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HomeMy WebLinkAbout17278-z e FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICA`T'E OF OCCUPANCY No Z-18193 Date JULY 18, 1989 THIS CERTIFIES that the building ADDITION Location of Property 195 BUNNY LANE NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 6 Lot 21 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 22 ~ I988 pursuant to which Building Permit No. 17278-Z dated JULY 28, 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 DECK ADDITION TO EXISTING ONE FAMILY BWELLING AS APPLIED FOR The certificate is issued to JOSEPH ARENA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A ~,LI~~ uilding Inspector Rev. 1/81 r FORM NO. 4 ~i TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18561 Date NOVEMBER 13, 1989 THIS CERTIFIES that the building ACCESSORY Location of Property 195 BUNNY LANE NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 6 Lot 21 _ Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 22, 1988 pursuant to which Building Permit No. 17278-Z dated JULY 28, 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 ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to JOSEPH & MARION ARENA (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 rosai xo. s 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+, 017278 Z Dame t9.~© Permission is hereby granted to: ~ ~ at premises located at .........................................~9,5...~'~*-~i.~-.. County Tax Map No. 1000 Section Block Lot No....~~..,l............. pursuant to application dated ...................~,~~7f.~-:................, 19~~ and approved by the Building rln7spector. e~ ~ Fee S• r~ C.„~ ~ r ~ ..,~Z~!• • din 1 for Rev. 6/30/80 f :Y ..~..~n.~~.....--~-.~.,~, TOWN OF SOUTHOLll ~ r~i(~ (G ( C1~~1 F rV BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 11971 765 - 1802 84DG. DEFT. TOWN OF SOU7H0LD APPLICATION FOR CERTIFICATE OF OCCIIPANCY ' DATE.!!/ , r/ ~ - - NEW~CONSTRUCTION OLD OR PRE-E%ISTING BUZLDZNG......VACANT /LAN Location of Property..~,~y7,,,,~~ry~~ ~~~.._-..!!-~~,~(„/~f~• - ----HPU-SE--NO~ - -STREET - ~ - ~ - - llAt1LRT - Ovncr or Owners of Property.... GS4!I4•' _.~.r~A~~IGA~. " Coun[y Taa Map No. ]OOO~.Section Block Lot......... Subdivision.? J/j~ Filed Map ........Lot....... -....Date of Permit _._,.,,.,,Applicaot Health Dept. Approval Underwriters Approval,,,,,,,,,,,,,, PlanninC Board Approval • Request for Temporary Certificate s1~f~Ftinja~l Certificate Fee Submitted: $.~~~,00_,...~~/ r/6i(/~ s APPLICANT..._.. .........1-• "rev. 10/14/88 - - Q~,e,~ 359 ~ - - - eo ~ iBScut L, ~ I FORM N0. 6 ` , - TOWN OF SOUTHOLD ' BIIILDING DEPARTMENT ~ i ; ~~'i TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must by filed in typewriter OR ink and submitted to the Building Inspector with the follpwing; 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). 3, Approval of electrical installation from Board of Fire Underwriters. 4, Sworn statement from plumber certifying that solder used in system contains less than 2/10 of 1Z lead 5, Commercial buildings; industrial buildings, multiple residences and similar. buildings and instal><ations, a certificate of code compliance from the Architect or Engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 8. For existing buildings (Prior to April 9, 1957 non-conforming uses, or buildings and "pre-existing" land '',uses: I. Accurate surveq 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 O~ecupancy 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 Ce,rtific~te of Occupancy: 1. An application for vaunt land Certificate of Occupancy shall be submitted, and a certified abstr~ct 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 Dwe~ling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses, $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00, 3. Copy of Certificate of Occupancy - $5.00 - over S years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 S. