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HomeMy WebLinkAbout23844-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25491 Date: 01/16/98 THIS CERTIFIES that the building ADDITION Location of Property: 640 HARVEST LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 120 Block 3 Lot 8.12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 18, 1996 pursuant to which Building Permit No. 23844-Z dated DECEMBER 6, 1996 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to AMB PROPERTIES LTD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 14392 12/10/96 PLUMBERS CERTIFICATION DATED N/A 2 B ld g Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25490 Date: 01/16/98 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property: 640 HARVEST LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 120 Block 3 Lot 8.12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 18, 1996 pursuant to which Building Permit No. 23844-Z dated DECEMBER 6, 1996 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 AS APPLIED FOR. The certificate is issued to AMB PROPERTIES LTD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 14392 12/10/96 PLUMBERS CERTIFICATION DATED N/A r ldi g Inspector Rev. 1/81 FORK NO. 2 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) N° 23844 Z Dote .......... ... .�......................... 19....� Permission is hereby gra d to: ...... . 7/.��' .. ............................ '�� ....��.° � ..P.�.G. -Y...., i�? ........ J .... ........ / r am.. . ey. .. .. `1..... �r.:f:: r!""T. ... .. at premises located at .................. ....... .�' ................................................................ .. .. .... . .......... !:t:f' .......................... ..........................................................................G W44 -or:.................................. .............. County Tax Map No. 1000 Section ..... ....... Block ...... ........... Lot No. .jE.Y.'? ..... pursuant to application dated ......................... -n!1.�407.......... 19. , and approved by the Building Inspector. Fee $. 5. .. ..... ......... .. ........0........... Building I for Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR.CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 Undefwriters.' 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of l% 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 a 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 - .25v, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ` Date . . . 1..-).Lt. .9 F. . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . Old Or Pre-existing Building. .``. . . . . . . . nn.��. .��. . . . Location of Property:. . . . . . . : . .4a . . . . . . . . . ...: j t .� � . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Q. . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . .. . . . .Block. . . ..D . . . . . . . .Lot. . /�. : �. . . . . . . . . . . . Subdivision. ....._.e .�.... . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filedd Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . �Permit No3'eS. .! . . .Date Of Permit! Z.� . .% . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . .Y. . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary /Certificate. . . . . . . . . . . Final Certicate. . .� . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . G Q,QG. S�6'� V . . . . . . . . . . . .APPLICA. . . . . . . . . . . . Ca---t- is q i I Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR.CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 a 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 - .25V. - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15jj.0.,,0, Commercial $15.00 ` Date . . . . 