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Home My WebLink About27253-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall ' 1 Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27253 Z Date APRIL 19, 2001 Permission is hereby granted to: RICHARD W ABATELLI PO BOX 517 SOUTHOLD,NY 11971 for ADDITION AND ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR WITH TOWN TRUSTEE ' S AND NY DEC APPROVALS WITH FLOOD PERMIT at premises located at 1915 LAKE DR SOUTHOLD County Tax Map No. 473889 Section 059 Block 0005 Lot No. 005 pursuant to application dated SEPTEMBER 6, 2000 and approved by the Building Inspector. Fee $ 478 . 00 Au oriz—e-d Signature ORIGINAL Rev. 2/19/98 D ,�--,-�+-- SEP 4. 7.1990 TOWN OF S UUTTHOLD POOL6g ..i Mlm t� p po 'x 1 " s O T�. .r `� a .r. Kr 3, i , ` , bin , f � a tr. , h r, . t rt.,, !� ^f �✓i ,1l wt J.��iat�� X3:Y, i F �.y`'`! r! . J'�`�Y t'� t„ lrT ahGi �• :t kl•1 l�f ('rti�1i�4t��'k� ��y 4 -:3 r s fxa 1r�•! N kPSS w .�+x� ..fix t♦ +� '� M�� t�. �Y� � �`4 ., i, � �. "' .N QFF\ , t �f��. WI. la ! r yl3,. .iey: off• 5c `" 'er ROOM + - n4 xAR. 1 .�Ay��4+�yyY rt 1 d !Y 1 2 'F'w �f �. r'1.t.')�4 w��M1•'..yi M`^%'T.,��Y", I �'•,� ai5GjA' In 1 a.rs0, ` . '' �+X�S �"" n��7a" ;�, �, ' wY.�' ;. h ",, I � �T. a • lr c i r `. hf. .1 ZSl''.. Oyu :')!� .L�'" AsdTr<<-i GAIi✓F — 5007000111 , �� NOTC°: L_OT ^ J'S. 5NJWN r) uF—LTt1 Ei *J G. 6 - - Z-4 Oti nID.' SUFFOLX COUNTY HEALTH DE""T"N! x. D. xEF. # 6s The semsFSG di ipo3al and meter supply fecilitle.*. Yo^ Chi.& I Or,t'" t0-L have been v this depar�D:e�at and f, Ed inspected b„ /A` ///1 to Do. sa�ti fact Y• '�y,I'l`/,r,�,,�_ SEA=. . ` Chief of General Engineeriag �- Serwices ,03 1/ �q1 A A, 10 Arc. 149.37 Rad . 31(0 Coo b (o foo ra. 6 9 = CF SPOOL ? \° Y NOW OR FO ?MEU;_'/ O V1ELL UZMANH ® = TE5T HOL n 191 D Q _ D NOi"[: : ELEVATIONS xCFER TO WATFf2 LEVEL INGPE:AT FflNO. I I r yy' ,1 )4 0). - >o ' / - ♦i of 192 � 1 -i wlPII, <.:� � Pcircel 0.1 / " 1 rt1-�'v`•`-' TE5T HOLE 0 Zbr lca c CLEAR Lk Z SAND r i9b o � Pavc k o t 1 o I Rk sITS L86 CA JAMES MEO GAO UNAUTHORIZED ALTERATION OR ADDITIGq C s TO THIS SURVEY IS A VIOLATION OF Epi ix 2 k\`�- SECTION 72C9 CF THE NEW YCRK STATE I \� Q 0 EDUCATION LAW, Qi O COPIES OF THIS SWV.Y MAP NOT BEARING ". V� O • THE LAND SU'V YO;,L p;_ D ;FAL OA %V T - �Iv1 L S in �U' EMBOSSED SIAL �? �O TO BEAVALID rFi_PfCcrISIDIm �.� 0 f k GUARANTLS l :A] ,i 6:C. ]Yd n 1 eed iO A H i c a r Ttle ONLY i0 v HALL RUN ��„Y O ems, p IS PREPARW A U 2:S 110'iXE vEt E�1Y v TITLE CCM A f PIAL AGENCYTHE ANC I I ( \"C+ i' r_E "--Ott t! i'Ll L.' $ RJt�V 4L LENDING 1;,ANr,LJry LST;' 111111 L K"RLON, AND `Il.I 1• ' . I P1 / _ TO THE ASS.GNL•-S CF 11iE LENDING INSTI. TOTADDITII+ONALI INS1SA,16 NOT IiUTIONS OR SUBSEOUELNT , I I Iv. 4C r I OWNERS. — AML= NDEG APz, l8, 1977 i. Li'IJL � E AMENDED .SAN. 19. 1973 O��F S�UryO Southold Town Hall Annex �Q 54375 Route 25,P.O. Box 1179 EDWARD FORRESTER 411 Southold,New York 11971-0959 DIRECTOR OF CODE ENFORCEMENT Telephone(631) 765-1939 Facsimile(631) 765-6639 e-mail: ed.forrester@town.southold.ny.us TOWN OF SOUTHOLD March 10, 2008 Richard Abatelli PO Box 517 Southold NY 11971 Re; Property at 1915 Lake Drive Southold SCTM# 1000-59-5-5 Dear Mr. Abatelli, Please be advised that the Building Department has forwarded your file to this office for enforcement action. Letters have been sent requesting you obtain a C.O. for the work that was performed under expired permit#27253. It is a violation to use a building without a valid C.O. issued by the Building Department Please take the steps necessary to remedy this violation. Thank you for your anticipated cooperation. Sincerely, Edward Forres r Director of Code Enforcement cc: Building Department �o,*pF SO!