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HomeMy WebLinkAbout32249-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32146 Date: 01/19/07 THIS CERTIFIES that the building NEW DWELLING Location of Property: 2655 ROCKY (HOUSE NO.) County Tax Map No. 473889 Section 30 POINT RD (STREET) Block ~ EAST MARION (HAMLET) Lot 3 Subdivision Filed Map NO. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 17, 2006 pursuant to which Building Permit No. 32249-Z dated JULY 31, 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 SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE & COVERED FRONT PORCH AS APPLIED FOR. The certificate is issued to KONSTANTINOS & ZAHAROULA SOTIROPOULO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMEIIT OF BEALTH APPROVAL R10-06-0051 01/05/07 ELECTRICAL CERTIFICATE NO. 112572C 01/05/07 PLUMBERS CERTIFICATION DATED 01/11/07 HI-TECH PLUMBING Rev. 1/81 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. 32249 Z Date JULY 31, 2006 permission is hereby granted to: G SOTIROPOULOS (ZOUMAS) POBOX 361 E MARION,NY for : CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE AND COVERED FRONT PORCH AS APPLIED FOR PER PLANNING BOARD APP. at premises located at 2655 ROCKY POINT RD EAST MARION County Tax Map No. 473889 Section 030 Block 0003 Lot No. 003 pursuant to application dated JULY 17, 2006 and approved by the Building Inspector to expire on JANUARY 31, 2008. Fee $ 1,265.70 ~~ . Authorized Signature ORIGINAL Rev. 5/8/02 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 9)c;~y S7D APPLICATION FOR CERTIFICATE OF OCCUPANCY .. 11 ?e~7 This application must be filled in by typewriter or ink and submitted to the Building Department with the followir1.g: . ,--..1 A F b 'ld"i'l!C, J' . or new Ul 109 or new nse: ", . ,<,_, 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 2/1 0 of 1 % 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: 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 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 1111/07 . Date. Location of Property: X )6JJ House No. Old or Pre-existing Building: W; fo..,! Rd. Street 6. S()i,r/'fdJ Ins SD ( check one) G IiJ f II Wit)/! New Construction: Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision twt Mm.", W6'.J/ Permit No. J :)J. Y q Date of Permit. Block J ~1..rq Z 6.JA? Ii] Lot 3' ]3 Filed Map. Lot: '7/ JI/~ ( Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: \/ ( check one) Fee Submitted: $ :25'.00 \r-!J~ . ~:o...-'" PI. p lcant SIgnature .;> B.-ez- 7/ ~ s7 Co 7::32/ L( (p Electrical Inspection Certificate Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11172 (631)286-8642 Issue Dete 1/5107 Issued To: Street: Village: Section: Zoumas Cant. Corp. 2655 Rocky Point Road East Marion 30 Block: 3 Application 112572C Zip: 11939 Lot: 3 Town: Southold Contractor: D. L. T. Electric (L) Lie. # 4966-E Was examined and found to be in compliance with the National Eledrical Code. rJ Commercial D NV Defects [] Pool 00 1st Floor [] Indoor 00 Basement [] Hot Tub 00 Residential [] Del Garage 00 Attic 00 2nd Floor [J Outdoor [] Addition [J Survey Switches Receptacles Fixtures 30 47 57 Dishwasher Washer/Amps Dryer/Amps 1-20 1 20 1 30 Furnace Oil Gas Circulators 1 X 2 Meter Amps Phase UG/OH Jacuzzi 1 200 1 [J<] / 1/20 Bldg. Permit: 32249 Other Equipment 1-200 amp IVIIB Panei -30 amp NC Disc. 1-20 amp Well Disc. 1-20 amp Spec. Outlet -Garage Door Opener Recept. GFI 6 Oven Range/Amps 1 Gas Heaters AlC 2 Fans 3 Microwaves Smoke Detector 7 Television Bell Transfonner CO Detector Hl}ffl/~ President ____.m_____ Rough Inspection: 1012512006 --..