Loading...
HomeMy WebLinkAbout18447-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19440 Date OCTOBER 11, 1990 THIS CERTIFIES that the building ADDITIONS Location of Property 1525 ALBO DRIVE LAUREL N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 3 Lot I7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 14, 1989 pursuant to which Building Permit No. 18447-Z dated AUGUST 31, 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 & DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to ROBERT W. TURNER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-015112- APRIL 3 1990 PLUMBERS CERTIFICATION DATED OCTOBER 11, 1990 - PERFECTION PLUMBING Bui1 ing Inspector Rev. 1/81 Fosst xo. s TOWN OP SOUTHOLD BUILDING DEPARTMLNT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- X 8 4 4 7 Z Date 19...x`1. Permission is hereby granted to• , to ..~~1.~~.....c~:~,..G'~.... . . . . _ at premises located at ..fi,~`.,~.ti`1.........4~:sitr:i~:'.... County Tox Map No. 1000 Section .......1~.... Block Lot No.......~..~......... pursuant to application dot d ~ 19.~~., and approved by the Building) IFnsp~ector. Fee 3••L.G...!°.~,.. P Bui ng I for Rev. 6/30/80 4 - Form No. 6 TOWN OF SOUTHOLD ' ` QCC~ OM ~ OI~ ~ BUILDTO~DEHPAARTMENT U' 765-1802 BLDG. ptP'i. . TOWN OF c'1t 414dRi.4~ ~ 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 1~ 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. Fox 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 $15.00 Date ~Q...l~.:.~~ New Construction..~:~~... Ol/d~,Or Pre-existing Building i Location of Property..~~~-S..l:.(:~..' ~2~.~~~ House N/R~ ~ Street Hamlet Onwer or Owners of Property.~S.~~~~•~•• County Tax Map No 1000, Section...j~...~~. ...Block...... ~.~.....Lot......1/. Subdivision ................................-7....Filpped Map....... ~,(y?~,~/+,~Loyt~.`./.~.).....~.q~~~./...... J~~~~ he Of Permit..../..~ ~:0. .A licanta : Y!.~:~`::. J/.U..: MS'S!::: Permit No.... . •a~a • PP Health Dept. Approval ..........................Underwriters Approval.... Planning Board Approval Request for: Temporary Certificate........... Final Gerticate........... Fee Submitted: ~~.s~..•••.••••• Qom,, ~(oG~( . `t Q ~ , tf'2~F8 APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS Incr. t 3 f.117;i E,S { BUREAU OF EL..EGTRICITY J 85 JOHN STREET, NEW-,YORK.. NEW YORK 10038 ~ r Date `l~t'R7L (13, 1990 ~ Application No. on file 61a77'7%fltp/$'4 N Q1571-2 THIS CERTIFIES THAT only the electrical equipment as deacrihed 6ebty and introduced 6y the applicant named on the shove applicotion number in tha premises of e{ T ~ .v R~BCRi W: TWRNf4'~r', 75?.5 A~L.~iO DR.; hJA11S'ft)GK, Ni'Y~." in theJollouing locotion; ®Basement ® lst Fl ? 2nd Fl (;Af2 - ~ Section126 B[oeh? Lot j'/ was examined on nnRCF 22, 1'('9Q and found to 6e in compliance with the requirements of this Board. FIXTURE ~KEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FWORESCENi OTHER AMi K W. AMT. K W. PMT. KW. AMi K.W. AMT. H.P. Z ~ ~ ti 7 0 ~ ~ p DRYERS R)RNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS gELL UNIT HE tERS MULTI-OUTLET DIMMERS ;i {f SYSTEMS AMT. ' K. W. Oll H. P GAS N P AMi NO. A W. G. AMT' AMP. AMi AMPS. TRANS. AMT. N P NO. OF FEET AMT. WATTS of ~.f~ (1(I -SERYIEE-OISCCNNECF^-..NO:QF ,~.._~...~.._..-_...~,..r.-_w...~..,_~,..._,,,-.,.,_.R..;...__...,hy.__-._.-,.T..,_,--._._+{ .°.