HomeMy WebLinkAbout32200-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31788
Date: 08/28/06
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property: 1950
(HOUSE NO.)
County Tax Map No. 473889 Section 55
YENNECOTT DR
(STREET)
Block L-
SOUTHOLD
(HAMLET)
Lot 30.1
SUbdivision
Filed Map No.
Lot No.
conforms suhstantially to the Application for Building Permit heretofore
filed in this office dated
JULY 11, 2006 pursuant to which
Building Permit No. 32200-Z
dated
JULY 11, 2006
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to JAMES & STEPHINE MULLIGAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N-539756
10/17/00
PLUMBERS CERTIFICATION DATED
N/A
Signature
Rev. 1/81
r)
~/
7(,5 - /75'i'
Form No.6
TOWN OF 80UTHOLD
BUILDING DEPARTMENT
TOWN HALL
I'j I 765-1802
L ~~.~.=_~~~~i~L~ APPLICATION FOR CERTIFICATE OF OCCUPANCY
JG ,17
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:
I. 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 (8-9 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 I % 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-existiug" land uses:
I. Accurate survey of property showing all 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
I. 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 $15.00
Date. '8117/0(..
Location of Property:
1'15'0
House No.
Old or Pre-existing Building: /
Yenl1e <:-uft b r:
Street
( check one)
::;ol-(+/.o Ij
Hamlet
New Construction:
Owner or Owners of Property:
.:r <U'J1e$
'1 Skr~4J'lie. M..dl~OJ1
05!:.oo Block C74-,DO
Suffolk County Tax Map No 1000, Section
Subdivision Ye.t1/'1e<::.t+ f~k
Lot 030.001
Date of Permit.
Filed Map. SI'i!7
Applicant: -:r Q.J01C!:-S
Underwriters Approval:
Lot: 4- 4- 1- "'5"
F. Hr.<(8QJ'1
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate:
(check one)
Fee Submitted: $
-d"'L~~
Applicant Signature
tX.M:.-.7 0 ~ft0
Co -f..317'6'6
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)
11, 2006
PERMIT NO.
32200 Z
Date JULY
Permission is hereby granted to:
JAMES & STEPHINE MULLIGAN
1950 YENNECOTT DR
SOUTHOLD,NY 11971
for :
CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH
FENCE TO CODE IN THE REQUIRED REAR YARD AS APPLIED FOR. (REPLACES BP#26312-Z)
at premises located at
1950 YENNECOTT DR
SOUTHOLD
County Tax Map No. 473889 Section 055
Block 0004
Lot No. 030.001
pursuant to application dated JULY 11, 2006 and approved by the
Building Inspector to expire on JANUARY 11, 2008.
Fee $
150.00
~.~
/Authorized Signature
ORIGINAL
Rev. 5/8/02
1'.,,01 :: .:'0
I
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
P_l\Gl~ 1
Dale
;X~'T(A3EH 1"7! 2('}0'1
Application No. on file
11~)'J 1 ~100/(J0
N 539756
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
Jl'J.!ES F. IlULLIGAN, 1950 YENNECOTT DRIVE, POOL, SOU'l1IOW, NY
O 0 0 ou'r
in the following location; Basement 1st Fl. 2nd Fl. Section Block
was examined on CCTOBER 02.2000 and found to be in compliance with the National Electrical Code.
Lot
FIXTURE
0UTLE1S
RECEPlACLES SWITCHES INCAND"'"
FIXTURES
FLUORESCENT
OTHER
RANGES
AMY. l.W.
COOKING DECKS OVENS
AMY. K.W. AMY. K.W.
DISH WASHERS EXHAUST FANS
AMT. K.W. AMY. H,P,
1
-,
.
1
DRYERS
FURNACE MOTORS
FUTURE APPLIANCE FEEDERS SPECIAL REC'PI. TIME CLOCKS
AMT. K.W.
OIL
H.P. GAS
H.P.
AMY.
NO.
A. W. G. AMY. AMP. AMY. AMPS.
BELL
TRANS.
UNIT HEATERS MULTI-OUTLET
SYSTEMS
AMY. H.P. NO. OF FEET
DIMMERS
AMY. WArn
2 20
AMT.
