Loading...
HomeMy WebLinkAbout17336-za, am Z-18481 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date NOVEMBER 20, 1989 THIS CERTIFIES that the building ALTERATION TO ACCESSORY Location of Property 23;75 SIGSBEE ROAD MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section Subdivision 144 Block 2 Lot 23 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 5, 1988 pursuant to which Building Permit No. 17336-Z dated AUGUST 22, 1988 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. ALTERATION TO EXISTING NON HABITABLE ACCESSORY GARAGE BATHROOM INSTALLED. The certificate is issued to MARTIN V. & CECILIA ZUZULO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-092216 - SEPTEMBER 18, 1989 PLUMBERS CERTIFICATION DATED OCTOBER 20, 1989 -JOHN E. WALTERS PLUMBING 4Z44,1 d- 1e�l Bui ding Inspector Rev. 1/81 FORK X0.2 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) NQ 017336 Z Date ...G. ......A.A.............. 19469 Permission is hereby granted to: to......r.-Jil ....... ... ........................ �•,-, ��T�✓1�...... ................. ............................. ... . .... at premises located at .......� 1 ............ .... �..1%..1........................................ ......................... I..................��<.. �' .� . ,1..../...1.... ................................ ........................... ..................................................... ................................. .................................... County Tax Mao No. 1000 Section .../... L�... Block ..... 0...�.......... Lot No. 2. pursuant to application dated ..... ........ti./ ...................... 19..&G, and approved by the Building Inspector. Fee $ uilding Inspector Rev. 6/30/80 ` TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 11971 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ��// DATE.0&.IV' NEW CONSTRUCTION ....... OLD OR PRE—EXISTjING BUILDING.,' ...VACANT LAND.R...Q.�_.. Location of Property. .��:�i?2,. HOUSE NO. j� STREET HAMLET 6 Owner or Owners of Property.. .lVVYJY'.N �f—,C�Ge,�`c���........-.._ County Tax Map No. 1000 Section _1�.Block ..�._. Lot-..... Subdivision........... ......... Filed Map ........Lot. 3 36 '��/ Permit No.i .� ,. Date of Permit .�d.?:: pplicant Health Dept. Approval .................. Underwriters Approval.e', Planning Board Approval ................ Request for Temporary Certificate Final Certificate Fee Submitted: $.q „ c APPLICANT.... .. _ ..... rev- 10/14/88 3sqs FORM NO. 6 TOWN OF SOUTHOLD J BUILDING DEPARTMENT TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusuallnatural or topographic features. 3. Final approval of Health Dept, of water supply and sewerage-disposal(S-9 form). Approval Of electrical installation from Board of Fire Underwriters. 4. Sworn statement fromiplumber certifying that solder used in system contains l than 2/10 of 1X lead.! ess 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, -existing(iprior to April 9, 1957) non -conforming uses, or buildings and "pre" 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' ting to the applicant. 3. Date of any housing cede 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 OCCUPANCY - New Dwelling $25,00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $10_00 Addition to Accessory buildings, $10.00. - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3, Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4, Vacant Land Certificate of Occupancy - $20.00 5. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $15.00 tep• 10/14/38 oc��F F ULA- TEL. 765-1802 o O� TOWN OF SOUTDOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 IP Ems' 3� TOWN HALL Rn-) SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date 0c�bev- aU n9i Building Permit No. Owner ,SIA A) (please print) ,f Plumber �Jkh� IUM-"tL�15 V1uw8i�,f �tA-/Ic, (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this dny of 19 Notary Public notary Public, County HFLEDIE D. HORN! PuW* 9tt 0fNfW� OualiRed in Suffolk County Commission Expires May 22,19..E G THE NEW YORK BOARD OF FIRE UNDE7ERSRS PAGE 1. 100031,4 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date SF',PTtil'4BER J8'1'-jP'9 Application No. on file 643'13989/0092216 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the abomber in the promises of ZKOLO, 2335 STG8BI K, P01,F/ i9, NA.1.1fTUOK, N� V, in thefollowing location; ❑ Basement � Ist Fl. ❑ 2nd Ft. COT GAGEock LotAlis, S 2 ar! ound to be in com liance w•ith the rhis Board.wasexaminedun 0 1 '1l f p FIXTURE FIXTURES RANGES COOKING DECKS WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT K.W AMT K.W AMT K W AMT. H P OUTLETS ECEPTACLES SWIiCNEs 2 '7 5 n DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT TRANS. HEATERS MULTI.OUTLET SYSTEMS NO. OF FEET DIMMERS AMT. K. W. OIL H. P. GAS H. P AMT. NO. A. W. G AMT AMP. AMT AMPS AMT H P AMT, WATTS SERVICE DISCONNECT NO. OF S E R V 1 C E AMT. AMP TYPE METER I A, 2W I g 3W 39 3W 3,8 4W NO. OF CC COND PER PER A W G. OF CC. COND NO. OF HI LEG A W' G' OF HIAEG NO OF NE TRALS A W. OF NEUTRAL OTHER APPARATUS: PAN81i,B0Aff[IS:1.-3 (JR, 100 Yf.�I. H;LF^"1`ACC° CU. i,IC.#2S"70..ja BOA 16,STIIJfWATkR. ANF. , cu'ft;HOGO E, NY, 1.1 ms GENERALfAANAGER t Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PA" 1 1000663 BUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NEW YORK 10038 r 5Fs1't13tiH�R }:9,7Ag`% 5'7918 SAIS N 094711 Date Application No. on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MARTIN 7A)ZOLO, sHiEBE,l".--N71ST "1UY* OF ST, POIX #29, P-ATTITuCKr N.Y. gg e, SAP Section Blork Lot in the following location• ane e.t Ist Fl. 1:1 2.d Fl.. J'1"Gf }51.22 T9a f was examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS FLUORESCENT OTHER AMT. K, W. AMT.. K.W PMT K.W. Ami K.W. AMT. H.P. OUTLETS ECEPTACLES SWITCHES INCANDESCENT Fi `7 6 5 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT TRANS. HEATERS MULTI -OUTLET SYSTEMS NO. OF FEET DIMMERS AMT. K. W. OIL H. P. GAS H. P. AMT NO. A. W. G. AM,. AMP PMT. PMP&. AMT. H. P AMi. WATT& SERVICE DISCONNECT NO .OF S E R V I C E AMi. AMP. TIPE METER EQUIP. I A 2WNO.OF CC COND. PER % A. W G. Of CC. COND. NO OF Hl LEG A W G NO OF NEUTRALS OF HJAEG A' W. G. OF NEUTRAL OTHER APPARATUS: GAVAGE APARTMENT TOREING 010' :y—:1 PANPLBOARD4t'I-3 t'.1I. 100 GLEMN R. HRADLHY LIC.#2227 P.O. Box 602 LAUREL, NY, 1.1948 GENERAL MANAGER 11. Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS pAGX 1. 10 00663 BUREAU OF ELECTRICITY F 88 JOHN STREET, NEW YORK, NEW YORK 10038 S@:PTxmv 29,J.989 30972685/85 N 094861 Date Application No. onfile THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MARTON ZU2UL0, SIGMA RD— WAATTC`!' ICK, N.Y. in the following locottgn,=� pva �mBr�t Ist Ft. ❑ 2nd Fl. Section Block Lot was examined at, and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTAClES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT K W. AMT K.W AMT K.W AMT K W AMT. H P. DRYERS F1IRNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT TRANS. HEATERS MULTI.OUTUT SYSTEMS NO. OF FEET DIMMERS AMT. K. W. Olt H. P GAS H. P AMT. NO A W. G AMT. AMP AMT AMPS AMT. ry p qMi WAITS SERVICE DISCONNECT NO.OF S E R V 1 C E M1i. AMP TYPE METER FOUIP. I %. EW 1 % 3W 3 %3w 3%4W NO. OF CC GOND. PER% A. W G. OF CC CON, NO OF H4lEG A W. G. OF M4LEG NO Oi NEViRAI$ A. W O. OF NEUTRAL C13 1 X 2 1 1 I OTHER APPARATUS: 