOLD, N.Y. 11971 DECEMBER 15, ]989 SECOND NOTICE To whom This .iay Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. An application for Certificate of Occupancy is not on file. ENCLOSED No Underwriters Certificate on file. ham/ The check is(outdated/not on file.) $25.00 No Health Dept. Approval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit 18 2 5 7 Z Building Dept. ***/~j No Plumber Solder Certificate on file.. ( all permits involving plumbing being issued after April 1,1984 ) THE NEW YORK BOARD OF FIRE UNDERWRITERS NAI:1: ' 807.~i7h5 BUREAV OF ELECTRICITY 88 JOHN STREET. NEW YORK. NEW YORK 10038 NOVEISBER 27,198') APPlicationNo.onfile 66004789/89 A 072958 THIS CffRTIFIffS THAT only the elactrlcd puipment a dascrihsd LeloEO and introduced 6y tAe appllcont nomad on the a6ooe application numher in the premises of VF.NETYA NCKEIGHANr 495 RAY V?'r'.41 AVE., S()UTHOLD, N.Y, in thefdbtcinq loco ' I~ L7 Ist Fl. ? Ynd F'l. Sertion052 B/ock05 Lot ~ ; IIYi~ENR'E1?~';`~VJ~i , I roes examined on and found to Lein compliance Erif.h the reyuirernents of thb Board. A%lUN AC7B fYVITQIK R%TURES RANGES COOKING DECKS OVENS qSH WASHERS EXHAUST FANS OUTIETf INCANDESCENT HUOIIES[EM OTHEn MAT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. N. P. ~ ~ 7 { 1 Y DRYERS RJRNAGE MOTORS wt1ME At7DANCE /!EONS SMCIAt pt'n TIME CLOCKS eitl UwT NEAnes ~ ~ DIMAIIRS AMT. K. W. ql N, P. DAS N. P. NAT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. H. P. ~ Di t~T AMT. WATTS SNtVIQ gfCONNRCT NO.OF S E R V 1 C E AMT. AMP. IRE ~ 1 / ~J I R SW 3 X SW ] / AW KRC.eCOND, q CC COND. NO. Oi M41F6 a~ X1 NO. OF NEUIIIALS pP NEUTMI OTNEE AFFAEAIUS: L-800 WATT RATED FYRED SHALT. AYPI,, 1 G. F. C.1:-1 YENETYA McKEf.GHAN 495 BAY VIEW AVf:. SOUTHOLD, NY, 1.1.47 I Ii~AI MAFIAQu 17 Ptr This prtificah muN not ba shared in orry manner; return to tM office of the Board if incorrad. Inspectors may be identified IsY; ~ i c Is. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANT MANNER. ~~FfO~C TEL. 765-1802 DO GG TOWN Oi~' SOUTIIOLD :`c OFFICE OF BUILDING INSPECTOR ~ m P.O. BOX 728 :r, ~ TOWN HALL 0~~~~ ~~0~ SOUTHOLD, N.Y. 11971 DECEMBER 15, 1989 SECOND NOTICE To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons. fig/ An application for Certificate of Occupancy is not on file. ENCLOSED No Underwriters Certificate on file. The check is(outdated/not on file.) $25.00 No health Dept. Approval on file. ATo final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit Ik 1 8 2 5 7 2 ~ Building Dept. No Plumber Solder Certificate on file.- ( all permits involving ,plumbing being issued after April 1,1984 ) ~'`~~FOf ~ TEL.'GS-180? 0/5I ~O; T0~'N UI' SOUTIZOLb l=~t'76+,.vt~' y4y OI'f'ICE Ol' GUILDING INSPECTOR ,,4,n'~;1~, x 1'.0. UO`C 1179 ~ ;.Y~ S„i,; ~ TOtiVN!lALL Off' SOUTIIOLD, N.Y. 1 1971 October 19, 1989 Venetia McKeighan 495 Bayview Avenue Southold, N. Y. 11971 To Plhcm This, May Concern, 47e are unable r.o com lete P your Certificate of Occupancy because of the folloc•ring reasons. ~ An application fur Certificate of Occupancy is not nn fi7.c. 7(Xx~c Dlo tJnc]erc~rrit-ers Certificate on file. 3tX?ILt The checF; .i:; (x>~i7S~F:~c$/nut on file.) $25.00 1`:0 llea].L'h Dept. Approval on file. D:o final inspect:ion hay bceu made. Plc;ase r_ontact: our office on this matter. - Thank you for your cooperation. Ihc.ilc]inc) Pcrm.i_t: It 1 2 5 7 Z building Dcpt-. i. .k k/X.,(..-tlk~ Plumber :;older Ccr t.if icate on file. ( al.l permit':; involving plumbing being .issued after April 1,1984 ) 4 „ i IELD S;: S: .li:;. ~ `JniC. II CODtM L:NT° ` ~ ~ m "G ~ ~ _ .