1 ... .1. . 1__j . .E?. . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . Old Or Pre-existing Building. . . gg���� . Location of Property. .L?H!!� . . 1�/,�.�,7� .S. .L . . . . . . . . . . . . . '". : J. X . . . . . . . . . . . . . . House No. a Street y� Hamlet Onwer or Owners of Property. . . . !�.! .�. . . �.� !�S. . .���.-!. . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. J. .Z-.V . . . .Block. . . . -3 . . . . . . . .Lot. . J � . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit NoZ a�.t7: . .Date Of Permit.t!. P..!f`a? . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .'Y . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . APPLICANT co zxaS� T 6 I j I I I I TI-i S ;- 311- - 17+ F Ut I f - _ I - I 1)ATL; ....... '01 I"()I If I D AT I ON IN I(O11(:ll FKAHR CD 111.111.111 I NG, ---------- VJ I Off Pirit tj y C.ODIr. ------------ -- F I VIA I. ADDITIMIA1. COMIP"UTS: suauiNa DEPT. INSPECTION . ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] GAMING [ �AL REM S• Jr- DATE YtT0177 INSPECTOR 0 ss-ieoz 9% UILDING DEFT. S PECTION [ FOUNDATION iST�� [ ] ROUGH PLBG. [ j F DA OND [ ] INSULATION U [ ] 24 FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: Af DATEle�' l � INSPECTOR 765-1802 BUILDING DEFT. INSPECTION [ 1 FOUNDATION iST [ ] ROUGH PL [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: �JI Lo G d L DATE � � C � INSPECTOR A� T65.1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [�-FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE l INSPECTO 765.1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE � � INSPECTOR ' Nov 13 96 02 51P Parcel Plus/C .World 203 459 1184 P.03 JUL 23s!' 161� .TR, S C BAgRY 5G16 499 9113 � TO. 5Yr�� 3940 P03 q 4 Forn Ma.F aYC-"'%l s L'v'`•�' ` '�L''7 Ygp t 9 hbf.GP �'y`!Q'~` ^- '♦ 7� ' ` TOt,Q ` $OQTfiOLD Y4�d!lUI3 C�E'DEPARTMENT DNG R . . rl q X`i Q�. iiiL.li1 _ � VM � Z y } U �r > f�69 180Z �o dw.•,wy+�� W. r �'- I{y�{.6+ r �}E.w'' r r- 4 , 3 ti � .r L`r t •�7 . APPLICA?IQ� R CERTIFICATE OF OCCUPANCY r< �' t ewri tar 08, iak and submitted .to the.building. 'must be filled iriby YP idiu or new.:uae �,(istibaatbtadththe lollowiag 1ii►cetsiriy o.f prapartyjwith` QCCurmtO'lo,Getion of'all 'buildings,,. property ]ices. tti,�;xndRiunusual cdruYml Ror�ftopogrsphi4 16AWFes. 3T ir.ty,tr' ,ri� cf h { � o Firp � Y'3riaAp �vva1_Rfrom-.Kaa].thDiapt! ,al water ;eupplY anr9 form), ��i7�' E�Sa1QotYic�a1"iiiscallatiton{from Board ! saWerage-dispoeal(S d .RTnd>srra :Ys. ameuC',fram`p3�smbar' ceYtiFying that the solder used in a:ystea� contazAi �o ­, �tb ati Z��1QikQf-l 1ad .�� pW':Ica v 1 �aladus alp bµL1d1n94;muLCIP, a residatscs: and similar :buildings "�>�' r`'•ans �e it 1*q�, Campii.ance -From erchi.tec.e or enKinaer .. 1 t . certr# raaA A• �a r n.f .f;°ss ' fit'�'� ''I 5 7r�t 's<• ? e" fated aft® fan tie yiransats P 4 N.V. ''�s '?i`R'nnirgV Aazd°J►PP.� 9 ti � ( "'� f �:` tlrild3�►8stPri•orytol1p=iY>9.�1957) non confosn►3ng vans. or buildings and 0ir�'�4r��. t1Q °"alit kO Arty► liAR!r streets, building •nd �r�� t��ea�rVay,��ol���.p'copart=Y s, H� P P ' rura1l � pd7.1 faacyleia . q r4¢ap 14;- 3a ndF`ss con8aat:to ;iaspec t, �sgnad by• the applicant• �'• k ,`' t ,tho.Building Inspactttiz shall state the. alY? Ccu a ieV�fn t 7�l 1efaF'iz► iting�ta .tl+p �pPllcaat ■ *.. �'�t is •.of;Occ�ipar�ay4�;�Dt4��dw4lling ti:2S 00, "e�ddcian�� to duelling .4?!�•QO a da�l�►irn8`13S� O, Swimmitt# poop^,525.00s, Accessory building �25 00. of "tom ° CQ �CGRaAOL'y���Lt.Lt g�, �044 �,;,.Hu,siaesae� r5S0�.00. - �. �� R v� ,. a r7z t :suildtn� -°i 100 DO '# dau�pa �i� rt a-� is lf►Rtf %cu ''Cy• .