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Home My WebLink About32963-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 01/03/07 110: Z-32816 THIS CERTIFIES that the building IN-GROUND SWIMMING POOL Location of Property: 2797 CEDAR (HOUSE NO.) County Tax Map 110. 473889 Section 79 BEACH RD (STREET) Block 8 SOUTHOLD (HAMLET) Lot 15.2 Subdivision Filed Map 110. Lot 110. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 22, 2007 pursuant to which Building permit 110. 32963-Z dated APRIL 30, 2007 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 GIACOMO F CHICCO & CLAIRE CROSSLEY (OWNER) of the aforesaid building. N/A SUFFOLK COUNL' DEPARTMRNT OF HEALTH APPROVAL 06/11/04 ELECTRICAL CERTIFICATE 1110. 4189 N/A PLUMBERS CERTIFICATIOlII DATBD Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 'foaL /';Ui( 3 aJJ4 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: .J 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 2/1 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: 1. 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 New Construction: Old or Pre-existing Building: J. 1- q") House No. 0?#CO/YIO C edt:tr lOea r h Street Date. Oc..t.B .,wO"\ V FZ..d 1- Owner or Owners of Property: Ch/c.co :;-q Block Cky.e (j> (check one) S,oufho Id Hamlet LrOf;S.Ie(j-_ Lot 15, z.. Location of Property: Suffolk County Tax Map No 1000, Section Subdivision Permit No. 30). 5 1- Filed Map. Lot: Date of Permit. Ltl;. YO'dAPPlicant: '5(;.;/~ k, ~ Pc> <::> /.s. Underwriters Approval: t;/ if D'f #: . Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate ") C~ Fee Submitted: $ ~ J Final Certificate: / (check one) ~ T~,,- A P . cant Signature 8-.eA-- ')35161 CO-b 3,2<?/Cp James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0272C Date November 15,2007 THIS CERTIFIES that the in-ground swimming pool and pool backwash drvwell At 2797 Cedar Beach Rd.. Southold Suffolk County Tax Map # 79-8-15.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 2/25/03 pursuant to which Trustees Permit #5730 Dated 3/18/03 and Amended on 4/21/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions oflaw. The project for which this certificate is being issued is for an in-ground swimming pool and pool backwash drvwell. The certificate is issued to GIACOMO CHICCO owner ofthe aforesaid property. ~o<1r Authorized Signature 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. 32963 Z Date APRIL 30, 2007 permission is hereby granted to: GIACOMO F CHICCO 120 11TH AVE 5TH FLOOR NEW YORK,NY 10021 for : CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN REQUIRED REAR YARD W/ FENCE TO CODE. THIS PERMIT REPLACES BP # 30257 at premises located at 2797 CEDAR BEACH RD SOUTHOLD County Tax Map No. 473889 Section 079 Block 0008 Lot No. 015.002 pursuant to application dated APRIL 22, 2007 and approved by the Building Inspector to expire on OCTOBER 30, 2008. Fee $ 150.00 thorized Signature ORIGINAL Rev. 5/8/02 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 6 '7 ,)1 I '- BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD \ ..LJ CERTIFICATE OF COMPLIANCE # 0272C Date November 15, 2007 THIS CERTIFIES that the in-ground swimming pool and pool backwash drvwell At 2797 Cedar Beach Rd., Southold Suffolk County Tax Map # 79-8-15.2 Couforms to the application for a Trustees Permit heretofore filed iu this office Dated 2/25/03 pursuant to which Trustees Permit #5730 Dated 3/18/03 and Amended on 4/21/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for an in-ground swimming pool and pool backwash drvwell. The certificate is issued to GIACOMO CHICCO owner of the aforesaid property. ~o<~ Authorized Signature Nassau Suffolk Electrical Inspections, Inc. 5ACanal Street + Center Moriches, New York 11934 + Tel: 631-878-3500 + Fax: 631-878-3764 Application: 4189 6/11/04 Date: Issued to: Chicco Address:. 2797 Cedar Beach Rd Village: Southold Introduced By: B&R Mechanical Lic#: 2761-E was examined and approved up to the above date and was in compliance with the NEC JltIic 1st Roor 2nd floor R:lsidenial 00 Pool 00 l-tHlb Pddtim [)t G:rcvl Base.,at 0. ,,,..dal Switches Receptacles Fixtures G.F.1. Pool Panel Heater 2 2 Fans Dishwasher Washer/Am ps Dryer/Amps Oven Carbon Range/Amps Monoxide Furnace Oil Gas Heat Zones Smoke Bell Detectors Transformers Meter Amps Phase Motors Other Equipment: Inground Pool o ut,Res 7Yf~~~ This certificate must not be altered In any manner Permit#:30257 .. NassauS,tiffe}k Electric:alWsp~ctions, Inc.. 5ktanatStl1lei. eentlltMoticlie~ New Yoril: 119:l4 . Ttil:631-878.3500. Fax: 631-878-3764 .,"-',' -d",,""-.'" '--"-, - ". "-,- ,,'.. ,:' -, ,'. ,'.." j\pplication: 4189 Date: 6/11/04 Issued to: Chicco Address:. 2797 Cedar Beach Rd Village: Southold Introduced By: B&R Mechanical Lic#: 2761-E .Omrerdal Pooll&l i-bt Tlb . Del Qlrage Pddtion was examined and approved up to tl1eabove date and was in compliance willi the NEC }lttj(; '13aSer11lill 1stRoor 200 floor .................a1= ._..'''~:~ ':LOJ , o.j( .Meter Amp. Ph..e Motor. . :.ll!.th:~rJ~<i.aIP m;en t: . h\grou.nit. pool i.~~ :":; ut,Re. . -u ?J4P~ This certificate must not be altered in: any manner Petmii#'30257 ., ',', . "3 2- q~ ) 2: TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~ATION [ ] FRAMING/STRAPPING [---rFINAL ~ [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: 9/cr (' ~ ~ f/ps cpr 7". . t DATE Pf It) 7 t INSPECTOR 3D~{~ 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROU H PLBG. ] I ULATION FINAL ] FIRE SAFETY INSPECTION REMARKS: ~. DATE / () / / I/o r;L'- I I bdo jJ, INSPECTOR :30L'S7-e- / TOWN OF SOUTH OLD BUILDING DEPT. Sp 765.1802 INSPECTION -...--::- [ ] FOUNDATION 1 ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING I STRAPPING [ [ ] FIREPLACE CHIMNEY [ s:~ . DATE/O 1t3 rOD { I INSPECTOR .' FIELD INSPECTION REPORT DATE FOUNDATION (1ST) ------------------------------------ FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PERN. Y. STATE ENERGY CODE FINAL COMMENTS \ '..............._-, , /0 II n)~ R / 0.,1 ." ./. ..::7-.-" I I II. :J.C/ ~ 4,/ 0.. /.L "L';{ nt::IJ ~/U AX -'-: ..-If ~ -r / . , '1-"" /F /J IOIl~ v,.. (j o. .I...:~ .u Ai- .J, ^ I J.J. J. L . '"). 