----- Inspector: John Me Mahon III ___'0- _____ Rnal Inspection: Inspector: nf2728i2ooo--- ...- -- -------- John Me Mahon III This certificate must not be altered in any manner. Inspectors may be identified by their credentials, Towa H.... $309$ MaIll RoN P.O. Bole Jl 19 ScludMIfd.1'kw Yark 1.,71.09$9 l'u (631) 76s.1823 T-"-(QI) 76S-1802 BUILDING D8PARTMBN'I' TOWN OF sotn'HOLD CER TIFICA TION Date: 111110'1 Building Permit No. J:JJ~9 Owner: Gvj .so }, rclp"" 10J (please print) J)i-]~.~ flv"ib~ Cl~J~'\/ V#.U,),""; (please print) Plumber: I certifY that the solder used in the water supply system contains less than 2/10 of 1% lead. ~ ~ -- (pI Signature) Sworn to before me this I 7 dayof ~v1 .20tl Clfttz~<-~{yL- Notary Public, SJr. ffvet(. County PAmlGIA RORmSOi~ Not."\rv P!Jblic, State of ,;,~ Y(';-'c. SuffoU:: County ~'!o. 52--4',..,3539 Commf::=sion Expkas ~~-:Jr.~ll :'0, 1" /It!l3~ ~ () c'7 L Sk-~y-1-ts TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] R~ PLBG. [ ] FOUNDATION 2ND [pYfNSULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION -r- r () ---- -~ REMARKS: ~~~.w Ute. DATE INSPECTO 3 J-2- ~7 6:- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [~GH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ~ING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: F ~ &f:- -Y-1- L .,-!~ ~- DATE It) !t1(l~ t INSPECTOR 3),,-2--~7c TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] F~ATION 1ST [ [~OUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ REMARKS: ~_.t~ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION q(:.- 2-( J7 ~';MJ DATE f/J-f/O!, INSPECTOR gJ-2-~(-C TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 NSPECTION ~;o DATE fl~/er; [ FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REIlARKS. ~~ ~ INSPECTOR . JAMES J. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 14 I , ..' Date: September 13, 2006 To: Town of South old Building Dept. Re: Strapping Inspection Sotiropoulos 2655 Rocky Pt. Rd. East Marion Permit # 32249 To Whom It May Concern: After a Strapping inspection was preformed on the above property, it is deemed that all work performed was completed to plans and meets all state and local codes. Any other questions please call. ~. ..... Sincerely . \Jare J. eerkoski '- ~ . . FIELD INSPECTION REPORT DATE COMMENTS IJ.l PhU/r r" L. / 7: ~~ CI/f. -fa d. ',~ ~;:; / 'I ' l / L /~ .L ~ .J ./ ~" ' . 'f Z. L./ ~ "....9 =l .. -------------------------------- ~%:/d.>;:J~ 1): ~ ':'7j/;;:J:~r:y~ ~ ~ 10',J//dJl ;{) .~. ...J i/c. J /. .'::. ... 0 " / 1'<Y,/ ~ FOUNDATION (2ND) "j f. I / '1 /f .p J. 0 t"I ~~ o~ f'/IJJ .