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Home My WebLink About29764-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPILNCY No: Z-29836 Date: 11/13/03 THIS CERTIFIES that the building ALTEP3%TION I~)cation of Property: 58775 CR 48 GREENPORT (HOUSE NO.) (STREET) (HAMLET) Cotknty T~x Map No. 473889 Section 44 Block 2 I~Dt 20 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 25, 2003 pursuant to which Building Petit No. 29764-Z dated SEPTEMBER 26, 2003 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 WINDOW REPLACEMENT TO EXISTING RESTAUR3~NT AS APPLIED FOR & AS PER ARCHITECT CERTIFICATION DATED 10/18/03, The certificate is issued to RACHEL S LEVIN of the aforesaid building. (OWNER) SUFFOLK COD1TTY DEPARTMENT OF }IEALTH APPROVAL ELECTRICAL CERTIFICA~ NO. PLU~4BERS CERTIFICATION DA'£F~3 Rev. 1/81 N/A N/A Authorized SignOre FORM NO. 3 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) PERMIT NO. 29764 Z Date SEPTEMBER 26, 2003 Permission is hereby granted to: for : RACHEL S LEVIN 11220 SOUNDVIEW AVE SOUTHOLD,NY 11971 WINDOW REPLACEMENT (IN KIND) TO AN EXISTING RESTAURANT AS APPLIED FOR PER TRUSTEE APPROVAL WITH FLOOD PERMIT at premises located at 58775 CR 48 GREENPORT County Tax Map No. 473889 Section 044 pursuant to application dated SEPTEMBER Building Inspector to expire on MARCH Block 0002 Fee $ 300.00 25, 6~,2005/ / Lot No. 020 COPY Rev. 5/8/02 TOm OF SOU.IOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: , 1. Final survey ofprop,.erty with accurate location of all buildings, property lines, streets, and unusual natural or topographic fe~ures. ' 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approvai of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains Iess than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences'and similar buildings,a~d installations, a certificate of Code Compliance from architect or engineer responsible fbr 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 ail property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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 - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. ///<5 ~ New Construction: Location of Property: ~? !~'~ House No. Owner or Owners o f Property:-~.~e ~ Suffolk County Tax Map No 1000, Section Subdivision Permit No. ~? ~,~ ~ __ Health Dept. Approval: Old or Pre-existing Building: ~ (check one) Street Hamlet Block 2 Lot Filed Map. Lot: Applicant: Date ofPermit. ~/.~lO_e'~ Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 50,110 Final Certificate: (check one) ~ignature · ' · ,j~H T. TEI~RY TOW~ CLERK OFFICE OF THE TOWN CLERK TOWN OF $OUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 29, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two [2) new forms to be used under tfte Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Oevelopme~a~t Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)}. T0,,WN OF $0U~.~O_LD. I Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE I ol ~ FLOODPLAIN DEVELOPMENT PERMFF APPLICATION This form is to be filled out in duplicate. SECTION !: GENERAL PRQV/S~[O/',/S~.APPLIC~ANT lo read an~d si,~n): L No work may start nat3 a permit i~ issued. 2. The permit may ~ revok~ ff ~y f~e statemeau ~e made hercM_ 3. If revok~ ~ work m~t ~e ~ pe~it ~ re-~ued. 4. Developmea~ ~h~ ~o{ ~ ~cd or ~pied um~ a Cert~{e of ~mp~ ~ ~ued. 5. Thc pc~i~ ~ ~ d bo ~rk ~ commenced M[~ s~ moat~ of ~su~. 