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Home My WebLink About17854-z , i FORM NO. 4 TOWN OF SOUTHOI,D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22274 Date April 22, 1993 THIS CERTIFIES that the building ADDITION Location of Property 800 WEST CREEK AVENUE CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 13 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 31, 1989 pursuant to which Building Permit No. 17854-Z dated FEBRUARY 17, 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 RENOVATION & ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RONALD BARRETT & BARBARA SCHUBECK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-112220-1/29/90 & N-112221- 1/31/1990 PLUMBERS CERTIFICATION DATED APRIL 13 1993 - MATTITUCK PLUMB & HEAT ~1.,- Bui ding Inspector Rev. 1/81 rows 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) N° 017 8 5 4 Z Dore ....?:R.~) V Z t 9.~..1. Permission is hereby granted to: ro .~1~.~9'...~^..a..l~~.:~.'F...G,d,:d..:~u....~...,~4~n-a~rir:c~......o.~...~....1.....4a~::gR....t,.~a1. ~V""""" at premises located at ..g.V.U.....~:!-a~'....~~r.~...4:k....Qh?o.:... ~~.Q'c;~.)5.. Caunry Tox Map No. 1000 Section .....~°.~z............ Block Lot No.....Q.~a............ pursuant to application doted ..~.aN..l:~l.......,~.~ 19.~'.q.., and approved by the building InspeQCtor. ~1 Fee $...l.~.1.:.4, Building Inspector Rev. 6/30/80 t FORM NO. 6 TOWN OFSOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted to the Building Inspec- torwith 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 water supply and sewerage disposal-(S-9 form or equall. 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible far the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 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. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory -$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4. Vacant Land C.o. $ 20.00 Mar 27, 1992 S.Updated C.O. $ 50.00 Date NewConstruction,,,,,,OldorPre-existing Building Vacant Land Location of Property ...$9p„W~st„Creelc,Ave. Cuthogue, NY House No. Street Hamlet Owner or Owners of Property „Ron Barrett and Barbara Schubeck County Tax Map No. 1000 Section 103 Block 13 6 Lot................ Subdivision ..................Filed Map Nojz., --..Lot No. ' ' ' Permit No. 0.17851}..2 Date of Permit 2/.12../$.9..Applicant . ~~'J. ;~,~4'"~l~!,~~-~-, Health Dept. Approval ........................Labor Dept. Approval , Underwriters Approval ........................Planning Board Approval , Request for Temporary Certificate .....................Final Certificate . Fee Submitted $ ~ S ~ ~ Construction on above described building and~~,pjjermi~+t~ meets all app ,icable codes and regulations. Applicant .~~!~!U,L!FI~!d~.. Rev. 10~10J8 Q'') ~r V k..7 en~aaa~~ g,al~Qa2~ 4ct.?uGSccac ~ av w+=-sT C Rc: rtc . Cuzu~?oG~u~=, nrw ~ t ~ 3S ~ ~ ~P2?t. 93 7r=~R 13utu~t~rG ~cQla(LTiu.~NT °,R~ LfrGuc95c0 nL~/aSc Ftn~r~ iW~ go~f~~2 , , s GG!'Z'~tFcC/a'itdN t={2o/K ouR G4.~natj~u2, ~Vt~~ti t'fuG~ ~~>.un.