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Home My WebLink About11389-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11389 Z Date .......:) .1 . :: ° 19. Permission is hereby granted to: ....... .- -ee `r�:........ to .... �d. cl.:......0,f. �Jrr.S ....<;� fE.,�. .�:.,� ...... ........ .. ... .. .... .:. ....... ......................... ....... ............................ . at premises located at .....��.............................�r� ................................................................................ ................................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section ...(2.1;5 ....... Block ... ....... Lot No. C sG�............ pursuant to application dated �G—` ��"� and approved by the Building Inspector. � /(J Fee ............� ...... ... , ... .. . ....:... . .: . Building Inspector Rev. 6/30/80 FIELB�IN3FECTION JIDATE 11 COMMENTS - - Id �v H _ FOUNDATION ( 1st) �y T� FOUNDATION ( 2nd ) 2 . z oC)\ ROUGH FRAME & . Q PLUMBING H 1{ 3 . x r� INSULATION PER N . Y. STATE ENERGY CODE ' x 4 . t1�� FINAL ADDITIONAL C MMEN �\ H H\ O - ' x r� ' r H x C1] '-d H FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examinedl . . ., 19 Application No'f. .J� . . . . 6/1 Approved ` �. . . ., 196 Permit No.f :n Disapproved a/c . . . . . . . . . . , , ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) ' APPLICATION FOR BUILDING PERMIT Date .SSP!. . . ��. . . . . .. 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre( or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apr 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 pern 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . (Signat a of applicant, or name, if a corporation) .4wd ALZEE S611J /4. , . � z �/� ��lo� (Mailing address of applicant) //5�7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises a ✓L . . . . . .�: . VV f�!/�S?� L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. .�� 9U/�A i3 '�!So . . . . 4!VL. .. . . . . . . . . . . �.yU. . . . . . . . . . . . . . . . . -.C3 � .!✓. .�.AN : . . . . . . . . . . . . . . ... . . . ... , W. House Number Street Hamlet �i�Q� County Tax Map No. 1000 Section . . . . . . . . . . . . �� . . . . Block . . . . . . . . ./. . . . . . o . . Lot . . . ' . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of propo"sed construction: a.' Existing use and occupancy . . . .-•�CJ�� s � I�;� C•• '� c�►! � L b. Intended use and occupancy . . . �..et=r1f �U c5 . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . work (check which 3. Nature of w applicable): New Building . . . . . . . . . . Addition . . . . . . Alteration . . . . . . . . . . pp licable) Repair . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . 0 ® (Description) ' Estimated Cost . . . . . ®d ®. . . . . . . . . . . . . . . . . . . . . . . . Fee . 1.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) �. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars .+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . % i. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . �. Dimension of existing structures,if any: Front . �.� . . . . . . . . . . Rear . .�!�.� . . . . . . . Depth .��1.�. . . . . . . . Height . . . . . . . . . . . . Number of Stories . . ,/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ,l . . . . . . . . . . . Rear : . . . . . . . . . . . Depth .40!. Height . if. . . Z Number of Stories . . ®. . . . . .f . . . . . . . . . i. Dimensions of entire new construction: Front . . . . . . . . . . Rear . ;&.Z, . !. . . . . . . Depth .Cf . . . . . . . . . Height P. f.. . . . . . . . . . . Number of Stories . . . . !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ). Size of lot: Front . . . . Z. . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . k" ). Date of Purchase . . . . �.1�?�7(�'. .... . . . . . . . . . . . . Name of Former Owner ®�lu.�. . . .. . . . `.r 1. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . ..�,:,. .r. . ..... . . . . . . . . . . . . . • • Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Will lot be regraded . . . . A/. v. . . . . . . . � Will excess fill be removed from premises: - Yes No I. Name of Owner of premises/3.t00C.4 . !fir.VY ® '.G. �/��• • .Phone No aS 4 s'W.7".�. Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Narne of Contractor . . . . .°! . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :tenor or corner lot. 0a /U TATE OF NEW RI SS OUNTY OF . . . . . . .ze.k4C,Jdivi . . . . . . . . . . being duly sworn, deposes and says that e is the applicant (Name Of ual signing contract) )ove named. �eisthe . . . . . . . . . . . . . . . . . B. ctrl (r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed, the s i wo k and to make and file th )plication; that all statements contained in this application are true to the best of nowledge and belief;and that t1e 'ork will be performed in the manner,set forth in the application filed therewith. worn to before me this (� / . . . . . . . . . . . . . . . .day of. y!c't?�.lo e!!. . ., 19 ota Public, . . . . . . Gia• �•a�. . . . County ELI BETH ANN NEVILLE � � . . . . . ... NOTARY BLIC, State of New York � � . . . . . . . .�� . . . . . . . . . . . No. 52-8125850, Suffolk County (Signature of applicant) Term Expires March 40, 1 I f' A . coe4Lx ml '1 1 V- �•ti�L.t+ + •w. i� UNAUTHORIZED ALTERATION OR-ADDITIOt4 A ,om,,4t� ,)us SECTIOIN 2209 OF A VIEW YON ST `Y' THE NEW YORK STATE EDUCATION LAW. — 7 owN or-- Sou rl-4oi-,� ,N.Y. COPIES OF THIS SU RVEY MAP NOT BEAR:Ne THE LAND SU?VE7OR'S IN'aD SEAL OR EMBOSSED SEAL ShALL N.'T BE CONSIDERED • TO BE A VALID Ti;UE COP•• GUAPq:TC:S INDICATCD"rP,'ON SHALL RUN ONLY TO TtI,&SON TO;; .,It :QAI )HE SURVEY IS PRE-A EU, &t T)O;7 1L` o:'`._c TO Th: ' iiTLL CClA„ra, �'�•,•�,itJi AGENCY AND LEND' - 'O er ..,SON, AND ••f ti� )•' Un'G INSTI- t,UALAI;1LfS P,'C hC=I f,,A;VSFERAl1LE 4 u,�.l It)NAl !h$iln.tlUl•.S Ok SUBSEQUEN( L_if-e 774(t: lrt--ur'r'7YpGe C:arTl%xrr(J Scale; 60'a!" a;5 urtih:rj��' Ar�:v, 8 , lei"7G C7 =- manurrrrr>'f /,?c��F��_r'G!G '✓�'iN_�t1 YL.. ,f�C�. 1 �_!c�aa,'r T:f'S:I' L_t�r rd .`.�✓+/G'c/or'G t , S.C.T.M. NO. 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