The URL can be used to link to this page

Home My WebLink About24630-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) Date ..... ........;�........................... 19...9.0.... 24630 Z Permission Is hereby granted to; .......................................................... ........ ...1015T...VTR.;F.T........................................ .......ER.E$.H...MF.OA.QW.S.9.NY...1.13.65........................... to ........QQ.N$.T.R.UG.T..A..F.FNFR..FA.UR...F.EF.T...Z.hI...H.E.I.QRT...ZN...T.HF...FRQNT...YARD-A5...... ,.IZA...EDR.P....... . .................................................................................................................. .................................................................................................................................................................. ....................................................................I............................................................................................. ........................................................................................................................... ....................... . at premises located at................2.90.0......S UNDV I.EW„AVE..... ......................MA.T.T.I.T.U.GK........ ................................................................................................................................................................ County Tax Map No. ....473889...... Section ...094............. Block .....0002........ Lot No. .A.42............... pursuant to application dated ..I A........................:...................... 19............. , and approved by the Building Inspector. Fee$........3.5.00... .............'..... . ... '.. ............................... ilding Inspector Rev. 6/30/80 BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD ✓ SURVEY . . . . . . . . . . . . . . . . . . . . . . . . - 1 BUILDING DEPARTMENT /CHECK P . . . . . . . . . . '1 � TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . OEC 29 1997 f yi SOUTHOLD, N.Y. 11971 E [ TEL: 765-1802 NOTIFY: LUG.MEW I CALL TOWN OF O iTHOLD iQQ - 6 9 —� /& .� 1'�nined..... 19../.� ` MAIL- . . _ . . Approved..... y. ......., 19� . Perini t No.pL �P. _.. R e...1 ObZ....._.. Z_'... Disapproveda/c .................................. .................................... ...................................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT 'f Date. . . . . . .. . . . , 19 Y! INSTRUCTIONS a. •this application must be completely filled in by typewriter or in ink and submitted to the Building Tnspector wid: 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan slowing 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. Tire wrk 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 Buildinrg 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 Iaws, 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 }wilding for nec ssar7 ins tions. ..(Signature (f�'appliQ•an-t,—.or•name,.i f.a• corporation ) Jr •.'.• . . . � (Mailing address of applicant)t) )13& State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................�(,�� .............-...............---.................................y.,... ................---- Name of owner of promises ......... ..U'... I�/✓......t:! . ... ��'l!Y...................... (as on tore tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. ........................ Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... �� ... 00 �avn. t�/L57 cJ _ . 1. Location of land on which proposed work will be dome............................J...�..yL.................... ..,Z"9 oa �a�n flub rn`�_�`' ............................�.`. ;//f7 C/6 ...............•.. .. ............................... - House Number Street Hamlet County Tax Map No. 1000 Section .....� ,/.I...... Block ... ........ Lot .....z ........ Subdivision ...................................... Filed Map No. ............... Lot ............... (Nave) 2. State existing use and occupancy of promises and: intended use and occupancy of proposed construction: a. Existing use and occupancy ............ :/.V.. ... / !�/L. !�blJ .............................. b. Intended use and occupancy ............ .....i...••-5�4�� 3. Mature of work (check vhicli applicable): New lkjilding .......... Add i t ion .......... Alteration .......... Repa i r ............ Removal ............. Demol ir t i on ............ .Other I%k)rk ... ....................... Iq (Description) 4. Estimated Cost ......................... fee ....................................... . (to be paid on filing this application) 5. If dwelling, md)er of dwelling units ............ Number of ck,?elling units on each floor .................. If garage, ntimber of cars ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type';pf use.......::. 7. Dimensions'of existing structures, if any: Front................ Rear ............... Depth ................. height ......................... amber of Stories ...................... Dimensions of sane structure with alterations or additions: Front ............... Rear ............... Depth .................... Height .................... Nad)er of Stories ............... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth .............. height ......................... Rimber of Stories ..................... 9. Size of lot: Front .................... Rear .................... Depth .................... 10. Date of Purdiase ..................... Name of rorner Owner ........................................ 11. Zone or use district in vAiicli 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 N3 14. Names of Owner of premises ........................... Address ............................... Phone No. .............. Nameof Architect .................................... Address .............................. Phone No. .............. Name of CA)ntractor ................................... Address ...............................Phone No. .............. 15. Is this property within 300 feet of a tidal wetland? * YES .......... NO .......... *ir- YE-s, sourluD 71 4N mmsfim wwrr MAY BE. wpum, . Pi.o,r DIAGRAM Locate clearly and distinctly all buildings, wliether 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 %iliether interior or corner lot. 51-ME (V M;W YOl?K, SS ("INIT Or. ...... ............ .......... ....being duly sworn, deposes atxl that he is the applicant . ... ........... . .............i ual si ni.tig Klie of ii i d, ji con c L aliove named, Heis Lhe .......................... ......................................................................... (Contractor, agent, corporate officer, etc.) of said owix--r or owners, and is (July 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 IxAief; and diat. time work will be performed in the manner set forth in the application filed therewith. SM)rn to beforq9me this ...... clay of /_Q, ..F9........ Notary Public . ............................... ..... ........ .. ......... ........... i (Sig t1j. Alipticai 4`nt_.-LEM-1 D. HORNE No!_iV Public, State O'lNewYork No.4951364 Qualified in SuffoN County Commission Expires Nqay 22, 19 zz VkS 5/ T y RGG iSLFrivo ABST.QRC7' L�� SL/��pLK COLIA/7 T,4�C MAP /+ro.QTNE.�4STE,eN m0�2T6.4�E /�/�ESTir�EnrT p/ST.Q �C'T /�O O S CC T/�/v �� CoRP, ♦TS S[/CGESSO2S .4�rp�o.e ASS/�iJS QLO GK � TRX GOT Z �RBARA S4"R1DA,4Q - A7T /v1lQT77/71C./CK G A N To .2EE✓ES .q✓CT� �epgo o. 3 m N z 8.3 s -L-O.7 7 /Az5To,¢yLq F2F7�/C °p W O j Q �PESiDE,�lcF•� �Q O � � N �z9oo 3.S N N zs.zs 1_ S �o 0o as w z5/. ¢moo F,,,o.l Siv 11 GUMo oe y�,� 0. " v APO. QO>< z z C-�> S E.L Z7lE�'-Y7/. s�,e vE yEv DEB. �J /D 13