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Home My WebLink About21655-zFOBM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ 21655 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of THE WORK AUTHORIZED] Date .....~../. ,,/./. ............................................... 19,?.~,... Permission Is hereby granted t~ , .................... .................................. to, ~ ....... ~..~.~.~. ......... . .~:~....,.~ ........... at premises located at ........ .~,..~....~. ....................................................................... County Tax Map No. 1000 Section ...... '.~.,,.~,,, ......... Block ........ ~ ............. LotNo. ~ pursuant to application dated .....~,./,/. ........................................... 19..~..~ .....and approved by the Building Inspector, Fee $.,~r.. ........... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ......... 1~.. Permit No...~../.e.?.3..'7. ~:~ Disapproved a/c ' BOARD OF HEALTIt ......... 3 SETS OF PLANS ......... SURVEY HAIL .... :i ". ......... "' ' -Inspector) ....... APPLICATION FOR BUILDING PERMIT Date .~.'.ff.P.. t.. ........... 197.~. , 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 sti*eets 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 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 for any purpose whatever until a Certificate of Occupancy shall have been granted bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South')Id, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describbd. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary i~s2,~;tZ/] ~ ~ ' --' . (Signature of applicant,' ~r name, if a corporation) c 14:/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises .~.l(.~.~e¢~....~... ff_~ .Z../~'../. ~'.f*(..Ut....M.,.../7/..~.~.~..~,~. ..... ~ ..................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~.'.~.~..~. .............. Plumber's License No .........................-'/ Electrician's License No. Other Trade's License No. 1. Location of land on which proposed work will be done. ' ...... House Number Street Hamlet cotmty Tax Map No. 1000 Section ...: .~ ~ .......... Block .... 0~. ' Lot...3 ~ ............. Subdivision ,(~Ot~° ~ o~- c~ r-,-~ Filed Map No. ~51 Lot .~.. (Name) 2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~.. b. Intended use and occupancy ................ ( k whi h ~ppli ) Additi ' ,3. Nature of work chec c cable: New Building .......... on ...: ...... Alteration .... ; .... Removal Demolition , Other Work Repair .............. . ............. . ............. . .... ' '~ ~Sc0 (Description) 4. Estimated Cost ............ ·: .o.o. ..................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ................ Number of dwelling units on each floor ................ If garage number of cars ' · 6 If business commercial or mixed occupancy specify ............................................... · ' nature and extent of each type of use 7 Dimensions of existing strucfi:r'es if any: Fr&nt ' ' .................... · Rear Depth Height Sum~er of Stories "dt')i ........................................ Dimensions fshm truct with alt rati or additions: F o e s ure e ons ront ................. Rear .................. Depth Height ' Number of Stories ' · D~mens~ons of entire new const~, ction: Front Rear Depth Height 2 Number of Stories .............. :' ' ..................... . 9 Size of lot: Front i Rear ............................. · ' ........ '' .................................. Depth ...................... 10 Date of Purchase . · · ......... ; .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ! gl ...... ;; ................... ' ...................... ' ..... .12. Does proposed construction rio ate any zonin aw, ordina ce or regulation: .......................... 13. Will lot be regraded . ........ ~ ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. i ................. Address ................... Phone No ............... Name of Architect ......... ~ ................. Address .... Phone No Name of Contractor ........ : ................. Address ................... Phone No ............ ' .... 15.' I.s this property within BOO feet of a tidal wetland? *Yes ........ No ......... ~If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA/VI ocate clearly and d~st~nctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORV~_ COUNnLY OF .... ~,j.¥.~.kv:-.... (Name of individual signiqg contract) above named. NOTIFY BLItL~ING DEPARTI~4~r ~ ' Ff.~R POURED CONCRET~ .{~., ~zi~qAL. CONSTRUCTION ~ ,,, NOT ...... being duly sworn, depose9 and says that he is the applicant He is the ~.w9'''''''~'~' · ' (Contractor agent corporate officer etc ) ............. of said owner or owners, and is duly'authorized to perform or have performed the said work and to make and file this application; that all statements contai0ed in thisapplication are /rue to the best of his knowledge and belief; and that the work will be performed in rheem-an-ocr set forth in the application filed therewith. Sworn to before me this / . ........... .... 10.X . Nota. Publ~~.~~r~ CouP? -- --, . v N~Y PU6LIC, ~ ~ ~ ~ ' ' ' NOTE: [. I= MONUMENT S. SUFFOLK COUNTY TAX MAP DIST. IO00 $EC1~098 BL,05 LOT52 3. SUBDIVISION MAP FILED IN THE OFFIC~ OFTHE CLERK OF SUFFOLK COUNTY ON MAY 2T~ AS FILE N0.551. Lo~ ~5 ;URVEY F'OR ~,LFONSO J. LOSCO 8~ ANN R LOSCO >ART OF LOT [5, "INDIAN NECK PARK'~ ST PECONIC OATE ~ JUNE 21, 1985 TOWN OF SOUTHOLD SCALE~ I" -' 20' SUFFOLK COUNTY, NEW YORK NO. . 85-647 GUARANTEED TO; COMMONWEA D TITLE YOUNG S YOUNG .O00STR ~OE"AVENUE RIVERHEAO, NEW yORK