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Home My WebLink About15735-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_ 15735,z Date ...... jr ..................................... , 19 ....... Permission is hereby granted to: /~ , ................ ................. '~ ..... ~ .... ~.....~ .... ,~j. , ..~./.~.~... Count~ T~x Mop No. I000 ~cbon ........ l ........... Block ........ .L.~....,,., ot No ............. ~ur~uon~ ,o o~,,l~ot,on ~ot~ .....~..~....~......~. ................... .1~..~..2 on~ op~ro~ ~ t~ Building Inspector. Building Inspector Rev. 6/30/80 , ,'-.1:;;: I Examined . .~CL~.~.O..., 19 Approved .~/¥~3~.. ~.~.., 19~. ]. Permit No.~..~..~.~.~...~:' Disapproved a/c ..................................... (Building Inspector). APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: 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 g 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, building code, housing code, and regulations, and to inspectors on premises and in building for necessary inspections. admit authorized .~.~. ~.~.. ............ (Signature of applicant, or name, if a corporation) .9.39..0.! .e..q ~ j .e..L.a. :..M.a.t..t.i.t.u.c..k.,..N.y..1.! 9..~.2..' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·...C.o.-.O~ p.e.r. ....................................................... A,~;~,5~{9¥~. &~.~ · ...... N~m~e of owner of premises .0 O h-~.. P. .a.n d. LJ.nd 8..E... l(o~.81 s kJ ..... (as on the tax roll or la~fest §ee~/) ~/ ~ /.., If applicant is a corporation, signature of duty authorized officer· ·..N/.P,. ........................................ (Name and title of corporate officer) · FooNDA'rtoN ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... TH~ 1. Location of land on which proposed work will be done... 8 e s J.de 9 g J.a Natt~ tuck .93.Q .03a..au.la..Lane .......................................................... : ............. House Number Street Hamlet County Tax Map No. 1000 Section ] ] 4 Block ] 2 Lot ] 3.4 ~u/7/83 d ' Christine King Ninor Subdivision Lot 4 bdtvmmn..OEP..ag~..~iO¢~..~0~B.].~k~..&nd .... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ...~ } J ~P.q ~ Al.. ~9~..~9 FJ.q~ ] ~P.E~]. ~.q~e...{ ~.l.l.} ¢9.) ............. b. Intended use and occupancy . .~ame..(.wi Zh..fen.ce ) .............................................. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair ........ ~ ..... Removal .............. Demolition ..... ......... Other Work...F.e.n?. e. ....... (Description) 4. Estimated Cost ....$.7.5.: .0.0 .... , ....................... Fee ...................................... ' (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 ............................................. :" ....... : i ................ 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 ............... Numb6r of Stories .............. ; ....~ .......... ' ........................... Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i Height ...................... Number of Stories ...................... -8. Dimensions of entire new construetion: Front .......... ' ..... Rear ............... Depth ............... Height ............... Number of Stories .................... .................................... 9. Size of lot: Front ......... ~ ............ Rear ...................... Depth .~ .................... 10. Date of Purchase .... ] .2./.8.... ~ ................ Name of Former Owner ~ .e .f f.k.e. ~1. ~ ...... A-80 Residential and Agricultural 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 ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address.. .................. Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......... ~ ............... Address .... : .............. Phoni No ................ 15. Is this property located w£thin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRA~ Locate clearly and distinctly all b~ildings, whether existing or proposed, and. indicate all set-back dimensions from ?roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :.nterior or corner lot. .iTATE OF NEW YORK, S.S 2OUNTY OF .$U£.EOL K ......... LINDA F. KOWALSKI ............................... , .................. being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) ~bove named. co-owner ~te is the ......................................................................................... (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this tpplication; that all statements containSd in this application are true to the best of his knowledge and belief; and thatthe york will be performed in the manner set forth in the application filed therewith. ;worn to before me this ' ...9.t.h. .................. day of.., .... ~a.~ .c.h ........... 19.8.7. ' Suffolk ,lotary Public .................. Cou ty (Signature of applicant)