6. Appfi~t ~ hereby ~o~ed that other pekin may be req~ed to ~ Io~, sta~e ~d federal rc~lato~ ~. App~[ h~eby ~ ~( ~o the ~ Arima(rotor or ~/her repr~emafive ~o m~c fe~oaable ~o~ r~ ~o vc~ ~mp~. 8. ~ ~ ~P~, ~R~ ~T ~L STA~ HEREIN ~ ~ A~AC~ TO (~l~S SIO~ATU~E) SECTION 2: PROPOSED DEVELOPMENT (To be compJ[clcd by APPLICA/g-I) HAME ,ad)DRESS ) TELEPHONE ,31 -q'F]_ PROJECT LOCATION: To avoid delay ia proce~hag the apptlcadoa, please provide eoough information Io easily ideatff'/the project Iocatiom Provide the street addrc~ lot number or legal dc-scHpfion (atlach) and, outside urban are,is, the dLstance to the nemre~t hat~'sectlng road or wcll-kuoum l~dmark. A sketch altachcd lo chis application shocdng (he project location would be helpk~/ A~pLICATION ~ ~ PAGE 2 OF a DESCRIPTION OF WORK (Check ~li app6cablc boxes): A STRUCTUI:LAL DEVELOPMENT &(~IVTFY ~TRUCTURE TY~'E ~ New Structure [] Addition [] Alteration [] R~locatlou [] Demo[ition ISl/Replacemeut El Residential (1-4 Family) g] Residential (More than 4 Facnily) [] Non-residential (FIoodproof'mg7 [] Yes) Gl~ombined Usc (P.~idenfM & CommercbJ) [] Manufactured (Mobile) Home (In Manu- factured Home Park'?. 123 Yes) ESWINtATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: El Fill [] Mining CI Drilling n Grading [] Excavation (Except for Structural Development Checked Above) -- - El Watercourse Alteration (Including Drextging and Channel ModLficatiorts) [] Drainage Improvementx (Including Culvert Work) O Road, Street or Bridge Conztruction O Subdivbion (New or Expansion) [] Individual Water or Sower System After completing SECTION ~, :sd:'PL[~ shouJd submit form to Local Admi~.btrator for rcX4cw. ~ECTION 3: FLOODPLAIN DblERMINATION (To be completed bv LOCAL ADbfINISTRATORI The proposed development is located on bllz~v[ Panel No. ~ Dated The Proposed Development: [] I~ NOT located ha a Special Flood Hu?ard A~ea (Notify thc applicant that ~c application review ix complete and NO FLOODPLAIN DEVELOPMENT PERMTF IS REQUIRED). F1 Ix located ioa Spex:ial Flood Hazard Area. FIRM zone de.qignation ix 10n-Year flood elevation at the site ix: Fc NGVD (MSL) [] Unavailable [] The proposed development is ~ocaled in a floodway. FBFM Panel No. Dated [].gee Section 4 for additional mslruclmns SIGNED DATE APPLICATION PAGE 3 OF 4 SE~-i-IQN 4. ADDITIONAL INFORMATION REOUI RED][To he completed by bOCAL AD/V!INI~TR..ATOR~] Thc appLic.ant must submit thc documents checked below' bdorc thc application can bc processed: C] A site pl&a sbo,x, mg Ibc location of ail cx~stL~g slrucluxcs, walmr bodies, adjaccm roads, Io; dimeusio~ and proposed devclopmcm. O Devclopmem plans, drawn to scale, and spccificat~ns, iucludia§ where appllcablc: dot,Is for a-ncborlng structure, proposed elevation o£ lowest floor (bacJudh2g ba~em¢at), types of water rnsistant materials used below the/-u-st floor, dctads of floodproofiag o£ utilities located below Lbo first floor =od dct~l.s of cudosuscs below d~c firsl floor. Subdivision or other dcvalopmem pla~s (If thc subdivision or other dcvclopmcm exceeds 50 lots or 5 acx~, whichever is the lesser, the applicant must provide 100-year flood clevatioks if they arc not othcrwisc awilablc). I-'1 Pla~ showing thc extemt of watercourse relocation and/or la~cfform alterations. Top of new £dl elevation Ft. NGVD (MSL). Floodproo£mg protectiau level (noa-r~idcntla] only) Ft.' HGVD (MSL). For floodptoofed structure, applicant must attach ct:rt~catlon from registered engiae..e.t- of architect. 