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Home My WebLink About24603-Z FORM NO.3 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) Date.....aAItIUARY........1.5........................... 19.3.13.... 24603 z Permission is hereby granted to: .......THOMAS...G...&...L.AU.I.SE..E..A..HLIZ.................... .......;�a...GHURGH..I..AN13................................................ .......NIARLE;...151,.AWJ2,NY...1.1.4.5 ............................ to.....INS.T.AI.A....6...NEW...32...FAG ....Q.I.I -.P.DWEFiER...HOT...WATER...HEATER-AS...AP.P.LIED. FOR .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. at premises located at................2.10.0.....P.I.KE-9T................................................MAT.T.I.T.UCK......... ................................................................................................................................................................ County Tax Map No. ....4.7..38EI19..... Section ...1A.0............. Block .....OOL13......... Lot No. f022............... pursuant to application dated ...DECEMBER.....1212........................ 19......9..7..... and approved by the Building Inspector. Fee$........7.5..0.0..... ..... ....... .... .. �'tl � Iding Inspect Rev. 6/30/80 I- ILIM IIlli l'1; lull Illi 1'11111 � 11A�1ill ----,-- (:Vill WIIID � [� 1� rnul 11(11('1111( ( I!�7) FVunuAI W11 ( 21111) v) n IIIIIII:II I'll Arll; A 1'L1❑111118: - V ---..----_------..._..----- ---- -•------. ---------.._...._--- -- -_•-----------_f------------------------ W I� I II:.III.A'I'I1111 I'll Il II , Y !I I A IR I'.IIF.IIIIY - ____.. --__ _______ ________ __________._-_.--____.--.-----------------_-______--___-_-__. rr '/ � J u - -- -- - 41 1.. --- t 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLB6. [ ] FOUNDATION 2ND INSULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: V/w DATE � IN8PECT0 j BOARD OF HEALTH . . . .;: . . . . 9� n� -6RM N0. 13 SETS OF PLANS . . . . . . . . . a vF SOUTHOLD SURVEY . . . . . . . . . . .`. . . . . . . BUIL I�NG DEPARTMENT CIIECK . . . . . . . . . . _ , • EG 1 21997 TgWN HALL SEPTIC roRrl , , , , , , , 1 SOU HOLD, N.Y. 11971 ---- ----- EL.: 765-1802 t:UTIFy FDD y B?-DG DEFT. . . Examined �s r� CALL . . . . . . . . . /. . . . . . . .I , rIAIL TO . Approved . ./. . . . . . . . . . ., 19 l.�Permit No. .A� T(OCJ 3 . . . . . . . . . . . .'. . . . . . . . . . . . . . . Disa . . . . . . . . . pprovedac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building spector) 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 necessaryZr4,0 ctions. . . . . . . . . . . . : . . . . . . . . . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whet r applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises � ��.S. . . . . �. . . . . . . . . . . . . . . . . AP . . . .FAA.WE0 (as on the tax roll or latesOA� 05 AA �.R M .�� If applicant is a corporation, signature of duly authorized officer. NOTIFY §VLWO 000INAENT AT 766-1 SM 9' TO 4 WA FOR THE (Name and title of corporate officer) UNDERWRITERS ED IFICATE 'O 1'!MO ANWRED Builder's License No. !OR o • PLUMBING Plumber's License No. . . ` 3` :• IN 4. IIMAI. • {;ONtiTR11CTtON MUST Electrician's License No. . .�.ALU tz0!!C.O: ALL CON! UCTION SHALL MEET Other Trade's License No. TME RRpMEMENTS OF'THE N.Y. •TAU CON$TRUCTION .&, ENERG,Y CODES. ' NOT RESPONSIBLE FO 1. Location of land ++on which,p posed work �will _ be done. • •D119101.OR CONiTRUCTION•EPAORS . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N . . . . . . . . . House Number Street Hamlet . . . County Tax Map No. 1000 Section . . . . . `.O. . . . . . . Block . . . . . . . . . . . : . . . Lot . . . . . . Subdivision . . . . . . . . . . . . . . . . . ... . . . . . . . .'. Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) 2.. State existing use and occupancy of premises and intended use d occupancy of proposed construction: a. Existing use and occupancy 1. ��:' � lf/e . ///�t . P Y . . . . . . . �1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . .� C/ �. . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . ... . . . . . . . . ,3. Nature of work (check which applicable): New Building . . . . . . : : Addition . . . . Alteratior. 4 t'� Repair . . . . . .. . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . ... . . . . . Other Work`2: ' . . . . . . . 4. Estimated Cost . • (Description) / . . . . , . . . . .'. . . . . . . . Fee . . . 7- _ . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . .. . . . . . . . . . Number of dwelling units on each floor. If garage,number of cars . . . . . � � • • • •.� • • • • 6. If business, commercial or mixed occupancy,specify nature•and exte t of type . • . . . . . • • • • • . • . • • 7. Dimensions of existing structures,if any: Front . . n YP of use . Height . Rear . . . . . . . . . . Depth . . . . . . . . . . . . g . . . . . . . . . . Number of Stories Dimensions of same structure with alterations or additions: Front • • • • ' • • • • • • • ' ' ' ' ' ' ' Depth . . Height . . . . . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . • " Number of Stories . . . . . . . . . . . . . . . . . . . . . . g . . . . . . . . Number of Stories.Height . . . : . . . ri . .es . . . . .. .. . . . .. . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . ' 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . Rear. . . . . , . . . .Depth. . . . . . . . . . . . : . . . . . . . . . . 10. Date of Purchase . . . . . . Name of Former Owner ' 11. Zone or use district in which premises are situated , • • ' ' ' ' ' ' ' . . 12. Does proposed construction violate any zoning law, ordinance or regulation: • • • • • • • . . . . 13. Will lot be regraded �-�y�� . Will excess fillbe Femoved fro . premises: • . • •Yes . 14. Name of Owner of premises l//�/�A.� . .Ac�,y; , • Address�l�v1 No Name of Architect • • • e .Address Phone No. Name of Contractor , , , , , , . Address �? ,Phone No. ��G'- s • 15. Is this property within 300 feet of a tidal-wetland? * *If yes,- Southold Town Trustees Permit ma be required. . . . . . e uired. . • • " No. . . • • . PLOT DIAGRAM 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 rndeed, and show street names and indicate whether interior or comer lot. t ill�A 03V " , r 31Ur� N" a of ! > ' ' : li'�1j1171�b fid! :a,�� ; CAIN• S STATE OF.NE 0 COU/ .' ( . �!�+ . 1AMM. ►S . . . being duly sworn, deposes and says that he is the applicant �(Ne�ln2f�lN1�1103l6 g contract) above_name&.� 1;40JT)�i T&"03 3YAf He is the :. . . . . . :. . . (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. . . . . . ., 19 . Notary.Public, . . . . . . . . . . . . . . . . . County KENNETH A.MIONE ,I NOTARY PUBLIC,State of New York No.01M15040174,Suffolk Co t ' ' . . _j ' ' ' ' ' Term Expires March 6, 19l�/ (Signature of applicant) .