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Home My WebLink About5713-z ........................................ , 19. ....... Pem~t Ne ..................................... Disopproved o/c ................. ,..- ~. .............. , ............................................ APPLICATION IS HEREBY MADE to the Bui~ Degartment for the issuance Building Zone Ordinance of the To~n of Sou~)id,~ CouP/, New York Regulations, for the constructlan of buildings, ~ or alNlel~,, or for The applicant agrees to comply with all applicable la~s, orcttnance~, buildlr~ ......... ........... ('~'"~"~"~'*?'~"'~'*'~'~""'"'~'"'~'~ of ~tk~lt) ] ................. State whether applicant is owner, lessee, agent, architect, engineer, 9eneral contractor, electrician, plumber or builde~ ......... ' ......................................... Name of owner of premi,s .............. _?..~.~j.......~.__ ........... ..~1~...~ ................................................... I, applicay ,,~ a corpo~,~, ~1/1~ a. tur. of du~uthetiz~ officer. ................ i~r~'~:~ title of C'""""*'"'"'~'l~'l~'~"~f~i~er""~ ........ I location o{ ha~d on ~i~'(~,~'~h p. _n:~:l wllrk ~ill ~ dcl~. h~il ~o.: ................. ; ...... ~...~ ~ ........................ s~ .. ~ ...~_..~m..~.~ ....... .......................... ~~ ........................ Exisiting u~e and occupancy ..................................................................................... ~....? ................................. Intended u~e'and occulx~ncy .............................. ~.....~':~M~.V ..................................... ~; .......................... 3. Nature 'of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal ~. ................. Demolitio~ ........... .~... ~/~ W~k/(Describe) ........................................ 4. Estimated Cost ..........,.~.~1.~:C6.¢r~I?.." ........................ Fee ..... .~.....~...~.:.'c~"~....i" ......................................................... (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 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 ................................ 8. Dimensions of entire new construction: Front ....... ~J.~.~...~..~'. .............. Rear ..... ~..,~..%..4~...~.~ ...... Depth ......~..~.. ............ Height ......~..I ........... Number of Stories ............... /...~. ................................................................................................ 9. Size of lot: Front .......... .~.~1~ ............ Rear ......... ~.~tl~. ................... Depth .......... ,,~.~ ........... 10. Date of Purchase ..... ~..~J~.~ ....... ~.../..~.~.~ ................... 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? ........ ~ ............................................... - .......... Name of Owner of premises ~.~.¢~;S......~. Address ..~.~,..~.~;:...~.....~s~,^. Phone No. ~.~L;.../.~.~'. 13. Name of Architect ...................................................... Address ............................................ Phone No ............ ::~ ....... Name of Contractor ..~-~....~.(.~...trJ,,-/~L~,&...Address .Z~...~J~...~....~.e~ ...... Phone No..?..Jt.~...~.~./.~e ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all Set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate Whether interior or comer lot. STATE OF NEW YORK, COUNT ,,S, ............... n~J~'~.~.....J...r~,~J~ ......................................... being duly sworn, deposes and says that he is the applicant (Namd of individual signing application) above named. He is 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 w.or~ will be performed in the manner set forth in the application filed therewith. Swam to I/e~6re me this ........................ day of ............... L~,., _~ /I I ~ /1/i " ............. -~...-:.<.....'-.~........~.-.'~..;,.~.--;-..~.. ..................................... Notary Public, ~,:,(,.~.~ .~;,~./.~/...,~Z~ ...... County /(Signature of applicant) t ELIZABETH ANN NEVILLJL/ NOTARY PUBLIO, State of N~'w York No. 52-8125850, Suffolk CouJ;tt~,., Term Expires March 30, TOWN OF SOUTHOLDi BUILDING DEP.~RTMEN~ TOWN CLERK,S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5713 Z Permission is hereby granted to: .......... 7¢.....~7~;~C ......... ~:~......~..~ Building Inspector. Building Inspector THIS APPROVAL EXPIRES SUFFOLK COUNT~ DEPIRTMENT OF HEALTH H.D.Reference No ~ EASTERN DISTRICT, RIVERHE D,N.Y. APPLICATION FOR APPROVAL TO .CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS , Approval tn construct said systems is requested,pertinent data herewith: Date i-Applicant ~ ~ . _" ~,~ " Phone ~ * ~9 6-Sub div ' Address. . ~ ?. ~' a, . 7-Section 2-Detailed prope~tion ~,~: e~ ~ 8-Lot No, Hamlet :~-~J~ To~n . ~P p 9-Private well? 3-Public ~ter supply name Distance to nearest main 4-Lot Size: WidthJ~ ft. Length~ ft. (also enter on center plot plan below:) 5.Dwelling: Single Family f~ Tw~ FAmily? ~ YCellar? ~.