31FIRVFC.E, CHANGE ONi'lY-1 F,O, BOX 6012 flAttfou" fly, 11 9118 GENERAL MANAGER Per) This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. Mom COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANMER. TOWN OF SOUTHOLD OFFICEOF BUILDING; INSPECTOR 1'.O.BOX 1179 TOWN IIALL SOUTHOLD, N.Y. 11971 OCTOBER 11, 1989 MARTIN & CECILIA ZUZULO 789 PELUAMDALE AVE. PELHAM, N.Y. 10803 To Whom This May Concern, We are unable to complete your Certificate of occupancy because,of the following reasons. TEL. 765-180' VAn application for Certificate of Occupancy Please contact our office on this matter. Thank you for your cooperation. lu.ildir.g Permit-. 0 1 7 3 3 6 Z Building Dept. rlo Plumbr_r SOldcr Certificate on file. ( all permits involving plumbing being iasucd after April 1,1984 ) is not on file. (ENCLOSED) jx/ No Underwriters Certificate on file. /x -L The chick .i:: (najdakxtnxic/ of on file.) $25.00 No 11cal.th Dept. Approval on file. No final inspecUion has been made. Please contact our office on this matter. Thank you for your cooperation. lu.ildir.g Permit-. 0 1 7 3 3 6 Z Building Dept. rlo Plumbr_r SOldcr Certificate on file. ( all permits involving plumbing being iasucd after April 1,1984 ) 16 L�< < r �� �..J�/ y t i l •I�i r of BLDG. DEPT. TOWN OF SOUTHOLD Con 75'/I 7� uS(o9V Y VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516) 765-1802 FAX (516) 765-1823 Town Hall, 53095 Main Road P.O. Box 1179 I' Southold, New York 11971 ,y® , OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD November 1, 1989 Martin S Cecilia Zuzulo 789 Pelhamdale Ave. Pelham, N.Y. 10803 Re: 2335 Sigsbee Road, Mattituck S.C.T.M.61000-144-02-23 Dear Mr. and Mrs. Zuzulo: The Building Department has received complaints that more than one family has been living on the above property in Mattituck. Please be advised that according to the Code of the Town of Southold, Article III Chapter 100-31A1 and 100-31111 only one (1) family dwelling or one (1) two family dwelling by Special Exception of the Board of Appeals is allowed on your property. If you are found to be violating the Town Code you are subject to legal action and possible fines. Very truly yours, Southold Town Building Dept. uUA'� k W Vincent R. Wieczore VRW:hkd Ordinance Inspector VICTORLESSARD's EXECUTIVE ADMINISTRATOR} " (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD Mr. & Mrs. V. Zuzulo 789 Pelhamdale Ave. Pelham, N.Y. 10803 N Town Hall, 53095 Main Road P.O- Box 1 179 Southold, New York 1 1971 August 23, 1988 Re: Suffolk County Tax #1000-144-02-23 2335 Sigsbee Road Mattituck, N.Y. Dear Mr. & Mrs. Zuzulo: During a recent inspection of the above property in regard to application for a Building Permit, I saw an apartment in the rear of the one family dwelling. According to the Code of the Town of Southold, Art. III 100-30B(15) an apartment use is only permitted by a special exception by the Board of Appeals. Please contact this office immediately to request the necessary variance to avoid any legal action. Thank you for your cooperation in resolving this problem. Sincerely yours, 0- tuo VRW:hdv Vincent R. Wieczorek Ordinance Inspector C. '-W V c. L' ., ujQ c.�Yc,•e.-l' 'U�.