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $50.00 Commercial I~ i Caw. 10/14 /S8 - e TOWN OF SOUTUOLD BUILDING DEPARTMENT TOWN IlALL SOUTIlOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY ' DATE. 7(18/89 NEH C0:7STnUCTION „ OLD Oft PRE-E%ISTZNG BUILDING......pACANT LAND..._._.. Location of Pro crt 195 BUNNY_LANE NEW SUFFOLK, N.Y. P Y IlOUSE N0. STREET " " " IlAMLET Ovncr or Ouncrs of pro ert JOSEPH ARENA P y County Tax Map No. 1000 Section 6 21 Block Lot'...,,-•-• Subdivision.. Fi1cd Map ........Lot........_. Permit 1l0. ~727s:Z .Date of PermiC JOSEPII ARF.PA .__.Applicant Bcalth Dept. Approval Undcruritcrs Approval.._......._ Planning Board Approval Request for Temporary Certificate Final Certificate ,_•XR Fcc Submitted: $.-_25;00-•-•.-•'•.'• APPLICANT......, JOSEPH ARENA a rc~• !0/14/88 QZG. J7 ~~oa- C°o ~ I $193 ss/al/ol •n~ II . IE?aaawwoA UO.OS$ ° iIE?JUapisa~ 00'5',1$ - .~ouedn¢op ;o aJrat;i73bA Saraodmay •9 00'05$ - 6ouednaa0 ;o a7roT;t7aa~ pa7epdp 'S 00'OZ$ - 6aardnaap ;o a7rar;?73aA pucZ 7aearp •y 00'Of$ -,saea6 S Sano - 00'5$ - 6aardnoo0 3o a7EO?;?7aa0 ;o ddoA •00'001$ - Sa?iianp 5u?7stxa_a3d no 6~uedn~~0 ;o a7r~t3i73a~ •Z 00'SZ$ do?Pi?nq ~aoss0a~$$ sassaa?sng _ 00•SZ$ `s3a?piinq 6aossaaoV o7 voc7Tppy `00'SZ$ ~u?ITanQ a7 sao~700'SZ$ Iona 3u?mm?ng `00'SZ$ sa?iia~'~0 07 uoI7ESa7iV PPV 00'SZ$ S??IianO naN _ aAEIy~I11000 :IO 8yV0I:II7,1IgA •1 ~S333 •0 •7aEaxidde ay] 07 3n?7?Sn at ao;a3ay7 suosra3 ay7 a7r7s iTrys Soaaadsnl $aipi?ng a47 `pa?aap st 6anrdnaa0 3o a]ra?;?73a0 E 31 -aot7EailddE a47 Surdmo~~e osir IlEysiLS6I `6 i?adV o7 So?Sd 7oi a3i7va ay7 ;o d?ys3auno a7eaedas pnE alAnts 8a?noys~~uedmoo ai7c7 E ~q panss? aI7i7 ;0 7aE3JSgE pai;i73aa E pue `Pa77rmgns a4 iiEys daardnaa0 ;o a7Ea?;?JSaO PnEI aurarn So; ao?7EaliddE ay • I :6aurdnaa0 3o a7ea?;r7aa0 paeT 7uEOEe Sog •A 'a7r~?;?7aa~ E a3Edaad o7 pa3?nba3 ao?7Emao;ut 7uauiJaad Say7o So `sasrmaad ao, s3arpi?nq ;o aoiJaadsu? d7a;rs ao apoa ~u?snoy bur ;o a~r0 •e •anEa?IddE ay7 07 $u?7?~ a? 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'SEI?m?s paE saaa~pisa3 aid?7lnm `s3a?pI?ny iE?37snpu? `s3u?Pi?ny TE?aaammoA -S ssai so?r7uoa ma7sds Qi asn Sa •prai Y! 3o OI/Z ucy7 P Pros 7ey7 3atS;?Jaaa aagmnid mo33 ]nama7E7s aaonS -y '(~03 6-S Iesods~apaN a3?g ;o paeog mo3; uot7eiir7sa? IEO?37aaia ;o Irno3ddy •E p-a:lEaanas pae 6lddns Sa7rn ;o •7da0 y7IEaQ ;o Irnoadde IEarg 'Z •sa3n7ea; ~iydE33odo7 So IESn7eu IEnsnan paE `s7aa37s `san?I S73adoad `s8o:pii?nq IIE ;o aoi7Eaoi a7E3nooE y7?n ~73adoad ;o ~anans IeaT3 •1 :asn nan So s8a?pi?nq nan so; :3u?noiio; ay7 y7in ao7~adsvl BatPI?n8 ay7 07 Pa77tmgns puE xu? g0 Sa7tanadS7 u? pai?; ay 7snm uo?JEOiiddE s?yy, •y SNOI.LOfitIZSNI 3ANVdflA00 30 iLLV0I3ISHfl0 a03 NOIZVAI7ddV • 2081 - S9L i'ivu Nrloy yNH{ddtlVdHO ANI01IA8 Q70ILIf10S 30 NMOy ~ 9 'ON WN03 A,,d~n''2"~~, TEL. ?GS-! 80' C.\~E F r~;r~' ~C~ TO~TrN OIL 5QUTIZOI.D r~"~=,,'L~~ v 1w276;;:« ~ Y.~ OI~i'iCl: OP flUILDING INST'I:CTOR ~?e~ j~. ~ I'.O. IlO~C t 1 7 9 „~rjt ~ TOIVNIIALL ' ~.4y~ ~~Z' SOlJ7'IIOLD, N.Y. 1 1971 ~ ~ r~,Si ~ ~~i o~-. ~a, ~ y~y 'I'o Sdhcm This May Concern, Fle are unable r.o complete your Certificate of occupancy becaus•~ ,of the folloeriny reasons. An application for Certificate of Occupancy is not nn fil.c. D!o tJndcrwritcrs Ci:rLificate on file. 