--.E, AMT. AMP. rypE METER I 4W I a. 3W 3,9' 3W 91d' dW NO. OF CC. COND A. W. G NO OF HI~LEG A W' G NO OF NEUYgAlS A W C'' z EQUIP. PER9 OF CG COND OF M4LEG OF NEUTRAL OTHER APPARATUS: - 4lIP,tNG F'Of2 LdAR. & 'L SI't)12Y nUDJ7S(JN--J, ~ j ` G. F. C,. T:-.2 . i ~ .i { ~ AMOUNT ~ PLEASE'REMIi 81^6HECK pOR MONEY l" { I n ~ L) ~SORN BpARD OF FRE UNDERWRITNERS ~ AS CASH SENT BY MAIL WILL BE Ai .J ROBF''X'W TURM{; RISK OF SENDER. i i~n~h I>ft. , E Peri 1 THIS 1$ YOUR BIIL FOR SERVICE RENDERED AND IS NOT A CERTIFICATE OF COMPLIANCE: THIS BILI PAYAEL&AdTHE NEW YORK OFFICE, 85 JOHN STREET, NEW YORK, N. Y. 1003R , 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST [ } ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: ~ ~ DATE ® ~ ~ INSPECTOR TEL. 765-1802 Q~~FFDU,~~o'~ TO'4Y~N OF S(3YJTIIn~.D _ ~ 'y° , , ~c OFFICE OF BUILDIPIG INSPECTOR v P.O. BOX 728 O ~ j ~ T u' TOWN HALL "O ~ ~ ° `c- SOUTHULD, N.Y. 11971 ~b0 C E R T I F' I C A T S O N Date ~Gt } U Building P//ermit No. {~'~'~i~7 Owner ~o(~ ~vriye2- _ (please prinnty Plumber f~~~?L'~,U ~~yYY) ~irUg ~~C~.t (please print I certify that the solder used in the water supply system contains less than 2/10 of to lead. (plumber's signature) Swo n ..o before me this Il~day of ~a 1~• 1{/ Notary Public tlotary Public, ~~r r~ County ~ Wo,4g79606 My ~ ~pifesuDecen+bet B. ~ 1~LD I,1:S. c~:;~;: ~~lln:n ~Oa~fMF:NI°. m 1. _ i f t ~ _ ~'Q'` ~ ~ ' 1~1.. FOUt7DATI0N '1st G~~ `~-~rY FOUIJDATION 2n 1 _ - 2 . "',a~ ~ n o ROUGH FRAME ~ ~ . G~ .PLUMBING H ' N~ 3• T T E N. Y. _ y I17SULA IO 7 P R STATE ENERGY CODE ' a . Aw G1 r~-r,~~„ FI11AL -LRiv ADDITIOPIAL COMMENTS: '1 x ~a ~ H\ ~ `n ~ \e) y \ H O i m > \ • ~ H cl S W b m rv ~uF ~ ~ ros-zso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION iST ( ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~?J ~~e DATE 10 3 ~ INSPECTOR r~.~) l (~~T ~ 765_i8~2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ } ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ~RAMING [ ]FINAL RE ARKS: ~.e~-- ~.,e_ DATE ~ G INSPECTOR C g ~ ~ ass-iso2 BUILDING DEPT. INSPECTION [~O NDA ON i5T ~ ] ROUGH PLBG. /FOUN~~N 2ND [ ]INSULATION [!i] [ ]FRAMING [ )FINAL REMARKS: ~ ~ ->-!~-x. ~ ~ ~ o c~.,4.~..~~P DATE ~ g' INSPECTOR L~ y ~~~7 765-1802 BUILDING DEPT. INSI~ECTION [ ]FOUNDATION i5T ( ] R GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ DATE ~O INSPECTOR i~ ' FORM NO. 3 / 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date ~ ti~ ~ 19 1.4? . a9.~r . PLEASE TAKE NOTI~C^E that your application dated ..~tc-~r!w4°.'\~~~~ < <P 19 for permit to C'1+`^'°/.r".~c~ 0.,,., C>..uac.5~?eJ~ • • ~T~..~. M~*w45.at Location of Property . • • House No. Street Hamlet County Tax Map No. 1000 Section ~-.4'...... Block G7. Lot . Subdivision Filed Map No. Lot No. . is returned herewith and disapproved on the following grounds Vim. .~~:30 A.`'~ • , Building Inspector RV 1/80 F -ti rT'f A .G ~ ~ 'ten Ni"::~, ~ ~ .Q ~ ~ ~J 14`:.. r.w'. ~!`I' ( / ~ N 20 .-AcU `a',.'~Vv' 143 L~x4t t ~ W - r o S ' ~ ~ c D NZ oa ~ A er ~ (v D ~t r i7` r' r' f7 i~ lf1 s. 1` ~ 1> In ~ ~ - Fco c-. ~ kr,_ ~ i ~ ~ o ~ T~ u ,R ~y ~ 1~} 'c, _1 r l` % 1 P. ? ti h 1 ~ 7 ~ ~ / ~ G ~ Q , it ~ ~ f: ~i: ~ 4 ~ ~ T ~ K L. . d' - _ e.. Q + _ 1 ~ ~ t r(C . ~ In ' ~ r n i , e i. ~ ~ ~ - K ;c- ~ ~Y t i s Q ~ 8 Z y r b~ ~ ~ 1 ~ © ~n o . a ~ ~ . v w G~ 0 ~ p o ~ 1 i~. / ! /'v. .1 5U'~/'1 143 5h D 1,1.2p . Co ~ Z - O In xr-Y ~ df ~ v'. ~ ~ ~ ~ ~ N 00 0 ~ O~ 4 ~ TS tTt U'4'~4 r N A a I ~ ~ ` ~ ~ ~ ~ 1 d~ ~ i 33' 1 {L•~. , 1 r iY yV 7 ;y ~ S ~ 1 '?[['~~~A.af ~ PM r.4'~~x~. i S - n~ ~5~.