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Home My WebLink About21342-z IroBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N-oN.o 21348 Z Permission is hereby granted to: . ~ ~ ....... ..~..~.,..~......../.~ .................................. ...... /.~-.~.-7.. ...... ./..:.~ ................. -~ ,,t pramS,e, ~ocated at ....//.~.~.......~.~......~..<~.,. .................................................................... .......................................................... :~'.'~... ..................................................................... County Tax Map No. 1000 Section ....~...~../.. ......... Block ....... i~....."~:... .... Lot No ....... ..~.......~... ..... pursuant to application dated ...... . .,~.~..~ ................................... , 19..~., and approved by the Building Inspector. Rev. 6130180 FORM NO. I LDING DEPARTMENT TOWN HALL ~UTHOLD, N.Y. 11971 B~ARD OF HEALTH ......... TEL.: 765-1802 ........ ,19¢ ' ' ,' Disapproved a/c ..................................... o APPLICATION FOR BUILDING PERMIT 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 streets ~t,~s, and g?ing a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 Southold, 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 described. The applicant agreeS~tb '~difipl~with~·i~ll applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on prem!ses andj~ building for necessary il~l~ections. __ . : ......... . .... -- '~' (Signaturd of app/icant, or name, if a corpofd'tion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. Name of owner of premises 0 . .'.'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 .............................. ' ............... Ilac ' Itouse Number Street Hamlet County Tax Map No. 1000 Section ...: ./..~/]. ......... Block .... .0. ~;~ . ' Lot....~.~. ............ Subdivision ........ . ............................. '. Filed Map No ............... Lot ............... (Name) 2; State existing use and occupancy of premises and intended use and occupancy of proposed construction: · - /~ E.<d~Og~C,'~ ·' a. Exishng use and occupanc ' y ................. ,,., ......... ,,t)[ .... h !ppli ' · 3. Nature of work (check whic cable): New Building .......... Addition .......... Alteration ...... Repair .............. Removal .............. Demolition ' ' ~' }'~OtherWork 4. Estimated Cost ...... ~.-?~ ~ (D cription) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor If garage number of cars ~ ................. 6 If business commercial ormix~d occupancy .........~ ............................................... · , . , specify nature and extent of.each type of use 7 Dimensions of existing structures if any: Front ..................... ................ Rear .............. Depth ............... Height Number of Stories i ' Dimensions f shine structure With alterations or additions: Front Rear Depth ~ : Height ~ "' iq' .................. ' ............ ................................ ' ........ umber of Stories 2 ~... 8 Dimensions of entire new construction: Front ; ' ' ' ............ ..... ' Rear Depth Height Number of Stories ............................................. Size of l;;: ..................................................................... Front ' Rear ' ......... '" .......... Depth Date of Purchase .......... i ......... ' ......... Name of Former Owner Zone or use district in which pr~mises are situated ..................... : ....... Does proposed construction violate any zoning law, ordinai~ce or regulation: ..... ............ Will lot be regraded ....... "~ ................... Will excess fill be removed from premises: Yes No Name of Owner of premises;.; ............... Address .... Phone No ..... . Name of Architect ........... ........................... Address ................... Phone No ................. Name of Contractor ........ ~ ............... Address ................... Phone No ....... 15.' Is this property within 300 feet ~'f a tidal wetland? * , ' ....... ' Yes ...... ,.. No..~. .... I ' · If yes, Southold Town Trustees Permit may be required. " PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. 10. I1. .12. 14. STATE OF NEW YORK, COUNTY OF ......... . .... (Name of individual signi4g contract) above named. AP OYEDAS NOT£D NOIllY BUILDING D~PARTIV~I~F./A'I'- 76~-1802 ~ AM ~ 4 PM FOR THE FOLLO~N~ fNSPE~IONS: 4. FOUNDATION - ~O REQUIRED FOR POURED CONCRETE 2, ROUGH ~ FRA~ING & PLUMBING 3~ INSU~TION 4~ FINAL .. .CONSTRUCTION MUST ME COMPL~E FOR C.O. ALL CQN~TION $~LL ME~ ~E REQUIR~ ~ ~E ~[ ~ ~~ & EN~ ..... being duly sworn, deposes and says that he is the applicant (Contractor agent ....... ~ ............................ , , cori~orate officer, etc. of said owner or owners, and is duly~ · ' ' iauthonzed to perform or have performed tlie said work and to make and file this application; that all statements contaiged in this application are t'rue to the best of his knowledge and belief; and that the work will be performed in the manner iet forth in the application filed therewith. ' Sworn to before me this ~ .... ,~.; . .day of. i . ~.c.'.~... '......, 19 ~7._~ . Notary Public, ..... .x~~. :A-...~.-... ~...c~..~.: '~ ...... Coun[y ~ __ .;, - .... .". .... ......... ................. N.o. 4962246, Suffolk County .... (Signature of apphcant) . mrm Expires June 12, 19_~ ' 'oreh .... NOT£~ I. m.- MONUMENT 2. SUFFOLK COUNTY TAX MAP/ DI~I'IOOO SECTI41 BLK O~ LO'~04- SURVEY FOR ROSEMARY d. BYRNES AT MATTITUCK DATE · MAY 15~ 19S4 TOWN OF SOUTHOLD SCALE* I" · ~*0' SUFFOLK COUNTY, NEW YORK NO. S4"489 GUARANTEED TO~ ~ YOUNG ~ YOUNG 400 os,,~N~[R Av~.~uE RiVERHE/~O , NEW YORK L ALDEN W YOUNG,PROFESSIONAL ENGINEER N.~S* LICENSE NO. 45893 NOT~I. I= MONUMENT 2. gUFFOLK COUNTY TAX MAP1 DIs*rlooogECTI4~ BLK ol L01'04 SURVEY FOR ROSEMARY d. BYRNES AT MATTITUCK OA'rE MAY 15, 1984 TOWN OF SOUTHOI.D SCAL? I" SUFFOLK COUNTY, NEW YORK NO. 04-409 ~IUARANTE ED TO~ "'"""0"'"'"""'""0'"'"'""'" , k~ ~.:/ / iL YOUNG ~ YOUNG .ooo~,.~.,,~. RIVERHE~D, NEW L ALDEN W. YOUNG,PROFESSIO~A~ EflGIREER AND LAND SURVEYOR NYS.LICENSE N0.12845 HOWARD W. YOUNG, LANO ~URVEYOR NXS. LIC[NSE NO. 4589~