~6~ - H ~..1 OUI7DATI0*I ( 1s~C) ~I _ ~ M c A ?OUNDATIO;J (2nd) _ _ m o~ ROUGH FRAME PLUMBING ` ~jjjjjj n ~r Cn f H 1V 3. ~ I2JSULATIOPI PER N. Y, y ~ STATE EPIERGY CODE 4 ~0 ~ ~ y FI;IAL QF- - ~ o p~ ,.,b ADDITIOPJAL COMMENTS: ~ S`-' p. ra x ~ 1 H . 9 H ~ H ~ O ~ r S d '9 H 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( ROUGH PLBG. [ ] FOUNDATION 2ND [ r]" INSULATION [ ]FRAMING [ ]FINAL REMARKS: _ ~ DATE / / INSPECTOR Jj~ s~ 765-1802 U BUILDING DEPT. 1 NSPECTION [FOUNDATION 1ST ( ] ROUGH PLBG. [ ~ FOUNDATION 2ND [ ]INSULATION [v]`'~~MING [ ]FINAL REMARKS: -~1wU~ - r- DATE ~ INSPECTOR i ! . •1 ~ f i . . L ~ ~ t .w . ~ <~i ~ ~ N i p 4 o V .~q, i ~ : °1 h Z 0 r~t.~h• ~ ~ BAYV/6W AI/~'NUG ~ ~ R 0 ~ ~ o a L i. ~ L ~ o I I ~ I C , ?I F I~aI r f, ~ . . J III ~~'~1 ~ ~ ~ ~ ~ ~ `i ~ M1 f!s-It'd. 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N N - ~ r >I ~ o~, I ~ ! i _I I , fJ _ _ ~ ~ _ f I . _.f I ~ C- i - - I ~ _ _ _ _ ~ r a - I ~ 1 c+~ _ t~ s ~ ui j ~ ~_l I I z i ~____.:_.~-.-I i ~ i v, ~ ~ t I ~4 5~ I i _ a~ r, h ..~i I i ; ~ i ~n p- i r, n, N ~ N ~ _ r (l -C ~ ;fir --r-4- I i' i„ ~ ~ - ti_._.__.._.__~.._--._._._.__ I _ _.w-- ' I - = - ...._......I~ ' _ I Ii , i. I ~ o _ ~ . _ _ r r .__.._..o._....._..._.,.~ . - . I _c ~ I I N . _ ii ~Aw_....e~____....._..... _ ~ ~ - ~ - i ~ a t n T~ I N T 6~ ~~-t li ` cn -C a ~ ~La it V ~ ~ ~ ~ li ~ FORM NO. 3 TOWN OP' SOUTftOLD BUILDING .DIPARTMENT TOWN CLERK'S Ot:C'ICE SOUTIIOLD, N.Y. NUTICE Or DISAPI'RUVAL bile No . Date :3............. , 19~d' ~e ~C,,~j ~ / . . PLEASE TAKE NOT'1CE tluit your application dated 3..........., 19 for permit to construct ,o~,r7~ ;yard/, Location of 1'ropcrty . .~A/,; , Lc~(G/ ~yj~j~ House No. SPteet ~ ~ ~ ~ ~ ~ ~ ~ ~ Flam et County Tax Map No. 1000 Section ...J~.~...... Block ..0 t.T~ ......Lot . Subdivision Fi]cd Map No. Lot No. . is returned herewith and disapproved ou the following grounds .~i.~~,~[.r ,/~U-//~/~~`/,~ ..0~.. l ~ . actor RV 1/CO f~Z ~ BOARD OF HEALTH 3 SETS OF PLANS D ~ ~FORMN0.1 SURVEY TOWN OFSOUTHOLD CHECK P 2I98B 'i BUILDING DEPARTMENT SEPTIC FORM . . . . Fil a o TOWN HALL NOTIFY -i_~' .~OUTHOLD, N.Y. 11971 • - • 7.6 s' yc ~ s^ ~1.1~=: F,,: . CALL ......1.... a TEL.: 765-1802 Yt ~ MAIL T0: Examined 19 . Approved 19 Permit No........... . Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERPAIT Date 7......., 19~ i INSTRUCTIONS a. This 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 stxee 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 t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspection~~ ~ ~ . (Signature of applicant, or nam0 e, if a corporation) .Z 2 S S@ 4 wvvv'~ .Sv c~o~cl (Mailing address of applicant) State whether/applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde /t?v/~G(er - e Name of owner of premises ~S'.~ N; ~ a.....~.../.\ E (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. P?- K.~: ~.q . Plumber's License No. . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done. ~~{:~yK-f (~.~,~.Q". ~.~1. ~ . ..............y.~.~--.........,~~ ~+eW...~vL house Number Street Hamlet r~ 5 ~a 3 County Tax Map No. 1000 Section Block Lot . Subdivision l;l r"(LYC1 ~ r', . ~I, a V ~ i1, , , , , , , ,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 ....-Sin /e l-a r ~y f7~~ y . . . . . b. Intended use and occupancy S~`~%je ~."'E.~~!" ~ Re atr Re Ipplicable): New Building Addition Alteration 3. Natpure of work (check which oval Demolition Other Wark ..~~~1`•,• • • . (Description) 4. Estimated Cost ~r~, v~'I Fee t'i f . ` (to be paid on 61ing this application) ' S. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars . 6. If business, commercial or mix2d occupancy, specify naturg and extent of each type of use 7. Dimensions of existing structu;es, if any: Front ds....... Rear !6.......... Depth ..~6.......... . Height ...'~.6 Number of Stories , C ~~7c........... . - Dimensions of same structure with alterations or additions: Front . S.!~M~=......... Rear . p ...Height Number of Stories . 8. D menstons of entire new construction: Front ...q ~ Rear ...............Depth ..6 . Height Numher of Stnrias . . . 0 9. Size of lot: Front Rear P Depth . ?.:34 10. Date of Purchase ..~.~~20/~~ ................Name of Former Owner . 11. 'Zone or use district in which premises are situated . 12. Does proposed construction viplate any zoning law, ordinance or regulation : /Y~ . 13. Will lot be regraded ...!?4 . ...........::..Will excess fill ba remove from premises: Yes No 14. Name of Owner of premises y ene~ia.. ~~(~~~6~Address ..Q~ ?~e ...Phone Na . Name of Architect .........Address Phone No....'. Name of Contractor ..~°.jeyn:.. `S~er • ....Address . ! Segj':OO°'~~hone No.. 7~ s yq2 S~. 15. Is this property located within 300 feet of a tigidal wetland? *Yes No *If yes, Southold Town Txustees PermitPLO~ DIAGKAMed. 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. C S v R ~I~ Sys ~ ~„~~1- ?eG~ i i~ I STATE OF NEW O S.S COUNTY OF , ~7 c f~~.orr-ra! !i. ///~:~r/~`R!~......... being duly sworn, deposes and says that he is the applicant (Name of individual stgning contract) above named. He is the.......... ~ (Contractor, agent, corporate officer, etc.) of said owner, or owners, and is c{uly authorized to perform or have performed the said work and to make and file this application; that all statements coptained 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 ~ ~ ry~~. ..day of ..~~~r~ 19~.~ ' tary Public, j~~~%~~`J County C LOAETiA A. SCHWERDT ~ , , . . . Notary Public, State of New York (Signature of applicant No. 52.8882150 Qualified In Suffolk Coun I Commissian Expires ' -•9 ~ BO.1RD OF HEALTH , • • FORMN0.1 ] SETS OF PL,~,yS •t/ SURVEY _ •;~j"'• TOWN OF SOUTHOLD CHECK • • ~ • BUILDING DEPARTMENT SEPTIC PoRPI • • • ~ ~ ~ TOLVNHALL • ~OUTHOLD,N.Y.11D71 NOTIFY TEL.:7G5~1302 CALL -~j?•~ • Examined 19 I•fA I L~- TO • . Approved 19 Permit No:..~, ~-?••y "'7i D E~,c°~+-`=~ ~ \J HIg~~ Disapproved a/c ~ ! JUhI Z 614~i~~ ,1 r I! . 1:1 Y.!~`~-s~~ ,.,;,.A,~Tiil',`f~~~t4. :i0aYPii7f~t7 n...._<~, _,_.._.,as,.,,~ (Building Inspector) APPLICATION FOR BUILDING PERMIT ' Date ~~1;7?4' „~~y . " 15~. • INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with :ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli .:anon. c. The tvork 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 petTlli: shall be kept op 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 bfADE to the Building Department for the issuance of a Building Perini[ pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bui]dings, additions or alterations, or for removal or demolition, as herein described. site applicant acrees to comply with all applicable laws, ordinances, buildurg`code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary ins coons. 1 it , • ~,t . c ~t!. ~ (Si~na[ure of app is r name, if a corporation) • ~ • (Mailing address of applic~) • • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 6:~11~Z.~II/.... Vame of owner of premises ~L ~ ~ ~ ~ • ' • " • {~~~Lf~G.