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HomeMy WebLinkAbout18555-z jl Town of Southold 7/25/2020 P.O.Box 1179 C3 T 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 20798 1 Date: 6/16/1992 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1835 Naugles Road, Mattituck SCTM#: 473889 See/Block/Lot: 99.4-20 Subdivision: " Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/2/1988 pursuant to which Building Permit No. 18555 dated 10/3/1989 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 and porch addition to existing one family dwelling as applied for. Corrected 7/25/2020 for address only. The certificate is issued to Weisent,Francis&Marguerite of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. H-029170 6/5/1992 PLUMBERS CERTIFICATION DATED A o ' e Si ature r ~ ~ FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20798 Date NNE 16, 1992 THIS CERTIFIES that the build~.ng ADDITIONS Location of Property 1925 NAUGLES DRIVE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 99 Block 4 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 2 1988 pursuant to which Building Permit No. 18555-Z dated OCTOBER 3, 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 & PORCH ADDITION TO ESISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to FRANCIS F. WEISENT (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVRL N/A UNDERWRITERS CERTIFICATE NO. H-029170 - JUNE 5, 1992 PLUMBERS CERTIFICATION DATED N/A rIi B ding Ins cto Rev. 1/81 ¦osae< 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) C N a 8 ~ 5 5 Z Date ..C~.~`.".. 3 19.C7...~ Permission is hereby granted to: .....~..1.:1~!.e:~fr1.~ ...:.~l..~r.P...a2rta~.. ...1..%..~.~'... ~ lll~-P G~ ii ys ?Z.~. at premises located at ....~..:l...!/~. ...~.d•. 6.G•.,.:~.lur p~~ . f Gi7~~h:F? . County Tox Map No. 1000 Section~o.~..~J... Block ......~..~....~.yLot No......~•.~,..`}~~^ pursuant to application doted ......./.1.~,~'.t/ 19L1~ and approved by the Building Ins'p1ector/. l//J~ Fee S~G~...:/..~•{...0 C / A:....:...f... ~:.:.f:..I.. 4 Building Inspector Rev 6/30/80 f Form No. 6 ~lj%~ l~ ' TO1dN OF SOUTEtOLD ~ BUILDING DEPARTMENT ~~r},r 2 ~ ;~r,~ 765N1 02L i APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typecoriter OP, 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 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. 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. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimmang pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Euilding - $100.00 3. CoE~y of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary CerCificate of Occupancy - Residential $15.010, Commercial $15.00 Date .....5.. ew Construction........... 01d Or Pre-existing Building... .o cation of Property...~~{aJr.....IVGUa~2~.... pf I U.~ House No. Street Hamlet nwer or Owners of Property..,.~.~:n~!S..r., W.~JL~ti},1 . ounty Tax Map No 1000, Section.... .....Block...... ~.......Lot....~.(.:(.Q,....... ubdivision....++~~...++~~ ............................Filed Map............Lot...................... limit No.. ~.C~,:!,J~. V.....Date Of Permit....~~...'./~...~,~.Applicant...~E: Czn,~l',„ ~„l,C,l~ 1;;f fJ _alth Dept. Approval ..........................Underwriters Approval......................... Lanning Board Approval 4 quest for: Temporary Certificate........... Final Certicate,.~,,,,,, ~5.