0 CcrtLficatiou from a rcE6-stcrcd caEanccr that thc proposed activity i~ a regulatory floodway wi/l not result in ~ hacrca~e in thc height of ~bc ZOO-year flood. A copy of a/d data and ca/culations supporthag ttfi~ {'mding must ~so be submitted. Other: SECTIO~ 5: PEPU'vIIT DETERMIHATION (T9 be completed bY L0(~AL ADMINL~'TRATQR.~ I have dete..rmhaed that the proposed acti,Aty: A. E3 Is B. [3 Is not La cou/ormaace with provisions of Local Law # , 19 attached to a~d made pa_~ o£ tla~ ix:trait. SIGNED , DATE · The permit is issued subject to the conditions If B0~ A i~ checked, ibc Local A. damiaJztrator may i~suc a Dcvclopmcm Permit upon paymcal of dcsi~ated ~.thc ~lAdmimItralor ~1 pro,nde a ~iuca summ~of deficiently. Applier may re,se and resubmit ~ appfi~tion to Lh~ ~lAdminis~rator or may request a bearing from Ibc Bo~d of App¢~. APPE~d~S: Appealed to Boned of Appeals? [] Yes [] No Hca.ring date: Appeals Board D¢cbioo--- Approved? [] Yes Conditions O No APPLICATION PAGE ,:1 OF ,1 SECTION 6: AS-BUILT ELEVATIONS (To be submiued by APPLICANT before Certificate 0[ Cgmpliance is issued~ The following information mint be provided for project structm'es. This section mnst be completed bY a registered professional engineer or a licensed land surveyor (or attach a certification to th.is application). Complete I or 2 below. 1. Actual (As-Built) Elevation of the top of ilae lowest floor, including basement (in Coastal Hiuh H aza'rd Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr..orr) 0~SL). Actual (As-Built) Elevation of floodproo£mg protection ks FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above bi'on:nation is at thc risk of the Applicant. SECTION 7: COMPLIANCE ACTIQN (To be completed lpv LOCAL ADNIINISTRATORI The LOCAL A.DMINIS'TRATOR will complete this semion ns applicable based on h:~pection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICFENCIF--.S? [] YES [] NO DATE BY DEFICIENCIES7 [] YES [] NO DATE BY DEFICIENCIES? [] WES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comt)leted bY LOCAL ADMINIc-'TRATQR} Corthqcate of Compliance Ltsucd: DATE: BY: Attachment B ~A/{PLE CERTIFICATE OF CO~{PLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD ItAZAJLD ,ad:LEA (ov~rNER MUST RETAIN THIS CERTIFICATE) PRJEMISE$ LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [21 NEW BUILDING [] EXISTING BUILDING C] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW # , 19 SIGNED: DATED: COMPLIA~NCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW #__, 19__, AS MODIFIED BY VAF3ANCE # DATED SIGNED: DATED: OF OF C/C(93) CHRISTOPHER R. STRESS, A.I.A. ARCHITECTURE AND PLANNINg P.O. BOX 821 JAMESPORT, NY 11947 PHONE/FAX (631) 722-7865 18 October 2003 Southold Building Department Main Road Southold, N.Y. Re: Soundveiw Restaurant Permit # 29764 R Sirs: This letter is to notify the Building Departmem that the work completed ( Strapping, Insulation and Header installations ) at the above mentioned building project has been reviewed by me and as I see it meets or exceeds the current NYS Codes. Should you have any questions on the above or other aspect of this project, kindly contact me directly. Christopher Stress, A.I.t~ Architect 025339 NYS License # CC: Soundview Restaurant, Rachel Terry Bemagozzi, Bemogozzi Contracting Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 5, 2003 Ms. Rachel Levin Soundview Restaurant, Inc. 11220 Soundview Ave. Southold, NY 11971 SOUNDVIEW RESTAURANT, INC. 58775 NORTH RD., GREENPORT SCTM#44-2-20 Dear Ms. Levin: The