-1-. ~/ f/b:;I:f 'I. . z , '.. n' It) III' ^' L . ~J ". t. ,.:, / ~ 9 fr4ItL i / I ~ /.1.. L. .,~. II ~ ~ . ":if / ~'" ., ~ ~!:l " K S , -b o 4-i ~~ FOUNDATION (1ST) ROUGH FRAMING & PLUMBING 1//: ,,, \ (Ju ...P'. 'T:L - w<:-. ..) _ Y.:,L /1 /':/ INSULATION PER N. Y. STATE ENERGY CODE I !'..jj A't'A~ J4, t^ ... - A/./.... II.' - k.n. .:__ > [ , ( 1/ '--V L~-"~'\.. .7 If' _ . h,". . l . N. 1&1"' ,J. ,~ '-" p~_"i /J /I . ~ .:... /' fV'L.. ~/pJ ) FINAL ~tJ". A. dl. r / ~.y-, 3 / ./// ...- (../ ADDITIONAL COMMENTS !f + -. ,,~ _17 0 o :E ~~.. I)' -........' Wcr;1 t / '( I -~&z..!f fi--- . "'~ rz~ . ::::: . D~ 4 0 z ):::;= o t"I .. b ~ ..;j I - . 0 tJ 0 t'I '" U1 ~ . ._-~ - P~G BOARD MEMBERS BENNETT ORLOWSKI. JR. Chairman WILLIAM J. CREMERS KENNETH L. EDWARDS GEORGE RITCHIE LATHAM, JR. RICHARD CAGGIANO Town Hall, 53095 State Route 25 P.O. Box 1179 8outhold, New York 11971-0959 Telephone (631) 765-1938 Fax (631l 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD January 5, 200 I Edward Forrester Building Department Southold Town Hall Southold, NY 11971 RE: Determination of Streets East Marion Woods subdivision Dear Mr. Forrester, The Planning Board does not recognize the right-of-ways in the East Marion W cods subdivision to be streets as defined in the Section 100-13 of the Town Code. They are driveways. Lots fronting on Rocky Point Road should have a side yard setback from the driveways. The rear lots, because they have no direct street frontage, will use the driveways to determine their front yard. For rear lots where the driveway terminates at the lot comer, the front yard may be taken from either intersected lot line. ~'~ Bennett Orlowski, Ir. Chairman LOT AREA = 52,273 SQ. FT. 1. 200 Qcres <f) w .... !.! it} :> 8 ffi a . <f) u.. I 5 ~w t ~ ~~ ~ l:5 ~~ ci Iii! 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SEPTIC TANK clI: WELL LOCAllONS BY O1HERS. 12-20-2006 ~NAL SURVEY 8-23-2006 FOUNDATION LOCATION JOB No. 06-274 SURl/EYEO FOR LOT NUMBER 13 MAP OF EAST IolARI0N WO SITUATED AT EAST MARt TOWN OF SOUlHOLD, SU SCALE I" = so' ~l.E0 MAP No. 8759 DATE 8 TAX MAP No. (REF ONlY) 1000-30-3-3 DISK 2006 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR P.O. BOX 616 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 631-929-4695 LOT AAFA - 52,273 SQ. FT. 1.200 DC.... -f-~20- N 13"OS'SO"W LOT NlNBER 12 Ul '-I ell t11 .jlo. ~ o ~ r- o .... ~ C I: ~ .. 48.0' ~ Z ;0 ~ o (,oj ~ "" "" 2804.41' ~ I 3 ;; I - ,F-;; 164.47' \ \J&,.I/ I, I Ii \ ): I Lzs'- I I Il I I I II ; : : I g I I I I !i1 I J I I ~ J J I I! I I -25'-1 I / I II I I I curD I S.S'N I I I I I I o~ I 4 . att ;1 II ~ I 1111 I ( i { II \ 1\ \ 1\\ I \ \ I I /' 165.00' ROCKY POINT ROAD S 08"30'00.[ lHEu.IINClEfl'...-",.............. OIF ...... " NIt. liar .... II<< mr .-..rIID. H aFfIIta (III .... __.... ... 'H ~ 1D 1M[ .........,. UB lIE .. 