~Slab? ~._~Crawl Space? 10-Proposed system: Septic ta'--~ ~_~recast~Cesspools ~ yShallow pools ~_/Other il-Septlc tank inside dimensions: Volume&~Gals. Length ft. Width ft. Liquid depth l - ecast sections: Cess ols: elock size incs. D__ s.H Total blocks below inlet. ~i $2 $3 PLOT PLAN il . ! ins. Capacity~A Gals. G.P.M. ~° ~ ~ Indi ~ ~ N~ The Underslgn~ ~RT~S: "Const~ction of authoriz~ installations ~11 be in acco~ance ~th the Suffolk County Health De~ments' current Stan~s, ~lletins, a~ amendments thereto, covering Private Se~ge Dis~sal Systems". Date Sign~ ~er ~ or ~ilder FOR ~LTH DEPART~NT USE ONLY. ~s~ on the infection present~ he~tb, it is the opinion of the H~lth De~ment, that an ad~te and satisfacto~ S~ge Dis~sal S~t~ can be installed on this ~ot. Date evis.) Da ~a ~eet 0 2 c~ ~ 6 · 8 10 12 ~6 18 FOEM NO, ! TOWN OF $OUTHOL~ TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. / 7 .5/- Examined Approved '/~' ~""/- --/ ~--' --~ 7 /~ ~ ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ........ ]]'"~' "~'L:~:'"'~'~ ..................................;: ..... (Building Inspector) Application No. _~ '7/ 3 APPLICATION FOR BUILDINGs,PERMIT Dote /~7 19 ~Z INSTRUCTIONS a. This application must be completely filled in by typewriter or in':ink and ~ubmitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, rela~.ionship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be draw0 on the diagram which is part of this application. c. The work covered by this application may not be commenced bef6re issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issu~ a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the prc~tress of the work. e. No building shall be occupied or used in whole or in part for any p~rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for thb 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, afl for removal or demolition, as herein described. The applicant agrees to comply with oll applicable laws, ordinances, buil(]ing code, housing code, and regulations. ......... ........ .................... ........... ..................... State whether applicant is owner, lessee, agent, orchitect~,~n~ne'ral coatrac:tor, electrician, plumber or builder. Name of owner of premises ~ '~' '~' i ff applicon)/ is a eorporate, ~gq~ature of duly outhorized officer. (No~d~e end title of corporate officer) 1. Location of lend on which proposed wo~rk will be done. Map No.: ..~ ...................................... [.~t Nx~ .................. Street and Number ...././....~...~.~....~.......~...~.~....~.... ....... ~...] ..................... ...~...~:...~.... .................... ,, Municipality State existing use and occupancy of premises and intended use on~J~ occupancy of proposed construction; o. £xisiting use and occupancy ............>~.... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building / Addition Alteration Repair .................. Removal .................. Demolition .......... ..,J.~... Other Work (Describe) ........................................ 4. Estimated Cost .......... ~.z/.).~:..~... ........................... Fee ....'~....,Z.~,,~.....,~....~.. ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~ .............. Number of dwelling units on each floor ......... ( .................. I'f 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 .................... Neight ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ ' ,, ....... 8. Dimensions of entire new construction: Front ........... ~....~... ................ Rear ..... .~..~. ................ Depth . ~.~.. ............ Height ..... ?r..! ........... Number of Stories 9. Size of lot: Front .......... ./.~.0.. ........... Rear .........../..Z,...~. ................... Depth .......... .~...'~..~.~. ........... 10, [)ate of Purchase ........ .,~..,,~.?. ........... ~.~,~. ................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........................ ~ ......................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ........ ~ ............................................... 13. Name of Owner of premises__ _--,-,Z,:.~.~...e~.t.....~..Z.:,/~r.~' ......... Address ..j~.~/.¢..,'./.~..c.¢...~.~......~.q~.~.:. Phone No. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ,,.~...¢~R....~.~./e.f.~'...../~#.¢.~.f.,~h.~...Address ..~,~.~...~.g.X....~.~......~k .~.' ...... Phone No..Z.~.~....~.~...~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock 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. STATE OF NEW',.Y~ORJ~, ~' ~ ¢ ~ couNw ............................... ~ ......................................... being duly sworn, deposes ond soys that he is the applicant ~ individual signing application) above named. He is 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 fo~h in the application filed therewith. Sworn to before me this X .... ............. ............................................................... ,