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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)
x.8949
N ° Z Date ) 99a
Permission is hereby gra d o:
at premises located at %Z ~6 ~f~...r
. . . . . . . . . . . . . . . . . . 5 L.
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..........................................................................pv.....................................................................................
County Tox Map No. 1000 Section ........~.s7......... Block ........1,P......... Lot No.........~~..X':....~...
pursuant to application dated 199., and approved by the
Building Inspector.
00
Fee $..r°.~3,CF
I
! Buildi Inspector
V F~~~x~,n~..l
Rev. 6/30/80
765-1802
BUILDING DEPT.
1NSPECTtON
[ ]FOUNDATION 1ST [ ] ROU PLBG.
[ ]FOUNDATION 2ND [ ] 1 ULATION
[ ]FRAMING FINAL
REMARKS: {
I
~
DATE INSPECTOR ~
I
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BOARD OF HEALTH ......./.G K
3 SETS OF PLANS
FORMN0.1 SURVEY • . F?..:A~L~.
°°'",,,~V TOWN OF 50UTHOLD CHECK . ~.(.Z~ ~ .
BUILDING DEPARTMENT SEPTIC FORM~2~ 3 ~ ~j. .
' ~ ~ TOWN HALL
y„ .,OUTHOLD, N.Y. 11971 NOTIFY ~
gLpt;• pBpT. TEL.: 765.1802 CALL ~ •~l
~'':1: • • . .
TOW OF SOU7ti01.O MAIL TO
Examined . • ~!c/•3........, 19~
Approved T~-~......., 19~~ Pennit No. ~~.Z~.
Disapproved a/c
' (Bull no I pector)
APPLICATION FOR BUILDING PERMIT
Date 19 .
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 o 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 applicant, or name, if a corporanon)
.
. (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name ofownerofpremises.......~ ~ '~LC,CY ~4°NL
8
...............~/............K.........
(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.....d~J~iL........... .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
House Number Street Hamlet ~ ~
County Tax Map No. 1000 Section d ~ • . • • Block ....4.6........... Lot . .
Subdivision Filed slap No. Lot .
(Name)
2. Slate existing use and occupancy of premises and intended use and occupancy of.proposed construction:
a. Existing use and occupancy ......~G?;£tc r,/~ .
b. Intended use and occupancy • • . S?:o~' 9F~ • , • , , , , , , ,
3. Nature of work (check which!,applicable): New Building ..Y Addition • ...•j• `t~S~rF}tip~j .
Repair Re#noval Demolition Other Work . , i .
,,(Description)
~t o~ ~
• r(' IS`a o ~a........... „ Fee 3~~,~ g ....p............
4. Estimated Cost ,
(to bye paid on Ellin this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars ..TfC~~£ .
6. If business, commercial or mined occupancy, specify nature and extent of each type of use .
g g res, if any: Front 6.Y........ Rear 6.`f......... Depth y3 ~ .
Heie}tt s~.........
. Nu
7• Dimensions of sametstructure tuber of Stories ....I y~ .
,with alterations or additions: Front 6 y:........... Rear 6: Y .
Depth , ~ ..height a. Number of Stories `
' Dimensions of
ce/ntire new construction: Front ....y~ ; Rear ,Y, 4 Depth ~Y.'....... , .
Hci~ht r1~. 7.`.... Number of Storieys ~.~h.. .
9. Size of lot: Front ....'a°~!!~,•f ~ s? p~.•.~` . , Rear 8 ? I : s Depth . ~ Y°.` .
10. Date of Purchase .....~~a~~~.~ ..............Name of Former Owner , .
11. Zone or use district in which premises are situated ....,R~s~n~'+'f~4~ .
12. Does proposed construction violate any zoning law, ordinance or regulation: ,N. o .
13. Will lot be regraded Al p . .......Will excess fill be removed from premises: Yes Io
14. Name of Owner of premises . J !.>ir~B..>: Sit;;<oF1; ~~~sN[ Address r~&s ys r,,v~,•• Ro phone No.. a.ii!s $ Tn? , . .
or1r,~N-r
Name of Architect .................Address ..............Phone No............... .
15.isthisontroctert loc ..•.........""••Address ...................Phone No.
p p y ated within 300 feet of a tidal wetland? *YES....NO,)C..
