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28987-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29128 Date: 12/17/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 8415 SKUNK LA CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 104 Block 3 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 6, 2002 pursuant to which Building Permit No. 28987-Z dated DECEMBER 6, 2002 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 ONE CAR GARAGE AS APPLIED FOR. The certificate is issued to RICHARD JERSEY & WF (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 835197 10/01/87 PLUMBERS CERTIFICATION DATED N/A /V. "'/t 9 y 111kut riz d Signature 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. 28987 Z Date DECEMBER 6, 2002 Permission is hereby granted to: RICHARD JERSEY 8415 SKUNK LANE CUTCHOGUE,NY 11935 for . CONSTRUCTION OF AN ACCESSORY GARAGE AS APPLIED FOR; THIS REPLACES PMT #161492 . at premises located at 8415 SKUNK LA CUTCHOGUE County Tax Map No. 473889 Section 104 Block 0003 Lot No. 011 pursuant to application dated DECEMBER 6, 2002 and approved by the Building Inspector to expire on JUNE 6, 2004 . Fee $ 75 . 00 Authorized Signature COPY Rev. 5/8/02 FORK NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUITHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 16149 z Date ........Im-eftX........Q3............... 19.1.7 Permission is hereby granted to: sa-d Q2 �� �4-&.................................................................. .................................................... .... ........W................ to ...... .... ............................................................................... ................................. ............................ ...-+.,.....***"**... at premises located at .33..q!o�...... ... ........ ........... ..................................................................... County Tax Map No. 1000 Section ..... ......... Block ......�.'A....... Lot No. .....1.)............... pursuant to application dated ... .................... 14.1, and approved by the Building Inspector. Fee $.A: ............... CDt...................................... Building Inspector Rev. 6/30/80 2UO2 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: 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 2/10 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 / Date. 12, /� _ (DZ New Construction: �/ Old or Pre-existing Building: (check one) Location of Property: $ g l 5 S U N K L,fltss E Cy TO A o G t.J E House No. —SSttreeet Hamlet Owner or Owners of Property, 1 C FE 6 RD —3J 625 E Suffolk County Tax Map No 1000, Section 10400 —Block—( O y Lot 3 —( j Subdivision Filed Map. Lot: Permit No. z$q $ '7 Date of Permit. ®21 Applicant: " (C 4{f..-A I' D .� t Health Dept. Approval: nderwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: v"' (check one) Fee Submitted: $ Ic: 63 D!(:2 A __ , 10001093 THE NEW YORK BOARD OF FIRE UNDERWRITERS F— BUREAU OF ELECTRICITY PD 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date October 1 1987 Application No.on file N V THIS CERTIFIES THAT 5058411687 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Richard Jereey,95A Bay Avenue,ptebogue,N.Y. in thefollowing location; ❑ Basement ❑ Ist Fl. IIJJ 2nd Fl. Garage Section Block Lot was examined on September 21 1987 and found to be in compliance with the requirements of this Board. NXTURE FIXTURIS RANGES COOKING DECKS 0VENS I DISH WASHERS EXHAUST FANS OUTLETSCUIS STCB1S INCANDESCENT[FLUORESCENT WVW AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P. 1 4 2 DRYERS FURNACE MOTORS FUTURE APPUANCE PEEDMRS SPECIAL REC'PT TIME CLOCKS FELL UNIT BEATERS NMTI.OUTLET DIMMERS AMT. K.W. OIL N.P. GAS N.P. AML NO. A.W.G. AMT. AMP. AMT: AMPS. TRANS. AMT. N.P. SYSTEMS AMT. WATTS NO.OF PEST SERVICE DIS<ANNW No.OF S E R V 1 C E AML AMP. TYPE 1 A�1N 1/3W 3 !3W 3 X 4W NO.ORt�COND. OFC W.0. NO.OF MI-tEG OF•MI•l Ci NO.OF NEUTRALS Of A.W. OTHER APPARATUS: Gary Dorski 425 Kofzrwsell Lane Lic#2941-E Cutchague,Mea York 11935 AGER Per This artificgte must not dhered in S+r!y Ctanner; return to the office of the Board if incorrect. InspectorsmQ be ident y it credentials. A., � OPY !"Q AUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT 8g.. TERED !N AFiY M INER. T wrw+•wr..... r• KP-ON— (9 gn N.874'01�20E, 11676 N� r` .. 2 z C( g o u Lil , f Li ru I ILj f ' a µ. .: o i Ao BAY A FNUE. 5CLr-- 40'=i" z OTIQCN PIPE r . ' 1&'' ►'lk MN��5 �F ?i.K� 7t,fN'iY.GL. RE '� ' A p Nle.II-AI . 1 ' " a MAP OF PROPEPT'Y ` • ' 7. 