AMP.
lYPE
NO. OF 5 E
METiR
EQUIP. I' 2W I' 3W 3' 3W 3"W NO. O~fRC.COND.
R
A..W.G.
OF ce. CONO.
v
SERVICE DISCONNECT
NO. OF HI.LEG
C
A.W.G.
OF HI-LEG
E
NO. OF NEUTRALS
A.W.G.
Of NEUTRAL
OTHER APPARATUS:
POOL-1
PANELBOARDS: 1-4 CIR. 30
G.F.C.I,-1
. (Sl'mnm:!G POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
envirop~ents it is advisable to
have frequent test/and or repairs
made by a qualified person.
<<< Continued on Page 2 >>>
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Ll2~
GENERAL MANAGER
Per
This certtflcate mu.t not be altered In any manner; return to the office of the Board It Incorrect. Inspectors may be Identified by their credentials.
COpy FOR BUiLC:i,G D~PARTMD~i n::s CO?f Or CH:ilriCAiE MUST t~OT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
PAGE 2
Date OCTOBEE 17, 2000
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
1 J,)t.) 1290
I
BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
1 10:'? 1 (1.>;1
',")0.(71
"-;~"
Application No. on file
II 539756
JJl.MES F. HULL WAN, 1950 YENNECOTT DEIVE, POOL, SOUTHOLD, NY
in the following location; 0 Basement 0 1st FL D 2nd Fl. OUT Section Block Lot
was examined on OCTOBER 02,2000 and found to be in compliance with the National Electrical Code. '
FIXTURES
FWOIESCENT
OTHER
RANGES
"Mr. K.W.
COOKING DECKS OVENS
AMY. l,W. AMY. K.W.
RECEPTACLES SWITCHES INCANDESCE
FU1URE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS
DRYERS
FURNACE MOTORS
BELL
lRANS.
l.W.
OIL
H.P. GAS
H.P.
AMT.
NO.
A. W. G. AMT. AMP. AMT. AMPS.
NO. Of S E
METER
EQUIP. l' 2W I' 3w 3. 3w 3.'W NO.OFPECRC.COND.
SERVICE DISCONNECT
AMP. TYPE
R
A.W.G.
OF CC. CONDo
V
NO. OF HI.LEG
~'"-,>-. fr:"-
\. -, ":L -J-\
-~",::,t~-~ ~ "'~T~'
.., <' r ~".Ii" j >', ..
_]'::.\' "~.-\.J;,:
.: .. t'>>}"--'/""'1~t..:
.1 "~l~'t 'I"!'
If I ~,I _ \J-, ,--,~, 1^-- '. ' ,
-~i,. -~~ ~2f~~~:'" :\ -
~'"- - ~
...
C-CAT CO./DAVE CHESHIRE ELECTR LIC.#953 E
9280 SOUND AVE
~~TTITUCK, NY, 11952
DISH WASHERS EXHAUST FANS
AMT. K.W. AMT. H.P.
UNI1 HEAlERS MULTI-OUlLEI
SVS1EMS
AMT. H.P. NO. Of fEET
DIMMERS
AMT. WArn
C
A.W.G.
OF HI.LEG
E
NO. OF NEUTRAL$
A.W.G.
OF NEUTRAL
Ll2~
GENERAL MANAGER
11
Per
Thll cerHftcate mUlt not be altered In any manner; return to the office of the Board If Incorrect. Inspectors may be Identified by their credenttals.
COPY FOR BUILDmG DEPARTMEt,T. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
3u~
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
REMARKS:
DATE r/ ;..,/ (0 ~
INSPECTOR
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ROUGH FRAME [,
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
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. TOWN OF SOUTHOLD PROPERTY RECORD CARD
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OWNER ,
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VILLAGE
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LOT
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TYPE OF BUILDING
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COMM. CB. MICS. Mkt. Value
$(J()
or. 0 /
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IMP.
TOTAL
DATE
REMARKS Co
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AGE
NEW
FARM
BUILDING CONDITION
NORMAL
BELOW
ABOVE
Acre
Value Per
Acre
Value
nllable
-iause Plot
I
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
Noodland
v\eodawland
-
BULKHEAD
ratal
DOCK
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:xtension
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xtension
arch (n'" '7 _ J/ y
erehfL Jr IJxt!?~ j-/{.
reezeway
arage 12<Y A" J.$ '" $C; r:;
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otal
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Foundation c,g Bath i '0'
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.to 21 Basement ;r'LA / / Floors ..... . K. 1
)//." "-/1<1
. r;<.t- /..2 q Ext. Walls Vr~. f Interior Finish I Sk I lR. , !