/r,�ol 0 Town Hall,53095 Main Road Fax(631)765-9502 P.O.Box 1179 G • 0 Telephone(631)765-1802 Southold,New York 11971-0959 '%O < cou TY,� BUILDING DEPARTMENT TOWN OF SOUTHOLD September 25th, 2007 Richard W. Abatelli P.O. Box 517 Southold,N.Y. 11971 RE: 1915 Lake Dr. (Addition/Alteration) FINAL NOTICE SCTM# 59 5 5 Dear Mr. Abatelli, Please be advised that your Building Permit#27253 issued April 19th, 2001 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit,please submit a fee of 478.00; at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. *pF SO�l�olo Town Hall,53095 Main Road Fax(631)765-9502 P.O. Box 1179 G • Q Telephone(631)765-1802 Southold.New York 11971-0959 o, coU BUILDING DEPARTMENT TOWN OF SOUTHOLD January 23rd, 2007 Richard W. Abatelli P.O. Box 517 Southold,N.Y. 11971 RE: 1915 Lake Dr. (addition/alteration) 2nd NOTICE SCTM# 59 5 5 Dear Mr. Abatelli, Please be advised that your Building Permit#27253 issued April 19th, 2001 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit,please submit a fee of$478.00 that time we can schedule an inspection by one of our Building Inspector's. If you have any questions,please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. pF SOUr,�ol 0 Town Hall,53095 Main Road Fax(631)765-9502 P.O.Box 1179 G Q Telephone(631)765-1802 Southold,New York 11971-0959 '.2► �� Cow,� BUILDING DEPARTMENT TOWN OF SOUTHOLD June 20th 2006 Richard W. Abatelli P.O. Box 517 Southold,N.Y. 11971 RE: 1915 Lake Dr. SCTM# 059 0005 005 Dear Mr. Abatelli, Please be advised that your Building Permit#27253 issued April 19th, 2001 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of$478.00 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions,please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. � r ho�,�oF so�lyo <o Town Hall Annex Telephone(631)765-1802 54375 Main Road y� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD March 15th, 2010 Richard Abatelli P.O. Box 517 Southold, N.Y. 11971 RE: 1915 Lake give SCTM: # 1000-59.-5-5 To Whom It May Concern: It has come to our attention that you have not started construction on your Building Permit # 27253. We will be voiding said permit. If you choose to renew your Building Permit, please send a check made out to Southold Town in the amount of $806.00 upon receipt of this letter. Any questions please call 631-765-1802 Respectfully, Southold Town Building Department 4 583 b23b ?�08 1830 �� 2 s2 BUILDING PERMIT REVIEW CHECK LIST DATE REVIEWED: ///so /oo APPLICANT NAME: `�, DATE SUBMITTED: I /ao SCTM#--- DISTRICT: 1,000 SECTION: .Sq BLOCK: S LOT: PROJECT LOCATION STREET: 19 Y.S 4A-Ke Ar?vc CITY: .At_r_Adzw SUBDIV. NAME: ARCHITECT/ENGINEER: /3Ace-_ FAST TRACK: oR N0 SINGLE& SEPARATE CERTIFICATION-REQUIRED: YES oN NOTES: sT•-e ZONING: PERMIT MATE AMOUNT:-$—*dK .00 ZONING DISTRICT:(R4fl R80 AC CONFORMING: YES 00 REQUIRED LOT SIZE: 401< SQFT. WHERE ACTUAL LOT SIZE FRO AX c <9,4c,. ACTUAL LOT SIZE: SQFT. REQUIRED —REQUIRED REQUIRED FRONT:'PROPOSED:d2,0 ' SIDE YD: /-< $s PROPOSEDA3 '/3' REAR:SB 'PROPOSEDAl ' LOT COVERAGE: ALLOWED: ,20 _% EXISTING: sf % NEW: sf % TOTAL:.24gsf.;> % CORNER? YE R NO WAT ER FRONT? E R NO DESCRIPTION: LOTS 40,000SF --100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger. (A nonconforming at any time after July 1, 1983.) PROJECT DESCRIPTION AD ALT ACC OR N/D: 9JJ f7##, C AGENCY PERMITS REQUIRED FOR REVIEW NEEDED TOWN SPETIC PERMIT: YES or NO 3/'x0 ,1pr< ly q e,.x c. re - r..f. SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): DTE:_/_/_ PERMIT#:R10- NEW YORK STATE DEC: PRE-DE 9/1/7 r NO -4JB&�oy68-7 000 ,•fir goo' SOUTHOLD TOWN TRUSTEES: or N 4 co jqr- 2ZI TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES or O FLOOD COMPLIANCE ZONE: PRE-FIRM 3/18/80 PANEL #: fR FLOOD ZO :AAA NYS ENERGY: R NO : (,l=-fes EGRESS: VENT: LIGHT. NOTES: AgF'or s IS L� ./C'00, �Iris.if C [ .G• S ke dsox Or oa a,r FEE STRUCTURE: TOUNDATION: SF FIRST FLOOR SF 21 x tZ SECOND FLR : // SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE TOT( SF)-.