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HomeMy WebLinkAbout1000-125.-1-19.2 LDY Qa FORM NO. 3 NOTICE OF DISAPPROVAL DATE: August 14, 2009 TO: Eastern Long Island Hospital C/O FPM Group 909 Marconi Ave. ' Ronkonkoma, NY 11779 Please take notice that your application dated July 21, 2009, !,' - For permit to construct alterations and addition: 2009 AUG ' Location of property: 6355 Main Rd., Mattituck - County Tax Map No. 1000 - Section 125 Bloch 1 Lot 19.2 Is returned herewith and disapproved on the follgwi, grS'und The proposed Sober House/Convalescent Home is not a permitted use in the General Business (B) District. The proposed alterations and addition is not permitted, pursuant to Article XXIII, Section 280-123 (A) (1) (b), "nothing in this article shall be deemed to prevent the remodeling, reconstruction or enlargement of a nonconforming or conforming non residential building with a nonconforming use or construction of an addition to existing building(s) or additional building on the premises, so long as said increase in size of the building(s) created by enlargement of the existing buildings or structures or by the construction of a new and separate building or structure does not result in an increase in the overall building footprint(s) of more than 30%, except that said increase shall not exceed the applicable maximum lot coverage, and all other setback and area requirements shall apply, provided that the following sire remediation measures, in full or in part, as shall be determined by the Planning Board within its sole discretion, are included as essential element of the aforesaid expansion:... The proposed use requires site plan approval from the Southold Town Planning Board. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, ZBA, Planning Board • TOWN OF SOUTHOLD • BUILDING PERIOAPPLICATION CHECKLIST p BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined ,20 Storm-Water Assessment Form Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration �}�] 20� nc 1 J�'_ O9 Dl 0 v Building Inspector q�l_G 1,L DS JUL 2 , 2009 APPLICATION FOR BUILDING PERMIT �^ Date 3uw (.0f4. ,20 6c1 INSTRUCTIONS BLDG.DEPT. TOWNWssowtifetign MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plant .Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall 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 purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit p rsuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other .plicable Laws,Ord' •nces or Regulations,for the construction of buildings,additions,or alterations or for remov,fl or.- olition as herein d; 'bed.The applicant agrees to comply with all applicable laws,ordinances,building code . .ing ode,and r._ a i ins, • . o admit authorized inspectors on premises and in building for necessary inspections. 1 ,Ail A. t _ (Signa a of applies t or name,if a co.:.C .n) °i0°1 14 r —e,r41 AVE, KO N✓-OtMA,►JY I 111 (Mailing address of applicant) State whether applica t is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder i � eCX C-*tGI n1EE(L 11 1c Name of owner of premises •Cf.I2-N �ts1 G. `st.At4 A- TTL (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer C62,v5TOPPE . S---1a Wes 2Z, PE (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 6,'355 NIA 04 12-0 AC) I-IA"IT!-1'UC.I. House Number Street Hamlet County Tax Map No. 1000 Section 12.5 Block .j Lot Vt.Z Subdivision Filed Map No. Lot r • • 2. State existing use and occupancy of premises and intended use d occupancy of proposed c struction: a. Existing use and occupancy jgri.12_ 4-11. 