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Home My WebLink About29254-Z FORM NO. 3' TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNT L FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT No. 29254 Z Date CH 31, 2003 Permission is hereby granted to : THERESE CIAMPA 182 MILL SPRING8 RD MANHASSET,NY ] 1030 for I� INTERIOR REPAIRS/ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS, APPLIED FOR VOID - 3/10/4 at premises located at /650 BEACHWOOD LA SOUTHOLD County Tax Map No. 473889 Section 070 Block 0010 Lot No. 056 pursuant to application dated MARCH 27 , 2003 and approved by the F Building Inspector to xpire on SEPTEMBER 31, 2004 . :f } / Fee. $ 150 . 0 F; i ' < Aut oriz'e Sign e ORIGINAL Rev. 5/8/02 t _ _ TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: 765.-1802 Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. Examined20 �� Contact Trustees Approved3 20 - Mail : Disapproved a/c _ EL i Phone: -_ __ Building Inspector ?APPLICATION FOR BUILDING PERMIT , MAR 28 M - — Date. G H 27 , 20Q3INSTRUCTIONS 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 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 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 what-so-ever until a Certificate of Occupancy 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, Suffdlk 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 building for necessaryinspections. (Signature of applicant or name,if a corporation) too .60K 1412 SO ,7Wk,,z Aq 1177/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder BIZ K /776c-7-/AseAjr Name of owner of premises �S PM f 7-i_2Z_� 0/a n pA (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer �1�A (Name and title of corporate officer) Builders License No.- IuvT 31E t-4-Cr-46.6 ET Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which oposed work will be done: Le Sa do rf wooer LA,dE &U7-0,0 c� House Number Street Hamlet County Tax Map No. 1000 Section 70 Block /a Lot $� Subdivision Filed Map No. Lot (Name) 2.' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy SIA)Gt.� b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration �C Removal Demolition Other Work h Ai NTENA,✓cd Repair (Description) 4. Estimated Cost Fee (to be paid on filing this application) 5. If dwelling,number of dwelling units I Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. &// q F w Rear � 8 ' 7 Depth 7. Dimensions of existing structures,if any: Front 9 �° Height 2 Z. Number of Stories / Dimensions of same structure with alterations or additions: Front �0 8 T Rear Depths/ 3 Height Number of Storied. S. Dimensions of entire new construction: Front Rear Depth Height Number of Stories _ 9. Size of lot: Front /,3S— Rear /2/' may` Depth /4 7 77 10. Date of Purchase -too Z Name of Former Owner TIc�Cn/i� 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ND 13. Will lot be re-graded .'yo Will excess fill be removed from premises: YES NO /B2 You,OR., G 14. Names of Owner of premises C/A n Pa Address M,.^'amass�r, �- Phone No. Name of Architect �47,it ^� Address 's 0 a M Phone No Name of Contractor Address Phone No. 15. Is this property within. 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey,to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OR&LrA�G ) being duly sworn, deposes and says that (s)he is the applicant gj p1,"ff- A- j;,e e,,/G (Name of individual signing contract)above named, (S)He is the 4 AC"/7-44-T 44 G'df ✓r- (Contractor,Agent,Corpo a 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 application; that all statements contained in this application are true to the best of his 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 C 77-9 day of IYA e,GJ -. - 20P3_ _ - --- Notary Public , Signature of Applicant Saroara A. Strang NOTARY PUBLIC, New York No. 4730085 Qualified - Suffolk County Comm. Expires July 31; Za of E • "K,),7t� INV 41 NN tt ��;, +k+14�"'�'►tom tw+�'t'" � VA, all � v l .y r� din