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Home My WebLink About26013-ZFORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26013 Z Date OCTOBER 4~ 1999 Permission is hereby granted to: DOROTHY KOTYLAK & ORS. 280 PINEWOOD ROAD CUTCHOGUE~NY 11935 for : PERMIT TO DEMOLISH AN EXISTING 10' X 15' CHICKEN COOP (AKA) OFFICE IN THE REAR YARD OF A SINGLE FAMILY DWELLING. at premises located at 8850 County Tax Map No. 473889 Section 073 pursuant to application dated JULY Building Inspector. BRIDGE LA CUTCHOGUE Block 0002 Lot No. 004 9 1999 and approved by the Fee $ 15.00 Authorized Sig~ture ORIGINAL Rev. 2/19/98 FORM HO. 1 TOWN OF SOUTHOLD BUILDING DEPARTHERT TOWN HALL SODTBOLD, N.Y. 1 ]97 I TEl.: 765-1802 .. , 19 .... Permit No ................. Disapproved a/c .................................. BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ....... ................... SEPTIC FORN ................... No'ri FY: HAIL TO: .......... ..cf. .... ......... Date ............. , INSTRUCTIONS a. 'Ibis application mast' be ce~apletely filled in by typemiter or in ink a~d su~itted co & ~fildi~ Ins~tor 3 ~ts of pl~, ~ate plot pl~ to ~ale. F~ ~rdi~ to ~le. b. Plot pla ~ l~tim of lot ~ of ~ildi~s ~ ~s, relati~ip to ~joini~ pr~s or ~lic struts or ~e~, ~ givi~ a ~tail~ ~ariFi~ of last of pro~ ~t ~ dr~ ~ ~ di~ ~i~ is ~rt of this a~li~ti~. c. '~m ~ c~r~ by ~ia a~li~ti~ my mt ~ ~ ~fore isle of ~ildi~ Pemit. d. U~ a~al of Sis a~li~ti~, ~ ~ildi~ Im~ctor xfi11 is~ a ~ildi~ ~t to the applicat. ~t ~11 ~ ~pt ~ ~ ~s avail~le for i~ti~ ~r~t ~ ~rk. e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~rt far ~y ~ ~at~r ~til a ~rtificate ~ ~11 ~ve ~n ~t~ by ~ ~ildi~ I~tor. aI~I~ IS ~Y [~ to t~ ~ildi~ ~nt for ~e isle of a ~ildi~ Pe~t ~t to the ~ildi~ ~ Ordi~ of ~ T~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~r a~li~le ~, ~di~s or ~lati~, ~r ~he ~sr~ri~ of ~ildi~s~ ~iti~ or alterati~, or for r~al or ~liti~, ~ ~rein ~ri~. ~ applier ~s to ~lY ~i~ all ~li~le 1~, o~i~a,~____~ildi~ c~, ~slng c~, ~lati~, ~ to ~it ~ri~ i~tors m pr~s ~ in ~ildi~~~~tims. {Si~ ~ a~li~t, or ~ if'~) . State ~hether applicant is owuer, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........ .................................................................................................... Nam o£ o~ner of premises..~. / .,,~..../~.0./~ .¢-~. f.t~ ~....~....~... .................... ~?.P./.~O~J~};a ~[0]~ .' ................ (as ~u the tax roll or latest deed) DATE: If applicant isa corporation, signature of duly autI~rized officer. FEE: (~ and title of ~e officer) FOLLOWING INSPECTIONS: /~,. 1. FO~h~DAr~ON . TWO REOUIRED FOR POURED CONCRET~ l~ilders Licerme No .......................... 2. ROOfCi - ~&f~tHG ~ PLUM~IN~ 3. INSULATION Plt~bers Licease No .......................... 4. VIM. AL CONST~UC?IO~ MUll' Electricians License NO ...................... BE COMPLETE ALI. CONSTRDCTIO~ Other Trade's Licemse No ..................... ¢..~- ~__TH[ ~I¢I~IF.~T~ ~: I. Ix)cation of land o~ which proposed ~ork will he done ............... _o~__~_,..~.,~. st ot ............ Subdivision ...................................... ~iled Map No. ~ ............. Lot ............... 2. State existing uae and eccupaany of pr~i~a and intended use a~d eceupa~y of proposed co~straction: sting ..... ......................................................... ~. Intec~ed use ar~ eccupanc~ ...... .///~. .................................................................. 1 3. Ia;]ture of ~ork (ct~q:k ~id~ applicable): ~ Iluilding X~ ..... ~iti~ .......... Alteration .......... ~ir ............ ~1 ............. I~llti~ ..~ ..... O~mr ~ .................................. ~. Esti~mt~ ~st ~ ~ ¢~ ~~ ~ripti~) (to ~ ~id ~ filing this a~licati~) ~. 1[ ~lli~, ~r of ~lli~ ~mlts ............ }~r of ~lllng tmits ~ ead~ fl~r ......... ~ ...... ............... If garage~ ~r~ If ~i~ss, ~,,,=reial or ~ ~, ~i~ ~ture ~ ~tent of ead~ ~ of u~ ...................... ~mt .... ~. ....... ~ar.~...~. ....... ~pth ................. 1. Di~~isting st~ms, if a~: ~ *l~i~t ..~.~: ............ [... ~r of Stories ...................... Di~nsi~ of ~ st~e ~th alterati~s or ~itions: ~t ............... ~ar ............... ~pth .................... ~i~t .................... ~r of Stories ............... /. Di~nsi~ of entire ~ ~st~tim: ~t ................ ~ar ............... ~pth .............. l~iO~t ......................... ~r of Stories ..................... ~. Si~ of lot: ~t .... ~]./_' ............... ~ar .................... ~_~_~pth ............. j ...... II. ~ or ~ district in ~i~ p~i~s am si~tM .............................................................. $P. ~s ~o~ mt~ti~ violate a~ ~ing 1~, o~i~e ~ ~lati~: ........................ 13. ~ill lot ~ ~ ......... ~.~.... ~ill ~eas fill ~ ~ ~ ~s: ~ ~ 16. ~a of ~r of pra~s ........................... ~reas .............................. ~ ~ ............... ~ of ~ddt<t .................................... ~ress .............................. ~ ~ ............... ~ of ~tr<tor ................................... ~ress ......... H~ ~ ............... ........~........ . ...------- .¢------- PLOT DIAGRAH Iccate clearly taxi distinctly all buildings, ~aehher existing or proposed, and indicate all set-back dimensions property lines. Giv~ strt'ot and block taraber or description according to deed, and ~ street ms and indicate ~ether interior or corner lot. ..~e~ ..... .. .... ¢~.~.~..~f~ ..................... I~.~; d,,y ~... de~,~ ~ ~y~ ~ ~,~ i~ ~ ~i~,,~ · ~ of i~ivi~l si~ing cmtract) (C~tractor, a~nt, cor~rate officer, etc.) f ~id ~r or ~rs, a~ is ~fly ~tl~ri~ to ~rfom or h~ I~rfo~ tl~ ~id ~ m~l to rake a~ file this ~llcati~; that al hat the ~rk will I~ l~rfo~l