'i'he chccl: .i:; (rn;tdatr_d/nut an file. ~ ~a5- D:o flea].th Dept. Approval on file. P:o final insl~~ect.ion has been made. Plensr. contact our office an this matter. - Thank you for your cooperation.G Ihitlclir;g Permit: II ~ ~ ~ ~ O Z Gam fluilc3inq Dcpt. tlo Plumber Solder Certificate on file. ( a7.1 permil•s involving plumbing br-ing issued ?ft.cr April 1,1984 j 2cew- V y~ i/9s.~ J ~~~~~~~N~tk~~.r IELD II:SPEC:iUN ~~UAiE ~ COht'ME,VTS m P.~ 3 H _ _ C 1~ FOUtJDATION (1st) Ca ~'`C FOUNDATIOtJ ( 2nd ) m~ 2. z o ~ ROUGH FRAME & PLUMBING ti 3. m ra IIJSULATIOPI PER N. Y. y STATE ENERGY CODE ` x y FIiJAL o z n ADDITIONAL COMMENTS: x 'Yl~n~-~i? ..o,n..,~.~A. in rKj.f' 7 ~1 I~q-~-~ I ~ t g ~ - _.~c~t I~2yr~ x ro \ H p\\ ~ N 9 \ H H 4~ O ~J z ~ x • r H x ~,jN d LTI H o~~FFOLk~O ~ ~ VICTOR LESSARD ~ 1 Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR ? ~ P.O. Box 1179 (s 16) 765-lsoz ~ Southold, New York 11971 t'AX(516)765-1823 ~~~~1 ~~~Ot'- OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD July 28, 1989 Mr. Joseph Arena 96 Homestead Avenue Scarsdale, New York 10583 Re: Building Permit #17278 195 Bunny Lane, New Suffolk, N.Y. Suff. Co. Tax Map #1000-117-6-21 Dear Mr. Arena: Enclosed please find herewith Certificate of Occupancy No. Z-18193 for the deck addition to your home. Also enclosed is Building Permit #172782 which covers the deck and the accessory shed. A Certificate of Occupancy is still required for the Accessory Shed. Please call this office and arrange for inspection for the shed, and also for a final inspection for the addition under Building Permit #13991-Z. Building Permit #13991-Z has expired. The last inspection done was on July 21, 1988. At that time, CO was denied as a smoke detector is required. You are in violation on the Southold Town Code. In order to avoid legal action, you must contact this office immediately to resolve the violations. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector GJF:gar encl. o~~FFO~~o VICTOR LESSARD ~ ~ Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR ~ ~ P.O. Box 1179 (516) 765-1802 Southold, New York 11971 FAX (516) 765-1823 y~Ij`o~ ~ `,~0~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD June 30, 1989 Mr. Joseph Arena 96 Homestead Avenue Scarsdale, New Xork 10583 Re: Building Permit #17278-A 195 Bunny Lane, New Suffolk, N.Y. Suff.Co.T.M. #117-6-21 Dear Mr. Arena: On May 2, 1989 we sent you a letter informing you that we could not process your permits for the deck and shed because your check was outdated. We returned your check and asked you to send us a new check in the amount of $100.00 to cover a permit for both the deck and shed. Also included in the $100.00 would be the fee for the Certificate of Occupancy for the deck. To date we have not heard from you. According to the Code of the Town of Southold Chapter 100-284 it is unlawful to occupy or use a building without a - Certificate of Occupancy. In order to avoid legal action, please forward your check in the amount of $100.00 immediately so that the Certificate of Occupancy can be issued and this violation can be resolved. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary J. Fish, Building Inspector GJF:gar o~~FFOIK~O,' VICTOR LESSARD ~ ~ Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR ~ P.O. Box 1179 (516) 765-1802 ~ Southold, New York 11971 PAX (516) 765-1823 ,,o.