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Home My WebLink About6563-z FO~M NO, 1 TOWN OF,OUT.O,D BUILDING DEPARTMENT TOWN CLERK'S OFFICE '~,~f SOUTHOLD, N. Y. lIB."1-, o APPLICATION FOR BUILDING PERMIT go , .......... ................... , INSTRUCTIONS a. This application must b~ completely filled in by tybewriter or in ink and submitted in triplicate to the Building Inspector, with 3 .~ts 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 ad|oinin§ premises or public streets or areas, a~d~ giving a detailed description of layout of probert¥ must be drawn on diagram which is part of this application. ¢. 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 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 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~.~ )plicant agrees to comply with all applicable laws, ordinances, buildingcode, housing code, and regulations, andtoadmitauthorizedin~~"~'~2~;~'~i';'~i'~remisesandinbuildingsf°rnecessaryinsbecti°ns' .... State whether applicant is owner, lesspe~ agentjarchit~ct, engineer, general contractor, electrician, plumber or builder. Name of If applicant is a corporate, signature of duly ~uthorized officer. Builder's License No .......................................................... Plumber's License No ....... .~...~..-.P.. ..................................... Electrician's License No....~Cl~.~; ..................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ........................................... :...Lot No ......................... IIESTa/a8 0 COZ I~Cg ROA9, 100.01 Pt. 8/0 ~ROEll AVEiI~ Streetand Number ...]~(~[d~l,~t ~.~, .................................................................................. 'l~i~i~;"'t:~/ ' 2.State existing use and occupancy of premises and intended use and occupal3cy of proposed construction: a. Existing use and occupancy ........... ~ ............. ~. ........................................... ~ b. Intended use and occupancy ..;L-.~.....J~. ~i~'..~.~T,~I~ .................................................................................... .~.. ~;~: Nature of work (check which apl31icable): New Building ....~.. ................ Addition ..................... Alteration ........ Demolition Other Work Repair Removal ............................. (Description) /,% 4. Estimated Cost ...~.~.~00~ ............................. Fee ...'~.../. ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... 3. ....... Number of dwelling units on each floor ......... ..[. ............................. If garage, number of cars ............ 3, ............................................................................................................................. 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 samd structure with alterations or itions: Front .......................... Rear ......................................... . Depth ..... ~...:...~'..[A ...... ;.~,'....:. ......... Height ......................................... Number of Stories ........................................ 8.. Di~e~i'~o~f~enti.r~e----- - n;w construction: Front ......~...~'.~ ...... Rear ..... ~I~..~P~ ......... Depth ...... ~...~.~. ............. Heiaht' ':~- ..... .t.. ~. :...~,.~... ,~.~.~;. ..................... Number of Stories ..... ..~....e. ............................................... ; ............ , ................ .9. Size~"of I(~ F-ro.nt,'.'..~:~...~.. ................... Rear ......... ..2...0~...[.6...~. .......... ; ....... Depth ........ ..~....0. ................................... · 10. Date of Purchase ..~Z~x~12...~.......~..~.... Name of Former Owner ..... ~/.4J.,./~./.~..~ ..... ~...~....~, ........... I' 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 premiss: [ ] Yes [~ No 14. Name of Owner of prem ..... ..~:~..~....~...~.. ............................ .~.R.{~.'~l'-~,r...l~....~.....2..~...~..../. .............. (Address) (Phone No.) Name of Architect ................................................................................................................................. (Address) (Phone No.) (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, COUNTY OF ..................................................... He is the .............,C,~...~.....~... ..................................................................................... ; ................................................................................... (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 statements contained in this application are true to the best of his knowledge and belief; and that the ~i~l~ I~ [B~l~dlf~n the manner set forth in the application filed therewith. ~'J NOTARY PUBLIC. State of New Yorl( -') -~ J/ No. 30.325~965 ~ da,, of "~ ,rix II /~ Qualified in Nassau County ........................... ~ .......... . .......... ~-.