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Home My WebLink About12712-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 12~12 Z Permission is hereby granted to: ..~...~.l~J......l.~)..~~ ........... ...~.~:~..~....¢...~.....~. .................. ........................... ,o ..~~¥.~..~.~......~.t.,~~.....~.....x4/~~ ................. ~,~-~ -~,_?& ~ ~..<.~.,~.,. ~ ~_~ ~ .¢,.:~ ~ ,,. ............ at premises located at ....~,.,~,,..,~.,...~'.,..~,,-L....~.,,~..{~.~.....~)~-....~,,..~.~ ............. County Tax Map No. 1000 Section ..... ~.~...~. .......... Block ...... ,~. .......... Lot No.......~...~ ............ pursuant to application dated ~c~'~-~- 1..~. ....................................................... , 19.~....~, and approved by the Building Inspector. Rev. 6/30/80 HE%,~ YORK STATE DEPAR~E~T OF E~!¥IRO'UIE~TAL CQ~SERVATIO~ Regulatory Affairs Unit Building 40, SUNY~ Stony Brook, NY 11794 ~)0 PERi-~IT NECESSARY - TIDAL ~ETLA~!DS ACT Henry G. ~)illiams Commissioner Re: ,~ Dear ~. ac///l~5. /D'ecd~a~ : A review has been made of your proposal to: It has been determined that no permit is necessary under Article 26 {Tidal ~etlands}. However, any additional work or modifications to the project may require' a permit. It is you~ responsibility to notify this office in writing if such additional work or modifications are contemplated. Assuming you have obtained any other aoplicahle permits, you may )roceed with your project. Very truly yours, I _ Daniel J. Larkin Reoinal Permit Administrator 9JL:RNT:l 1 Memorandum from.., BUILDING INSPECTORS OFFICE TOWN OFSOUTHOLD TOWN }~LL,]~DX 728, SOUTHOLD, N.Y. l1971 765-1802 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .~....~. · . .~". t ....19~t. Permit No. I .~.~.~.~'..~. · . Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 a~ljoining premises or public streets or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of this appli- cafion. 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 a licant agrees to comply with all applicable laws, ordinances, building code~,housing code and regulations, and to admit authorized ins ectors on premises and m building for necessary ~nspe~t~ons ,, . ,.-.' o~_I ~ ~ "~ · ~' .................... ~'~-- ". ........... ' (Signature of applicant, or name, if a corporation) ~. 7.~.-~..Q.4.~5 .s?~ .x: g..../~; .;3..... 57'../7. ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........'X//- ~c-ZP//<'O-.- ............. O ./ (as"!~"O'g~ .-,:~r/.~. '.77...on the tax roll or latest '~'''deed)' .~fT..~../.~ ................. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) c.:. ~u~!a_~s License No ..... ~. J~. ' .~. ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ...... ~./~.g. ....... ,/.x.~ .<<,:~../../..~...w... ~..~.. f~ ..... ~.'~e~-/:,'~/~0~'7-' .. House Number Street Hamlet County Tax Map No. 1000 Section . . ~ ~ ..... ~-~''' Block ..................................... ~ Lot ~'~ Subdivision .................................... Filed Map No. .. g(~ ....... Lot ..... ~ .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ¢..~%~5 .Q% ~ .... /~.w~ ... ' ............... / /:~,',-,~- ./~g~ ............................ b. Intended use and occupancy ........................ 3. Nature of work (check which applicable): New Building .......... Addition ......f'f~.... Alteration ....f~...,... Repair . ............. RemOval .............. Demolition .............. Other Work ............... ~ (D ripti i esc on) 4. ' ' ~ ~:~..O. [',stlmated Cost ....... ~.'*. ........... Fee ...................................... : (to be paid on filing this application) 5, If dwelling,number of dwelling pnits ...... ~. .... Number of dwelling units on each floor ..... f. .......... If garage, number of cars ......i ........ .~.... ....................................................... 6. If business commercial or mixed occupancy, specify natu~re and extent of each type of use .................. ._. 7. ' ' ' ~ ' ,, -.. r -~ D th...'Q-~...~.~.'.,('..~,~.. Dimensmns of exlstttna~tructurqs, if any: Front...~.~.. ~ ..... Rear .. '.~.~...~F.. .... ~p. Height ..... /.ff...~../... Number of Stories L ........................ Dimensions of same structnr, q with alterations or additions: Front . ~-T.~....~. ...... Rear ................ Depth ..... ~' .....f.. ~7,',~.... 2.. Height .......~...~. .......... Number of Stories ....... ~. ............ 8. I)imen]sions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height~ ~.c~. ~ Number of Stories .f. 9 Size of lot: Front ~ Rear Depth 10. Date of Purchase . . . .;(.o..r-( ./~ ~ .../.cT../.. ( ??..5~.... Name of Former Owner .. d,~?. f... · .c~..~. ~. 1 1. Zone or use district in which premises are situated ..... ~... ~.z~ ~. .............. 'b ...... 12 Does proposed construction vi61ate any zoning law ordinance or regulation: 13. Will lot be regraded ........ } ..... Az.c> .......... Will excess fill be removed from premises: Yes Address ../."/?.~...~.~.s;~:,<%~(o.-!. Phone No.C~.Szf~':w ~.~. 14. NameofOwnerofpremises,~..,~..a'~.-E-.?.~.'~.'~.25'.~.~.. a ,~o,-~o~ st,- , Name of Architect ...~.¢.~.,~. ~ ."-Z-... ?..~-.~.~/Y. '.~7.... Address ...x.o..o..~.~.~o. t-.~ ..... Phone No. T ¢' .~-7...~'..'~.-X~'~- Name of Contractor . .f~.,. ~,..-~'..,C...r~., 9.~.17. .... Address ...~.,'~.~?.r..,E,o.,g. fT... Phone No..¥.7. 7. 77./.o..?.~ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockmufaber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF'NEXX('~K..~-- /~/ ~ ~ COUNTY OF~. ~'~ , , -"---(~me of individual signing coi~"r~ct) above named. being duly sworn, deposes and says that he is the applicant He is 'the ..................... I ....· 'x'<'':EE' · · · · ~ ................................................. . f'Tx,~C°ntract°r' a~nt' c°rp°rate °fficer' etc') ~ of said ow,ncr or owners, and is duly a~honz"~a:k-~ p~m or have performed the said work and to make and file this application~ that all statements con(ained"in,Jhis application are true to the best of his knowledge and belief; and that the work will be performed in the manngr set forth in the application filed therewith. Sworn to before me this ~~. (Signature of applicant) fearn Expires F4arch 30. 19~.~,/''~ -