HomeMy WebLinkAbout10261-z FORM 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
CQMPLETION OF THE WORK AUTHORIZED)
N? 10361 Z
Dote .............................................. 19.. .
Permission is hereby granted to:
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at premises located at .~......~z.'.~..ff.~......z~,.Z./'./~-.~...~......ff~..Ct~...~.~.,., ........... : ......................... ' ........
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pursuant to application dated ......... ~..~ffw(s~_.....~.... ................... , 19.7...~.', and approved by the
Building Inspector.
Fee .....................
Bu~ldir~g Inspector
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
November 12, 1980
Richard Oliver
Box 37-F
Little Neck Road
Cutchogue, New York
Dear Sir:
This is to noti~ you that Building Permit No. 10261Z
issued Jzrae 13, 1977 to construct A/G. pool "
will exp--ire~ on De'~ember 13, ~9~0 ] ......
If more time is required to complete the job and obtain a
Certificate of Occupancy, you may apply, by letter, for a
six (6) month extension.
If the work is not completed and the Certificate of Occupancy
not issued after the six (6) month extension period, you are
than required to apply for a new building permit.
Very truly yours,
GEORGE H. FISHER
Sr. Building Inspector
Re; Above - As told in my phone conversation on Nov. 19, 1980 I
am informing you that the A/C pool p~+up under this Building Permit
is no longer in use. It has beeu taken down. We installed a new
In the Ground pool uuder a new Building Permit. Thankyou
Mrs. Arleen Oliver.
-~'~'% ' FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1803
Examined . . / ':
· ~r>. ., 19
Approved. JJd~'.~.f'~../?.. ~Permit No. / .~..~.4./. ,~--~ /
Disapproved a/c ....
(Building Inspector)
Application No../..(4..~. 4'./. ....... IX]
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 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 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 described.
The applicant agrees to comply with all applicable laws, ordinances, buildine code, housing code, and regulations, and to~
admit authorized inspectors on premises and in buildings for necessary ini~5'~'~n~. /' L-,
..... ~'~'4 '~'' '~i~/~'~'L'' 'c' }' ~;a'i 'n'''
(Signature of applicant, or name, if a o p t'o )
..... Box..3Y.-F. Li.t~l~. Neck Rd...,. C~.tchog~e.,.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~
.................. .0~t~o;r.. ........................................................................ t
Name of owner of premises ..... ltlohaaxt. Dlf.ve~. ......................................................
(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 ...... .,~-~.. ~ ............
Plmnber's License No .........................
7-7=
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ............. - .....................................
~7, frO_.~ Little Neck Rd. Cutcho~ue N.Y.
House Number Street Hamlet
County Tax Map No. 1000 Section ... ,/.0..ff. .......... Block ..... Q..~. ......... Lot
Subdivision Sg.~y' .S.h,o?..s ................... Filed Map No ............... Lot 19
(Name)
2. State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... .1. ~.a~..i.ly..D?.e.l.l.i.n~.
b. Intended use and occupancy ........ Pool... 7.../fl.~ * ¢¢... ~. t'.s. ~e ~. d. ................................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .... ......
Repair .............. Removal .............. Demolition .............. Other Work.. ~ooJ- .........
· Fee ............................
4. Estimated Cost ... ~ .~...~. .................... (Description)
(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 ex~sting structures, ff any: Front... 79 .......... Rear .. 79 .......... Depth ...g.8: ..........
Height ............... Number of Stories ....... 1 ................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height . .; ............ Number of Stories ........................................................
9. Size of lot: Front ...................... Rear ...................... Depth ......................
10. Date of Purchase ............................. Name 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 .. I~o ........................ Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .. lt&cho~'etl. 01~.~rer... · Address . L:l.t~tJ~. Neck. Rd .... Phone No.. ?~4.-67./4~ ......
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 whether
interior or corner lot.
STATE OF NEW YORK, S.S
COUNTY OF .................
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .........................................................................................
~ ~ (Contractor, agent, corporate officer, et&) · '
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.
Sworn to before~me this
...¢ 7.6/. .. ............ day of('~ ..~ .......... ,
~oU~,a i,, u,,,o. Co..tv t~> ~ (Signature of applicant)
3. Nature of work (check whictt applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work..
4. Estimated Cost .......................... Fee ............................
(to be paid on fling 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 ... 7.9 .......... Rear ...7.9 .......... Depth .. ~8"' ' '
Height ............... Number of Stories ....... .1 ...............................................
Dimensions of same structure with alterations or additions: Front ........ ......... Rear .................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new constrUction: Front ..... /(,'. ....... Rear ............... Depth .a*¢~.. ..........
Height .. ~.: .......... Number of Stories ........................................................
9. Size of lot: Front .... /d?,.~...' ............ Roar .... ./,~.~/ ............. Depth ./.~.~ .................
10. Date of Purchase ...... ./.~.~. ............. ' ....Name of Former Owner ...~. ~.*~A...~..t/f/~.tt,.~ ......
I 1. Zone or use district in which premises are situated .......... : ..........................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..../b{.o ..........................
13. Will lot be regraded .. bl~ ........................ Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .. ~R;t.eh~...0~y.~.~.... Address . ~}.~.1.o..}lo.o.k..R.d .... 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 whether
interior or corner lot. ~ /,j'"O ,--
STATE OF NEW YORK,
COUNTY OF .~?..~.~.Oj. ~.~. ...... S.S
...... ~. ~ ~. ~ ~ ~'.g... (~../. ~. V~ .,(? ................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
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;and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this ~ .
....... .~./. ~.'/.3 .......... d~,, of.
NorAIlY PU~LlC, $tate af
Ye*lc
No. $0-64074~0 ·
~.OIIflefl in Nass.. County0.] (Signature of applicant)
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