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FO8ffi NO. !
MOWN Og SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SAUTHOLD, N. Y.
BUtlLDlNG PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No 1 915 t~ Z Date ~,/••~.6 i9.~:o
Permission is hereby granted to: ,
to .~i~?~•:a%`lk~r~,.....~..
~.....7J.~.~A?~jl.
..LG~..r....S~n~~~-:...~,I.....~''~~r~BG••
of premises located at ....,lQ.~~~G• ..........17~~N
County Tox Map No. 1000 Section .....,.1~....... Block ............~....QQ. Lot Na....../..?.~...
pursuant to application dated 19.1..., and approved by the
Building Inspector.
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Fee $..1.°..i.7..... o a
Bui g Inspector
Rev. 6/30/80
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F087H NO. A
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)
NO ~17d2~ Z Date 19.~~
Permission is hereby grante to: '
(gyp//~ ~ /~//J~ ~~~~r~.~-'~
ct premises located ot ........~~.~~.....fi.~.~~L:~.l..::...~~~."(""'...Fi
fir..:
~................................q...............................................
County Tax Map No. 1000 Section ........1..~......... Block Lot No........?..!:.. ~,.~...Cl..
pursuant to application dated 19~~, and approved by the
Building Ins(p~ector. i
Fee
Bu ....ng Inspecd
Rev. 6/30/80
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'OUIJDATION ( 1st )
7~, P ~ M
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'OUNDATIOtJ ( 2nd ) - - ~
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PLUMBING
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=IJSULATION PER N. Y.
STATE ENERGY
CODE _ 's
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ADDITIOPJAL COMMENTS: s.h c
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BUI4DING DEPT.
tNSPECTI4N
[ ]FOUNDATION i5T ( ]ROUGH PLBG.
(FOUNDATION 2ND INSU4ATION
[ ]FRAMING [ ]FINAL
REMARKS:
. DATE / ~ INSPECTOR~~~
~~0~~
765-1802 .
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ 7 FRAMING [ ]FINAL
REMARKS. ,
` -
,~~L-.~
T~~
DATE ? ~ ~ INSPECTOR
~ .
BOARD OF HEALTH Y.
3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OF SOUTHOLD CHECK • • ~f':.... .
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
F,OUTHOLD, N.Y. 11971 CALL
GD TEL.: 765-1802 " " " " " " " "
Examined `!,1~~ p~j ~ ~ MAIL TO: K/~//G`s /{am.C
19...
~~o v4r.,r,,, r s ?vr„
Approved .J~.~• • 1~~Pe~rmi'~t/N/~/o. ~ Po $a x -rho
Disapproved a/c .................r'~/ ....,/9~~~~ Sor~~Hoc.o~<vY, //9'~/
~tt~~ r jj 1 ~ 3~3 - ~5~7
APR ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ (B ' ding I s ctor)
APPLICATION FOR BUILDING PERMIT ,
BLDG. DEPT. Date 19 .
TOWN OF SOUTHOLD
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 appIi-
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 Occupanc~
shall have been granted by the Building Inspector. ~'vi j~ a~:~''~
~ntif
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.
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. B . ~~Hc s„ h6s9 l.w;P•tay,rn„~,.,rr 1^.~4'...... .
~(1Signature of applicant, or name, if a corporation)
N ~ BOX J ~O .S'O~-~i,
ec,o, A/, lig7J
:7.........
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
,~~i(~R~ .
Name of owner of premises ......~.o,jEp~fJ aoAulC N, , , , ../J.v,,Q, , , , ,0~9Ni~~, , ,~ie,t/A.,C,ovi C , , , , , . , ,
(as on the tax roll or latest deed)
If applicant ' a orporation, sign ture of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Loc++atioppnrrof land on which proposed work will be done . ~ .
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot ...1. ~ B .
Subdivision ......L~1. S'.. , , E,v®,,, , , , , , , , , , , , , Filed Map No. ..~.9. 4.`~ Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy UA ~ C'~"/'~
b. Intended use and occupancy ........f1/~/`! J6i!~€ CC <N~
3. Nature of work (check which applicable): New Building Addition Alteration , . .
Repair Removal , Demolition Other 1Vork .
,,yy.t ~ ' (Description)
4. Estimated Cost T'.~. 7S p o o Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......owl, , , , , . 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 ...............NumlierofStories........................................................
Dimensions of same structure with alterations or additions: Front . Rear .
Depth Height , Number of Stories .
Hei ht ~ Numbction:-Front ....5.5!.~ Rear . ,S!{ ~ ........Depth ~q.'........ .