-t�.c, J�22�$°( 1 �i + I O � �L �J�� �eL�/�- _ ✓ vA - -- - - -41 06 16V3z- ? `� �aA u'� pti '7�-3 3S- rowrv°'o°F 'sou'nto�p Ae zL4) - - - C3i-v Y\,O -' \k �knA-Q- . a -_ h ► s- -- ----- -- -- - -- �- 0 r I( calL f t �p e VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516) 765-1802 FAX (5 16) 765-1823 LO m OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD November 1, 1989 Martin S Cecilia Zuzulo 789 Pelhamdale Ave. Pelham, N.Y. 10803 Re: 2335 Sigsbee Road, Mattituck S.C.T.M.31000-144-02-23 Dear Mr. and Mrs. Zuzulo: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 The Building Department has received complaints that more than one family has been living on the above property in Mattituck. Please be advised that according to the Code of the Town of Southold, Article III Chapter 100-31A1 and 100-31B1 only one (1) family dwelling or one (1) two family dwelling by Special Exception of the Board of Appeals is allowed on your property. If you are found to be violating the Town Code you are subject to legal action and possible fines. Very truly yours, Southold Town Building Dept. Y U—%U-t"J Vincent R. Wieczore VRW:hkd Ordinance Inspector 0 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST A�I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ) FINAL DATE `_INSPECTOR , l7a M-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION 1ST ( I ROUGH PLBG. [ ] FOUNDATION 2ND [ I INSULATION [ l FRAMING [I'�] FINAL REMARKS: -cr DATE Z 1NSPECTOR N X 1 rock CoycaA. N+,404 paodtx," Cho ;e.sut0.�ionl Tki'S7 Wta tgo u to i" �� a�11 uw�s;dewaLls� z Xy_ imS�Ya�cc� (� rc.,l. 6aEti) Gn y9e r P.ea ev WCOA ........ . .. ... �aa��t ink �K�,} Fntranc� .00r e ire �b ofa-e'fi reQpt ear►�n ���� ��Iz.` tu�ti hfi„LV Oct, a frox., pq L.. A/ 'C up'J.4Oc t V2 =io, pk son -caSe- � rsir,ee. 14y) �Coo� +0r twaso�1,E5�,, .t W l OCCUPANCY or, ullk"3 MUT 1 APPROVED AS NOTED DATE:- B.P.N`�� FEE: _�.._ lBY: __ _ ___ _� NOTIFY BUILDING QEPARTMENT AT 765.1802 4 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Z ROUGH - FRAMING S PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTbN MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SMALL MEET THE REQUIREMENTS OF TME N.V. STATE CONSTptiCp011l a EIyeV CODES. NOT RESPONSIKE ROp DESIGN OR CONSTRUCTION ERRORS lELD i;:SPEC".iON JJDATE „ CUaKMbNT _� FOUNDATION (13t) FOUNDATION) (2nd) H 13 C CT] 2. ROUGH FRAME & PLUMBING z o (� U 3. INSULATION PER N. Y. STATE ENERGY CODE H ra 9 4. FINAL �6 /_rte �H r 1-1?'Gam.-cl��� Cp -- or /0/0 elo I / ADDITIONAL COMME z • x ro H 71 KII 2 .\ r C1 • Y r H S ��J; �;c�s_2;��•c�.� ���r�o�� Ma,��-t•, uc� ��,�c�.���:-;�:���;,;:: �-E_._Ea s� ray .,t - - ::rili-FOf.'� �';)..:ttk:1:`. c`_.E=FiC✓r tw�'�"u+4'"�tG'.ESUf. c'..- _-.._._ - , .. / - -, `-;. IiS }Y u4 -/AL"6P;2ED ALTER VOR OR ADD1FiOk FO THIS SURVEY IS A VECtATU� ``( f ECTfON 7209 OF T} !v\V YOBn $inTE f - ( 11 7 DUCATION CAVI. 1 M - OPIES OFT S <.,TV=Y 3r. ffj z D 4 AT j IS .0.•tcu" -lWFB w {1, ' THE LAN SNOT -A'- EMBOSSED 5.,. E -re.• 'rt TO BE A I _ GUA2i.N`.E,S l\,:Ogi9D f(LR:^v;a iNALt'UK /f OK.Y T, TO O TF:E FE IS PEO ` FCP y;f^ hi ME ^ f i.F.JARD =AYE' J MU CCtA,t,,,O fi- Ofi "81u^(. ACrA.E• :Y AN f lEND!NG1171 S•1 ! zc Tae As,zr..;; in, r• -s .;v, n: ; - r _ .r` a Ar YE moi, s' .v3ltknfiPi iCir Y.j _i"'Ebtfi..ii T•`1^.?ri 'i<t'%e'i h. �R'.y'Yf' ._....�.^^,-••�...--�...--�..,.......:..T `. �... ice', vz�: : - ` FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined . ... —�..., 19 ,:Q /1 q Approved !7`dE, .., 19A Permit No. U 49! _Z Disapproved c ..................................... .................................... ... (Building Inspector) BOARD OF"HETH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: APPLICATION FOR BUILDING PERMIT Date . b.4-9. S......., 19 ET 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 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 inspectors on premises and in building for necessary in a tions.... D .. ............ (Signature of applicant, or name, if a corporation) �..1'e.I l�.. :....... (Mailing afldr!Ctrician, of applican lf,/b JVr 106 C� 3 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, e plumber or builder. ......