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SURVEY 8-23-2008 FOUNDATION LOCATION JOB No. 08-274 FILE No. EAST llARlON WOODS SUR\IEYED FOR LOT NUMBER 13 MAP OF EAST llARlON WOODS SITUATED AT EAST MARION TOWN OF SOUTIiOLD, SUFFOLK COUNTY. N.Y. SCALE ," - 50' DATE 7-24-2008 FILED MAP No. 8759 DATE 8-7-1989 TAX MAP No. (REF ONLY) 1000-30-3-3 DISK 2006 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR P.O. BOX 616 1866 WADING RIVER-hAANOR RD. WADING RIVER. NEW YORK, 1V92 631--929-4695 LOT AREA - 52,273 SO;,~ P re' 1.200 ac.,.. r . ~_ CL~" (~ ~:h- " : II t << p~~" f ~_L - ~~/ l~l. V .. ~ru \ \, III ~ \r~' 164.47' \ \.:&./ I II I II \ / II L25'- I I I I I I I I ~ I I I I ~ I I I I ~ / / I I ~ I I I I / I I I -25'-1 I I I I I I ~I 1-5'N I I I ! I ~ I I curD I O.TN lblr NUMBER 12 ~,Qt.a-05'~"W VI -..J 0} U1 .... ~ o :i 5 ... z C I: CD '" '" ... 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No. 2115-E Z -..J 0} U1 ... ~ o . I"Tl 5 ... z C I: CD ~ o ("j ~ ... ... ... 8-23-2006 FOUNOA~ON lOCA~ON JOB No. 06-274 FILE No. EAST MARION WOOOS SURVEYEO FOR LOT NUMBER 13 MAP OF EAST MARION WOODS SITUATED AT EAST MARION TOWN OF SOU"lHOLD, SUFFOLK COUNTY, N.Y. SCAlE l' = SO' DATE 7-24-2006 FlLED lIAP No. 8759 DATE 6-7-1989 TAX MAP .. (REF ONLY) 1000-30-3-3 DISK 2006 "ROLD F. TRANCHON JR. P.C. LAND SURVEYOR P.O. BOX 616 1866 WADING !WEft-MANOR RD. WADING RIVER, NEW ~K. 11792 631-92.....5 . SURVEY OF LOT 13 MAP OF EAST MARION FILED JJNE 1. jQ8Q, FILE No. 815<1 51nJA TEl EAST MARION TOHN: SOUTHOLD SUFFOLK COUNTY, NY SURVEYED 11-23-2005 PROPOSED HOU5E 05-03-2006 SUFFOLK GOUNTY TAX II 1000-30-3-3 CBRTIPIIlD TO: r..._ SolIIopcluJoe ZIbaroaIa SoIImpciaIoI North PoIt Blat PIIIt jo-..... 'l1de r............. OapuIyafNewYllIk o "j. ~ :5 '" \...ot \\ ----------- Test Hole McDonald 0eoscience 04/11/2006 OL D~' ...~ """ c- o 5 0 ...O~ '''',,' "j. Silt ~ " Pol" :5 ...O~ '" ,,~ ;0 Co<r~ "'" ~. 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' . . , ' , . , / , .... 0,,e105?c_ - -l - - 'OJiIOlf'.S} ~ - - : ff\~o,:>t - - I SO\')\(\00~ W v C) WOODS \ 0,",,6\\\00 \...ot \0 - - - - \ \ - - - - - ----- --- ",- - , ....~ L- ---t,-W - - - - - - ~i0'(\" .\ 0~O'\ C >-- 0.<,-1..... ___ , - --_ 'So' ................-- ---.... -- ......... -- , ---- ---, '~- ',--:""'-~- ., , , , , , --... , \ ""........ ..... \...ot \'? - -,.,0~ "(\v' ._.... ,<:f'v\J"" ~e\\ .... te.",t )8( \,,\ol:'S, r-' 131. 00'\. --JOv " ----_~SO' ~, 1,' ~, 'l,' 5' "' " '"' 't... ~ ~ V\, Q, ! \ \ Vo" \ \ \ \ \ \ , V ,', / -: - -\- - -/~ \ \. - - ,,'_ _ _ _ ....-l. - - , , OS~'\O"~ S16 ~ \...ot \2 ,.... $ @------- -- -_.~ --- I SUFFOLK COUNTY DE7>AR RMIT FOi. ",Pl'ROVAL FCONST!..;~CTION iloaA PE . ;jINGLE FAMILY 'SJDENCE ,)NLV /_ /' \ ~\~ _O,",-tluS' TE ~r22..o1O SRE NO "~" DA _ APPROVED __.._..__ ""'M 'JF '\.1$ FO;-.:. ~~A Xh,"'v\ ' o MAPS REr 'rHREE YEARS FRO; 0'" TE OF A,PPROV AL EXPI " - - --- -/.. ' o~'beVl /." 1';rI"e""~\V _' ,/ /:.' - - - , -:;,...- .' ." " ... "i) .... -::CO ~~ Il'Il' 'll'll 0.. ""f.!;:,. ~,- '~~- -J.--.~ f ' f f f _ / "Ev" -/. '3\'\.'2'2' f I I I I I I I . I 3/ I I f I I I 0"'6\\\00 / I I I I f I I I I @ \...ot \4 , el.4O' i ~ I, 'I, " " \ ~ '~ I I, o "j. ~ :5 '" 0'. ~~\:.\,,\O -$- VIlell 'a, ~ %. ~ ~\:.\,,\50' N W*E S o )C ~ :5 '" -$- l"Iell - """"'"oc"~,, ""~,,,troo '"' "Mlllon lo "":V~~ "'''<' ","Drlog " "<~"""''' '''''''' ''''V~~Dr~ ...,,1 ." v;o'o<lon or ~.ootr"n 1~04, .....,-dh.I.;Qo;l, ", '"~ ~~" ~ot~ ">t",~ EdJ<otr9" ~"" .On'~ <"p'~' "0"' t;,~ "...g"'" "F th', .....