~gtriG 8 lam A'ztNG c~o~2P, ~ T l S zU t: Ln+S'T' (~OCU M4 NT Q L QU l l2-t: 17 p(jT/arN Oul2 Ct= 2rt t Ft C/a~r O h OCGU Q/aNCy , CNG~.OSNO /at..SO t=1n3t~ A Ch+LGtc i-Ut2 $ 2S. ~,/u1Z SCJh1=04~G ~OvNTy TAX /~A~ )~IUM(jt(~ !s 103. i3 - to, QI.C,G~^,(; SChi(] Cor- O To dull MANt-tIi'i'TAN Ac~o2css : 3~~.aAt~ SCrtv(3~GG 3g G' '~N~ST 72 ST. N~.n, yvkK. Ny 10)023 AnT ~ Tti ~,~N y cau , TEL.7G5-18472 ~o5~FF0~h-~~` TORN OP' Sp~JTE30d.1J ;~~~c OFFICE OF IIUILDIPIG INSPECTOR p rn P.O. ilOX 728 v' ~ry~ ~ T01VN I-TALL O~fc''- ~~'r SOUTFiOLD, N.Y. 11971 . Ol ~ - ,~J ~s a C E R T I F I C A T I O N Date_____ V F -C-~--~ Building Permit No. j ~gJ` L{ Owner (please `print) I } Plumber vc.~ ~ 4~~n ,m.~l:~~r~~ (please pra.nL-) I certify that the solder used in the water supply system contains less than 2/10 of to lead, - (plumber' si , ~t~f Sworn to befor~//me this !/~jl~'T~c'n/tf~"day of 6y-i~,~Y/G 19 3 . , ~~-P c - o~~J Not y ublic Rotary Public, C~~~~GL~~ County ~yryRgle Slma of Naw Yore T k ~ urty INSPECTORS r}~~; Victor Lessard ~ ~~J; F$1( Principal Building Inspector ;.r ~'Q Curtis Horton SCOTT L. HARRIS, Supervisor Senior Building Inspector r'~~ 'r- ~ w '}r F'-~':'~';ti ~ Southold Town Hall Thomas Fisher r ,v " ~ ~ P.O. Box 1179, 53095 Main Road Building Inspector 1,..~'^ Gary Fish °~'7/~ :^v~s Southold, New York 11971 Building Inspector ~ 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 APRIL 1,1992 PROPER-T SERVICES JAMES E. FITZGERALD, JR. P. 0. BOX 617 CUTCHOGUE, NY 11935 RE: RON BARRETT & BARBARA SCHUBECK 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) No Underwriters Certificate on file. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. XXX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ 17854-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. CC: BARBARA SCHUBECK I-i;D : ~c:,~;i flu„.a ccrrM~rrrs ~s ` m ono 1. ~ ~ H OUi7DATI0^! _ t 1is~) ca~ P _ N~d~ FOUtJDATIOt•1 (2nd) ~ z . P~a 9 a,E _ . P,OUGH FRAME .PLUMBING k 7 ~ ~ 3. ~ ~ IIISULATIOPI PER N. Y. r°~ STATE ENERGY CODE x \ - ~ G. U ,_Jti FItdAL ~ o ADDITIOItAL COMMENT'S: x P . ~ _ )p ra xJ v F-1 S. y o ~ z O x c~ A H _ ~ d [T7 b H i Q'4 C/1 a ~'7 °ss ~ vi V ~ m ~,r~ ~N~~3~ ~~~~is ~ pa~~ 1 M M ~ 6Y ~ ~ L81 1 ~ O q^~ ml !~Y 1 ~ z -~y~ r'I ;r ~ ~ ~f U 1 y~~ Z 3~ ~Q` < ma ~a W 1. g g~MZ ~ ~ ~ 1 ~ {.~a_ ~ 3 x 8 ~ ~ w ~~a o ~ N ~ 1-3jy f~~ 9.r~+z cl f ~4~6 ~ +1 ~ ~ i 'L 1 O 1L ~ w r 3 eg u~ e° ~ M ~i M Qs4z ~ ~ ~ R 3 ~ ~ V ~ o OZ~~ ~~3~u R - ~'t+~~r~7 ~ ~ 4 3 ;~;~a ~>r~,. 9t~3 ~.9-' h-dl'o 54h ~ 5 e ° 8 y< 1 q W~ Fr ~ n: ~ ; ~.1 Ca ayx~~ h ~ ~ ~ v~~~ ~~y, ~ ~ to o m - C j. `~~b,~~b- ~ ` i r ti, ~ G ~ jai h , ql D 1 ~ ..30 ~ 7t NQ ~o . N ~ ~ ui Q 1) (U i ~ } ~ ~ i ` ax n v Q ~ Z r- a. S m t(~t~~ 1kid+' 4'rA `Y ] i ~ ~ 5 C~ • sy ~~1 Q f ~4 m L! ~ l7 , V i V t a Y " ~ n a `cca2a 4 ra a ~ ~ N %.p r~ r N Q ' J/V?3/1 N .d l~I tT~ ~ ~ ~ ~ ~ ~ . . F 1 r ~ ~ : ~„s ' 1~' r ' Prape"r-T Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935 (516)734 -5800 January 20, 1989 President Board of Town Trustees Town of Southold Town Aall, 53095 Main Road Southold, New York 11971 Re: Request for Confirmation