©a :e Submitted: $ ' ~ ,14 ~ APPLICANT a 1 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8033095 BVREAU OF ELECTRICTTY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Dote JUBB 05,1992 ApplicatianNo.onfile 69057590/90 H 029170 THIS CERTIFIES THAT T only the electrical equipment as described 6ekrF0 and introduced by the opplkwnt named on [he oboDa oppBcation number ifs the premises of PRABR MBISBBT, 1925 BAUGLBS DRIVE, BATTITUCR, B.Y. in thefdlou•inp location; ®Basement ®lat Fl. ? Ynd FI. GUT Sectian Block Lot Froa examined on JUBB 01,1992 and fonnd to be in compliance with the reyuirementa ofYhia Board. HXTUK ECBTACLK SWITdK RXTURES RANOFS COOKINGOKKS OVENS DISH WASNLRS EXNAUST FANS OUTLETS INCANDESCENT flUp1ESCENT OTHEP AMi. K. W. AMT. K. W. AMT. K.W. MIT. K. W. AMT. N. P. 23 33 5 23 DRYERS FURNACE MOTORS gtTUK AFFDANCE IfEDEK SFECIAL REC'FT TIME tAOCKf EEII UNIT NEATEK MULTIAIITIET DIMMERS - SYSTEMS AMT. K. W. Oll H. P. GAS N. P. AMT. NO. A. W. G. MIT. AMI. AMT. AMPS. TRANS AMT. N. r. N0. ~ IEET AMT. WARS 1 SERVIC! DISCONNECT NO.q S E R v 1 C E y AM7. AMP. TTR MEOINF. 1 / TM 1 / SW S / 3W S / AW MM eCCwD. OF CC. COND. NO. OF N4LEG Oi ~ IWp-~l G1 NO.OF NEUTKA45 Of NEUTGNAL * OTHER AMARATUS: [ NGTGR8:2-P H.P. G.F.C.I:-2 I } - { FRABCIS MBISBBT G//~~ - ~ 1925 BAUGL68 DR. BATTITUCR, MY, 11953 OBSRAL MANATEN it ~I Per `G This certificate must not bs altered in any manner; return to the office of the Board if incorreN. Inspectors may be identified b their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPEC'T'ORS r Victor Lessard ~i~~;,+Jt1=0(;r~J Princtpul Butldtng Inspector y ~ Curtis Horton p ~1G~ SCOTT L. HARRIS, Supervisor Senior Building Inspector ~ ~ • , 'i Thomas Fisher V y~ ~,T n ~ Southold Town Hall Building Inspector ~ c, ~ P•O Box 1179, 53095 Matn Road 4 ~ , n~ Southold, New York 11971 Gar Fish ~ ~.t,2 ' Building Inspector ~ •:~s Fax (516) 765-1823 Vincent R. Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD MAY 29, 1992 FRANCIS WEISENT 1925 NAUGLES DRIVE MATTIT[1CR, NY 11952 To Whom This May 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) ffi No Underwriters Certificate on file. The check is (outdated/not on file.}$z5.00 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 # 18555-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 1_} ~ _I:.S. E t II~:_ II ~~k:~LNrC w+ 1. ~ ~ ?0 ISDAT 0:1 (1st) ~ 'OUIIDATI0;1 (Qnd) v ~ o .'.OUGH FRAME ~ PLUMBING ti 3. y n I7SULATIDII PER N. Y. I 'j STATE EIIERGY CODE L ~ 4, a d _ FILIAL y r~ry - o A ITIOIIAL COMMEtJTS: s m H 9 ~ N~ O cTl } _ r ~ H d m ^o 765-1802 BUILDING DEPT. INSPECTIQ~N [ ]FO~UNDATIQN 1ST ( ] ROUGH PLBG. [ ] FO DATION 2ND [ ]INSULATION [ ]FRAMING ( ]FINAL REMARKS: ~ f ~ G~~ DATE I~ INSPECTO s ~ l ~~J ~ 765-18~~ BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ) ROUGH PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ]FRAMING [ )FINAL / REMARKS: DATE ~ ~ INSPECTOR ~~~SJ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION ~RAMING [ ]FINAL REMARKS: ~~.Q cJ'K--~Q~ _ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( } ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING INAL ~fl REMARKS: 2e /1 ~ DATE ~2 ~ INSPECTO l Q~~g~FFCI(.,~~oG ,s FRANK A. KUJAWSKi, JR., President ~ TELEPHONE ALBERT J KRUPSKI, JR ,Vice-President ~ (516) 766.1692 JO{IN M BREDEMEYER, III Off, ® ! ~ Y J HENRY P SM TOHKI, JR. ~Q~ ~~o . BOARA OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Marn Road P O Box 728 Southold, New York 1 1971 ~ ~ June 24, 1988 Mr. Francis Weisent 1925 Naugles Drive Mattituck, New York 11952 Dear Mr. Weisent: The following action was taken by the Board of Town Trustees during their regular meeting held on June 23, 1988 as follows: RESOLVED that the Southold Town Trustees approve the request made by Francis Weisent to register his walkway, ramp and floats in Mattituck Creek under the Trustee Permit. Very truly yours, Frank A. u7 ski, Jr. President Board of Town Trustees FAK:ip cc: Bldg. Dept. file b~, 4 c;+ig~~IL'~~, HENRY P SMITH, ~ TELEPHONE JOHN M. BREDEMEYER, III, President rJ~ s ~ m (5161 765.1892 John Bednoski, Jr. p, =`~8<.