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HomeMy WebLinkAbout17734-zFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218495 Date OCTOBER 25, 1989 THIS CERTIFIES that the building ADDITION AND ALTERATION Location of Property 4125 SOUND AVE. MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 121 Block O1 Lot P/0 1 Subdivision Filed Map No. Lot No. LOT #2 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV. 4, 1988 pursuant to which Building Permit No. 177342 dated JAN. 4, 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 & ALTERATIONS TO EXISTING ONE FAMILY DWELLING. The certificate is issued to JOHN SIMICICH (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE NO. PENDING SLIP 9/19/89 PLUMBERS CERTIFICATION DATED K & K PLUMBING 10/23/89 uilding Inspector Rev. 1/81 ansaa xo. a 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 ~ ~1 ~. ~ -~ 3 ~f Z Date / ...........% .............................. 19..... Permission is hereby gr nted , ,.,r ... ct premises located ot .....`t.`~ .....................`a!'.~1/..`.f,........................................................ ...y7,~ ,.....~~ ...... //~3 z_ , ............................................................................................................//................................................... County Tax Map No. 1000 Section ......~~~....... Block ...........1........... Lot No...(.`"~....1..... '/ ~°r-~ 2 pursuant to application dated ..i/~~ ............................................ 19~., and approved by the Building Inspectar. ~~ l/ ~/~~ yO fee $.•fo.,,l.C?..s,. .... •..T. Buil g Inspector Rev. b/30/80 V ; t .". . F ' {ti' i t " ' F ~' ; V 5". i £;:,. ~4~. f°6 ~56d,. KC \~ 11 T E~ W V E 1 °1L rn V ~ [: L o~ c q T 3 O NN o ~ 0 `o a6 ~~ ~a 0 AT2 9L\ G~ S~V~O ' i 4 .~ ) . ; '~ ~F tFrv t L , ) I . I , ,. y~ ~ ~ i L ~ ~ ~ ~~ " 1 1. 1 .{ t ' ''t E 1 Y now or formerly 'Thornton E. Smith ) ~ 1 1 *' ' ~~5.88°3903 ~E. 220.16 r A a 1 a° -_ pj ..., r W . O " ~ ' . Area = 1.8366 Acres' T ~'. .t' " ' , or 80000 s.f,'' ~ , o ~ ~ ' ` ,r of i m 1, l I 311''. ~ .~C ~. e ¢ µ / '' O jl q 1 '~ Li b D °z ~ I s '1 I.1 r y :. m w . i $ L ° N > {ir. ar q - ;~~ ~3~e az x° + 3 a~ ° . b x } L 4 1 - ~ 1~~ . Y 0 W N 1 ~, ~_, w i ~ V ~ ' . N b ~ m .., c ~ ..1 w >+i ia. (x , i z (. 1 L r.- ~• i~ ~_y ~ 1 _.-T~ ~~ - 227.07., . - ~~ a~) 8.86°5620 W ~: .,~j .., ; ~'~s° ~ ".'AVENUE ' •- 9o° I z4 > 49 . 2 W I ~ ~ --~_ .' , s~ ~.t SURVEY FOR „f ~'e ' THOMAS 2AWESKI~ d CHRIST INE' ZAWEBKI ~~ "~~ onrE sEPr a 198 AT MATT17UCK 1 ~ TOWN OF SOUTMOLO '~ .~ - ~ .SGLE I so i ~ SUFWI.K COUNTY, NEW ,FORK ~_- - ;',NO. es osTa?' " a~,wwrxali[o eLi[nwnox on woortlox ro rxls I OUARANTEEO T0~ a rN•vlanlox aa(nmx r[o}DF ix[ 'Tx OMA9 2Aat`°~'-' r/ 3A'a ' N6VfR1MT[`f TIxD T(O ~LRLON aH4L~RUM lxLY 1D~ rORIWMN TNC }uRICYp VRfPRn[D" TM[rER ENT-0470. FOR APP OWLTO CONSTRUCT R ! 