0s E Copy VAU"'-'-F:r4 T or-i b. Intended use and occupancy op ' 1-‘otsc ( &,t-I,vAcesc&.NT 43!'•1F 3. Nature of work(check which applicable):New Building ✓ Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 4, 1 •3.5 Y4 Fee 4.50 (To be paid on filing this application) 5. If dwelling,number of dwelling units N/A Number of dwelling units on each floor IVA If garage, number of cars NA 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. C_Co4VA ^ T t.qE 7. Dimensions of existing structures,if any:Front 6t.0` Rear 6 2.0 Depth ei S S.O' Height 18 .CI‘ Number of Stories_J Dimensions of same structure with alterations or additions: Front 60.01 Rear 6 0.. Ot Depth R3- at Height 33.& Number of Stories y • 8. Dimensions of ent4 new construction:Front 60. 01 Rear 60. 0' Depth 93.D' Height 35.0 Number of Stories 2. 9. Size of lot:Front 156.71 1 Rear 151.72 Depth 25/.Off, 10.Date of Purchase �/1/B CI Name of Former Owner 1/t ou-r i j. li 12T.5GH 11.Zone or use district in which premises are situated '.. i5"cFLtGT - I:5 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO ✓ 13.Will lot be re-graded?YES NO/Will excess fill be removed from premises?YES NO Eossream Lot-16 64- No $1t-0. 4Z2isoM! MI. 14.Names of Owner of premises aOSP l int. Address Qw ri.2 '4Y Phone No. 631-36/^65.14 6 Name of Architect PM C' 909 `ij tt r'Z' itlot)pi LTP Address Phone No 631-737- 4Zr)0 Name of Contractor Address Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO ✓ *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO ✓ *IF YES,PROVIDE A COPY. M5 STATE OF NEW YORK) y SS: COUNTY 0 ij/, N CO >2 N g C'hr,s lop her hi.o c i I va`L being duly sworn,deposes and says that(s)he is the applicant a) s,•' (Name of individual signing contract)above named, 0� 0 W -) (S)He is the g`] /nee/- (Contractor,Agent,Corporate Officer,etc.) coo-EL o x of said owner or owners,and is duly authorized to perform or have performed the said irk and to make an• fi e this application; o Z t17 that all statements contained in this application are true to the best of his knowledge a . H elief;and that the o k will be u p O performed in the manner set forth in the application filed therewith. J d 9, i Swop't before menthis►'- v'' c m rn E w- day of u u/ 20 c9 CD z a 0 t-t/tZt oY• =e iA Notary Public 111111.'igna ,e of App:cant / i` HEDGE (TYP.) - '\::::.:-...-\- SITE ANALYSIS - DISTRICT ' B' S.-',r.r`r.., `\ 0,. EXISTING MIN/MAX PROPOSED - `:- ;. LOT AREA 32,819.0SF 30,000.0SF 32,819.0SF •- ` - ` - = ;\\ (±0.75AC) (±0.68AC) (±0.75AC) r.4 r r ;\ LOT COVERAGE 7.84% INCL ACC. 25% INCL. ACC. 14.57% ' rr . •-:.'t ,. (2,576.0SF) (8,204.8SF) (4,784.0SF) , • .--' ' Y-` cP , FRONT YARD 40.0' 30.0'(AvG FY) 40.0' 7, • SIDE YARD 41 .4'/88'(ACG) 25'/50'(ACC) 37.6'/80.3'(ACC) f/' i REAR YARD 123.9' 35.0' 72.9' LANDSCAPE AREA 71 .91 % 30% 52.89% (23,620.0SF) (9,845.7SF) (17,359.5SF) PROF • BUILDING HEIGHT ' 1_ 35.0'(2Y� sTY) 33.0' 2—sTY SCALE: 1 20.0 ( sTY) ( ) • \ l • • s h � \• •';i Ul / - Ayr °•► • i� ".'. / " . " " - *A*\ PROP. 6'-0., PROP. 6'-0"H CHAIN • "`.`• ", .`"` WHITE OAK (TYP•) LINK FENCE (TYP) � +` • . .a. . •`+ . ".� ` `PROP. SEEDED "- - • --, \4' \ •��►` • -,AREA (TYP•) 7 •` - ► —0"H EASTERN RED CEDAR .v�.4 "'. . " " / " - :►i u■ . . • . • - - • • • A \�'�► PROP. PAVED i ,�" ?° O,r , ��\ PARKING AREA so.". i ° \ 4 \�:► PROP. 6'-0"H CHAIN . . . . . . ."""••`" -- `---�. :IIII/IIIiii;,c#® 0 I!�` ��� LINK FENCE (TYP) EX. CONC. CURB TO• �`. • ." ."