Fire Place / Heat 1-1.. -r?. DR. I
/
}.~ t:.3J Type Roof _6461 p Rooms 1 st Floor BR. 1.-
Recreation Room Rooms 2nd Floor FIN. B
Dormer Drivewoy
0'7 () </.
,
.
-
w
,
',;.,
,
/ ALUMINUM L..Vt"II'IU
_~r::l
r\-~
. 10-32x%" SELF
DRILLING SCREWS
SPACED @ 12" O.C.
CONCRETE OR WOOD DE(;i"~
UP TO COPING (BY OTHERS)
SLOPED AWAY FROM POOL
PANEL STIFFENER (Beyond)
LONG STEEL ANGLE
._ 'A' FRAME 3ASE
~.-
/
r'~/-
1" LONG WELDS
ON SIDE OF PANEL,
WELDED TOP AND
BOTTOM AS SHOWN
(COAT WELDS WITH
"GALVA.KOTE")
I" LONG WELD
W/ALUM.
COATING (TYP.)
VINYL LINER
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I
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II" '
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y,,"-16x1" BOU,-_
NUT, & 2 WASHi':F1S ii I
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STEEL ,.\NGLE
DRIVE S r ,\KE
STEEL WALL
PANEL
\_ MOUND WITH
'. CONCRE E
'- MIN. 1 sa. FT.
.
SAND OR VERMICULlF
AGGREGATE (MI)() -
HARD BOTTOM
. :
,
~....
STAIR WALL TOP CORNER FILLER
AND VERTICAL WORKING
FILLER POINT FOR
'\i,"'16x'h"LG. BOLT POOL
WASHER & NUT DIMENSIONS
,
IElll['3J,...:.t'
- 1,.qr,i3J'
- I I
. i >'-,,-
~
UNDISTRUBED
EARTH
SHORT
STEEL
ANGLE
18" lO~G STEEL
REINFORCING
ROD DRIVEN
INTO UNDISTRUBED
EARTH THROUGH
HOLES IN BOTTOM
OF PANEL
CURVED VERTICAL
FILLER TO RELIEVE
DETAil #1 LINER. BOLTED WITH
5/16" DIA. CARRIAGE BOLTS
TYPICAL WALL SECTION AT A-FRAME
DETAil #2
. .
CORNER CONNECTION DETAIL
j
f
j
FILTER
PUMP& MOTOR
SKIMMER-SUCTION
C~
It
MANDATORY ROPE & FLOAT
12" FROM TRANSITION
M
RETURN
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SAND OR VERMICULITE
AGGREGATE (MIX) HARD BOTTOM
LONGITUDINAL SECTION
F
E
SUCTlO
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B
PLAN VIEW OF POOL
-3-_ .
C~-
TYPICAL "A" FRAME
& BASE
NOTE: APPROX. VOLUME
OF POOL IS BASED ON
WATER LEVEL BEING
6" FROM TOP OF lINER.
POOL DIMENSIONS
--
SIZE V- B C D E F G H K L M N P R
12><24 12'-3" 24'.3" 3'-4" 6'.0' 6'-0' 8'.0' 6'.3" 4'-0" 4'-{l" 4',J" 4'.{)" 6'-31/16" 9'-.4" 27'-2"
f4x28 14'-3" 26'-3" 3'-4" 6'-0" 8'-0' 12'-0" 4'-J" 4'-0" 4'-0" 6',J" 4'.{I" 6'-31/16", 12',11 1/8" 31'-711/16" .
