HomeMy WebLinkAbout12517-z FO]~L~ ~qO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO 12517 Z
Permission is hereby granted tO:. , , . . 4 ~ ~
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co,,~ ...................................... ~x ~ No .............................................. ,000 sec, o.1 ....... ;", ~ '~ "*~'~=~'~ ...................................... ~ ~o, No .... I: ......... ...... ~ ~ ............... ~ .......
pursuant to application dated ..... ~...~.~ ......................... , 19.~.~., and opprov~ by t~e
Building Inspector.
Fee $.]...~..I ...............
Building Inspector
Rev. 6/30/80
klargrave Vineyard
North ForI~
Long Island New York
Cabernet Sauvi~non
Long Island Vineyards, Inc. - Alvah's Lane, Cutchogue,
Bonded Winery No. 637 516 - 734- 5158
N.Y.
11935
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined..~_~...~.k,..,..&.~. 19~'~.19~
Approved ....., Pe=it No.
Disapproved a/c .....................................
................................ .....
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No .... )..~_..~..I..~ .....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 the diagram which is part of this appli-
cation.
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 issued 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 described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and j;egulations, and to
admit authorized inspectors on premises and in building for necessary inspection~~
· Wickham,. W~ckal~am ~. Brass/er.,.. ?..c .............
(Signature of applicant, or name, if a corporation)
Mattituck, New York
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
Attorney for Owner
Nameofownerofpremises Dorothy L. ChapJ_n
(as on the tax roll or latest deed)
If applicant is a corporation, 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..s.o3~ .t,h..s.i.d.e..~-.'.dgl/,e lqo~,.(.C.R...4B.).,. Cutchogu~,. ~%Y. ·
.... / . 7. ! ...... . ..... 8. .................. d/o c,..,. . . . ............... ,...
House Number Street Hamlet
County Tax Map No. 1000 Section ...19.1 ............. Block .... 2 ............. Lot..1.8...3 ......~:.. :.....
Subdivision . . . .N./'.A ............................... Filed Map No .... ' ........... Lot .... ."~ · . .: .....
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....W.Si)..e.ry ............................................................
b. Intended use and occupancy . . . .A.d.d..F.e.n.c.e ......... ~.?*.,~.~ !:..~r,r~ ,~U~iL.¢I..~.~,.1'~'~ .........................
Structure
3. Nature of work (check which applicable): New ~ ...X ...... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
i (Description)
4. Estimated Cost .. $9.00,QQ... i ......................... Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelli~giunits ............... Number of dwelling units on each fioor ................
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 ................... i · · Height ...................... Number of Stories ......................
8. Dimensior}s~of~ent.!~,%eF construction: Bi~fXlen~ch. 120. £e~: Rear ............... Depth ...............
Height .~ .r.ep.~ u. 7.,,. Number of Stories ~
9. Size of lot: Front ...5,8.5 ..... ~ ........... Rear...5~3B ................. Depth 2.41 ...................
10. [)ate of Purchase .......... i .................. Name of Former Owner . Wesley. $imch£ck .............
I 1. Zone or use district in which promises are situated .A...R~s..i.d.e~a.t.i.a.1..a-p~l .A~gr.i.claJ..tpr~aJ. ......................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..N9 .............................
13. Will lot be regraded ., NQ ..... ................... Will excess fill be removed from premises: X~ No
14. Name of Owner of premises Dorothy...... · ....L, .G3.ap.iR .. Address .R.o~.e~..t~r.,. ~1..7.... . . Phone No .......... ......
Name of Architect ......... ~ ................. Address ................... Phone No ................
Name of Contractor ........ i ................. 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 inumber or description according to deed, and show street names and indicate whether
interior or corner lot. i
See Atta ch~l
STATE OF NEW YORK,
COUNTY OF..S. ~..t~...Lt~. ........ 'S.S
.......... .A~..i.g~aiJ, A.. W.i.c~i .................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
S He is the . Attorney. for. ........ ...................................................................
(Contractor, agent, corporate officer, etc.)
~ 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.
Sworn to before me this
........................ day ofj...J..~.e. ............... 19.8.3.
Notary Public ............................ % ...... County
,,~,~.x~ I ' NO~&~Y I~J~ Sa~ 0f New yM~_ I~ 4~ S~Y~k (:(wl~/ ~ .~..y .................. (Signature of applicant)