5uc2YE'YED Poz fi - X RrHA"DiHILARY JEZEY _. PT ` TITLE IPiZU"N COMPAW e0 -JUNE 114 1%8� P�C�:NIC i .r \AN TUYL SON MWN OF a�r� to 765-1802 BUILDING DEPT. INSPECTION [iellF, NDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: � DATE 7 INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU N [ ] FRAMING [ NAL [ ] FIREPLACE & CHIMNEY REMARKS: 114) DATE � INSPECTOR i Il H / y UNDATIC11 _ ( 1st✓)" I -- UtJDATIO;J ( 2nd ) m z 0 oco UGH FRAME & H PLUMBING H m SULATIOPI PER N . Y. y STATE ENERGY CODE x a I m H FINAL o . ADDITIONAL COMMENTS : m x X ^o H � N a H H � 2 e6 • r H d. m �v ' y BOARD OF HEALTH . . . . . . 3 SETS OF P-ANS - FORM NO. 1 SURVEY v TOWN OFSOUTHOLD CHECK - • - - - - - - - - BUILDING DEPARTMENT SEPTIC FORM . . - : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971c ��5 TEL.: 765-1802 CALL , p MAIL T0 : 1987 i/ `, a-1o.1 pproved AT Permit No.� 4�.1 .. isapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 2861 G Z N(lf I . . . . . . . . . . . . . . . . . . . . . . . . ` 11 IL (Building Inspector) APPLICATION FOR BUILDING PERMIT -7 Date . . �'.�. t1 . . . . . . . . ., 19�/. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 is 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 all 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 all 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 iilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or ion, as herein described. `ie applicant agrees to comply with all applicable laws, ordinances, building code, hous 'ng c e, and regulations, and to :mit authorized inspectors on premises and in building for necessary inspecti s. . . . . . . . . . . . . . .�Jz. . .. . . . . . . . . . . . . . . . '? (Signature of applicant, or name, if a corporation) �+e} 1111 Ttl.rY��+?� :�. . `�. � . ,t� . .71 . . . . . . . . . . (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 10 &Iut0. Cau -r�` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . arae of owner of premises . . ►� 1 eL7 ;�{ 1 1"'q�17 =�s�st_r 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE- SU FFOLK COUNTY LICENSED Builder's License No. . . .t.L9`1 . . 1.1-.1. . . . . . . . . . Plumber's License No. . . . . . . .Z�4f' . . . . . . . . . . . . . . I.Jectrician's License No. . . . . . . .OL.%4. . . . . . . . . . . . . . �= Otlici-Trade's License No. . . . . . . . .. . . . . . . . . . . . . Location of land on which proposed work will be done. `I �A`( Avg StcvwK La ��'-TciwaQ%.. . .(6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . . . Block . . . . 3. . . . . . . . . . . . Lot . . .�. . . . . . . . . . . . . . . Subdivision N65a J. .Fa.e-C!S. . . . . . . . . . . . . . . Filed Map No. . ,t�.�. 1 . . . . . . . Lot . . t� . . . . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: .r '!'!•`- `(.Ili-jt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. Existing use and occupancy . . . . .�. b. Intended use and occupancySA-"'`t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work A 4-:1%-'.A .Ci �-< (Descriplion) 4. Estimated Cost . . . . . . . . . . . . . . . . . . ` . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . .I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 df same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height Number of Stories . . . . . . . . . . . . . . . . . . ` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . I o '°. . . . . . . . . Rear . . . . . . . . . . . `I . . . . . . . . . Depth . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . ... . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: a . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . . . . !-? . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes --No 4. Name of Owner of premises`.`!^^•'. .TS`?` ��Jl. . . . Address .!�'�'f 14a.�'��c�'N4 ��phone No�3y"� fir '. . . . . . . Name of Architect . . . . .. — . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor '`` ^+� ""'�^- '�+. !!!l r.a-f�a..` Phone No.-) . . . . . . . . . . . . . . . . . . . . . . . . . . Address 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 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. —rA —T ;TATE OF NEW RK' S.S ;OUNTY OF . . G; . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ibove named. n ieis the . . . . . . . . . . . . . . . . . . .`�.� u �f i.� e. To . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) )f 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 vork will be performed in the manner set forth in the application filed therewith. worn to before me this . . . . . . .day of. . _ . .. 