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HomeMy WebLinkAbout17510-z~1` T FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18848 Date FEBRUARY 27, 1990 THIS CERTIFIES that the buildina ADDITION Location of Property 1220 SIGSBEE ROAD LAUREL, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 144 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 20, 1988 pursuant to which Building Permit No. 17510-Z dated OCTOBER 6, 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 ADDITION TO EXISTENG ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MAUREEN COYNE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE N0. N-057767 - 2/9/1989 PLUMBERS CERTIFICATION DATED_9/25/1989-MATTITUCK PLUMBING & HEATING CO. Vii-- _ B ilding Inspector Rev. 1/81 aoaat xo. s BUILDING PERMIT TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON T)1E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ti1751O Z Dote ... ~~.:-~....... ..., 19.x.$ Perrnission is hereby granted to: gip. z,~-....~~:.....~,~. .. ~- ..~~~~~.~.,~: ........~4.........a~~ ... ~....... ~„'` ct premises located a~...l~ ~.Q.......~~.~~.~!!z.....~~ .............................................. County Tax Map No. 1000 Section .......~~r..... Block ............/........ Lot No............r......... pursuant to application dated ... building Inspector. ~~/y Fee $..~./...~.i... _„/ ./~f. ,fl ....................................... 19. and approved by the Buil ' g Inspector Rev. 6/30/80 _nY'' TONN OP SOUTIIOLD vV" BUILDING DEPART:fENT TONN HALL SOUTHOLD, NEH YO[tK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPAL7CY FEB 2 Z 18~ DnTE. F~px~~arY. ??~_ ?990 NEH CONSTRUCTION .......OLD OR PRE-E%ISTZNG IIUILDING......VACANT LAND.....__. Location of Propcrty...,1220._..~Sil,sbee /_Ro&d__.•_ Mattituck ,` UOOSE NO. STP.EET HAMLET Os+ner or Ovncrs of Pro ert i4aUY'een Goyne County Taa Map No. 1000 SecCion ,a:~}~~,. Elock .. ~._. Lot' 4 Subdivision ....................... Filed Map .._..._.Lot._.._..._. Permit No. .7..7J~9~._..Date of Permit 1o~6/t38 1;nvironm©t1t F:g~t Tnc, for •- ...Applicant .....__ owner' ....... Health Dept. Approval N/A .............. Undcrvritcrs Approval..........._.. PlanninE Board Approval ..NrA........... Request for Temporary Certificate ....... Final Certificate Pee Submitted: $.~5„j~,,,,,,,,,,,,,,, APPLICAN T~~,,~~ .. _ _ Pre9~, 1~ ~ron~~ent a ,'Inc;. .....---•-.. rey- 10/I4/8 al,~. 3 9o y~ coy ~ssv~ 7d '.