-v~" mDr~" ~"h ~ ""g''''''' "I l"~ ''''''' '"'V~\l"'" M""1"eo ...,,1 .,,,,, "" ~"""idoo'eo to".. ""~'~;:~~ 'C~rl'J;o"l'.,.,o ''''''''"l~'' ""c~oo ",gn;'~ 'hot 'hi. ,.r~v~';,;;,,'" X:;~~~"';.'~,,..""t;:~:,,~~h~~~;~ I:J!' ~he....~ '-0" <;to.. AMOGI"liOO of Pro'".."",,' Cond """'Y~'l"".. Sol" "~""'CQtl"". .""" con "",, '9 ~h" p~""'" '0< ~hom t"" .OC""~ '. p'..pa-"" 0"" 0" ",. ""h~11 ,,, lhe "tie GO"'P<>",. 90""'""'''0- to ~~,,~;:~";; ~""II~?,;:,:;;:;;;;;:,';~~'t~:" he~~ir~~ trcoo<X""",,'lc:>o.F,,,w'" to oddtlo",,1 ,",_,,"t1""" By_ ~J6FIN C~ EHLERS LAND SURVEYOR N.Y.S. LJC. NO. 50202 V) 'i 0', ct:JI o I, ~' 01. ~ ' g" 4 I 4 , tr\ '" I so' '.. , , , " I, i " ,....~ ~~~; ~ , ;l. I \ i i - . . - I, - - . 40' .i ::-.... - e\. ". i ""ell tv (y () ~ ~ , , , 'oe,ea l'ro~ell' , !fD) [E & ,rE n ~' MAY 232006 ~ ~ \ 44' .' \f 6 EAST MAIN STREET RlVERHEAD, N.Y. 11901 369-8288 Fax 369 8287 REF.-\\COMPAQSERVER\~s\05\05-345.pro TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD. NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northrork.netlSoutboldl PERMIT NO. 1,;;-;;P/9 b BUILDING PERMIT APPUCATION CHECKLIST Do you haw or _ the follow:::.... app!yms'/ _ofH_ / 4 acU of Building Plant ~~, Check , 4 ScpticFoon N.Y.SD.E.C. T_ Contact: ," ~~::~ Examined Approved ~eda/o Mail.., ,/>,/ .211 0'11 I..~_., f1wnc, Cf2 'i - 4 5 7 0 Ellpiratioll APPUCATION FOR BUILDING PERMIT Date I/O .20 06 IN!rrRUCTIONS , a. This appIioatioo MUST be oomplmly filled in by typewritor or in ink and submitted to 1he Building In_tor with 3 sets of plans. """"'ate plot plan to seale. Fee acoording to sebedule. b. Plot plan sbowing locatioo oflot and of buildings 00 pmoi"", relatioosbjp to adjoining premise> or public s1ree1s or ....... and waterways. c. The work covered by this applicatioo may not be commenced belixe issuance of Building Permit. d. Upoo approva1 oftbis appIicatioo, the Building Inspec10r will isaue a Building Permit to the applicant. Such a permit sbaU be kept 00 the premise> available fur inspeetioo 1broughout tbe work. e. No building shall be oc<upied or used in ,wole or in part for any purpose \Wat so ever ootil tbe Building Inspector issues a Certificato of Occupancy. f. Every building permit sball expire if1he work authorized bas not commenced witbin 12 mootbs after the date of issuance or bas not beeo llOOlpleted wi1bin 18 mootbs from such date.troo zooiog amendm",1s or other regulatiuos affecting tbe property have beeo ",acted in the interim. tbe Building Inspector may authorize, in writing. the _sioo of the permit fur an additioo aixmootbs. Th_. a oew permit shall be nquired. APPLICATION IS HEREBY MADE to the Building Oepor1meot fur tbe issuance of a Building Permit pursuant 10 tbe Building Zooe Ordinance of the Town of Soutbold. Suffolk CoIDlty, New Yor!<. and other applicable Laws, Ordinsnces or Regulatioos, for tbe cons1ructioo of buildings, additions, or aII_tiuos or for removal or demolitioo as berein described. The applicant _ to comply with all applicable laws. ordinsocea. building ~ code. and regulatioos, and 10 admit autborized inspee1Drs 00 premises and in building fur necesaary inspectioos. . /<3-5>- ZClVM~ (Signatu.rCI of applicant or nam~ if a colpOl'Ation) !Jojl1U (0 f!,.'