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Home My WebLink About19390-z FOEM NO. 0 TOWN OF SOU'/HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 19~90 Z Permission'is hereby granted to: ....... 0t premise~ ~ocoted at ...q/..~.2..O. ............. ~ ................. ~ ........................ Caunb/ Tax Map No. 1000 Section ........ 1...~.. ........ Block ......'~.....~. ........ Lot No....j....~..:..~ ........ pursuant to application dated ..... ..~..~...~.~......~ ............. , 19.~...O.., and approved by the Building Inspector, ' ' ~U U ~"1 ~'~'"1' '"~t'~r ..................... Rev. 6/30/80 O~ ~0~ ~qGiSNOdS~ :&O~ 'S3QOD 'A'N ~HZ ~0, SZNa~mne~M aHA : FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL,: 765-1802 Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERNII' INSTRUCTIONs BOARD OF HEALTH . ..~/.. suRvgY ............. !!! "' c. .cKOM-SD ..... "' SEPTIC FORbl ................ NOTIFYg CALL . . . o,b l Date S?ptember 7z 199.Q a. This application must be completely filled in by typewriter or in ink and submitted to the Building lhspe~'tor, with $ 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 liyout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 ~:emovalor demolition, as herein described. Fl~e applicant agrees to comply with ail applica~e laws, ordinances,' buildin~ code, hc~ing code, and regulations, and to ~dmit anthorized/nspectors on premises and in building fgr necessary inspections: j~ C[J) O. Is' orpo auon) Nathan Hicks ...P., P,. JtQX. {~.~ ~. Or~i.e. nt o. R,Y,..1.1.9.57. ..... (Mailing address of applicant) itate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... .. . -~ ............. Age. at Mary Jane Hicks {ame of owner ofpremises ....................................................................... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. N/^ (Name and title of corporate officer) Builder's License No ........................... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... , Location of land on which proposed work will be done: House Number Street Hainlet ............. County Tax ~ ap No 1000Secti 1..5 · Blo k 9 12 1 Subdivision ..................................... ]Riled Map No ............... Lot ............... (Nan,e) State cxtst ng use and occupancy of premises and intended use and occupancy of proposed constroction: A. Existing u'se and occupancy.. Vacant . Ram,= B. I;ntended and occupancy ~;r;".~.... ~. ~,, , , ' ,., 'f 3. Nature of work (check which appiicable): New Building .......... Addition .......... Alteration ......... '. Repair ........ ~ ..... R~mov~l .............. Demolition .............. $~rimmlng pool ............. Tennis Court ........ Accessory. Building ........... Fence .X.X. .... Other XX 3.2,.5.00 i Fee {.2.5 0.q 4 Estimated Cost ' ' ] (to be paid on filing this application) 5. If dwelling, number of dwelling uflits . .i~./~, .......... Number of dwetfing units qn each floor·. ...... *" :, ~ .... Ifgarage. numberofcars .... N./.i~ ................. '' ' '* ~ ' · .......... 6. If business, commercial or mixed bccupancy, specify natnre a~d extent of each type o,f use · · NJA ..... %,.;,,... 7. Dimensmns of exist ng structures'~fany: Front ........... ~ r'. ..... ..... · '.,. De t~i ........ . ..... Hcieht Number of Stories Dimensions of same structure witb alterations or additions: Front ................. Rear ................. Depth ' Height Number of Stories Dimensions of entire new con;tru~ction: Front Rear Depth Height ............ NumUer of Stories 'Rear .. fi.~..5.,.1.3,[' .......... Depth 7,:O=...t.q.)5.'fi, 1.l · 43" ' 9. Szeoflot: Front ..... 6. ...... i ................. 10. Date of Purchase , ,1.o~'16 ..... 'i. ~... ~ ........... Name of Fenner Owner fi. qgPP.e. .'I,~'i.c. rto~P.e.l.~ ...... 11. Zone or use district in which premises/ire situated FI ~I .................................. 12. Does proposed construction viol~t(} any zoning law, ordinan.ce or regulation: ,.Rp ............................ 13. Will ldt be regraded ....... .N.q .................. Will excess fill be removed from premises: . Yes .... No. 14. Name of Owner of premises M· .m-.y~..J.a.n .e .H,~.qk.q f.... Addres~B.o.>~..8,12. ~ ,qr.i.m..t.,.. N. ~ ~hone No, .3 2 3 ~-.Z4.7..5 ...... Name of Architect .......... ~ ................ Address ................... Phone No ....... Name of Contractor . .T°. .bp..s.e~l.e.c.t.e.d,. i ........ Address ................... Phone No ................. 15.Is this property located within 300 feet of a tidal wetland? *Y~$ .... NO..X. ~If yes, Southold Town! Trustees Permit may be required. ' ' PLOT DIAGRAM Locate dearly and distinctly all l'buildings, whether existing or proposed, and, indicate ail set-hack dimensions from property lines. Give street and block umber or description according to deed, and show street namesand indicate whether interior or corner.lot. ' In accordance with th~ attached plan of dgtail and location on attached survey on lot described as Sgction 15, Block 9, Lot 12.1, located adjacent West N/S end of State Route 25 at 0rien~ Pdint~ cqnstrued~.t6 be a corner lot. To construct 443' of.~' vinyl coated chain l%nk fence beginning at. the NW corner of the lot and offset 3"i to the i~terio~ bf the ~ot; thence pa~allgl to the westerly property line a distance of 300~'and turning to the interior of the lot to intersect the center lins of the lot at its southern terminus. And to construct adjacent to the southern terminus of said fence, and located within the lot and pursuant to the agtached detail plan, 21 bollards 3' in height above ground made of 3" galvanizedi pipe filled with co~crete and ca~ped. STATE OF NEW YORK. COUNTY OF ................. · ~.~th~n Jt~.~ ... i .................... g d ~y ............ bein u sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) shove named. ~ - He is the Ag.~n.t. . . . . of said owner or owners ~d is du y ant mr zed to perform or have perfo~ed the sa d work and to m~e and file this application; that all statements cent?meal m this application am trne to the be~t of Ins knowDflge and behef; and that the WOrk wilt be perfonned in the m~n~r set fort ~ in the applicahon qlcd therewith. Sworn to before me this . ............ .7 ....... (Signature of app~ic~t;