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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
70WN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°- 18495 Z Date ....9/~~ 19.x.1.
Permission is hereby grante to: ,
1~.~ssa.......~.,~. ..,s~~
ct premises located at ..,~Q...l~.."~.1~ .............~~I.li...4~1.............~~...............................................
County Tox Map No. 1000 Section Q.......~1....... Block ...........ll...... Lot No............l.a:....
pursuant to application dated ......f.~~ 19.~., and approved by the
Building inspector.
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Pee S..eGrd.•~• ••j~l"
uil ~ g Inspector
Rev. 6/30/80
INSPECTORS
(s16~ 7~s-lsoz ~~gpFFO(,~C
VICTORLESSARD,Principal OG SCOTfL.HARRLS,Supervisor
CURTiS HORTON, Senior o 'y~ p,0, Box 1179, 53095 Main Road
VINCENT R. WIEC7.OREK, Ordinance ~
ROBERT FISHER, Assistant Fire = Southold, New York 11971
Building Inspeaora ~ ~ 'LC Fex (516) 765.1823
GARYY FISH SHER y~O! ~ Telephone (516) 765-1800
OFFICE OF BUII.DING INSPECTOR
TOWN OF SOUTHOLD
November 14, 1990
Mrs. Betty Billman
10850 Main Road RR #1
East Marion, New York 11939
Re: Building Permit #18495-Z (Acct' Shed)
Building Permit #18496-Z CO Z-19501
Suffolk Co. Tax Map #1000-31-11-12
Dear Mrs. Billman:
Enclosed please find Certificate of Occupancy #Z-19501 for
the addition to your dwelling.
Please be advised that Building Permit #18495-Z for the
accessory shed has expired since you did not start construction
within a twelve month period. Please resubmit your application
when you are ready to build the shed.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
Victor Lessard,
Principal Building Inspector
VL:gar
encl.
_ _
BOARD OF HEALTH
` ••1 FORMNO.t 3 SETS OF PLANS
SURVEY
TOWN OFSOUTHOLD CHECR
BUILDING DEPARTMENT SEPTIC FORPt - „
• TOWN HALL NOTIFY
SOUTHOLD, N.Y. 1'1971 CALL - • - • - -
TEL.: 765.1802
~ MAIL T0:
Examined ~a.........., 19
Approved . g,/ S~ , . , 19 ~ Permit No..I .g`S.. ~ Q~fl
Disapproved a/c ~ '1
~ U
~r_p r O~
;OWi•! OF SOUTNOLD
(B ~ ding sp ctor
APPLICATION FO BUILDING PERMIT
c
Date ....l........., 195 J
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of per, 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 stree
or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apps
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 perm
shall be kept on the premises available for inspection throughout the work.
e. No building shalt be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit putsuant to ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary in pections. "y
~
(S nature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
Name of owner of premises v. , ~Q~~ .
'a~ G (as on the tax roll or latest deedl
If applicant is a corporation, signature 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. ~S.ovr.n..C~Y.•~2.......... .
Other Trade's License No . .
1. Location of land on w}tich proposed work will be done
. .
House Number Street Hamlet
County Tax Map No. 1000 Section Black ~ Lot
Subdivision Filed ~1ap No. Lot . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy
3. Nacure of work (check which applicable): New Building Addition Alteration
Rep , ~
, , Removal Demolition • • • • • • • • • • • • • • Other 1Vork .
(Description)
4. Estimated Cost .......~?U Fee . ~ A•S .
` (to be paid on filing this application)
5, If dwelling, number of dwelling units ~ , , , . 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 ..:i . .
7, Dimensions of existing structures, if any: Front . Rear Depth .
Height ...............NuntberofStories.......................................................
Dimensions of same structure with alterations or additions: Front Rear .
Depth . .............Height Number of Stones .
8. Dimensions of entire new construction: Front Rear ...............Depth , .
Height N'uniber of Stories . .
9. Size of lot: Front ~Y:~D............ Rear ....w y:.L~4............ Depot .?,Ql.y.~.'i%............
I0. Date of Purchase...... • f 9~.A , , . • , , , , , , , , , ,Name of Former Owner ~::'z:?-Pr.(lLi•c-C~ .
1 I. Zone or use district in which premises are situated . .
I2. Does proposed construction violate any zoning law, ordinance or regulation: .
13. tVii3 lot be regraded ...J14~ ~ , Nill excess fill be removed from premises: Yes No
4. Name of Owner of.premises .?:.lMr~, .Address.~~:K.~t L~.*.^y!~~{..Phone No,7'77.:Z:j`~.?......
Name of Architect ..Address ...................Phone No. .
. . .
Name of Ccwtraclor . ~f ..~~y^.u--.......Address :fit R~ Phone No. t: :-.?-3>-~.
!5. Is this property ocated within 300 feet of a tidal wetland? *Yes`..... No i%...`
*If yes, Southold Town Trustees Permit may be re uired.
PLO"I' DIAGI~2AM
Locate cIeazly and distinctly all 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
nterior or corner lot. / ~ g s^d `?^~a.~.:. ~,ct ~a„.r+-~~ccn~:uv~ - 3 ~ ~Q,,R 7J - ~,7i2
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P~~ASNOTED 3~,
DATE: B.P, q
O ( l
NOT~FYFY
BU~DEPAR E AT ~ ri^,r_.-r"`~ i .~yv..~w
765-7802 9 AM TO 4 PM FOR Thi'c (iC~--""Zor ~ t~~~~ ~~i
FOLLOWING fNSPECTICNS: ~ r ~ v I
1, FOUNDATION - TWO REQUIRED k
FOR POURED CONCRETE
2. ROUGH -FRAMING dr PLUMBING ,
3. INSUI.ATIDN ~F `v
4, fINAL - CONSTRUCTION MUST G~yr ~ o
BE COMPLE'Cd FOR C.O. ! o,,~,);x,,,:~3 ~y_ y ~
AL4 CONSTRUCTION SHALL MEET - -
THE REQUIREMENTS Of THE M.Y. ~ l 7~ y_ - ~
STATE CONSTRUCTION de ENEf~iY Z
i ~ ` !
GORES. NOT RE5PON51Bi~ FOR AR~.~t..:~ h,,,A,
DESIGN OR CQNSTRUCTION ERRORS t , j
.1.~,.., ~ N.o,r.?,,,~J
io'x~L~f y 'd~
f'~•i id 3 ~
~-C....a 3,~
TATL OF NE~~' YORT:, S.S ~ 6 r
OL~NTY OF ~'77 ~ c~ ,
. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
rove named.
cisthe
(Contractor, agent, corporate officer, etc.)
' said owner or owners, and is duly auihorized to perform or have performed the said work and to make and file this
~plication: that all statements contained in tftis application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner set forth in the application 1-iled therewith.
vorn to before me this Q
~tar}• Public, ~•...~A ~!l~`~:....... County
HELEN K. BEYOE (Signature of applicant)
N07AftY PUBLIC, Sh{e of Brew Ya+k
Na 4707878, Suik~Ik Caunty~
Term Expires Mxrah 3Q,