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HomeMy WebLinkAbout27993-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-2997- Date: 01/27/04 THIS CERTIFIES that the building ACCESSORY Location of Property: 620 MEDAY AVE HOUSE NO.) (STREET) County Tax Map No. 473889 Section 113 Block 10 Subdivision Filed Map No. Lot No. MATTITUCK (HAMLET) Lot 15.7 conforms substantially mo the Application for Building Permit heretofore filed in this office dated JANUARY 4, 2002 pursuant to which Building Permit No. 27993-Z dated jANUARy 8, 2002 was issued, and conforms uo all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY FIVE CAR GAP_AGE AS APPLIED FOR PER ZEA ~5020 DATED 11 29/01. The certificate is issued to BRUCE M & MAUREEN CAMPBELL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF~EALTH/~PPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'£~U3 Rev. 1/81 N/A 80690C 11/19 03 ~I~ _ ~//~nature FORH NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27993 Z Date JANUARY 8, 2002 Permission is hereby granted co: BRUCE M CAMPBELL 62} MEDAY AVENUE MATTITUCK,NY 11952 for : CONSTRUCTION DF A 1,280 SQUARE FOOT GARAGE AS APPLIED FOR WITH ZBA CONDITIONS at premises located at 620 MEDAY AVE MATTITUCK County Tax Map No. 473889 Section 113 Block 0010 Lot No. 015.007 pursuant to application dated JANUARY 4, 2002 and approved by the Building Inspector. Fee $ 309.00 Authorized Signanure ORIGINAL Rev. 2/19/98 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled/n by typewriter or ink and submitted to the Building Department with the following: Ao For new building or new use: t. Final survey of property with accurate location of all buildings, property lines, streets, and mmsual natui'al or topographic features. 2. Final Ap~oval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of F/re Enderwdters. 4. Sworn statement fi:om plumber certifying that the sdlder used in system contains less than 2/10 of 1% lead. 5. Commerc/al bui!ding, i~dustrial buikiing, mult/ple residences and similar build/ngs and knstallatid~as, a a~ificare of Code Compliance from architect or en~eer responsible for the buitd/ng. ~17 ' 6. Submit Planning Board Approval of completed site plan requirements. Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurat~ sarvey ~£ pr~perty sh~wing a~~ pr~per~y ~ines~ str~ets~ bui~ding and nnusual natura~ ~r t~p~graphic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate o£ Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees l. 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 New Construct/on: Location of Property: _~¢~ House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Date. Old or Pre-existing Building: BIoe Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ &~ ~ (check one) Hamlet Filed Map. Lot: Applicant: Underwriters Approval: Final Certificate: ~(check one) ~¢pApp~ic~ APpEALs BOARD MEMBERS Gerard P. Goehringer, Chairman James Dinizio, Jr. Lydia A. Tortora Lora S. Collins George Homing BOARD OF APPEALS TOWN OF SOUTHOLD Southold Town Hall 53095 Main Road EO. Box 1179 Southold, New York 11971-0959 ZBA Fax (631) 765-9064 Telephone (631) 765-1809 FINDINGS. DELIBERATIONS AND DETERMINATION MEETING OF NOVEMBER 29 2001 Appl_ No.5020'- BRUCE AND MAUREEN CAMPBELL Loca,t, ion of Property: 620 Meday Avenue Mattituck 1000-113-10-15.7 Date,Cf Publib i21e~idng: ' NOVember 15. 