~o~ ~ ~oa0~" OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD May 2, 1989 Mr. Joseph Arena 96 Homestead Avenue Scarsdale, New York 10583 Re: Building Permit #17278-Z 195 Bunny Lane New Suffolk, N.Y. Suff. Co. Tax Map #117-6-21 Dear Mr. Arena: Enclosed is your check dated July 22, 1988. We cannot process your permits for the deck and shed because the check is outdated. Please send a new check in the amount of $100.00. This will cover a permit for both the deck and shed. Also included in the $100.00 will be a Certificate of Occupancy for the deck. You will have to apply and pay $25.00 more at a later date for a Certificate of Occupancy for the shed. Thank you for your cooperation in this matter. If I can be of any further assistance, you can contact me at the Building Department. Very truly yours, SOU OLD TOWN BUILDING DEPT. 4 Gary J! Fish, Building Inspector GJF:gar encl. ~ S~EFQr~~®~` VICTORLfiSSARD ~ry +-ii e; EXECUTIVE ADMINISTRATOR ~ ~x Town Hall, 53095 Main Roa °a'®``~ 5 P.O. Box 1179 (516) 765-1602 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD September 19, 1988 Mr. Joseph Arena 96 Homestead Avenue Scarsdale, New York 10583 Dear Mr. Arena: We have tzied to reach you by telephone numerous times. As you know, you have two outstanding building permits. Building Permit 1113991-Z for an addition and Building Permit 1117278-Z for a deck and shed. Kindly call this office and set up an appointment for the final inspections so that we can clear up your files and issue the Certificate of Occupancies. Thank you for your cooperation, in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary Fish Building Inspector GF:gar ~ d fy?q to ..C. VICTOR LESSARD ~ ! ~ 4 EXECUTIVE ADMINISTRATOR zyy ; ~ ~ Town Hall, 53095 Main Road (516) 765-1802 ` P.O. Box 1179 €~+~4~® _ Southold, New York 11971 .6 L~ OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD August 1, 1988 Mr. Joseph Arena 96 Homestead Avenue Scarsdale, New York 10583 Dear Mr. Arena: Please be advised that your building permit for the attached deck addition and unattached accessory storage shed is ready. In order for us to clear up your files and issue the Certificate of Occupancies, we must reinspect the addition under building permit IO13991Z. Kindly call this office and set up an appointment for the reinspection. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Gary Fish _ Building Inspector GF:gar B0.\RD OF HE,\LTH 3 SETS OF PL.\NS FORM NO. t SURVEY . TOWN OF SOUTHOLD CHECK . BUILDINGDEPARTM[NT SEPTIC r•oRrt _ TOWN HALL ~ EOUTHOLD, N.Y. 11971 NOTIFY l~/~ TEL.: 7G5-1802 CALL y. tl;lq ~,o~,r C•xamined..~r7.~~.p.~.... 19~~ © MAIL T0: \pprov~d ..../,(~!0. , a, 19~Pennit No.~,~~s, 71,7, • Disapproved a/c/......... ~ ' ~ / ~l2NMt Gv,ti occuPA~c~ o uild- In ector) USE 9S UNIAFUL APPLICATION FOR BUILDING PERMIT ~TH~OUT cERTlFiCATE Date . G~"'..^~....~~..'L..... Is~ INSTRUCTIONS ~"c° ~ i lua~p~c'~tibn'tn"ustba completely filled in by typewriter or in ink and submitted to the Buildinn Inspector, with 3 sets of p]ans,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 Xork, and other applicable Lavvs, 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 ail applicab'l'e laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Sigr2pture of applicant, or name, if a corporanon) (Mailing address of~aepplica~/nf~t) State wh ther appli/c~ant is owner, lessee, agent, architect, engineer, general contra ~lrmber b ilder. ~.-~?.y... l.j~t.~t~ DATE: 7~~ B.P. N 1~ . • ~!O. FEE: B ~ . . Name of owner of premises f: ~:y.~;°:'-, , , , , , , , , , , , , , , , • . • „NbT NT A7 (as on the tax roll o~~iNS 4 PM FOR THE • . pECTiONS: If applicant is a corporation, signature of duly authorized officer. 