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Home My WebLink About6491-zApproved FORM NO. 1 BUILDING DEPARTMENT TOWN CLERK'S OFFICE MUTHOLD, N. Y. 19 ........ ~ Applicofi~ NO .......... ~..[. ................. 19.~. Pemit No...~...~..[.]...~ ......... Disopproved O/C ~ ...... ~....:...~ ......................... \ 'oz. ( ~'~-\~'\~"~AP~:ATION FOR BUJLDING PERMIT~.~ ~' gv~,~4~,'~'~,,'/" ~:~ ............. ........ , ...... a. This application must be completely fi~ed in by typewriter or in ink and submitted in trip~icete to the Building ~nspector, 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, relation~hTp to adjoining premises or public streets or areas, and giving a detailed description of layout of properw must be drawn on diagram which is part of this application. 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 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 Count,/, 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ..... (Address of applicant) I I-77 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~(~5 ...... ~.t~.~.O.~.I~..P~'. .................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No .................................................... , , 1. Location of land on which proposed work will be done~ Map No..~....~z~7.~..ox'_'z~C....~.~g/AL~...Lot No..~[1~. ................ u- - Street and Number .....~'...~O~...C~......~.....~. ......... .~.C-~'.~.,..G. ............. z/y. .................................................................... ~/J~- Muni.cipality 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 ....... ~/~'~dZ~'......~.~.~.4T..'. ................................................................................ ~ .... 3. Nature of work (check which apl~licable): New Building ...... ..~..... .......... Addition ..................... Alteration ............... Repair ......................... Removal ....... ............. ..... Demolition ........................ Other Work ...................... (Description) 4. Estimated Cost ..~..~.~,.¢)..o..~ .......................... 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 cars ........... J ............................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Del~th ................................... Height ,. .......................................................... Number of Stories ............................................................................. ~ :Dimen ,s~ons of same structure with alterations or additions: Front Rear ............ Depth ............................................. Height ......................................... Number of Stories ........................................ 8~ 'Dimensions of entire new construction: Front ....... ~,~ ............. Rear ...~q,~.~. ................. Depth ,..~. ........................ Height ................................. .~ .............. Number of Stories ..... ...~ ............................................................................... 9. Size of lot: Front ....... ~...~.. ........................ Rear ..... ,~..O...~. ........................... Depth .../,~'.(~..../. ................................... 10. Date of Purchase ..... ~...~..~.~..~/.~'.~-- ......... Name of Former Owner ...... ~..~.~.....~.~..c..~'.~.,~. ............................................ 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 rer0,oved fromoremises: [ ] Yes [ ] No_ r f remises Lo,.u,~ ~'.~uo.%.~_~ .~H~ - ,~, Z'~-- 14. Name of Owne o p ....................................................... ~/~..~.......~.. ...... /~¢Y~..~/~ ....... .~..~...~. ............... (Address) (Phone No.) Name of Architect ............................................................................................................................................. (Address) (Phone No.) Name of ContraCtor ....................................................................................... ; ........................................................... (Address) (Phone No.) 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of ~nd~Mual ~io~Jng contract) 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 forth in the application filed therewith. Notary Public ...................................................................... CounW ......................... ~~ ................. (Signature of applicant) ~OEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N? 6 91 Z Permission is hereby granted to: ~,.~d,~...~a,~.~,a .............................................. .......... ~g.....Fesee~,..P~l ..................................... ............ Rel~oi~eala ....... .~ ,,.Y., ........................... to ~ui~.....m~w...om~ ..~m~ i~.. ~well~ ................................................................................... at premises located at .........3.o~...313....~.e~.o13,:l,0...~s .............................................................. .................................................. s~c~'~..k~.e ......... P. ee.on~ ............................................................ pursuant to application dated ......................A[~],.~-1. ........ 1.8 .......... , 19...~., and approved by the Building Inspector. Fee $ ~.