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HomeMy WebLinkAbout17051-z z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19056 Date MAY 16, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 27754 ROW OFF MAIN ROAD ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 6 Lot 2I.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 12, 1988 pursuant to which Building Permit No. 17051-Z dated JUNE 2, 1988 was issued, and conforms to all of the requirements o£ the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE, DECK AND COVERED PORCH AS APPLIED FOR. The certificate is issued to JOHN & CLIFFORD CORNELL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-26-MAY 14, 1990 UNDERWRITERS CERTIFICATE NO. N-112560 - FEBRUARY 1, 1990 PLUMBERS CERTIFICATION DATED 3/20/1990-GARDINERS BAY SOLAR SYSTEM LTD Building Inspector Rev. 1/81 FOBM NO. A TOWN OF SOUTHOLD 6UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO ~~7~Jc~ Z Date 19..~.~~ Permission is ereby granted to: ~ a// i ~ r L~ s i?~~ ~ y~/~ of premises located at ..~,:.~..~.~~.~_,~.L..../L.Q.t~...~~~......~~G!0.1....~ ~.""v1~........................................................................................... pp / i County Tox Map No. 1000 Section .......l.Zl.......... Block ...............4",~..... Lot No.......~~:..°d....... pursuant to application dated 19.G~G~, and approved by the Building Inspector. Fee $...?~U.~~,.•.. a~ ~jy ,'l/ ~ . ~"~l ~Bruihl. g I actor Rev. 6/30/80 4. Form No. 6 (~y~ ~ ' ~C.-j ~z= ~ ~ ~,~`tr i ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT tttt MAY ~ ~ I~O ; TOWN HALL 765-1802 TOlIU~I OF 0!!:ftlPSli~ APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal (S-4 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains ` less than 2/10 of 17 lead. ' 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from 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, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.010, Commercial $15.00 Date ~ ! ~iC~ . New Construction..../`:.... Old Or Pre-existing Building . Location of Property.. ...............mP. C?..~Q,r~~.........~s~~:........... House No. Street Hamlet Onwer or Owners of Property...~rl:~. Q:~.~...~n....~4t.n~-~~.~ r County Tax Map No 1000, Section... ~.~.~.....Block...nn~.~. ....Lot.. MCd9_p ~ ~~Q`~h'r CY w:n ~UG'tRt 2.l Subdivision.~:r)In.-P~~,v,~s~z.o5';djsi:m...........Filed Map........../.~.Lot Permit No.. J~~!....~~'.,~~~.t~~D~a///~~~Ce Of Permit.. ~ll~"~:~.~.~.....Applicant.S-~~:'~~~?^~~:~4~.`n. ~GCne~ Health Dept. Approval. ~..11 .................Underwriters Approval. V . .1~,' U Planning Board Approval... n Request for: Temporary Certificate........... Final Certicate. U........ Fee Submitted: $ ~`:~1. ~ . / -('/1 ~~1 APPLICANT ~,l,J• 7~ `'7` ~ n~.i 40s THE NEW YORK BOARD OF FIRE UNDERWRITERS i~rLr,iat .i 7 C?C)t) I Y [I BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date Cr:P\F•;UAi:Y ClY r'I if lid APPliration No. on file P: e,{$h11 $itlfiie PS 'f ;l ;r,!; f,C3 THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant nomad on [he oboce application number in the premises of :'i,it~`b" +1, ,)(etifti i'~XZfVP;Id,, i7tti'('g Y~i~i.., ttlJE,tE~~1.§~~> t3~.7"M;M9'„ §VeY_ = in the following iocation> 0 Basement ~ 1st F'I. ©2nd Fl. GAitfl)!II .Section Block Lot uws examined on iJ Ab!{f AliX %f, l,it`)tY and found to br in cornplianre with the requirements q(thia ltoard. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT RUOflESCENT OTHER AMT K W AMT K W AMT K.W AMT. K.W AMi H.P. '4°~ .~'1 i~r .f ti DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS EELL UNIT HEATERS MULTI.OUTLET DIMMERS AM! K. W. Oll H. P. GAS H P AMT. NO A. W G AM7_ M1P. AMT AMPS TRANS. AMT. H. P SYSTEMS AMT. WAiiS NO.OF FEET ,k I'' 1 1 `J~i SERVICE DISCONNECT NO.OF S E R V 1 C E METER No. of cc corvo A. w e A w c A w G x AMI AMp. TYPE E.