The URL can be used to link to this page

Home My WebLink About17207-z FOSM NO. A TOWN OF SOUTHOLD BUILDING DEPARTMEN4 TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~0 ~172oZ Z Date ...l.,.lf.,c3 19.:~ Permission is hereby ranted to: G ~..~.~..~r.~~ ......r~a......> of premises located at .....~.r~..1.~J............~...~.~.sr•~~.......~L. .ri/~• Caunty Tax Map No. 1000 Section .........9~....... Block Lot No............~~...?..... pursuant to application dated ..............~~J~.............................., 19.~~ond approved by the Building Inspector. !~v Fee $.~G~ . ~ C~~~ Buiidi Insp tor~lA~ G Rev. 6/30/80 i i r § FORM NO. t .2L ~fa t "i i 1 TOWN OF SOUTHOLD tI ~,t - 5 ~ BUILDING DEPARTMENT TOWN HALL ,f EOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined . 1~~ Received. , , , 19, Approved i~bPermit No. ~7:~'.O ~t=tzerff~ ~'gS . . Disapproved a/c f: ~ jam',//~y ~yA• uildi nspector) . APPLICATION FOR BUILDING PERMIT..„ Date .~/+•.-1.~.~:', . 190. ~ INSTRUCTIONS ~ ~ • r 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 a 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 comrpenced before is§uance of Building Permit. , d. Upon approval of this application, the Building Inspector'will issued a Building Permit to the applicant. Sucn 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, housi g code, and regulations, a' d to admit authorized inspectors on premises and in building for necessary in potions. a I ~~A ~ ign~t~e of appl~nt~,/prpam if a corporation) ~~I ~ ~ ~ z ~d N ? G f... . IB ~~t`"'}` ~ (mailing eddresa~of~appiicant)~~~•••• State whether ~gtyn~ j~ee, yggtlAt;'.~irchitect, engineer, general contractor, electrician, plumber or builder. • D W N r :~~l~wr S~~IC~,~;3: tw ~•a ~,pMy1F yiflilAelY1U#; . I . . Name of owner ~~~s°7° ~,~.!?F-;~: ~S-~~~~ . tq('tf(R.tU~ rU ~ (as on the tax roll or latest deed) ' If applicant is a 3E~IIb#~f4~r ~s~~"~• ~il~t ?1a~ ~ ~q~.¢ul~pathorized officer. T~~dv't J.?Afi$ y1Glit'~l1t;1~ ' . (NameYa~d e ~ leer) Builder's Lie~~`s~~~Bl~~~~r't..~i~ee„~ F.;fi(1. Lt11f 4'. !'I Plumber's License No . . Electrician's License No. I Other Trade's License No . 1, Location of land on which proposed work will be done. ~ _ ~3 -~,5~_ 'House Number ~ - - ~ 'Street ~ ' ` Hamlet ~ „ r., .3 County Tax Map No. 1000 Section Q':~~....~. Block , Lot , Subdivision Filed Map No., Lot . •(Namej 2. State existing use and occupancy of premises and intended use anCdroccupancy of proposed construction: a.F.xistingoseandoccupancy.~~,'(U,~~,~,,,.S~,J,~n'.~-...,.....,,,, b. Intended use and occupancy ~:m!m:e.... . ~~/y~:~~........ ..3 Re rair of work (check which applicable): New Auilding , , , , , , , , , , Addition ~~r ./U I Removal , , • Alteration . • • • • • • Demolition .Other Wgxk . 4. Estimated Cost ;~5e> ~ I' b a ~ ~ (Description) • Fee................... g ~ (to be paid on filing this application) 5. If gdwe~lin number of dwelling units Number of dwelling units on each floor . If era a number of cars , , , , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . 7. Dirensions of existing structirres, if any: Front ,Rear height Number of Stories • Depth•............ . Dimensions of same stnrcture' with alterations or additions: Front ~ • ~ ~ • • • ~ • • ' ' ' ' ' ' ' ' ' ' ' ' Depth...... .Height . Rear................., 8. Dimensions of entire new construction: Front . ' ' ' ' • • • Number of Stories . . . . Ilei lrt Rear ...............Depth , B Njrmber of Stories • . 9. Size of lot: Front y.4.G~ Rear Q, p, , . • . • . • • . • • ' " " . , Depth ~'7.?i~•. r. 10. llate of Purchase Q~ ~ ~?,Y•', ~ d ,/Q~'? • , , Name of Former Owner . ~/9:~~J,~S • ~ • ~ • • • ' p p premises are situated ' ' ' ~ • 12. Does ro osed construction v 1. Zone or use district in which iolate any zoning law, ordinance or regulation: , , , , ~ • • ~ ~ • • ~ • • ' • ' ' ' ' ' ' ' ' 13, Will lot be re raded ~ . g .Will exces fill b removed from remises: Yes 14. Name of Owner of premises• {~/~"'S,.tS ~ ,Address .i~iQ ~ / p No Name of Architect ~ ~ ~ ' • • Phone No.735<, ,(p,~?/~, . Name of Contractor . ' ~ ~ ~ • • ~ • ' ' ' ' ' ' • • • • Address ...................Phone No.. . .Address. .PhoneNo.. 15. Is this property located within 100 feet of a tidal wetland?, *,Yea No * If yes, Southold Town TKustees Permit may be required, PLOT DIAGRAM Locate clearly and distinctly atl buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloci~C number or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~ 1~ DATE: ~1~~~_"' ~R N 0 9 FEE: ~ N FY 788.180? $ AM 'Ip i OM 0611 'lilt . ' I FO4t.OWIN01NSMkCTI6N1{; . ' t. FOUNDATION TV11~ FOR PbURED ~ ' ROUQM r RRAMNNI' ~ ~ MISUI,/ATION 4. IMNAI CON91'RUC11ON MUST BEtlpMP4ETE FOII C.O. I, THE R ~ N~ wart: CONi/1F~CTIOq 8 tiNtR6v ' i _ CODES. Nall' IlE'SPONSIeI.t OgR nt=SIGN OR' CONS1'pUCTIQN FRROR$ STATE OF NEW YORK, ICOUNTYOF,,,,,,,,,,,,, S.S , i, • ~ ~ ~ ~ ~ ~ ~ ~ ' • ~ ' ' • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above gamed. Fie 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 make and file this applic,~tion; that ali statements contained in .this application are true to the best of Iris knowledge and belief; and that the work will be performed in the manner! set forth in the application filed therewith. Sworn to before me this .....•......~~.~..,:...,•,dayof.... 19.~~ Notary Public, ffdN~~/--//eePP_~~,,.,,~~.. ~'!t/,1.~ , County HELEN R DE VOE~w Yak , - ~ No. 470787$ 3aNolk Cpunq . (Signature of applicant) T~ EKgres Merch30t1 MAP OF ARROWHEAD COVE' FILE# 3810 N 07° 00'00" W roo.ra• ~ z v ~ ~ w w ~ ~ - 0 0 0 0 ° 3.9. ~ za.3• ~ m EA3' E ~ ~ ~ N N 44y (p V fi ~ M N 7~ ~ 1 ~kk~ 37.3' 10.1' m 24.7' ~ o Sk z p ~ K W 2o.a• Rl a.e• 37.3' K ~ T ~ V (D ~ o 4 D 1,300.00• SMITH ROAD ~ (privofe, road) ~~Z~~~ DDOO~~ ~I ~1 ~1 ~ (n O-~tC=D~~ ~~o~~o D --1 zz~omv--i ~ r _ y~~rnZ~ -co 0 o z O ~l D C7 1 _y w v ~ ~TI z Z b D ~ P° j'1 m° ~ v O Q Z ~ r'- C C~3,0 ~Am b n° ° I rQ m N z I ~7 O C~ Z n c y u- v o O ~1 1 z D O m~ ~r ~ ~ ~ n n. - O z -1 ~l r TI N ~z ry fg-f r n oD ~ m in ' v = a ~ z ' a. m W ~ r e~ ti 3 -A m n n. m ; ~ 3 ~ O f y O -i ;D ~ m N ~ W