1x0 a Np' K LI, ~ THE ntt[ ~CNPIxY)OOV}H1'= ' RIM YL~}}OIMCCCa WEiIRi MIMTC~IUKIC~ L L°T Y(11 aCLlI0M l3L[VXR bfi~ D f 11 'j.CM01M[dxft }VLIDM LISi[tl Y' NLNLIL} M NUCDM~aN Y R1fIDxg4 PPix[4EH°M°i III" ' I _ . - Y[LLIM} WITNIM 0° [Cq,Or TMf IROY[RTT NOWM N[RCOM 'I L IM}TliVrl i[q 1RE W+ iqµ}i(RI[ 10 RadT) iVi0.Wb 011 ~VjRCODCMi f !YN }CNN.KdW ~1Y[TGa aV1 MI1 Rg1D[1x[ OWMERf t NDIn1x N[n[D Irnbi Irnar[nrr oMi ( ~ F N{}LSMlW010[iH{SIxI0.N COVNTYDVRRTYLMY i0[Ifi RLI Mf I0R12I[CIIIC I 1 I ' ', {4 ~i I 1 ~ + { ., { r°naos[ Di ro }[ Vs{tl ro [susu}a lox a r[nf a} ton rx[ yn[c rlroraRt ~ , ~ ~ , III 1,} ~ I I all I • x Hx-d ~,el k.d~1 ,,,I '' 1)1- 1 i ., ~. ).. ~ 11 ~g.~ 1 I .I ~~. ~, ~ .,.,,~ f I .. t p ; P .I ~ t ~IPoVFrRIIEIA ~, F~ NOYd ^ MONUMENT 4 STAKE ,, A ~' I I I ~l J Jri Ip i {I., ~'~ ~ RE LBT 2 MINOR SUBDIVI IONI fOR ~ JOHN AND UNOSURVE~YOR NEYY §LLICENSE N0 ~?1E~3lI I~ ~ I I ~ ~ ~ I SI MICCR~~ UR ~ i ;~I I, I,., ~ f '~~."i ~ ~"AOWARD W. YOVNO~~'LANO SURVEYOAf 1c 1' ~~ z 'I NIK Ld'JYQI IJsat(WI}rancnxNl(tl[c[farooLfla)NIDRx MGCLM ~' N.YS. LICENSE NOASB93 1 ~j ,Ili 1S NIC RACY niln o[acRV~lw}yyon Dnn o}ryx[o IR°N O.xEns ~ I I' Il I~ ellllxni} • aoNl uw, I _' 1'„ I y' i ; N r TOWN OF SOUTIIOLD BUILDING DL•PART?IENT _ TOWN HALL - SOUTIIOLD, NEW YORK 11971 " 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE ................. NEW CONSTRUCTION ...../,OLD OR PRE-EBISTING~B/AUIILDING.Y ...VA'/CANT LAND.._..... Location of Property„`.i~~~/„_~~~~~_.IIYC~.. ~Q_~~~(~~.1~U_ 1{/ .....:.. UOUSE N0. STREET IIAMLE Ovner or Owners of Property. /l shy. ~~:~~~~,~!~ ..........................:. County Taa Map No. 1000 Section ~~~, Block .!..... Lot" .~~~!. / ~~ °~ Subdivision ....................... Filed Map ........Lot.......... Permit No. ..........Date of PermiC ..........Applicant ................... Health De C. A royal ~-' P PP •--• .............. Underw a ters Approval.._........... Planning Board Approval ................ Request far Temporary Certificate ....... Final Certificate ........, Fee Submitted: $ .................... APPLICANT.: ._f:`.~t:~~.;(1(,C:....~. ~ ~ ..... n~ 3 ~S~OD ~a/xs/s y rev. !0/14/88 L ., _ roxrt No. 6 TOWN OF SOUTHOLD BIIILDING DEPARTMENT TOWN BALL 765 - 1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must befiled in typewriter OR ink and submitted to the Building I Inspector with the following; for new buildings or new use: ' 1. Final survey of property with accurate location of all buildings, property lines, j streets, and unusual patural or topographic features. ' ~2. Final approval of Nealrth Dept, of eater supply and sewerage-disposal(S-9 form). 3. Approval of electrical. installation from Board of Fire Underwriters. 