~' ~ ALBERT KRUPSKI, JR Vice-President iY.'n~,~~ ~id0`t' BOARD OFClTO'1Y'N TRUSTEES TOWN OF SOUTHOLD Town Hall, S309S Main Road P O Box 728 Southold, New York 11971 February 24, 1488 Mr. Francis Weisent 1925 Naugles Drive Mattituck, New York 11952 Re: 1000-099-4-20 Dear Mr. Weisent: The following action was taken by the Board of Trustees during their regular meeting held on February 24, 1988 regarding the above matter: RESOLVED that the Southold Town Trustees TABLE the application of Francis Weisent for a Wetland Permit on certain property located on 1925 Naugles Drive, Mattituck. The applicant is to clear this matter with the Board of Appeals for lot coverage. The bank is not to be disturbed. Relocation of the cesspools is recommended. Very trulyl~yours, iJohn M. Bredemeyer, Pres. u Board of Town Trustees JMB : ip ,cc: Bldg. Dept. " Board of Appeals file ~lJo ~(S CQ~ FORM NO 5 ~ ~cQ TOWN Of SOUTHOLD c '~2~ ~.f BUILDING DEPARTMENT ~c~, ~ TOWN CLERK'S OFFICE ~ "2~ ORDER TO REMEDY VIOLATION C Date April 29, I9 88 Francis Weisent TO (gW~gr~r at~thor~ed agent of owner) y S aug es r. Mattituck, New York 11952 . (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violaY~on of Zoning Ordinance ,CHAP. 75 Other Applicable Laws, Ordinances or Regulations of premises heremofter described m that ..A Cesspool/Septic tank is being (state character of violation) constructed without the necessary permit. in violation of ,CHAP. 75 ART III 75-3 1 (State secrion or paragraph of applicable (aw, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the low and to remedy the conditions above mentioned forthwith on or before the ,IMMEDIATELY day of .April 19...85. The premises to which this ORDER TO REMEDY VIOLATION refers are situated at 1925 Naugles Dr. Mattituck, County of Suffolk, New York Suffolk Co. Tax 111000-099-4-20 Failure to remedy the conditions aforesaid and to comply with the applicable provisions o{ law may constitute on offense punishable by fine or imprisonment or both \ .%K ~ l1. ~ . $anlt3tlOn Inspector _ _ NOTIC£ 8 Police Dept. - Bay Constable Town of Southold Peconic, New York 11958 ~ NOTICE OF VIOLATION December.15, 87 Date:------ 19--~-- Francis Weisent To: (Owner or authorized agent of owner) • 1925 Naugles Ad: Mattituck, N.Y. 11952 Address:------------- (Address of owner or authorized agent of owner) Please take notice there exists a violation of the Code of the II 20 Town of Southold, Chapter 97 Article------------ Section-------------- za--~,-;~-mm-••"*-.»'.~~-r~-~--••..e..,.• , _ o-„.,. . _ _ a 1'J~~ high x 100 ft at premises hereinafter described in that----------------------------- bulkheadi_~4_ft of _stairsL_3_landire~sz_with-septic-system and backfill was constructed within 75 ft of a wetland without a permit. You are therefore directed and ordered to co~ply with the followin Cease all further activities on bulkhead. Apply to the g:------------------------------------------------------------- 8outhold Town Trustees for a permit. If permit is denied you must remove structure arm restore area to its original state. on or before ---?~-----day of --J~u~-------, 19-88---- , . _ p. , ...............m._. F.,.,. , The premises to which this Notice of Violation refers are situated at: - 1925_Naugles_Rd•_Mattituck Poi-1n of Soutk~old, Suffolk County, N".X. {Suff. Cowity i'ax L1ap Designation: Dist. 1000 099 4 20 Section:--------~----Block:--------Lot:-------L Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine or imprzson~nent or both. NOTICE: You have the right to apply for a hearing before the Board of Trustees of the Town of Southold, provided that you file a written request with the Clerk of the Trustees within 10 days after service of the Notice of Violation. Such request shall have annexed thereto a copy of the Notice of Violation upon which a Hearing is requested and shall set forth the reasons why