16x24 16'-3' 24'-3" 3'-4" 7'-{I" 6'.{l" 8'-0" 6",3" 4'.0' 4"-0" 8'.3" 4'-{I" 6"-87/B" 9'-8" 29'-25/16"
16.<32 16'-3" 32'-3" 3'-4. S'.{J" 8'-6" 13'-6" 6',]" 4'.{)" 4'.0. 8'.J" 4"-{)" 7'.4" 14'.10' 36"13/S"
~: 16'.3" 34'.3" 3'.4. 8'-{J" 10'-6" 13'-6" 6',3- 4'..{)" 4'.{)" 8',3" 4'-0" 7'.4" 14',10. 37'-107/8"
18'.3" 36'.3" 3'.4" 8'-0" 10'-6" 13'-6" 8'.3" 4'-0" 4'-0' 10'.3" 4'-{)" 7'.4" 14'.10" 4O'.r
20><40 20'-3" 4O'-J" 3'-4" 8'.0" 12'-6" 13'-6" 10'-3" 4'-0" 4'.{)' 12'-3- 4'.{)" 7'-4" 14'-10" 45'.11~16" -j
~-------_..
25= 25'.3" SO'.3" 3'-4" 8'-6" 19'-0" 15'.(1" 12'.3" 4'.(1" 4'.{)" 17'-3" 4'.{)" 7',715/16-. 16'-"!~/8" ~'.27/~"
30><60 30'-3" 60'-3" 3'-4" 8'.6" 20'-0- 15'-0" 20'.9" 4'-6" 4'-6" 21'-3" 4'-6" 8'.23/S- 16'.57/S" 67'S
GAl.
9,050
12,100
13,750
19,750
20,900
25,500
32,O<!O
52.750
79,550
TYPE I POOL..
NO DIVING BOARD
TYPE II POOl..DIVING
BOARD PERMITTED
TYPE III POOL--DIVING
BOARD PERM'TTm
<0 <0 ~ V> "
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Bill OF z < " ~ w z w Z w w z z
< ~ w ~ ~ r ~ V> Z V> ~
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MATERIALS w w w w w ~ w V> j ~ 0 " ~ V> dO .0 w m 0 0
w Z Z Z Z Z ~ i" ii: ~ 0 z < 0 ::; 0
z < < < w w ii: ~o x ~ ~m ;;.m r w 0 0 0
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V> ~ ~ 0 0 => I ;c ~ ~ < :l
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;; '" '" '" iD '" 0 ia. :0 15 w 0 '" .. w .i ~ ' w :::: ~ ~ 11 !?
> ~ .I X .Ix ;;; 0 S
Item 11 121 31 114 I 51 61 7) l8J Il9) 110 1111 1121 a31 MI 115J 1161 11IJ 118 91 2(1 1211 I~ ~
t2x24 1 2
14x28 1 2 2 B 8 8 8 4 4 4 6 56 110 415 170 b 8 8 4 10
16x24 1 '0 6 6 6 4 4 4 6 56. 145 360 145 8 8 6 4 10
t6x32 , '2 8 8 8 4 4 4 7 56 170 4'5 170 8 8 8 4 12
18x36 1 '2 4 4 4 8 56 170 8 8 8 4 14
20x40 1 2 '4 12 12 12 4 4 4 9 56 215 495 215 8 8 12 4 14
16x34 1 8 4 8 8 8 4 4 4 7 56 170 415 170 8 8 8 4 12
25x50 1 '2 6 14 '4 14 4 4 4 9 68 255 580 255 8 8 14 4 16 3
~Ox60 1 2 '2 8 18 18 18 4 4 -.:!- 14 68 320 710 320 8 6 18 4 20
-
--
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,FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD. N.Y. 11971
TEL: 765-1802
. ~ A5 32200-6-
Exanioed. . :..........~
:~?!ti::~:::~~... .~~~~ .~:. :::l.ft}/l.~
I
...................... ...... ...... .................... ~
.....~........
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEy........................
CHECK .........................
SEPTIC FORM ...................
NOTIFY: r:
7;1.7 b'?/2-
CALL .... :i~-";~;i' ~l. lfd
MAIL TO.....................
1tJ4:6.s;~..1Jy.~....... .
itl.q~/Y:l.~~.L? .fW..If?'!/...
Date. .'!;/......... ,~.~
a. This application IIlISt be cm.>letely filled in by typewriter or in ink and sutmitted to the &dlding Inspector wi
3'sets of plans. accurate plot plan to scale. Fee according to ~le. .. .
b. Plot plan showing location of lot and of buildings on premises. relationship to adjoining pranises or JUblic
streets or areas, and giving a detailed description of layout of property IIlISt be drawn on the diagran which is part of
this application.
c. The \;Ork covered by this application may not be C<JlllEnced before issuance of Iluilding Pennit.
d. Upon approval of this application. the Iluilding Inspector will issue a Building Permit to the applicant. Such
pennit shall be kept on the premises available for inspection throoghoot the \;Ork.
