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Home My WebLink About17616-z FO~w NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017616 Z Permission ~s hereby granted .... . , premises located at ~....~...~......~,......~-~1~..., .,.,~..~(~ ....................................... County Tax Map No 1000 Section . /(,/,..~.. , Block pursuant to opphcat,on dated .......... Building Inspector ./~.... ........ Lot No ...... ./...~., ..... , 19~., ond opproved by the Rev 6/30/80 BOARD OF HEALTH .......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORM ............... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.. 765-1803 CALL .................... Exammed .//. ? ........ 19 ~.~ MAIL TO: ~ ,f /~ - ..,,_,. o, Approved .' / ../. .. , 19~Pe~,t No /./~{~ . //~ff~- .......................... , II ~/~~~ '' ' TOWN O~ ~OU*OL. Cud~ Inspector) APPLICATION FOR BUILDING PERMIT Date ...... [.[- .t.~ .... , 19~ IN STRUCTIO NS a Tins apphcat~on must be completely filled in by Wpewnter or ~n ink and submitted to the Bmldmg Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule. b Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or pubhc str. or areas, and g~vmg a de,ruled descnphon of layout of properW must be drawn on the diagram winch ~s pa~ of t~s ap ca,on c. The work covered by t~s apphcahon may not be commenced before msu~ce of BulldOg Pem~t. d. Upon approval of flus apphcahon, the Braiding Inspector w~l issued a Braiding Pem~t to the apphcant Such pe~ shah be kept on the premises ava~able for mspectmn ~rou~out the work e No bmldmg shall be occupied or used m whole or m part for any purpose whatever until a Ce~lficate of Occupa. shall have been granted by ~e Building Inspector APPLICATION IS HEREBY MADE to ~e Bmldmg Dep~ment for the ~ssuance of a B~ld~ng Pem~t pu~uant to Bml&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable ~ws, Ordm~ce Regulations, for the const~chon of buadmgs, add,boris or ~teranons, or for removal or demohhon, as hereto descnb (Marling address of apphc~t) State whether apphcant lS owner, lessee, agent, arcintect, engineer, general contractor, eIectmcmn, plumber or bmld ............ O..~ .~. ~ .C ..................................................... Name of owner ofprem,ses . ...~..c,Xc~. ?,. ~-. ~. -~-_*~.~ . 5¢ ~?._~--.G.~. ~'.. .......................... (as on the tax roll or latest deed) If apphcant ,s a corporation, signature of duly authorized officer (Name and t,tle of corporate officer) Bu,lder's L~cense No ............. Plumber's L~censc No ................ Electrician's License No Other Trade's L~cense No 1 Location of land on which proposed work will be done .. House Number Street Hamlet County Tax Map No t000 Section [[~ f.~ ...... Block ~ ~ Lot .~.~ Subdivm~on '(Nan~e) . Fded Map No . . . Lot 2. State eMstmg osc and occupancy of prenuses and intended use and occupancy of proposed construe,mn: a Exlstmg use and occupancy b Intended use and occupancy ................... ~ ~ 4~~ ...... 3. Nature of work (check which applicable). New Budding ..... ' ..... Addition ......... Alteration ...... Repmr ............. Removal ............ Demolition ........ Other Work .......... (Descmptio 4. EstimatddCost..~...~C~.....~ .... ............... ... Fee ........................... ... (to be paid on filing thls application) 5. If dwelhng, number of dwelhng units ............. Number of dwelhng units on each floor ........... If garage, number of cars .............................................................. 6. If business, commercial or mixed occupancy, specLfy nature and extent of each type of use ................ ?. Dunenslons of exlsting structures, if any Front ............ Rear .............. Depth .......... Height ............. Number of Stones ..................................... · ..... Dimenstons of same structure with alterations or additions. Front ................. Rear Depth ~ll~ ~'~' ......... Height ................... Number of Stones ................... 8. Dimen~6'~ of~n ~'fi~-e new construction Front Rear ............ Depth ............ Height .............. Number of Stones ...................................... 9.' Size~o£1ot. Front .... t ............... Rear .................... Depth 10. D2t'e 'of Pu~r~chas~ .... .'~.~..~ ................... Name of Former Owner ................. I 1. Zone or use dlstrmt in which premises are s~tuated ................................................. 12. Does proposed constructlon wolate any zoning law, ordinance or regulatlon' 13. Will lot be regraded ...................... Will excess fill be removed from premises. Yes 14. Name of Owner of premises .................. Address ................. Phone No ............. Name of Architect ....................... Address ............... Phone No Name of Contractor ......................... Address .................. Phone No ............. IS.Is this property located within 300 feet of a tidal wetland? *YES .... NO .... · if yes, Southold Town Trustees Permit may be required. PLOT DIAGRAIvl Locate clearly and distinctly all buddings, whether existing or proposed, and. indicate all set-back dzmensions property 1/nes. Give street and block number or descnphon accordmg to deed, and show street names and indicate whet interior or comer lot. STATE OF NEW Y_...O. RK~'_ COUNTY OF . .~..X_________________~.k r~ S.S · ..'~.~?-.~' ---[-.~. ~..~..~-..~. ? .'~ ............... being duly s~vom, deposes and says that he is the apphc (Name of individual $~gmng contract) above named He is the ............................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to mal{e and file apphcahon, that ail statements contained m this application are true to the best of ins knowledge and belief, and that work wtll be performed in the manner set forth in the application flied therewith. Sworn to before me this ~. ............ Commission Ex~iros Docornber 8, 19..~ The sewago di?pos9l and water suPgl~ £acilit_~es for ? ~ lo,at!on bawe be~n. ~u ~ satisfactory, ~~ ~hie~ ef ~eneral Engineerin~ Semites HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~S U RVE'Y FOR JACK SCHEFFEF~ ~ dEAN SCI~SFFER 10T NO J4, "DEEP HD£E C~K ESTATES " ~ MATT/TUCK ; ~WN ~ SOUTHOLD ~ SUFFOLK COUNTY, NEW ~RK , ~GUARANTEES IN~TED H~REON ~ALL RUN ~LY ~ OF NEW