~4 . (as on the tax roll or latest deed) • ~f applicant is a corporation, signature of duly aut orized officer. (Name and title of corporate officer) Builder's Licaase No. ~ " Plumber's License No . . Electrician's License No, , , , , , , , , , , , , , , , , , OthcrTradc'sLicenscNo, Location oCland on which proposed w ~k will done. Ifouse Number ~ 'U~:..... ......~~~2~:~i;J/~ • Street . ~f Hantlet . County Tax ,~1ap No. 1000 Section . , , , , , , , , , ~i7; n Block Lot . of Subdivision . • • • • . . F.ilcd ~tal~ No. (Name) Lot State existing use and occupancy o(prcin• es and intended use and occupancy of proposed construction: a. Existing use and occupancy ' b. Intended use andoceupaney ~ ~ 3. A'ature of work (check which applicable): New [luilding ' Repair Rgmoval Addition ,Vtcrapon ' ' • • • • • • • • Demolition .Other Rork . • 4. Estimated Cost ~~~.(~Q,C); , , , , , , , • • , • • • , • • • • . , . (Dacr'ption) . Fce 5. IC duelling, number of dwclli~ (to be paid on Cling this application) ~[g units Number of dwcllinS units on each floor. . ICgara;c, number of cars • ~ ~ • • ~ 6. If bustncss, commcrctal or mi;xcd occupancy, spccily~ aturc and extent of cacl • ~ • ~ ~ 7. Dimensions of existing struct4res, iC any: Front . 7•Ltypc of use , • Hcicht . Ny~mbcr of Stories . Rear 7 Depth .,;J,Q,~ • • . . Dimensio s of~amc structurcl,with alteration • • • • ~ ~ ' • • • • • ~ • Depth.;; © soradditions: Front ..Jr'.,t.i........... Rear Y~~.......•.•. . lIcight . . Numbc of Stories ' 8. Dimensions of entire new construction: Front ~ • ~ ~ • ~ ~ • ~ ~ ~ ~ • • • • • • Height N~mbcr of Rear Depth ~ZO 9. Size of lot: Front Stories , , , • • • , • • ' ..+~.0.,. Rear. .Iba1.. 10. Date of Purchase . ~ ~IF) 7 ~ p ..ol~O.~.. , c t ' • ~ ~ • • • • • • Name of Pormcr Owner ,~CS~n l 1. Zone or use district in which premises arc situated , , , " " " " " 12. Docsproposedconstrucxt~onvil'olatcanyzonin law, ~~~~•~•••~•~•••••~.•~o....•••."""'•••••.•..•. l3. 1Vi11 lot be recraded IV S ordinance or regulation: • • ' ' • ' ' ' ' Will excess fill be r move from premises: Ycs 14. Name of Owner of pr miser ~h 4t, ~ { ' ' Nmnc of Architect i . ~ i-~~1~'^"~ Address ~fr3~vjeul,~U~' out{~Dt~honc No. `x( ~~jr, Name of Contractor_~~~.5 . Address~~?I!1,0,{~~,~~; ;Phone No. 'f • • ~~n i~~~~~~ Address y~J~ VieuJ~VP Phone No. ' (d IS.Is this property 1 ated with in~00 feet of a 'tidal wetland? *YESr/1,t70.r.~.~~• *If yes, Southold Tow'in Trustees Permit may be required. PLOT DIAGRAM , Locate clearly and distinctly'a~l buildings, whether existing or proposed, and. indicate all set-back dimensions ft-or, property fines. Give street and bloc} number or description according to decd, artd show street names and indicate wheihr. interior or corner lot. (~-apvs~ d Caddi}~on t 5 tur'~~eV ]mr'n i-He u,cr~r tlztn the rxrs+~'n3 hau5c~ gnct - ` D (y Ivlcurp~VCttPS ~h ~xis~nr~ I~orch. c _ _ ^ . VIII ~ ~ ~ p ~ ~ ~ ~ c~ 1 _ ~ ~ ;;;s., ~ ~ ~ ~4 ~ b ~10.N C~ i ~ I l~~Y~ ~kz~N View ~uc • ~'hshqu>~>Jm~c~ue - ~t'hi~ t~s a,v, Irk-~rio1' I o~-• I T,1TL• OF XE I UU\TY ~L(1 ~ S.S • • • • • • • being duly sworn, deposes and says that he is the applicant (~amc of individual si^ n,g contract) rove named. =isthc .l. (Contractor, agent, corporate officer, etc.) ~ • • ~ • said owner or owners, and is duly 'authorized to perform or have performed the said work and to make and Gle this 'ltcation; that all statements contain~icd in this application arc true [o the best of Itis knowledge and bclieC; and that the rk will be performed in the manner set forth in the application Glcd therewith. orn to bciorc me this ......44~..~.........day of..~l~~1!)4d-.-........... 19~r. ar; Public, ~ ..........~5t-c-<,~ACm.~.~~.. 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