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Home My WebLink About29805-ZFORM NO. 4 TOWN OF SOUTEOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29870 Date: 11/26/03 THIS CERTIFIES that the building ALTERATION Location of Property: 505 KAYLEIGH'S CT EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 4 Lot 16.9 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 10, 2003 pursuant to which Building PeZ~Lit NO. 29805-Z dated OCTOBER 13, 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 ALTERATION TO 2ND FLOOR OF EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. "AS BUILT", & AS PER CERTIFICATION OF CONDON ENGINEERING DATED 11/13/03. The certificate is issued to TAMMY H3~RNED of the aforesaid building. (OWNER) SUFFOLK COUNt"f DEPARTMENT OF~ALTHAPPROVAL ELEC~RICAL CERTIFICATE NO. PLUq~BERS CERTIFICATION D~r~ Rev. 1/81 N/A 1174021 10/23/03 11/21/03 STEVE BURNS PLUMBING INC. 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. 29805 Z Date OCTOBER 13, 2003 Permission is hereby granted to: TAMMY HARNED 505 KAYLEIGH'S CT EAST MARION,NY 11939 for : AS BUILT ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. ADDITIONAL CERTIFICATION WILL BE REQUIRED at premises located at 505 KAYLEIGH'S CT County Tax Map No. 473889 Section 031 pursuant to application dated OCTOBER Building Inspector to expire on APRIL Fee $ 300.00 EAST MARION Block 0004 Lot No. 016.009 10, 2003 and approved by the 13, 2005. /~/~ l th oqd~~i~ re ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 6 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 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-9 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installati .9335. ~.~ a, certificate of Code Compliance from architect or engineer responsible for the building. . · 6. Submit Planning Board Approval of completed site plan requirements. 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 ur 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 w?iting 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. New Construction: Old or Pre-existing Building: V/ (check one) LocationofProperty: ~o~ ~qtgfO..t~'s ~1-~ /~c~£3 /~t~r,'or~ House No. -- ,.t Street Hamlet OwnerorOwnersofmroperty: %rom7 {]Orr~pz,/ Suftblk County Tax Map No l000, Section O ~3 [ Block 00oq' Lot 0 I/~.OO~/ Subdivision Permit No. o) ¢~>o Health Dept. Approval: Date of Permit. Filed Map. Lot: fO/l~/O.~ Applicant: '~'~-,,',,c~ Under~vriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: V/ (check one) Eye Submitted: $ dT.. o5o Condon Engineering, P.C. New York State Licensed Pmfeseional Engineer 1755 Sigsbee Road Mat~tuck, New York 11952 631-298-t986 Fax 631-298-2651 November13,2003 Mr. John Boufis Building Inspector Town of Southold Building Department Town Hall 53095 Main Road Southold, New York 11971 Dear Mr. Boufis: I have inspected the plumbing for the second floor bathroom and i~ ~sulaiion of the second floor spaces at the Hamed residence at 505 Kayleighs Court in East Md[ion, New York and have found the installation to be in accordance with the New York State Building Code that was in effect at the time of the construction. It is my understanding that the work was performed pdor to January 1, 2003. If you have any questions please call me at 298-1986. Yours truly, Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631 ) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Pemfit No. Owner: 'W~. IMM ,q/ ~. ~ }O~J t,-~l~ ' ' '(Please print) Plumber: (Please print) / tOC_. lead. I certify that the solder used in the water supply system contains less than 2/10 of 1% .. ~.. v (Plumbers Signature) Sworn to before me this dayof ~L~i) / , 200'Z.~ Notary Public, .5~ County DAV1D G. CH£SHIRE No.q, Publ/c, State of New Ou-' .N.o: 4)'83676 .anna n Suffolk Count._ Commiss on Expires Dee, BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by C-CAT CO. TAMMY HARNED 9280 SOUND AVE. 505 KAYLEIGH'S CT MATTITUCK, NY 11952, EAST MARION, NY 11939 Located at 505 KAYLEIGH'S CT EAST MARION, NY 11939 Application Number: 1174021 Certificate Number: 1174021 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residentia! occupancy, wherein the premises electrical system consisting electrical devices and wiring, described below, located in/on the premises at: Second Floor, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 23~d Day of October, 2003. Name QTY Rate Rating Circuit Type Alarm and Emergency Equipment Sensor 4 0 Smoke Appliances and Accessories Exhaust Fan 1 0 F.H.P. Wiring and Devices Receptacle 19 0 General Purpose Switch 16 0 General Purpose Fixture 6 0 Incandescent Fixture 4 0 Fluorescent Paddle Fan 3 0 Receptacle 1 0 GFCI lm the I ectn on at v d~sn r nt and the]n I~e~mn A visua ' spection, of de ineated el 'cai installati , determined th an ob ious hazar ' ot p ese ' sta .