such notice of violation should be modified or rescinded Bay Co stable, Town o Southold, _ ' oS~FFO~x~o FRANK A KUJAWSKI, TR , Ptestdent TELEPHONE ALBERT ] KRUPSKI, JR , Vtce-Pxestdenl ~ ~ (5161 765-1892 JOHN M BREDEMEYER, III yd~ JOHN L BEDNOSKI, JR 'Wl ~ ~~0 HENRY P SMITH BOARD OF 'I'Oa'N 1'RUS1'EES ~ D TOWN OF SOUTHOLD ~ Town Hall, 53095 Mam Road PO Box 738 BLD .DEp1G Southold, New York l 1971 OF S September 29, 1989 Francis Weisent 1925 Naugles Drive Mattituck, N.Y. 11952 Re: Application No. 604 - Francis Weisent Dear Mr. Weisent: The following action was taken by the Board of Town Trustees during their regular meeting held on September 28, 1989 regarding the above matter: WHEREAS, Francis Weisent applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated Jan. 4, 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 Sept. 28, 1989 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 Francis Weisent BE AND HEREBY IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO: Construct stairway and replace retaining wall at property located at 1925 Naugles Drive, Mattituck, N.Y. 4 This permit will expire two years from the date it is signed if work has not commenced by said date. Fees must be paid and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. Very truly yours, Frank A. Kujawski, Sr. President Board of Town Trustees FAK:jas cc: Bldg. Dept. Conservation Advisory Council file ~ S~FFDC,(~~P~ HENRY P SMITH O TELEPHONE JOHN M BREDEMEYER, President cn (5161 765.1842 -John Bednoski, Jr. ~ • ~ ALBERT KRUPSKI, JR Vice-President '~-lfQl ~ ~'~0 BOARD OF TO~'N TRISTEES TOWN OF SOUTHOLD Town Hail, 53095 Mam Road P O Box 728 Southold, New York 11971 January 22, 1988 Mr. Francis Weisent 1925 Naugles Drive Mattituck, New York 11952 Re: 1000-099-4-20 Dear Mr. Weisent: The following action was taken by the Board of Town Trustees during their regular meeting held on 3anuary 21, 1988 regarding the above matter. RESOLVED that the Southold Town Trustees declare itself lead agency in regard to the State Environmental Quality Review Act in the matter of the application of Francis Weisent for a Wetland Permit on certain property located on certain property located at 1425 Naugles Drive, Mattituck. The Trustees will inspect the property on February 17, 1988. Should you have any questions or concerns, please do not hesitate to contact this office at the telephone number listed above. Very truly yours, ~?~'?J bL/ _ Joh//n M. Bredemeyer, President Board of Town Trustees JMB : ip cc: Commissioner Thomas C. Jorling, D.E.C., Albany Robert A. Greene, D.E.C., Stony Brook Stephen idars, Army Corps of Engineers Thomas Hart, Coastal Management John Holzapfel, Chairman, Southold Town C.A.C. Victor Lessard, Adm_m. , Building Dept. Planning Board Board of Appeals file ~ ~ BOARD OF HEAhTkI ~'~r..... 3 SETS OF .FLANS . ' FORM NO t SURVEY ? n.a«~= ~ ~ TOWN OF SOUTHOLD CHECK ~ -3$.~ . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY ;OUTHOLD, N.Y. 11971 CALL - :5 ,3 .S 7. - . TEL.: 765-1802 - MAIL T0: Examined . , 19 ~+-Q S~'-0/$$ Approved~~.. 19t/ (Permit No . Disapproved a/c ~ ~ I _ , `Cj ~ 4 ~~r~~~ ~ ~j"ZC~7~t- ~ (BuAdmg Inspector) TOWM A ~ ~ APPLICATION FOR BUILDING PERMIT i Date . , 19 INSTRUCTIONS a. This application must be completely filled m by typewnter or m 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 adlommg premises or public stree~ o: azeas, and giving a detazled descnption of layout of property must be drawn on the diagram which is part of this appl catron. c. The work covered by this apphcahon 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 perms shall be kept on the premises available for inspection throughout the work e. No building shall be occupied or used m whole or m pazt for any purpose whatever until a