(lalp. 1.a' ]W 1 ,a' 3W J.6' 3W 3{S 4W pER A' OF CG COND NO. Of HI-LEG OF HbIEG ~ OF NEUTRALS OF NEUTRAL S@ 2utiY Ls-~ t ~1 l.tt~ r ? rte OTHER APPARATUS: t~, t'',T', A: ~1.N;.t;;c)„I{s,h~-4'ttJt; Ci?ltt'. biC„~}7,IIJ.ts 1s / p ~!~xi50 C`Ultt~.fTfiY itl>,rFt T'i~s;(~N1C, ~tY', t i.tSt; GENERAL MANAGER f :i .~i~ 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 MANNIER. ~~F~O~ C TEL. 7G5-1802 ~O O,, TO'4VN OF SO~JTIIOb,ID , . < OFFICE OF BUILDII4G INSPECTOR ° „ ~ ~ P.O. BOX 728 ~E ~~f -e TOWN HgLL 001 SOUTHOLD, N.Y. ] 1971 T~ C E R T I F I CAT I O N , Date ®~~ao~ `I~ Building P~~1e//r~~mit No.II~ 7OS ~ Z.. Owner C~;+tor~~ cJC~~?r~ l~ol^~p~~ ~~.(pleas'e print) Plumber ~--~y~t~lP.~S p~~Qli ~S (ple~~se print) I certify that the solder used in the water supply system contains less than 2/10 of to lead. (plu er's signature) Sworn to befor,~~/~ ,",me this ~ ~Z~~ o2d~ day of N~c{~c~ , 19 Rd j'`ui.¢ti¢/JQ /~/a.~..c?a~~.e..~.u.e cQ Notary Public HOtary public, TP1E,~C5.At< rdF,,;~RLL•'ND SC.~FFoL1C County • NorARrr-ue{ic,s~arECFNewYO>~ N0. 4854555, SUFfOlKCOUN7Y TfRM EXPIRES MARCH 10, 19,~[L 1 ?os~ ~ ~ 7~-~BOZ BUILDING DEPT. INSPECTION [ ]FOUNDATION iST ( ) ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING - _ [ ]FINAL REMARKS: c~~~cGu~~ ' < DATE ~ INSPECTOR ~2 ~~~1 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST (ROUGH PLBG. ( ] FOUNDATION 2ND [ ]INSULATION [)FRAMING [)FINAL / REMARKS: d v - L DATE ~ INSPECTOR. ~ 7~~"/ 7f5-1802 BUILDING DEPT. INSPECTION [ ] F UNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE g INSPECTOR ~l ~l G~ DLu,~C, t~~ 2 ~ 765-1802 BUILDING DEPT. INSPECTION [ i.~ OUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: J O ~~Uoll~ 1~l~pF' ~U,Gb ti[~ S c~ ~.U ti Y ~t~Gj t' I,~R~ ~1 J +~a~~c_~1 ~-l DATE ~ C S"Sf INSPECTOR (J , MELD Ir.si~EC:iu:J ~~u„,~ ~cuMr,rars wz - m~ 1. ~ z ~ H _ y FOUiJDATION (1st) FOUNDATIOiJ (2n~ p m^~ N 2. t o gA P,OUGH FRAME & ~ PLUMBIId"G ti f7i~ ~-7 3. x m IIJSULATIOPI PER N. Y. y STATE ENERGY CODE x J-~ H 4. ~ FI;dAL (n~ S pYc L' .O . ADDITIONAL COMMENTS: .o xN H ~ N H ~i.t0 Q ~oAw~i H O z rn M a "~i r a~ x °~4 c7 ~ ro N -o ~ H 325 Willow Point Road Southold, NY 11971 May 17, 1989 Town of Southold Building Department Main Road Southold, NY 11971 To Whom It May Concern: We are requesting an extension of building permit number 0170512, issued to Cliff and John Cornell, on June 2, 1988. Sincere y, C1' Cornell 325 Willow Point Road Southold, NY 11971 May 17, 1989 Town of Southold Building Department Main Road Southold, NY 11971 To Whom It May Concern: We are requesting an extension of building permit number 0170512, issued to Cliff and John Cornell, on ` June 2, 1988. Sincere y,~ C1'~ Cornell ~ S~FFOt,~~o~ 1[ENRY P. SMI'CII, President ti TELEPHONE, JOfIN M. BREDEMEYER, Vice-Pres. ~ (5161 765^1892 P}fILLIP ,l. GOUBEAUD v~ ~ `F ELLEN MKLARSEN JR Oy~~! ~i ~~O! eonttn or •rou~rr ~rrsus"rFFs TOWN OF SO[1THOLD "Town 1-tall, 53095 Main Road P.O. Box 728 Southold, New York 11971 December 18, 1987 Mr. Glenn E. Just J.M.O. Consulting North Country Road Box 361 Wading River, New York 11792 RE: Clifford Cornell -Determination Dear Mr. Just: Pursuant to your request for a determination of jurisdiction on the above property, please be advised that we have inspected the premises on December 16, 1987. We have determined that we have no jurisdiction in this matter pursuant to your survey submitted on December 12, 1987. Should your plan change regarding the location of the dwelling, please contact this office for a new determination. Very truly yours, 7~~1~~ ~ C~ Henry P. Smith, President Board of Town Trustees f HPS:ip cc: Bldg. Dept, file ~ ~ 95-illb (9ie6)-75c NEW YORK STATE DEPAR?MENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EfFECTIVE DATE , 10-87-2181 ~ 2/12/88 FACILITVIPROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Eaw N/A 