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FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10665 Z Date ..l:f~....<f:............................., 19tfO
Permission is hereby granted to:
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at premises located ~S~?d......M./i!7#....;?JA,P-............................................. ... .
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pursuant to application dated #A/CC.r.(.....Z:.s::........,.."., 1%;1-:-0, and approved by the
Building Inspector.
Fee $./~~....
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TEL. 765-1802
TOWN OF SOUTH OLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOVTHOLD, N. Y. 11971
May 13, 1980
Twin Fork Fence Co,
P,O. Box 41,
Mattituck, N.Y,
REVOCATION: B.P. #10665Z - JOHN XIKIS
North Road,
Greenport, N.Y,
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Your Building Permit is being revoked in accordance with
Art. XIV, Sec. 100-142 A. & B. of Chapter 100, Code of the
Town of Southold, N.Y. for the following reasons,
Subject property is located in a "B" Light Business District.
ART VI, See, 100-60 does not provide for fences in regulations
for this district. Application did not state zone district and
permit was issued in error,
A Zoning Violation exists on above mentioned premises,
Inspector
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FORM NO.1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL , -
SOUTHOLD, N.Y. 11971
TEL: 765-1802
Examined H.4~. .!......, 19 to --, Application No.fo.C6. ~. . . . . . .
Approved flr<?~..f......, lc0.ihennit No. .I.Q~{~~
D' d / - /
Isapprove a c ....... .-:-; . . . . . . . . . . . . . . .
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APPLICATION FOR BUILDING PERMIT Date.. .qjt!fJ?:... .. ...., 19 ,~
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 prcmises 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 Pennit.
d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit
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 Penn it pursuant to the
Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances 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 regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
. . . . ~T'-Y.I.(\. . . f:qf".~. . .P~""!I:~. (A: . . . . . . .. .
(Signature of applicant, or name, if a corporation)
RQ:.8o.,*.. ~IJ.. .M~+:I:"+'\oi.<:.-K. .N. Y.........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. .... .c,.fH1~~~. . . . ... ... . .. . .. . ... .. ... . ....... .... .... . ................ ..... . . ....... ...
Name of owner of premises .. ~~~.0. . . 'I.. \ K \ .~... .. . .. ... . ... . .... . .. ...... .... .... ... .... .. .. ... ...
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
......... .~.'. .\~<?y:~.,.~'()~~................
(Name and title of corporate offIcer)
Builder's License No. . .1!'. !..-r.. . . . . . . . . . . . . . . .
Plumber's License No. ........................
Electrician's License No. ...,..................
Other Trade's License No. .....................
I. Location of land on which proposed work will be done. .................................................
4 ~~c(?r{J........ Hp.~T.I-f.. .f".4-1>.................... ::?~d.O..,,\~.... .~~t:<?o.~........
House Number Street Hamlet
County Tax Map No, 1000 Section .. (!!J(r:. . . . . . . . .. Block ....o.?.......... Lot.. €YOI. . . . . . . . . . .
SubdIvision, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot.............., ,t
" (Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .,
, a. Existing use and occupancy . .C:l()~.-: .~fl'.Ji.' d!<V~'\\!~'1""""""""""""""""""
b. Intended use and occupa!lcy . .D.f,\~.,... .~; ) t . . d!J.?~h~l' . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . .
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3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition. . . . .. . ... Alteration ~........-,.
Repai, .............. Re~oval . . . . . . . . . . . . ., Demolition .............. Other workf<}-(\c,\>:'j . , . . .
J 1 . , '.:;?f (Descrip ion)
4. Estimated Cost. . . . .-1!. .. <'-PI!? I R9. . . . . . .. . . . . . . . . . . . Fee. . . . .~.l).q. . . . . . . . .. . . .. . . . . . . .. . , . .
(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 mix~d occupancy, specify nature and extent of each type of use .. . . . . . . . . . . . . . . . . . , .
7. Dimensians of existing structures, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth... . . . . . . . . . . . .
Height ............... Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
,
Dimensions of same structure with alterations or additions: Front . .. . . . . . .. . . . .... Rear..................
Depth. . . . . . . . . . . . . . . . . . .:. . . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . .
8. Dimensions af entire new construction: Front. . . . . . . . . . . . . .. Rear............... Depth ..... . . . . . . . . . .
,
~.eight ............... r;um~1jof Stories. . . . . . .. . . . . '3'76' ./. . . . . . .. .. .... . . . . . ',a'o" ',' ... . . . . .:.
9. ,)IZe ofJot: Front ....... . . 9. . . . . . . . . . .. Rear...................... Depth ........ ~. . . . . . . . . . . .
10. Date of Purchase ..........'................... Name of Fonner Owner ........................... \ .
11. Zone or use district in which Premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction viqlate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ....... ~ . . . . K . . . . . . . . . . . . . Will eljess fill be removed from premises: Yes No
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'14. Name of Owner ofpremises"Jd t:'. '1-.. }",:......... Address . ,~. \?J.. .~';L~~Id.. Phone No. . 71tf.-: ff7pj...
Name of Architect. . . . . . . . .'. . . . . . . . . . . . . . . . . . Address. . .. . . . . . .. . . . .. . . . Phone No. . . .. . .. .. .. . ...
. Name of Contractor .... .. . .,. ... ..... ..... .... Address.. ...... ...... ..... Phone No. ,........,...,.
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PLOT DIAGRAM ' /..
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Locate clearly and distinctly ~I buildings, whether existing or praposed, and, indicate all set-back dimensions from
property lines. Give street and bloek nu ber or descriptio accor . n eed, and show street names and indicate whether
interior ar corner lot.
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STATEOFNEWYORK,~ ~ I SS
COUNTY OF .. .. ..~~ . .\....' .
..... .. .~: .'P~~~.\M.I')~ .'.. . . . .. . .... . ........ being duly sworn, deposes and says that he is the applicant
(Name of individual sigping contract)
above named. '
He is the . .c..~.~-:\-~~:.-. . ., .,.... . .... .. ......... ..... . . ...... " ... .. . .. .... . . ..... ..............
, " (Contractor, agent, corporate officer,'etc.)
of said owner or owners, and is dJjly authorized to perform or have performed the said work and to make and file this
applic:ation; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be perfonned in the man*r set forth in the application filed therewith.
, Sworn to before me this
,
. . . . .. . . . . . . ./Fif:. . . . . .day of. . . . . . . /711, . . .. ., 19~ ,
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Notal~'~' ~. County ,
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NOiI'ARY pua ,Stat. of New YOfk ...... .
, No. 52.8125850, SUffolk ~ (Signature of applicant)
rorm EMpires Mltoh 30. 19
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