Southold Town Board of Trustees has reviewed the letter from Christopher R. Stress, A.I.A dated September 2, 2003 and your application submitted September 4, 2003 and hereby grants you an Emergency Permit to replace all the windows on the east side of the restaurant building. This determination is not a determination from any other agency. Very truly yours, Albert J. Krupski, Jr., President Board of Trustees AJK:lms BUILDING PERMIT EXAMINER CHECKLIST DATE SUBMITTED: '~ /,¢5'/03 SCTM# DISTRICT: 1,000, SECTION: Z~- , BLOCK: ;. ., LOT: ~ SUBDIVISION: ~olta ADDRESS: ~S-lg~J ClZ t4~ CITY: ~ ZONING DISTRICT: __ CONFORMING? __ BUILDING PERMITS OPEN/EXPIRED: PRE,~/BOp_RN BP -Z / C/0 Z- INFO -Z / C/0 Z- INFO BP -Z / C/O Z- INFO ./ / BP- -Z / C/O Z- , INFO t~/~ NOTES: - SINGLE & SEPARATE CERTIFICATION-REQUIRED LOTS 40,000SF -100-24. Lot recognition.(CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger.(A nonconforming at any time after 7/1/83 REQ. LOT SIZE: ACT. LOT SIZE: __ REQ. FRONT PROP. FRONT REQ. REAR PROP. REAR PROJECT DESCRIPTION: I,o ESTIMATED PROJECT COST: ~ ~'°~'-"'ARCHITECT/ENGINEER: WATER FRONT? Y~ DESCRIPTION: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES r~3(BED #): DTE: __ SOUTHOLD TOWN TRUST-'-~'~.' ~r $Ol~..6~ DTE: TOWN ZONING BOARD APPROVAL: YES o~ DTE: TOWN PLAN. BOARD APPROVAL: YES o~ DTE: TOWN HISTORICAL PRE (SPLIA): YES ~ NEW YORK STATE CODE COMPLIANCE (SEE PA,(~: YES'or NO NOTE S: REQ. LOT COV. fQ SIDE-REQ. HEIGHT ACT. LOT COV. ACT. SIDE PROP. HEIGHT PANEL # / / PERMIT #: / / PERMIT #: '~ /~---/ g PERMIT#: / / PERMIT #: / / PERMIT #: FEE STRUCTURE: FOUNDATION: FIRST FLOOR: SECOND FLOOR: OTHER: TOTAL: 1. ( SF)- ( .SF)=. SF X $. 2. ( SF)- ( SF)= SF X $ 3. ( SF)- ( .SF)= SF X $ SF SF SF SF INIT SF FEE =$ +$ OTHER TOTAL FEE FEE +$ Ioo = $ ~*o =$ +$ +$ : $ =$ +$ +$ = $ FINAL TOTAL: $ '~ CHRISTOPHER R. STRESS, A.I.A. A ARCHITECTURE AND PLANNING P.O. BOX 821 IAMESPORT, NY 11947 PHONE/FAX (631) 722-7865 18 October 2003 Southold Building Department Main Road Southold, N.Y. Re: Soundveiw Restaurant Permit # 29764 R Sirs: This letter is to notify the Building Department that the work completed ( Strapping, Insulation and Header installations ) at the above memioned building project has been reviewed by me and as I see it meets or exceeds the currem NYS Codes. Should you have any questions on the above or other aspect of this project, kindly Christopher Stress, A.I.~ Architect ~ NYS License # 025339-- contact me directly. CC: Soundview Restaurant, Rachel Terry Bernagozzi, Bernogozzi Contracting 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FO/~DATION2ND [ ] INSULATION [ /_.~FRAMING [ ] FINAL ] FIREPLACE & CHIMNEY Old"- .~_~ ~-<-~<~ ' /" 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUG~I. BG. [[ ]]~OR~NMiDNA~ION 2ND [[~ON [ ] FIREPL~~M~ DATE ~SPECT~ /VN OF SOUTHOLD .CILD1NG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 v~vw. northfork.net/S outhold/ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST ! Examined ~{.?~ ,20 ~ Disapproved a/c Expiration ,2 ~uil~ting Do you have or need the following, belbre applying'? Board of Health 3 sets of Building Plans plamamg Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: ~ "' Mail to: ;2~.....~. Phone: Inspector i; AP~PLICATION FOR BUILDING PERMIT SkP 2 5 2003 t ]' i ......... X { INSTRUCTIONS Dates ~ ,200.