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Home My WebLink About22290-ZFORM N0,3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAiL $OUTHOLD, N.Y. BUILDING PERMIT No (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22290 Z D~,e ............. ~.~..~ .................... 19..7~ Permission Is hereby granted, to:. .. . . , ..~ ~x..(..4 . .~Z~.~....~..~...../../.~~ ................ -7'~ ~''-'~ .~ ......... .~./.~ ~../'C~....../...~.~. ...... ,.-....?~...~?/~...~:.?.... ~ to ............. £~.~..~.~..~ .......... ~s~..~.~.~ .................................................... .~./...~.~?....~..,~,,,,,.~,,~ ....................... County Tax Map No. 1000 Sectlon.......?.....(~).....,~..... Block .......... ~- ........... LotNo. ~....~ .......... pursuant to application dated .....~...~.7..~.~....~..'. ....... ../.....~%...., 19....~....~...., and approved byihe Building Inspector. Rev. 6/30/80 :ULATIO}~ PER'N. Y. STATE E}IERGY CODE .I ADDITIO~JA'L CO,~-~EISTS: ~! ~'~\ ' . ~ TOWN OF SOUTHOLD SURVEY '' :"]~'V ~.~ BUILD NG DEPARTMENT ClI~C~ .................. t ' ............ ~.. TOWN HALL ,~ , N.Y. 11971 ~~ TEL: 7G5-1802 ...... /' - Approved ~<~ ~O ,~9~. O~'~ 'i .. ..... ~ ......... ~=<~ ~'ermit No.~. ~'~ ................ ............. .... :... .............. Date~ .... 19 ' INSTRU~IONS a. TNs application must be completely filled in by WpewNter or in ink and submitted to the Build~g Inspector, with s~ts of plans, accurate plot plan to scale. Fee acco~ing to schedule. b. Plot pl~ show~g location of lot and of bulldogs on premises, relationship to adjoining premises or pubic st}eet: or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this app,. cation. e. ' ~e work covered by tNs application may not be commenced before issuance or Bu~ding Pe~it. . d. Upon approval of this application, the Building Inspector will issued a Bu~d~g Pe~it to the app~eant. Such pe~it sh~ be kept on the premises ava~able for ~spection throughout lhe work. e. No bulldog shall be occupied or used in whole or in p~t for any purpose whatever until a CeNificate of Occup~cy shall have been granted bY ~e Building Inspector. APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for the issuance of a B~lding Pe~it punuant to ~he Bufld~g Zon~ Ordinance of the Town of Southold, Suffolk CounW, New York, ~d other app~cable ~ws, Ord~ces or Regulations, for the const~ction of.bu~d~gs, additions or alterations, or for removal or demolition, as here~ dese~bed. The app~cant agrees to comply with all app~cable laws, ordinances, bu~d~g code, housing code, and regulations, and ..... .... (SignatUre of applicant, or name, if a corporation) ' ' ' · (M ailing adci ;e~;; } '~iSpii;-;r;t ) ' ' ' State ~vhether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. Name of owner of premises .......... .. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corPorate officer) Builder's Lmense No Plumber's License No... ' Electrician's License No ....................... Other Trade's License No. Location of land on w~hich proposed work ,viii be done ...... ~.~.S~.~.(~....~1~.~.~....: ................ ' . . · Hamlet ~ " County Tax Map No. 1000 Section :...' .ACM Block . ...... a. ' .. Lot ..... l~ ......... St,bally/sion .~58~ ~ (Name) ....... . State existing use and occupancy of premises and intended Use and occupancy of proposed ~onstruction: b. lnlcndcd usc and occupancy .' . . . ~3. Nature ofwoak (check which am, l; ....... , ' . ' , ~! Rt.,-,-,;, r, ."~' ,'-dole): ~cw Building .. Aa~;~- "~ ....... ~emoval ~ ; ~ .... · ' ' ......... ~tera~o~ ........ . ' ............. oemohtmn .... : ..... Ot~r Work .~.~ 4. Estimated Cost ........ .Z. OO' .... Fee ........ ' ... .. ......... ~ .................... (to bc paid on ~hn~ this 5. I~dwclHn2, numb¢r o~dwcH~n~ units ..... ~ ...... ~umb~r oPdwcJHn~ umts on cach ~oor.. . I~ 8ara~c, number o~ cars ~ ' ~.' ~,h,~,,, ~om~,,~ o, ~ o~,,an~. ~,~,, " ................. ' ................. ;;;;;;;. nature and cxtcnt o~ each ~ o~ usc ?. Dimensions of cx~tjn~ structures, ff any: Fron~...~ ~ ~ R - r ... .. . ........ ..... ...... ?~ ....~ ~ .......mm~ o~ ~to~ ........ . u~mcnsions o~ s~mc 5t~zcturc with alterations or n~d~fions- ~ Depth ' ~ . ~root ~ . ........... ..................... Hc[~h~ . . .~ , . · ' · ;~ ............ ~ca ..... ~ ....... ........... ,. · ~umber o~StorJcs ...... ~. ' . 8. D~cns~ons o~cnfirc new cons~ctiom Froot .... ~ ........ ; 10. 11. 12. 13. Will 10t be regoded ...... ~~~::: Yes 14. Nme or Owner of premises .d.. ~/ff~ ~Phone No. 2~ Nme of Architect ....... ': ........... Will excess fill b~emoTed from premises: Nme of Contractor . ' ...............' .... ' .................. Phone No .... ~ ....... ............ - ........... Address ~ .... - . Phone No .... ~ ..... ' 15.' Is chis property w~th~n 300 feet of a t~dal wetland? ~Yes..~.'No ......... ' ..... · If yes, 8outhold Town Trustees Permit may be required. ... PLOT DIAG~ Locate clearly ~d distinctly ~I bulldogs, (¢heth~r existing or proposed, ~d. indicate ~I set-back d~ensions from prope~y ~nes. Give Street ~d block number or description accord~g to deed, and show street n~ex and indicate whether ~tefior or corner lot. '- · .................. (Name of. individu;~l signing contract) aye nanlcd. I 5 0'59~ ~-r : --- 4, ,~ ..... ~ .kYAt :10 '±;~ ,0; ...... L ---k ¥ ..... ,)---.~ --~, ~-.~t ........ being duly Sworn, deposes and says that he is the applicant C,.~L~j J,,_~ ,~' is the . .,. , ontractor, agent, corporate officer, etc.) ...... said Owner or Owners, and is duly auttlorized to perform or have performed the said work and to make and file this dication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the rk will be perfo~cd in the manner set Torth in the application filed therewith. · om to before me this~ ,, . ' ............ ~ ........ Count .~ m~o~ mb~8~ '-. --' ....p'.- . ......... ~ 472~, ~ ~ (Signature of applic~ ~myaLl9~~ , o MOT~ o · ' LOT NUMBERS $1-10WNI REFER TO, "lvlAP OF NJA$SAU FARMS" FILED IN TI-IE SUFFOLK COUNTY CLEEK'S OFFICE AS MAP N.° 11-/9 MAP OF PROPERTY SURVEYED FOR ALFRED J. a MAP, IA KROkI'?i -*~,~,.,. D!,.kPglL20 19'/Z SITUATE A'I- PL-'COMIC TOWN OF $OUTIIOLD, SCALE° 40'= o=IRON PIPE GU/NRAHTEGD SURVEYED VAN -I'UYL ~ SOH LICENSED LA~D G~EENPOR'[.