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Home My WebLink About21713-zFOI~M NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date 21713 Z / ................................................. ~.~..ZZ..~...~.~.. .......... ~..~...,......../,./f..~... ................................ Coun~yTax Map No. 1000 Section .......~..~...~... ......... Block ........ /....,~.. ........... Lot No ........ ~ ................ pursuant to application dated ...... ~ .................................. 19...~ ..... and approved bythe Building Inspector. .... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ............... , 19 .. ^pproved .... .... DisapprovedI a/c ................................ : .... (Building Inspector) ~'.PF! !CATION FOR ~'~ ' ~,r, ,-* ,~,: .... . - ~,,.,1 .....i~ , ~;~',/~ ,T · BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. ClIECK ................... SEPTIC FORH ............. NOTIP¥I CALL ................... IL TO: ,~,, · :' " · INSTRUCTIONS Tiffs 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 sti'eets ~or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tl~is appli- cation. 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 issued a Building Permit to the applicant. Such permit 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 four anWpurpose whatever.until a Certificate of Occupaficy shall have been granted by the Buitdi.ng Inspector. ' APPLICATION IS HEREBY MADE t6 lhe Buil¢ing Department for th~ issuance of- a Building Permit pursuant (0 the Building Zone Ordinanc~ 6f the Town b~ South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal 'or demdlition, 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 in buildingforn$cessaryirt~l~ctj~' ills. iL.t-/ , ~ . . (Si~,nature,,~-'~ of applicant, or ~e,, if a .............. corporation) , , (Mailing .gddress o'f applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene3fii 'coniractor, elebtHcian, plumber or builder. ( o lffest deed) If applicant is a corporation, signature of duly authorized officer. . Builder's License No ........................... Plumber's License No ......................... Other Trade's License No ...................... (Name and title of corporate officer) NOTIP/ BUILDING DEPARTMENT AT 765-1802 9 AM ~O 4, PM FOR THE FOLLOWING INSPECI'IONS: 1. FOUNDATION ~ TWO REQUIRED FOR POHRED CON..RETE 2. ROUGH ~ FRAMING & PL~tBI~I_G ¢ FINAL CONSTRUCTION MUST 8~ COMPLETE FOR ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE N.Y. 1. Location of land on which proposed work will be done ................... ~ATE' ~O~STROCTIU~ ' ~' 'ENERGY' ..... '... e.4ef, t ........... e ................... llouse Number Street Hamlet Subdivision ........ . ............................ '. Filed Map No ................ Lot ............... (Name) State existing use and occupancy of premises and intended use an.d occupancy of proposed construction: a. Existing use and occupancy ...................... L~.~ lq ~:&',L ,,.! .'t,¢,~2 ~ ................. b. Intended use and occupancy..........,. . . · ·" .............. ~'~-'~;~,'"':, ~,t · ,'.," * .... ~,, ................ :3 h ~ppli · Nature of work (check whic cable): New Building ......... Addition .......... Alteration .... ; ..... Repair Removal Demolition . Other Work .~£. ~t . . .... ' '~ (Descr on 4. Estimated Cost ....... . ............ Fe . .................... ... .. .. . .... . i (to be paid on filing this application) 5. If dwelling, number of dwellim, units ............... Number of dwelling units on each floor If garage number of cars 6. If business, commercial or mi.x~d occupancy, specify nature and extent of,each type of use ............... ~ ..... 7 Dimensions of existing structures if any: Front Rear Depth Height Nuinber of Stories ' Dim f · with dditi ensions o same structure alterations or a OhS: Front ............ Rear ............. Depth ' ~ Height ' ' Number of Stories Dimensions of entire new construction: Front ' Rear Depth .Height ... ~ ........... N~ber of Stories ........... ~ .............. . ....... Date of Purchase . .0¢~...'~'Li .......... ~ ....... .. Name of Former Owner ~',~e~.e.,~.~..~...~.~i'.~.~.~. ., Zone or use district in which premises are situated .............. ' ................... ~: ' ', ' Does proposed construction viglate any zoning law, ordinar~ce or regulation .. ~,~$ ............ Will lot be regraded . .gl~ .... · ......... '. ..... _~ ............. Will excess~fill be remosted from premises _ _ Yes __ No Name of Owner of premises .,fo~..ff'~e,.R. t~,y ....... Address btO~.'~. ~.ele~..~.a,~.~. e .... Phone No. Name of Architect I ~ Address Phone No Name of Contractor · ,. Address Phone No ' ~.s this property w±thin i300 feet: of a t±dal wetland? eYes.../e~.... No ......... · If yes, Southold iTown Trustees Permit may. be required. ' ' PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. 9. 10. 11. .12. 13. 14. 15. TATE OF NL~O~RI~,_ fh, ~ S (Name of individual sign: ng contract) above named. He is the... ................... ....... being duly sworn, deposes and says that he is the applicant (Contractor, agent, co~i~orate officer, etc.) authorized to perform or have performed the said work and to make and file this ned in this'application are t'rue to. the best of his kn. owledge and belief; and that the of said owner or owners, and is dub application; that all statements cont~ work will be performed in the manner set forth in the application filed therewith. Sworn to before me this l Commission ExpireuJun~ ~0, 1~- [ , ' ' I, IV IP $2~ VI ~ 14~' NI4~42~E 15,5' $. H 22* O~' W 4, N49%~,9~ W 11,8~ 5. N Gd° 53' E 2.7' CESSPOOL LOCATION BY OTHERS DATUM FOR ELEVATIONS; USC ~O DATUM SOURCE; SUFFOLK COUNTY DEp1; OF PUBLIC WORKS WATERWAYS DIVISION only to ~he per, on for whern Ihe survey !s prepered, and on his beh~ff to the title ~:¢rnpcny, C. over,, enr,~ l.~¢ncy, *.Jnding instI~t~on, if, listed Ilereon~ end to the ossi~;nees of lhe len~z~g ~nstitutlon. Guarantees are not transfcr~ldo to addlti~al Institution~ or s~bsequent owner~ s*~ ~, a violation of $~t;on 7209 of ~1~ HeW York ,State ~:ducatZon Law~ DEEP HOLE CREEK HIGH WATER (~ ~ ~~ /"POST /, _ ~10~~ I0 CESSPOOL TIE = / SS4.~8 DEEP HOLE DRIVE EL = 1~.51 ~ EL -' 14. G2 TM ~ /000- 115-12- 09 CM FD -- Concrete Monumen! , r Found v Coples ~f ~l£-~-~bP~ ~ot bearing , ,the Land surVeyors ernbo~sed seal shall :'not be considered to be a w!id true copy, GUARANTEED TO .' R/CHARD FRERKING PAMELA FRERKING '., i EMPIRE ABSTRACT,CO. · TIT~E NO. .i~~ TOWN OF $OUTflOLD 1995 Show r~ SURVEY OF DESCRIBED PROPERFY SI TUA YE MATTITUCK, TOWIV OF SOUTHOLD SUFFOLK COUIVTY, N.Y. SURVEYED B AUG.,1991 SCALE: I"= 30' AREA =9~912 SF or 0.23ACRES SURVEYED FOR R/CHARD and PAMELA FRERKING S~IRVEYED BY ~ STANLEY J. ISAKSEN, UR. £0, BOX 294 N~W SUFFOLK~ N. Y, 11956 ..~.~