2001 FINDINGS OF FACT PROPERTY DESCRIPTION: The subject property is a heavily wooded parcel of 2.9 acres in Mattituck, with northerly frontage on Meday Avenue (about 300 feet) and southerly frontage on Westphalia Road (about 254 feet). The easteny side of the property is bordered by Illinois Avenue, an unpaved Fane. The property is improved with a frame house and several accessory buildings. BASIS OF APPEAL: Building InspectoCs Notice of Disapproval, dated August 13. 2001, denying a permit to build a garage because the proposed structure would be in the front yard in violation of the requirement of Code section 100-33 that accessory structures be in the rear yard. AREA VARIANCE RELIEF REQUESTED: Applicants request a variance authorizing construction of the garage in the proposed location (as described below). REASONS FOR BOARD ACTION, DESCRIBED BELOW: On the basis of testimony presented. materials submitted and personal inspection, the Board makes the following findings: 1. As a result of the shape of the subject property and the location of the house, most of the properly is "front yard" within the meaning of the Code. Applicant consequently needs a variance for virtually any location for the proposed garage. Applicant will use the garage for storage of a vehicle collection, and wishes to place it in an out-of-the-way location. The proposed location is about 140 feet from Westphalia Road. and is well screened: it is closer to Illinois Avenue but that rough lane is little used The Board concludes that grant of the requested variance will not produce an undesirable change in the character of the neighborhood or detriment to nearby properties. 2. There is no evidence that grant of the requested variance will have an adverse effect or impact on physical or environmental conditions. 3. Applicant testifies that he understands that his two adjoining lots, facing oh Meday Avenue and Westphalia Road. respectively, have merged, and that only one principal use - his home - is permitted on the property, and that the garage cannot be more than an accessory structure. 4. Grant of the requested vadance is the minimum action necessary to enable applicant to enjoy the benefit of a storage garage while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. Page 2 - November 29. 2001 ZBA AppL Nc~ 5020 - B. and A. Campbell 1000~113-10-15.7 at Mattituck RESOLUTION/ACTION: On motion by Members Collins. seconded by, it was RESOLVED, to GRANT the vadance as applied for, subject to the following CONDITIONS: 1. The garage shall be used only for storage, as an accessory structure to the dwelling.and shall under no circumstances be used for sleeping, 2. The garage may be supplied with the utility of electricity only. This action does not authorize or condone any current or future use. setback or other feature of the subject proper~y that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote Of the Board: Ayes: Membe~r (Ch~i,'rrfi-~ff~ Dinizio, T~ortora and Collins, (Member Homing of Fishers Island w?J,~sent.) ~ Re?lution~..s.