Certificate of Occupanc 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 Budding 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 descnber The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authonzed inspectors on premises and in building for necessary inspect ons (Signature of applicant, or name, if a corporation) /yeas /t/c~u~./~ (Mailing ad ress of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electncian, plumber or builder ,v ~ / Name of owner of premises 1'~r21C'lS I~L~C/SG-sau,/ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authonzed officer . . . . . (Name and title of corporate officer) ALL CONTRACTOR`S MUST BE SUFFOLK COUNTY LICENSED Builder's License No C?W ryun Plumber's License No . Electncian's License No , Other Trade's License No - . pp 1 Location of land on which proposed work will be done ~ l'?~'s ~/g z!-~-.~~.. G~~^, . House Number Street Q Hamlet County Tax Map No 1000 Section C1 ! Block Lot . Subdivision Filed Map No Lot . . (Name) 2 State existing use and occupancy of premises and intended use a/n/d occupancy of proposned construction a. Existing use and occupancy ~l~z•:L1./~/f . . 1?`(..j.u.$ ~ qt. Q,A--~+~., n.... . b. Intended use and occupancy f ..~I?7~{ 4 J. y ~'S'{ar q„~,~, c~,~~"pys,~, , ~t~e~ - , , - ~ - - - - 3. Nature of work (check which applicable) New Building Addition Alteration . . . Repur Removal . , Demolition ....Other 1Vork (Descnpiion) 4 Estimated Cost " .9. C ~ ~ . Q J. Fee . .G~. ~r . ~ ~ . ` (to be paid on filing this apphcat~on) S. If dwelling, number of dwelling units . ~ Number of dwelling units on each floor . . If garage, number of cazs off..... . . 6 If busrness, commercial or mixed occupancy, spec>fy nature and extent of each type of use . . . 7. Dunensions of existing structures, if any Front . Rear Depth . Height Number of Stones . . . Dunensions of same structure with alterations or additions Front Rear . . Depth Height Number of Stones 8. Dunensions of entire new construction Front Rear Depth . . Height ...Number of Stones . . 9. Size of lot Front ..SQ Rear ~t? Depth ..3~l~..... yyf.. . 10. Date of Purchase Name of Former Owner . . 11 Zone or use district in which premises are situated 12 Does proposed construction violate any zonrng law, ordinance or regulation 13. Will lot be regraded Will excess fill be removed from premises Yes No 14. Name of Owner of premises .Address . Phone No . Name of Architect Address Phone No.. Name of Contractor Address .Phone No.. . . 15. Is this property located within 300 feet of a tidal wetland? *Yes No *If yes, Southold Town Trustees Permit ma be required. PLO DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dunens~ons from property fines Grve street and block number or description according to deed, and show street names and indicate whether interior or corner lot , STATE OF NEW YORK, S S being duly sworn, deposes ands plican~ (Name of mdmdual signing contract) r above named ~Y ~ ~ t He is the . (Contractor, agent, corporate officer, etc) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file tlu application, that all statements contained in thrs application are true to the best of his knowledge and belief; and that th. work will be performed m the manner set forth m the apphcahon filed therewith. Sworn to before me thrs 4. day oyf .%~'rl.. , 19~~ Notary Public, ~~/n lt'!t/G County ~t~f~1E.t~E.K.K DE Y0E ///Jt r ~-y`~"~ Ipfi1RYPU~.iC.SMteetN~ewqYeyrplc :r '~~.~J/~1:74 <.~.-9..`.~~._ .~C..~.Ir.L~ . l . Tin~n Nu h30.119-=f (Signature of applicant ~ * ~ I- _ - i ~ I - - 1- _ y. _ y i~~ i ~ I ~ I I - - - - I I _ ~ _ -I - - - - - I ~ ~ _ I I _ - - I r - ~ - -_II i - ~ ~ I ry II ,;~~T r ~ ~ ~ ~ ~ ~ - _ ~ h. I _ _ vv,.. ~ ~ - J i ~ ~ I T- _ _ ' .r... 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