!- < 61, w.,J...) !<,v-r, JJ f 1/7q,) (Maillag'- ohpplicaol"j State wbetber applicant is owner. I...... agent, architect, engineer. genom oontractor. electrician. phmber or builder gUL' \A .fr Name of owner of premises Gu,> t ,7..hG.(ovl"l ~O+'I'Of6Jlo.J (As on the tax roll or latest deed) ~~S z; SiQDatU~~~d..~autbO(1;~~,) (Name ti e of corporate officer) Builders License No. Plumbers License No. Electricians License No. Otber Trade's Lice... No. ? 0 \50 .'^~ I..\'iH I. Location ofland on wl!if:b PWJlOSC!l wor~ will ~ ojone: ~(,,, f.~1 ~l" House Number Street fttJt Hamlet Ma.(I...., county.Tax~N~I0Q0 Section SubdIVISIon . .I'\~(, Oil ame) Sj7 l<J CQ Block J Filed Map No. ~7.n Lot Lot J L./ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: s. Existing use and occupaney . b. Intended use and occupsncy .i F<\I", I,j I Dw-cJ('I1J ~ .' 3. Nature of work (check which applicable): New Building ~ Repair Removal Demolition Addition Other Wor!< Alteration (Description) 4. Estimated Cost Fee 5. If dwelling, nwnber of dwelling units If garage, number of cars (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupsncy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Resr Depth Dimensions of same structure with alterations or add"rtions: Front Depth Height Number of Stories /'']' <III /';)' II 8. Dimensions of ....tilJ'ilCW construction: Front h - '1 Resr b - 'I Pepth Height oi J Number of Stories .;L /1, ( Rear If.. ( Depth J.l Y I ~ I/) S" NarneofFonnerOwner rra~(o I..... Rear 3.l' (" 9. Size oflot: Front 10. Date ofPurchsse 1 I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO J:. 13. Will lot be re-graded? YES-.l NO_Will excess fill be removed from premises? YES _ N~ J- I . J vf,l/~'J'I Fe 14. Narnesof Owner of premises .50 ,ro/<>-,..v Addre..JllA R.dt i'< {I~ !JONo. Crl 'f 77-, YJ '-" NarneofArchitect ~"(" (V't.o J, " Address. o.b "t No q (;) f ":j J 6 Name of Contractor "....J f-p,...' , Address (. ,., ,u.iJ'honeNo. C(J - .r7 () 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? "YES N~ " IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAYBE REQUIRED. - b. Is this property within 300 feet of a tidal wetland? " YES_NO_ "IF YES, D.E.C. ffiRMITS MAYBE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. Ifelevation at any point on property is at 10 fi:et or below, must provide topographical data on survey. STATE OF NEW YORK) ss: COUNTY OF ) \J ;G~o\aJ ? u.-'iIIl () j beingclulyswom,deposessodsaysthat(s)beis1l1eapplicont (NomeofindividuaI signing contncl) ebovenomed, CC>-,\ k~ d~ (Cootnctor, Agent, Corporate Officer, etc.) (S)He is 1I1e of said own... or own.... and is duly au1l1orized to perform or bave performed 1I1e ssid work and to make sod file this application; that a11_ conlainod in this application are 1rue to 1I1e beal ofhis knowledge and belief, sod that 1I1e work will be perfunned in 111. mann... set fcr1h in 1he spplicstion filed 1I1....wi1l1. $'fpfcreme1l1~' day of :woe:: .. ~:~~l~ 2v~<-~- NINA L NICCHI Notary Public, State of NewYort No. 4814600 Qualified in Suffolk Comtv Commission Expires ;;{ 01 () ~ - of Applicant ~