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Home My WebLink About10088-z FOI~M NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~.o w0ss z ~o~e ..... .~.~,.., ,~..7..~ Permission is hereby granted to: .~.....~..'~....(~ ................ ...~...~: ......... /.z~...o ..... at premises located at .~, .~....,..,~.~ ~//~,~L.~7.....Z/~~~ ?.,~,/~ ....~_~. ~.. ~.~.. ~ ~.~_ ~ ~ ........... ~ .......... : ........................................................................................................... ~....~.~..~ Building Inspector. Fee $....,~.~...X~..... Buil~lin~ Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE . SOUTHOLD, N. Y. E am,ned ......... :. .......... ,//.. .:.. ^pp,,eation ............... proved .......... , Ig.X Perm. No. .... Disapproved a/c ........................... i..Z..'::~ ...................... ~ ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ......... ../..~ ...................... ~.:.?..~... 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 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, os 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 ' ....... ........ ~' (Signature of applicant, or norr~,ff a corporation) ............................................. ............. ,........,....~.z~ ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .¢..~.,:.~:: ~.~z.~ ~...~.... ............................................................... Name of owner of premises ....~.~.~..~....~.~..~.~.~..~ ....................................................................................................... If app~ca/t is a corporgfb, ~s~gnature of duly authorized officer. ...... .: (Name and title of cor~rate officer) Builder's License No ..................................................... Plumber's License No ......... ..~../..'..~..Z..~... ..................... Electrician's License No ..... ~.....~...~::.:~ .................. Other Trode's License No ............................................... Location of land on which p, roposed w,~ork will be done Mop No', (~¢~ f-'~-~ Lot No ~K Municipality State existing use and occupancy of premises and intended usa. and ~o cupancy of proposed construction: a. Exisiting use and occupancy ................ ~~,.~. .................................................................................... b. Intended use and occupancy .......................................................... / 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ~..~/ ~)~' ~ 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 ............................................................................................... . ....................... 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: Fl.ant .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of enhre new construchon: Front ................... , ................ Rear ................. ~ ...... Depth ........................ Height .................... Number of Stones ....................................................... ~ ............................................. / ,' 9. Size of Jot: Front ............ ~....~ ................................... Rear ....~ ................ Depth ,..~..~....~. ............ 10. Date of Purchase ....... ~.~.~ ..................................... N~me 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 ..~[[~l~ .~O~B ~[. Address ~.~.~.~:~.. Phon~ Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ~.~[~..~..[~, .................. Address ~4~J~.. Phone PLO~ DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y 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, QgL(,,_ , (¢ ¢ COUNTY OF ...~ ............. ~ ~'~ ~. .~... ~ ~ /~<. bein~ ...~....~ ................. : ........................................................... u duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) above named. He is the ....~..~..~....~'.~....T~....?..,......~/~..E..~.~......~..~....~Z'../.~..~m... ........................................................................ (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 applicatio~ are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatic/n filed therewith. Sworn to before me this ~ ....... ..... o, ...... ....... , //I,. , Notary_ Public, ........... ~ ................... Collnty .... ~....~..~-...:....~... ....... . '.,~ ......................... il/ ..~u~F~ (Signature of appliCatOr) JANE FLATLEY~' NOTARY PUBLIC, ~;tote of New YorA No. 52-4665418, Suffofl~ County Commission Expires March 30, 9 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY ~THE~E ARE ~ DWELLINGS WITHIN lO0 FEET OF THIS PROPERTY OTHER TH~N THOSE SHOWN HEREON NOTE:B :MONUMENT SUBDIVISION MAP FILEDIN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON OCT. 7,1977 AS FILE NO. 6609 #THE LOCATJO~ OF WELL(W),SEPTIC TANK(ST)~ CESSPOOLS(CPI SHOWN HEREON sURVEY' FOR GREENBRIAR HOMES, INC. LOT 8 '~GREENBRIAR ACRES" AT MATTITUCK TOWN OF SOUTHOLD ~UFFOLK COUNTY, NEW YORK DATE: DEC. 26,1978 I" 40' SCALE: NO 78-829 YOUNG s YOUNG O00STRA.OERAVE.UE RIVERHEAD, NEW YORK ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR NY_S LJCENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR N Y S. LICENSE NO 45893