2/28/93 328c1329: Aquat c Pes is des 27 ~ Water QualOity~ Certification ~ Tidal Wetlands P otelctlon~ofltWate~r ~ SPDES t7, Titles 7, 8: ~ Solid Waste IMa agemeniRR 360: Watele $15pP ~ le 15: ~ A~I pollution Control" ~ Hazardous Walste ~Managemunt 3~ WateBTransptortt5. ~ Mined land IRecamatlon ~ Coastal3Eraslon Management L-_J Long Island IWellsS~ ~ Freishwat r Wetlands ~ F oadpla n~ Management Article 15, Title 27: N-New, R-Renewal, M-Modification, Articles 1, 3,'17, 19, 27, 37; Wild, Scenic and Recreational C-Construct (*only), 0-Operate ("only) ~ 6NYCRR 380: Radiation Control Rivers PERMIT ISSUED TO Clifford Cornell ADDRESS OF PERMITTEE 325 Willow Point Rd., Southold, NY 11971 AGENT FOR PERMITTE EICONTACT PERSON enn uS TELEPHONE NUMBER J.M.O. Consulting, P.O. Box 361, N. Country Rd., Wading River, 23Y 11792 NAME AND ADDRESS OF PROIECTIFACILITY (If different from Permittee) Marsh off Nallocks Bay; Right of way off the southside of Main Rd. directly opposite B LOCATION OF PROlECTIFAC(LITY COUNTY TOWNICITYNILLAGE UTM COORDINATES ROd Orient Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY Construct a single family dwelling, septic system and driveway as shown on the attached survey by Peconic Surveys and Engineers dated 11/16/87. GENERAL CONDITIONS ey acceptance of Ihia permit, the permittee agrees that the permit fa contingent upon striM compli- ance with the ECL, all applicable regulations and the conditions epecilied herein or altathed hereto. 1. The permittee shall Hie In the office ofthe appropriateregional permit administrator, or other office designated In the special conditlona,anotice of intention to commence work at least 4g hours In advance of the time of commencement and shall aBo notify h(mfher promptly in wrlting of the completion of the Work. 1. The permitted work shall be Subject to inspection by an authorized representative of the Depanment of Environmental Comervation which may Order the work suspended if the public interest so requires pursuant to ECL §71-0301 and SAPA §401(3) 3. The permittee has accepted ezpressly, by the execution of the application, the full legal responslblliry for all damages, director Indirect, of whatever nature, and bywhomever suffered, arising out of the project described herein and has agreed to Indemnify and save harmless the State from salts, actions, damages and corn of everypama and descrip- lion resulting fiom the said project. , 4 The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when: a) the scope of the protect is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulellons ere found; or b) the permit was obtained by misrepresentation or (allure to disclose relevant facts; or ' c) newly discovered information or significant physl<al changes are discovered since the permit was issued. 5 The permittee is responsible for keeping the permit active by submitting a renewal application, Including any forms, fees or supplemental Information which may be required by the Department, no later than 30 days (100 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date. 6. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work or as authorizing the Impairment of any rights, title or interest in real or personal property held or vested In a person not a party to the permit. ' 7. The permittee is responsible for obtaining any other permits, approvals, lands, easements and righnof-way which may be required Eor this project. 8 Issuance of this permit by the Department does not, unless expressly provided for, modify, supersede or rescind an order on consent or determination by the Commissioner Issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination. 9 Any modification of this permit granted a in writing and attached hereto. PERMIT ISSUANCE DATE PERMIT ADMINISTRATOR ADDRESS 2/12/88 Alfred T. Kellar Bldg. 40 SUNY rm. 219 Stony Brook, NY I1 94 AUTHORIZED SIGNATURE Page 1 of 4 cc: BMHP A Ii`61 iy~y {!Y IYIISO{+Ii1i1!