~'{:}. ........... SUFFOLE COUNTY D~2ART~/~NT OF H~LTN -~ H.D. Reference No, APPLICATION FOR APPROVAL TO CONSTRUC'T A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~$ 7 ~W~ P~one__5. Subdiv. ~ 2' Address ~ ~ l'~ ~~ 6. Section Pro erty -- ' Lot No. - ' { ~ ~8. Private well_.~~ Vi~la~e~Township~9. Public water 3. Public W~ter Company ~ame Distance to i. LoC size. Width ~ fee't Length t~ feet (Enter on center plot be10w) 10. Sewase Disposal System: A. 900 Ballon septic tank: Pretest ~ ~quivalent Block B. Leachinl pools: Number Preca~Block ~pecial , ~ ~a~ ~ If private well fill be ards in blanks beloW~ Tank capacity~als. Pump G.P.H. Total well depth~___~ Amount of~ater well~ Test Hole The,und~rsisned CERTIFIES: "Construction of' authorized installations will in accordance with the Suffolk County Department off liealth's current stand- thereto." ~ /~ Date ~/~ Signed ff~ Owner or Builder FOR HEALTH DEPARTHE~T USE ONLY. Eased on the information presented hareeith, it is 'the opinion of the" Nealth Department, that an adequate, and s~tisfaCtory Sewage Disposal System Can be ing'tal'led On this plolL,~-~ /~ )l f/// S 15 · Revised 4/1/72' · IPOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Examined ......................................... 19 ........ Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ............................................................................................ · Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 diagram which is pert of this application. 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 permit?hall 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 buildings for neeessery inspections. (Signature of applicant, or name, if a corporation) (Addrbss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....L..~:s~,.g ...... :';.tt.:.~,J..E.A£ ...................... .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... ~ Other Trade's License No ................................................... : 1. Location of land on which proposed work will be done. Map No...,,...../. ................... ./...., ....... Lot No.....~,/.~ ................ Street and Number ................... /.....~.: .............. /.., ......... v/. ................. ~ ....................................... .~i~i~,.ii~ .......... 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: ao Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ....... ~:.X~/~,,. ....... ~.'.... ............................................................................................. 3. Nature of work (check which applicable): New Building ..... ...~... ............ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ................................... . (Description) 4. Estimated Cost .~..:~1{~.~ ........................... 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 cars ..........i~ ................................................................................................................................ 6. If business, commercial or mixed occuoency, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Deoth ................................... 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 .-..e~,~ .............. Rear ..4-L~./. .................. Depth ..~ .......................... Height ................................................. Number of Stories ....;~L ................................................................................. Size of lot: Front ....~--~:;~..., ...................... Rear ..... s~'.lQ ............................... Depth .~'.~0 ......................................... Date of Purchase ....7....~J.~.~,~ ........... Name of Former Owner ....~...J~//.~(~'/~ ............................................. Zone or use district in whicl~ premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ Will'lot receded "- ;-'~'~"~----- ................. ,-_.. ~ ~ ~_ ,~,t--,a --~ _________~'WillexCeSSfillberer~°vedfr°m'premi~es: [ ] Yes [ ] Name of Owner of prem.ses ..../~a.~ ...... ,.%/~t~3....~.~xr-,~J.,.g~~,....~.v[...,(~..Z~.~..,, (Address) (Phone~No.) Name of Architect ..................................................................................................................................................... .. ~ (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly end distinctly ell buildlnge, whether existing or proposed, and indicate all sat~ack dimensions from property lines. Give street and block number or desa'lptlon according to deed, and show street names and indicate wheth- er interior or corner lot. 11. 12. 1~. 14. STATE OF NEW YORK, ) COUNTY OF .............................................. ) ............................ ~'~'~'~'~:'~/i~'~'~j .................... being duly sworn, deposes and says that he is the applican~ 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; ~nd that the work will be performed in the manner set forth in the application filed therewith. ...................................... day of .................................................. 19 ............. - / Notary Pub c ................ Countv ,~. ~.,~,.~.~..4~ ~ ~, (Si~ ture of applicant/ 8. 50 ' SECO~ ;D 5.54. "-229.92 1'~ $CALE-30"I" m = GUAg.,AN T'EF-L) TO THE SECi.)t2 ! ~ 'ri T LE ~ Gl, JAlPA L , f ,I