*~ Y'V! tSt~Yr~~ ~ ~~ix t.+'~f1ti f .7Y A~~w'iK.' t1 Y ~ ; # r - r S (per\'F` ~ ra e • 'C'._ max, r5.. , . y*. ~ iq t ~ "fir, ~~r A ~ ~ ~ x~ r ~ e~^ a o0 N FORM NO. a TOtiVN OF SOUTIIOLD BUILDING DEPARTbiL•NT TO~YN CLERK'S OFFICIJ ~ ~ SOUTHOLD. N.Y. NOTICE OF DISAPPROVyyAL Date ..rl. 19..~~ ,°.m~...Y~'. . it PLEASE T,A_KE~N~OTICE that your application dated ~ /.f.~ 19~~. . for permit to Go~~%zfGC~~.~'1e~~7?,~..'S~ ~~.~~.~LQ~. //~$~t.- ......./....~../Jat Location of Property • h~~~(~(~ . House No. Street Ham%et Coun[y Tax Map No. 1000 Section f c?? ~ ...Block ~ ......Lot l . Subdivision Filed hlap No. Lot No. .......'.....~.~..-.7'" is returned¢herewith and disapproved on the fol]owin~ grounds .U~~i.C....~.~1~ 1,..~ ~BUi1 ing Spector RV 1/80 ;5. NF 11 )ORn $IAi[ UE PAHIMhV qF kNVIRUn MkM AL ~UhSE R\n;.0r: RAIIi NUMBER ~ EFFECTIVE GATE 10-89-0340 w 6/5/89 i its n I n rl:u(,la Has na.Mnk Hia PERMIT k%PIRA7lOh UAI tlsl Under the Environmental Conservation Law N/A 5/30/92 ~1 Article 15, Tgle 3; 6NYCRR 327, ~ 6NYCRR 608: ~ Article 25: 328. 329: A vatic Pesticides Water Qualit Certification Tidal Wetlands --1 Artice 15, Title 5: Artcle 17, Titles 7, 8: Article 27, Title 7; 6NYCRR 360: PrDtectlon of Water ~ SPDES ~ Solid Waste Management` Article 15, Title t5: j ~ Article 19: ~ Article 27, Title 9; 6NYCRR 373: Water Supply Air Pollution Control' Hazardous Waste Management Article 15, Title 75: ~ Article 23, Title 27: ~ Article 34: Water Transport Mined Land Reclamation Coastal Erosion Management Article 15. Ttlle t5: Article 24: Article 36: Long Island Wells I N I Freshwater Wetlands ~ Floodplain Management f -1 Article 15, Title 27: N-New, R-Renewal, M-Modilication, ~ Articles 1, 3, 17, 19, 27, 37; <_f Wild, Scenic and Recreational C-Construct (`only), 0-Operate ('only) 6NYCRR 380: Radiation Control Rivers PERMIT ISSUED i0 ~ Mr. & Mrs. Robert Turner :\VUltk $S UI I'kHMI f 7 k L 9 Adams St., Hicksville, NY ]1801 AC WT rOH Pk H.\11T7f ErCONT ACT PERSON TELEPHONE NUMBER Garrett Strang, R.A., Box 1412, Southold, NY 11971 tinAtt AND ADDRt55 OF I'ROIECTiFACILITY pt di0erent from Permrctee) 1525 Albo Dr., Laurel LOCATION OF PROIECT!FAOLITV COUNTY TOWN/CITYNILLACE UTM COORDINATES Horton Creek Suffolk Southold I DESCRIPTION OF AUTHORIZED ACTIVITY Construction of an addition and deck to an existing single family home as per the attached NYSDEC approved plans. All construction will be at least 70' from DEC regulated freshwater wetalnds. GENERAL CONDITIONS 9y acceptance of this Dermil, the permitfee agrees that the permit is contingent upon strict compli- ance wrth the ECL, all applicable regulations and the conditions specified herein or attached hereto. t lhv permiuee shall idr in the off ice ok the appropriate regional perms administrator, or other office designated mtne speoal conditions.anobce of intention to commence wod as lean 4g hows m atlvanre or the time of commencement and shall also nobly him!her promptly m wnung of the completion of the work i he yvrmrtted work shall br sublet[ to inspection by an authorized representative of the Department of E nvironmen:al Conservation which may order the work suspended d the pubbr mteresr so requvw pursuant to ECL §71-0301 and $APA §401(3) f 1 h,• Inamntce has acn•ptctl rxpnssly. by the execution of the apphcabon. the lull legal responsibJny (or all damages director mdnecL of whatever nature, and by whomever suhered, arising out or the protect described herein and has agreed to mdemndy and save harmless the State From suiu, attions, damages and costs of even name and descnp lion rewllmg from the Bald protect. 