{i1i1i 3¦j{( ' ~ r ~j ~ I TI r-a `CI .SG y 4 ~ ~ i. 4 N of V ~ o. o Q ~ w F ~ ~ ~ m !H O y Q1 Q Y o ~ ~ F ~ z ~ ~ ~ 4 ! _ ~ 4 h ~o~ ~ _ 1 ~ x l~O~ ~ r O 3 ~ i1 0 4 ~ ° O ~ .a W i i ~ I~t ~ ~ U ~ ~ W G ~ i1i1i{i1i1 MM~N~i1 Y t i 1 . 95~266a (7/96)-25c - ADDITIONAL GENERAL,CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( ) 10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teratfon in tfie position of the structure or work herein authorized, or project. if, in the opinion of the Department of Environmental Conservation 14. ~ Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway ar floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused 15. There shall be no unreasonable interference with navigation by the work thereby witfiout expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, witfuout expense pieced, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in wch time and manner as the Department of Environmental Department of Environmental Conservation may require, remove all ar Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration. the State of Naw York on account of any such removal or alteration. 17. If granted under Article 36, this permit does not signify in any way 11 . That the State of New York shall in no case be liable for any damage that the project will be free from flooding. or inlury to the structure orwork herein authorized which maybe caused 18 If granted under 6 NYCRR Part 608, the NYS Department of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject protect will not conservation ar improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 12. Granting of thh permit does not relieve the applicant of the responsi- (PL 95-217) provided that ali of the conditions listed herein are met. biliry of obtaining any other permission, consent or approval from 19. All activities authorized by this permit must be In strict conformance the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State with the,approved plans submitted by the applicant dr Isis agent as part Office of General Services or local government which may be required. of the permit application. 13. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by PeconiC SUrVeyors of any wetland a waterway by suspended solids, sediments, fuels, solvents,lubricants, epoxy coatings, paints, concrete, leachate or any ~ Engineers P.C:s dated 11/16/$7 on SPECIAL CONDITIONS 1. There will be no disturbance to vegetation or topography within 50' of the tidal wetland boundary. 2. The driveway shall be constructed of pervious material. 3. Roof runoff shall be directed to drywells. , Supplementary Special Conditions (A) thru (J) attached. . Additional Supplementary Special Condition (M) attached. ' DEC PERMIT NUMBER IO-87-218) PROCRAM/FACILITY NUMBER N/A Page 2 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION UNIFORM PROCEDURES ACT ' Date: /a-frs, ReceiptNo.l7 480070 Region Na.: / Office: ~Kh7 Applicant: Snrn 11 I ~~~~~~nr~ nn Su~J-t~ Amount: $ lO • Q(~ i Application Identification No.: _ 10'.57- alSr / Permit TYPe: T(i 1 _ Check ~ Money Order ? ~~r~ ~ nF _ = _ Check or M.O. No.: ~(o ~ DEPARTMENT REPRESENTATIVE 34-14-7319/77) TITLE ' BOARU OP HIiALTH 3 SETS OF PLANS FORM NO. 1 SURVEY f~ TOWN OF SOUTHOLD CHECK • • • • • BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 • MAIL T0: Examined 19 ~ r"1 TO c~ / Approved : 19 ~.6Permit Nod~~~~ //3 D Disapproved a/c !