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly a}1 buildings, whether existing or proposed, and, indicate all set-back dimensions 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.S
COUNTY OF
n ! • . being duly sworn, deposes and says that he is the applicant
(Name of individual si,n~ing contract)
above named.
i
He is the
I (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed [he said work and to make and file this
application; that alt statements contained in this application are true to the best of ltis knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Swom to before me this
...............~i...,~.,..rr...day ofll,..~r~~.t-~-...~~.-/.~. 19 90
Notary Public, /~.~e=:-... I~'• * • • County ~ p
rtan,m coat .
HEIE ~ et~tlew YpM
No.47078~&~dk (Signature of applicant)
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4.
N/0/F MAY WATSON
Wks
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PLOT I 1 ° ' - n
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C SQCP ~\61p^i M HaE 9TOgY FR4YE ~ I3 \ Qa4° ~p~'~ ~ - _ N/0/F GEORGE L.YOUNG
LP qq, eg. ~ US£ 6 BAFA OE e ~
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MAIN ROAD ( NYS ROUTE 25)
SURVEY OF PROPERTY
AT ORIENT
TOWN OF SOUTNOLD
SUFFOLK COUNTY N. Y.
CERTIFIED T01 0
- FIRST AMERICAN TITLE INSURANCE 1000 - 018 - O6 - P/O 24
- COMPANY-OF NEW YORK
TITLE N0. 605 5 5414 SCALE I 30
PECONIC ABSTRACT INCORPORATED
B. O. H # B6 SO 197 LONG ISLAND MORTGAGE CORP. AUG.. 31 198 7
ROBERT A. KEEN. Ocl, 2~ 1987 1 foundation location )
SHELLEY G. KEHL June 2, 1988 (fine/)
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EQ' A ~rG
t~'ryQ INCA 94~ Prepared in accordance With the miniinura
Sp ~O/ Cy siondards for title surveys os Wslobli~.h~d •~1
rl `a O N Y S. LIC N0.49668 the L.LA.LS. and npprovad and ad~pied
A for such use by The Naw York SIa1W Lani~
N~ N V S 8 ENGINEERS \ P.C Title Auociaii°n.
1 ~ °6'~6~ PLOT NU MRERS REFER TO ~M INOR SU B0I VISIO N~~
PO ~ MADE FOR HOWARD L. YOUNG
MAINR ~~AD
SOUTHO LDI N.Y 11971 gEVI5E0 NeV. 2918°8 1 NEW WELLi
87-669(2)
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I OCCUPANCY OR
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~ • , ; ~ ; ~ • ' j _ _ ; ~ ~ WITHOUT CERTIFICA~'E
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OF OCCUPANCY
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_ - _ _ _ I 'I _ ~ -,I' it - , - I) -I ~ NOLLVOOI NorE~'~~i
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dH N33E7 SVI{ / &P. M 9
I _ ~ NOllb'ONnOd IFV e I I
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I ~ _ _t I ao ~nans uu
_ _ li I.-_... _ - if ! a3aooad yoNillNn FOLLOW HG N5PeonOPM F
! ' ~ ~y r---- ~ ~ DO NOTPROCEfD 7. FouNOarloN - iwoREQUIREO
` ' _ r ~ UNTIL 2nd SURVEY OF
' _ ~l ' ~ 2 ROUGHURFRAMINGR& PLUMBING l
I i FOUNDATION,LOCATION
- - - II 3. INSULATIDN
f I _ - HAS BEEN APPROVED
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I I}` r^~ N MUST
v~. FiN.:3. - CONSTRUCTIO
- ~ BE LOiUiPLETE FOR C O.
~ - ~4LL. CONSTRUCTION SHALL MEET
- ~ THE REQUIREMENTS OF THE N.V,
' ~ ~ STATE CONSTRUCTION & ENERGY
CDOES. N0T ,RESPONSIBLE FOR
17ES143N OH CON`: fRUCT10N ERRORS
-
_ ~ eoe a SNELLEY NEN4
ZSSCS MAIN BD.
ORIENT. NY 1108T
SOME: / ryL / / APPROVFD RV ORAWH 6Y
• _ ~ UAiE: REVl4E0
- - eoa IcElas iWME n11PNOV. ~2
- P. O. BOX 520
BOUTHOLO. NY 11071
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28545 MAIN RD.
ORIENT, NY 1796(
- ` ~ BGIE; //y , _ APPPOVED BY URAWN BY _
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_ _ + BOB KEHL9 HOME IMPROV. p4Q
P. O. BOX 526
SOUTHOLD, NY 17971
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