~ t:' ': : a. Tl~-app~cat~gn MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 ;ets of plans, accurate plot pla~ to scale. Fee according to scheduie. b. Pl~t plan showing location of lot and of buildings on prem/ses, relationship to adjoining premises or public streets or areas, and waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept on the preanises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the perrnit for an addition six months. Thereafter, a new perrmt shall be required. APPLICATION IS HEREBY MADE t9 the Building Department for the issuance of a Building Penn/t 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 inspections. ,..-~ (Signature of applicant or name, il' a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbdr or builder Name o£ owner of premises ~d _~q 'k (As on the tax roll or latest deed) If appl~n_ t is signature of duay authorized officer (Name and tit~o~orporate officer) Builders License No. 9.q 12- %- 14 Plumbers License No. ~,11/~ Electricians License No. ~[~t Other Trade's License No. /~ I]~ Location of land on which p~r.o~qsed work will bc done: H~tise N~wnber ' Streei Hamlet County Tax Map No. 1000 Section Subdivision (Name) Block 0 Filed Map No. Lot Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /f~'^,OK~jd'ff-'. ~ b. Intended use and occupancy 3. Nature ofwor, k (check which applicable): New Building Repair ~ Removal Demolition 4. Estimated Cost Fee 5. Addition_ Alteration Other Work (Description) (To be paid on filing this application) If dwelling, number of dwelling milts e,I[P~ 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 existizlg structures, if any: Front ~__Rear ['~[ ([;1[4~- Depth ,5?[- Height ?./~_~.,2~ Number of Stories Dimensions of same structure with alterations or additions: Front ~1~'~ Rear Depth ,_~',~! ~ Height ~.~.. Numbei' of Stories / ' ' 8. Dimensions o f entire new construction: Front~e~ Depth Height Number of Std~cr'~'~ '" ~ '"-J 9. Size oflot: Front ~q ~ ~-~ Rear ~ _Depth 10. DateofPurchase ~S~[!~C~q,~ Name ofFormer Owner "~'Ct_c.~ 11. Zone or use district in which premises are situated ~¢_~qt~ ~ [ .i~' 53! (~t~-(O.~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ~. 13. Will lot be re-graded? YES__ NO .,~._Will excess fill be removed from premises? YES__ 14. Names of Owner of. premises ~0.,~1~ ~l~ Address t[~) ~14~)14~l'°A~l~hone No. "~ Name of Architect~./,tl~E~n~ ~ . ~,~, Address ~ ~ff4'~-,/~/,~,'~¢/~llff/'Phone No Name of Contractor ~oue ~[t~o~; F_~g$-r. Address ~ [~- Phone C,rrcv u ' 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ~( NO * 1F YES, SOUTHOLD TOVCN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES ~( NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on surv.ey. STATE OF NEW YORK) SS: cot3rry OF ) ~.~'ld [,~[/ {'ff'~ being duly swum, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (_ CD ,l"~.~. J[~_.. C3~, 1~ -~ ('" (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 th/s application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be mormed in the manner set forth in the application filed therewith. bef°~ieay~ 20~)~ //~ .~ ~ Q~ J',f' l~ ' VeroniCa F. Cidone ~ Sign~t~"tf°~Applicant -- ( Notary Public, State of New York No: 52-4~o61406 Qualified in Suffolk Coun.!~ _ ~ Commission Expires Dec,31 ,~z~_.~ cO01~¥ ~' ? o~ co¢~~Y SURVEY OF PROPERTY SITUATED AT ARSHAMOMOQUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-44-02-20 SCALE 1"=20' SEPTEMBER 21, 2005 AREA = 17,658 sq. fi. (TO TIE LINE) 0.405 ac. Nathan Taft Corwln III Land Surveyor 992 Roanoke Avenue Riverhead, New York 11901 PHONE & FAX (631)369-5473 SOUNi