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Home My WebLink About21353-z FORM NO. fl TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-oiN',° 21353 Z Date Permission is hereby granted~tto: __ ~.. .......... ,o County Tax Map No. 1000 Section ......(~...~....~. ........ Block ..... .~...~ ......... Lot No..~..~. ............... pursuant to application dated ........~~......./..~.. ............... , 19.~.~., and approved by the Building Inspector. Rev. 6/30/80 · 3.~Natur. e of work (check which ipplicable): New Building . ~ ........ Addition '.. Alter" ' ' ' ' t~epalr ............ ~,4,/Removal ............... Demolition . ; ...j . · , %7 ~.~ . ', ...... v~ .~../. ~. ~/ ~ '~" ' Des ' ' Est ..... 7/~j¢~ ._ ~ ~ ( cnpt,on) 4. lmatea uost . ~ . . 7 ' , ~ / I ee ..... . ........................ - ' . (to be prod on filing this application) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor. If garage, number of cars I ' · .............. 6 If business commercial or m(x~d occupancy ................... specify nature and extent of each type oldie ....... ' ............... 7. Dimensions of existing structures if any: Front ................... Rear Depth ' Height Number of Stories Dimensions of shme structure with alterations or additions: Front ................. Rear .................. 8. D,mensions of entire new construction: Front... ~72 , j, 2'"' ........... :, ,,, . ' Rear.. ~.~. ( ...... Depth~ Height ..... ~. 5 ....... Number of Stories .......... . .... 9. Sizeoflot:Froht.../~... .. · Rear ~? ...... ' ....&' L""li;)41 ............ 10. Date of Purchase . $~ . .. Name of Fo~er Owner ~3~. ~.~~... ... /q, ~./.~-. · .~ ...... ~Zone or use district in which premises are situated . ' . . .~. ~,~ pr?osed construct~n l,i~l~ny~z~[ng law ordinance or regulation' . .~ ................ ' ' · .x n..~ ~.. · · ~. ~m excess Hll ~ removea xrom premises 14. N~eofOwnerofpremises~C/~JT~,Ada ..... 9< ~Z~..~ .~ '~.'2 ........... '"~':~r ......... ~ ................. Address ................... Phone No ........... ..... .. Nme of Contractor ........ 4 .................. Address ........... . ..... ~e No .. ' 15.' Is th$s property wtthtn ¢00 feqt of a Ctdal wetland? *~~~ " ' ........... ( . *If yes, Southold Town Trustees Permit may be req~'"'"~ ...... · '.. ] PlOT DIAGm Locate clearly ~d distinctly ~li bulldogs, ~heth~r existing or proposed, ~d, indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block humber or desc~ption accord~g to deed, and show street nines and indicate whether ~tefior or corner lot. ~ ~'rATE OF NEW~RK~_~ //~ ! -oozy oF.. . .... ..... ..... , ......... (Name of individual signin~ contract) *bore ~med. , being duly sworn, depose9 and says that he is the applicant Ie is the ' ~, (..~. ~....V~..'. ' I (Contractor agent corporate officer etc ) " '' f said owner or owners, and is duly huthorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this'application are /rue to the best of his knowledge and belief; and that the ,ork w/Il be performed in the manner s,~t forth in the application filed therewith. ' worn to before me this otary Public, . County ~ . ' Qualified In Suffolk County ~fzT~ , . / ./ (Signature of applicant) . · Commission Expires December 8,19~?/ ,(.,,,/' L NEW SUFFOLK AVE. · The loc?lions of wells and cesspools shown hereon ore from field observohons and or from dora obtained from o/hers. H. $. REF. NO. 87 - SO - /31 The water supply and sewage 'disposal systems for this residence will conform 1o lhe slandards of The Suftolk Countyx Deparlment of Healfh Services. SURVEY OF PROPERTY AT MATTITUCK 'TOWN OF SOUTHOLD /,~,, ,~o,-,.~:~ SUFFOLK COUNTY, N. Y. ':"~,'~ '" "~ '~ ':" 1000- 115- 17- 6.~ ' I-----1 SCALE: I = 40 - ,~' TO ' , INC. N.Y.S. LIC. NO 49618 ENGINEERS, P. C, MA IN SOUTHOLD~N. y. 119XI SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ON[.Y ' ~^~PR 2 2 1991 BOARD OF HEALTH FORM NO. 1 ~'~- 3 SETS OF PLA~$ . , I' TOWN OF sOUTHOLD ~SURVEY BUILDING DEPARTMENT ~HE-~K ........ ~ ........... APt I 5 t993 TOWN HALL SEPTIC ~ ~,, ~ ~ SOUTHOLD, N.Y. 11971 " ' ,. TEL.: 765-1802 ~,~ ~ ~ ~; "t ': . CALL Approved ~~-- , 19~ Pe~it No. ~( A~ ~ Disapproved a/c ' (Building Inspector) APPLICATIOM FOR BUILDING PEBMIT ~ · Date... ............. ,19. INSTRUCTIONS ~ a. TMs application must be completely filled in by typewriter or in ink and submitted to the BuildMg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~g location of lot and of buildMgs on premises, relationship to adjoining premises or pubfic st?eets ~r hreas, and givMg a det~led description of layout of property must be drawn on the diagram which is pa~ of this app,- cation. c. The work covered by tMs application may not be commenced before issuance of Bu~ding Pemit. d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pe~it to the applicant. Such pemit sh~l be kept on the premises ava~able for Mspection throughout the work, e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ceaificate of Occup=cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the BuildMg Dep~ment for the issuance of a B~lding Pemit pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, =d other apphcable Laws, OrdM~ces or Regulations, for the construction of bufldMgs, additions or alterations, or for removal or demolition, as hereM desc~b~d. State wheth~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .' ....... - .f ' ~ ~ on th~ tax roi1 or lat~;~;~f ....................... If applicant is a corporation, signature of duly authorize~fficer. (Name and title of corporate officer) B rider s Lmense No .......................... Plumber s Lmense No ............... . .......... Electncmn s L~cense No ....................... Other Trade s License No ..................... Locatio~n of. Jand on which proposed work y~jff Ce~done ............ ~ ............... · ......... 7: ' CountyTaxMapNo. 1000Section .~.q- .... ~Block ...~. ......... :... Lo~~... [Name) State existing use and occupancy., of premise~, and inten(ed use and occupancy~roposed_ . . construction: _ ..... W .~ .... ~ ....... (7' "~fi.:-' '-~:~"~::~' ' ~' ~ ~" '1 .... '. ~.--:.....,,,,~ '3. Nature of work (check which ~pplicable): New Building .......... Addition..'... . Repair ............. ,. Rem, oval .............. Demolition . ..: . . · .... Alteration .... ~.. ~ ... 5. If dwelling, [ (to be paid on filing this application) number of dwelling[units ............... Number ofdwelling units on each floor. · If garage, number of cars ' ' · .............. 6 If business commercialor mixed occu-ancv s~cc,r .......... ' ['- ..... f ........ 7 Dimensionsot exlstlngstructhres if andy: "~ "' · · . I . nt~llt el,eden [ype o[use Front Rear ' ' ' ' ...... ' Depth Height Num, ber of Stories ' ~mensmns of same structure wtth alterations or additions: Front ................. Rear .................. Depth ..................... 1. · Height ......... ~ ......... :.. Number of Stories. ' · . 8. imensions of entire new construction Front.. .~/. f. f ..... ; Rear ...--~..~..~.' ...... Depth--f .~Q'. .......... Height .... 5//. .... Number r~{' (t_ ~fit-.one or USe OlStrlCt in which premises are situated / ....... *: ....... T2. Does proposed construction violate anv zonin~ law ~.~:__2 .... ';~¢¢'~ ...................... 14. Name o t Owner of premises .,.~ we ~ ~ ~/~ F_' ~:_~7~ff, j ~ o.n.~l~ ~, re~°v.~ea rr,~p_om premises: ......... ~ ............. Address ................... Phone No ........ .,....,. Name of Contractor .......... I .............. Address ... ' PbJ~a~. 15.' Is th±s property w±t:hin .............. '"~'~ ....... 300 feet of a txdal wetland? *j/,~~,,,~.~:) ........ ,: *If yes, Southold ~ogn Trustees Permit may be required. ' ~' .... I PLOT DIAGRAM Locate clearly and distinctly all btlildings, 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, ~ ..........~ ~)~ . .... ' ......... being duly sworn, deposes and says that he is the applicant fact) fe is the .' ' ' (~ontractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this'application are .true to the best of his knowledge and belief; and that the ,ork will be performed in the manner set forttl in thc application filed therewith. worn to before me this · , ............ day o . ' Qualified in Suffolk Count*/ ~z,c . / / (Signature of applicant) · ' . ~,omml~lon Expires Deoember 8,19~] ,/_~ ' ?ou y oF., (Name of individual signing cont ~bove ~hmed.