'l~ .I. hI" \ LJ~~j. A'rlA-.J! /A":-/ J>h//J~ c-~ L7~'()/J . 1 / I I j;/ ./ '/ /J';I~-, ~ 0 'l-. I 0 ./f. -1. I~",./ // / / ( ~./ ADDmONAL..cOMMENTS ' ~ .~ . " \." , .. , " . " !,=W lO'J}j -- ~ ~ ..,~ ..~ ~~ \,~ 'Z 2Jp ~" -.J", ~; ~ ~ s.- ~~ ~ .., I o ~ t ~ ~. r.'\ 0 I" U0 :E (' J~~ ^J ~ ~ ~ ,j ~ ' g& Z I gj~ )~" o lO'J ~ . .. l101f)-=Lq-8-15~ d. TOWN OF SOUTHOLD PROPERTY RECORD CARD .- .- - ~... ---. -- - . .u - ~ ._- OWNER STREET ~7q 7 VILLAGE DIST. SUB. LOT 3 - ... GI {.()() t?:t h r fJd (if wh Qd. ~uthi) /,4 S van hunl Ac.ns ACR. 13.9~ REMARKS f TYPE OF BLD. 3/Q2tf-/07,-L 1;),- . '!/trre chs/A-K. (J.&(,.) ."2.0:1 J Cllark:. CQ.nrefl4.reAS tr/u<< ~ ~ j" -JljDl Mil J.J (n:::iD () +-I€-u),+L PRO~ CLASS I , 10 ;; Jd-7/0'!> e,f>#=~"1'fJ.lf (eDkxc.P<:. f1:J>#- J'10t.f"L LAND IMP. TOTAL DATE :Fb:? I f12.. R. P tl::.. ;). '1 Lf d:;- . ... e~ ESP#- C).~&.q I 3'RDD 7Qno ( I. 7 00 /3/'/0) \ v - .-.-- .sgoo I~, 300 1f.:,' f O() v .3 /, /040/ , ' I -- .-- -- . .. - -- --- . ---._- - I I ! . FRONTAGE ON WATER TILLABLE i . .. .-.- __n._ _._- - FRONTAGE ON ROAD WOODLAND . _..~~--_. DEPTH MEADOWLAND i BULKHEAD HOUSE/LOT --- --- TOTAL , .;~'~.~il3~~~." ., Z-~ Lrc- -'.-1"'> . ( .:.....,. I .0'1 .-' <.... o;.~, ~~ ;., .. ~t' 1"f~"i~'~'<1~~;J.:.?",.;;. ., . ':-~J~~;'.,:J''}~.::Xf': 'C " . '~,' 'j;-.4:~'?",< ': " .,',\>40'" ..1r F=ul TOWN OF SOUTHOLD PROPERTY RECORD CARD STREET z.. 7 7 VILLAGE DIST, Lecb( &ach K'd '-(,'Y c::: ""'.-.} . OWNER REMARKS l .' ~' PROP, CLASS ZID TOTAL DATE 11 .~ '1 '.~, S ~ # ~ l ~ .%"t'ct1l" -I PfHC-'^ - flCl76-ono . ..'i;! - 81' / 9f~;)t;- ('t?nS!t.. T""3~/ lbc/ ~/J:;"'MC'P - #,30 Di"')".:, "''',';'r'\~ I I / i': ".-;-.' ~.\ , .", ::1 "1 "'I 1 FRONTAGE ON WATER FRONTAGE ON ROAD . DEPTH TILLABLE WOODLAND MEADOWLAND TOTAL ! <602-- .' ,:50 /10 HI '0. 0/11__ 1360 S;OO "5 :3 7!'j ")..50 . /EEi<te,nsi n -f"r,: "'C" " ;, " f\;,',;'Ii:.,;-,;{, . .... \\ , . ,'i;,~;,j. ,.' .''';:,' - '~">:'i... . 1 \ I ('DV(r?,J. D~~ ~.' I / ()Vcr rb-kretL~ , /4 I COLOR '77a .1 r, I '-, I ,6 , ~. . h ! I/, , ~ J- ,sr. l> ',,-' 0 '[{ CN'd.. 10 / - If> pc<<l, -............ ,b. i , " ~, !..~ .- ID TO + FI' I"p , i '... TRIM -:UL;d::t-J -,'," ,- '. 'J." / 1Ie 'f." '''1 , s: I 1 > -i$ > -rH ,~b STO~ ";~i 3 I ;,., 15 z~ "C 1= 'J> ! - I-- '< po "ji. d~ 1\ covEl<t:fl; PoAl:J4 , , " '0 < -i ~ . , 10 Foundation j; - .. . , ~ 20 Basement ~ Ext. Walls , 5 Fire Place 'I I! I Dormer , , a~~~ ~k& I I .. ! , 1(;lQ}t !/ . -----_.-~_. ;y,~ 5 ", . , ~,.J I .. J~JS d-~'~ ~n () Driveway i " , - '. ~ il -J,-! '~L.. : , .,' '- , '.'1'~ , 0 <it. "fi'<":~-.-:;'.:(";:.r ---, ~ , "il"Wrtt'0;C~t'= .' > ~. . , ....2.tJ~~1Yr 1 <-,"1> .A....~ ~"k;.,' !. ,".,~: . .,:l:, . . ?"." :.~.K~' :; -.:' . . '_.'"4 ..., 15 5 f 8/ 8 Ifc i()~O ,;-- Wv D1S) i~ LrlUlta McKenna Sll.N.mbaum, ShUmbaum P,I'. l10x 8 I6Up, IJV 11751 Re: 1~4738.00121/00001-0 fuU. /I..il\" ReaUy COItp. 1770 l'o.tOJt rOltklll(1l! SuLte 2B . Hauppaltge, New YOtr.r 1178s .a ..... ~ New York State Department of Environmental Conservation Region 1 Headquarters SUNY, Building 40, Stony Brook. NY 11794 DATE: ^tvu1 19, 1990 & Jab/oM/U Thom.. C. Jorf'ng Commlll'oner Dea r 1.16 McKenna, A review has be...., Wilde "t' your proposal lO: COM.tJwct a 2-~toJr/J dwel/A.J1p. (l{l""M., rlJL.i.VeL'l(1.lf and oep:Uc I.