> 9~ ~~yppyypp z~ FO[tM NO. 6 Til01E! .i '.'s I:~.i 5 TOWN OP SOUTTIOLD BIIILDING DEPARTMENT TOWN BALI. 745 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY l~ p, This application must be'filed in typewriter OR ink and submitted to the Building Inspector with the following; fqr 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 Bealth Dept. of water 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.', 5_ Commercial buildings,lindustrial buildings, multiple residences aqd similar. buildings and installations, a certificate of code compliance from the Architect or Enginees recpoxisible for the buil"ding. 6. Submit Planning Board~lApproval of completed site plan requirements. B. For existing buildings ~PrlOr to April 9, 1957] non-conforming uses, or buildings and "pre-existing" land µses: I. Accurate survey of prpperty 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 tl~ ~ntire lot prior to April 9,'1957. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing 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: y 1. Aa 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: d. ?:ER.TIFICATE OF OG`CL=PANCY - b?e=a Pnaelling $25.,00, Additions tq D~:elliug $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. 2. Certificate of O~cupancy'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. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy -$15.00 Residential Commercial CO. 10/14/38 O~~FF~~ CO/ TEL. 765-1802 ~ ~, TORN OF SO'UT730d,D ,~~. = s . ,. ;~ OFFICE OF BUILDING INSPECTOR o ,,~' ~,r ;.;:, P.O. BOX 728 ~' E '~ -e TOWN HALL y ~ 1 ~~ SOUTHULD, N.Y. 11971 %pl ~ A`~ C E R T I F I C A T I O N Date C/'''~-5~~' Building Permit No. ) "']S /~~ Z Owner_ hl.l b1..41~.-~. (please print) Plumber ` - ~/ .~ C (please print) (~~ ~ G`-~~ I certify that the solder used in the water supply system contains less than 2/10 of to lead. s Mme(/" (plumber's n ure) Swoy~r~n~~to before me this Notary P ~ Rotary Public,f ~ ji y~„~ County £DI rH F. JACKSON Notary Publk, State of New YoAC No. 4920158 Qualified in SuNoik County Term Expires Feb. 16, 1990 ., ,, ,.~~,:~,:~:~'.i~. ~, ~'. ~ ~ t ~e t 1 ~^'~°~ a E' ~~ ! r ~~ P4 z= `, n Ire ~ r Nd '4 v' IIryR IF~Itlf~ VfUYF~011 w ~ r ` tra :~~ n}r C 'ASm~ Op QS ~~ , i" Y t Y~ I~rvnY N 0 vIEI~Yon Of , ,R ~r ./ Tr.aim.TX.MYq~~q~'R~atT4fkB7f~1 e '. ~ ~ < GlNMn d tAYf MvvOY 04y1 IKX A9{I(J `r;. ~~' .., n ~ ~~~ ~ ~~~ ~.Y., ~ rep 'f ~. ~, ,/~r^1~. aq-` 41~, ~tOdY 00WW .. ~''~~ar~.r~Z ~~~. !I ~~~ ~~ F~./ ., ~ ~ ~ 'tl ~ ~,. '~ i~ ~ M ~'~ bY4 9P~'n~~F~ ~' ~ r k `at+ - muvr~ri w~ . ,+.v ww - n «+. F ~ ~ • ~ f x wtinp MrNpgNyd M/A41 MIKA 1 ^ ("~ `t ~~fR~i;Si LL„'* wMY 1D pn fvhlilbM ' ~/7k~ /~ + ~ « ~~~-,,,,~,,,,....//// h i^'x." ~- ~ «+m~,++ro- fh { r P ~: kW'r~1WW. tlW 011 ~MNIM ~.,, ~ , ' ^~ 'T~ ~ ~~ fw P ~~ M / / R' •~d\ ~ ~ MY0 p11hMM1Y• W WfMIWM1N111Yp110y '~J 4+RIR(~i 4 ~T' °~~i ~"""'» ~ ~ ~( i' ' W ~ 00M4V14~ i~M ~M~1~11V (~ {j~{I s r ~; Wfal.OmrMigO ato lWl kWw! a "1 ~, ~ f".4Y~i raf, ~ "~. ~ ~ Y, w+Ntnpr~I1~M 'Y ~ 1 1 Mre9 ~~ a q p ~fG~414!k' W ~ ; '+.S ~ , ra z, ~ ra,K` 1w~¢ - : ~ ~~,/~( ~i'~'i Y1 ~~ ~ ~ ~. .. ,y-... ., .:.~ Cr, ' ~~t, ~} t< ,~FYE ~,, Ise i.n ~ ~ ' Y+g'~ .f'F ;~+M'j' +eN rm.