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FORM
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
$OUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Perml~n ~ hereby granted
....... ~.E.,EE~CE,,CO,.,£~/CI~ODZ.I.O~Z~ ...............
....... EO,,,BOX,.,4Z6 ..........................................................
....... ~A~.I.~C~N¥,,,~l.~52 ......................................
t~R~C~4~CK~D~E~E~N~E~N~H~A~8~D~E~E~C~N~
........ ~C.EL..,D~.,~ND...~..~L.[E~..~Q~ .................................................................................
at premises located at .................. ~Q.....~VE~EE$~...E~ ................................... ~ [ ~U~K .........
CounlyTaxMop No...,.4~5@~ ...... Section ..,[~0 ............. Block ....OOO~ ......... Lot No. G~GG~ ....
pursuant to application dated ...~E~E~B~R ........ ~ ......................... 19..,,.~ .....and approved bythe
Building Inspector.
Fee $ ........ 3; 5 ,, 0.0 .....
Rev. 6/30/80
BLDG. OEP
TOWN (DF S(~OLD,
Examined ....~
Approved .
TOWN OF SOUTtlOLD
BUILDING DEPARTMENT
TOWN ,ItALL
SOUTIIOLD, N.Y. 11971
TEL,: 765-18D2
iI~,;~RD OF Itl:ALT.II · .... ...
.3 SETS OF
SURVEY ...... ~ ........ ~ .
hO~ , DY
HAIL
EzS. , ..................
., 19... Permit ..........
Disapproved a/c '
' ' APPIZICATION FOR BUILDING PERMIT '
· ate
~ INSTRUCTIONS
a. Tiffs ~pplication must be completely filled in by typewriter or in ink cud submitted
sets of plans, accurate plot plan to scale· Fee according to schedule.
b. Plot plan showing location of lot and Of buildings on premises, relati
or are~, and gi'~ing a detailed description of layout of property must be dra
cation·
c. The work covered by this application may not be eomm6need before is
d. [Ipon approval of this application, the Building Inspector will issued a i
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 purp
shall have been granted by the Building Inspector.
: APPLICATION IS HEREBY MADE to the Building Department for the i
Building Zone Ordinance of the Town of Southold, Suffolk County, New Yc
Regulations, for the construction of.buildings, additions or alterations, or fm
Thc applicant agrees to comply with all applicable laws, ordinances, buildin
admit authorized inspectors on premises and in building for necessary i.nsl)ecti
.... '
-- t6Signature
· 6¢
~ship to adj0inifig i~remise~ or public street,
'n on the dlfigtam which is b~Irt of this appli.
uanee of Bmldmg Pemtt. ,
uflding Pe~tf to th~ appficaht. Such pemit
,se wliatever fir[Il a Ce~ificaie of Occup~cy
} :, ., ,;~ ': . ': ,
mance of a Bmldmg Pem~t pumu~nt to ae
k, ~d oth~'a~p~ca~l~ ~w~, Ord~mces or
removal ~r demolition, as here~ described.
:ode, h~ugtng e0, de,~nd regulaQons, and
' . , ' 'f ' ;, '7' .. '
of applicant, of name, ff a cOrporat~pn)
State whether applic)v4 is owner, lessee~rchitect, engineer, general ~ntra6toh electrician, plumbei' or builder·
ir aDplica~"t ;iS/a eor, rr~atiou,)ionature o r d ul~v authorized o rficer., ~ .
Builder's License No .......................... 1 FOUNDA?ION ,. 'I~VO REOUIR[D
FOR POURED CONCRETE
2. ROUGH - FRAMING & Iq,UMBING .
Plumber s L~ccnsc No. 3~ INSULATION
· 'a ' · 4.. FINAL * CONS?RUCTION MUST
E|ectrJc; n s L;ccuse No ....................... BE COMPLETE FOR C.O..
other
ALL CONSTRUCTION SHALL MEET
Trade's
t ~ .... /~ -- // .... ~ ~,., .~' j... ' DESIG~ OR CONSTRUCTION ERROFiS
[louse Number Street I l,']mlet
Couhty~ T.~X ~a'b ~o. ~000 Socdon "....: .........mock ........ :... Lot ..... ' ........
(Name) ,,
',; Stale exist/ug Use and occupancy of premises aud inlcndcd usc and oecupaucy, of proposed construction:
.3. Nature orwo,k (c, heck which applicable): New Buildin'g .......... Addi!tion .......... Alterat~.n__. ......
Repair .............. Removal ..... ,;,.,.... Demolition .... ; $ .... Oilier Work .~ ....