of Non-Jurisdiction; Project on ' the Property of Barbara Schubeck Barrett Dear Sir: Attached are drawings and maps which describe a project to expand the home of Barbara Schubeck Barrett, located at 800 West Creek Avenue, Cutchogue (Tax Map No. 1000-103-13-6). The project is located more than 75 feet from wetlands or a body of water. Proper-T Services represents Mrs. Barrett in this matter, and a letter of authorization is enclosed. I would appreciate it if you would confirm that the project does not require a wetlands permit from the Trustees, in order that the application for a building permit may proceed expedi- tiously. If you need any more information or have any questions, please call me. Yours truly l J mes E. Fitz aid Jr. Enclosures: ' Vicinity Map Tax Map Survey of Property Project Plan Grade Profile a ,subsidiary of THE PECONIC EASTERN CORPORATION Pro~e~ -T Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935 (516)734 -5800 January 20, 1989 Regional Permit Administrator New York State Department of Environmental Conservation Regulatory Affairs Unit Building 40, SUNY, Room 219 Stony Brook, New York 11794 Re: Tidal Wetlands Jurisdictional Inquiry on behalf of Barbara Schubeck Barrett Dear Sir: Enclosed are documents prepared to enable you to render a decision of whether or not a DEC permit will be required for a project to expand the home of Barbara Schubeck Barrett (home address: 344 W. 72nd Street, New York, NY 10023; home phone: 212-362-2156). The site of the proposed project is the prop- erty at 800 West Creek Avenue, Cutchogue; Suffolk County Tax Map No. 1000-103-13-6. Proper-T Services represents Mrs. Barrett in this matter, and a letter of authorization is enclosed. We request that favorable consideration be given to this request for a letter of non-jurisdiction on the basis of the enclosed documents which indicate that the elevation of the project is landward of the 10' contour line as is indicated on the enclosed enlarged portion of the USGS map of the area, together with the measurements made by me and set forth in the "Grade Profile" drawing. We found that it would involve a significant expenditure to have a surveyor add the contour lines to the survey, and a a subsidiary of THE PECONIC EASTERN CORPORATION Regional Permit Administrator -2- January 20, 1989 considerable length of time would be required. If it is not possible determine non-jurisdiction on the basis of the data enclosed, please notify me so that we can prepare and submit an application for a wetlands permit in lieu of providing a new survey with contour lines added. If you need additional information,. please call me. Yours trul , ames E. Fit ral J . Enclosures: Vicinity Map Tax Map Property Survey Project Plan Grade Profile USGS Map (portion, enlarged) Site Photos (5) 344 W. 72nd Street New Xork, New York 10023 October 11, 1988 Executive Administrator Building Department Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Services to act in my behalf as my agent in the submission and processing of a permit applica- tion for