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Home My WebLink About9156-z FOEM ~/0, ~ TOWN O~ ~OUTHOLD BUILDING DI/PARTblENT 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? 9156 Z Date ....................... Fm.~eh......3.1 ............ Permission is hereby granted to: .............. //a.~:~_...~.d .......... t~t.t.t%uek ............ to ~..',.~..~.~..~y....o.~.e:...~.~.~..~...~.e..z..~ ~ ...................................................................................... or premises located at ..I.~/.~...~]~:.w..a...~..h..~....?.~.~...h. ................................................................................. .................................................... .~o~It h.cl/~ ........................................................................................ pursuant to application dated ................. ~JJ~ .............. J~..~Jj ....... ~ 19.~.~._, and approved by the Building Inspector. Fee $...,~.,5.0 ......... 1st floor only / ~- Buil8ing Inspector FO:~,~ NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GL£RK'$ OFFICE SOUTHOLD, N. Y. APPLIGATION FOR BUILDING PERMIT Date ............ .......... , ...... INSTR. UGTIONS a. This application must be completely fil[ed in by typewriter o~ 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 ofproperty must be drawn on the 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 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 descrlbed.~,~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations and to adm t author zed nspectors on prem ses and n bu Id ngs for necessary inspections. '4 t,p-' ,, ...................................................................... I ~ .90 ' (Address of applicant) State whether applicant is owner, ~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... ....................................................................................................................................... ..........................a.:~.:.~. ~- ../.'~.~:...,~',; ............................ ~.'f' ~:...o:..:...~::.: Name of owner of premises ..,,. / if applicant is a corporate, signature of duly authorized officer., (Name and title of corporate 'bfficer) Builder's License No ..................................................... Other Trode's License No ............................................... 1. Location of land on which proposed work will,be f~one. Map, No.: ........................................ Lot No ......................... Street and Number ......... ...... (..:....z~..~..~..~/.r..~..:/....,~<..r~..~.~.../d.,~.~'. .................. / ~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ .:.. - b. Intended use and occupancy ..................... Z~.Z?~ .......... ~;~...~.~...~. . .7..~....~..?./. ...... 3. Nature of work (check which New Bull lng,. ........... Ad .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ...... ~4~ ................................. Fee ~' ........... i[;"~';"~;iZi"~'~"~i'li';'~" tfii~;l'~'~;ii~;;ii;;~i .................. 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 ............................ F)epth ................................ Height .....................:..:...Ncimber of Stories ................................ 8. Dimensions of entire new construction' Front . . .Z.~. ~ZT....~.~..;~... ............ Rear ....~../~,.Z~Z~... ......... Depth ,~,~,..~ ...... Height ..~gy.,./~..~: ..... Number of Stories .... l.'.~i .............~..~./~-.-.~-.,.~,..f~,~. ............................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ..... ,..,. ...................... 10. Date of Purchase ........ ./(.~.~.....~.. .................................. Nome of Fort]ne, Owner ~-/~,:.;~.~).?L~..../~.,..~.4..~;~'~-./~..~..'.//..//....." '~-- ~'/'/~'~-- 11. Zone or use district in which premises are situated ...... .Z.~.-Z~...~..~..~/,.....Z4.C/.~...~.z~..Z~.,~..~ .......................................... 12. Does proposed construction violate any zoning law, ordinancez "~/or r~(~latlon:'"z ......... ~..~.. ....................................... 13. Will lot be regraded . ....... .~..~. ............. Will excess fill be removed from premises: ~, ) Yes (,)() No 14. N a m e o f Own e r o f p re m i ses ~/'~.~.4~ ~.Z~..~../~ · ~..~. ~..~r"t~... Add res~/~..~'~.~. ~./~..~..~.. Phone No. ~.~ Name of Architect- ..............................................................Address ................................Phone No, Name of Contractor .../~/~.-/~/4.~c~...//~.../~..~..~.~.~.~.Z;z....... Address/-~.~X.~2,2/.~ ..~,.~.. Phone PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate oll set-back dimensions from property lines. Give street and block number or description according to deed, and show street names end indicate whether' interior or corner lot,,, ¢,,~ .............. JZCzr ......... STATE OF NEW YC).RK .... ~ S S COUNTY OF ........ ..~.~..O.~E ...... ~' ' ....................................... ..T~...~.~..?..~......I~....~_~...~...¢~...?.~., .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~on~o~ 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 / ........... aay o~ ............................................ , i ........ , , / Not,~ P,b~ic,. ............................ :~,--"--~.~.~e.~, Co,,U ......... ~....:.C..,.:.....'.;;;.~ ....... Z:.~,6 ..... ,~..Z ........................ x ~ .... / ~"/ ? ) /7// (Signature of appl'i~a~) -7 ~[I~AB~H ANN ~EVILL~ NOTARY FUlL ~, St~to of New I p. ~ J. Alesci I10.00' Carl ~oergesson NOKOMIS F O, D THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FfELD OGSERVATJONS AND OR FROM DATA ODTAINED PROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THfS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMEN~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY , HS REF. NO.~ NO TE: · ~ MONUMENT NEAREST WATER MAIN- I MILE_+ WATER SUPPL Y-PRIVATE WELLS REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: CARL P. BOERGES$ON & MARY C. BOERGESSON SOUTHOL~ TOWN OF [. SOUTHOLD MAR. II~ 77-117