*' ~s believed to be in comfonnance with the applicable reference standard for the estimated period of construction of the premises wiring .-),stem. seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. Permit Number Checked By/Date REScheck Compliance Certificate New York State Energy Conservation Construction Code REScheckSofiware Version 3.5 Release la Data filename: C:~Program Files\CheckLREScheck'~.ARNED.rck TffLE: HARNED RESIDENCE COUNTY: Suffolk STATE: New York HI)D: 5750 CONSTRUCTION TYPE: Detached 1 or 2 Family HEATING TYPE: Non-Electric DATE: 04/21/01 DATE OF PLANS: 9/21/2003 COMPANY INFORMATION: CONDON ENGINEERING, P.C. COMPLIANCE: Passes Maximum UA = 200 Your Home UA = 200 0.0% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Flat Ceiling or Scissor Tress 1105 19.0 0.0 Wall 1: Wood Frame, 16" o.c. 893 19.0 0.0 Window 1: Wood Frame:Double Pane 94 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 1105 19.0 0.0 0.470 56 48 44 52 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of his/her knowledge, belief, and professional judgment, such plans or specifications ~Cod~ Builder/De~ Date lllEScheck Inspection Checklist New York State Energy Conservation Construction Code REScheckSoffware Version 3.5 Release la DATE: 04/21/01 TITLE: HARNED RESIDENCE Bldg. Dept. Use [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Ceilings: 1. Ceiling 1: Fiat Ceiling or Scissor Truss, R-19.0 cavity insulation Comments: Above-Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation Comments: Windows: l. Window 1: Wood Frame:Double Pane, U-factor: 0.470 For windows without labeled U-factors, describe features: # Panes Frame Type_ Thermal Break? [ Comments: ]Yes[ ]No 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space, R-I9.0 cavity insulation Comments: Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of ak leakage must be sealed. Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate ak-tight assembly with a 0.5" clearance from combustible materials. If non-IC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: Required on the warm-in-winter side of all non-vented flamed ceilings, walls, and floors. Materials Identification: Materials and equipment must be installed in accordance with the manufacturer's installation instructions. Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Duct Insulation: Supply ducts in unconditioned attics or outside the building must be insulated to R-8. Return duets in unconditioned attics or outside the building must be insulated to R-4. Supply ducts in unconditioned spaces must be insulated to R-8. Return ducts in unconditioned spaces (except basements) must be insulated to R-2. Insulation is not required on return ducts in basements. Duct Construction: All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric, or tapes. Duct tape is not permitted. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts [ I [ ] [ ] [ ] [ ] [ ] [ ] [ ] operating at less than 2 in. w.g. (500 Pa). Ducts shall be supported every 10 feet or in accordance with the manufacturers instructions. Cooling ducts with exterior insulation must be covered with a vapor retarder. Air filters are required in the return air system. The HVAC system must provide a means for balancing air and water systems. Temperature Controls: Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: Separate electric meters are required for each dwelling unit. Fireplaces: Fireplaces must be installed with fight fitting non-combustible fireplace doors. Fireplaces must be provided with a source of combustion ak, as required by the Fireplace construction provisions of the Building Code of New Yorl{ State, the Residential Code of New York State or the New York City Building Code, as applicable. Service Water Heating: Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: I-IVAC piping conveying fluids above 105 °F or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipe& Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts · Temperature (F) Up to 1" Up to 1.25" 170-180 0.5 1,0 1.5 2.0 140-160 0,5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Circulating Mains and Runouts 1.5" to 2.0" Over 2" Table2: Minimumlnsulation ThiclcnessforHVACPipe& Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pipin;g System Types Range(F) 2"Runouts l"andLess 1.25"to2" 2.5"to4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1,5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1,0 1.0 1,5 2,0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) / / / / Permit Number Checked By/Date REScheck Compliance