>!fl.>tem M per. a:t/:a.tc.hed p.(.anbrf (f!.U.rM.m R, S.u...oY1.6 TIT dated JanuaJty 25, 1990. Loc.~on. Cedalt Ueac.h Road, Southold SCTM # 1000.079.08.015.002 Basad on tne informalion you hilve submitted, the New York State Department of Environmental Conservation has determined that the r-' :.!(XlQ(X project j s: Grei'tler titan JtJU' frolH invcr:'>IHorJt.:cj t ictal wetlands. [,and\v,Hd of d substantial man-made st.ructure greater than lOO' in length which was constructed prior to 9/'20/'7'7-:- XXXXX Landward of the 10' above lIlean sea level elevatiop contour on a gradual. natural slope. Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' in elevation above mean sea level. / Therefore, no permit is required under the Tidal Wetlanq~ Act (Article 25 of the Envi ronmental Conservation Law). Please be advi.sed, however, that no construction, sedimentation or disturbance of any kind may take place seaward of the lU' contour or topographic crest without a permit. It is your responsibility tu ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project. Such precautions may include providing adequate work area between the 10' contour or topographic crest and the project (i.e. a IS' to 20' wide construction area) or erection of a temporary fence, barrier, or hay bale berm. Please note that any additional work, or modification to described, may require anthorization by this Department. this office if such are contemplated. the project as Please contact Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, . .' ~ /' - [ f_' . I"",", . 'r ,', '." .. -1" Hl?!9'i.OI:~1: t:!rlltil AdlOilllSII.;ator C',I." nfoptlty I , 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 SOUTH OLD April 21,2004 Mr. Randy A. Rodecker Swim King Pools 471 Route 25A Rocky Point, NY 11778 RE: GIACOMO CHICCO 2797 CEDAR BEACH RD., SOUTHOLD SCTM#79-8-15.2 Dear Mr. ROdecker/' ( The following acti'n was taken at the 8!6uthold Town Board of Trustees regular meeting held on Wednesday, April 21,2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit #5730 from Glenn Behr to Giacomo Chicco to install an 18'X 40' rectangle swimming pool approx. 30' to 40' off the house. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Ji~.$ 9. ~.tj.. Albert J. Krupski, Jr. President, Board of Trustees AJK:lms ~ . PERl\fiT NO. BUILDma PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey ~S7 -l::, Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: JWI; ;JDb ~OL-5 '-01 f r. _fJ & _I+. /1778 Phone: &>..1/. 71./ '1- ~/{)() roWN OF SOUTHOLD 3UILDING DEPARTMENT CPR 23 31M rOWN HALL . . ;OUTHOLD, NY 11971 rEL: (631) 765-1802 lAX: (631) 765-9502 I.pproved )isapproved ale .20_ ,20_ ixaruined ixpiration .20_ Building )'nspector APPLICATION FOR BUILDING PERMIT Date L/- p- D L/ ,20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or reas, and waterways. c. The work covered by this application may not be co=enced before issuance of Building Permit. Ii. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit hall be kept on the premises available for inspection throughout the work. . e. No building shall be occupied or used in Whole or in part for any pUlpose what so ever until the Building Inspector :sues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized hii.s not co=enced within 12 months after the date of suance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the :operty have been enacted in the lnterim, the Building Inspector may authorize, in writing, the extension of the permit for an idition six months. 'Thereaftcr, a new permit shall be required. . APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of South old, Suffolk County, New York, and.other applicable Laws, Ordinances or e.gulations, for the construction of buildings, l!Ciditions, or alterations or for removal or demolition as herein described. The lplicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit lthorized inspectors on premises and in building for necessary inspections. "IMMEDIATEL Y" ~ ENCLOSE POOL TOCQOE OCCUPANCY OR UPON COMPLETIOIi BEFORE "WATE~" -2 _ I. 1 \ .I , USE.5 UNLAWFUL LJ71 '1\+ ~6A :R0u-'1 -:Pt. IVy 1/778 ~=~TIr~CATE WITHOU~ CERTIFICATE (Mailing address ~rapPlicant) ate whether app'!ant IS owner, lessfOF~eePJ(NCYeer, general contractor, electrician, plumber or builder de.V\evO-- \ C-lHl\+-r<,<-c--tov' AP~ uneofownerofpremises I(L<:"OW\ C-~-\ LLO DATE: #~#B.P., frO;! ,>7C " .. . (As on the tax roll'or latest fttJ;l) /<;7) BY: apphcant IS a corporation, SIgnature of du1y~dt)N SHALL NOTIFY BUILDING DEPARTMENT AT Ul=~ THE REQUIREMENTS OF !HE 765-1802 8 AM TO 4 PM FOR THE (N arne and title of corporate oflicer) CODES OF NEW YORK STAtE. FOLLOWING INSPECTIONS: . 1. FOUNDATION. TWO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING I PLl.lBIG 3. ~TION 4. FtlAL . CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE S OF THE CODES OF NEW Ate, ,NOT RESPONSIBLE FOR cilders License No. ~ I LJ J ().. H unbers License No. ~ctricians License No. a IR?S~ ner Trade's License No~ Location of land on which propoJled wO! . CeAltt (', House Number Street ''lty Tax Map No. 1000 Section 79 J,ision Block 'if Filed Map No. Lot IS ~ Lot $lll\~t' ~'I k/ r-ffJld:e/l1C'.-L I " b. Intended use and occupancy I V\- 3r(),A"V[) __<;WI"'" ~~~~\ ~ 3. Nature of work (check which applicable): New Buildinll: Addition Repair Removal Demolition Other Work a. Existing use and occupancy 1~y-iJ() Alteration I VI - f!fPufd) ()c>() r . (Descl:iption) 4. Estimated Cost J 0 000. -- . I 5. If dwelling, number of dwelling units If garage, number of cars . Fee (To be paid on :filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situsted 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO_ 13. Will lot bere-graded? YES_NO,/' Will excess fill be removed from premises? YES ,/ NO_ ,J7Qf) llrlh"L R.v '. .., 14. Names of Owner of premises (?ItU'.N\fi) C.niCLo Address honeNo.QI'7- 3)1", <7-i'9J- NameofArchitect./JelJlcllyl\ JohV\5n1\ Address (<:' v.e PhoneNo(p">I-+'\I- ~JO~ NameofContractor~ll.lM-j)y 1.1\'c&i'rbor Address:W11It bt\ =fbol5 honeNo.b3/-J'Il/- g-JV() . . 