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Home My WebLink About22859-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / __ 22859 Z Permission Is hereby granted. ¢ , ...~-~ .4 ....2'..~~...~~~ ....... .... ~.......~¥_~..... ~..,. ....... ............. ~~~.. ......... z¥.~:. ~~....+:..:~.,>:...~.~, -~ ..~...-.~.~ ......... O'/".._ ~_ ...~......,;~.. ,~. ' ,. CounlyTax Map No. 1000 Section ...... /~.,. Block .......... ~.. ........... LotNo../..~.. ................. pursuan/to app,ica,lon dated ............ ~~...L~ ........... ,9.~... ~d opproYed by,he Building Inspec~;;~ Fee $...~...¢~.....~.. Rev. 6/30/80 ROAD CM N 88 ~25 'LO" W /0. O0 A; Z8.54' $ FRA ME Guarantees indicated here on shall only to the person for wborn the survey is prepared, and on bls behalf to the title company, Govermontal Agoncy~ lending institution, if listed hereon~ and to the cs~i~ees of the lending institution. Guaranlees are not transferable to additional ~nstitulions or s~,bsaquent owner~. Unauthorized alteration or addition to thls s~.rvey is a violation of Section 7209 of ~h~' t,.ew York State Education Law. Copies of this survey map not bearing the Land Surveyors embossed seal shall not be cons:.dered to be o valid true copy. CM 6'CL So O, l' 86°26 45,56' LOT 17 F/LEO SEPT B, IBG5 TM ~ I000 ' 115 - O~ -24 GUARANTEED TO: VINCENT I~ ORLANDO TRACYSU~' OR£ANO0 SUPFOLK COUNTY N4TIONAL BANK ,~M~'t~ICAN TITLe' IN~. CO. TOWN OF SOUTNOLD SURVEY OF IOT I5 IN MAP OF SUBDI VISION FOR MATTI'TUCK ES TA TE$~ INC. ~ITUATE MATTITUCK, TOWN OF SOUTHOI D '" SUFFOLK COUNTY~ /V,Y SURVEYED FOR VINCENT M. ~ TRACY~UE ORLANDO SURVEYED 22,,MAY 92 SCALE-: / '=30' SURVEYED BY . , ~¢ STANLEY d. ISAt~$EN, JR I .~ t?0. BOX 294 ~ ~ // NEW SUEF~, NY, 92R479 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ttALL $OUTHOLD, N.Y. 11971 BOARD OF IIE^LTII 3 SETS OFV..~LA~S ...... SURVEY' . ......... C,ECK ............... SEPTIC F 0 I(I'1 Disapprov4 .................. ~i~'..~..~' ' :' · ~PLICATION FOR BUILDING PERMIT CALL ', · ti^IL TO: INSTRUCTIONS ' a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s.ets of plans, accurate plot plan to scale. Fee according to schedule. ; b. Plot plan showing 19cation of lot and of L~uildings 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 wllictl is part of this appli- cation. c. Tile 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 Permi~ to tile ~pplicant. Such permit shall be-kept on'the.premises aviii.lable forhlspedtiou"ihrougho,ttt tile work. c. No building shall be occupied or used iu whole or ill part for any purilose whatever until a Certificate of Occupancy shall have been granted bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for tile issuance of a Buihling Permit pursuant to tile Bnikling Zone Ordinance of tile Town of South')Id, Suffolk County, New York, and otl!er app icable Laws, Ordinances or Regulations, for tile construction of buildings, additions or alterations or for removal ~r demo trion, as herein described. Tile applicant agrees to comply with all applicable laws, ordinances, buikling code, housing code and regulations, and to admit authorized iuspectors on pre~nises and in building for necessary'inspecti~ ]~.~ (Signatur9 of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant i lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o£ premises .... .~,/~. ,~.. ?..~.: O~.t~?, .~. O .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signatnre of duly anthorized officer. (Name aild title of corporate officer) B ulder s k cense No .................... Plumber's License No .............. / '; ........ Electrician's License No ........... ,~/3 .......... Other Trade s License No .......... .