~ a~pted (4-0), /' /-~er.ard P. Goehdnger '' /,/  Chairman / TO: Bruce Campbell 620 Meday Avenue Mattituck, NY 11952 FORM NO. 3 NOTICE OF DISAPPROVAL DATE: August 13, 2001 Please take notice that your application dated June 27, 2001 For permit to construct an accessory garage at Location of property 620 MedayAvenue Cotmty Tax Map No. 1000- Section 113 Block 10 Lot 15.7 Subdivision Filed Map 4, Lot = Is returned herewith and disapproved on the following grounds: The proposed accessory garage is not permitted pursuant to Article IliA Section 100-33 which statesk "Accessory buildings shall be subject to the same requirements as 100-33 of the Agricultural Conservation District," which states; "In the Agricultural-Conservation District and Low-Density Residemial R-80, R-120~ R-200, and R-400 Districts, accessory buildings and. structures or other accessory uses shall be located in the required rear yard." The proposed accessory garage is located in a front yard. Authorize~iguature CC: file, Z.B.A. Issue Date 11/19/03 Electrical Inspection Certificate ElectdcallnspectionService, lnc. Application 375 DuntonAvenue 80690C EastPatchogue, NewYork 1t772 (631)286.6642 Issued To: Bruce Campbell Street: 620 Meday Avenue Village: Ma~tituck Zip: 11952 Section: 113 Block: 10 Lot: 15.7 Town: Southoid C~ntr~ct-o~T'Ron-*~-E~t End E~e~c (L-) [i(~. # 4860-E Was examined and found to be in compliance with the National Electrical Code. Commercial [] NV Defects [] Pool Residential [] Det. Garage ~_ Attic [] lstFIoor [] Indoor [] Basement [] HotTub [] 2nd Floor [] Outdoor [] Addition [] Survey Switches Receptacles Fixtures GFI Heaters A/C Fans 10 14 24 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Trsns~ormer Meter Amps Phase UG/OH Jacuzzi 1 200 1 [] / B/dg. Permit: Other Equipment Television CO Detector Hugo $. Surdi President Rough Inspection: 09130,r2003 Inspector: Eddie Reddguez Final InspeoUoa: 1t/18/2003 [nsp~Iz3r: Sean P. Hightower This certificate must not be altered in any manner. Inspectors may be identified by their credentials. Alpine Engineered Products, Inc. 13389 Lakefront Drive Ear~hCity, MO 63045 (314) 344-912t Page 1 ofl Document ID:lS8¥219;Z0623134028 Truss Fabricator: S.I~. S/oan JobIdentificatlon: 1873821 GLOBAL DES iG~q Model Code: TrussCriterla: A~ISI. 17I 1995(510) ~gine~rlng~t~,z~e: Alpine proprietary truss analysis software. Version 6,10. Truss De$ign Loads: Roof 67 PSF @ 1.15 Duration -loo~ Nil Wind - 90 MPH IASCE 7-98 Closed) 1. Determinatior as to the suitability of these truss components for the structure is the resnonsibility of the building designer/engineer of record, as defined in ANSI.tTPI 1-t995 Section 2.2 AS shown on abtached drawings; the orawing number is Dreceoea Dy: MOUSR219 Details: BRCLBSUB Submitted by KB 13:40:09 12-23-2003 Reviewer: Unknown $ g Ref Oescrintion .~rawinq~ Date L i 12035--T 1 SPECIAL 50 03357106 12/23/03] Seal Date: 12/23/2003 Scott L. Schnrwan Ne~v york License Number. 61647 SPECIAL 50 7 10 16" ocKF) Top chord 2x4 SPF #1/#2 90 mph wind, 35.