@x 1 ~ I ./. ~.'~i'Aa ~' ~ „' f'~'~ ~:~ ~I ~ ' .~ ~ u s ~, ~ ~ - ~ i ~ ` ~ ~ ,, 4K' ~ ~'T~ : ~ ~ ~ 1 j y + x: i , ~, ~ ~ .,, x~ rt .. ~ ~ t. ~ p ~ y f ~,i ~~ s/.M cD,F,~1Fy~\ ~q~ „,.. .~ ~, ~ .j ~~ ~~y~,KV.yti o + ~ i s ~ , . ~ .. s 4 a ~ ~~ p~,A~~(y 2 hh~ f!rl ~r~/rte 'Tfw+/( ~' f ~ ~ +~~ ~' s~,~r~ .~~.,~/ ,T ~.,,~ ~ " '~/~rf14'~~Ir~ e~//+~~A .y~ ~ .~ ~ ~ I~f .t ~~~5'"`~~ ~~('1ri f+ '`}t^FZ a'~'~,"~,~~'~ (,„TJc~414~Y~ .._ ~~ i ~; ~ / .., ~ ,, ., ~ 1 i _~ . .~ .,n ~~' ~# tr. ~ d t ~~ ~~ ~..., ~Y f~ ~8 • ~tPldN~t:7s~~+ ~/urffA~ ,off ~'rc,~,~r~' ~ c~~° ,. ~ ' v' ~ ~:Y ~;! E ~ ~ ~u~a as~,/ ,~Y~x . tna~' ~c ~ ~'~}}~~ «az ;~,~~ra : a~esa^~~~~ '~~r 4~.~ .,.,~~ ,~' ~,r ,.,. P. ,~ ,.~ „ ~ ..1 ~ .. i s/ ~ ~ i,. ,~ 'ya rr ~~ ;'tlg%' 4 x i 3 +"' ~ ~. x 5 i~ N, 1 p ~ !p t. `1. 1' ~ "KV.e v~ F~ ~r t ~~ f /cP.OPliUvt~~ ~e ~Q4~ c,~e ~a~ad~~a~r~.~ ~e ~c~ice Environment East, Inc. R. R. No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 5 1 6-7 347 47 4 Septr:mber 20, '1988 Southold Tawn Building Dept. 'Down Ball Main Road Southold, NY 114371 i'iear Sirs, Iii~~:los~fl are the application, plat plan,twa sets of plans and check for the Coyne addition in Mattituck. A third set of plans are with Mr. Larry Tuthill for review and stamping. They will be fowarded to you as soon as we receive them. nlt:as~ review the close and let me know if there are any cluest~ions or add'tional information needed. '1'hanY, you for ya,Yf~r a~istance with this matter. Sincmrroly, 2U/~ Deter R. Staut' burgh i'r. esidant I~'nvironment ast, Inc. l::ncl. PN.S:;j;n lELD I;:S:'EC:iU;J ~IUnTr. ~ i;OMMENT~ , 1. ~l! Q(~r, m ~ _/ ~7 .? _ H FOU1dDATIv~~ (1s ) ~~ ~ c-tr/ cis ~ - "g , ~ FOUNDATIOid (Qpd) - - ti ( m ~ 2. ~ ~ , z ~ o / ROUGH FRAME $' R C PLU MBING ~~ H 3 . W~-~_ ~ m m I1ISULATIOP7 PER N. Y. - H c STATE ENERGY ~~ T nom' CODE r ~ r- e ~ ~ '"~ , k ~ y . ~ ,~ FI;dAL i ~ ~ ADDITIOPIAL COMMENTS: x m x .b H O O m ' A r _ \ H x e m - c H ~ ~ ~~d 765-18®2 BUILDING DEPT. f NSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ( INAL REMARKS: ~.r4xz-C'~ ~~ '~ / .~ _ DATE ~ ~ / ~'C~ INSPECTOR ~7S~o 7ss-1802 BUILDING DEPT. INSPECTIC'~N [ ]FOUNDATION 1ST [ ] RO GH PLBG, x [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL DATE~~~~ ~ U ~~ INSPECTORS REMARKS: ~._~~~ ~-~~ 1?~° - ass-isoa BUILDING DEPT. INSPECTIt'~N [ ]FOUNDATION 1ST [ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL DATE /~ ~ S~ ~ 1' ' INSPECTOR /)alb 765-1802 BUILDING DEPT. ~, [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [/] INSULATION [ ]FRAMING REMARKS: [ ]FINAL DATE ~~ ~ INSPECTOR ^~~ 17 si res-zso2 BUILDING DEPT. ~~ [ ]FOUNDATION 1ST [ ) ROUGIi PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [~ FRAMING [ ]FINAL REMARKS: ~..