construction to expand the residence on my property located at B00 West Creek Avenue, Cutchogue, and designated by Suffolk County Tax Map No. 1000-103-13-6, and to furnish, upon request, supplemental information in support of the applica- tion. Yours truly, Barbara Schubeck Barrett Proper-T Services POS7 OFFICE BOX 617, CUTCHOGUE, NEW YORK 17935 (516) 734 -5800 January 30, 1989 Executive Administrator Building Department Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Attached are documents prepared in support of the application for a Building Permit for expansion of the home of Barbara Schubeck Barrett, 800 West Creek Avenue, Cutchogue. Proper-T Services represents Mrs. Barrett in this matter, and a letter of authorization is attached. It should be noted that the project is outside the jurisdic- tion of both the Town Trustees and the DEC, and copies of my letters to each of these agencies in this regard are also attached. I would appreciate it if you would begin review of this application as soon as possible. If a formal written response from the two agencies is a prerequisite, please let me know so that I can attempt to expedite the responses. If you need more information or have aray questions, please call me. o trul a es E. Fit raid, r. Attachments: Application for Building Permit Letter of Authorization Plot Diagram Copy of Survey Architect's Plans (3 copies) Letter to Trustees (1/20/89) Letter to DEG (1/20/89) a subsidiary of THE PECONIC EASTERN CORPORATION l 0 765-1802 BUILDING DEPT. t NSPECTION [ ]FOUNDATION 1ST ( J ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: /~tiar~-- G~ DATE ~ ~ INSPECTOR rss-isoz BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST f di} ~ UGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ] FINAL K Ov~ REMAR S. . - I i ~ I DATE INSPECTOR i 765-1802 BUILDING DEPT. INSPECTION [ ] F,,~~UN ATION 1ST ~ ~ !ROUGH PLBG. p"O~ ATION 2ND [ ]INSULATION [ 7 FRAMING [ ]FINAL REMARKS: C!=~=~-----,~ ~ - 1/`'?~. DATE INSPECT _ ~ ~ 76~-1802 G~~ ~ ' BUMLQING DEPT. ~ INfiP~CTI~I [ ~ FOUNDATION 1ST ( ] ROU~H~PL"BG, [ ] FOUNDATION 2ND ,,fSLLAT~~~t! [ ] ~RAMINti [ ]FINAL REMARKS: G?~i~ ~~?~7 -~Ez~ _ ~ ~ . ~ L < e ~ i7~~1e~~ 7.~d° QA~TE ~ _~INSPECTOR 7 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~At'~' 2000093 BUREAU OF ELEGTRICTTY 85 JOHN STREET. NEW YORK, NEW YORK 10038 iALir`,:.: .....JANUARY .31,1990 ApplieaNonNo.onJue 39016986/kb N 1.12221 THIS CERTIFIES THAT only the eMctrkNd equipment o, described 6ekno and introduced 6y the opp/tcant named on the ahow applicetton numksr Jn the premises of BARBARA SCBUB6CK, 800 W.C.RE:I:K ORIYE, POI,S 7, CUTCNOCUF., N.Y. in theJolbmInR kre ' e ~ lat Fl. ? Yrad F'1. .Section Block /.ot S'f~vAl~ Y'496 uw examined on and found to 6e in compliance with the reyuirements of thu Ortord. pXTV~ AQES fWRCN6 RXTURES RANGES COOIttNq DECRS OVENS dSN AUST FANS WTIETS IMCANDlSCENi ~ NVOIIESClNi OTNER AMT. K. W. AMT. K, W. AMT. K.W. NAT. K. W. AMT. N. P. 4 0 4 4 ~ DRYBtS RJRNACE MOTORS pITURE AMMIANCE WENS S?lgAt REC1T TIA16gEOCKS qLL aNIi HEATERS MalT40YilRT DIEAEARRS AMT. K. W. ~ pt. K R. GAS N, P. AMT. NO. A. W. G. AMT. AMY. AMT. AAVS. TRANS. AML X. P. ~a t~T AMT. WATTS Q fRRVKS: DKCONNECT tt0.0? 