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Home My WebLink About24166-zFORM NO." TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 24166 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ....... P./~.T. ~ I ~ I ,~,, g.O.Y... L~BEN~E ............................... ....... 2.7,5~15...VJA I,~1.. ~OAD .............................................. ....... CLI .T, ~ UEIG~JE...N.Y....~ 1,9,3.5 ~ .................................... to ....... E.~EC.T....A...EE.N~E...~.~.. ~RP..L .I.Eg... E/.O I~. .................... ' ............................................................. at premises Iooated at ............. ~.7. D.I~ ~)..... ~t~9.:L N...B~ ............................................... .C;kI.T. gJflg.~.Ll~; ......... CountyTax Map No.....~Z.~..~..B..~ ...... Section ..J.g.~. ............. Block ....g.~).g..& ......... Lot No. C).J..,5 ................ pursuant to application dated ...~.~.¥. ................. .~..&. ......................... 19......c/.7. ...... and approved bythe Building Inspector, Fee $ ....... ,~ ,5, , :, ,0, , ,0. ..... Rev. 6/30/80 'OUNTYOF ........... ...... S.S '~ .... .~;. ,:-.' .................................. being duly sworn, deposes and sa) s (bat lie'lsqbe (Name or individual signing cont~ac/) eis thc ..',..:: :..: ?, ...... -' , -.,.~fi).q...: . (Conlraclor, agent, coq~oralc olficcr, etc.) ,> , , said owner or owners, and is duly authmized Io mrform or bare perfozmed lira said work ,and 19 mn~e.~rd fi~ plicalion; Ihal all statements qgJUaincd in Ihis a ~1) ca on arc, t lc lo lho Ires[ o[]lis knowledge and belief; ahd that ~H: will be performed in the manner set forth in tlm application filed therewith. 'om lo before me Ibis day of ' 19 ) Ears, Public County (Signature of applicant) ",~-'~ .......... ~:i i TOWN OF SOUTtlOLD ~, ~UILDING DEPA[tTMENT HAY I 6 IggT ,- TOWN ttALL /] · - ................... ~ ; TEL: 70~-1802 Disapproved a/c ..................................... 'APPLIC'ATiION FOR BUILDING PERMIT INSTRUCTIONS §~ARD OF R£ALTIi 3 SETS oF PLn~s ........ sugv£~ ................. CHECK . - - . a. Ttfis apl~lication must be completely filled in,by typewriter.or.in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to scLiedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public or areas, and gNing a detailed description of layout of property must be drawn on the diagram which is part of this cation. ' c. ' The work covered by fids application may not be commenced before issuance of Building Permit. .. . .~ d. Upon appwval of this application, the Building Inspector will issued a Buil¢ing Permit to the applicant. Such p~rmit shall be kept on the pr.cruises available for inspection throughout the work. '- shal~' No building shall Be o'~cupi~d or used in whole or in part for any purpose whatever until a Certificate 6f Occup~incy have b'een granted by the Bhilding Inspector. ; APPLICATION IS HEREBY MADE to the Building Department for the issua/Fe of a Building permit'buCuan(to :~e Building Zone Ordinance of the TOwn of Southold, Suffolk County, New York, and other applicable La,si o?dinance~ or Regulations, fl)r the construction of.buildings, additions or alterations, Or for removal or de~nolition, as h~reifi descril~ed. The applicant agrees to comply with all applicable l:aws, ordinances, building code,~ousing~code, and reguiMions, and to admit authorized inspectors on premises and in building for necessary inspectio s.~t~~ ~, (/.,q/J~t' 3q~. A/e>~/~ ~ . ' (Signature of appl c~t, or name, if a cb'rporation) :,,,~ ._, (Mailing address of applicant} State whether appli~'an, is owj~er, le?s~architec,, engineer, generai 'contractor. electrician, plumber or builder· (as on the tax roll or late~Atl~fit~B.p.