- ,"�^�ti`Zz., '" c�e�r�i>�a� ie xt1 zfx ihc Sa..♦t+etr!oL'[f Py"n i'�',e� cpu�np•�•aa�ynj�y�c"��y�cr�y?5f5 01le.0s0i deati'a1v.,5 1 500 Camsaa=ci,41';15. 00 C 0a .. 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M '3t `d"'1�'�'� ssc��[ y'ii `�w»d.+. t•'`•,.a. •v tf•x.• . t �••,•,. fi� /t, r g } 41 Y r PLICAZIT: t .a.` ,Ts' r r/ ihla sn"`34 '}+� �c'',�rs5`"iC �•"yf•c+h"Y..r. tJ `�".. 7 'a > ..r6 } ;� 5'..r 5 1�C�, '�, � ,�' �y,,h-F+r�}�' i. i+f�� -'F i 'y F 5-••�,t��,{+t'r t �t,, 5 + � Nov- 13-96 "02 : 50P Parcel Plus/C .World 203 459 1184 P.02 JLL 23 996 16:14 JAMtS C BARRY 516 499 9113 T0'. 516 369 3940 P02 loam Igo. 4 TOWN OF SOUTH= BUZLDIra DEpARMOINT Office of the Euilding Ynspectcr Town 9111 Southold, N.Y. (ZRT'IlICATZ OF OCG'D Xg= Na 7.4501 pate, JULY I$, 199fi TMIg LImTIFIES that the building— CMZ VAK2LY MLLING Locstian of Pedperty "0 RARQEST 101T=Tg=f N.Y. .. House No. street xamlet county Tax Rap Na. 1000 section_ jLQ _ clock 7 Lot 0.12 subdiviaiion Piled Hap NO- Let No._ cgpgormv substantially to the AP91190tion for Building perml.e heretofore filed In this office dated SA. 1995 _ pursuant to which Building Permit No. 225;.7—s dated MARCD 9 logs was Los%iod, and conforms to all of the requirements at the spplLcable provisions of the law. The occupanoY for which this cartilicate is issued l.■ ONZ FAMILY VNSLLIN6 M TE ATTACWW OaRA6= As APPLIED FOR. The cee;ifioatik is issued to PAZOW A9SOCIATEe (owners) of the Ilforeaaid building• iUFFOLX COUNTY DEPARTMENT OF HEALTH APPROVAL g1�9s..c�070�7OLY Sq 1996 SL$C'PR=t7�'+ INBFZCTIQN CERT. #9533 — Dam Ir 1995 PLUMBERD CERTZFYCATIDN DATED AUGUST 15 1945 DERCY PLMjBxIna a M11TZIM 1 9 Inallec, r Rev. 1/111 Nl BOARD OF HEALTH . . . . . . 3 SETS OF PLANS FORM NO. 1 SURVEY . . . . . . . . . . i+ TOWN OF SOUTHOLD CHECK . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . : . . . . . . . . TOWN HALL NOTIFY -OUTHOLD, N.Y. 11971 CALL . . . . . . . . . . . . . . . . TEL.: 765-1802 MAIL TO : Examined . . ! Approved m.� . . . . .. I qt Permit Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) Al'r CATION FOR BUILDING PERMIT Date p��� 1\ . !U���'�C�1.��19�F! INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 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 stree, or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl 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 perm 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 Occupanc 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 tl: Building,Zone. Ordinanc'e•of the-Tobin of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein describe( The-applicant agrees to comply with all applicable laws, ordinances, build'pg code, hour' b code, and regulations, and t admit authorized inspectors on premises and in building for necessary ins -eti ns. . . . . . . . . . . . . . ( igna e o applicant, or name, if a corporation) (Mailing address'of applicant) State whether applicant is-owner, lessee, agent, architect, engineer, gener ,contractor, electrician, plumber or builde . . µK5 rt3G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � ,'Y + Name of.owner of premises wb'l �.f . • � + T '`�`'. : R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 BE SUFFOLK COUNTY LICENSED Builder's License No.,)41a.44 ... . . . . . . . . . . Plumber's License No. /` . . . . . . . . . . . . . . . . . Electrician's License No. c�:2.Ua-7.✓ . . . . . . . . . Other Trade's License No. .1 r 1. . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �` . �- -�".V l . . . . . . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._: . House Number Street Hamlet County Tax Map No. 1000 Section . .�. 2-0 . . . . . . . . . . Block . . . . . . . . . . . . . . . . Lot . . . . . . . . . . Subdivision . Fa,(mve .A. . . . . . . . . . . . . Filed Ma'p No. . . . . . . . . . . . . Lot . . . . . . . . . . . . . ... P (Name) 2. State existing use and occupancy of premises and intended use and-occupancy of proposed construction: a. Existing use`and'occupancy .c> �✓1 : �� .P.li(,m.�.I. �"W6il•1. . . . . . . . . . . . . .. . . . . . . . . . . . . . b. Intended use and occupancy u ., u� ! i. . . . �.� -. • . • • . . . 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . ... . . . . . . . . . . . . ._0theVeAfe�. 1. . . . ot rep l (Description) 4. Estimated Cost . . . . . . . . . P. . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . 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 Stories . . . . . . . . . . . . . . . . . . . . . . S. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . _ . . . . . . . . . . . _ . . . . _ _ . . . _ . . . . . . . . .. 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . 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: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . : . . : . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . 15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No . . . . . *If yes, Southold Town Trustees Permit may required. PLOT DIAGRAM Locate clearly and distinctly ',all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street d block number or description accordingto deed, and show street names and indicate whether interior or corner lot. 6e!?, :5 urlelv &ff4/j 6j UNDERWRITERS CERTIFICATE REQUIRED - 221%E1•r AS NOTED .2 P , 1 AR�� �;rq � SATE: .�icn BA# . VV G, NOTIFY SUILDING D 765-1€02 S At41'd TO 4 PM. FOR.THE g 77v r ii,yr,,ili, 1. FOUNDATIONFOLLOWING PECTITWO REQUIRED c✓..r �'1. U + FOR POURED CONCRETE �� 2. ROUGH - FRAMING & PLU.MBING 1�7 . INSULATION 4. FISCAL. - CONSTRUCTION MUST BE COMPLETE FOR C.O. 41,1MMEDIA LY" ALL CONSTRUCTION SHALL MEET, ENCLOSETHE REQUIREMENTS OF THE N.Y POOL STATE CONSTRUCTION & ENERGY UPON C CODES. NOT RESPONSIBLE FOR' ATFR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK,COUNTY OF S.S . .�� �1�G.. . . . dd,B .,Q.r.. . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of�idividual signing contract) above named. Heis the . . . . . . . . . . . �.- e. f . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 �.� . . . .day of. . ���P►-,�.6,er- ., 19 T.(,P Notary Public, . . . . . . ... . . . . . .al.% . . . . . . . . . . . . County RI�I L.HAGER . . . . . . . . . . . . . ®. 2-526433 Dual° in SutfdV,Co,LiJ;t7 (Signature of applicant) �iy�;7lrP�i§siDn Exrir � �t1��9� -. �. {.• SIMVOtK CO-HEAL-glitPT', VAC . � _ �ENT • Vs— THE WATER SUPPLY AND SEWA4ZE fl13l�0.9A1< = '-_ - - SVSTEW FOR ' MIS .R ES IDEN" CONFORM TO THE STADIVARDS qE THE SuFFOLK CO. DEPT. OF MEALTM.SERV%CM. , {S! A1PPLlG4MT i = 5 !l=FOLJ4 COUNTY •DEFT. JaP EIE }.TH SERVICES FOR. APPROVAL IA -. "F PQ0PER T`f COHSTR�t�TIC vnrty :. WE YE Q S. "EF. No.: i��4• -�} 1�._ '_ OE Tcoo APPROVED: UPON COMPLETIOR ,ENCLSOOLoE BEFORE•10VATER., - SUFFOLK CO.TAX MAV 13FStt;l+l�t'1�1Z1�1� .i -SECT- BLOCK.TITO ol .' �,_• •,''- - co _ .. - . - __w.r..t.�1¢r•+4a.^�a..w�-•,.. _ r• _ _ `fir _ .,+7� •ice-•t• `f •i \ �•►:• _ '?• ,1. •:�ti •}j.i.: _ _"k, 1 - :F;..I ... .. `yam: f L- 1.. _� t .. ... _ •Z::,-.y•p _ new - ry-`�i:.,4a• - >.:•. `ti� L' - +1•! -_ '• �.' - - � - `,-`�'' - .. 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