•"• . ; � .. ►.: ° p ',► • 'll 1 �. .►�� BE REMOVED (TYP.) A. • . . 11 COiIC PAVERS .\_\, '.. ...4:14.*:*:*:*;.* * , 4,4..6%, 7 IP ' .: Ate ( P.) ..:,,,,..:::::-.,;:e.s!"--t..:t.4.-''''+11.4.:t'ittlitit,.\ ..:::‘.:\•*1\-„.\ ' : '(2.'s.-'1-4)7: ,‘ ' '4*. *.P.. • \ -.•y*.**. t,,,._ 4,,(0/, , , ,/:•t-4"Sol•110‘rs,41,44 Ittitt •.;4\ , ‘‘.I.I f.:;,,• • ok. isito •� �V1•4•4 V■� VVA r�V' ��•'��1■ .ff � 0� .c . 0•4 • 0♦ � t*N 0tst`t a.st:+ ', .gtse • p t%.44.41, - t %` t • ' �`,p4� o. , •' � 4,1 O`*, • ', `` ` • �� • / " �,� ��` O . •`. N.\C`o`sta,, ., ` RE / • /4\illik - - • - - - . 'ts,e, \:,‘, • ..- / „„, ir , # IP. FOUR SEASON .".•.`••• ;\ `.` P-� —STORY \ �� •'-; •`."•"•`.". WERING ANNUALS/ ' ••:►�••••• .�. ,I�� \ :;• • , � • �ILDINGA � � :••;ENNIALS MIX • •-. . . • - - I •." ". ••)P. CONC . . .;: a, 0 �\ i i9• • � - . ', „ `DP. ILEX CRENATA +I •\ , �` - `DGE (TYP.) . . . • \\1 • . .. . ,1. • • • • \ '\*1,%; • •.** . .. ,. •/c * X PROPOSED • . •:�.` .`. . `" • . • : . . • • . . j (±0.75AC) „A . • o • - 8AC) ••-. • •. t I�,, ••• .•••:.::..`' / PROP.• INCL. ACC. 14.57% •. . `c\ ` . ‘:. - ''' LANDSI 4.8SF) �6' \ `-"- ,jl,: x \ EX. SE RECON eN AVG FY ?, -." .,:1 1g o �(�� VEGET� '( ) 40.0' 1 S 0 vg!•C 0° /50 (AGG) 37.6 /80.3 (A ) ci- 0' 72.9' 7 52.89% SITE PLAN - OASAS/ELI (17,359.5SF) PROPOSED 45.7SF) SCALE: 1" = 20'-0" .0'(2 STY) 33.0'(2—s ) • • • FOR INTERNAL USE ONLY { i SITE PLAN USE DETERMINATION Initial Determination Date: '7 /30 / O 9 it. Date Sent: —7 t 30 / d Project Name: E L____ 1 Project Address: 63 3---...c- / Y I Q,,,Jed MaM i.1. `(__ Suffolk County Tax Map No.:1000- /c ` 1 / - / • Zoning District: C3 Request:D n SS r 4-- YuLLo So b e y, u S-e_7 Con va (esck tki (`,`a, e •s \?-1 - (Note: Copy of Building Permit Application and supporting documentation as to proposed use or uses should be submitted.) . Initial Determination as to whether use is permitted: _ 5 f)0,-[ 0.__ sZ.-f v\- U S Q_ ∎ .-e. z v-1-ey a I .e k J,n e s 5 C6 ",s f v)'c+ Initial Determination as to whether site plan is required:_b a/ Sc4- a2�(�- I a 3 CA > ( i ) (b) y P 5 5iAC .19.-7 re o;ft° -, a-' C84- Signature of Building Inspector Planning Department (P.D.) Referral: P.D. Date Received: / :50/ 0 y Date of Comment: / I) / 0? Comments: ?)440in,L17j717 31 - c a �-e S ` A AdfccJ O ,JG -)X-3 t)(/ 6 �-h�►� Si. A 7) ;.5 f21tecv 4"S 1/ a S C)�� Z 8 A 4 h-e Esc . U i :.....4.) ri-z-%-t--, _ ,. Signature of Plan ngDept. Staff Reviewer t Final Determination �' � � V , Date: / / JUL 3 0 2009 ; ._: I 9. . Decision: `�-�-- , ,w ..a....} . 1'i?.. FW4S,;) Sianature of Building Inspector • • - FORM NO. a 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) N9 16400 Z Date , 19 7 Permission is hereby granted to: (-71-4941' ..:i/ (74-1211?:217:1S a"--P-Cuite • SE:: \-Q4.41;5 ..)7= NI... ,i/.714 Gletige‘, ceea ,A-1"/Soil- %,.. a--3 ckilfee44 2rit• at premises located at ..b.:x�S‘ C l i ci^"" Zel ' -- oi-4-4-4-4-14 j) 9 County Tax Map No. 1000 Sec '• .../ � Block ( 1 Lot No. J t ' 2'-- pursuant to application dated 5 A-4-1107- -p� / f , 19...7., and approved by the Building Inspector. � ' ^ Fee $ i`: g 4 l Building Inspector Rev. 6/30/80 FIELD INSPECTION - 'DATE i COMMENTS b j — R m - H FOUNDATION ( 1st) w , _ ' CP FOUNDATION ( 2nd ) ' T_ - - ('-?)1 r; 2. 2 / _ .-2/42-- ativj _ o E- b. R 0UGH FRAME iG-r 't -- 4 7' v) PLUMBING vi 3- 3. _ Z r� INSULATION PER N . Y . H STATE ENERGY Q CODE " . . x 4 . Y3 .t FINAL Pk 0 .