. e. No building shall be occupied or used in whole or in part for any p.rrpose whatever lIDtil a Certificate of
Occopancy shall have been granted by the Building Inspector.
. APPLICATICN IS JERE8Y MA1E to the Building JJepart:ment for the issuance of a Building Pennit p.rrsuant to the
Building Zone Ordinance of the Town of Soothold. Suffolk County, New York. and other applicable Laws. Ordinances or
Regulations, for the construction of buildings. additions or alterations, or for reooval or deuDlition. as herein
described. The applicant agrees to lXIIt'ly with all applicable laws, ordinances, building code. hoosing code, and
regulations, and to acbrlt authorized inspectors on premises and in '1 ng f't r:tsary inspections.
UNDERW~~ERS CERTIFICATE --1M MEDIA TEL V-- 1~~~t:F ";'if~ if' ~. ~~;'~~~i;';')'
,*:A~ P J EN~~Ec"cf3~~ ...................................................
if~ BEFORE 'WATER" (Mailing address of applicant)
:-.ether applicant is owner, lessee, agent, architect, engineer J general contractor, electrician, phnber or bJilder
....~..c:~.,,~.......................:................................J.~~.AS~'""'..........
Nate of ~r of pranises V;w:.."!:.."!?r:.~.fJf#!~~.....'!J.t!.'+.~.'j.1,y....f!.A::~:.. ... ..~~.~.~.... .
(as on the tax roll or latest deed) FEE: BY:
-'NOTIFY BUILDING OEM ENT J
765.1802 9 AM TO .. PM FOR THE
FOLLOWING INSPECTIONS:
1 FOUNDATION. TWO REQUIRED
OCCUPANCY OR 2 =~~~:'=~PWMBING
Builders License No. ..I.1~/.!-.'!/.I!;J;..--.'~Y:HIOSUUTNCLAWFUL : ~~~~~ONS.,."UCTION MUST
. '..11 ' ERTIFICATE BECOMPlETEFORC.O.
PlUIbers LIcense No. .... uo.................. ALL CONSTRUCTION SHAll MEET
.. .f: OCCUPANCY THE REQUIREMENTS OF THE N.Y.
Electncla05 LIcense No. ..................,... STATE CONSTRUCTION . ENERGY
Other Trade's License No. .................... CODES. NOT RESPONSIBLE FOR
. ., DESIGN OR CONSTRUCTION ERRORS
1. LocatIon of land on \inch proposed \;Ork W111 be done..............................................................
....! ~~............ y..~~~. ~~.l??2....'P. .~/.~.~....... .~:: ~/ A~~ !:?........IY. Y..... /('7..7. (...........
Hoose lbIber Street Hanlet
County Tax Map No. JlXX) Section ....O.~C..... Block ..r............. lot ..'$/?:!........
If applicant is a corporation. signature of duly authorized officer.
.
...........................................................
(Nate and title of corporate officer)
Subdivision ...................................... Filed Map No. ............... Tnt ...............
(Nate) j
2. State existing use and occupancy of premises and inteoded use and occupancy of proposed construction:
a. Existing use and occupancy .............................................................................
~ "lOll ,M AOM'fJ
S,.. J("'1.MI"-/< 1W110;w'a.::l: ..:./lYRlJOM
b. Intended use and occopancy ..........VY.............y..... .~...-i ....1rt.!\1,.....'l'O"-,14..................
'. . ""I '..;1 l.I<.,...A
~:o.).,. ~" _'." ',' d..: ,.,V\,J'
_.. v~~; iLf.,'..1 ;;ti~l4.1i j 1,1.~T
1-
"'.1lllre of work (dled< "jlid, applicable): New ~ilding .......... Mdition .......... Alteratio~:........
Repair ............ Raroval ............. IlffiDlition ............ Other Work ~!~:;~t~l1rh.......