195�� lota ublic. . . . . . . . . . . . . . . . County / ��a� . . . . . . . . . . . . . . . . . . . . . . . . . . . . ELIZABETH ANN NEVILLE (Signature of applicant) Note ry Public,State of New York No.52-8125860,Suffolk Co Term Expires October 31, 120�4- BOARD OF HEALTH 3 SETS OF PLANS �C. . . FORM NO. 1 SURVEY . . . .. . . . . . . TOWN OFSOUTHOLD CHECK . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . , , , , _ , ; TOWN HALL NOTIFY _ SOUTHOLD, N.Y. 11971 CALL . .�� 5 a -75 TEL: 765-1802 MAIL TO : Examined . . . �. ?-`�. . ., 19$7. 8 7e—,' cr t.da0 DOlB Approved 19$7. Permit No. q. . . . .[ Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18612 Z a. . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT G Date . . L.I. �� . . . . . . . . ., 19?.7 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 orTce, ion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hou and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti s. �-J. . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. GLZ0. (Zou-si%,- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .-.r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of prem ? � :� F{ ises . . 1 C_t4i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR' S MUST B SU FOLK COUNTY LICENSED Builder's License No. . . .l. �9`1 . . Plumber's License No. . . . . . . .Z3 `C . . . . . . . . . . . . . . . Electrician's License No. . . . . . .?'.�"L Other Trade's License No. . . . . . . . ... . . . . . . . . . . . I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . . . q. . . . . . . . . Block . . . . 3. . . . . . . . . . . . Lot . . . �. . . . . . . . . . . . . . Subdivision M4.p.4 . . . . . . . . . . . . . . . Filed Map No. . . �.�. 1 . . . . . . . Lot . . t . ... . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . .�. . !"_ ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . .��'""`'e—. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work A .Ci �<. „ft. (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage,number of carsf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions aii?e structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . :S. . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . I o rt -°. . . . . . . . . Rear . . . . . . . 11 1. `I t_ . . . . . . . Depth . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . ... . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t 2. Does proposed construction violate any zoning law, ordinance or regulation: . Q.,ht . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . . . . !-? . . . . . . . . . . . . . . . . Will excess f ij be removed from remises: Yes -No :4. Name of Owner of premises1. !�. . ... . . . .. .i+'J. . . . Address .`3°�'f Name of Architect . . . . !�... — Address . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . '""'•^- �?'!��.^. . Phone No."l��.- '1�. . . . . . . . . Address . . 15. Is this property located within 300 feet of a nidal wetland? *Yes . . . . . No . . . . . *If yes, Southold Town Trustees PermitPLOTmay be required. 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. -T-rA T iTATE OF NEW RK, S.S _'OUNTY OF . . . . . . . . . .✓.A.«l44' ►A�` . . 4. . �. !�.�?. . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. 3 e is the . . . . . . . . . . . . . . . . . . Cou Yew e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) )f 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 vork will be performed in the manner set forth in the application filed therewith. ;worn to before me this . . . . . . . G , .day of. t . . . . .I 19$� Iota ublic, . . . . . . . . County t, ' . . . . . .�� . . . . .I. . .. . . . `--' . . . . . . . . . . . . . . BETH ANN NEVILLE (Signature of applicant) blic,State of New York No.52-8125850,Suffolk Covnivv Term Expires October 31,19 • i— I .v R � h 1 ii IZ I� _. y• . . . 11 -. d p .r I• r 1 1 li 1 1 i - .r d.tel.Il�i illlnnW. ii 14, $ ,• i.--_ —'—^—'-�,'�...•._„_,-,_,-.,,,-„ - 1"1 SP.ar4�Y 71�i wet-u1 1[."�m.C .� 4' P c tz.�nrc. I, I. r ,g - ..�: .�..-�.....:.�� �• 4'f.a ;:L.p m :H(V27>• A•h --Y-n-erN-AnF.r� �� - . I r �. g;j �j 1'^�4 f�-F-1 vA`T'r glrJ —" 7L�C'T t2 '- - _ r ,r4TE 4);h1 B.P -26 FEF aW•�Btl. Nol� :JILDWr DEPARTMENT AT � 7F., I90*' 9 4nn TO 4 PM FOR THE rD, Zrlrr r INSPECTIOS: NCY O' ” Fido r?EQUIREU OCCUPAN - r:ONCRETE I - Rs',1u �AMlNG tl1�'LUMBING (\1 1 �FUL - A4 .e-. uf10 , 'RUS UN - 1 �i WSTRUCTION MUST E I� _ ' may IGI0T - PIR CERTIFICATE M-i IJCToOS,l SHALL MEET " OUTFHE70 T t,u 1c�UIFU" OF THE N.YpF nennen $70 TE CJN:;rRUCTION h ENERGY - - CUO€ WlI RESPONSIBLE FOR U6 �N•,' RI['31 'N OR CCNSTRUCTION ERRORS. I + I� - � onliwl rau.Ydn .