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Home My WebLink About24041-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT JU.7- �1�� (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 24041 Z Date N/A 2000 Permission is hereby granted to : ANDREW C FOHRKOLB P.O. BOX 106 MATTITUCK,NY 11952 for CONSTRUCT AN ACCESSORY BUILDING AS APPLIED FOR.EXP . PERMIT LTR 5/06 (PLANNING BOARD WAIVER 4/1/97) at premises located at 27980 MAIN RD MATTITUCK County Tax Map No. 473889 Section 102 Block 0006 Lot No. 006 pursuant to application dated N/A and approved by the Building Inspector to expire on N/A Fee $ 0 . 00 Authorized Signature COPY Rev. 5/8/02 I I 1:1,11 I Il:il'I;1;I'loll in, I I►(VI l•: 1 011 �a a r ;UIIFIII�( IUFI- „w( INp)^- 1 tnrtal 1�1tn►nt R ..z � n I'I.IIFIII 1 111; V — -9 n:;ul.n r 11111 rlut 11. Y . ,. !;'t'A'1•I! 1,1111( J z39 ----------- 1 _----- -1 I,AI. ------------ ----------- --.-.-- --.,---1.----.-,----.-w -,-----,•.w -----------------------------------------------------I —f,w.w.rr..nn—tim.•-r r,e,—,..,,r—rnrw.nlw,.wrw.n n, • -1--w-e------- ----------------------.►.n. . .. .n. n ,. n....A1111 1'I-I I)IIAI,R(:1111111�1f'I'!i : *O --.------ ------w--w---------- 111 101! AA) o � IZ1 r BOARD OF HEALTH . . . . . . . . . . . . . . . >._ FORM N0. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CHECK . . . . . . . .. .. . . . . . . . . . . . . .. APR �,_a TOWN HALL SEPTIC FORM . . . . . . . . . . .. . . . . . . . SOUTHOLD, N.Y. 11971 a TEL: 765-1802 NOTIFY: L �D�!'T., ., CALL .. .7 . :4A$51 . . Examined.....-T .f .., 19../..7 MAIL TO:. . .. . . . . . . . . . . . . . . . . Approved...... �./..�....., 19.7../ Permit Permit No. ,Q-T 1. .................................... Disapproved a/c .................................. .................................... ............................................./........ / (Bui ng-- .tor) APPLICATION FOR BUILDING PERMIT l Date . .h/. . .. !. . . . . , 199/. 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, acuate 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 application. 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 Buildicg 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 HUM MATE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Canty, Neuf 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 buildi for neces i t'on .. ............. (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. .......................1.��S ' ...................................................................................... Nave of owner of premises ..✓.!.!L..l?'::..5 'y..� (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Nave and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's Linen-9e No. .................... 1. Location of land on which proposed work will be done..a..0O./Yl..1 ....................................................................................................................... House Ntmber Street Hamlet COUnty Tax Map No. 1000 Section ... 2- ...... 1 Block .... ........... Lot ...�.......... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupeneynA of/ premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .tt�. �-Wil" S ��S'�J✓S a1PO4�/�c�h� ........................ .............7........................... b. Intended use, nd. .. .....1:°::.�'�°. P..�.�....�,y..n•ZO�!�.s�`°re.. ./.................. 3. Hature of work (dreck which applicable): New Building Addition .......... AlterAtioik ........ Repair ............ Removal ............. Demolition ............ Other Work .Ac.0 .......................... (De" tion) 1 i 4. Estimated Cost ..�.........�j....v „,H� fee ....................................i....... . (to be paid on filing this application) 5. If (kielling, mnirer of dwelling units ............ Uimber of (knelling units our each floor ................ Ifgarage, comber of cars ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t7pe of use.. . 7. Dimensions of existing structures, if any: FronC....... ..... Rear ........ Depth ... i-sr......... Ileiglht .. (�..................... Numiher of Stories ....�.............. Dimensions of . same structure with alterations or additions: Front ...,?m2.�... Rear ...�U....... . Depth ..... ,...y�.�.... lieigl►t ......aa....... Amber of Stories ..... ........ �+ f3. Dimensions of entire new construction: Front ..�?........... Rear ... ......... Depth ......... Ileigl►C ... ................. Number of Stories .... f ............... i .J 9. Size of lot: Front .. ............... Rear ..... ........... Depth ... ............. 10. Date of Rhrdmase ..................... 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 ...... ...... Will excess fill be removed from premises: '/ YES NO lei. Names of Owner of premises �^.:�2 �:..S',(.&...... Address l o?��5�!(lt!►.!�'../ZV A4?r . Phone Name of Ardhitect .................................... Address ...........:.................. Phone No. .............. Name of Contractor ................................... Address ...............................Prion No. .............. 15. Is this property within 300 feet of a tidal wetland? * YES .......... NO ..... *IF YES, SOMKID 1U4N 'IMSMS PERMIT MAY BE RE(XIIRfI. 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 deed, and show street names and indicate whether interior or corner lot. Sf/llli Or Nil YORK, O0t1NlY (Jr. .S�L' � �;�� .. ( S ---.. �.- . ... I ......................being duly sworn, deposes and says ural Ire is the appl.icanl (None of individual signing•contract) above namied, Ileis time ..........d CZ Q�A:.......................................................................... (Contractor, agent, corporate officer., etc.) of said (wn)er or owners, and is duly authorized to perform or have performed the said work and to make and file this applicati(nh; that all statements contained in this application are tnhe to the hest of his knowledge and bel.ieE and that the work will be perfonaed in the mr►rn►er set forth in the application filed tlherewidr. Sworn 19 j)efore me this !..............day of .....19!�I... 1 Notary Public (Sigrumture o Applicant' _ DOPABM def Qanmlas ,E*.My