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Home My WebLink About16400-zFIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME/' PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FOR~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. RUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 1 6 ~ 0 0 Z Dote ..... ~~......~l~......., 19...~...~ Permission is hereby granted to: .~ ~ · I ~ ICPO .- ~ .... at premises ocated at ..~....'~ .............. ~.].~ .................... .~.....~-.. ............................................... County Tax Map No. 1000 Sect, ia'~.../....'~....~.. ....... Block ....... ...C~....J ....... Lot No ....../..~-.J..'...~.. pursuont to opp,,cat,on do,~ ~.....~...~..L.~. .......... . ,,.~...~.., ond opprove~ by the Building Inspector. Fee $~,~i"~.. ................ Rev. 6/30/80 ? "f ,'0 T~'~'L~ INSURANCE'COMPANY ~ (~16) . ?2?-4455 ~0~ TITL. E NC), 0 o ~ 0 ~ o & TITLE NO ,0 TITLE INSURANCE-COMPANY (SI6) - 727.4455 ,77 ! BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL,: 765-1803 CALL ................ Examined .~..k~..~7..~.., 19 .~.? Approved~ .%~.?T..'~., 19~.~. Permit No./..4 .~..0~...~.. MAIL TO: Disapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..August .L4, ........ 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 publi9 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 shill 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 Btlilding 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) .4..~.o.o.t!eg. M.Ley.,. 9r.e.e.n~.or.t.,. ;~y...1.LgA~ ......... (Mailing address of applicant) State whether applicant is_.gwner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premises . .~.a.s.~r.n..L.o.ng..I.s.l.a.n.d..Hp.sp.5.~.a.1 ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No..]_.~p.8.6.~.~ .................. Plumber's License No...Iq/) .................... Electrician's License No...N/.A .................. Other Trade's License No...N/.A ................. 1. Location of land on which proposed work will be done~ ................................................. .. ....................................... : ............. House Number Street Hamlet '~ County Tax Map No. 1000 Section ..... :,(.~?.'.'~.f'. ..... Block ........ / ........ Lot .... /~.. ~.. ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .B.l.o.o.d..C.o.l.l.e.c.~fp.n..S~.a.~.~p.n..f.o.r..E...L...I....H.o?p.5.t.a.1 ........................ b. Intended use and occupancy . · .S.a.m.e .............................................................. 3. Nature of work (check which applicable): Ne.w Building. .... ' ..... Addition ...' ....... Alteration .X. ........ Repair .............. Removal .............. Demolition ........ ~ . Other Work ............... I (Description) $ qqq F 4. Estimated Cost....7.,. ............................. ee ..... ... ' ...................... .. ... (to be p~id On filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unitslon each floor ................ If garage number of cars ~6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... 7. Dimensions of existing structures, if any: Front .... Rear ~ .. Depth Height Number of Stories Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of ~tories ...................... 8. Dimensions of entire new construction: Front .......... . ..... Rear ......... i ...... Depth ............... Height ............... Number of Stories ............................. : ............................ 9. Size of lot: Front .t .... ~ ..~ ..~, ........ Rear ...................... Depth ...................... l(~DateofPurchase '...~.t.~[I.~.'~. ............ ~?~,Name of Former Owner ~..~f?....'~..f~fi~ .......... 1 l~Zone or use district in which premises are situated.. ~.. J .................... ! ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... i ........................... 13. Will lot be regraded . .N9 ......................... Will excess fill be removed ifrom premises: Yes XNo [4. Name of Owner of,~remises E.L.I. Hospital A~ .... Manor Place, Green~r..t..~ xT~ /,77-1000 Name of Architect ........................... Address ................ i' · ' Phone No ................ Name of Contractor R. Saetta G. en. Contr. Inc.a~a .... g ~oqtleg a&gey~ ........ 477-1633 15. Is this property located within 300 feet of a tidal wetland? *Yesl ..... No ...~. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indi:cate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show ltreet names and indicate whether nterior or corner lot. See Attached .TATE OF NEW YORK, S.S iOUNTY OF..~uf~qlk ........ ........... .R.o.b.e.r.t..S.a.e.t.t.a ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) hove nmned. [e is the General .C.o.n.t.r.a.c.tp.r.,. Vice-President (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 tkis pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the fork will be performed in the manner set forth in the application filed therewith. worn to before me this ....... 1.4t.l~ ............ day of .... .A.u.g.u.s.~ ............ 19 lotary Public,~%-~... County Notary Public, Stat~ of N*w y~dt " No 47~M9, ~uffolk ~ 8.7. (Signature of applicant)