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Home My WebLink About10852-ZFORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH -OLD, N. Y. BUILDING PERMIT 1\i (THIS RMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO LETION OF THE WORK AUTHORIZED) Nc 10 R 5 2 Z Date .. M.%, ` <.e". ....S:5....... I9.4c) Permission is hereby granted to: ......AAAr so n.•....... .... ep ........................ ..C.......�...Y.:.... C.o�L-s �c�ic. ....— to......................1.......................T..'..lr:!C..�.r......: 1�0.dL%..:.. �..d .................. ........JE -x cv ...; 1/�ti .........':...k.....: at premises located at..1..��.. �Q.......401Y..4"A<9.................�� ............................. *1 .OGX................................................... < .........................ASU T.... 12. Q....................... County Tax Map No. 1000 Section .../(..? ........ Block . ............ Lot No. ......... pursuant to application dated......................................................... 19......... and approved by the Building Inspector. Fee $../� �..... ........... ..8ding Inspector .. r ......................... Rev. 6/30/80 FIELD INSPY'IdN DATE COMMENTS - 1 FOUNDATION (1st) FOUNDATION (2nd) zo �. _ 2. ROUGH FRAME & PLUMBING o t^ _ INSULATION PER N.Y. STATE ENERGY CODE m ,1 x 4' FINAL ~ fi c -F ADDITIONAL COMMENTS: µ Ui W O � V 'x m w C+ 0 m C+ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined s z Approved ...�.f... � ...., 19� .Permit No. l0� .... . Disapproved a/c ......'. –.7-77 .......... .............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. AlfZ337...... . Date . .. Z...., 19V a. This application must be completely filled in by typewriter or'in ink and submitted in triplicate 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 issue 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,Ordinapce 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 f r removal or demolit' , as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil g co e, �17= lations, and to admit authorized inspectors on premises and in buildings for necessa .......... (Signature of applicant, or name, if a corporation) W1?JrF.Q , /J� fvloel- A -m AD 64AYdE.49Y /� 'h*ssAu /#F Cv, fcNvyvE ,IY c.Ty �y �ir3� 4A�eD49� ', (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 14 A01 -/C -A" F .. /.f .. occ u .�1 �...................................................... Name of owner of premises .. f-4!t!Of�..... S..... !. �Q..................................... . (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 License No. ............. . Plumber's License No . ........................ Electrician's License No. ..- ............ . Other Trade's License No. ..7 .................. 1. Location of land on which proposed work will be done. ................................................. "'2.36 ..............Q!� -A*060 V ....h�.......... %li4SMd. . Aw�77... 6L T! N,Y p qc.... . House Number /j Street Hamlet / County Tax Map No. 1000 Section !. ��' L) Block .. 1d ..... Lot ..../. Subdivision ............... ..(Name) ....... Filed Map No. .............. Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....f ,iL4�M j'4= ... �j�4��j.. ` .D/y!C .. lCi4/�71�. ?/.................. . b. Intended use and occupancy ... 4L i-,liab S!'1 W Cil— 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....:.. . . Repair .............. Removal .............. Demolition .............. Other Work ................ 4. Estimated Cost.........20,6. !� ..................... � (Description) ` ........................... Fee ..l �J................................ . (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 . *7 :-............................................................... . 