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Home My WebLink About20099-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 200~)~] Z Permission is hereby granted .to~ ~ ~ ...... ~....~.....¢...~~~......:./..~ '"'~?~'~'"~/~'X/ .................. :~'~ ................... :"~":'"';' ........... .............................. at premises located at ..... L../'...~?..~..~.-.., ....~.~'.'~..~C.....~~. ...................................... County Tax Map No. 1000 Section ...... ~..../...~....~. Block ......... ./.~.. ..... Lot No ....... ./.. .............. pursuant to application dated .... ~././~;~ ....................................... , 19..../.~1 and Building Inspector. approved by the Rev. 6/30/80 Examined. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 · No....~'~...~./.? .~e~ Approved / Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH SETS ,suRv£Y .... ~.~ ........ . rf ..... SEPTIC FORd . ..~... .... CALL HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. e. The work covered by this application may not be cbmmanced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for neces~p~ections..~ff ~...._.~/~ ~ -- (Signature of applicant, or name, if,~c'6rporation) 1.255 .~ .o.n.n.a...~r3.~e...~.a~ ~. $ .t.u.e.k...~7..1. ~. 9.5.2. ..... (Mailing address of applicant) ~,tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Xlame of owner of premises . .Mj..o.h.~..e.1..~....~.ig.~..~..a..z'y..4..K.e.l.l.y. ........ , ................................. (as on the t,ax 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 ...................... Location of land on which proposed work will be done .................................................. .... 1.2.55 ................ ~. o..n.n.a..B.T.J.y.e. .... ; ...................... .~.a.¢.¢. J:..¢.ug.k' .................. House Number Street Hamlet County Tax Map No. 1000 Section ...... J./..~.~ ....... Block .... /.~ .... ' ....... Lot.../..~ ............. Sobdivision ..................................... Filed Map No ............... Lot 62 (Name) Statue ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... Dwe. il±rig ii -' b. Intended use and occupancy .................................. 3.Nature of ~vor (check whmh apl~hcable): New Building .......... Addition ...... Alte: Repair ............ Remoyal ............. Demolition 4. Estimated Cost ......... ~. 1..8.0.O.,.0..0 .................... Fee .. 5 Ifd ' · welling, number of dwelling uimts ............... Number ......... · If garage, number of cars ...... 6 If busin cial o mi edioccupa cy pecffy nat d e t of ! ........ · ess, commer r x n , s ute an xten er ..... 7 Dimen ionsofe i tingstructu iifany: Front 7.2.~.~.6 Rea Depth ~ ' · s x s res ..... .... r ....................... Height .... .15.t ........ Number of Stories ....................................... Dimensions o ]ne structure with alterations or add' ' Depth .................... I:' ~e~ght ...................... Number of Stories ......... .o.n.e. ...... 8. Dimensions of entire new construction. Front . · ................................... Depth ............... Height .... 6.t ....... Number of Stories ................... 10. Date of Purchase .S..ep.t..1..6,. ?.9.?9 ............. Name of Former Owner . .M.~.~.~.x.n.~ .~..n.~?.l?.~.z.s.e.q..~.n.e., 11. Zone or use district in which premises a~e situated ........ .R.e 8.:i.d..e.n.~.~.a..1 ................ 12. Does proposed construction violaie any zoning, law ordinance ~,~ r~,-,-+;.--. ' ' '~10 ............ 13. wnl lot De regraaea ......... ..i ................. v~m exqe~..mtJ0e remo~d from premises: ~,.,~. Y~a ~ No 14. Name of Owner of premises . ~.~ql?.a?.l. ~...e..L:L?. Address .'t.~?. ?. 5°.~..n.a. ?Y.... Phone No.. 5.~?.?.! ?? ..... Name of Architect ........... i ................ Address .............. ..... Phone No ................ Name of Contractor .......... l ............... Address ................. Phon~ No ................ 1_5. Is this property w±th±n 300 feet of a t±dal wetland? *v~o '' · If yes, $ouchold T~wn Trustees Permit may be requ%red. PLOT DIAGRAM Locate clearly and distinctly all t~uildings, whether existing or proposed, and. indicate all set-back dimensions from property 'lines. Give street and block ncmber or descripfio~ according to deed, and show street names and indicate whether interior or coruer lot. See copy of survey attached. Dismantle existing wo~d fence and construct new wood fence on hilighted areas on copy of surw~y. iTATE OF NEW :QUay ...... Michael F Kelly (Name of individual signin bore named. ~. ~OuNOA'rloN 'IWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING · PLUMBING 3, INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHA~ ME~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ON & ENERGY CODES. N~ RES~N8IB~ FOR DESIGN OR C~STRU~ION ERRORS .................. being duly sworn, deposes and says that he is the applicant contract) Michael ~ Kelly (Contractor, 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 s~t forth in the application filed therewith. worn to before me this 16th ,~.,,,~e : August 19 .91 ~otary Public ......... ~_~. .. County NOTAflY PUBUC, Sta~ of New Ye~ i · No. 4707878, Suffolk ~,~4~/ ! of applicant) Te~m Expl~ March 30, ~a o ,& 0 ... .-t N, 2° 40"10"£, 31E 6 ?' r- o = 0 ,~ o. -tm