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Home My WebLink About21995-zFORM TOWN OF $OUTHOU) BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .................. ~.~-..~... ............................. ] 9,...~...~...~ 21995 Z Permission Is hereby granted to: ~.~ ....... ./...~..~ .................................. t o....~.....~. ......... ~.~....~ .......... Z~ ........ ~/.../-........~/.,~......~..~ ........ ....//,~ ......... ../...../../..~ ......... ~..~ ............................................................ ~...... '~+ '"'emisGs Ioca* ............................... CountyTax Map No, ]000 Section ...... .~.(~.. ............ Block ....... ~...~.. .......... Lot No....~.~.....~..- ............ pursuant to application dated ........... ...~'.~.....~... ................................ ~ 9....,~...~,,,., arid approved bythe Building Inspector. Fee .................... Building Inspector Rev. 6/30/80 CAROL BEET'~¢,;'~', THE LON~ ISLAND SAVlN6S BANK FSB SUPERIOR ABSTRACT CORPORA TION Pre, ere8 In ~ccordence wBh lhe minimum slandards '.for I/lie surveys as eslabllshed fly lhe ~,I.A.L.E.. an~ approved and adopled Ior such use by The,New York Side Land Tille Assocldion ~r~,~" The woteAsupply ?=nd'sewege disposal ,sys/em= /o~.lhls residence wi# conform Io Ihe Counly The , cesspools shown hereon ore from field observollofls and or{from dela oh/a/ned from olhers. ' , SUFFOLKCOUNTY D~ARTMENT OF HEALTH SERVICES -~ ~OR ~PPROVAC,O~C~S?~UCT~ON O~CY , rev/se lox number SURVEY OF LOT 1" "MAP OF $OUTHOLD VILLAS"' FILED JUNE 25, 1992MAP NO. 9237 A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 70 - 01 - 6.2 Scale~ 1"= 40' March 11, 1992 JUL Y 15, 1992 (foundation) Oct. 23. 1992 (find) ,PE~.t~ ~YOR$, P.C, (5F6~F~6"5 - ~0 N.Y. II~?'l ~ N.Y.$. LIC, NO. 49616 q3 - io1,' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT -TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ...................................... , .. . ~ c~ (Builc~ng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK,,~....'; ............ .. , SEPTIC '~o~ .............. CALL ....... MAIL TO: BLDG. DEPT. ,' : ~ ' ~TOWN OF SOUTHOLD :'.//.q. ......... , 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 PermiL d. Upon approval of this application, the Building Inspector will iss.u.~d a Building,P¢~/fiit to the applicant. Such permit shall be kept on the premises-available for inspeot, ion~th~roughout the work~ ........ ~2 ......... k~. .... e. No building shall be occupied or used in whole or in part for any purpose whatever un~til a Certificate of Occuptmcy shall have been granted by the Building Inspector. ............. ,: ~ APPLICATION IS HEREBY MADE to the Bu!lding Department for the issuance of a Building Permit pursuant > the . B, uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinan es or ',Regulations, for the construction of buildings, additions or alterations, or for removal or den~olition, as herein desc ibed. The applicant agrees to comply with all applicabl~ laws, ordinances, building code, housing code, and regulations, ai td to . admi.t authorized inspectors on premises and. in building for necessary inspections. , :.. :. '. ............ - .... i(Signature ~f applicant, or name, if a .corppration~ State whether applicant is owner, lessee, agent, ffrchitect, engineer, general contractor, electrician, pSurnbb~- 4r builder. b . !. APPROVED AS NOTED ~-m.?-~- ' . .... i.. ~,~, ':~,~?~¢,~. .......................... ' . ~ ~ ' o~o~_' ~-I,~ ~ Name of owner ofprem,ses.. .- ........ , ................ : ................... -- (as on the tax roll or latestl~q'~[F)Y BUIL~I~G DEPARIMENI_~_I If applicant is a corporation, signature of duly authorized officer. FOU.OWI~G INSP£CIIO~$: :. ...................... : ........... .............. . . ~o~ ~o~m ¢9~,~m,.,; ".,' (Name and iitle ~' ' ROUGH I:ltt~!Na:& PLU~$1NG. of,corporate officer) ' guilder's License No ........................... 4. FlOAt - eoN$?RU~IION Plumber's License No ......................... ALL CO~$¥RUClIO~ $HALL M£FT STATE ¢ON$?RUO?ION & Electrician's License No ....................... ¢ODE$~ NO¥ '~i:$PON$1$LE, Other Trade's License No .................... .. ' ,' , ' ' ~ r 1. Location of land on which proposed work will be done... ~'~*-~.~:?. :.. . ~ .~.:.{. .......... . House Number Street Hamlet County Tax Map No. 1000 Section ...~..(.~ ............ Block ...J .............. Lot...~.'.?~.... ........ Subdivision .c'0~$-9...~: .~..9~ .~<.~1 .......... Filed Map No...~ .~.'b'.--~. .... Lot ....'! .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , ~~..~..,.,~.?. ~ ] .~~, :"~ b. Intended use and occupancy ..... :' i,i ' .... · ...... ~'" ' ] '.' ..... 3. Nature of work (check which a~plieable): New Building .......... Addition .......... Alterati~.~ .......... Repair ...... : ....... Remgval .............. Demolition .............. Other Work.. ! .~-~k-~... 4 ' ti d C ee'.. Es mate est ' F ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling nnits ............. Number of dwelling units on each floor ................ · If garage, number of cars ..... I ................................................................... 6. If business, commercial or m~xe0 occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing struetur6s if any: Front ............... Rear .............. Depth ............... Height', ............. Nun~ber of Stories Dlmensio~s,0~,~e: ~ ' Slstructure .................. w~th alteratmns or additions: Front ........................................ Rear ............... Depth ..... ~ Height . Number of Stories ........... 8. Dtmelliflpns,of~4~re new construction Front .../.0. Rear l~nfh ~'O · Height ~, ./ · · Number of Stories I ..... , ,~ 1 I. Zone or use district in which premises are situated ...... 12. Does preposed constructmn wolate any zoning law, ordinance or regulation: .k'~,~ .......................... Will lot be regrahed ..... ~ ...................... Will excess fill be removed from premises. Yes 14.' Nme of Owner of premises ~~ ~.. Address ~.~.~. Phone No..~¢~XCP~ ~.[. '~. Nme of Architect ~ Address Phone No Nme of Contractor ......... ................. Address ................... Phonic ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.~ ...... · If yes, Southold Town Trustees Permit: may be required. PLOT DIAG~ Locate clearly and distinctly ~l~bufldmgs, whe~er existing or proposed, ~d. indicate M1 set-back d~ensions from prope~y Hnes. Give street and block ~umber or desc~ption accord~ to deed, and show street n~es and indicate whether STATE OF NEW YOR.~: ' 3, · · .~ .~ ~ · ;,..O~ ~ ~ .... ~ .~ .., ..~ ................... being duly sworn, deposes and says that he is the applicant ., ~,.. ~ ~Name of individual sigajCg contract) ' rabove named. ~e is the ~~ ' ' ~. , ~ (Contractor, agent, corporate, officer, etc.) , / of said owner or owners ~d is duly] authorized to perform or hav~ ~erfomed the said work and to m~e and file ~is apphcat~on; that all statements contamed m this apphcat~on are true to the best qfhis ~owledge and belief; and that the work will be perfomed in the m~ner 'set forth ~ the application filed therewith. Sworn to before m~i~ ~ ~ ' ' Nota~ Pu ... County ,. Qualified in Su~olk Cou ~" ~ ' ' ~ pp ' n ~ ~' '" ~ ' ' / (S~gnature cfa hc~t Commission Expires December 8, t9~