~1! ~ ~ O TOWN[ OF SOUTFIOLO =-F'~1 ~ildin~pector) APPLICATION FOR BUILDING PERPIIIT Date .I„t~y.l?.........., 19~~. INSTRUCTIONS a. T}us application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans,accuratc.plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings otr 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 throug}tout 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, fox 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 insp ~ • s. (Sig lure of applicant, or name, if a corporation) • •f31 • Gar, diner ! s• ,rely, llr,, , , S.helt.er.. I....r?TY (Mailing address of applicant) 17-9E5 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Build-er • Name of owner of premises ,John & C7_; f f Cornell (as on the tax roll or latest deed) If applican a corpora 'on, signatur'/r{e/(/!/QQ~f~JdJUIy authorized officer. . .5..°. y... ame and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. 1,5~ . Plumber's License No. . 2?8tjp ' ' Electrician's License No. ,~~aaGO. ff~~1.6~ . Other Trade's License No . ,~,~75"i/ ,p ~ ~iyla~ 1. Location of land on which proposed work will be done. ~'rivate, ro,~c~, ,(>ri.en//~ s • ~Y • • • • • 1Iouse Number Street Hamlet County Tax Map No. ] 000 Section ..07,8............ Block R~ Lot '~•Ll. ?7.. • • • • • . Map of minor ."ubdivi~~ion, .Made fodr~Toseph & Edvrina 1Ja+La~er Subdivision . Fde ap No. o . (Name) ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . •JVew• single • family, framed, ,d~~relling,• • • • • , • • , • • . . . . . Re air , , jcable): New Building ..Liom.G Addition Alteration . 3. Natpure of work (check whiRemoval . llemolition ..............Other 1Vork , . , . (Description) Q. Estimated Cost S'v1.~Q,OD.0.00 Fee . (to be paid on filing this application) g, g ~ Tf gf7rallennu nber of carswellin units ...L Number of dwelling units on each floor . . . . g, cax ' 6. If business, conunerctal or mixed occupancy, specify nature and extent of each type of use . 1. ~nrotl~r "e i•es, of any: Front ...............Rear Depth , . r h~"*,,,, nber of Stories 4 ` . Dihie~tsions of same stnict ~a. rth! alterations or additions: Front Rear . Depth ..#~f.a?.~. f .'4~ .3 , ~ ~ lleight Number of Stories . 8. Dcn }'Ysioi~~ f entire new c Nuipbetion: Front ...69 ~ Rear , ,C9 Depth ....l}?.! . g . r of Stories ..1-1/2............ . 9. Sizc of lotc-Front . z~5.....n. Rear .....~'-.?~.5............ Depth .3t+.7.«66 . . ! 0. Date of Purchase : ................Name of Former Owner Jos epY] , rx, !!i~~Nlria .1Jatai er. . t ] . Zone or use district in which premises are situated ..~-7 . f 2. Docs proposed construction violate any zoning law, ordinance or regulation: No , , , , , , , , , , , , , , , , , , , , , , , , , , , f3. Will lot be regraded ..yeu . . . ..............Will excess fill be removed from premises; Yes No Iq, Narne of Owner of premises .JVhXI .CVxXi.e~.~-.....Address . ~~9. yV~,J,~.~,w. ,Jr'~,, Phone No, . 7F~.5-.21.`x£3... . Name of Architect ..Address .........Rgad,~S4R.tirlfAh~No L5. Is'thisCpropertyGlo a red wry ~ .I3ay Con. Co. Address Shelter 1s,,~NY. ,phone No. 749.:~~-~~ thin 300 feet of a tiidal wetland? *Yes . ~ No *If yes, Southold Town TrusCees PermitpLO~DIAGKAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from troperty lines. Give street and block number or description according to deed, and show street names and indicate whether nteriororcornerlot• Survey and plot plan included, ~'1'ATE OF NEW YORK, S'S 'cJTJNT'Y OF . • • 1 ~ . . ,(Name of individual signin• ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ' ' ' ' ' ' ' being duly sworn, deposes and says that he is the applicant g contract) above named. j le isthc........... .........i (Contractor, agent, corporate officer, elcJ ~f said owner or owners, and is duly 'authorized to perform or have performed the said work and to make and file this pplication; that all statements contairjed in this application are true to the best of his knowledge and belief; and that the vork will be performed in the manner het forth in the application Gled therewith. worn to before me this I L-~.... day of .'y.~~ .............19 ]otary Public, ~.t'!?~~...... County NOTARY PUOLIO, St . 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