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Home My WebLink About18428-Z IPOIM NO, S TOWN OF SOUTHOLD BUILDING DEPARTM£NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18428 Z Permission is hereby granted to: -- -- / . County Tox Map No. 1000 Section .......... ./...~...,~...... Block ...... ~ ........ Lot No ....... ..~...t'../... ...... pursuont to application dated ......... .~....~,,/. ................................. , 19..~..~..., and approved by the Building Inspector. ~'~' ~-~ ~/~ ~ Rev. 6/30/80 BLDG· DEPT. ,..._..,~...~_~ O F SOUTHOLD FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 7G5-1803 D~sapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT gOARD OF HEALTH ........ 3 SETS OF ?LANS '~ SURVEY ........ NOTIFY Stephen Thomson AIA C^LL .~.~.~l~q ........ MAIL TO~homson Architects 302 Elizabeth'Street Third Floor New York NY 10012 Date . .1.1...ACg.u.~..t ....... 198.3.. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to thc Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pt~-u showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ando~vm=-' ' o a detailed description of layout of property must be drawn on the diagram which is par~ of this apph- cation. 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 issued a Building Permit to the applicant. Such 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 aay 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 Re~.ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Till applicant agrees to comply with all applicab~le laws. ordinances,....b.m~i~g cofle, ho.~code, and regulations, and to admit authorized inspectors on premises and in building for necessary~/ps:l' ~ I I · .... ?.%_.. [ ! ........... (Signature of applicant, or name. if a corporanen) Thomson Architects · ~02- .lil£a~beth..qtreat.. NY., .I~Y...100.12.... · ~,. (Mailing address of applicant) State whether applicant .i~ (~m~r,,l~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. -- Architect New York State RA~15616 · Adrian H ~ourtenay III Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ............. .lb. ............................. (Name and title of corporate officer) Builder's License No ....... .P.e.n.d..i.n~ .......... Plumber's License No. . Pend.iD.cir ..... Electrician's License No. Pending Other Trade's License No. Pendinq Location of land on which proposed work will be done ....... ' ......... '. ................................. 7~0~- Wickham Avenue Mattituck [louse Number Street, Hamlet 107 5 6.1 County Tax Map No. 1000 Section .' ................. Black .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing usc and occupancy of premises and intended use and occupancy of proposed construCtion: · Si. ngle Fatally Residence ~ a. Ex~sting usc and occupancy ....................................... ~ .';z% ~".~ ~ ............. Intended use and oecupancy ........... , 3. Nature of work (cb. eck which applicable): New Building ' Addition~-7. · · Alteration ~'.. Rep. air .............. Removal .... ,.:, .~ ..... Oemolition /-~x. · · .,..".~.. Other Wb¥}~,. I..[,',3 ......... 4 Estimate'dCost .. ~ .................. ~ Fee ................ .;....~. (to be paid on filing this application) 5. If dwelling, nmnber of dwelling units one Number of dwelling units on each floor ............. If garage, number of cars ............. .two ....................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each tvve of use ..................... 7. Dimensions of existing structures if any: Front ..... 4..8..f.e.e..t.. Rear . 57...f~.e.t. .... Depth . 3..8..f.e.e..t.. Hei_~ht . 2.4. fe~.t. ..... Number of Stories ... iqn. e...a.n.d...n.a.l.f....(.1~). ..................... '" Dimensions of same structure with alterations or additions: Front .4 ~..f.e.~'¢ ..... Rear 4.7 feet Depth .3.8. f o.e.t, ........... Height ........ 2. 4...f.e.e.t.... i.. Nmuber o} Stories..qn. ¢i i~.na' }~ia~'f ~ ' '('1'~ 5 8. D mensions of entire new construct on Front .... (1 ......... Rear...1.2...f.t..6...i.n. Depth . '5' ~'t Heght . .1,1,? ......... NtmberofStories..P.n.e. ............................. 9. Sizeoflot Front ...3..5.9 1.0 .ft Rear 653.85 :~t ' i;~'5~2"}:7''i~ ....... .' ................................. Depth 10. Date orPurchase .... 12..JO.n.u.a.r.Y. }.9.8.3. ....... Name of Former Owner . .~i~¢~.l.,:n, p,g.clf~Q.r.d ......... 11. Zone or use district in which premises are situated ..... .A":C ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....N.o. ............... 13. Will lot be regraded ... y.e.s ................... Will excess fill be removed from premises: '' 14. Name of Owner of premises .A.d.r.i.e~O..C.o. u r. .t .e / l o, YAddress . .S.e.e...B.e.l.q¥ ....... Phone No .... ~ ........... Name of Architect Stephen Thomson . .Address See Below .. Phone No. Name of Contractor , :['.ending ....... Address ................. Phone No ....... ' ' 15.Is this property located within"400 feet of a tidal wetland.* ~¥ES .... NO .... · If yes, Southold Town Trustees Permit: may be required. PLOT DIAG Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. Owners Address Mill Hollow Corporation 19 West 21st Street New York NY 10010 Architect Adresss Thomson Architects ' 302 Elizabeth Street New York NY 10010 Third Floor S~e Plot Plan on prawings STATE OF NEW YORK, S.S COUNTY OF ................. ........... .s.t?.p .h.e.n..C...T.h.o.m..sg.n' ................. (Name of individual signing contract) above named. Sheet No DA-1 AP/PROV, ED AS NOTED , ~:EE: ~:~,~-y'v~-~-r eY: ~/~ NOTIFY BuILDf~'-G DEPARTMENT AT 76s~~802 9 AM TO 4 PM FO~ THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. IN.qULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY COOES NOT RESPONSIBLE FOR r ?c!GN OR CONSTRUCTION ERRORS being duly s~vorn, deposes and says that he is the applicant Architect I{e is the ......................................................................................... (Contractor, agent, corporate officer, cfc.) of said Owner or owners~ and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~'ork will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... ................. day of.. \'otary Public ....................... County (Signature of applicant) Ne. 4804072 _ ~ in Suffolk County ~... * [;~mWNllk~ Ex:pifel May 31.