4. Sworn statement from ¢lumber certifying that solder used in system contains less than 2/10 of IZ lead.' I 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: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or 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 shall 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 state the reasons therefor in vr;iting to 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 to April 9, 1957 shall also accompany the 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 OCC~TPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accesspry buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificatg of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Ccrtific~te of Occupancy - $25.00 Residential ~I $50.00 Commercial rev, 10/14/SS ~S~FF~~~C TOWN OF SOYJTFd0~0 ~? „~: ~ r` D~ OFFICE OF BUILDII4G INSPECTOR P.O. BOX 728 ~' .~` ,I~. ~ TOWN HALL ~ ~ ..~ ~~ Dec SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N TEL. 765-1802 Date ~Q1~~~j~~~ Building Permit No. ,~~~,,.~`\`_~~ Owner ~p~l~ ~~1m\UCX\ (please print) \ \\ Plumber ~~. ~ ~ ~~UM~J\(~ G.~1~ 'c"~~~~ (please print) --_----- I certify that the solder use~.l in the water supply system contains less than 2/10 of 1~ lead. ' (plumber's signature) S o ~/to before me this e J day of ~' , 1 3~ -~ . ~; p~ otarf Public Notary Public, U/c _ County KoCN~~ TMnM l~ . ~~ ~ . ~ 4 (~ i~J ~ Y Alf ~..~ Town Hall, 53095 Main Road ~~ ~~~~'~ ~°r ~ ~'~ `~"' ~'` P,O. Box 1179 9 "~" ~ ~ ~ r Southold. New York 1 1471 -- ''~ , TELEPHONE ~,~ (516) 765-1938 PLANNING BOARS OFFICE ~ TOWN OF SBUTHOLD October 17, 1989 Charles Cuddy P.O. Box 1547 Riverhead, NY 1.'.922 RE: John 5imicich,Jr. SCTM #1000-121-1-p/ol Dear Mr. Cuddy: The final public hearing was held and closed at the Monday, October 16, 1989 regular meeting of the Planning Board. A final determination will be made at the November 20, 1989 regular meeting. Please submit four additional paper prints and two mylars, all stamped with. Health Department approval, prior to the November 20, 1989 meeting. If you have any questions, please do not hesitate to contact this office. -'; Very truly,,-yours~t .,'"t eJ _ ..,. y /`~ n~ BENNETT ORLOWSKI,JR. CHAIRMAN jt =IELll 16SPCi;ilU;J ~~UnaL ~ i;OMMLNT~ /+ 7. - ~ .p a I -~ H - - H / 2 4 D /"'~ , ~~ FOUNDATIOtJ ( 2nd ) _ _ m~ 2. ~ ~, z o . ROUGH FRAME ~ ~~- ~ PLUMBIN~ d ` ~~ 3 I ~ ti H . ~ ~ z - ~ ~ IdSULATI0P7 PE N. Y. ~ y E ENERGY ~~ CODE ~ ~` 4 . '~ e l g // ~ .~. ~. y F I;J - ML ~ ly ~ ri DI,T~IONAL C w ~,L, ti~ x~~ "' r Z ~~ ~~ : -- ~ a~. ~ ® . . C~ to Ss- ~ ~ 3 SDO /a/s ~~~/ ,~/es, ~~ x ro ~~ H ~ ~ H ® I H O y ~ ~' r CQ H I x ~ ' v m ~ •o ~., H ~ _ _ ., ~~1"- - - - - - -- - -- - - 1-~. d ~ ,. ~, ..~L ~ ~ ,1 1- "_ ~ :~` ~ . - s^~- -, -_ ~~.~.. ~ ~ ~~. 