4. Estimated Cost ....... 4 ...... ~ ........... Fee j ...........
~ ~ ](to be paid on filing this nppl. ication)
5. If dwelling, number of dwdling units ............... Nmnber of dwelling units on each floor ..............
,. If garage, number of c~rs ....................................... [ ...............................
6. If busincss~ colnlil'ercja] of mixed OCCHp~H~cy, specify nature ~nd extent of e~ch typ~ of use .....
1. Dt hens OhS ot ex~stmg structures, if any: Front ............... Rear . .~ ............ Depth .............
lleight ............... Number of Stories ....................... ~ ...............................
Dimensions 'of shine stmctm e with alterations or additions: Front ....... ~ .......... Rear ................
Depth .... ~ .................. lleigbt .......... : ........ ,.. Nmn'ber of Stories .... : ......'..;. ~ ......
8. Dimensionsofenfimnewconstmclion:Front ............ ... Rear ..~ ............ ' ' Deptl~ ........
]leight ........... N~mber of Stories [ ' ~ ' ....
10. I ateoflurclmse ................ ~mmofl'or ~e O , e' -~:~ ~' ',~ ·
12. Does proposed construction vio ate any zoning law, ordim ce or re ~u at ~h" ~ . - ~..~ ........
Name of Arclfitect , ., ' . Address ~, , . ........ ~p~
15~' Is this prope,rty within, 300 feet of a tidal wetlandV *M~;&;~f~t~r~lhl~F~~ ' '. '
' . *If yes, Southold Town Trustees Permzt may be reqp~:e~; ........... ,,~,,~.~*~T ,,
, I LOT DIAG RAM ..... .~., ............. ~ '~ b ~
Locate dearly and d~stmctly all bmldtngs w mt mr existing or,~roposec, afl~}ffd4e{~e~'ll:~'t~h'[k d)nens ors fro
,,,.merty hnes. Gtve,~?geband, block number or descnptmn according,to deed, afitJ~s~ow street names an~ ir d cate wheth~
TATE OF NEW Y-OB.J~., ,~ ...... . .
· - · ~ being duly swmn, deposes and says tllat lie ~s~the apphcant
(Name of individual sigsing contract)
mporam officer, dc.) ' '
said owner .or owner~, and is chdy authorized to perform or bare perfou]md th~ said wink andto make- Amd file', r iluf"~" '
plicafion: that all slatements (gq~ained is this application are, hue to the best of!his knowled~m and'belief; find tliat the
~H: will be performed in the man--et'forth in the a ¢ ~lication filed therewith. ~ '
~ ............. ~ ..... ellfi~ in Surf Oun ' , ·
TIE=86.82' ~
R=26.$8
A=40.02'
WA VECREST LANE
XN 75' 00' $0" E
~5'97'R = 1292.69' A=90.05'
FD CM
LOT 45
LOT 44
I
I
METAL ANTENNA
// / '\ V/J MULITPLE GU)' WIRES
\
\
\
\
BOATS \
&
MOWERS
STORED IN
THIS AREA
LOT 45
Fo cM S 75' 41 ' 00" W 105. 94' FO CM
N/F LUTZ
FM# .4682
FILED AUG. $, 1966
TM 1000-100-0.5-02.5
MAP
SURVEY OF
LOT 44
IN
OF SUBDIV/S/ON OF SALTAIR£
SITUATE
SURVEYED 28 OCT., 199;7
SCALE I "=$0'
AREA= 22,$70.5.42 SF
OR
0.514 ACRES
ESTATES
unovth,.r~:~,J .:lto~-.tlo, or oaamo,, ~o m~A TTITUCK,
,urvcy b ,~ viol~llon of Section 7209 o¢ SUFFOLK
the New York State Educalion Law.
TOWN
OF SOUTHOLD
N.Y. ¢op~ ~f t}~t~'survey mc~p not [~eo6n9
the Lond ~urv,:y~rs embossed seal shall
~ot be considered to be a valid true
copy.
COUNTY,
GUARANTEED TO
CRYSELLEN BOUZIOTIS
TOWN OF SOUTHOLD
SURVEYED FOR CRYSELLEN BOUZIOTIS
SURVEYED BY
(.~uar~ntees ~nd~cotecl here on s~l~Jl[ rul~
Chh' to tile perso~ for whom lhe sur~e~ STANLEY J. ISAKSEN, JR.
i~ prepored, and on h~s behaH la Ih~ P.O. BOX 294
filtq cern;thy, ,, NEW SUFFOLK, NY 119~6