Certificate New York State Energy Conservation Construction Code REScheckSoflware Version 3.5 Release la Data filename: C:~Program Files\CheckLRESeheckXHARNEDrck TITLE: HARNED RESIDENCE COUNTY: Suffolk STATE: New York HDD: 5750 CONSTRUCTION TYPE: Detached 1 or 2 Family HEATING TYPE: Non-Electric DATE: 04/21/01 DATE OF PLANS: 9/21/2003 COMPANY INFORMATION: CONDON ENGINEERING, P.C. COMPLIANCE: Passes Maximum UA = 200 Your Home UA = 200 0.0% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Flat Ceiling or Scissor Tress 1105 19.0 0.0 Wall 1: Wood Frame, 16" o.c. 893 19.0 0.0 Window 1: Wood Frame:Double Pane 94 Floor 1: All-Wood loisffrruss:Over Unconditioned Space 1105 19.0 0.0 0.470 56 48 44 52 COMPLIANCE STATEMENT: The proposed building represented in this documem is consistent with the building plans, specifications, and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of his/her knowledge, belief, and professional judgment, such plans or specifications ~C od~..._ Builder/De~ Date l~tEScheck Inspection Checklist New York State Energy Conservation Construction Code REScheckSoffware Version 3.5 Release la DATE: 04/21/01 TITLE: HARNED RESIDENCE Bldg. Dept~ Use [ ] [ ] [ ] [ I [ ] [ ] [ ] [ ] [ ] [ I [ ] [ ] [ ] [ l [ ] [ ] Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-19.0 cavity insulation Comments: Above-Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation Comments: Windows: 1. Window 1: Wood Frame:Double Pane, U-factor: 0.470 For windows without labeled U-factors, describe features: # Panes Frame Type. Thermal Break? [ Comments: ]Yes[ ]No Floors: 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space, R-19.0 cavity insulation Comments: Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate air-fight assembly with a 0.5" clearance from combustible materials, lfnon-IC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. Materials Identification: Materials and equipment must be installed in accordance with the manufacturer's installation instructions. Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and senrice water heating equipment must be provided. Insulation R-values and glazing U-factors must be dearly marked on the building plans or specifications. Duct Insulation: Supply duets in unconditioned attics or outside the building must be insulated to i*,-8. Return ducts in unconditioned attics or outside the building must be insulated to R-4. Supply ducts in unconditioned spaces must be insulated to R-8. Return ducts in unconditioned spaces (except basements) must be insulated to R-2 Insulation is not required on return ducts in basements. Duct Construction: All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric, or tapes. Duct tape is not permitted. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] ] 1. ] ] operating at less than 2 in, w.g. (500 Pa). Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions. Cooling ducts with exterior insulation must be covered with a vapor retarder. Air filters are required in the return air system. The HVAC system must provide a means for balancing air and water systems. Temperature Controls: Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: Separate electric meters are required for each dwelling unit. Fireplaces: Fireplaces must be installed with tight fitting non-combustible fireplace doors. Fireplaces must be provided with a source of combustion air, as required by the Fireplace construction provisions of the Building Code of New York State, the Residential Code of New York State or the New York City Building Code, as applicable. Service Water Heating: Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part cfa circulating system. Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is f~om non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: HVAC piping conveying fluids above 105 °F or chilled fluids below 55 OF must be insulated to the levels in Table 2. Tgble 1: Minimum Insulation Thlekness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes He*tM Water Non-Circulatin$ Runouts Circulatin8 Mains and Runouts Temperature (F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table2: Minimumlnsulation Thicknessforl-lV,,ICPipes. Fluid Temp. Insulation Thickness hi Inches by Pipe Sizes Pioing System Tvl~es Ran,ge (F) 2" Runouts I" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressurefremperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed wate0 Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0,5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FELl) (Building Department Use Only) 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~ULATION [ ] FRAMING [//] FINAL [ ] FIREPLACE & CHIMNEY INSPE~ TOWN OF ~qOUTHOI. D BUILDING DEP&RT~IEN~ TOWN HALL I SOt0'I I-~OLD, ~ 11971 BUILDING PERMIT APPLICATION CHECKLIS~I Do yoa ~ or a~t ttae followi~, b~o~ apl~lying5 Board of Heakh 3 sols o~ ttullllmg l'la~s plamaing Board at. royal Survey. Cheek N.Y.S.D~E.C. Trm~ Con~act: APPLICATION FOR BUILDING PERMIT 'INSTRUCTIONS a. This nppl/c~tion MIZqT bo oomplet~l¥ filled in by ~ter or in ink and submi~'d to the Buildi~ Inspector w/th 3 sets of plato, aeou,at~ plot plan to ~de. F~e according to ~hedul*. b. Plot plan showiag location oflot ami of buildings on pr~mlses, relationship to adjoi-jng premises or pubhc streets or areas, and w~ervcays. ~. The work cov~a'ed by ~ application may not be oo~m~l b~for~ issuaxm~ of Building p~mlt. d. 1Jpon =Pl~, oval of lids application, th~ Builffmg ~ will issu~ a B~fildln~ Permit to thc applimmt, b"u~h it permit shall be kept on tl~ premis~ available for illap~on throu~out tl~ v~ork. e. No building shall b~ ooeupiecl or used in w~holo or in pa~ for any purpose what so ever until th~ B~ ~or i~ae* a Ceatificate of Oc~-upeacy. £ Bvory Imilding permit ~ ~tf the work authorized has not ~ ~ 12 monrh.q afl~ th~ dal~ of issuanc~ or has not be4m completed within 18 month~ from such date. If no zo-in~ ~ or other regulations affecting the property have be~ ~in tho interim, the Buildi~ lnspoe~ may authoriz,, in wrhlln~ the extension offl~ ptamil for an addition six months. Thereafter, a new permit ~ bc r~quired. APPLICATION IS Itl~REBY MADE to tho Building ~ for the i~mnc~ of a Bttihtln ~ Permit punmant to the Building Zone Ordinance ofth~ Town of $outhol~ SutToIIr Coullty, Hew York, a~l other applicable Laws, Ortt__~an~ or Regulations, for the oonsm~on of buildinga, additions, or alt~r, alo~ or for _removal or d~molit~ a~ her~ described, Tiae applicant lgrees to comply with all appHcatble laws; o~, bl~ltli-g code, homing code, ~ r~gulafion,% alld to adini~[ authorized inspectors on pmnais~ and in building for nec~zsary r. sl~ffi~~ ~ of applicant or name, if a corporati&) State whether applicar~ i~ owner, le~e~, at,mt, architect, engi~or, general coniractor, elearician, pltnn~ or builder Name of owner of premises '~g ~A } ./4. ~ &D (As on tho ~x roll or'iat0st de~d) If applicant is a corporation, signature of duly authorizod officer ....~ (Nam~ a~d tide ~f corponite officer) Builders License No. Ptnmb~ Lic*a.s, No. F.k~da~ ~ No. O~er Trade's Lieonse No. l. Location of land on which pwposed work wilt be done: House Number Strut County Tax Map No. 1000 gubdivision (Name) Se~ion, Block Pile~l Map No... Lot 2. 8tat~ existing.use a~t oe. oxl:u~cy 0il:tretlg,~ ~ ~ u,~ ,~d occupancy of propm~.xt construction: a. Existihgu~e~nd oec'upanoy b. tnt~nd~l use and occupancy Nature of work (check which applicable): New Building,, Esthnated Co~__ . If dwelling, mmaber of dwelling units. . .{. If ~ar~e, number of ram ?_ ......... Addition Alteration Demolition Other Wtrtk (Description) (To be paid on filing this application) Number of dwelling units on each floor If~.~mm~rWtal m:.mix~d oc~alp.apey, sp~/g7 j.~an~ a~l ext~mt of cash ~ of u.~. Height_ Z~.t~q t-,, , Number of Stories ?~ ........ Dep~ Dimensions of same structure with alterations or additions: Front Depth_. Height ........ Number of Stories 8. Dimensions of~ new construction: Front Height. Number of Stories R ar 9. Size of lot: Front . R~ar D*pth ..... 10. Dam of Pumhase ........ Name of Former Owner I I. Zone or ase dLm~ in whiCh pr~xi$e$ ar~ a~Watod 12:17o~s pmpos~I comtracti,n violate ar~y zoning l~w, ordinanc, or regulaion? YES .... NO ~ 13. Vqitt tot t~ro-gmdod? Y~ NO_~Wilt excess fill t~e~ved liom premises? YES NO 14. Names of Owner ofprlanis~s Name of Architect ..... Name of Co~ Address ,., Phone No. Addr~s~ .... Phono No Address ~ PhoneNo. t 5 a,. h this property within 1 O0 f~t of a tidal w~tland or a fr~ahwater w~tland? *YES NO * 1F YES, SOUTHOLD TOWN TRUSTEES & D.E.C, PFAIMIT$ MAY BE REQUIRED. b. Is this prop~r~ within 300 fegt of a tidal w~land? *.YES. NO ,e~ * IF YES, D:E.C. PERMIT8 MAY ]~ REQUIRF~; 16. Provide survey, w scalo, with acvura~ ~ion l~m mci diatanc~ to pr~ linea. 17. If elevation at ~y pOilat on property is at 10 fc~t or below, must provide topographical data on STATE OF NEW YORK) ', SS: CO~/NTY OF ~.~t.e-~-~ ~ ~r.x~c//~) being~ulyswom, d,lx~esandsaystbal(s)heistheapplica~ ~me of ~d~ ~i~ ~) a~e ~. (S)He is ~e ...... yCo r, Ag om , of said owner m- ovnaers, ~.~ is duly aWdlorlz~ to pea'form n~ haw p~f-orm~l th~ raid work ~ to ~ and ~e this application; that all statem~ats comainexl in this application ~¢ true to tl~ be~t of ids lmowkxtge and beliof; and that thc work w/Il be performed in the ~ s~t fom-h in ihs appl/cation filed therewith,