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Home My WebLink About15683-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA~IT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N9 15683 Z County Tax Map No 1000 Section ....... ~..~' ~..~ .... Block ...... ./...~... ...... Lot No ..... I~.~... ..... ..~-,~~......~ .............. , ,,.~.]., ond o..r~,ed b~ ,he pursuant to opphcation dated Budding Inspector. Fee $.~.,,~,.?....~ Building Inspector Rev. 6/30/80 FORInt NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.. 765-1B02 Examined .~."~a.~ [ ~, Approved ~J-~044~1'i[, i9~ Permat No ~ ~'~..~-:~:' .¢ Disapproved a/c t ......... (Budding Inspector) APPLICATION FOR BUILDING PERMIT / -,-° k/to 87 FEB - 6198'i Date off, ¢ .~.. . . ,19~, INSTRUCTIONS a Tins apphcatlon must be completely filled m by typewriter or in Ink and submitted to the Building Inspector, with sets of plans, accurate plot plan t6 scale. Fee according to schedule. b Plot plan showing locatmn of lot and of binldmgs on premases, relatmnsinp to adjoining premises or pubhc sire. or areas, and gwmg a detmled descnptmn of layout of property must be drawn on the daagram which is part of this ap,[ cation c The work covered by tins apphcatlon may not be commenced before issuance of Budding Permat. d Upon approval of this apphcatmn, the Budding Inspector wall Issued a Bufldmg Permit to the applicant Such pern shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or an part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector APPLICATION IS HEREBY'MADE to the Building Department for the issuance of a Budding Permit pursuant to t Binldlng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constructaon of buddings, add,bans or alterations, or for removal or demolition, as herein describ- The applicant agrees to comply ~wath all applicable laws, ordmances, budding code, housing code, and regulations, and admit authorized inspectors on premises and in budding for necessa, w ~nspect~on~ · (,Sagr~(ure at appucant, or name, ii a ~poratlgnl ~.maz±±ng address,or appzzcant) State whether applicant m owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or bmldc (as on the tax roll or latest deed) If applicant ~s a corporation, s~gnature of duly authorized officer (Name and title of corporate officer) Builder's License No Plumber's License No Electrician's Lacense No Other Trade's License No 2 Location of land on whack proposed work wall he done House Number Street County Tax Map No I000 Section ~t//,_~ Block Hamlet Subdivision M~ ~x~'~'/Z)~/'~/~Z~,d~;'~/~ffi,~,led Map No ~ ~-'K Lot ~/ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Exmting use and occupancy b Intended use and occupancy 3. Nature of work (check whlbh applicable) New Budding ...... Adchtlon ........ Alteration . Repar ....... Removal ......... Demolition ........... Other Work..~ffr~.~'~.~.. 4. Estzmated Cost .. a?~. ~ ............ Fee eg-ff ~ ....... (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. Dnmensions of exmtmg strulctures, if any Front . Rear ......... Depth ......... Height .......... Number of Stones ........................................ Dimensions of same structure with alterattons or additmns Front .............. Rear ........... Depth.....t'~'ri-...' --..i Height ............. ...NumberofStones ........ 8. Dnnenslons of entire new construction Front ........ Rear .......... Depth ....... Height ...... iNumber of Stones 9. Size of lot Front ........ Rear ................. Depth ............. 10. Date of Purchase ............... Name of Former Owner ..................... 11. Zone or use dmtrict in wtnqh premises are situated ...................................... 12 Does proposed constructlo9 violate any zoning law, ordinance or regulation- . ................... 13 Will lot be regraded .................... Wall excess flu be removed from premises Yes _. 14 Name of Owner of premises ............ Address .............. Phone No.~.~r~..- Name of Architect .... [ . .' .......... Address ............ Phone No. ~,,~ 7-fiji.-- Name of Contractor ............. I Address ............... Phone No ....... 15. Is this property loca~ted wlthlnl00 feet of a t~dal wetland? * Yes ..... No ..... · If yes, Southold Townl Trustees Permit maybe required. ' PLOT DIAGRAM Locate clearly and dlstmctl~ all buddings, whether existing or proposed, and, mdmate all set-back dtmenslons fro property hnes. Give street and block number or description accordmg to deed, and show street names and mdlcate wheth. mtenor or coruer lot. STATE OF NEW~ YOJR~(, m S S COUNTY OF .xl,.~-'/..--~,--c~.:.. ' ...~-F~yL)/.~. .L . ~(~.t~.. be~ngdulyswom, deposes and says that he is the apphca (Name of md~wdual mgmng contract) above named He is the .... D~~ ......... (Contractor, agent, ~orporate officer, etc.) of smd owner or ownem, ~d m duly authorized to perfom or have perfomed the smd work and to m~e ~d file fi apphcatmn, that ~1 statements contmned m thru apphcatmn are true to the best of hm ~owledge and behef, and that t work wall be perfo~ed m the intoner set forth m the apphcat~on ~ed therewith. Sworn to before me thru ..... &.~ .... dayof~~..,19f7 mota~Pubhc, .~~'~ ~~~ ~ ..... ~~~~ ~ County ~.~~.~ ~ ' ~~~. LOT 20 0 0 0 0 NEW SUFFOLK AVENUE TEST WELL 120 09' LOT ~.1 S ¢5 ° 08'00" E N 87° 19'20" W LOT 44 0 0 0 ¢~ / 120 00' LOT 23 122 09 .... LOT 22 ~ Z Z 0 "MAP SURVEY OF LOT 21 OF DEEP HOLE CREEK FILED JAN 28 ~ 1965 FILE NO AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY , N.Y. I000 115 15 - 25 SCALE I" = 40' JUNE 20 , 1986 ESTATES 4256 P 0 80X 909 MAIN ROAD SOUTHOLD, N Y CERTIFIED TO TICOR TITLE GUARANTEE STANLEY L DANIE LOWICH HELEN E DANIELOWICH 49668 11971 ENGINEERS , P , JR Prepared In accordance with the minimum ~tandards for title surveys as establishes ~y t~ne L. LA.L.S. and approved and adopteu for such use by The New York State Land Title Association. 86 - :342