1 -- ~, ~ - -- - -- - -- - - - - ~ ~ '~ O o. / i~ - - - - -- -- - - -- - -- - - -Q - -- i 8 ~ 1 - t -- - - - - v - - - ~ - ~ -- - - _ . - - __ _ - . __ ___ _- _ _ L u ~ la i, ~ ~ ~-+ TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, NEW YORK STOP WORK ORDER TO: John Simicich Jr. Owner, Owner's Agent or Person Performing Work %3.50 Bergen Avenue Mattituck, NY 11952 YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: re TAX MAP NUMBER i Avenue, Mattituck, NY is to be stooped 1000-121-1-p/o Pursuant to section 100-141 of the Code of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescinded. BASIS OF STOP WORK ORDER: Demolition and building being done without t. CONDITIONS UNDER WHICH WORK MAY BE RESUMED: ector. When a building permit is Failure to remedy the c6nditions aforesaid and to comply with the applicable provisions of !aw may constitute an offense punishable by fine or imprisonment or both. DATED: 11/10/88 BUILDING INSPECTOR / Vincent R. Wieczorek ENFORCEMENT OFFICER ~~~~ y 765-1802 BUILDING DEPT. INSPECTION [ )FOUNDATION 1ST ( ) ROUGH PLBG. [) FOUNDATION 2ND [ ]INSULATION [)FRAMING (~INAL REMARKS: DATE ~~ ~ ! ~ INSPECTOR -~ ,17?~~ ~sS-isos BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [)FOUNDATION ZND [ )INSULATION [ ]FRAMING [ FINAL REMARKS: --'/~~ DATE / ~: ~~ ~~ z ~ ~ i~ ~~ ~>-a ~~ ~---- J G~_.. ~ ~i ~ ,// n ,Y ~ 1 NSPECTOR ea~X~ n?3~ 765-1802 BUtLDiNG DEPT. f NSPECTION [ ]FOUNDATION i5T [ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMlNG [ ]FINAL /' _ REMARKS: Y-~-~ ~. ~ ~ it / / ~(„ ~~ DATE ~ < INSPECTOR ~%.,('~1i N1~6~, 765-1802 BUILDING DEPT. 1 NSPECTI~N [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMING [ ]FINAL DATE 3 INSPECTOR ~~~ z 765-1802 BUILDING DEFT. INSPECTIC?N [ ] FOUNDATI iST ( ]ROUGH PLBG. [ FOUNDATION 2ND [ }INSULATION [ ]FRAMING [ }FINAL REMARKS: ~~ ~ 113 j~ ass-iso2 BUILDING DEPT. ~r~s~-EC~°~oN [ FOUNDATION 1ST [ ]ROUGH PLBG. [)FOUNDATION 2ND [)INSULATION [ ]FRAMING [)FINAL REMARKS: Z -~"' T ~~~~_ DATE ~ 0 INSPECTOR ~ ;~ 2~3~~i~~ ~ ~ ~~ 4~ ~~ ~ l ~' .z~y"'~' ~ ,fi ~7 a Y ~ E.! flfV~~. ,. ~ ~~ ~ 4 tJ ~ 1 ~ v `` ~ ~ v F.i"~5 ~Q r\ f ~~..* P ~m 7 a ~® ~ ~,+ p u a 1s a 4 ~ , ~ a 0 ° • W ~ . Op ~ i \9 p J o~ ~ a W p Qr1 w w a ~o z ~ 2 ~~ ~ ~ ? o ~ m~ ~' W ~' Q~ ~ M N ~O qa ,..s °"1 b °"J ~ ~' ~ ti ~ .,p w a vwi o a f v d Q \ (~ g H ~ U w ~. 4 ~ ~~ ~. ~ 41 O ~ 41 O T' O O '~ ~ a o a w ~ ~i ~H ~ O O O p 0 0 p ~w~tz-+ ~ ~, z J M ~ O d ` F - F Q ? Q ' ~, v-~ ~. . . . ~ ~ o Q N ~ 4 m ~ ~ e ` ~ U Q Q ~ w W n^ 4' ` Y ~ w ~ w 0 ~ 0 '~ ~ ~ ~ A . r ° O ~ a a q~ v ~ ~ N M M U ~° ~ U v ~ °~ ~ • W ~ ~~; ~ ~/ ~ ~ ~ a ~ ~ ~ ~ .., r oro F ~ ~ ~ ~ ~w~•-imz t R e ~ ~ \ ~w ~r ~ ~J ~ '~ Q~ Q Q ~ ~ ~t ~ 1~ "~ ro ~-~ ~wa°~«w~l W ~; a d ~ ~ 2 ~ h ~ .. ~;°~~H~~ z d ~ $ ~ ~ ~L ~ a~~ ~~~' W 'I X ~ ~ ~ V 4 V ~ N ~ ~ r v zz`~xHCnx 7W W~ H H C w ~ Z ~ r m ~ 3 a ~ v w 3 .1 N N V' ~ ~ .S v a, g o E~ O G C) o` al3 ~~ .y 0 D _~ ro s°~'Na -~ Area = 1.8366 Acres or 80000 s.f. FRAME SHED ~~ ~, ~ ~,~ ~_.A ~~. ~i 11~ n ~ ~ ~~ L S ~ S ~ ~ l~ [~-~~~ ~ _ f IG p STORY FRAME HOUSE 34.3' N. age , 24. yZ , 9 40"ly .K COUNTY TAX MAP X00 SECT. 121 BLK. I LOT P 0 I 2 , MINOR SUBDIVISION - ~~JOHN SIMICICH,JR.° AVENUE I 1 I s. el of .~ I 227, l,i }I, t:: fi' lip ~1, r i `~ { '~ f.~R~'re~'~.i: SURVEY FOF~ ~ ~~~~`~.