--- I -?. r ADDITIONAL COMMENTS: w X 01 / 7 . : : , _ , 01... , x _ ro paa H ..... d &'m V �- 1.71 8ii‘4111) AD e. ) `. Ig 3 H ob i _ • t r3 . x d rn -n H ■ . ,g `'_-1 1'� d HP 1 !Zw 1 1 yy+ . • rE'A2 Don 2 '_" • � I ..... 6f1 c`L�y.' iul re ..I`) 2 T 1.x / [ Mq,r — - c ) _ t cLo • i /?9x /s_• -, .2/ " To DCO t. H i ;/-(dlT- T � �°�' I-R r ' A4' 'g , f-x io '4 { , ,. � ttiAiriN( moo M 7 Y .._ __ -� �� i � / •EX r w •Z . s ` ' S., c>/, .(/i t'. °v d '/ ' W,r / /yvc4 /a Ja /o L &1O5X• a • 4 C ki) ;• 4)/1.ers/.3 )0 mit4Lo ../4 ,i, ±f° Jetc. . 7X//'/ - - 4'M vc /5,2 47-.1's S ✓Z . ._... .....__-----_._..... ._ _ r N.6"4./ .vmo,e ocJAy G°e/.: i A/A://S A 4.7-",J 5 • , 0'f/cc 7-I. Tit r /3 R o)( 4a� /mrrtaZ At ,74 /� y • �� r ; AA IA/ p4,55 : Tt1R(1 1A1/ht-aO+V Ct0• 1 .1- 1, fl , S 1 - . • " . • - i l rn IC:tae.1 km‘ 001?N AIS\WV\V"`��� ,gyp .' ..E� �s..,iqA. r fr oy , kdO‘ . \itil 1°\C 7t1C) . _ CW 0_ `91C1)1k)?!N Ar c A 4 1 ,_, i S A 1 i f ! � , • ` o. 1- 20'-0"-m aas oa nori --- • a F- - `tar..--tsovt:- Q •arc te.v c ; , #W- t o • - , uszr04-a ;i ' APPROVED AS NOTED • • � �:�,__.-.-..,..__ _4 r(01+Ub oTtvy F • i uik.GiNG 8DEPARTIVICEO ET AT • ' 165-180/. 9 AM TO 4 PM FOR THE . . FOLLOWING INSPECTIONS; • FOUi4 C1/41O TWO rif.OlitHED ' • OOP POURED;' i..ONCP: 'IF. • _ ' RUUGr+ .•Pzuhly9t 5 •At PLUMBING • . IN OLA•Ci>*+? . i ..A. FINAL t.teaiSTRtiC Y zOti MUST' ' -a i,otoPit t FOR C.O. . k k.t. ts2,4 i.0u& irtOfti StiAtt. 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Av1ATT/TUCAC . 1772 W 474"� ,N/ G7-- 5pL/7'H34- 9 J'C'L/ _A -, . ,.�y LIE. NO. 47401 516.475-0349• - / LIG• NO. 19 =YED://-5--7G U.C. -2-22'2 . aNTEED TO: %N/:-'<J.>CJ 7/.7-‘_E /n�.5• Cc.'>. f'/G-,A7 - yiT!F pi✓. /nl.4L.—TC'>-77 -.:4r0.. _ . FILE NO 7. —C.;`-9j•I- NO /�J TITLE NO • ,0 TITLE INSURANCE •COMPANY 6 THI_ uI. I.uN Ol (516) - 727-4455 ;ECTION 72.. t+-w YORK STATE �f ' / / % .LICAT IUN _ /I 'I/Y-i Ip1E5 uF Yr ..,,,,,1,-.E.0, •IJ�-.E:' NOT BEARING .17E LAND Sul. :l k,� Y EO SEAL SR rISOSSEI:.SST,. •�I• NE CL:IU S10EREU Sii) l R A EKS,uARANTE ES IN •HER.:ON SHALL RUN ILY TD .V`IUN 1NSLIRV E,PR•EPARE.T. A . •1.G 3EHALI TO THE /'S nom) I ILE COM1•AN is N•�EN At AI+ENCY AN• C' �• /J RL/�{(•/ =NOI NG IN:'f . . . I-IO'TED HEH'�ON, AND C,-( U C B /Q RAIL ID THE AS:. iN.. i,-.: L ND,NO INSTI- `G�A/ -j IuTION. GUA..A1, .1+E PUT TRANSF ERABL( • N� 1O AOOITION"L •• - nu SUBSEOUEN7 Q OWNERS. LW AY= . 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Y. �ESC.Z/BEO F'ROF7.; •� .1f. .' . .•• 11772 ON Ai1/-.1TT/TCJCK, ✓\\11 o •• -'- -../ . .: .a.-.. .:ij• _- r-!. -- . ..W 474" e ` k..,,, �/� LIC. NO. 47401 516.475-0349• v G>c �Ot�Ts/OC—o SU �- `sW')! Loc. tJ0• J19JC "Y ED://—S-7lo 4./".•:=-2-.2.2 7. 7 -NI'I-.ED To- . f/<.xle:33C? !-/r._ „,/../.!-;-. C -c'> -/G-,ME 7/77' ri/✓. Fin/gG-7- -77 .-N , —7/2—,----..',..-7)..-"L �•,.- ca �c..��j`�IJ;�.R,T i.. ' • BOARD OF HEAL. • .. .. 3 SETS OF PLA ..-..pp..,.:��..�:_.,:..........:. �I FORM SURVEY f*J6 4 981 E i ! TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM • DE-pr.G . "- r TOWN HALL NOTIFY TOWN OF SOMMED I SOUTHOLD,N.Y. 11971 TEL.:765-1802 CALL MAIL TO: Examined 0-4.4 4 -.0' a4, 19'&.7 ` or Approved :ur!r�, 1913.Permit No � �"4, Disapproved a/c � 2\1 \11 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..August .14,. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issued a Building Permit to the applicant. Such permit shall 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 purpose whatever until a Certificate 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 applicable Laws,Ordinances or Regulations, for the construction of buildings,additions or alterations,or for removal or demolition,as herein described. The applicant agrees to comply with all applicable laws,ordinances, building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. Richard Saetta.,, General, Contractor,,,Ipc,..,,,, (Signature of applicant,or name,if a corporation) 4 Bootleg, Alley.,, Greeppprt,,_ NY., .1.1944 (Mailing address of applicant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premises .Eastern, Long. Island, Hospital. , ,,. .._, , • ,, ,,, ,, , ... ...... .. ...... .. ... ... (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer. Vice-President (Name and title of corporate officer) • ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. 1308681 Plumber's License No. N/A Electrician's License No. N/A Other Trade's License No. N/A 1. Location of land on which proposed work will be done. 6355 Route 25 (Main Road) , Mattituck - House Number Street Hamlet County Tax Map No. 1000 Section 12.E Block /y Lot. . . .t /..2. ... .. . Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Blood Collection Station for E.L.I. Hospital b.Intended use and occupancy Same 3. Nature of work(check which applicable):•Building Addition Alt n X , .Repail Removal Demolition Other Wor (Description) 4. Estimated Cost $7,000 Fee ' (to be paid on filing this application) S. If dwelling,number of dwelling units Number of dwelling units:on each floor If garage,number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use 7. Dimensions of existing structures,if any: Front Rear Depth Height Number of Stories Dimensions•of same structure with alterations or additions: Front Rear Depth Height Number of tories S. Dimensions of entire new construction: Front • Rear i Depth Height Number of Stories 9. Size of lot: Front ,t., �J Rear Depth 1 Date of Purchase ;. .� .q g�7 Name of Former Owner �.g.ff tz.-TS'Gh 1 Zone or use district in which premises are situated. ;1 I 12. Does proposed construction violate any zoning law,ordinance or regulation: 13. Will lot be regraded No Will excess fill be removed f rom premises: Yes XNo l4. Name of Owner of premises tL.I..} I tal.,,,Address Manor Place, Gr en a No.477-1000 Name of Architect Address Phone No. Bo6fie"A Ie 'i" Name of Contractor R t.Saetta,Gen..Contr., Inc Address seeripost,.NY..11944Phone No.477-1633 15. Is this property located within 300 feet of a tidal wetland? *Yes! No ...$. *If yes, Southold Town Trustees Permit may be required. • PLOT DIAGRAM I Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from )roperty lines.Give street and block number or description according to deed,and show',street names and indicate whether nterior or corner lot. See Attached ■ . PATE OF NEW YORK, '-OUNTY OF..Suttolk S.S Robert Saetta being duly sworn,deposes and says that he is the applicant . (Name of individual signing contract) bove named. le is the . . ...General,Cop,tractor, Vice—President (Contractor,agent,corporate officer,etc.) i f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication;that all statements contained in this application are true to the best of his knowledge and belief;and that the fork will be performed in the manner set forth in the application filed therewith. worn to before me this 14th day of August , 19 87. lotary Public, .13 .„, .\,3, s. . ..'.. Q :3'\.., County vi ra �.` ' a BEVERLY k BROWS i 0 Notary Public,State of NOV 1t•k ■ No.4734549 lCon�r i (Signature of applicant) _ Ezphgq rt _fib