EstillEted Cost ..../;7.~.......... fee ':i~~'';';'~;d';'':'f;ii~.~h;~:~;';'ii';;'~;;'':)'"''
If cl...lling, fUllJer of d<;elling Imits ............ lumer of a...lIing units on eadl floor ................
If garage, lUllJer of cars ......................................
If business, CXJIJrercial or mixed occupancy, specify nature and extent of each type of use......................
Oinensions of existing structures, if any: Front......... ," .,H.. Rear.. u........... Depth
1.
(!eight ......................... lUIDer of Stories ......................
Dimensions of same structure ~th alterations or additions: Front ............... Rear ...............
Depth .................... IIeight .................... lbtUer of Stories ...............
DiInensions of entire new construction: Front ................ Rear ............... Depth ..............
(!eight ......................... lUIDer of! Stories .....................
Size of lot: Front.................... Rear.................... Depth....................
Oate of Purdlase ...,................. Nare of I'onner o.mer ........................................
Zone or use district in IoAlidl prenises are situated ..............................................................
[bes proposed constnx:tioo violate any zoning ImJ, ordinaoce or regulation: ........................
Will lot be regraded .................... Will excess fill be reroved fron pr...uses: QiiJ IV .
Nares of o.mer of prsnisesstrlfN~.':i[,.,.~!'?t:-.'.~~~ress !.~..y.~'~:~.~ff~~... Phone liJ.7.~?:::.!.V!.
Nare of Ardli teet .................................... Mdress .............................. Phone liJ. ..............
Nare of Contractor~~l!!.1t: k~. kll/.......... Mdress 1(J.$-:f?P~-r.~. ft.Y.f/:. .1f!.t!....I'norY;, liJ. 7~7..:~.~!.?:-
Is this property within 300 feet of a tidal ....tland? "YES _.... ...... IV X......
"IF YES, mmnn TlHl '\R1SIEES ~ MAY BE REQJIRIID.
).
I.
3.
I.
1.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, loi1ether existing or proposed, and indicate all set-back dinensions
ran property lines. Give street and block IU1lJer or description according to deed, and shw street nares and indicate
lether interior or corner lot.
.
"V I~TAln~~,.~r,i'l..
~ _ .41 ',.-c.-. , '.. \~
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t!;._.... ":"";:U"\I:C;' ~..'.,
'''f ;
'T- . :.' '+"t.~ -:;'-1 ~
't'! ',;,;;
"'l "'
-,-,..oj if~!nlA'l::J(j' :)~;j;l Hi,:,! ,,",
"; ~~"'-')~ Mq "" <"')1' fA':', (" ~f'c.
~~.)fr:)-;~C4"t Ojlll~W(',
(1 dl\....~")~A OWl . Vf,. T..lVA.'il'('-
,^"lE lX'..l"I~ miii:'f"]~"qUOq.. :,,-)
:,lMW'l .~~ ~ ."f)lllS "
mlY Cl' . "':>lJ:T.. . P. .... 1'I()1-1"1."
",.-',)f..; J1.PP"fiJR';;'''1,) , ," .'// '
){'ftV .r ' .. atC-. .... ' IK'. '.. '..
I:E\;~i\4!ii~i"~'~j:~~~tj......................IJelng duly swom, deposes and says that he IS the applIcant
\" 1.0' "I\.fT 1(, ,....\ H, ,..'"" ',"
lO'Ve ~- - ,', --
\('Rl",,:l:.S, ;,.t,"":'.,~"'(:l'd'_'~' .:",.
, is ili~:,.4~W~<~~:.'.(: f.~~~;.~:.......................................... ............. .............
(COntractor, agent, corporate officer, etc.)
.. said <Mler or owners, and is doly authorized to perfonn or have perfottred tile sai'd work mxI to IIEke and file this
>plication; that all statenenls contained in this application are tnJe to the best of his tuu.ledge and belief; and
.at the work will be perfonned in the IIEm1er set forth in the application filed therewith.
,1Qm to ~re ~ this ,.--
.....\..I...........dp of .~l1-.~V.~..~..aQQ.O /\ tJ
liJtaryPubIic25.Z~.m.~ I ~
..O...T....-. . ~.... ....
lVNDA M. 80HN ignat re of (: t)
II01MVPUB~",,_
No. 01
Cuelllled In Suffolk ~
Term ExpIres March 8, 20 ~