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FORM X0.3
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)
WN9 21075Z Date ...0 a-
Permission is hereby gr ted to
4 le art-.
oa..o...'.... ,
to.. 4.0........
o.................................................................................................
a premises located at ..c J~_.... r~~~...../
. 71
G..~
County Tax Map No. 1000 Section .....rs~ Block s.-.3............ Lot No......,/ /
Pursuant to application dated ......ll~ 19~ and approved by the
Building Inspector.
Fee $..rSf.J!
!•.rf.
g Inspector
Rev. 6130180
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ODUDATION {1st)
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Town Hall, 53095 Main Road p ` Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, NewYork 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
February 6, 1996
Mr. James O'Keefe & Ms. Elaine Pryhocki
54300 County Road #48
Southold, NY 11971
Re: Building Permit #21075-Z
Premises: 54300 CR#48, Southold
Suff. Co. Tax Map #1000-52-3-1
During a review of our files it was noted that the above
building permit has expired, and a Certificate of occupancy has
never been issued.
According to the Code of the Town of Southold, Article
KXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
aF, Ac..,'~~ BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS ...V'.....
TOWN OF SOUTHOLD SURVEY
OV "'"CJ B BUILDING DEPARTMENT CIIECi` .(Ofo.7::~~5. •
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765.1802 r:OT I FY
Examined.///? Z- CALL
191n MAIL TO:
JbIA
Approved , , , , - , , 19l`. `zPerrnit No.. ~,~OjZ6~ ' T(qq
i2S00 J AX JW .
Disapproved a/c EAST /-t+Z10AJf J4,
~rq
(Bu' ng Inspector)
APPLICATION FOR BUILDING PERMIT
Date ..~~V 199
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
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 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 to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of app i name or oration)
1. ~Sfo Jy~~nl./Lsa .rte . M9~Zi0~?. f N l~ ..,?0.~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~Ft1geal,~. 6nlrrr.4UDn! .
Name of owner of premises
(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. ...14t
`y 7n CI J. .
f..
Plumber's License No .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
540oa A10XV1.. tea.W......................~ d~-.......
House Number Street Hamlet
County Tax Map No. 1000 Section .......5-;? Block ........3 Lot f
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...;'466x. rlo-.0L f A G4!N4r .
b. Intended use and occupancy .........`1 1a "
Removal New Building Addition Alteration
Repair oor f woo (check . which applicable):
• • • • . Demolition Other Work AWE. /KL 4tvr?
/ (Description)
4. Estimated Cost...... / q5) Fee 6?:!~._...............,............
(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 or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories .
.
Dimensions of same structure with ;alterations or additions: Front Rear
Depth ......................IHeight Number of Stories
8. Dimensions of entire new construction: Front Rear Depth .
Height Numbelof Stories
10. Date of Purchase . . ~ Size of lot: Front Rear...................... Depth
11. Zone Name of Former Owner
vipremises are situated
12. Does or use o ict -In which
PrsPseed any zoning law, ordinance or regulation: .
13. Will lot be regraded Will excess fill be removed from premises: Yes No
of Architect . . . . • • • • Address Phone No............... .
14. Name of Architect remises . . Address Phone No, . Name of Owner of p
Name
Address . Phone No.
15. Is this property within 30Q feet of a tidal wetland? *Yes.. No..
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions frpm
property lines. Give street and block nummber or description according to deed, and show street names and indicate whether
interior or corner lot.
i
-P
# NOTED
DATE: A-~ AS
FEE: ~
FEE: B I BY,
NOTIFY P
785-18802 9 AM TO 4PM FOR THE
FOLLOIrJING INSPECTIONS:
1. FOUNDA'NON - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMPING
3. WSW ATION
4. FINAL - CONSTRUCTION MUST
6E COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE MY,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORK, S
COUNTY OF ..5:/FrbaCL......... .
Tony.. ~1A.,....... .
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heisthe..... 6)117 17{ -
(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 contair~'ed in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
: .day of. . N0..
Notary Public,
County
R08ERT ROB L
472BL1 OINK ignature of applicant)
ff'or Expi
res s May 81119
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Q COGIEB OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMW_
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PIPE ERECTION FENCES. RETAINING WALLS S LICENSED LAND $ V OHS
POOLS. BUILDING LD ING ADDITIONS OR ANY orEEH SUFFOLK COUNTY TAX MAYA 125 ROIiTE 25 A P AWER N SCALE:
u.'N'iuFNl I nN[TRUCTION OE PIANTING AND SHOULD TFSTFOIL LOCATION OF WATERLINES WELLS
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