-~.~, ................ ~.., ,o ............. l/ ~! ~ // Ter~Expires March 30, 1975 Notary Public,' ..~.....~....[~.~unty ......... ~J/J//~~ ........................ [ '~ (Signature of a~ant} NO Z',~ : · · MONUM£NZ' "! .-v,..o.. YOUNG & YOUNG .,C~.~, 19;X:~ 400 OSTRANDER AVENUE, ~I~ERHEAD, NEW YO~K BEN MENDOZZ A ' ~* ' ~TTITUCK ~ov SO~LD -~ ~ · ::. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING FER~IT (THIS PERMIT MUST BE KEPT ON THE PR. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6563 Z Permission is hereby granted to: F~ne e~s.. ~o~e.. H~e ~.. Inc.. JL/.C .. ~.jr.. -S he I ~ ....... ~w~ ..................................................... -..li~ek~.. ~o.~.~$,r ......... .N~.~. ........................ to ...l~;~l~l..~....o~e...fa~ily...d~llLug. ................................................................................ at premises located at ..... .~./.~.....qg.~...K~g~;..~a~...-....~Z..~.er. gen..A~.~ ........................................ ........................................ ~t.~ltuCk ......... ~,~, ........................................................................ '. ...... pursuant to al~plication dated ............................. ~?t.L~ ....... ~.~- ....... , 19.~.~.., and approved by the Building Inspector. Fee $.-.~i'~rO(~ ........ Building Inspecto[ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No.' A_P_PLICATIO_______~N FOUR APP~OVA~ T~ CONSTRU~T ~ PRIVAT~ S~AG~ D~S~OSA~ SYSTE~ 1. Applicant ~OES RO~ HO~B,INC. Phon~~ - 5. Subdiv. ~~ Address NO ~Broa~way,P.O.Box 1033tRockyqmB~. 6. Section '~ 2. Property location W/S ~0XI~]~K ROAD~ 100' 7. Lot No. S/O ~,RGEN AVENUE 8. Private well Yes Village ~T~'~ Township SOI~]~0IJ~ 9. Public water NO 3. Public Water Company name None Distance to main NO W~e~ C~O~p: 4. Lot size: Width199.9~feet Length 180 feet (Enter on center plot below) 10. Sewage DisposaJ~'S~stem: A. /~00/~allon septic tank: PrecastMf/~quivalent Block B. kI~e~ching pools: Number / Precast~z~Block__.Special__ Vacant ~aean~ , Street 00X ~0[ ~oa~ Ipu,~l' Vacant Vacant -'~11 If private well fil in blanks below: Tank c ap a ci ty~__~'~a 1 Pump G,P .M. Total ~__.ell Depth to Amount of w~a~er in we ~ Test t{4~1 e Data '" ~Feet~ I 2 I 8 I l0 I ~2 The undersigned CERTIFIES: "Construction o~ ~uthorized installations wil be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ~._ _ .~_ Date f FF~UAI{Y 1973 Signed ~ 0w~e~ or' ~ui~er MEN ~ ~OOZZA, Pres.~NCES R0~ FOR HEALTH DEPARTMENT USE ONLY. Based on the i~formation predated herewith, is the opinion of the Health Department, that an adequate and satisfactory Sew~ Disposal System can be installed on this plot. Date ~/2-"-~ ~ ~ Signed ~._ __~ ~ ~ S-15 Revised 4/?/7£ · ~ MO NUM£N ~' .EV,S~ONS YOUNG & YOUNG .z'~.&, /,~TE, 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK AL. DEN W. YOUNG HOWARD W. YOUNG BEN MENDOZZ A ~ ..... '--~ ~ /. .q:' ..-, ~ MATTI TUCK ' ~.~ SUFFOLK CO., N.Y. BY' ~ ' '~' ," = ~0' j~..:~...~ j.o. ~_~, NO. I Approved ................. -- 4(. ........ !...0. ....... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..'.'~.. 192,~.. Peru, t No..~"'... · .~/...~'... ~...~ ........ Disapproved o/c ............................................................................................ APPLICATION FOR BUILDING FERh,ilT Date ~CH 22 19 73 INSTRUCTIONS a. This apphcatton must be completely filled in by typewriter or tn ink and submitted In tnphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot plan showmng location of lot and, of buildings Qn premises, relationship to adjommng premmses or pubhc streets or areas,; giving a detaded description of layout of property must be drawn on dmagram which Is part of th~s application c. The work covered by th~s apphcatlon may not be commenced before ~ssuance of Budding Permit d. Upon approval of th~s applmat(on, the Budding Inspector wdI ~ssue a Budding Permit to the applicant Such permit,shall be kept the premises available for inspection throughout the work e. No budding shall be occup)ed or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have b. granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Bumld~ng Permmt pursuant to the Budding Ord),nance o1' the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordtnances or Regulations, for the construct(o, buildings, additions or alterations, or for removal or demoht~on, as here~n described The apphcant agrees to comply with all applicable ordinances, building code, housing code, and regulations, and to admit authorized inspectors ~ premises and ~n buildings for necessary mspectio, P.O.BGX 1033~ROCKY POINT.N.Y. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ........................................................................... c.. tT ........ .......................................................... Name of owner of premises ...../..~.~:~..~...~ ...... ~.~..~.-...~....~..~.....~.. ....................................................................................... If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's L,cense No ....... .~..~...~..-.~ ...................................... Electrician's License No. ,.~.0.~ ...................................... Other Trade's License No ................................................... 1. Location of land on which propomd work will be done. Map No .............................................. Lot No ........................ WEST S/0 COX NECK ROAD~ 100.O1 Ft. S/O BOKRGEN AVENGE Street and Number "~[T~¥T~¥"N~'~ ................................................................................................................. N1unlcipality 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~.l~...~../...~..~.~./'.//.-.~.-,.~. .......... /./~...;:.~..[~.T,...F~.L~.'. ,~.. .............................. b. Intended use and occupancy ,,.1.~...A~...~..~.~'.,.~f~T~,T,~ ....................................................................................... 3, Nature of work (check which applicable): New Building .....~. ................. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ....I..~.~.Q.~ .............................. Fee ..,..'~....{. ...................................................................................... (to be pa~d on fihng th~s apphcat~on) 5. If dwelling, number of dwelling units ....... ~ ........ Number of dwelling units on each floor If garage, number of cars ........... ~1, .............................................................................................................................. 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: F~ront .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~.~...;['.1~ ....... Rear .... .,~.~....:~.~., .......... Depth ......~.~...~..~ ............. 18 f~. · r · Ot3e Hemht ................................................. Numbe of Stories ........................................................................................ 9. SIz~ of lot. Front .... ~..9.?.....9,.9.. ................... Rear ......... .~..0...~..,..~...~. ................... Depth ....... .]..,~...O. .................................. P u rch a se~,, .~?.;.,, .~....-....~...~. 10. Date of ......... Name of Former Owner,~ ....... '.,~,.:!..L...L../.,,~,..~..,,.....L.,t.,,~.....~..~ .~,,~... ............. 11. Zone or use district in which premises are situated .............. /~[ ..... ~....~...~....'~.., ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~..0.. ............................................... 13. Will tot be regraded ..... ..~...~ ..................... Will excess fill be removed fromj~remis.,es: [ ] Yes tX] No 14. Name of Owner of premises ..... ; ....... ..~.~.~,L...~...~....~/....~....O..~...2,,.f~......~...~.,I,~.~.~,T.'..~,~.Q~.~..~.~.,~.~.~. (Address) (Phone No.) Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ........ ]~t~j:[~`~T-[~e~~`~~~ ....... .?.~...~,....~.~.~.zJ... ........ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines, Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. E~RGEI~ AVENUE STAT/~OF NEW YORK, ) ~ ,-~'~-j~Y ~--, · · ~[ ~ .................... being duly sworn, deposes and says that he ~s the applicant above nan ~ '(_Ne meoJtnd, ~t~l stgm ng co n tra cZ) He s the ..0..0.~[:{~.C~(~., ............................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s dulv authorized to perform or have performed the sa~d work and to make and file this apphcat~on; th~ · ;tatements contained m th~s apphcat~on are true to the best of h~s knowledge and belief, and that the work ~l~lF~l~e~fo~l~j~I t~ ma set forth in the apphc,]t~on fded therewith ~ NOTARY PUBLIC, State el ~/~ No 30 3251965 New York · .,~.,..day of . . ~....~.... ..... 19 2.. .4,~. -- QuaIIfmd m Na,,~al, County otary Pubhe, ~ ~... tV .......... II, I-I ED INSPECTIONS: 1 BEFORE BACKFILLING FOLJNDA- q IDN OP, START FP. AMING 2. BEFORE COVE~.ING PIPELINEi 3, FIN^L WHEN JOB COMPLETED :i . i "7--0 0 7-0 7-0 --q~C Ti OM ~'A