HomeMy WebLinkAbout26834-Z FORM NO. 3
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)
PERMIT NO. 26834 Z Date OCTOBER 11, 2000
Permission is hereby granted to : I
JAMES C. & DEBORA M. MILLE )
677 HERRICKS LANE
RIVERHEAD,NY 11901
for
NEW CONSTRUCTION OF A 12 ' X 26 ' ACCESSORY BUILDING IN R
/Z
YARD AS APPLIED FOR.
at premises located at 2100 ARBOR LA MATTITUC
County Tax Map No. 473889 Section 121 Block 0001 Lot No. 001 . 011
pursuant to application dated AUGUST 28, 2000 and approved by the
Building Inspector.
Fee $ 35 . 00
Authorized Signature
COPY
Rev. 2/19/98
FIELD INSPECTION REPORT DATE COMMENTS W
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ADDITIONAL COMMENTS_---
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BUILDING DEPARTMENT CHECK . . .., . ... ... . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM
;�► SOUTHOLD, N.Y. 11971 DEC
TEL: 765-1802 TRUSTEES . . . . . . . . . . . . . . . . . . . . . .
NOTIFY
�c3 /�. ... ,, CALL X0. . .)
Examined.... ..,! ., ct1.�Q MAIL TO:/.
Approved. (?......... Permit No.0163.Y.: .. �. `..!-:�s,,.?e ... ......
Disapproved a/c ..................................
....... .... �.
.. .............
(Building Inspector)
HUl7 8 [QQQ ; ; ,j APPLICATION FOR BUILDING PERMIT
Date�� .i,�.. . . . . . , 2G�L?G1
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector
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 c
this application.
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 issue a Building Permit to the applicant. Suc
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, housing code, and
regulations, and to admit authorized inspectors on premises and in 'lding for neM-0.Ary
9��Z
.( ignature of applicant ,•if a•corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil
.........................V.�.��.�.cls...............................................................................
Name of owner of premises .Va:!�:1 ►./:{l��e ...�I. .... ...... .1. ..................................
(as on the tax roll or latest deed)
If arl)licant is a corporation, signature of duly authorized officer.
...........................
(Name and title of corporate.officer)
.•••• . • . .
Builders License No. ..................
Plumbers License No. ..,.,_,,,,, '!
Electricians License No. ..................... PFQ. Fc, b. S h e
Other Trade's License No. ....................
1. Location of land on which proposed work will be done...,p .[.QQ,
House Number �'��..�1���. Street A p�...�.ICW�.. ............................
County Tax No. 1000 AL�.0.0... (Df ... Hamlet
Map Section Block ��,U,
Lot
Subdivision ....... �.Name...... ................... Filed Map
PNo. ............... Lot ........
2. State existing use and occupancy of premises and intended usT
oe
p cmmpancy of proposed construction:
a. Existing use and occupancy ...k;e,I��1�
y� �f ...!�:?�.. �.'......................................
b. Intended use and occupancy ...Lt<ll �K .CA......f'1: .FAb......�lQr.�t.er.. .�.e.� ... ..
Nature of work (clieck Which applicable): New Building .......... Addition .......... Alteration .......... ,
Repair. ............ Removal ..e:.......... Danolition ............ Other Work ...............................
(Description)
Estimated Cosk0c).O.:�t7......... fee ............................................. .
(to be paid on filing this application)
If citaelIing, miler of dwelling units c?�S e'.•. i r of chael.ling units on each floor ..14o((SA.4..S'ora5e•
'If garage, txnber of cars ... `v
�. If business, conmercial 'or mixed occupancy, specify nature and extent of each type of use.........)).��..h/.
7. Dimensions of existing structures, if any: Front..pp.l Q i........ Rear .9 C.)......... Depth ..../T.0 .�......
}}eig}tt ......................... Nutter of Stories ......................
Dimensions of same structure with alterations or additions: Front ......... .. Rear ...............
Depth .................... Sleight 1knber of Stories ..
� nn
3. Dimensions of entire con
. st7NuTber
tion: Vont ...0?1�........ Rear ... cam.• ...... Depth J ........
I...... .�.Q1.8Lof Stories ....I..... .........
