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Home My WebLink About19485-z FO~,M NO. ,s TOWN OF SO~THOLD BUILDBNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THINS' PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 19485 Z Permission;is hereby granted to:~9 /,..,~- ,o :::::::::::::::::::::::::::::::::::::::: ...... Count,/ Vox Map No. lO00 Section ............. .~......'~... Block ............ ../. ....... Lot No. / 7 pursuant to application dated ........... ./....~'...~......~.....~... .................... 19.~., and approved by the Building Inspector. Fee $ .......... Rev. 6/30/80 BI.OG. DEPT. Approved :.~ .., 19~Pennit No. Disapproved a/c ..................................... FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH .......... 3 SETS OF PLANS ..~Y~....~.. '' survE .... .... cUECK .... .e. . NOTIFY ~ 9~s~ CALL ...~.. MAIL TO: ( B.u.i'fd lng Inz!~t or) ' APPLICATION FOR BUILDING PERMIT /Date October 2~b 1.9 90 INSTRUC;FIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Iiaspector, 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 descr/bed. The applicant agrees to comply with all applicable laws, ordinan~ilding code, jlo. psing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insd~ctions. {' '} /.---.. - . .... - . (~lgnature of ~pplicant, or na~d'evq4 a corp~'ranon')' ' ' }(..t.> .... x. 123,. Southold, y.y. 2;1971 .... (Mailing address of applicant) State whether applicant is owner, lessee, agerit, architect, engineer, general contractor, electrician, plumber or builder. '¢ Owner Nameofownerofpremises Wesley~ Bed,nds'k~r ,, . ..... (as on the tax roll or latest deed) If applicant is a corporat on, ~ignatu,re oi7 duly authorized officer. ' 47 ~- ..... (Name and title of corporate officer) Builder's License No .... ~ .............. Plumber's License No ............. ; ........... Electrician's License No ....................... ther Trade s Lmense No ...................... 1. Location of land on which proposed work will be done; 205. Bo~sseau' Avenue, Southold llouse Number Street, Hamlet County Tax Map No. 1000 Section . . .6.2. ............ Block .... · · · ......... Lot ..... Subdivision Oseaz, It/ells Y2,state .. Eilcd Map No., G-42 28 " State e" ' . -- resting ,se and occupancy of premises and intended use and 9ccnpancy of proposed construction: A. Existing use and occupancy ........... .M/.~.. ~..~.~.~ B. Intended use and occupancy... 3. Nature of work (check which applicable): New Building .......... Addit:on .......... Alteration ........... 4 Estimated Cost 750.00 11 Fe~ ' ' (to be paid on filing this application) 5. If dwe ag, number of dwelling units .... /~ ......... Number of dwulhng units on each ............... If garage, number of cars ...... { .............................................. N72 ........... ' 6. If. bus ness,, commerc., al erin .xed,.occupancy. specifYNnatureA and extent of each typ~ .... of uso ..... Depth/'~ ........ .... ~ ~ ~ ~ '' 7. Dtmenssons of exmtmg stmctures~, finny, Front.. ). ~: ......... Rear ......... · ....... Height ............... Number of Stories ................................................. Dimensions of same structure wi(h alterations or additions: Front ................. Rear .......... Depth .................... ,. tle~t ....... ~ .............. Number of Stories ........... ~ .. 8. Dimensions of entire new constn~ction: Front ..... ~ ........ Rear ............... Depth ...... zo= i, ....................... : b>. :-.. :..::.:: ............. , 12. Does proposed construction violate any zoning law, ordinance or regulation: ................... 13. WHI lot be regraded .., ~Q... ~ .................. Will excess fill be removed from premises: . Yes .... No. 14. N~e of Owner of premises ~9~ .~ ~PP.~ · .:'.~< · Address ................... Phone No ................ N~e of Architect ........................... Address ................... Phone No ................. N~e of Contractor ................. ~ ....... Address ................... Phone No ................. 15.X$ th~a property lees :ed ~ithin 300 feet of a t~dal watland? ~Y~S .... ~0.~. *If yes, Southold Town Locate clearly and distinctly property lines. Give street and block interior or corner lot. Trustees Permit may be required. PLOT DIAGRAM buUdMgs, whether existing or proposed, and. indicate Mlset-back dimensionsfrom umbcrordescriptionaccordingtodeed, andshowstreetnameaand ~dicate whether See ~2tacbed STATE OF NE~VYORK, COUNTY OF .................. S.S ............................. being duly sworn, deposes and says that he is the applicant (Name of mdw~dual slgllnlg contract) named. above ' Hc is thc i .............. ! (Con tractor, agent, corporate officer, etc.) of said owner or owners, and is dt)ly authorized to pegform or have performed the said work and to make and file this application: that all statements contained in this application are tree to the best of his knowledge and belief; and that tile performed in the man~cr set forth in the application filed therewith. be Sworn to before me this Notary Public ....... '~'"'"~'~' i ................ County NOTARY pUBL C,,State of New Yel~, (S~gnature of applican .,. m'm Expires M~rch ~0,19--z / BOISSEAU A VENUE RO01~ OVER FND CERTIFIED TO' ~ o~ ~ZO0' ~s'.~ " SUFFOLK COUNTY NATIONAL B,4NK N II°25'00'' WES BEDNOSKY, Jr. N/O/F SOUTHOLD FIRE D/STRICT Prepered in eccetdonce with the minimum slenderds for t/lie surveys es e$/obll$1~ed by /he L.I.A.L.$. and mpptoved and adopled Title A~soalet/on, E(N. Y.S.LIC. NO. ~p-~. / MAIN ROAD 5~JTHOLD, N. Y. 49668 88 - 466