(30 Ft mean hgt, ASCE 7 98, CLOSED bldg, Local;ed anywhere Bob chord 2×4 SPF #1/#2 :B2, B4 2x4 SPF 1650f 1.5E: in rooF, CAT II, EXP C, wind TC DL 5,0 psf, wind BC DL 5.0 psf. Webs 2x4 SPF Stud Roof overhang supports 2,00 psF soffit load. Calculated horizontal deflection is 0.26' due bo live load and 0,08' due to dead load. (A) Con~inaous lateral brac'ng equally spaced on member, Trusses to be spaced at 16.0" OC maximum. Deflection meets L/240 live and t/180 ~otal load. Plates sized For a minimum of 2,40 sq.in,/piece, 4X12~ ~ ~~~~~~,~ 4 2X4/11 4 4X6(A2)~ 4X6(A2)~ 12-0-0 ~ 24 0-0 Over 2 Supports R 1229 U 271 W 5,5~ R ]229 U 271 W-5.5 PLT TYP, 20 Gauge HS,WAVE TPI Design Crib: TPI 1995(STD) ~ ~ ,_ ~ NY/4/ /-/-/R/ Scale LL 50,0 PSF REF R219'- 12035 '" ~' ~~'- 7.0 PSF DATE 12/23/03 Bfi LL 0.0 PSF MO-ENG /SLS [ TOT. LD_ 67. 0 PSF SEON- 106743 EartI]City, MO 63045 A"SI/TpICOMPONENT1'1995FOR ANYsEcTiONPAR%ICULAR2. BUILOING IS THE RESPONSIBILITY OF THE ~UILOING DES[G"ER' PER SPACING 16.0" JREF- 1S8Y219 Z06 TIIIS DETAIL IS TO BE USED WHEN CONTINUOUS LATERAl, BRABiNG (CLB) O~ IS SPECIFIED ON AN ALPINE TRUSS DESIGN BUT AN AL'iSRNATIVE WEB NOTF~. BRACE MEbIBER LENC, TII '['HIS DETAIL IS ONLY APPI,ICABLE FOR CHANGING THE SPECIFIED EbB SHOWN ON SINGLE PLY SEALED DESIGNS TO T BRACING OR SCAB aX3 OR 2X4 2 ROWS 2X6 2 2X4 BUILDING PERMIT EXAMINER CHECK LIST APPLICANT NAME: ~ ~"~£~ .~/ //ffDg/~'ff'~FW ~/4,W//,z~/p~ZG SCTM# DISTRICT: 1,000 SECTION: ,//~ STR-EET:~90 ./~f. ~D~/ ./~//~7~/b/~ PROJECT DESCRIPTION: _ J~d6~_ ,c/ DATE REVIEWED: DATE SUBM TTED:ZT_/; /02 BLOCK: /0 LOT: CITY:/~/pIT?TZ/V//---- SUBDIV. NAME: O ARCHITECT / ENGINEER: ~ 6/7'~/_.~C'¥7~/~¥.-~ FAST TRACK? SINGLE & SEPARATE CERTIFICATION-REQUIRED? /lifo NOTES: LOTS 40,000SF -100-24. Lot recognifion,(CILEATED before June 30, 1983 ;, UNDERSIZED LOTS FROM $AN.1997 I00-25. Merger4A nonco~fforming az any time after 7/1/83 ZO GDISTRICT: REQ. LOT SIZE.~ ACT. LOT SIZE:__ REQ. LOT COV. ~ ~ ACT. LOT COV. REQ. FRONT' ~ PROP. FRONT ~ REQ S]I)E~ACT. SIDE REQ. REAR _2.~_~9 PROP. REAR ~ ' ...--O / ~ '~A TOWN SEPTIC RECEII~T: Y orN NEW YORK STATE DEC: SOUTHOLD TOWN TRUSTEES: YES o~ TOWN ZONING BOARD TOWN PLAN. BOARD APPROVAL: YES TOWN HISTORICAL P,~_~PLIA): NYS ENERGY: YES ORtNO EGRESS (18 H min.? 4 sq"f'6T~) .~/~r VENT (SQ. FT. 4%) BUILDING PERMITS OPEN/EXPIRED:--~ BP HAVE PRE CO'S: Y ORN NOTES: --~ c~ o .m- ~-5:z~ ./a~.- LIGHT (SQ. FT. x 8%~ -Z/C, 0Z- _,. BP -Z / C/0 Z- , FEE STRUCTURE: FOUNDATION: SF F1RST FLOOR: /~o~,C.,~ SF SECOND FLR : SF TOTAL: SF POT~SF)-( _~o SF)= 7-~O SFX$._30 =$ D'~q INIT OTHER TOTAL FEE FEE FEE 4X~2~ 50.0 7.0 PSF Scale REE R219-- 86377 DATE 12116103 TOT.LO. 10.0 0.0 ~SF 67;0 PSF OUR.FAC. 1.15 S=PAC I~,IG }~IO-ENG /$LS SEON- 106743 FROM B~ JREF- 1S-BT219_~1 10--',',',',',',',',',2S--2~'2 9:'I2AMFROM ISLAND SL.DG SUPPLY Connecticut Steel . Corporation Box 928 Wailbgford, CT 06492 Tele'fa×: (203} 284-8125 www. connectlcutSt eel .corn ~ART NUM~E~ ~OeO~T MINIMUM W~LD SHEAR.~ !OO1 ,qVERAGJB: W~LD. ~H~QR~ .. !8~T G. MN. ~) I~© 11.) I880 5.} 1810 ~.) MO. · 05 ,08 ,34.. ) ~ -y CU. A MACN~NE~ MO? WIRE ~t~E: W ROLL WglBHT: ~OLL DIMENSION: ~N. N. .O15 ,OOO 37.> 44,) 40.) THI~ MATERIAL CONFORMS T0 ASTM AI8~ AST~~ I.~A-AN'D BLDG SLDPLY 1C~,$17r-~SDDDD c~i~kr~ ~ Corporation P. 1 BiLL OF EADING 140248 ~LD TO: NAME ~J{|P TO: ,~Y iz7~2 ~o~ w~ ' ..... *, .......... 