3. Size of lot: Front . .'........... Rear .5"t. t../.
. /. .. Depth Rt,J&AL9 .......
10. Date of Purctase-& .� .��....... Name of Former /Owner �hA��:01�1:.. n .S.N.!�:C.{ ��.........
11. Zone or use district in which premises are situated . ' (�9e��.M�!�../'f.4�:S��.��e�. .........
"`www .. �.C)
12. Does proposed construction violate any zoning law, ordinance or regulation: ... ..........
13. Will lot be regraded ......I ).Q...... .i. Will excess fill be rammed rompremi
14. Names of Owner of pr^�emises S�i��1��R........ Address(7(11��l:tJ,l�Q C.��.tet��..IT��.,e No '
Name of Architect 1:J���?.. ��1/.�/Let;`.�S........... Address '7 Q..I.0 rt `�Pr Phone NcO/-
`/.7�J
Name of Contractor (�.�1:�i..lJele e-k' �.... ... Address�Q.. �. �I....{ ��'�D�'fhone No. . . .
15. Is this property within 300 feet of a tidal wetland? * YES ..........
*IF YES, SOLMM MN MMM-3 FE EMI MAY BE TT!q IRMi .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
5 an property lines. Give street and block numt�er or description"ccording to deed, and show street names and indicate
whether interior or corner lot. 1z 0 n;�G 0
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srntr cx raga Ytxuc,
SS
OUtJN[Y Of .......................
S
...........................being duly sworn, deposes and says that }he is the appl.icaut
(Name of individual signing contract)
above m7necl,
dieis Lhe ....... .............. M1to Q F............................................ ...................
(Ccmtractor, agent, corporate officer., etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work atyl to make aril file this
appl.icatiornt; that ill statements contained in this application are tn)e to the best of his knowledge acyl belief; aryl
that the Work Will be performed in the manner set forth in the application filed therewith.
%worn to before me this
......r2.� .......day ofO
Notary Publi
.. ELIZABETH A STATMI3 .... ... ..........
NOTARY PUBLIC,State of New York ( i g It+r,e o f App l i.can L')
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udivim fMttlw depeNdent ve"don is
tlbtib'rxoshom t *: SURVEY OF PRCP ATMA Effj Gly
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TOWN OF:SouTNOLD OOUN Y CF SUFFOLK, N•Y.
ioalzED ALTERATION OR ADDITION 11D THIS suavEY Is A t DM p* OooWAP OF-*M4o WT0l1 SNIT!-} SEGT L W4 2
ION Of SECTION 7209 Of TIE NEW YORK STA?E EDUCA' l * ''AM E S EBD RA M L LLE R
SURVEYED FOR'
OF TMS SURVEY MAP NOT BEARING DNE LANo sLFIVE1cgs
sm OR omsso sm SHALL NOT BE CONvDoiM TO CERTIFIED TO i�1=1 iTY NATIONAL TITLE COMfAgy
VALID TRUE COPY.
gTEES INDICATED HEREON SHALL RUN ONlY TO '11C P06014 -
'HOM THE SURVEY 6 PREPWtEO, AND ON HIS BEHALF TO
ITIJ COoWw4Y GOAMMENTA. AGENCY AND LENDING ' C
'UTION uSTED HEREON,ANO TO MASSIGNEE! OF THE SCALE'_ m 80 DATE: 29 1998
4 INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE f ouuJ�ATtO►J 4xwr�o� 5-to�g9
IOTTIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. SUFFOLK COUNTY.TAX:MAP SURVEYED BY F NEW yoR
XN S AND/OR SUBSURFACE STRUCTURES RECONCED OR 1060 112-LbO
K
CORDED ARE NOT GUARANTEED UNLESS PHYSICALLY DIST. . SECT- BLK. LOT LOTHAR K. REISSI
NT ON THE PREMISES At TIC TIME Of SURVEY•
VIRAPAMHOUSE.LAC4 DIANE LANE
yrs OR DIMENSIOtd SHOWN H FIM THE EAST MORICHES,
C up
sE AND � THE
IURM� ACRE Not IN ECTE'I�o UC.* 49 2 5 0 _ o�
ONUIiAET1t TIC PROPERTY LINES OR TO oth% tmO.P.
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