4 The Department reserves the right to modify. suspend or revoke this permit at any time after due notice. and, ii requested, hold a hearing when' al thr scope or the protect is exceeded or a violation of any condition of the permit or provisions of the ECL and penmen[ regulations are found, or b) the perms was obtained by misrepresemapon or failure to drsclose releven[ facts, or cl newly dn<overed information or srgmbcan! phvvcal changes are discovered since the permit was issued. 5 Thr cermrttee is responsible for keeping the permit active by submitting a renewal appbcanon, including any forms, reel or supplemental mformanon whrch may he regwred by the Department, no later than 30 days (100 days rot SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date. n Th,. Pi`rmu ahall not he construed as conveying to the applicant any right to,trespass upon the lands or interfere with the riparian rights of others m order to perform the permuted work or as authonxing the impairment or any rights, title or mteresr m real or personal property held or vested in a person not a party to the permit. i The permntee is responsible for obta inmg anv other permits, approvals, lands, easements and rights~o4way which may be regmred for this proie<'t. e luuance o! this perms; by the Department does not, unless expressly provided for, modrfy, sucersede or rescind an order on consent or determinaGOn b. the Commissioner owed heremlpre b, the Depanment or any or the terms, condmonz, or requirements contained in such order or determination ? nm• mud,; i<a bon or this permH granted bygtth3et~Departmept coos be in wnung and attached hereto 1{xaUl.!?~DR7 API(AIIIa I PERMIT ISSUANCE DATE PERMtI AD'htIN IS ATOR ADDRESS 6 5 89 Christine J. Costopoulos 8TAT6 UNEVEn8I?Y OF NEW YO?eER I AUTHORIZEDSIUnATCRE ' Page 1 of cc: BEP FARM Np, a TOIVN OF SOUTIIOLD BUILDING DEPARTbIL•NT TOFVN CLERK'S OFFICE , SOUTIIOLD, N.Y. NOTICE OF DISAPPROVAL v , ~j, J~~ 1 ~ yDate ..r/. 19..~~ ~m.... ~.9~......... PLEASE TAKE NOTICE that your application dated, ~ /./~.f......., 19 . for permit to e~ree~o-~.t~~~~.. ~ ".~Q~~.~~LQ,e~~.~?~.:......./.. ~.~.~.~./~at Location of Property /'~c7s - ~-r~li.`z°.........l~i~~lGG(:.. Houae No. ~ ~ ~ ~ ~ ~ Street Hamlet County Tax Map No. 1000 Section l~ ~ ...Block Lot r!.~...... . Subdivision Filed hfap No. Lot No. . is returned herewith and disapproved on the following grounds .U~~.../~!Gj.'~~ ^..~~m ~ ~ ~ ~ ~ ~ui ing Spector RV 1/80 y.,~ ~~;1 y~ ~ ~ BOARD OF HEALTH . 3 SETS OF PLANS ..a: ~ . FORM NO. 1 SURVEY • . . TOWN OP SOUTHOLD 'CHECK K .~..I~'~'-~....... . BUILDING DEPARTMENT SEPTIC FORPf TOWN HALL ` SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL MAIL To: Pa. X96 Examined 3~... 19~. / ~~~7 ~ - ~ Approved . ~ 19C~~Permit No....... ~ ~ .s _ ~ Disapproved a/c , ` BLDG. DEP'i. TOWNUFSUUTNOLD aiding Inspector) APPLICATION FOR BUILDING PERMIT Date . 7."./~~~c/....., 19... i INSTRUCTIONS a. Tlus 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- 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 perniit 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 construction 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 code, and regulations, and to admit authorized inspectozs on premises and in building for necessary ections. ig ature of applicant, or name, if a corporanon) (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. _ Name of owner of premises ~.r. ~ ~ V/~•~• u ~Z NL (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~'~2~!