~. JOHN SIMICICH,JR. AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK NEIIEON, AND TO THE ASSION[ES Of THE LENDING NISTITUTION. GUARANTEES ARE NOT TRANSFERA1lE !~ TO ADDITIONAL INSTITUTIONS OR SU/SEOUENT OWNERS M OI STANCES SHOWN HEREON fROM -RO-ERTV ONES TOE%ISTINi iTRUCTYRti ARE POR A SPLCIPIC -UI1P0/E AND ARE NOT TO /[ DEED TO SETA/LIEN -ROPERTY LINES OR fOR THE ERECTION Oi FENCES YOUNG & YOUNG ALDEN W.YOUNG,PROFESSIONAL ENGINEER ANO LAND SURVEYOR N,Y.S.UCENSE NO.I2843 0 o' ~. -,. 0 1 3 c~ -~ o~ 0 m.~ 3 7 DATE OCT. 12,19 SCALE I ° * S0~ N0. 88- 0934 NEW YORK STATE EDUCATION LAW ipD W V•P N COPT ES W THIS SURVEY NOT OEMWB THE lANO ~Q~ `OG 1' lUR VE YOR~3 INKED SEAL OR CMi033ED SEAL SNALL MOT /[ CONSIDERED TO DE A VALID TRUE COPY ~ Z NOUARANT[E3 INDICATED N[RCON SNALL RUN CNLY ro 0 ME rtRSON FOR WHOM TN[ SURVEY IS PREPARED AMO M NIS ![MALE ro THE TITLE COMPANY, OOVLRM- *~ MENTAL AGENCY AND 1EN01N8 INSTITUTION LISTED MUIMUTNORI2[D ALTLRATION OR AOOITION ro iN 13 SS SURVEY p A VIOLATION Of~SLCT10N 7203 OF THE 400 OSTRANOER RIVERHEAO, NEB p ~6~M.~~a ~ ~i~.+~~~...~ FORM NO. 1 NOV Q I9$$~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~~~G:jy ~;(. TOWN HALL TOWN OFSUOlFIOLD SOUTHDLD,N.Y.11971 - '! ~j TEL.: 765-1802 Examined ~.T ........., 190ppp.y Approved .. ,~/~. , ........, 190~Pcnnit No.. ~77t.~~~ Disapproved a/c ............../...................... ~~ :2 .py/y~.~- . ~ ...... ....... . /(I3ui d- g Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS , BOARD 3 SETS SURVEY CHECK SEPTIC OF HEALTH ........, OF PLANS .:::::::: FORM ..............• NOTIFY , CALL ~ MAIL T0: ©t ~~ ~~ q~ ~~ ~ 9~' V /ftit lX/ , ~f 3~g ~. Date ~~/~~........, 19~ a. Tltis 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app; 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 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 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 describes The applicant agrees to comply with ali applicable laws, ordinances, buildin; code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ...~`asU (b ailing address of applicant) y~'~S~a State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..... C~~G2;F-zL.;22c% ................. Name of owner of premises .~~Q.?`f. !~...~. (~?`.). ~G /. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of du]y authorized officer. .............................................. (Name and title of corporate officer) Builder's License No. ..~'~~?r~~:~"?J........... . Plumber's License No. . r~.,/. ,~ ~~....... . Electrician's License No. . ~~:~':?~:~~ ......... - Other Trade's License No . .................... . I. Location of land on wliicli proposed work will be done . ................................................ . ... -~ ~a. ~° ............. ~~-~ .:.........~~~.............. . House Number Street / Hamlet County Tax t,tap No. 1000 SCCIIOn .... ~a~........ Block ..../, , , , , , , , , , , , , , Lot . ?