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Home My WebLink About23813-z FO~e NO. TOWN OF BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~z ~o,, ............ ~/~ .,~.~. Permission is hereby gr$~ted to: ~- ; / , ,,~ /~ / , ..... ~~....~....~//.~..~ .... ~~=.Z~...z.z..~.~... Coun~ Tox Map No. 1000 Section .......... .~.~ Bilk ........... ~ .... Lot No...~ Building Inspector. ,~.~ Fee ............... Rev. 6/30/80 I'll~l.l) iII~H'I:C'I loll i(i~,l'oltr I:OUl'll)A'l' I. ON ( U^'I t': C l.)l li~l i,~ i,i ).,,~ Al)Il ITl ()UAl. C(.)fllql~,i't'l'~J: BOARD OF HEALTH ...... ' 3 SETS OF PLANS --~ .... 'FORM NO, 1 SURVEY ....... , · * TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM . ,... .... .~ , · .~ . ~ TOWN HALL NOTIr¥ P, OUTHOLD, N.Y. 11971 ' /~'2ff TEL.: 765-1803 Examined..,. ....... Z~..,' 19~... " -- / Approved ................ , 19 ~.~. PermR No ~ Disapl~roved a/c ..................................... // (Building Inspector) . / CALL ~ ............ ~ ' ~ MAIL TO: Date . p.c.D.b.er. 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 scheduh. 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· .' e. 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 shalle.be Nokept on the premises available for inspection throughout the work. building shall be occupied or used in whole or in part for any purpose whateve~ertifieate of Occupancy shall have been granted by the Building Inspector. . / . _// . · APPL1CATIO ,N. iS HEREBY MADE to the Building Department for the msuane~, a Builfl.(ng. Permit pursu.arlt to the Braiding Zone ~Ordmance of t.h.e Town of Southold, Suffolk County, New York, ~'d .oJher. a~t!.c,a, ble Laws, Ordinances or Regulati.o. ns, for the construction of buildings, additions or ,a. lterations, or .for r~l~ovlg~or ~molition~ as herein described· The apphcan.t ag?es to comply wit.h all app. licable laws, ordinances, build .m.g e, dde~o¢,~g/~ede, and regulations, and to admit authorized inspectors on premises and m building for necessary ~-6~ry FlarhSer Olsen, Esq. · .P., .Q...~Q)~ ,7.Q6, .~lai. n .Rd., ,Cutchogue,, ,N~ ,1,1,B35 (Mailing address of applicant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrieian~ plumber or builder, Name of owner of premises ...... .Cy, nt.~ia,L,q¢c,,o.~;Qqqq .............................. , ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized offi~r}l ii , ~',~ ! 712U (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ............ ~ ............. Plumber's License No ......................... Electrician*s License No ...... , .... Otimr Trade's License No ...................... 1. Location of land on which proposed work will be done~,.9.5.0..T.°.wn,. Harbor Road·, Southol c~,.,..N.Y. . ,, House Ntnnber Street Hamlet : County Tax Map No. 1000 Section · · .6.4. ............. Block Subdivision ..................................... Filed Map No .... , .......... Lot .... (Nmne) .. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existi g u e and o y A¢¢essorx ~tqr. o, gq .l~u.(] t .............. ,...,,, · nten e use and occupancy ............ I Accessory Garage as built ~ ' I ,X ' Addition Alteration ...... Nature of work (check whic I applicable) New Budding , ,,., .... ,., ....... ' ' " 3, Removal Demolition Other Work , .... : (DescfipIion) ' 5. If dwelling, number of dwelling un]ts , .... . ,,,,,,,,,, Number of dwelling units ' ' ' ' ' ' ' "' ' ' ' ........ nature and extent of each type of use , commermal or mixed c~ccupancy, Depth Dimensions of existing structures fishy: Front Rear ,,,,.. ,/,., ·,, ,.,, ..... ,, ' ', ' ' fSt?es, .... .': '. Dimensions'of same structure wltl~ alterations or addmons Front ,,., · ~,,,.,,,, ,, ear .,,,,, ·,,,, ~,. ? ~., ' Front Rear Dimensions of entire new construction' ' ' ' ' ' ' ' ' ' .... ' ' ' Number of Stories 10, Date of Purchase , ........ ' ' ' i ' ' .... :,,, .... ,, Name of Former Owner , 12, Does proposed construction violat~ any zoning law, ordinariee or regulation: , 13~ .WEll lot be regraded ,,,,,.,.,, ~,,,.,., ...... ,,,, Will excess fill be removed from premises: Yes No Pi No '14 Nam of Own fpr i Ph N 15, Is th~aIproperty located within 300 feet of a tidal wetland~ ~Yes · If yes~ Southold Town Trustees permit maybe'required, ; ,~, ' .. , . PLOW DIAGRAM ' Locat?, clearly and distinctly all building , whether existing: or proposed, and, indicate all set-back dmlenslons from property I~nes, Give street and block n~mber or description aqcordlng to deed, ~and show stree~ names and indicate whether interior or cornerlot. ' ~ i , ; , · See atgached survey RPI lOt/ED RS NOTED -- ~O'H~¥ B ILO~G DEPA~t~T AT 765-~802 9 AM TO 4 PM ~0~ ~ ~OMPL~TB FOB ~.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENT~ OF THE STATE (IONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OFt CONSTRUCTION ERRORS STATE OF NEW YO .Rg, S.S COUNTY OF, .S.U.F .F.0L. ~ ......... i Garv Flanner Ql, s.e.n. (Name of ~nd v dual signing contract) above named. being duly sworn, deposes and says that he is the applicant Attorne. s , . ?,', , , ..... Heis the .................................................... '"" ........ ' ....... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dub/ authorized :to perform or have performed the said work and to make and file this application; trot all statements contained tn this applicat!on are ~,ue [,o the b.e. st of his knowl~ and belief; and that the work will be performed in the manner set forth in tl~e appdcation mod merewim. / I Swo tobeforemet,,,, i " / I' ...... da of ..... ...... i,., / / ,, ~l~.~4~t~;mr~ -~' ' / (Signature o, appucano ~ tn Suffolk ~