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Home My WebLink About23018-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 AUTHORIZE Date............. .. ... . ... .... .. .............. 19.2 NE 23018 Z Permission Is hereby granted t94) / C../ .......... 2p............. ............. to ... ........... ............. . ............................ ................................... r ....... ..... ......... ................ .... ......... .......I............. ... • ..�....... .T .... .M• ..... ..... ................ ... n ..... ...... .......................... ... • . .. .. .../........................................................................................................ at premises located at............. ............. ...................... .................................................... ...W,.� .. .... ... ....................... .......................�.��-�........... P......... ................................................. . ............ County Tax Map No. 1000 Section ...... ..3........ Block........... ....... Lot No. ... �..,cf..... pursuant to application dated ...... .. ...... .. ....../.2—............, 19.. and approved by the Building Inspector. Fee$. ... / J y .... ..................... .. .... ...... ................... Build ng Inspec r Rev. 6/30/80 BOARD ' OF HEALTH . . . . . . . . .. FORM NO. 1 3 SETS OF PLAYS . . . . . . . . ., TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . .. BUILDING DEPARTMENT_ CHECK . . . . _ _ . . . . . . . . . TOWN HALL SEPTIC rORN . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:Oi I F1' 0G Q®`/ CALL �i4;� �fo . . . . . . . . . . Examined . . . . . ., 197�.' MAIL TO : Approved . . . . 19 � Permit No. ��/ . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . Disapproved,a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � . (Building Inspector) P LICATION FOR BUILDING PERMIT Date . . . . . 0 . . . . . . . . ., 19 . . . INSTRUCTIONS A. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 permi 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 tht Building Zone Ordinance of the Town -of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o: 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 tc admit authorized inspectors on premises and in building for necessary inspect � •. . . . . . . . . . . . . . . . . . . . . (Signature of applicant, >r na e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer; general contractor, electrician, plumber or builder. . . . . . . . . . Name of owner of premises 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) I Builder's License No. �-4 0wr 12 Plumber's License No. . . '. . . . . . . . . . . . . . . ... . . . � TOWN OF SDEPT. OUTHOLD _ Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which roposed wor will be done. i . . ... . . / . . oo�� House Number Street // Hamlet ) County Tax Map No. 1000 Section . : . :C7 . . . . . . . . . . Block . . . . . . . . . . . . : . . . Lot . � � . . . . . . . . . . . Subdivision . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . (Name) 2: State existing use and occupancy of premises and intended use a d occupancy of proposed construction: a. Existing use and occupancy . . , �/� ;�•,?/ l°sv b. Intended use and occupancy . . . . . . �� . . . . . . . ... . . . . . . . . . . . . . . s •3. Nature of work (check which applicable): New Building . : Addition Repair . . . . . . . . . . . . . Removal . . . . . . . . . . . . . ... � • ' ' ' ' ' • • • • • • • • • • Alteration . . . . . , . . . . . . . . . . . Demolition . . . • • , • • • . . , Other Work . /�'e►�!L 4. Estimated Cost (Description) : !�. . . . . , ; , , • . • . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. If dwelling, number of dwelling units (to be paid on filing this application) If garage, number of cars . ... . . . . , • Number of dwelling units on each floor . ... . . .. , . , • • _ . . . . . 6. If business, commercial or mixed occupancy, specify nature and exte 7. Dimensions of existing structures, if any: Front . . , nt.of•each type of use . . . . . . . . . . . . . . . y' Rear Depth Height . . . . . . . . . . . . . . . Number of Stories Dimensions of same structure with alterations or additions: Front • • • ' ' ' ' ' Depth. . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Height : Number of Stories . 8. Dimensions of entire new constructions:. Front . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . -Height • • • • . . . . . . , . Number of Stories.. . . 9. Size of lot: Front . . . . . . . . . . . . . . . . .: . . Rear. . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . 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 • . • • , • • • , • • , • . Will excess fill be i-mr"oved from premises: Yes 14. Name of Owner of premises . . . . . . . . . . . . No • • . Address ltPhone No. Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address `,� ' ' . . . . . . . . . . . . . . . Name of Contractor ' ' 'Phone No. . . . . . . . . . . Address . * ` Phone No.15. Is this property within 300 feet of a tidal 'wetland? `'` : • • " " " " " " ` ' Ye's:� .r . . . . *If yes,- Southold Town Trustees Permit may. .be required:' N`o. : . . . . . . . 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. 'VoTIFY U¢Lf'fa Eil�, 6,r;-iS'U2 9 Aa,7 (� F0LL,0W7q�, tGV pE�IIOIV.� FOR THE { ra ' .•_`...��• +, ';,r, l-lyj� it l:l�l�lrl Ci.f 1 f 14 f,J 1..t IUj'a i_f51i L..�i'••:.' STATE OF NEW YORK, COUNTY OF . . . . . . . . . . . . . . . . . .S.S ��•r• • • A• •`)•� p��7�o. . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) • Pp above named. .-le is the . . . . . -. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) )f 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 .vork will be performed in the manner set fortli in the application filed therewith. ;worn to before me this . . . . . .I , . . . . . . ... . .day of. . . .. 19 lotary Public, . . . . , County . . . . . . . . . . LINDA,J.COOPER (Signat re of applicant) Notary Public,State of N Y4b No.4822563,Suffolk Coun� 'Term Expires(December 3t,19 (VACANT) N/O/F JAMES M. GRATTAN N 70' 45' 10" E 142.00' FND - FND J PIPE 7G .177 PIPE I.O'E ..37.G SHED 4. O .J C o.4 OUTHOUSE Lo W O.O.6' O to Y W w rn bf O Q N y y 3 W Ljj2 W I" 2 W a Q ) 1�0 4'E y l CiJ V/ Y 4 ® ey �J-r 1 � � W IWZ (L J4 Q LLQt .�.1 J 3Ix O P �rwMe 4�w Se J Q h W N 3C.4'O 29.0' 1L 2 ^ Q 2OP FWD I 3G,4 h 320.71 IO- :may2 I 142.00' i IS 70 45'i 10" W ` WATER MAIM APPROXIMATE LOC,TION HUMMEL A VENUE TESr BORN 36.D DA rA OAw (LUMBER YARD) SURVEY OF -USES PUBLIC WATER PROPERTY .SAND R sRAVEL SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES < , T. S O U T HOL D FOR APPROVACOF CONSTRUCTION ONLY T&WN OF S O U THOL D DATE KS•REF.NO.9'3-SO-87 SUFFOLK COUNTY, N. Y. 1000 `63 - 02 - 16.1 APPROVED _ Scale 1" - 30' Dec. 2, 1987 The location*of wells and cesspools shown hereon are from field observations and or from data obtained from others. April 12, 1991(revise lot) April 19, 1994(foundation) Sept. 20, 1994(final) . AREA= 28,400 sq. ft. CERTIFIED TO' TICOR TITLE GUARANTEE TITLE No. T 1290-0834 ROBERT L. FISHER NORTH FORK BANK B TRUST CO. The water supply and sewage disposal systems for this residence will conform to the standards of The Suffolk County SEC,Lgti Department of Health Services. PHN r, o 0 Prepared in accordance with the minimum p o o� sre tandard.for title survey*as established N1IYOP� by the L.I.A.L.S.and approved and adopted % C. NO. 498/s for such use by The Kew York State Land Title Association. PECONC SURVEYORS, P.C. (516)7d5-5020 P. O. BOX 909 ELEVATIONS ARE REFERENCED TO MAIN ROAD AN ASSUMED DATUM. SOUTHOLD, N.Y. 11971 87 - 886 B