~/~ / Subdivision ..................................... Filed ;`fall No. .............. Lot .............. . (Name) 2. State existmli use and occu ens of remises and intended use and occu P' YC~'P pansy of proposed construction: a. Exrsting use and occupancy ..!~!`~.'1-'~~:Q:1 ............... . ...................................... b. Intended use and occupancy ..~!:`~-e-.-~.... Gc~D~~~ee?<- .. a!~~,~d'h .................... . 3. Nature of work check whi Re air ............ . . h applicable): New Building .....~..... Addition . ~..... Alteration`..`, P ( Removal ............. . Demolition ........ , . ' ' .... OtherlVork..._^„ 4. Estimated Cost~j>~~1a.Q;~ ..................... ... ........... , (Dscription; ... 'Fee ..,.. ..... 5. If dwcllin~ 9'6 'tto be paid on filing this-application) ding units ...!~,y~~!~? Number of dwelling units on each floor ............. . If garage, numbcb of carsvcl. • , •~ , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .. , , , , • ~ • • . ,~ - g lures, if any: Front ..~~dn-; ,4. , . , ,Rear *'~d~? i . ,9,~; . • .... ' . "' . " H` a `sions o~~istin struoNumber of Stories .../, , , , , , , , , , , , , ,, • • • • ....•........ .. Depth .~s',~•, 'f Dimensions of same structure with alterations or additions: Front Y .~-, .......Rear ~ . Height ... ~~ ~' 4.:.. • ..... . Depth .. ,~%~?-f ........... ~y, • .......... Number of Stories .. / , .... • . . Din~ensio~ of ntire necv c N struction: Front .. ~~a ' ""' • Hei ht • • • • Rear .. r~ `~y.:..... Depth ~i.~.-?~~, ; , umber of Stories . ../.~, , 9. Size of lot: Front . ~9%=z?vJ.......... Rear .....................Depth..................... ]0. Date of Purchase .. l~?,/:d'."~ ,,,, , , , , , , , , , , , , , , ame of Former Owner ~X~........ p p ~ premises are situated . ,,~ zo X/C--- 13. Will lot be~eedraded tructio~~ late any zoning law, ordi ~a'/ill excess fill be rem d from • rem' ~ • • ~ ~ • • ~ • ~ • ~ ~ ~ • g p ices. Yes 14. Name of Owner of premises 1 ?~~~~.!i?!!~r~y, , ,Address ~?Ca,~-~,-:y<•; ~9,, Phone No. ~ . Name of Architect .. . ~ . ' ' • ~~~ ~~ ..y. ••••••••••••.Address. .PhoneNo.. Name of Contractor .Q~!.%(/.~,~, , ,Address`S!~~~~r•-, , • P P Y ........... ........Phone No.oZ,cl~'S16, j~ 15.Is this ro ert located within 300 feet of a tidal wetland? *YES....N0.4•~'~ *If yes, Southold Town Trustees Permit may be required. ~, PLOT DIAGRAM Locate clearly and distinctly fall buildings, whether existing or proposed, and indicate all set-back dimensions fror property lines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. STATE OF NE\V YORK, COUNTY OF ................ . I S.S D, ... .. ..... ........ • I .. , being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 confgined in this application are true to the best of ltis 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 Notary Public, ....r,~, ~w •~ ~!