1. FOUNDATION TWpRE0URIED FOR PbUREDCONGRE7E 2. ROUliN,- FRAMINt; B pItAMBM10 Name and title of co orate offic ( rp er) 9. INSULATI(MI b. FINAL - CONSTRUCTION MUST Builder's License No . BE COMPLETE,FOR C.O. ALL CONSTRUCTION SHALL MEET Plumber's License No . THE REQUIREMENTS OF THE N.Y. STATE CONS'tRUC11DN i ENERGV Electrician's License No . CODES. NOR RESMONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Other Trade's License No . . Location of land on which proposed work will be done. House Number Street ~ ~ ••~~~~~~~~.Hamlet~~•~••~•~~••••••~•~~~~" 1 , / County Tax Map No. 1000 $CCIIO? ..~1. Block .........rC? , Lot Subdivision Filed t~tap No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a• Existing use and occupancy y~~~~L•`• • • s~~.137.,; 361tA;.} b. Intended use and ~ ~ l~~f ;6~~/(~y+^ > r,P .....~..1, ~ occupancy ..r:u, :C ,~l•I'r- • i ,.,Fsd , :G;:':~~Cct~i..•..(~( n T afet! '.,i'. '.a. i , 3. Napure of work (chec}. which'applicable): New Iluilding , , , , , Addition , , teration Re air •moval 11 Ucmolition OlhcrlVork• 4. Estimated Cost .....~J•~~"`~, a!`'D• • , • • • • . • • • . , , . (Description) Ifs Fee (to be paid on filing this application) S. If dwcllin , nuntbcr of dwcllin ~g units ~ /`z` Number of dwelling units on each floor . , • 6. If business. cornm nialror mix ed'occ~ancy, specifysb~tt~e and extent of each ype~f use . 7. Dimensianv"o( ristitig sfruc~tures, if any: Front . Sj ~ • • • . ' • • • • • • k 1Hutglft~s;. Rear . ~G Depth . t r=*?.a~~'~,~t~~+:~:....NumbcrofStorics. )~ile~tsions of same structure with alleratio ~ • ~ • • • • ~ ' • : : • • • • • • : • • • ~ • • • • • pc _ 1 ns or additions: Front Rcar . ' 8. Di ' ~ ' IIcight . $ions o cntt'rc new cohstnwtion: Front . • • • • Number of Stories , . He rG.~.,,,,..r:_~,•~::.;:`t3~'~r`'tt"berofSlories Rear....... ._Depth................ tt~ntila. `°g.+. Rcar . 10. Date' urc ase'"' Depth 1 1. 'Lone or use district in which ~ • • • • ' ' ' ' ' ' ' • • Name of Former Owner ~ • • ' ~ ' ' ' 1 Z. L)oes ro PRemises are situated ~ - ~ • ~ ' ' ' ' ' ' ' ' ' P posed construction violate any zoning law, ordinance or regulation: • • • ; ; , ~ • • l3. Will lot be regraded , , i ~ ~ ~ ~ ~ • • P ' ' ' ' • • • • • • • • • . • • , ,will excess fill.be tefioved from ,premises: • ~ ~ ~ .Yes • . 14. Name of Owner of remises . Name of Architect • ..................Address .....................1?hone-No. . Name of Contractor . ~ .................Address . Phone No.. , • . IS.Is this ro """'•••••..Address.......•• .PhoneNo.. p perty looted with in~100 feet of a tidal wetland? *YES....NO~,~ *];f yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM ' Locate clearly and distinctly alll 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. ~ l y~i~. W r s /~i --T ~ 30 L.O r }'t::. YYI~Nt'Alk"1:?Ea £S 3Nti~#i," ~:ifli,ll:1°l~l x511 ~"1 1.1 It, r~ d~t?lNJd3~ t3MlY TA~i l" k1441lIl~ktRl.l4 @6 t?4flM » i~lYt#lA a 1 it{t17A'Jit~bit ty' ~TnTE or ~•~i~^ R z :ltj r~:f~=~a ~ =OUNTpY OIs'~ ~ Visit ~ s!1 h~, td~M • dtu ~ts!- • • • • • • • • • • • being duly sworn, deposes and sa s ?IP.vtSt!'+:Ali~dfs°ttAtlal~'si; 'i ~ contract) Y that he is the applicant above named. . fc is the . ' ~~~L°.~...•...' (Contractor, agent, corporate officer, etc.) ~ • • • • ' ' ' ' ' ' ' ' ' f said owner or owners, and is duly :iuthorized to perform or have perforred the said work and to make and Gle this tPlication; [hat all statements contained in this application are true to the best oC his knowledge and belief; and that the 'ork will be performed in dte manner s4[ forth in the application filed therewith. •vom to before me t--h~~is~~jj ^^ll / Mary Public,~~• • County a°hr+' la''~ibNAlbq ~~""Y°'k /y:~~"•~. ~~..41!J~". t'f'1 . QuallHedfn 8utlalk~q~y~(/ CommissionEttpiresGscMnl ?I~ 8.7>l.Y.t~ (Si;narureofappticani) I