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Home My WebLink About27941-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall j Southold, N.Y. z/ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27941 Z Date DECEMBER 6, 2001 Permission is hereby granted to : MORTIMER M III KELLY 157 SOUTHARD AVE ROCKVILLE CENTRE,NY 11570 for ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR r' at premises located at 1195 GOOSE CREEK LA SOUTHOLD County Tax Map No. 47388:9 Section 078 Block 0008 Lot No. 008 pursuant to application dated JULY 27, 2001 and approved by the Building Inspector. Fee $ 744 . 30 i \� aAuthorized Signature 1 ORIGINAL Rev. 2/19/98 BIELD INPPECTTON_REPORT DATE A:: CO2II4ENTS FODNDATION ( 1ST)' c, ROUGH FRAME & i PLUMBING c INSOLATION PER N. T. STATS ENERGY CODS FINAL 7 r ADDITIONAL COHMENTSd FFF C c c C W TOWN OF:SOUTHOLD< BUILDING PERMIT APPLI".ATION CHECKLE BUILDING DEPARTMENT Do you have or neod the following,before appbdm TOWN HALL Board of Health SOUTHOLD,NY 11971 v 3 sets ofBuiildiugPlans TEL: 765-1802 Survey PERMrf NOo7 /1//Z_ �Check — n S Septic Form N.Y.SM.B.C, Trustees Examinad O 20 ell contact: Approved 200/ Mail to: Disapproved a/c :2:/7 Phone: Building 27 Al LJCA1 ON FOR BUILDING PERAM - - -'� Date 2 20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with: sets of plans,accurate plot plan to scala Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets w areas,and waterways. 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. Such a perm 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 what-so-cver until a Certificate of Occupat is issued 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 renoval 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 building for necessary inspections. ( igosus/e Of apvp/HOMA ,if a corporati on) 7 (Mailing address of apphcam) State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises MG/il mmol M 4ZI_-r '�� d- �L'1 vAl-Oed (as on the tfix roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. ron 9fland on ch proposed work be done: HRbuse Number Street Hamlet County Tax Map No. 1000 SectionBlock Lot Subdivision /t/ Filed Map No. Lot (Namd State existing use andoc occupancy ofprelnises and intended use and occupancy of pmrsed conshwdon- a. Existing doi occupancy FM22 / b. Intended use and occupancy. ,i 1n�np Nature of work(check which applicable):New Building Addition _Alteration Repair Removal Demolition Other Work (Description) Estimated Co . f��00� Fee (to be paid on filing this application) If dwelling,number of dwelling tmits__(_Number of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of structures,if any- Front q Rear Depth Height Number of Stories Dime 1 rig same structure with alterationns/oar additions: Front Rear Depth —3 Height Number of Stories. �✓ Dimensions of entire'new construction:Front Rear Depth HeightNumber of Stories 2 Size of lot:Front Rear Depth Z19 0. Date of Purchase�k-rn m-e - ��/d Name ofFormer Owner 1. Zone or use district in which premises are situated 2.Does proposed construction violate any zoning law, ordinance or regula*on: 3. W-111.lot be re-graded l Will excess Ell be removed from premises: YES NO )5"7 9nVil,#" #.,L 57b ,�3G Poi b' tlf 4.Names of Owner of premises mD�r m,, l/ Address �?OC Z/ .0 Gfy Phone No. z FAD l f (W) Name of Architect L �lk t kl t LL Address Phone No Name of Contractor Address Phone No. 5. Is this property within 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAYBE REQUIRED 6. Provide survey, to scale,with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. TATE OF NEW YORK) SS: :OUNTY OF ) being duly sworn deposes and says that she is the (Name of individual c ( ) applicairt signing oatraet)above named, We is the (Contractor,Agent, Corporate Officer,etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and Me this application; at all statements contained in this application are true to the best of his knowledge and belief;and that the work will be xformed in the manner set forth in the application filed therewith vom to before me this day of 2001 Notary Public / 1: 4?Siguature ofApplicant JOYCE M.VVMNS NOMW Staft of Now Yock 4952248,Suffolk Courdyy Term ExpiresJune1Z .1oo3 • R K oY � o GC,�EEf o� ��5 l P�^ OQS 0� Right 75 00 G 2 T� f o.• O . E 2ti 1.53.50 65 �, f IR 0. 15s 1� o 0 1 C 4 ' ZZ �,s 0 6• p .o � 5k1• o Jh , � '•a. NQS ?x N r \ N13\ \ O \o f•c d� ��a- . 3'So. W. P�NER 901*�, S 6� 5 S�NVM CN ER ° tLS A WSORANCE CORPORATION OF f� HPRRY C N M P Ww yow 5 WES IW4STER BANK (� N EONARD LERER & GER TIE LERER TITLE NO. 8752-61747 i i SURVEY FOR L EONA RD L ERER & GER TIE L ERER A T BA YVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. /000- 78- 08 -08 fit MEwyo� SCALE= 1 "= 30' NOV. 61 1987 N LIC. NO. 49618 ENGINEERS, P.C. :.cuTHl9LD^Y. 119.71 87 - 868