5 E R V - 1 C E AMi. AMR. TYP! METER 1 / tW 1 ,e SW t / SW S / AW NO.OF CC COND. A. W.O. NO. OF NI.LEG A. W. G. NO.Of NFYnAIb A. W G EOUI?. YER / Of CC. COND. OP MI-U'G or NEUTXM 1 100 CB 1 X 1 2 1 'L OTIpR A??ARATUS: G.P.C.1:-1 sNt~xs nlsTKrroR:-1 ~ ~i- ~ r- G 6 S BLRCTRIC COM. 4TC.f`~'J8 821 KRNT AYRNUE BROOKLYN, NY, 1120!i oY1RA/ MANAGER 11 Pn ,.•-'G Thit cerHf'leaN mutt not bs altered in a~ly monner; return to the office of the Board if .incorrect. Mtpecton may 6e idenHNad (hair «edeMiak. FOR BUILDING DEFAdtTMENT. TINS OF FIG AMJST BE ALTERS NI ATIT MMt1ilER _i ,r. ~ _ ~ _ _ _ _ Tt#E NEW 1f~t71RK QARp OF FIRE UNDERWRITERS PACr•: 77$5077 AV OF ELECTRICITY - BS JORN ,'NEW YORK, NEW YORK 10038 Date. JATIUARY 29,1990 ApplicstionNo.onfile 61x36089/89- it 77E220 TNfS CERTIFIES THAT only thealactrfsi equipment a described belmo and introduced by the o/tp//leant named on the. shove appliestion number fn the promises of R.BARR~1'T, -A00 iiEST CkF.ER AVE, PCII.F. 'l, CUTCROGUF:, N.Y. in tkefATf(~o~a~Y,4fe~~ril ~SXRUARIT' BasepEe~~ ~ let F(. ? Ynd FI. `BUT Section Black Lot uweeomified an Jhlfu TT tJ8 , l.7 and found to 6e in compliance uilh the reyuirernenta of this Board. gXTUEE RXTYRlS RANLi6 t:001IM1fi WOKE OVlNS DISH WAEIIlRB EXHAUST FANS OUtt6S ~C<iE EWIiCNlS INCANDESCENT ~ PlUDI1ESCENT OTHER AMT. K. W. AMT. K. W. AMf. K.W. ''AMT. K. W.. .AMT. M. P. s7 9 2a 3~. a 1.z ~ s DEYNS' fUI1NAC! MOTORS IUTUM AhIIAtEC! ItERlRE SP[CIAL EECST TIME CIOCIIf t1Y/ UNIT (MATERS MUq?0LIf1ET oYEMERS AMT. ~ K: W. dl N. P. GAS N. P. AMT. Eq. A. W. G. AMT. AMP. AMT. AMPS. TRANS. ,AMT. N. P. NO. ~ NAT. WATTS - 2 F 1 fi0x SERVK! MECDNSBCT NO.W S E R V 1 C E AMT. AAV. TYPE ~R t J TW I J Tv )LTV )JAW ~ER HCOND. OF Z COND. OP NFIEG OI NO.OF m11IKAle d~! F'lrGMl 3 Tao ce x 1 x 1 z OTtINI ArNiulATI1S: G.F.C.T:°4 SHOKS DE7SCTOR:-7. - RASLAR Ri.RCTRIC. LLC./3677 _ P.0.90X 164 ~ PATCROGUR, NY, 7.7.935 11 Psr _ Thit csrfificah muff not be .altered in any mamler; return to tM Office of fha Board if incorrocf: In r'.. be ' by ffstir crydmtialE. - ~ - COPY FqR BUILDING DEPARTMlNT. TMS COPY OF CER7IFIGTE MUST NOT 81~ A~ ~kN~IK IMiJt1ER. BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.:765-1802 CALL yy MAIL TO~:a Examined .CTa~:~~ 19 a ~ L~° ~,~__vV. ~..,~,~-y,, Approved ~A~^•!~^k'~ .1.~., 19$`). PermitNo.)~g.~~ti~.:. ~f. I'I) ~ JAN 3 I " ' Disapproved arc 989 '~f ..,_b,-„~-..~.,-.,~1~ . BLDG; Dcf37. (j TOWN OF 50UTH040 (Building Inspector) APPLICATION FOR BUILDING PERMIT , Date . ,January . 30.. • , 19 89 INSTRUCTIONS a. This 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 permit 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 Btilding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and oth r applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remov r e tion, as herein escribed. The applicant agrees to comply with all applicable laws, ordinances, ddin code, ng egul to ,and to admit authorized inspectors on premises and in building for necessary i s.. . PR®I'ER-T SE~tVIC~ 'g ature of applicant, ~ me, i orpo uon) Jaynes E. F6rzperald, Jr. P.O.Boac617,Cufch®guo,NY,11 Phono: (516) 734.5800 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Applicant is an agent of the owner Name of owner of premises ,Barbara Schubeck and Ronald Barrett (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. 