~. ........ 1. Location of land on which proposed work will be'done ................................. :. ................ D. ;2_ .a..... llouse Number Street llamlet Cot,,',ty 'Fax Mat, No. 1000 Section ...'.././.~.~''. ....... Block ..... (o ' Lot...~..I.'2 ........ Subdivision ~.aT'~.~l~ 6~. ~'~3~'~ t .~ ......... Filed Map No. ~/~/~ . .1.~ ...... ". ....... ' ..... .............. Lot .......... (Name) . 2. State existiug use and occupancy of premises and iulended n~ and oc'cupancy of proposed construction: a. Existing use and occnpancy .,..' ........ ~ ~.~:: tc .~ g ~,:d ~¢ ~a~o8 , ' ..... '~¢[~t 0;. :c'.~'~ O 'd~ ....................... J. l,h~ttuc ot ~tJ~ t, cncc~, w c atiPncable) New LtuUding .......... Addition .......... Alteration .... ; ..... Repair Reln6val ..... (Description) 4, Estimated Cost .... .'~..c~O:..O.O. .................. Fee .................................... (to be paid on filing this application) 5. If dwelling, number of dwellingiunits .. ~.0'7 ....... .,. Nuthber 6f dwelling units on each floor ................ · If garage, number of cars . .<:~-'. ~...//,?.~.'7 ............................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of,each type oi; use 7 D' ne~s'o~s ofex~stmgstmctur6s ifa.y: Front Rear Depth lleight Nmfiber o£ Stories Dimeosions of shine stmctu(e " ' ' ' Front Rear w!th alterahons or add~bons: ................................. Depth IIeight , Number of Stories 8. Dim6nsions of entire new construction: Front .............. : Rear ............... Depth ............. Height Nuo!ber of Stories 9, Size ofl0t: Front ......... ~ ..... : . Rear~.. . Depth_. .................... 10. Date of Purclmse ,. ~.~,.~. ..... ', Name of Fonner Owner 11. Zone or use district in which premises are situated 12, Do s l roposed o~ strt ct on v o ate any zonm aw, ordtnatxce or regulation: ......... 13 Will 10t b d I ' Will fill b d fr p ise 14 Nmne of Owner of premises ..:.. , PI N ...... ~ ....... Address ................... rune o.. Name of Arcbiti~ct Address Phone No Nmne of Contractor ' Address ' Phone No 15,' is this property within 300 feet of a tidal wetland? *Yes ...... ...~. ........ ' *If yes, Soutbold Town Trustees Permit may. i~e required. PLOT DIAO RAIvl Locate clearly aod distinctly alli buildings, whether exisfing or proposed, and, indicate all set-back dimensions fr~m property lines. Give street and blockinumber or description according to deed, and show street nanles and indicate whether interior or comer lot, ~OU,~rq CONCRETE' 2. ROUGH ~ FRA~,~NG f P~.U~BI~G 3. INSULATIO~ 4. FINAL CONSTRUCTIO~ MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMEN~ ~F THE N.E STATE CONSTRUCTION & ENERGy CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERroRs STATE OF NEW YORK. ._ i,.. COUNTY OF...,,a.- · · ..~..' to' ~"P"~//~ i~'~ .......... ' bei,, swot,,, de osea aays that i,e's t,,e app,,ca,,t (Name or individual sigdin~ contract) above named. Itt is the .., [dlq~.~".O..~.~..O'-,/~. · ........................................................ ' ' ....(Contractor, agent, cor'porate officer, etc,) ..... ' ..... of said owner or owners, and is do y authorized to perform or bare performed the said work and to make and file tbls ap ~hcat)o,; that all statements contained m tlns'apphcahon are true tO the best of his knowledge and behef, aud that tile work will be perfo.ned in the manner set forth in the application filed therewith. Sworn to before me this ..................... ', . ,day of ......... .A/...~. ' .., 19 . N~ Public, ~tatt of Ne. YO~ ................... No. 0iKL5040798 , (S~g.ature of apphcant) . aualified in ~uffolk County' {;emmisaion Exi~ir~i March 20, 1 ~ ' '