~ p ~'l~ DATE ~s ~ INSPECTOR t7~ro ~~ rsS-iso2 ~, ~~ BUILDING DEPT. INSPECT4®N [~FO N TION 1ST [ ]ROUGH PLBG. [~ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~6'~~-^ ~ ~ (" DATE / ®/ ~ ~ S~ INSPECTOR THE NE1N YORK BOARD OF FIRE UNDERWRITERS SAC}: 1 1001.093 BUREAV OF ELECTRICITY 83 JOHN STREET, NEW YORK, NEW YORK 10038 _ _ Date }'ENfiLIA)iY 09,1989 gppltcationNo.onfile 5k70d2kk/kk N O577fi'I R THIS CERTIFIES THAT only the aka;erieel equipment w dascrtbed 6eloEO and Introduced by tks alrplicant named on the shoos eppBcatbn numher iw tkas premiers q/ Atfk},'EN Ct)YNA~, 1.520 Sf.GSBC:h; kT+., 1P<1w#1.0, LAUNFI,, N.Y. in thefolbleInR locution; ©Boeemant © 1st Fl. ^ Ynd FI. Section Block Lot 'JANUARY 27 , 1.989 was examined on rnd found to 6e in rnmpliance with the requirements of this Bwrd. RXTUlK RAN06 COOKING DICKS OVlNS qSN W UST ANS RX1UR! ACTK liYRTCNM OUTLETS NCANDESCENT P1U011lSttM OTNEa AMi. K. W. AMT. K. W. NAT. K. W. AMT. K. W. AMT. H. P. 1'1 .1 15 ]'1 Y }• iLlT DRYBK IURNACE MOTORS R/TUR! ARLANC! IE®[K SMCIAL RlC7i 71MlttOCK3 pU UNIT NEAIMS MIX1 ~ OIMMlRS S AMT. K. W. Oll N. P. GAS N. P. NAT. NO. A. W. G. AMT. AMP. AMT. AMPt. TRANS. AMT. N. P. ~• ~ RAT AMT. WA1T5 SBiVIQ DBCONNlCT NO.OF S E R V I C E AMT. AMr. rrPe ~• l,e tw I / tw a i Sw t,f Aw ~' ~R % OND. a CC. OND. NO.OF NI-lEG a~HI ~~ No. or NEUTUU a 'r~uGTriAI 1 1_~0 <;A 1 x 1. 1 1. orNER AIhARATUS: SMOKR I1R,'('KCT(>R: -1 ~~ <;ARY ItOROSKI'. L2C.#1,9d1 F, d'l.0 MONSF:I:I: I.N. COTr.HgGtlR, NY, 1.1,y#'i OlfaylAl 71 1 This certificaN mwt not be altered in airy manner; return to the office of tfls Board if incorrect. Inspectors moy be nr~~w~~w~~~~~~~~~~~~wi~~~~~~~~~~~~~e^ere.~~ rnin~w N~ ~ ~ [~~~~~~ y a~~H~o~ ~ ~ ~ ~ ` ~ ~ ~ g ` N k y k ~ l,. ~ A z *~ H . rn H G1 ~I ~d ,a.~zrov~o C ~ A ~ ~ ~ A A ~ (~ 1 , yt'wro~no ~ A A y ~ ~~ ztn~w[n r P p ~ A: < ~.. ~~ ~ ~ ~ ~ W~ ~~~ ~ ~ ~ G ~ ,. y ~ ~ H W N ~ W y ~., ~ 5' n ~ ~ ^ p /~ ~ o ~ ~ d J ~ ~„ b t ii ~ ~' ~C! u m b1 ^y C V i 1 ~. ~ . ~ ~ p D . ~ , o ~ zW ~ ' .... ~ C ~~ ~ o N° ~ ~ ~ ~ ~ ~. ^ A ~ ~ C` ~ ~ ~. r ~ ~ j ~ .~ ~ C ~ o ~ ~ ~ ~I D aG C ~ ' a - - ~ 'A z ~~ H ° ~ ~ 0 o 0 o 0 ~ p O o p 1' C o C.. ~ ~ ~ ~ ~ p, W v, ~ v, ~ ~ ~. v 2 ~ ~ ~o ° D A H ~ ~ c,, w ~ ~ ~ ~ ~~z~ G o . G G G ~ ( , U' tZ d~r~ W~ rn r~ y ~ C ~ P ~ ~m ° ~ a ~ O ~ ~ 0 0 0 .., ~° D tai i ,\ s ~ ae ti~9u~v'''. ~ ~ A m M A ~` ~,p oa y ~ ~ eta C, !;?~~{ 4 . t w Y y ~ ~~, ~ 4' rc !1 "~ `~ In .. D ~ y~~NFEti * ~ ~ `~.,, -, FORM N0. 1 ~ ~ P. S~ TOWN OF SOUTHOLD ~~,~- V _ 2 ~ ~ BUILDING DEPAR7MEN7 ~'"~~' TOWN HALL BLDG. DEPT. SOUTHOLD, N.Y. 11971 0 n. pZa~` f TOWN OF SOUTHOID G TEL.: 765.1802 7/~ ~,a/8~ xamined ~~.~. `........ 19 Q ~ Received.......... , 19.. , pproved' .1~. r..~a........., 19' Permit Nof . ~~~.~ -t ~ ~ isapprov°ed a/c .............. . .:. `................. . ° uild~nspector) ° APPLICATION FOR BUILDING PERMIT ~ Date . S~,pt,9tnbe•~'. 