( &!90 SF)= e*$.ee SF X$ •ZG =$ 3 '3:eo+$ 7 +$ /OU —$ ,Cls Gs ✓a � . 9705 Taj( i7�,p..� J/ ►7r+e%!%►rpJ t1�l V47 a 1 / / l/ fN/ Co DDS ATf.�a9/�� I 4r �so6r - Szx of >,�,.Q► �s$l�/ �s8t6 � -��x 6Z �►��/ �1 96F= 6 //�rj.��i� R va INSPECTION REPORT DATE satssssa:aasass=----sssm sasasas u a-=�*ry,.�+ saasaa--aassmaa=a=aaa CNTSaaaa=aaaxaaaxaasaa FOUNDATION ( I STY 1 N j N -- H y FOUNDATION (21RD) _ sarsaa¢asa:asasxsasaasa a..aa=am�aacs=_=aaaaz===-aas---a==a=-a�rsaaaeaaasaaaaaaa ---sa I n PIN ROUGH FRAME &PLUMING Ii i a:::sass:aaasssssaaaa ass----aasasa=------aasaaa----amsx aaA=---- ti INSULATION PER N. Y. ! !: H STATE ENERGY CODE I In. a sasses:axes-----�----ax=ssa=s M db H n u FINAL asaaasasaatsss:aass��sasa� assess aaaaassasaaaaasa ADDITIONAL COMMENTS: avasssasassaaaaaa:assess----ss-asaDasaassa aaaaa -- aaaaas ! v C r� O b r i APPLICATION _ PAGE 1 o( 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1 GENERAL PROVISIONS (APPLICANT to read and sienl: 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re=issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. S. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL S MENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO BEST F KNOWLEDGE,'TRUE AND ACCURATE. (APPLICANTS SIGNATURE) DATE y yy�20l SECTION 2• PROPOSED DEVELOPMENT (Tb be completed by APPLICAN n NAME ADDRESS �— APPLI /c ✓ / s" l6J zl'1�1D BUILDER ENGINEER PROJECT LOCATION: • To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. 'A sketch attached to this application showing the project location would be helpful. /dov /.S Ao-1L do,,e-c FDP(93) �v APPLICATION f a PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE O New Structure Z-Residential (1-4 Family) %.Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofing? O Yes) ❑ Relocation O Combined Use (Residential & Commercial) ❑ Demolition F ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECTS 0 1,000 'au B. OTHER DEVELOPMENT ACTIVITIES: O Fill ❑ Mining O Drilling O Grading O Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) O Road, Street or1lage Construction O Subdivision (New or Expansion) O Individual. Water or'Se jer System O Other (Please Specify)' After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADNIINISTRATOR) The proposed development is located on FIRM Panel No. . Dated The Proposed Development- 0 Is NM located in a Special Flood Hazard Area (Notify the appGeant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMrr IS REQUIRED)- O Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site ii: Ft. NGVD (MSL) O Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated O See Section 4 for additional instructions. SIGNED DATE APPLICATION �! .• PAGE 3OF4 SECTION 4 ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: O A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development_ ❑Development plans,drawn to scale, and specifications, including where applicable:details for anchoring structures, proposed elevation of lowest floor(including basement), types of water resistant materials used below the Furst floor,details of floodproofmg of utilities located below the first floor and details of enclosures below the first floor. Also ❑Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential only) Ft.•NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result inany increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5 PERMIT DETERMINATION M be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity.A.O Is B.O Is not in conformance with provisions of Local Law , 19 . The permit is issued subject to this conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX Bis checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. i APPLICATION W PAGE a OF a APPEAIS: Appealed to Board of Appeals? O Yes O No Hearing date: Appeals Board Decision --- Approved? O Yes O No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement(in Coastal High Hazard ea , bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is Fr. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7:7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? OYES ❑ NO DATE BY DEFICIENCIES? OYES ❑ NO DATE BY DEFICIENCIES? OYES ONO SECTION 8 CERTIFICATE OF COMPLIANCEM be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: ti Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area f � TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIA-L FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 . AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) BOARD OF HEALTH _ O 3 SETS OFLANS . . �fx.:: ,o_,;� FORM NO. 1 . .. .. . . . . . .. . . . . . . . . . - E TONIN OF SOUTHOLD SURVEY rf #' BUILDING DEPARTMENT CHECK BAR y.•• ••. •• • .. SEPTIC FO �� !�f >�� $ �.�:�.� TOIIN HALL DEC * . ...... ........... Li ! SOUTHOLD, N.Y. 11971 TEL: 765-1802 TRUSTEES �• ..•p.••••••- BLDG. DEPT. NOTIFY:. . I.S .T QVN F S UTHOLD CALL . MAIL TO:— • . . . Examined...!Y/ZA. ....., 211.44. .... Approvea...�,�1�. ......., ..............Permit No.?—ZS3 .... ................................... Disapproveda/c .................................. ............................................... . (Building Inspector). APPLICATION FOR BUILDING PERMIT Date.9 1)N?-. . .I . .., INSTRUCTIONS a. 1 1 lis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and o .to adjoining premises or public f buildings on premises, relationship streets or areas, and giving a detailed description of layout of property must be drawn an the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. applicant- Such / d. Upon approval of this application, the Building Inspector will issue a Building Permit to the app permit shall be.kept on the premises available for inspection thra>ghout the work. e• No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of (�ccipany ahall have been granted by the Building Inspector. t for the issuance of a Building Permit pursuant to the APPLICATION IS HE�BY)!� to the Building Departmen applicable Laws, Ordinances or Building Zane Ordinance of the Town of Southold, Suffolk Carty, New York, and other app for removal or demolition, as herein Regulations, for the constriction of buildings, additions or alterations, or described. the applicant agrees and to comply with all applicable laws, ordinances, build' code, Dousing regulations, and to admit authorized inspectors an premises and in buildi for nary 'nspections. •(Sigq0&we.of•applicant,•or•name,•if•a corporation) 7 jo U. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,'general contractor, electrician, plumber or builde- ............CtrN:2Y........ ..........ff.,,.,,......//................................................................... r of premises .... ........................................................ Name of owner (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) BuildersLicense No. ......................... PlumbersLicense No. ......................... Electricians License No. ..................... OtherTrade's License No. .................... I. Location of land on which proposed work will be done............................................................. ................... ..................... eri v� .................... U.u. P./. ........................ ............... Haml House Number Street (� County Tax Nap No. 1000 Section ....... ...... Block ............... Lot ......r...... Subdivision Filed Map No. ............... Lot ............... (Name) 2. State eadsting use and occupancy of •ses and intended use and occupancy of proposed construction: �G /�... .................................... a. Existing use and ocwpancy ........ :�-...�• << ..� �(`' 1 b. Intended use and occupancy ........ 1�� t--- ►?��... �'m/e r�..................................... x ` 3. Nature of Work (c3teck whid� applicable): New Building .......... Addition .......... Alteration Repair ............ Removal ............. Demolition ............ Other Work _ ........... . (Description) 4. Estimated Cost ... ..i.................. fee ....................................:......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....�....... Number of dwelling units on each floor ................ Ifgarage, number of cars ................1..................... 6. If business, commercial or mixed occupancy, specify nature ``and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front... '40-+/...... Rear q041--/..... Depth ....... . .... Height .............1........... Number of Stories .......j............. . // Mot/ Dimensions of tame strycture with alterations or additions: Front ........gotl . Rear .,T of(: ....... Depth ..RT f 10. Height �1.......l1.7........�.. Number of Stories ...f/.�....... 8. Dimensions of entire new construction: Front .�11............ Rear .92t.......... Depth �1.�'�•/� �� Height ...........1..,./.a......... Nu beer of Stories ......1.............. �� 9. Size of lot: Front l T GC3?q:�p�l�7.6() .. Rear .....�Q�'s'...._�j Depth /W.9P 'f..... 10. Date of Purchase ...�.� ........ Name of cornier Owner S!`•LM,4.... 4 S: ................ II. Zone or use district in which premises are situated ......... i?.............................................. . 12. Does proposed construction violate any zoning law, ordinance or regulation: .....'rQ............... 13. Will lot be regraded .......MO......... Will excess fill be removed from premises: YES ND 14. Names of Amer of premises 1G�:4Y �(/,4.40- ��....... Address Not:J/7 jU � 1� yyf �/ n.� .. ..,.. ./?ZQ ane No.7�/J........ .- Name of Architect .....4.-W ..,11.Ac;;............... Address AM��Q�u�t10f�II1lW�l�.rPhone No.�td��Z�. Name of Contractor ................................... Address ...............................Phone No. ............. 15. Is this property within 300 feet of a tidal wetland? * YES .1 ...... *IF YES, SQ11IM MM MMWS PERMIT MAY BE WPM. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show, street names and indicate whether interior or corner lot. L 4KC as R, V /91S111q-ke- LJ 7116 f�Tix�/ago-S9-S� L ,.r —S'd v Tr'U,L � 6-rc •(tet- �d�� urr�S� � � kAyt, n,� 3 W(a SrA1r OF NDW YaRK, SS aoum or, .—SUFFOLK.......... .............. . .R.LCHMCL.1N..A6ATFLJ�Jo ..............being duly sworn, deposes and says that he is the applicant (Nameofindividual signing contract) above named, lieis the ..................................:.............................. (Contractor, agent, corporate 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 true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...........$.t b....day of ...J.0 n e ......:?0.0 d... Notary Public .......... JANEI-LATLEY ( ignature of Applicant)............. Notary Public,State of New York No.52-4665418,Suffolk County Commission Expires Dec.31,OM IN