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Home My WebLink About23644-z FORK NO. f TOWN 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) 4 Z .. 23.................. 19.Y236 4 Date ........ .. . ...... . Permission is hereby gronyq�d to: n/ % .........�°�2 ... ...� .�....... .. 0................... .. .. ........................ ... ... . .. .,1V ..... . ........ .... to 4a '211 ..• • .. • •..• ` • .. • • .•••.•..• 4 •. _ . ofremises located at ............. 7... ....... t. . . .. .... .. .......................................... ..................................................................... ..•.....................•.•..••........................... County Tax•Mop No.••1000 , �... Block ....... ./...........•Lot•No. ..�..:5 ........' Section ......./ . pursuant to application doted ...........124--C74 . 4t .................. 19.2( and approved by the Building Inspector. Fee $....a r ..... ..... ... .. .... ............. Building Inspector Rev. 6/30/80 09/13f1995 08: 49 5167347702 DEBORAH DOTY ESQ PAGE 04 ' N r �Q fE,�sr1 r+.T b LAMo o �+• tE 9 � O f lot -�rywLEr�.8g,�t�91cy,�,oe•c�yvicz /s�Z✓rxe.�Y w LEssii�sv�,c�i Locorraw.C�rt,.Kxrc �•os�v s�.�t�mc /i2-z�/iS •.+�rri i�rsvo w.S/ is M � BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF_PLANS. : : : : : : : : : : : : : : : U TOWN OF SOUTHOLD SURVEY A . . 6 1996 BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALI, SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 gam'•DEPT. TEL: 765-1802 RIOT IFY: '� L ()F Qeu ffwu n CALL . . . . . . . . . . . . . . . . . . Examined._ a3, 19 S MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved.. .... . . ., 19 ,o Permit No.�...... ? .................................... Disapproveda/c .................................. ..................................... ........................................ .. ...... -- . .......,. (Building Inspector) AP ICATION FOR BUILDING PERMIT Date.X(. . . . . . . . . . . . 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 mist be drawn on the diagram which is part of this application. 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 issue a Building Permit to the applicant. Such pernmit 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. APPI.ICAPIIN IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ?.one Ordinance of the Town of Southold, Suffolk Canty, 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 admit authorized inspectors on premises and 'n building for essary.i tions. ( •ure of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of. premises .......f:! !4C.. ...`:`:.!L :P.......A'IIC.� �L...(T.. c..`.P^.................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No.'/' Yuk rY' c.kcl�. ^ ! Plumbers License No. ......................... Electricians License No. ..................... Other Trade's license No. .................... 1. Location of lard on which proposed work will be done..2 s-F. s- q 0! ..��.............................. ............1....?.............�!.' .....................................C�z7C,�.o�v�...J.� House Number Street Hamlet .�• County Tax Map No. 1000 Section ...../().D_... Block ..........I .... Lot ........./:!L Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of prcpises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... 1�g S L vyie ................................................... b. Intended use and occupancy ............................................................................. 3. Mature of work (cix-ck wlri(1► applicable): New Ituilding .......... A(klition .......... Alteration .......... Relkrir ............ Removal ............. Dermlition ............ Other Work ..... ............ (Description) 4. listirrxrted Cost ....S.2 ........ fee ....� ... ............................. (to be paid on filing this application) 5. If (kael I ing, ruri)er of dwelling units ............ Iluidwr of dwel 1 ing units on each floor ................ Ifgarage, rxni)er of cars ...................................... 6. If lxrsir►ess, comrercial or mixed occupancy, specify nature arxl extent of each type of use...................... 7. Mimnsions of existing stn►ctvres, if any: Front................ Rear ............... Depth ................. ileigtrt ......................... Nurirer of Stories ...................... Dimensions of same stn►ctzrre with alterations or a(klitions: Front ............... Rear ............... Depth .................... ileiglrt .................... Nrniwr of Stories ............... 8. Din►ensions of entire new constmction: Front ................ Rear ............... Depth .............. lleill►t ......................... Awd)er of Stories ..................... 9. Size of lot: Front .................... Rear .................... Depth ..................... 10. Mite of 11urrchase ..................... Nalne of Former Qaner ........................................ If. 7Awbe- or use district in vhich premises are situated .............................................................. 12. Does proposed constnx-tion violate any 7cxiing law, ordinance or regulation: ........................ 13. Will lot be regraded .................... Will excess fill be removed from premises: Yl?S N0 14. Names of Omwr of premises ........................... A(klress .............................. 171►one No. .............. i'-me of Architect .................................... Address Plxme No. .............. Nam of Contractor ................................... A(klress ...............................ibone- No. .............. 15. is this property within 300 feet of a tidal wetlaml? * YI-S .......... N0 .......... *if.- yl-.-S, S(111i1m www nonju-s Puma MAY ill, itF palm. PLOT DIAGRAM t,ocate clearly aril distinctly all Imildings, whether existing or proposed, aril irxlicate all set-back dimensions from property lines. Give street and block mvi►er or (lescription according to deed, and show street nares arxl irxlicate 411 uhellwr interior or corner lot. �ilA'Il: (A. MZd Y(Aw' /- SS) (A' S xot l ........... �.. .........��:................. ..Ix,i ng (duly worn, delxuses arxl nays that he if-, the applicant (Nam of irx]ivid(r'rl signing contract) alcove rvIt"l, Ileis t_Irp .................... .. ............................................................. ((rnrlractor, ag t, corporate officer, etc.) of said uar►er or owners, arxi is duly authorized to perform or have lrerfornred the said work aril to rmke aril file I_his al>[)1 ication; thali al l statrvmnts contairxxl in this alrpl icat ion are t:ruxt to the tryst of. his krxrwledle aril lxtl ir'F aril that the work wi 11 lye perfonrre(1 in the rrrrnne.r set forth in the appl icati(n filed therewith. `#corn to I .fore nrrr this a .......6� .... . ay of Notary Public .. . .. CLAIRE L.GLEW (Sil;r>rture Al I icant) Notary Public,State of New York No.4879505 Qualified in Suffolk County Commission Expires December 8,19