6. If business, commercial or mixed occupancy, ... , specify nature and extent of each ty a of use ................. . P Y 7. Dimensions of existing structures, if any: Front .. I y:*X ....... Rear .. 9t.......... Depth . YY 0........ . Height ..2.1:3......... Number of Stories .....4"I! ......... 2 ................. �s .. Dimensions of same structure with alterations or additions: Front ...Z.•.� ......... Rear .. 3... ........ . Depth .... Y.g .../. 0.' ........ Height .. 2 3.• ? ......... Number of Stories ... b ��E . ...... . 8. Dimensions of entire new construction: Front ... �! 8 Rear .. !� . .�....... Depth ...�: �. ....... v' onE Height ....�c .......Number of Stories .. • • • .... • • • 9. Size of lot: Front .... $-P- vD ' Rear ... 94 ;3? .............. Depth .3?!11 /.RJ 6 10 . . 10. Date of Purchase .... 474-' y ................ Name of Former Owner ..P61 Q.AIA/ 11. Zone or use district in which premises are situated ........................... ....................... . 12. Does proposed construction violate any zoning law, ordinance or regulation: .... /V4? ........................ 13. Will lot be regraded ......IYO... .. ............ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises it -1. g!f4lq.5 . #0NF ..... Address 0,0106) `.4A . AMA. A /dr. Phone No. 7.r3'2.y ... Name of Architect ........................... Address ................... Phone No............... . Name of Contractor .......................... Address ................... Phone No............... . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set -back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. vie 110 �'r'$A4zc I- d.�rj aja. .qe lo -19-73 yo p N l a- S/a u.v y , C /4eLSdH 8^zs--3,T) STATE OF NEW YORK COUNTY OF . �4� S'S . , .k . . d �- e j�,�'LS , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the ....... �! �C................................................................ . (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 methis .............o.?O. :..day of ... C� �C .? �.., 19� Notary Public, .'&'.' LIND}1 F. KOWALSKI NOT:,H'r PUBLIC, State of New Yortt ":'�l''�.� ......... . No. 52.4524771 Qu ,lditd in Suffolk County (Signature of applicant) COMMISSion Expires March 30, 198&69 r—. T- SUFFOLK COUNTY HEALTH Di-PARTMENT DATE MAY 2 0 1974 H. D. RfF• The, sewage disposal and water supply facilities for this locatiotp have been inmpected by this de entt nd ou0' /� to be satisfactory. ,� U Chief of General FEngineering Service's 3� IE. N- 053 , �' d Geo/ /ire e /S 4 •-� /r^�Q[l�ar Cclr✓B J _O 0 T= LOCATION OF WELLS AND CESSPOOLS - SHOWN HEREIN ARE FROM FIELD OBSERVATION# AND/OR FROM DATA OBTAINED FROM OTHERS UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT IEARIW THE LAND SURVEYOR'S INKED SEAL OR EMIOSSED SEAL SHALL NOT EE CONSIDERED TO IE A VALID TRUE COPY. GUA A—THS INDICATED HEREON SHALL RUN ONLY TO THS PELSON FOR WHOM THE SURVIW IS PILL A..- A U ON HIS BEHALF TO THE TITLE CUMrANr, GOVERNMENTAL AGENCY ANI LENDING INS111U11vN LISTED HEREON, AND TO THE ASSIGNELS Of THE LENDING INSTI. TUTION. GUARANTEES ARE NOT TRANSFERABLE TO A0011I01HAL IFKTITUTIONS OR SUBSEQUEW OWNERS. t REVISIONS MAY 8,1974 NOTE •=MONUMENT LOT NUMBERS SHOWN REFER TO "AMENOfnO MAPS OFSECrIONB NASSAU POW, FILED /N THE SIFFOLI( COUNTY CL ERKS OFFICE AS MAP NO. 789. El e. V. -rfi"W• oit --c/s'--need /-e e►.s YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND. LAND SURVEYOR LA NO SURVEYOR, N.Y.S. LIC. NO. 12845 . NO. 45893 SURVEY FOR: SSP r GEORGE NOHE o�PRD W y 09� O AT NASSAU POINT GUA A!/CTEE�o,$g3 TOWN OF 4 SOUTHOLD , '``' 14ND SUR�E��Q SUFFOLK CO., N.Y. BY SCALE: 1 11 = 401 DATE: OCT. 191 19 73 NO, 73-1004 8AYSfAvy QP MATsAU ft- curcpfo4uE Ivy jqaumc i to fxjsj)r4 'ow�" cL/9l tA stiff Y Fo m DA T /bpi &v c smoueot 90184 To e4suse ove Vvoo 4w AY SHINaf FiffismeD AT Ll?jcllj7mj 1460s4s % It 3 JJ�J Ap _4 Iv 1 USS VII "f u 6 T C RTIFICAUE F OCAMICY