# If appLic,~'~')is a corporatimb signature ol~duly-autborized of J'icer. ' FEE:/*'~-~. 11~0% .DY: ~ · ' (Na~i0/and ti~:le qf corporate officer) FOLLOWING INSPECTIONS; , Builder's License No ........................ . . FOR POURED CONCRETE 2, ROUGH - FRAMING &:PLUMBING Plumber's License No ......................... 3. INSULATION : 4. FINAL - CON$1RUCTION MUST BE ~OMPLETfi FOR C.O. Electrician's License No ....................... ALL CONSTRUC?ION SHALL MEET .......... STATE CON$TRU~TION & ENERGY ~.--~ ~- , . . COOfi$. NOT REISPON$1BLE FOR Location of land on which proposed work will be done. ~:~.,.-/. v..?...L '..aK '... D~$1GN tlr ~,ON,ffrRIJOlIIIN ~.BBOBB. Itousc Number : Street . hamlet County Tax Map. No 1000 Section "-.../.'0"~ ........ Block ..... ' Lot ....... Subdivision ... Fi]ed Map No ............... Lot ............... (Name) ,, ,3 SI3tc exi$lJug use and occupancy or premises and iulendcd usc and occupancE of proposed construction; r. vi~dn~ USe arid occupancy .............. · · 3, Nature of work (check which applicable): New Building ........ Addition .......... Alteration ........ Repair ....... .......~ Removal ........ . ,~..... Demolition ....:......... Other Work.....~.~ 4. Estimated Cost ...... . ....... t ......... Fee . .~.. ..... . ' t (td be paid os filing this application) 5. If(hvelling, ri.tuber ofdwellin? re}its ............... ' N.mbcr el dwt:lling0mils ou each Iloor .............. ,. If garage, munber of cars ................................................ 6 lib id ixe I ac ifyl I t of each tyl ftse .................... · US IICSS~ COllimatE ~ or m ( Ctlpancy, spec latul'c alit cxte }~ o .................. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... lleight ............... Number of Stories ......................... , .............................. ,Dimensions of shine stnzctm'a with alterations or additiOllS: F'ront ! gear Depth ' lleight .................................. ........ ' ........ Numbe:r of' Stories ' ' 8. Dimensions of entire new construction: Front ............... Rear ..... !.'. ....... :Depth . ............. llcight ............... Number of Stories ........... - ';l . ze of lot: Fron ......... ~ Rear... ;' '" ' ' 11. Zone or use district in whic t prem set are sitnated . , 12, D.o. es proposed construction violate any zoning taw ordinance or rest atiou ....~.~... 2~. ............. ' ...... 13, ,!VIII lot be regraded ..... ~ '~...Q ................. Will excess fill bo removed from premises: Y:i .... N, Ins of Arcl.tect .... a, c ,-0~ -, ., 3e, ¢ ............ d ................ .................... .... · If yes, Southold Town Trustees Permit may be required.l . : p , . /'LO]' DIAG RAM ' ' .... Locate clearly' and dis'~inctly'"}ll buitdings,'v)heth;r enl.*ting or, ~roposed,, a:dO.'i~;~Iica'te }ll'~et-back' di.;,,ensio:,~ }:rom !',.,.erty lines. Give.s.t,r,eet. and,biock number or desci~pti0u ~ccordb]_,~ to deed, afi~ci,show street ," vr or corner lot.' ; .... ___~.~5_~,', ,, , . nJmes] , and, ,,,indicate~i whether TATE OF NEW YORK, S.S . 'OUNT)~ O? ...... (Name or individual signing conHact) .... (Contractor, agent, cmporalc officer, etc.) ?, , said owner or owners, and is duly anthorizcd to l~crform or bays l)c~fcumc'd the said wink a.d to make,an,d fi]~ ih~i'g? phcatios, that all statements qot~Jait~cd it~ this application arc, hue lo Ibc best of Jills knowledge and belief; and that the ~d: will bc pcrfommd in tbs ma]ii'er set forth iu thc application filed therewith. ' · om to before me this ~o. 4951364 / (Signature of applicant) - Qu?ifie~ in Suffqlk CounW ~7 ~ . ~ . ~ommmmon