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Home My WebLink About13248-Z 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~ ..... .~../.., 19~.~. .~'~..~. !.., 19 $.~ Permit No. ]..~..~,..~..~.~. Approved Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 ail applicable laws, ordinances, building code, housing code,~and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~j~y,o ~TZ~' ~/Z ~ ~ (Mailing address of applicant) State whether applicant~ ~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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../O~._.~. ~... ~ .--- OtherTrade'sLicenseNo...~..~....- .......... County Tax Map No., 000 Section../.~...~. ......... Block....~...~.. .......... Lot..0..c:~....(~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of~,.~7 ?~ il~7~n?,d;se and occupancy of proposed construction: a. Existing use and occupancy . . . 0'....~~ . .~rd'~'~.....~,-/ ............................. : ............ b. Intended use and occupancy .~.~..~. ~f4'/~C....o~.~'' ~-~...c~- 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ..... O..Q .~. Fee ./~,, ~ (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 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 of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of S~ories 9. Size of lot: Front ....~. ,~..~,/_.O. ...... ' ............ ~ ~'' ........................ ; ........ 10. Date of Purchase ..... /t'./. ~.o~, Rear....~/.~. !. ~ .......... Depth . ~..' .~ .~/.. ......... · . . · ........... ..AName of Former Owner . .~ .... : ................. 11. DZone or use d~stnct ~n which premises are situated.. ~.~.~.$..~. ....................... 12. oes proposed construction viqlate any zoning law, ordinance or regulation: .. . ~ 13. NWUa~I lot ~be..regrad? .......jLY~,...?.~, ...... ~. ...... Will e~Fess fill.be remo~eJ from ;remi~e'sl ..... 14. , e°Iuwner°tprem]sest'Y'l~/~'~..~J.°~'~. Jd~°~.AddresdO~t~..~.i,~r.'7~r- ~lP_~ PhoneNo ~ame of Architect ............ : .......... · · · Address Phone No .... Name ofContractor~./~.~'.~a. [~) ':~ ~.~:~ .... "'&i,22,,'22'~,g ' ', ......... ~_. ~-.. · -oI · :~ .- ..... a ..... aauress .. yj.r..r~.[W.,'4~.cl~' .. Phone No '"~-ct 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 COUNTY OF ~'.q~.oj./.~'--. S.S (Name of individual signing contract) above named. He is the (C°ntract°rOcorporate 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 ~~ ..... County //~ /~ ~u~uc,~..~,~ .... ~. ~ ..... ~ ............. 850 $uflO k ~ 52.8125 , ~ .... ~ -- ~ (Signat~of applic~t) MAIN OF CAPV~IN KIDD LOX'lO I LOFII 'VISION- ", KNOLLS'; S.C. F/L~ NO. ~0~$ 405,40 ° A/tEA = I~. 40~ ACB£S RiI ~,',:Le. L;NA'~ OI~K ROU~Y fLEA~8 D~-PART~! o~ for Lhis lccatlon have beon b~ %hfs d~oar%mon% ~]d found Chief of General ~gineerlq ~ARTMENT-DATA FOR APPROVAL TO CONSTRUCT TEL. i~ · 8TAKE SURVEY FOR ANTHONY DRIS 8~ HELEN DRIS AT MATTITUCK TO~N OF $OUTHOLD .~UFFOLK COUNTY~ NE~ YORK SEPT. 2~ DATE: .JULY 2~ SCALE: I"= 20C NO. 82-39: _# UNAUTHORIZED ALT£RATION OR AODITION TO 1~15 'YOUNG a YOUNG ALDEN NV. YOUNG, PROFESSIONAL ENGINEER ANt) LAND SURVEYOR N Y.S. UCENSE N0.12845 HONVARD NV. YOUNG, LAND SURVEYOR /qY5 LIC'£NSF NO 45893 400 O.~TRANDE RIVERHEAD, Ni