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Home My WebLink About13172-zTOWN OF SOUTHOLD BUILDING DEPARTM£HT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) N? 13172 Z Permission is hereby granted to: ~ -L- ~.~.....~..~.~~ ........ 2..~..~..o...~:......~1.~.....~.a.. ................................ ~~ .~.~...~.~..~.~ ....... !.!....~..~ ....... ,o ....... et premises located at ~.~..~..0..~. ....... ~ ....... ~.~..~ ............ ~~......~(~.~...~...;...~..: ................ ......... .~.. ....~....~'.. ..................... , 19.'~..~o., and approved by the pursuant to application dated .~: ¼ Building Inspector. Rev. 6/30/80 TITLE NO, 121046E ~i ,¢,0 SURVEY FOR HOWARD ROSENSTONE LOT I, "MAP OF HIGHLAND ESTATES~ AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE MAY 30,1980 SCALE 1"=40* HO. 80'291 GUARANTEED TO: THE TITLE GUARANTEE HOWARD ROSENST YOUNG e YOUNG 40,~AvE~~E RJVERHEAD, NEW YORK~.~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180'3 19 ?.1. Approved .... l )[.me it No..13 Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received..~/ Date ................... 19... INSTRUCTIONS a. This apptic~ition must be completely filled in by Wpewriter 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 ~howing 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. e. 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 perry, it 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. aTdhme i~ PaPulti~°a rnitz ea~ [~; etc°t °Cr~m°~nl Yprea~ihse~lla na~i~ Cbautll~ 'lma; ~g; ~de'icne ssana' ~ '.. ~2~ regulations, and .... to (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ;2e of owne; o~premises...~.~?.~. · .~..g..~/.~..ff .............. ' ................................. (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 d~deY~ .............................. ............................. .... House Number Street Hamlet County Tax Man.No. 1000 Section ..~/.0.~ ......... Block...~ ............. Lot.../~ .'.fl .......... Subdivision .~1~.~.. ~ ............. Filed Map No. ~ ...... Lot.. J ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~... ~ ....................... ~ ................. b. Intended use and occupancy ...[.. ~;~lq~ ~ ~ ................ 3.Nature of work (check which aOplicable): New Building ..... ' ..... 'Addition Repair .............. Rembval .............. Demolition 4 Estimated Cost , 4. (to be paid on filing this application) 5. If dwelling, ' ' ' Number of dwelling units on each floor number of dwelhnglunIts ........ If garage number of cars 6. If business, commercial or ' m~xeld occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurgs, if any: Front ............... Rear .............. Depth .............. . Height ............. Number of Stories.. ....................................................... Dim si f st e w'th alt t' add't'ons: Front Rear en ons o same ructur 1 era Ions or 1 1 ................................... Depth ................... i .. Height ...................... Number of Stories ...................... 8 Di en ion of entire strut' n: Font Rea Depth · m s s new cou c lO r ............... r .............................. Height Number of Stories 9. Sizeoflot: Front ...................... Rear ................ Depth ...... 10. ])ate of Purchase .......... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ..... 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. i ................. Address ................... Phone No. '~,~; r - :~-rt--~-. * ..... /. · Name of Architect ....... ; ................. Address ................... Phone No.-,/~.} ~..'~../. '/..X~' . Name of Contractor ....... i ................. Address ................... Phone No.---- ----.' .............. PLOT mAG A Locat~ clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from propei'ty lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. .......... Alteraiion .. ,~, ..... ..... Other Work ~.~/{~. ,T..~..~..~. (Description) COUNTY ...... ~-~ Y J~"/.' .~.. ~. 2! .............. being duly sworn, deposes and says that he is the applicant (Name of individual sign!ng contract) above named. He is the ...................... . ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly auth. orized to perform or have performed the said work and to make and file this application; that all statements contgined m this application are true to the best of his knowledge and belief; and that the work w~l be performed in the manner set forth in the application filed therewith. Sworn to before me this i ~ , · Notary Publi, c ............ ~ .... ~-~ ~/County ..... ~ ' 80~i1~ PUBIJ~ ~tofe of ~'~ ¥~m~ N (S'g ature o~ applicant) NO, ~.812~8~0, Soffe~k 0~. Tefra ~xpires March ~0,