�..................`...............f......................../.................. Name of owner of premises ../.:liP�...U.•e••?�-k�r�`�•••N G ZL!` �••••••••••••••• (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. ............. • • • ?,ham " Plumber's License No. 11 • • • Electrician's License No . ..................... Other Trade's License No . ..................... 1. Location of land on which proposed work will be done . ................................................ . 9,:s3-' ......<S�GjS.��."....1 t...K1ffi�!k!CAS............................ . .............. House Number Street Hamlet County Tax Map No. 1000 Section .....�. �f ....... Block ...a ............. Lot .... .�3........... Subdivision ..................................... Filed Map No. .............. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use andel Occupancy of proposed construction: a. Existing use and occupancy ' ^ �• r v .C% t� ............................... °4x b. Intended use and occupancy ....... • • • • �• !SSU ,„ 3. Nature of work (check which applicable): New Building ........... Addition .......... Alteration . ?/...... . Repair . , , vat .............. Demolition ...... ..... Other Work ............... 4. Estimated Cost ............. (Description) P •••... Rem !�......................... Fee ..... � �� .................... . (to be paid on filing this application) 5. If dwelling, number of dwelling ;units .... AP........ Number of dwelling units on each floor ................. Ifgarage, number of cars .... .. 4(9K.Q.......................................................... . 6. If business, commercial or mixed occupancy, specify_ nature and extent of each type of use ..................... 7. Dimensions of existing structuraIs, if any: Front .. L r Rear .............. Depth ............... Height ............... Number of Stories....................................................... . Dimensions of same structure with alterations or additions: Front ................. Rear .................. g .. Height ...................... Number of Stories ...................... 8. Height ........ e Nu ruction: Front ............... Rear ............ r .. Depth ............... 9. ize t lot Dimensions of entire new co umber of Stories....:..................................................... Font ..........47. 4........ Rear ....... 6._0 ..... Depth ... ....... 10. Date of Purchase ........ �. Q, &,p .... , • , , , , , , • NaMe of Former wner. proposed osed construction vuse districtP emises are situated .. �S.(.*a..' �� !• 11. Zone 12. Does ro iolate any zoning law, ordinance or regulation: N ©........................... . 13. Will lotrbe regraded in which r Will excess fiB be removed from premises: Yes No 14. Name of Owner of, 1 remises . 4d; i c u 1 p Address;�S,qr a� . 0(o. Phone No.. l `f .. ?*3.5: Name of Architect ........................... Addres Phone No..........>� P Name of Contractor ....... .................Address ...................Phone No.......... ..', 15.Is this property 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 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 �P V0. C) 1115 I STATE OF NEW YORK, COUNTY OF ................. $•S (Name .. individual s... .... • . • • . ' • • • being duly sworn, deposes and says that he is the applicant {:g 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 manner set forth in the application filed therewith. Sworn to before me this r ............... ?......day of ......c//_'' .4,9-7 ....., 19 ff. Notary Public, ...... K �.. i J .. 4?A-,Cld , , , County NORARVPUEN �NlwlbdC (� �� �� ....... No.4701370,Su0olktq (Signature of applicant) tum FxWms M�mn 30,1