(%G ~B~ ••, ••••.. County NEIENK.DEVOE ~• •"• •' •"' ""'••• NOTARYpUBLIC,SteteotNewlyYo~rkp (Signature of applicant) ierm~Exp~r7eas MBfC 30 18 0'~ ~ a b ~' ]4 -~~n =-a ~~~ ~. - , w~3~,~~ Vii; ~•~^,y , ~l}$J ,~° i'3iT ~1' _ ~iy~~ ~~~~ ,Ki ALl"~~a~~ ~= £~Y~~1s b r~~~Lt~ yam-. Y'_w /.V ~yby ~E jtlL~ s 3 Si ~ .' py ~; g e, r.. ~~ M= ~# Fi2'N _~ aL ~` y LI~ Y! h s , y_`~ j' - ':1e -~ ~- k" It-,~ t iiY~ ~ i {_ _ ~ F. h :. 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Li li, a~ , .1 ~--~h. s ~Y '.. ~ , o p-:'rla io .Y T: _ P.arur~~~ ---r---__ _-- ybr7z a3C y1r'ar~r2~ /79~iHi/ucl~ Ny //9s'Z now or formerly County of Suffolk ` I + I`I I ~~;° "IP I~ ` I I Ii II POND Lot 42 m -- ~ I I I Il Area=22357sf ~ N I gelR ~~n ~ Q Im i I I ~ ~ Ei / z i o I F I Mc2i l oe 1 I I l l) ~ t ~ 1 ~a I ~ /~ i o ~~ ~ ~ p~ 3 r~- ~ ~ ~ ~ ~~ PO P o I ~ \~ ,1. ~ ,I / / ~ N o INfi V) ~ ~/ ~ ^ .l ~WETLPNOS GOUNDARY L Z 1 ~ P I `c ~ / / /~ ' PIPE ~ `p ~ i~ i e.l ~ ~ ( Ise.eo 200.94 I a. r IE.O , -,TS`_-12, sae°os'od,w. z I I m N.3 ° 54 00 ~ W. 322.95 Lot 43 IV ACANTI m c. I o ~`e 3.s4, / now ^ 1 Barborar ~os~unzo //. SUFFOLK COIpNTY DEPARTMENT OF HEALTH SERVICES ' FO~F99IIAPPRDVAL DF CONSTRUCTION OF S CI Family Residence Only DI„~ ~~EF ~S©5 ,S APPRDUFn ~~,7.15~ EXPIRES TYPO YFARS FROM DATE OF APPROVAL ~,Qpvrd~/s ~y N-PP,e n'Yd Qs 85 sorby u~drC Y~~'/~~ c%~ca1yP sav/~s sc~,.rq'.z/~i NEW SUFFOLK AVENUE surrvEr FoR WILLIAM MOORE 9 BENJAMIN L. HERZWEIG APRIL 5,1986 NOT ES LOT 42, ~~MATTITUCK ESTATES,INC.~~ JULY 21,1967 1967 JUNE 5 I. 2. ~=MONUMENT p=STAKE AT MATTITUCK , DATE JUNE 4, 1987 3. SUBDIVISION MAP FILED IN THE OFFICE OF TOWN OF SOUTH OLD SCALE I~~=40~ THE CLERK OF SUFFOLK CO. ON SEPT 8,1965 A6 FILE N0.4453 SUFFOLK COUNTY, NEW YORK N0. B7 - 939 4. SUFFOLK CO. TAX MAP DIST 1000 SECT IIS BLOCK 05 LOT 07 NuW UTNMUrG ALreR.nox De ADmnox TG Txls OF 5 14 =EXISTING CONTOURS IUNVEY O ~ VIOLITION Of GECrlax Tzw aF rxE r N Sure EwunoN ur PTE NEw t . --- --- MEW D N s ~ 6. ELEVATIONS ARE REFERENCED TO N<DFIES of TNIE Gurv6r NGT AEAgwG TNf LAND SUq VEVONG INKED GE.LL OII ENEOIGEO PEAL fNILL ONl10[NED TO GEIVALID iIIUE [OPr T CE O PD w O,~P ~ `O N,r, N.G.V. D. 1929 (MSL) NO C UTEO NCIIEDN GNNLL qUN MLr T1 r ` NGUNq ENTCEE INOI * TIE FENION FOq WMON iXE GUINEY IE PNEFMCO 2 AND OI HIE IEIMLF TO THE TITLE [dIMNY~ OOVNIN- O NENTIL 1GENCr AND LENDING INITIiV TION LI6TE0 ~EIIEON, AND TO TIE AGGIGNEEG OF TXE LENDING Ti1Tlw nuY~YTifS ~rF N[1T TeW NFFN~Ni F MDI lT1NC[S IINWN NFIIEON FNON FIIWEIITY LIMf! iO dIGTMG GTRUCTUNEG M[FOq •GF[CIFlC FUr FOSE AND ADE NOi TO GE UGED TO EGTAGLIGN SUFFOLK COUNTY OEPARTMEN7 OF HEALTH SERVICES EIIOFENTY LI NEG Oq Fan iXE ERECTION OF FENCEG FOP APPROVAL OF CONSTRUCTION ONLY YOUNG a YOUNG ~OOOSTRANOERAVENUE RI VERFEAO, NEW YORK HS REF. NO. ALDEN W.YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S.UCENSE N0.12BI3 )VED HOWARD W. YOUNG, LAND SURVEYOR N Y.S. LICENSE NO.ISB93 agexms A soxs Ixc. Twfi