9. 3i e of lot SF onttire ne~ c~onstru,er of Stories .
g
~ ~ Rear . .3.00'
Depth ..~99............,....
10, Date of Purchase ............I .................Name of Former Owner
11. Zone or use district in which premises are situated R~ S! 44.v7~y f . . .
] 2. Does proposed construction violate any zoning law, ordinance or regulation: ...,h!o .
13. Will ]ot be regraded ~~.5 Will a ess fill be removed from premises: Yes 1~0
14. Name of Owner of premises .4na?>~fl...PyY!CH. ; ..Address a~! !+~A.vcR!90 . Fhone No..7.
~8,-a-,~5, 7,3,r~
Name of Architect ..Address ~O"P`'f~°,"'?.": Y!!!~3~, Phone No... ~j3r,~„~~.
Name of Contractor ~B. KEN.4 .~'~tu. X^:C.... Address .w.. Xa.x..r.~.,, soxT~wwPhone No..7~T: ~?S`y....
15. Is this property located within 300 feetyyof a tgiudal wetland? *Yes No .?G..
*If yes, Southold Town Trustees PermitPLO'f DIAGRAM ed. ~ 7~~i~ ~7f1~~/p~
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back d/imensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
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STATE OF NEW YORK, ~ S
COliNT1Y OF .
...cJ/.!le.l,~... ~ ~?h g , ' , , U; ;PYCS,., , , , , , , , being duly sworn, deposes and says that he is the applicant
(Naihe of individual si ning contract)
above named.
He is the .......................~i..............'...................................................
(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 contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the mannerjset forth in the application filed therewith.
Sworn to before me this
a.~. ~ ..............day of I' ..4-.........., 19 (f
Nota Public . .............C.~l.~x~',-~.'-... County ~~Q~,~ /
LINDA J. CO PER " " " " "
Notary Public, Stata of NewYark' (Signature of applicant)
No. 4822683, Suffolk County %p
Term Expires December 31, 19 a ~
lSO .~e~ L ~ l vi
LOT 29
a
' ( VACANT )
y ~ I~nderground S. 88 57~ 40~~ E . 200. 00
ucco !eo!! °
7!°iu
farlrar Se{
f cover Stk.
70.00 °n 49.9 ~~1\ 4e.9
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3; ~ m t LOT 28 N
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. LOT 2 5
30'
0 PROP f ( VACANT)
40 HSE _ 13
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E se>< qs2 97.5 LOT 26
49.7 stk p,Pe
N.88° 57~40~~W. 200.00 o'N
LOT 27 i ( VACANT )
N - _ - - -
~0 ( VACANT )
M
AREA = 40000 SQ. FT.
p THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
' \CeS OBSER4.A?!0"S AND DR FROM DAFA OBTAINED FN@d O1NER5.
S~~ ,
_ tt~", o ~~.oti~e L AN D' S END ROAD Tna w°lar supply & sawD~efS~~Y~9~~F~
tams for this re' c 47. {d
by (LA TH A M LANE ) aL r~d~se~aF^.tka~s ~4'r°rW°~~aP°r)-
~ s
TERRIAMARE ABSTRACT INC. ~Xp`~E~ SURVEY OF
TITLE N0.635 S 0844 L~T 28
DANIEL PUIIALOVIC " MAP OF LAND'S END °
JOSEPH PAVICH '
FILED MAY 3 1973 FILE N0. 5909
Prepared in aceordattm ~ablish h A' T O R T f= N T P O I N T
standards for ttiie survey and ad,p,a, TOW N" O F S O U T H O L D
the L.I.A. L. 5. and aPProved
for sash use by The Ne`" York State Land SUFFOLK COUNTY , N . Y
Title Association • I 0 00 - 015 - 09 - I. 2 8
~ ~~p,LANDSG SCALE Ire = 40'
`~2oy~,e~ N~~9`~ OCT. 20 , 19 8 7
~ ~ Zp p SUFFCdLK Ct~t96v#TY f*,titE§"}'~.43T ktl^.~LTti '[:VICES
+ ~
P~OR A~sKUtPA! OF CC9l~S'iG°.F~J~T4CSP~ C~Pti~~'
~ N , * Y. S . L IC. NO. 49668 ~R 19a~ ~'C~
9~ o. 0 DATE NS RCS. Ed 0
j,),lSEC ~ ~ RS 8 ENGINEERS, P. C.
x(516) NE 0
Are~ovE
P. 0. 8 OX 909 -
M A I N ROAD ELEVATIONS ARE REFERENCED
SOUTHOLD , N.Y. II 971 TO AN ASSUMED DATUM.
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~$~1~( $7 - 840
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