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Home My WebLink About22285-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) N2 22285 Z Date...�..i ...................................... 19�.,T°:.. Permission Is hereby granted to; , . ... .. . . . ............ ....... .. - L y � to ........... .. ..�.. ...... �:.... ............ .... �.... ........... .. .. .. ..................... .................................................................................................................................................................. ...................................:.................................................................................................................... . .................................................................................................................................................................. at premises located at..... ....A��7a—z:� -�.....w........................................... ..........................I.......................... .. ..............,................................................... County Tax Map No. 1000 Section ....... l .7.... Block..........Z.......... Lot No. ... ......... pursuant to application dated ........ /- 5..................................... 19..0 .. and approved by the Building Inspector. Fee& r ....... ..... ......... .... ................... Building Inspector Rev. 6/30/80 ry f [30.11;0 OF HEALTH U ; ; FORM NO. 1 �'3 SETS OF PLANS . . . . . . . TOWN OFSOUTHOLD SURVEY . i - - - - - - - - - - . . . . . . 19g4 BUILDING DEPARTMENT XCI1EC1: . . . . . _ _ _ _ _ , . , - . - . I TOWN HALL SEPTIC FORK . . . . . . . . . . . . . BLDG.DE T. SOUTHOLD, N.Y. 11971 TOWN OF S OLD T E L.: 765-1902 N O i i F Y P 3 yJ/a CALL . t Examined . ?� ., 19 MAIL TO : - . . . . . . . . . . . Approved . . . v , . . . . . 19/Permit No. 21 .9. 4 .�� . . . . . . . . . . . . . . . . . ... Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ . . . . . . . . . . . . . :�elf 4Z . . (Building I pector) APPLICATION FOR BUILDING PERMIT Date . v. . . . . . . :, 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, housi g code, a regulat' ns, and to admit authorized inspectors on premises and in building for necessary inspectio (Signature o •applicant, r na e, if a corporation). • . •Ali (Mailing address of applicant). Z. State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises (`.i((+v�- . .�U✓)l'r17 . . . ; . . . . . . . . ��•G�!(/�ls VCafl�f�.�C:�''i�•��• . . . . . (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. . . . . . . .A/.�j . • • . . . • • • . Plumber's License No. . . . . . . ✓�!� . Electrician's License No. Other Trade's License No. . /Vli�. • • • • . • • • 1. .Location of land on which proposed work will be done. . : . . : . . , • • ; , , • • • • , • . • • _ • . . . l �G . . . . . . . . . : . . : . . . . . h�� M> . . . . . . . . . . r�:rvc/ House Number Street Hamlet: • •� �j. County Tax Map No. 1000 Section . . . :. 1.0./. . . . . . ; . . Block . . . . . f. . Lot . . . _ Subdivision . r�'IfC11e_ /1`C—C-I4 .P: 1Tt 6" . . . Filed A1ap No. . . . . .:. Lot . . . . . . . . . . . . . (Name) State existii19 use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . I "e�G • , • - - • . • • • • • , • • • • • _ • • • • • _ • • b. Intended use and occupancy . . -7• • C . . . . . . . . . . . . . . ,,,.,, ' '[a=i!'.y• . .,. :'..w '. . . . . . . . . . . . . . . . . . -3. Nature of work (check which applicable): New Building Repair . . . . . . . . . . . Removal . . . . . . . . . . Addition . . . . . . . . . . "QI[eratori'�:F'- . mova • , , , , , , , , , , , Demolition . . . . . . . . . . . . . . Other Work ,} "Irl 4. Estimated Cost . . . . . . • • (Description) . • • - - . • . . Fee . . . . . . . ._ .. . . . .r.:., ":.._.....,_._ _.. . . . . . . . . . (to be paid on'films tfiis,aplieation) S. If dwelling,number of dwelling units . . . . . . • • • . . . . . _ Nuriabcr of dwelling units on each floor . . . . . . . . . . . . If garage, number of cars . . . _ 6. If business, commercial or mixed occupancy, specify - » » » » » . » » » » • • • . » " " " " " 7. Dimensions of existing structures, if any: Front • y nature and extent of-each type of use . . . . . . . . . . . . . . . , • • . y: . Rear Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front • • ' ' ' ' ' ' ' Depth . . . Height » . . » . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . ' - 8. Dimensions of entire new construction: • - • ' ' ' ' ' • • . » • Number of Stories . . . . . . . . . . . : . -Height Front . . . . . . . . . . . . . . Re . . . . . . . . . ght Rear Depth . . . . . . .. Number of Stories 9. Size of lot: Front ./.5d , . . D • » e . . . . . . . . . . . 10. of Purchase . . . . . . ... . . Rear. . . . . . . . . . . . . . . . . . �o' . . . . . Date rchase . . .�uti`�• • J�:9. -. . . . . . . . . . . N �D. Depth . o�(JC7. . . . . . . . . . . 11. Zone or use district in which p e of Former Owner .TP&".o . . »64t,iV • . Premises are situated , .12. Does proposed construction violate any zoning law, o • • • . �r » » ' ' ' ' • ' ' • ' ' ' - • • - • • • • - 13. Will lot be regraded . . » ,Nj�, rdmance or regulation: Q • , • , , , , • , • , . . . 14. Name of Owner of remises . , Will excess fill be removed from premises: Yes • No Name of Architect P �l�[lK� J .' ��'� :.:Address (.,QQf—,A1Jt , . . . , o. p:3 Phone N �J. Name ' r1 • • . . • . . . . Address Phone , , , . N of Contractor . � Address � � � • � � - • � ' ' ' ' ' ' No. . . . . . . • , 15. Is this property within 300 feet of a tidal wetland? �� ' ' ' ' ' ' ' ' •,cP,hone No. . . . . . . . . . .. . Yes. . . . . . . . N . . *If yes,- Southold Town Trustees Permit may. be required. ' 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 Iot. STATE OF NEW YORK, 'OUNTY OF . . . . . . . . . . . . . S.S . . . . . . . . . jV/.! �(AwY. . �(:T. JA being duly sworn de o p ses and says that he is the applicant (Name of individual signing contract) bove named. (eis 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 )plication; that all statements contained in this application are true to the best of his knowledgeand belief;and that the ork will be performed in the manner set Tort], in the application filed therewith. .vorn to before me this . . ... . . .day of. . :.D . . . . . ., 19 �y . Mary Public, . . . . 2Q.� . . ... .LN. . County JOYCE M WILKINS Notary Public,State of New Yoi1c . . . . . . . . . . . . . . . . . . No.4952246,Suffolk Cou r'�• (Signatu e.of applicant) Term Expires June 12,18 � )13e I. � 1994 i TOWN O SOEUTI OLD 3pp.0 0 5.10°0, A% �5o OO 006 A� � \ ��. A vp F/ �p rn s ' t •�p Aj�i� f�5��, �, 1.t•0 a �AS fRAMG `ARP i N N OOO t Ec% t o t t , t � t t t` No t ` O t to 01 t t eot o \t t`t \yo po .o t . o t t a\ W S•?0� 06 \.p t \ sG/�L 111s 4�1 SURVEY FOR DENNIS A. SCHRADER a WILLIAM a SMITH LOT NO. 3, MATTITUCK CREEK ESTATES" NOTE: AT MATTITUCK 1. A = STAKE TOWN OF SOUTHOLD 2. SUFFOLK COUNTY TAX MAP DIST. 1000 SECT 107 SLK. I LOTP/u 2 SUFFOLK COUNTY, NEW YORK 3. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OFSUFFOLK COUNTY ON N UNAUTHORIZED ALTERATION OR AODITION TO THIS CERTIFIED TO: MARCH 25, 1992 AS FILE NO 9203. SURVEY a A VIOLATION OF SECTION 7209 OF THE DENNIS A.SCH NEW YORK STATE EDUCATION LAW WILLIAM J. SP *COPIES OF THIS SURVEY NOT KARMNG THE LAND NORSTAR MOF SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SMALL pECO NOT•E CONSIDERED TO K A VALID TRUE COPY *GUARANTEES. INDICATED HEREON SMALL RUN ONLY TO C L� C P-I to GRoSti �-Af F j b 81-0" `(YMCA(, C6 AP. ROV 0 AS NOTED DATE: A FEE: BY- ILrLq (] C G}5-9 802 9 AR11 TO 4 P3`Uf FOR THE 0 FOLLOWING INSPECTIONS: 00 FOR POURED CC,NCRETE _ m0 . i�� U .iI9v� o 9E MMIPLETE FOR C.O. ALL CONSTRUCTIOr-t! SHALL iMEET r I-E eI EIsIMtT OF THE N.Y. CODES. NOT RESPONSIBLE FOR DPS!�N OR C06NSTRUCTION ERRORS At* co qe�,)q�ol pvj� TYPV�jFolZ �►-LP��