20.,.., 19 ,~$ INSTRUCTIONS i r a:_~T1Gs application must be completely filled in by typewriter or iri ink and submitted to the Building Inspector, with 3 is 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 • 8reas; and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- lion. 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 ' all 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 purpbsi; whatever until a Certificate of Occupancy all 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 gilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mil authorized inspectors on premises and in building for necessary inspections. L'nvironment fast, Tnc. 3(0 l~at~ ndoifa~ipl~e c k ofLanee, if a corporation) .. Peconic,•I?Y•11958••••• ................. (Mailing address of applicant) .ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (3eger~l Contractor ....................................................................... ameofownerofpremises Maureen,Goyne,,,,,•,,,,,,,,,,,,,,,,,•.....,........................... (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. President ............................................. _ (Name and title of corporate officer) Builder's License No...55~6, H7 • • , , , , , , , , • , , , • Plumber's License No . ............ . ....... . . . . Electrician's License No . ..................... . Other Trade's License No . .................... . Location of land on which proposed work will be done . ................................................ . .. 12?_0.......... Silsbee Road ...........................~:tt^1;1`ttc~ . 4GG""°"~. • ..... , House Number Street Hamlet County Tax Map No. 1000 Section .. x.44............ Block ....1: .............. Lot ......lt:........... . SubdivisionMat•tit;uek •Par • ~P.r p~srtie•s • • • • • • • Filed Map No. . 8Q1, ......... Lot .. 2~ . ~. 26,... . ~Name~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..Qr~e..i:amil.y..dwe ~ link ........................ . ................... . b. Intended use and u~~~~upnncy 0~?e. fnml ~3'• .awS.7,1~pE..W~. ~h..aad~t.I,911 ............................ ,,.- 3, Nature of work (check which applicable): New Building ......... , AdditiClr~ ~~' .w*a{r~~~+~'Alt~d'ti~n ' ...... . Repair ... . . ........ R~moval ..... , ........ Demolition ........... , .Other fit! .:.:....... . ?) ~ (P'escription) 4. Estimated Cost ...70,.O.QfF'rQo .............. . ......... Fee ..... ...'~.~i.~........ . (to•be pai,d;:or1 ~iliit~~,thi~,;application) S. If dwelling, number of dwelling units ........ . , .... Number of dwelling units on each floor .....3}......... . If garage, numberof.cars ~ .....................................................:......... 6. If' business, commercial or mixed occupancy, specify nature~and extent of each type of use .. . .. . . . ........... . 