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Home My WebLink About17698-z FO~t~ NO. ~ TO~N OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETIbN OF THE WORK AUTHORIZED) / N9 017698 Z Permission Is hereby granted to Dote / Building Inspector Rev 6/30/80 Examined ........ , 19 · FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, NY 11971 TEL,. 765-180:3 BOARD OF MEAL T~] ............ 3 SETS OF PLANS ............ SURVEY .................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL MAIL TO: Disapproved a/c .. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date ~v~mber ? ..... 19.~ INSTRUCTIONS a. Tins application must be completely filled in by Wpewnter or in ink and submitted to the Building Inspector, with z sets of plans, accurate plot plan to pcale. Fee according to schedule b. Plot plan showing locahon of lot and of bmldings on premmes, relahonsh~p to adjoining premises or pubhc street or areas, and glvmg a detmled desdnptlon of layout of property must be drawn on the diagram which ~s part of this apph cation. c. The work covered by this appl/catzon may not be commenced before zssuance of Building Permzt. d. Upon approval o£thzs appl~catmn, the Budding Inspector will zssued a Building Permzt to the applicant Such permz shall be kept on the premtses available for mspect~on throughout the work. e No budding shall be occupied or used m whole or m part for any purpose whatever untd a Cerhficate of Occupanc5 shall have been granted by the BmlCmg Inspector. APPLICATION IS HEREBY MADE to the Budding Depaztment for the issuance of a Bmlding Penmt pursuant to Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buddings, addmons or alterations, or for removal or demolmon, as hereto described The apphcant agrees to comply w~th aH apphcable laws, ordinances, budding code, housing code, and regulatmns, and t¢ admit authorized inspectors on premmes and m budding for necessary mspecttgns. Drawer B, F~shers Island, NY 06390 (Maflm~ address of apphcant) State whether applicant 1s owner lessee, agent, architect, en~neer, general contractor, electncmn, plumber or builder general contractor Nameofownerofprem,ses . .?Pe.t.e.r..°'..cr. lsP.. /,4d..L .................................. t (as on the tax roll or latest deed) If apphcant m a corporation, mgna ure of duly authorized officer (Name and title of corporate officer) Budder's License No .28fi ~I~H. I ............ Plumber's License No 4624' Electncmn's Lmense No 296-i[ Other Trade's License No 194-^r I. Location of land on which proposed work wdl be done. . Eque$1;rl ~n ~,¥~, F~shers Island .......... Equestr. 1 ao.Ave ......................... House Number Street Hamlet , f. County Tax Map No I000 Secnon . .. Block ........... Lot. .-.__ . Subdivmxon l (N. alne)...... Fded Map No ....... Lot ........ State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy .... r.e~.l ¢~lq~CJ ~q] .......................................... residential b. Intended use and occupancyI .................................................... 3. Nature of work (check which applicable) New Budding ' Addzhon ....... Alteration × ........ Repmr .......... Removal ......... Demolition ........... Other Work .......... 4 Estimate'd Cost .. $18,000 Fee .~....~g~.~v~' ~ (Descmptlon) (to be paid on fihng this application) 5. If dwelhng, number of dwelling units .... 1 ...... 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 structi~res, if any Front ............ Rear ........... Depth ............. Height ............ Number of Stones ............................................ Dwaenmons of same structure' w~th alterations or additions Front ............. Rear Depth ................. Height ................ Number of Stones .................. 8. Dimensions of entire new construction: Front ............ Rear .............. Depth ........ Hmght ............. Nbmber of Stones ............................................. 9. Size of lot Front ................... Rear .................... Depth ................... I0. Date of Purchase ....................... Name of Former Owner 3.qh.n..8.a.s. tqn. ............. I 1. Zone or use district m which premises are mtuated .............................................. 12. Does proposed construction Xlolate any zoning law, ordinance or regulation ...n.o. ........................ 13. Will lot be regraded .......................... Will excess fill be removed from premmes. Yes N, 14. Name of Owner of premises P.e. te.r.. 0... C.r.~. s.p. ..... Address H0r.s.h.0e..R.d~M.] Jl.s.n.e~.k .NY. Phone No. 17.9.22..40..56. ..... Name of Architect ........................ Address ................. Phone No. Name of Cnntracmr A. John Gada General Contract~ ng a~=.~: Drawer 13, F~ shers Isl, N'lShone No '7'8~;/2'3~ ....... 15.Is this property located within 300 feet of a tidal wetland-* *YtgS .... NO .... *If yes, $outhold Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and d~stmctly all buzldmgs, whether ex~stmg or proposed, and, indicate all set-back dimensmns fro. property lines. G~ve street and bloqk number or descnptmn according to deed, and show street names and indicate whethe interior or corner lot. STATE OF NEW YORK, COUNTY OF ...... S S ...... A., .J. oh..n G.a.d..a~ .Sr.; .............. belngdulyswom, deposes and says that he is the apphean~ (Name of individual signing contract) above named He Is the ]Contracto (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is d¢ly authorized to perform or have performed the smd work and to make and file th~ apphcatmn, that all statements con.rained m this apphcatmn are true to the best ofhm knowledge and belief, and that th{ work will be performed in the manner set forth in the apphcatton filed therewith Sworn to before me this 9th day of. November 19 88 Notary Public ....... Su££olk ..................... County ",t~( B. FANKIEWICZ (Sign~f applicant ,~P¥ PIlBLIC, SLATE [~F NEW a. JOHN GADA General Contracting, ]nc. Tt;L~PHONI:: (5i6) 788-7231 I:~shers Island, N. Y. 06390