The URL can be used to link to this page

Home My WebLink About18204-z FOBM NO. It 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) N~- 18204 Z Date .. ~./....<.. ..................... , .... ~..'../..~ ............. / County Tax Map No. 1000 Section ..... ~,.,-~, ........ Block ........... ,./,,. ..... Lot No .......... ,, ,'~,.,.~,. .... pursuant to application dated ......... ~,~...-.. ............................... , 19....~..~., and approved bv the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL EOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ......... NOTIFY CALL MAIL ........... , crmit No Disapproved a/c ..................................... Z ~ild ~t'InstYector) ' ''' APPLICATION FOR BUILDING PERMIT Date June.~ 89 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets o£plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on p'remises, relationship to adjoining premises or public streets or areas, and giving a detailed descriptibn of layout of property must be drawn on the diagram which is part of this appli- cation. ¢. The work covered by ti'tis 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 throu~out the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APP, LICATION IS HEREBY MADE to the Building Department for the issuance of a Buildin. wPermit pu'~Suant to the Buildino Zone Ordinance of the Town of Southold. Suffolk County, New York, and other a ~cabl aw' Regulations. for the construction of buildings additions ,--~, ..... :--~..-~.~ . .~ p?~[.c?l~L s,O. rdmances or The applicant a~rees to com~lv ~it~ql a-~]i'cab]e ' ,~- ,~. ..... ,~,,~x ~r.?or remo,,va~l or/~aem~lmo,a; as hereto described. admit authorized i~'l~J~d~e~ and m budding for necessary i~s~edions, f~h~ s~fi~ ~.~ d reoulanons, and to ~,, . ....... ~ZI,..j.,~ t~ eOB~ ;;,< ~.O. BOX 39, Southold NY 11971-0039 . , .. . ~ (Mailing address ap i State w~emer apphca~q,i~i[~}d~e*}¢}}ent, ~chitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises 'Donal~OG.' PisNer ~n~ Susan Krupski ' 'c" ' "5 % (ason the tax roll or latcst deed) ''' (N~md'~'nfl fie o~co~orate officer) Builder's License No .... n/a ~ Plumber's License No ........ n../9 .............. Electrician's License No. n/a Other Trade's License No n/a · Location ofland on which proposed ~vork will be done. .~L...a%~¢. pf. :¥ggAg~.~ky.e4qB¢,. ~.qug.h of Ct .48 2975 .... ti N b St ' ' · · ................................... · ............ {3p.tl~9 ~.d. ................. ouse um er reet. Hamlet County Tax ?,lap No. 1000 Section 63 · · Block ...... J- Lot ..... .2.6.. Subdivision .... I1/a Eiled Map No. (Name) .............. Lot .... . State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .S.5:.n. cff.l.e. ~.a..mii.j,7' dwe&ling. Single family dwelling ' ' ' ' ' b. Intended use and occupancy 3. Nature of work (check which ~pplicable): New Building ..... '. · · Addition ......... .;/dtcrarion .... Repair ...... . .. ........ Removal .............. Demolition .............. Other Work....X.X.X.X. ~'' Erection of 48" high galvanized Steel mesh fen;e to enclose child's (Description) play area. ~ · · 4. Estimated Cost ....... ~ .3 A 2. : 5. .0. ' ..................... Fee fi. 25.00 (to be paid on filing this application) If dv. elhng, number of dwe hn~ units . 1 " ........... .Number of dwdling units on each floor. ' If gara-.e, hum bet of care , n/a 6. f. busmcss, commercml ormixI ............... . ed occupancy, specify_ nature and extent nc o,, " ................ 7. DImensionsofcxistingstructufes, ifany: Front 28 '8" ...... chotgl~eo,°,fuse .... .n./.q ',' Hmght . 9pp. r..o.x...2.5. '... Nu 'i bet o f StoNes ............ Dimensions of Sa~e,,structure with a terations or a ...... '- oo, o, D, 31 1 I uution, on ~ ,, , ,, .,,.cpth., .................. I... }Iei~ht approx. ~5'hr t ................. Rear . .,,...2..8. fl.. 8. olmensmns ofentire new conslructin,,f~,~.~: ' ' '~'~; ............. Number of StoNes ..... ~z ..... ' ..... Hm=ht ....4.8. ......... Nu:nberorq~,,.4~ FEN?"~' ..... Rear . ..4.[I .......... Depth ...7,5.'. l0 ........ ,,.,,,~e . . .'% .'*.%~.,.~. .t~.l. ................. IJc tn ... ,5~. . .. S' ................ Name of Former Owner . .W.~l~.am M~b~ ........ I I, Zone or use district in which premises are situa Re ' ' . 12. Does proposed construction v 2 ........ ted .... ...s.A .d.ela.t.%a.-l/,h..g,r.~gg,l.t.u,];qaj. ......... 13. Will lot be regraded .... ,~'~;,~.--y zomng law, erdman, ce or regulation: .... no. ........ i'. ....... 14. Name of Owner of pre~n'iles' .D.~.~i~10' k'.l '~'llh'~3''' Wdl ex.?..s.s, fil.,l,,be ~move. d from premiSe's: .... y~.,' .... Name of Arch feet n'/a~ .............. Address e.'-?..97/..~.o..u.t.p..o.l.d, p mae No 765-.2.7.57 . Name of Contractor .(.s.e.l.f. }..D.:G.. Pisher . ...Ad, al. tess gL'_' 'aa'..,,...:,..,.: Phone No .............. 15.Is t'-' ~ .............. ,'~aoress .~.%~.?.~.,..~.o..utno.La,,, ,, 765-9'7a'7 '' · If yes, Southold Town Truste-- ~ u . t o~. a fido. 1 wetland? ~¥ES .... NO.~. , ,:~ rernllt may oe required. ! PLOT DIAG I-OkM Locate clearly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give Street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. SEE ATTAC~ED PLOT DIAGRA3{ FEE: ~.. FOLLOWING INSPE~ONS: I. F~DAT~N . ~ REQUIRED F~ ~flED ~NCR~ 2. ROUGH. ~AMING & PLUMgING 3. INSU~ON 4. FINAL CON~TRUC~ON MUST BE COMPL~E FOR C,O~ ALL ~NSTRUC~ON SHALL MEET THE REQUIR~EN~ OF THE STATE CONST~ION ~ ENEMY CODES. N~ RESPONSiBL~ FOR D~SIGN OR CONSTRU~ION ~RRORS. :TATE OF XEW YOR~ Donald G Fisher oove named(.Name of individual slgnln~ contract) being duly sworn, deposes and says that he is the applicant ANN R. NOTARy PUBLIC, No, 4764~27 Q~aJiJ~ ~ SU~ ~un~ (Signature of applicant) e is the q¥.n.e.r. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this plication: that all statements containdd in this application are true to the best of bis knowledge and )rk will be performed in the manner se[t belief; and that the 'om to before me this I forth in the application filed tt~crewith. ......... 5..t. t3 .......... day of.. i''' J.u.-,qe ........... 19.8 tory Public. ~~. County ~dc[os~.15 - ' ~E LLI 2~'Z"