471 hl- . .~ky VIIl t. / 15 a. Is this property within 100 feet of a tidal wetland or a freshwater w ana? oIeYES ~NO * IF YES, SOUTH OLD TOWN TRUSTEES & D.E.C, PERMITS MAY BE REQUIRED. b. Is this property within 300 feetofa tidal wetland? ole YES_NO_ " * IF YES, D.E.C. PERMITS MAYBEREQUlRED. -Ie. t1<" r o-t' (IDYl ju.rl Sd.IC+IO"'- 16. Provide survey, to scale, with accurate foundation plan and distances to property )illes. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data~~:.MMi . " ,_'. "'. ';'r .. '.,.', '. :..,,> -'. <',:,.' ., ',: ,\,. ~ STATE OF NEW YORK) ", '.." , " " '. SS.' I' '~", Po : ~:. ,...,1 :'" 0; ! '.; , It I"' ,: . I ) ...J. f.. . ~l COUNTY OF ) ,.... "" . ",' ,.--, '''';.r........'.~.".~ ". I '! ,."'~\j$,i ,..r '~."' \:,:; , i..\ ~..~!;', ,:,,;. : : ,,' ~ .\o<.~ ; ; . '_j ,. ' . :;j( Gl V\~ 'I. .1. . ? Dele c IU' v- . .' be~.~r~~ d~~~~ays that (s)he is the~pplicant (Name of mdivldual slgnmg contract) above named,. .f. . - " I. . :"i ", ",,~, I,t ,',",' """'.' '_' :~_,'" ," (S)He is tl:i? ! ','" .,'"' :..:e,o'V\'~ ic~L to 1/ -~-..._- '., " -,. ,....,(Contractbr, Agent, COlporate Officer, etc.) of saia;q,wneror:oWners: and:i~ ~~~ed to ~ertQrm or,aX~.~~~ed ~e said work,and to make and file this applicatic that all sJl\~~ts.cOl,1tamed),l1- !hilt~licatio~e trJ.l.elo,th!i~ of his knbwt~g~ and belief; and that the work WIll be . performe~ in ,~e~ller setfoz;tl:t ill, lhe applicatiOg!lle~ ~ei-eWi~', ~~" : ~" .:.' 'i. 0 Sworn to befor41~l4is . 'C ,","~ L' , I 2 \J5)"b\.oi .' ARx<kL.>q :joQ..1. \ ) ^ ^... L /,jAW'N,d' (' In., , -tZ (~lvy;-(vK"I_~~~ jU/L/ , Notary Public "",'''Y.' :'! "iHr T :<~,\.j ...." 'J<; ,~,'". /42.l--/~ / .. Si'WOf Applicant - .~;. ~'... -""'" " '."':' 'u~;-'::; )j3,~ ",,":,I<O..~:' ~f'!f!fIO D, EC~~ T2 ,"',f . ... ~"i,i OF tW ~. .', "", RV _ .v.~ .. .,....,.. ;,'" ,'. <":11'" ,.-.. . 1R ~4&'''' .,,-' i/., .:...." QUALIFIED IN SUFFOLK COUNTY MYCOMMISSION EXPIRES SEPT. 29, 2 10" T ?-?iY( '" co '" PLAN 12' .-l;.$ ~::3 '" , '" N , 'T SECTION A 10' --> , ~ SECTION B 10" 16' WA1t:RlH -t 10" t WllW FONI1IJl:1'/Wj 4 Uf.fRIW~ 21 . 4 FerM res 4" '<t 4 *x)f5Paw~ " ~lm~ 2" fa 4" 5/W, 4 / il:J il:J ' <,:;, fa fll1l'R fROM fll1l'f li:fROMSKII'<R ' fll11'R,AWfUIII' fO W;Sfe fa R!:nm; PLUMBING SCHEMATIC CA5f-IN-PlACf CONe. SffPS WAffR UNf 2" to 4" SAND I?OrfOM NOTES WALL SECTION I, S11aIC11J!X 15 t?!:Slui,W fCl1 use ~I'LOvV UfJlt;\; ANt7 OM- Y IN ff!tf6 wrfRO 1H' <AROUNI/ WA1I'R rmt'ISAMltJMUMOf 4'-B" ~ 1H' PRGrOSW flt.HSftI/ CiRAI/f', 2, ~ACKflll \Ii11H C!-I'AN t'AR1H, fRO" Of ROOfS AlP t?!:BI<lS, I/O Nor AllON 1H' It'ICiHf Of ~ACKflll fO I'xaw 1H' It'ICHr Of 1H' WA1I'R IN lit' PCU ~Y MORO 1WIN B" ?, WAlKS fO OC SMOOlH, NON SKII/ 1m, 5l-Cl'Or AWAY fROM PCU, 4 WA1I'R I/ISPOSAl- Sfnl OC llMI1I'1/ fO OvVNoRS PRCI'C'RfY fO SUI! lOCAl CONt:1~0N5, ~0 o Z -0 o cl ~ Q.. ~ ;= \J l:ci Z Z C\ ~ _~<(Z '::L 1-' lJ) 0 N"'- ~6~?2 S;Z~V ><(00 V'\ ol. ci. ci. ..- =0 il O_~ ~ E ~ i . ~ z", ZI-~~ OVa:::: v)WDrtl ZI-DZ-<i :C:C~i~ OV..J<(N '''''ci.IICXl C\A'\.]':'Ji'<i -.J'-u:.......o IO OI 0-. '^ 7-7-03 ~