20~7~0 ADDITIONAL INFORMATION 700 ~IORYH CROgSMAN RD Box ~ $AYRE~kE, NJ, F~: {732)T2~T~ TEL: BARKER S~EL GO INC s 100 BAWIEW AVENUE KEASBEY, NJ, USA p 08832-t00t A~tn:KIM SHELTERS T O REBAR 16 M tg5 REBAR{2[I FT) TESTING LABORATORY REPORT I~l[C o~ LAO~Nt ' a6 o6M. TRE CHEmiSTRY A~ALY~IS ~Ag OETEReaEO a ACCOROA~E WITH T~ST ~ET~OS '~ ASTM A6t~ GR4~ [GR~] ~6~t~$ KEA6~ ~ TEST RESULTS FOR HEAT t~30tlJ9 HEAT SEQ 1 1 .40 1,00 ,DO7 .O&l .20 ,44 .11 ~08 .04 035 MEC~L TESTS AVENGE OF 2 Y{~O: 67B~.5 PSi, T~ ~E: 1~3~ ~1%ELO~A~ONI. _ - ~5 GUAGE L~TH:~ .----8IM. BEND ~8T PA~S~D .... Date Printed: OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD STREET ACR. TYPE OF BLD, SUB. LOT ~ REMARKS LAND IMP. TOTAL DATE FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD TILLABLE WOODLAND v~EADOWLAND HOUSE/LOT TOTAL PROPERTY RECORD CARD OWNER STREET ~--~ '/'~) VILLAGE DIST. SUB, LO~ FORMER OWNER N ~ 'E ACR.. ,~,, ' S W TYPE OF ~UILDING RES. ~ {~2 SEAS, VL FARM cOMM. CB. MISC. Mk~, V~lue LAND IMP. TOTAL DATE REMARKS AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland' FRONTAGE ON WATER , _ Brushbnd FRONTAGE ON ROAD ~/ DEPTH House Plot BULKH~D ' "~, Totol DOCK OWNER FOR~MER OWNER STREET N VI LLAGE W DISTRICT SUB. ACREAGE T~PE OF BUILDING LOT5 ~ ..~ Est Mkt, Value LAND IMP. VL. FARM COMM. I ND. CB, TOTAL DATE REMARKS .z/ / D J MISC. r ? AGE NEW Farm Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Total NOP~MAL Acre BUILDING CONDITIOJ' BELOW Value Per Acre ABOVE Value FRONTAGE ON WATER FRONTAGE O'N ROAD BULKHEAD DOCK M. Bldg. Extension Extension Extension Garage O.B, Foundation Ext. Walls Fire Place Porch. ! '~-~: Driveway :. Bath / Floors nterior Finish Type Room.¢ ]~t Floor Rooms 2nd Floor July 22, 2003 Building Department P.O. BOX 1179 Southold, NY To Whom It May Concern: Would you please extend my building permit #27993 for another six months7 After two and one-half months of telephone calls, ['ye finally gotten an electric'mn to come to my house and agree to do the wiring of the structure. I need the extension because I expect that the job will not be~n for another two or three months due to the backlog of work that seems all electricians have. At the completion of the wiring I will notify the Town for the final iuspectio~ Thank you very much for your time and effort regarding this request If you need to contact me, please call me at home. 298-6581 or work 732-2000 ext 384. Bru~ M. Campbell 620 Meday Avenue Mattituck, New York 1 t952 765-1802 BUILDING DEPT. /iNSPECTION [/~,I=OUNDATION 1ST [ ] ROUGH PLBG. [~/---] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL FIREPLACE & CHIMNEY REMARKS DATE INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INS~JL-ATION [ ] FRAMING [ ~-~INAL~ [ ] FIREPLACE & CHIMNEY DATE /? INSPECTOR TOWN OF' SOIfl OLD BUH DI G DEPARTMENT SOUTHOLD, NY 11971 ~ ~::, . BLDG. DE?,T~' ,, ~[ roYea t ,20ooq-P mmTt O. Disapproved a/c BLrlIzD~O PERMIT APPLICATION CI:[ECKLtST: Do you have or need the following~ before appYy/ng Board of Health $ sets~of Building Plans Survey. Check N.Y.S~D.F~c. Tmsmes APPLICATION FOR BUILDING PERMIT Date ,20 INSTRUCTI~ONS a. This application MUST be completely filled in by rypewr/ter or in ink mad subrrdtted to':the B~ui~tg~Inspector with 3 sets of plans, accurate plot plan to sale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship m adjoining premises or public streets or areas, and gB,ring a detailed description of layout of property must be drawn on the diagram which is part of tiffs application. c. The work covered by this application may not be commenced before issuance of Building Perm/t. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permi~ shall be kept on thc premises available for Lnspecfion throughqut the work. e. No building~sball be occupied or used in whole or in part for any purpose whatever until a Cc~-tificate 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 Appl/cable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alteratioas or for removal or demolition as herein described. The applicant agrees m comply with all applicable laws, ordinances, building cocte, housing code, and regulations, and to adrrdt authorized inspectors on premises and in building for necessary inspections. (Signature of applicant I~t'name, Lf a corPoral)on) Name of owner of premises ~U ~,~. ~-A,~,~ [~ L,L (~ on.~e t~ roll or latest d~d) ~ app~c~t is a~mfion, si~ of dMy an~ofized ~e ~d fide of co~oram officer) B~ders License No. Plmbers License No. El.ec~ci~s Lice~e No. ~ Trade's License No. Location of laud on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section II7 Block }o Lot I~;'~ Subdivision Filed Map No. Lot (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and 0ccupancy ' ora6 - '~A~d,;'r' 1>~ ~bLt~ot~ b. Intended use and occupancy 3. Nature of work (check which applicable):New Building Repak Removal Demolition 4. EstimatedCost '~ '~ ~,I O(X) . O0 Fee 5. If dwelling, number of dwelling units If garage, number of ears ~' - Addition Alteration Other Work (Description) (to be paid on filing this application)' Number ofdwelllng units on each floor 6. I/business, commercial or'mixed occupancy, speci .fynature and extent ofeachtype of use. ~J//t~ 7. Dimensions of existing structures, if any: Front kl]4 Height Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear 8. Dimensions of entire new construction: Front Height )'~ 9. Size oflot: Front 300. FT'- 'Rear ~'~-t9~, ~'~. l~Date of Purctmse 11. Zone or use district in which premises are situated Rear ~,~ t. 4" Depth Depth ~-~9. ~to FT' I~0~ Name of Former Owner ~(L D. EF '[- ~-~T~I,3 £4 12. Does proposed construction violate any zoning law; ordinance or regulation: Iq o 13. Will lot be re-graded Will excess fill be removed from premises: YES N_._Q__O 14. Names of Owner of premises Address .of Contractor Address 15. Is this property within 300 feet of a tidal wetland? *YES Phone No. Phone Vq Phone No. NO - IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQ~D 16. Pro~Sde survey, indicate scope of project, to scale, with distances to property lines. 17. If elevation at any poim on property is at 10 feet or below, must provide topographical data on survey. STATE OF N~W YORK) SS: ~¢~0 ~ ~ ~ ~ ~ ~U berg ddy sworn, ~poses ~d says ~ (s)he is ~e appho~t ~me ofindi~du~ sing con~ac0 above nme~ (S)He is the (Contmeto . ~¢q.t, rCc._.. ..... Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are u:ue m the best of his knowledge and belief; and that the work will be performed/n the mariner set forth in the application filed therewith. Sworn to before me this ~ ~ dayof ~4~t- 20~? Notary Public GEORGIANA T. gORDE~ Signature of ~licant