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Home My WebLink About16645-Z FORM NO. 2 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) N,2 16645 Z Date .... ..A.Q......... 19.—7 Permission is hereby granted to: ............... ,n t0 .. ,.t':Yh.�'•�..y ....r.t.+�r......t c..::..t...�^..+C.. is e:.;. ... ::,.:n....'Ic}..�s�. trs ....0.n....CIA.? .k'..5.�.�+....P.i� � 1 (I ((/J ................................................................................................................................................................ at premises located at .r;t .r� ....fa .. .: ... s�.c..��,. ....�-: w�Q:.....�::x::�.a�..�.,c.:a ................. ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ..... Block .....O. ......... Lot No. .-V............... pursuant to application dated .... ............. 19......... and approved by the Building Inspector. VV 10 Fee $.h ................ \ 4ig ................... Bunspector Rev. 6/30/80 (..- � 765-1802 BUILDING DEFT. . INSPECTION [ ] FOUNDATION. 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ;y'�INAL O - REMARKS DATE 1 . q " INSPECTOR�/ AAfJ fO a�Q .Y, l_ELD JJDr TE COMMENTS rp 'T7 F OUNDATION ( 1-s t ) - c FOUNDATION ( 2nd ) m 2 . zU 0 d ROUGH FRAME & -PLUMBING . y 3 . M m I2ISULATIOPI PER N . Y. • • .'� STATE ENERGY CODE x a m 4 . y FINAL c�- 1 C; ,��V`�_ -e-� Gt%V� Zk . z ADDITIONAL COMMENTS : x CXJ y _ H y i� -"- BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . . . . . . . FrTOWN a• FORM NO. 9 . . . . . . . . SURVEYTOWN OFSOITHOLD CHECK0198f BUILDING DEP� RTMENT SEPTIC FORM . . . . . . . . . . . . .TOWN HALL NOTIFY pry'; SOUTHOLD, N.Y. 11971 •,kOUTI7OLt� TEL.: 765'-1802 CALL . . . . . . . . . . . . . . . . MAIL TO : Examined O,o 3? � a Approved/"a''`�`"'�!�`"'� . A?,., 193.1 Permit No). (4 .� � • (�. l O �1(r Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Q (Building Inspector) . APPLICATION FOR BUILDING PERMIT Date . .% . ./ . . . . . . . . . . ., 19 INSTRUCTIONS 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 building for necessary inspections. (Signature of applicant, or name, if a corporation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . .. . . . . .(i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises � r��tJr!lL �f1 !!/f , , i9Tf'�J`�!.Gs�!r4 c�'/l. . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR' S MUST -BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . = Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No.'s . ... . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . _. 1. Location of land on which proposed work will be done. `?�. . .Ce/,%}0(i. .�,/�1.�/lr�. .�!12S7. _&l.!Q151. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number �O,g Street G�b,B/L �,�j!/E ;Hamlet County Tax Map No. 1000 Section .p . . . . . . . . . . . . . . Block . 7 . . . . . . . . . . . . . . Lot . . . .. . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . Filed Map No. Q (0 . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . . . ..f17-14V . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition M zV- . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` (to be paid on filing this application) 5. If dwelling,number of dwelling units . . .J . . . . . . . . .•. . Number of dwelling units on each floor . . . . . . . . . . . . . . . .. Ifgarage, number of cars . . . . . . . . . . . A. . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ... :. . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures,if any: Front . .),7_3. . . Rear .,2.51. ?1. . . . . . Depth .a7.' .. . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . .0 RI L1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions-of same structure with alterations or additions: Front S./!`t . . . . . . . . . . Rear .fj. 126rck. . ... . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories .. .. .. . . . . . . . . . . . . . . . . . . --S. Dimensions of entire new construction: Front . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . ... . . . . . . . . . . . Height . . . . . . . . . Number of Stories . .Q A? . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . ./. AID . . . . . Rear . . . . . . . . . . . . . . . . Depth foc, . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . •. . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . f}S°j . . .�041PA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . ... . . . . . . . . Phone No. 71Y.- P6$7-Jo7f4 Name of Architect . . . . . . . . . . . . . . . . . . . . . Address . . Phone No. Name of Contract Address Phone No. 15. Is this pro to th'nt ,QO feet of a tidal wetland? *Yes . . . . . No . . . . . . *If yes� � � �., u ermit may be required. PLOT DIAGRAM X% Lpcat��)d Xrll st loll' b ildings, whether existing or proposed, and,indicate all set-back dimensions from property%line �GY tre �1oc� ber or'description according to'deed, and show street names and indicate whether <r interior or fkan to (yYr 1 _ Cam' c .5I:Ai ¢A.tD i= E ou c r A N! de K oLMu YC4 T�Yt? S/fEDOPPRV AS /113At FEE:. �-- IUMED S. INISULATiO_Ni 4. FINAL 00^#STV1,Lj€� BE OO P z Ty 4_0� t: 0 _ STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . �+' 0 1 Comm `NUCrICN B[1 F30 4& • . . . . . . • • • • • . . . . . . . • • • • • • • • • • • • • • • • • . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate 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 . . . . . . . . . .. . . . . . . . . .day of. . . . 4''f` . . . . . . . . . . ., 19 � Notary Public, . . . . . . . . K .4 County RELEN K DE VOE . . . . . . . . . . . . � /. . . . . . . . . . . . NWARY PUBLIC,State of New York (Signature of applicant) No.4707878,Suffolk Cou_r�iV�i9 Term-Expires March 31 n DATUM APPROXIMATE `IAA Z SURREY DEC /T, /984 LOT AREA 12,000 SCE. FT. TAX MAP DISTRICT 1000 87-497 SECTION 22 BLOCK 2 , LOT 38 NOW OR FORMERLY SIMON SANBORN TEST BORING ( by others ) FC•0 I'E EL. 40.0 fd. pl`E I pipe /S.10*46'OO"E eE 100.00rfd.1'pip¢ 2 loam FC.0.5'W� t GARDEN( I Ia 0 U —� ' IO z O u_ �—r—r— Y sand p1 CH.LINK F[fVCE I N a: o OLL 8 N SHED (f1 Its 0 W gravel 'w Ln F.C.o.iJ. . B Co. M L r Q Q ul 17 D SHE r 'O—' ' ,S W I I I W 0.5'k. Ito�cr; d z rr > r S6. L 0 � r `� /STY. PR. awzzz• gLIDI NC3 4 N Of W GSHSS_ W 7 QDoaK J Q W 0 o O 2o,a 2z7 W O XILL Cr 0 o %W ;3 0 0 0 0 cr < 0 h ° 0 3 7 z v w O O C� rn I Q1 3 z Q z I,n z ui ioo•oo Id. 4,90.00' pipe N.10046'00"W. 100.00 fd pipe,. ';i CEDAR LANE TTe exisfenm of rTgEt tN wqs Ona or, rft of record, if any, not shown are not guaranteed. RESURVEY 10- 15- 198.7` NOTE: TEST BORING AND THE EXISTENCE OF RIGHT OF WAYS AND OR' EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED, AVF--RAGE SET BACKS AS PER 13UILDER , OCT. l�, MOD PROPOSED DWELLING SUFFOLK COUNTY DEFT. OF THE WATER SUPPLY & SEWAGE NAME HEALTH SERVICES FOR DISPOSAL FOR THIS RESIDENCE APPROVAL OF CONST. ONLY WILL CONFORM TO THE STAND- ADDRESS DATE A'RDS OF THE SUFFOLK COUNTY H.S. REF. NO. DEPT. OF HEALTH SERVICES. APPROVED BY TELEPHONE ;NE '6PF M Wn DIE (Nu MOM ;HOn HENay FROM T H IA HHALI. NUN ONLY TO THE 'PUMP JOB NO. 8 0- 362 FILE NO. 376 F STRUCTURES TO YNH PRDIRSIM FOR WHOM THM b FIM IU PIIE- LINES ARE FOR A SPEDIFID PUA- PAM, AN® ON III& BEHALF TO POSE AND USE AND THEREFORE' THU TITLE 00i4144NY, GOVERNMEN. SURVEYED F O R ARE NOT INTENDED TO GUIDE THE TAL AMIROV AND LENDING I NSTI. E MA N U E L F_ T H E M I S K AT S A N E VA K I S I ERECTION OF FENCES. RETAINING TUTIUW LINTED HEREON. Arm TO WALLS, POOLS, PATIOS. PLANTING THE ASUIONECS OC TIIE I-Q4DING 4REAG, ADDITION BUILDIN09 ROT INSTITUTION. TRA TRANSFERABLE TO (C121IJ ARE ADDITIONAL v OR ANY OTHER CONSTRUCTION- INSTINTIORS OR SUBSEQUENT UNAU IMrSD ALTERATION 02 OWIIERS OF 7Y09 SITUATED AT EAST M A R i O M tDDI T TO This O 7 IS F WPnM OF TRIM MM, 1AAP NOT /IOLATiOM OF SaECT1OiY BFJMtIN9 WE LARD SNYEYWI M Min Win M=TW 4Ri® V_411L OR EMBOSSW 8 TOWN OF SOUTHOLD - SUFFOLK COUNTY N.Y. ' alms, _-•�® SCALE 1" - 30' DATE 9 - 15 - 1980 GUARANTEED ONLY TO FILED MAP NO. DATE 10- Is -1987 =1RST AMERICA"N Y1,7Lf= INSURANCE CO- OF N.Y. BOOK NO.. 86 PAGE 24 SOIIT"I-TOLD _Sal fr^3' 3f�5. INK HAROLD F. TRANCHON JR. P.C. Ef', NUEL 4?THEMIS ICATSANEVAKIS LAND SURVEYOR SUCESSOR TO WILLIAM G. MEIER NORTH COUNTRY ROAD - WADING RIVER J`� J NEW YORK 11792 N.Y. LIC. NO. 048992 HAROLD F. TRANCHON IJR' PENN. LIC. NO. 21115-E (516) 929-4695