7. Dimensions of existin& structures, if any: Front .... ~a.t:...... ,Rear ... ~,1,'.(T"..... Depth .. 1,41 ~~t, .... . Heiglrk .'... ];, story... Number of Stories ..... ~.: , ......... ............... ~ ... . Dimensions of same structure} with alterations or additions: Front ... ,65 ~ ~ ~r, , , , , , , , Rear . 6 e bit. Depth ...~.0! err ........ .. , .Height ... , 1 story, , , , , , , , , Number o Stories . 1. ~ • .... . $. Dimensions of entire new codstruction: Front . ?? ~ 6YI , , ...., . Rear ... .~~~ .... ,Depth . ~ ~t.)}~t...... . Height .~ . p tort'..... Number of Storks :':.. ~. , ................. ......... . 9, Size of lot: Front .. , . a.4~.13 .... , . , ... Rear . .~~.2,•.Q~:... .... , . Depth ... ~4RQ rP . . ...... . ... . (0. Date of Purchase ....... . : ......... ....... .Name of~Former Owner ........... , ....... , ....... . premises era situated ..)?e,~$.de,rtti,pl . .. . .... . ........ . ..... . .. . ......... . 11. Zone or use district in which' 12. Does proposed cgnstructron violate any zoning law, ordinance or regulation: , , ,No , ... , ..., 13. Will lot be regraded ...... ~o..... ..... Will a oess ill be ~e~loved from premises: 2 aY s2 Nc 14. Name of Owner of premises Maureen ,Coyne... , , Address~i s ee ne No.. , 9 . ,~. ~5 _ . , Name of Architect . , , , ' , , , . , , , , . Address3o~~iZna~~}r ~l~~ne No.. . , Nalne of Contracto~'i'~,vi,rQ~hm®nt, P,RSt,, ,Inc, , Addressgeeot2i•o3 t~7.~' ,3.3.9~'hone No.. 7,3,4c~47,4, , , , PLOT DIAGRAM Locate clearly and distinctly mall buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and b1oFk number or description according to deed, and show street names and indicate whether interior or corner lot. S4e ~uttachod , . STATE OF NEW YORK, ' S.S COUNTY OF ............ . . .. . (Name of individual si • ' ' ' ' ' ' ' ' ' • ~ • • being duly sworn, deposes and says that he is the applicant gnmg contract) above named, He is the .................... ..... ............ ......,......,.,.. .,.... l .. ~ (Contractor, agent, orporate of icer, tcJ ~f said owner or owners, and is duly authorized to perform orTiave per ormed the said work and to make and file this replication; that all statements contained in this application are true to the best of his knowledge and belief; and that the Nork will be performed in the manger set fortes in the application filed therewith, iworn to before me this . , .. , ......~.. day~o/f Jotary Public, ....6~~KG~t,i..1.]. HELEN K. DE YOE NOTARY PUOLIC, State of New York' No. 4767979, Su4tolk Coun 7ornr Expires March 30,19 r~.. //:........., 19~~ .. , , A!4-,!/~...... County (Signature of applicant) W-n VJ Q J- W J Ca 1 v 3 Q z ~ a 1' C ~ - 9,/ , i ~ _ ~ , ~ u~ ~ - - F` ~~ ~a S .-C G "~ S a ~ k x k W ~ ~ ~ ~ N N L~ O O O O ~ c ~ c : O ~ ~ , z 03 3 = ~ u u ~ 3 ~ aa ~ ~ Q C1 U 111 ~' i_i- - - u 1r N ~H .oE _~ V