~-/.......... - Plumber's License No . . . Electrician's License No . . . Other Trade's License No . . 1. Location of land on which proposed work will be done. . isa5'....~~~¢..1~~ ....:..........................~r.~G~.... N~~...~~~~ House Number Street, ~ Hamlet County Tax Map No. 1000 Section ......~~-~~."~0....... Block Lot 7 Subdivision Filed Map No. Lot . (Name) State existing use and occupancy of premiseys~a,~nd intended use and occupancy of proposed construction: a. Existing use and occupancy !~.~~1,F:~''dvGL? , b. Intended use and occupancy s~~It!lL . . . 13. Nature of work (check which applicable): New Building , Addition Alteration . Repair Ryrmoval , Demolition Other Work . ,p27 (Descripltion) 4. Estimated Cost C7aO.r..4~tT Fee 1. P:`!J~....'~'~,e ~Ii'~.'".. , , . (to be paid on filing this application) 5. If dwelling, number oC dwell ~Ing units .....QlY~..... Number of dwelling units on each floor . , D~~ , , . Ifgara„e.numbcrofcars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front Rear . Depth , , , , , , Height v~.~....... N,umber of Stories , .......GIN,~ . Dimensions of same structure with alterations or additions: Front ......~4:........ , Rear , , , , , , , , , Depth . ' a, Height , , , , , , ,Number of Stories . ° ' 8. Dimes~o~e¢ new construction: Front l~ . ,Rear ,IC7.~8.'.... , .Depth ,Q7~7,~, , , , , , , Height Number of Stories . , ,q,cN~. . 9. Size of lot: Front . ~Q:~?9........... Rear , , 1Z;1: !g. , DepthW~1p¢~3•S~, -C. i38,S/~ • • 10. Date of Purchase .$rZ ° , , , , , , , , , , , , , , , , ,Name of Former Owner /~Ub'.n ./1/: !b7l~N......... . . 1 1. Zone or use district in which premises are situated . . 12. Does proposed construction uiolate arty zoning law, ordinance or regulation : . . 13. Hill lot be regraded Will excess fill be removed from premises: Yes Nc 14. Name of Owner of premises!Y~l~w, , {~l/?~J,~-"1~, • Address/:CZ,r~~~l/ J7.~.~4tt.£L'"~.Phone No..~/~^ SA~v`Z 1. Name of Architect CT•.57'?RNCy, • • • • • • • • • , , , Addres~?kl~~~. ,~aut~fo4r?.N.•`~: Phone No. ~.CnS.::? y'`V'r+`.,. . Name of Contractor . IS.Is this property lo'•...,,..,..••"••..Address ...................PhoneNo.... sated with in~00 feet of a tidal wetland? *YL~S.'~.NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly pll bulldings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blogk number or description according to deed, and show street names and indicate whether interior or corner lot. ALBo ~~iv~ N as'*_ ~p~ 11 1~' 1~ FZ~ A . ~ C /itL . 1 aTORY ~ t?a, 'az~ ; pl A. ~rs~~-i looc~ ; .3ECtloN l7. ~ 5a' ± 1 dhoclL v~ ~ l,o~ l7 J . OCO \ r qy, P• p3G' STATE OF NEW YORE, ~ r Ci COUNTY OF S.S ? / .~G ~p ~~9 ~Qbi.'~fi • ,(uP.tVL--7~°, • Iii, • • • • • • • • • • • • , • being duly sworn, deposes and says that he is the applicant (Name of indrv~dual sigrSing contract) above named. He is the (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 manne',r set forth in the application filed therewith. Sworn to before me this ................./7.....d~~a//yof.....~ 0 ,19~./.. Notary Public, .n.-..,~.E K~........ County ,,~/e~... .Gs'~'~`- . N6YARYPUBIC S~feMNejvYak (Signature of applicant) Na. X7078'/8, SuffolN Coun Terra Expire Marsh 36,19' I -