1,10$-H~........... . Plumber's License No.Not known at this time Electrician's License No. , 3677-E• . , , , , , , • . , , , , Other Trade's License No. 1. Location of land on which proposed work will be done . . 800.Wes.t . Cx'e.~k. Avenue.,..Cut~.hogue House Number Street Hamlet County 'tax Map No. 1000 Section Block Lot 6 , Filed Ma No. Subdivision P Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,Single family• residence b. Intended use and occupancy Single ,family, residence ! 3. Nature of work (check which ap~licalile): New Building Addition ...X~X.... Alteration . Re air Remo, p 'val Demolition Other Work . ~ ~ (Description) 4.' Estimated Cost ~80,.~~,~ Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units ......One, , , , , , Number of dwelling units on each floor , , , , , , , , . If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structure, if any: Front ....¢0!...... , ,Rear ¢0!, • Depth ¢.p ! . Height ~ ' .6 n Number of Stories . . Dimensions of s dime structure with alterations or additions:nFront ,48 ~ Rear ~J?.r.......... . Depth .....45 . . .Height ~ 5. , , 6 Number of Stories . " 8. Dimensions of entire new constr~rction: Front . , , , Rear Depth . Height Number of Stories. 9. Size of lot: Front ?3.~ ~ . Rear Depth .23]!-2631. v~F..... . 101. one or use district in whi h 8 e • ~ • • ' ' ' ' ' ' • • • Name of Former Owner ....Mae ,I~al,],deM, , , , , , , , , , , , • A-Residential mrses are srtuated ..........................No , . . P 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded N;P Will excess fill be removed from premises: Yes No 14. Name of Owner of premisesBa><'bax8. ~aSX'Qtt, . ,Address 3.¢.4 .Id...7,2d. S.t.. Nlihone No. 212r.362c2.1.56 . Name of Architect r1.~rG~!iS, .lj}G)<tte~, , , , , ,Address ...G>: ~s???P.4~'t...... Phone No...¢.7.7.-099A . Name of Contractor .Bay, Creek ,1~uilders, , , ,Address , , Cutehogue, , , , , ,phone No... 734-62,70 , , , 15.Is this property locaXed within 100 feet of a tidal wetland? *YES.X..NO.... *If yes, 'Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block #iumber or description according to deed, and show street names and indicate whether interior or corner lot. See attachments STATE OF NEW YORK, S.S COUNTYOF..S'.~.(=F??-K.,,,,,, ; • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • 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 conta4ned 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 ~Vvl~, .day of'~... ; •J,fin~nn;~^•y 19 ~9. Notary Publrc, .......~~,f?-, , County JANE R. MINEHVA i NOTARY °I IRLIC, State of New iYork v • • . N~ '3- t.r~8, Suffolk County ~ ~ I/ t;OmmisSio~, ~xpues February 18', 19~ (Signature of applicant)