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Home My WebLink About22988-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE11ON OF THE WORK AUTHORIZED) ~,~ .................... ~/~ ....................... ~.~ N? 22988 Z Permission is hereby granted,to: ...~,~~_./.. ....................................... .~.~. ' ~ atpremlsesl~at~at.....~.~. ~ ~~ Building Inspector, ~,...~:..~ ....... ~J /Building Inspector Rev. 6/30/80 DATE FOII~DAT ION (IST) FOUNDATION (2ND) [NSIJLAT[ON PER N. STATE ENERGY FINAl. ADD IT [ONAI., (;OMMENTS: AUG 2 2 ~J95' ~ORM NO. 1 'TOWN OF SOUTHOLD BUILDING DEPARTMENT,. TOWN tlALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 19(?..5~ l)isapproved a/c ' BOARD OF HEALTll ........ ] SETS OF PLANS SURVEY CIIECK .................. SEPTIC FORH ............. NOT1 FY ~ CALL ~tAIL TO: INSTRUCTIONS Date a. This application must be completely filled in by typewriter or itl ink and submitted to tile Building Inspector, with sets of plans, accurate plot plan to scale. Fee accorcling to schethde. b. Plot plau showiug locatidn of lot and of buildings on premises, relationship to adjoining premises or public st?et . or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt: 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 Pemfit to the appficant. Such peru 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 ttEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance or 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 describ~ The applicant agrees to comply with all applicable laws, ordinances, build~ code, housUm aode, and regulations, admit authorized h~spectom on premises and in building for necessa, inspe~tio~s. D[[]} ~ ....... 0~.~. ~..~~ ........ -- ~n&tur~f applicant,~r name, ir a co potation) State whether a,~__~~licant is owne~le~ee,~/agent architect, engineer general contractor ~l~~~e?.Or bull& ............. ~~m,/c...: ................................ ~~.~ . .... ' . . .~...~-.~.:: ~>~..-,. (as on the tax roll or a~Ui~iNG DEPAR~ENT AT: ~f applicant is ~ corporation, signa{~re o[ duly authori~.ed officer. (Name aud title of corporate o,.~f~j:~er) Bu'lder s L'cense No.. Electriclau's License No ..... . Other Trade's License No .... T65-18~2 9 AM TO 4 PM FOR THE~ FOLLOWING INSPECTIONS: 1. FOUNDATION ' TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSOLATION 4, FINAL - CONSTRUCTION MUST BE, COMPLETE FOR C.G. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION .& ENERGY CODES. NOT RESPONSISLE FOR DESIGN OR CONSTRUCTION ERRORS Subdivision ' Filed Map No ............... Lot .............. (Name) State existiug use and occupancy of premise~; and in lended use and occupancy of proposed construction: ........ ..... : ........................... ,,,te,,ded ,,se ,,d o ee,,,,,,ey ...... t'a . . . . . D ................................... J. lqatme ol wink. (check which applicable): New Buikling .......... ~,ddition .......... Alteration .. ~ .... Repair .............. R~moval .............. Demolition ...... ; ....... r,_~th, er Work . .'~.'.~ ...... Esr.hated Cost / ~. O ~ ' ' ' 4. ' ' . .......... : ........................ Fee ............ ~ ..................... . . (to be paid on filing tiffs application) 5. Ir dwelling, number o£ dwelling units ...... ,~........ Number of dwelhng units on each floor ................ · If garage, number of cars .................. ~.~.. ............................... fia/p,/~ ............. 6. If business, commercial or mixed occupancy, specify nat~e,~..nd extent oLeacbAt~t.p,e of use ../,~.,/..~,;~ ......... 7. Dimensious of %x..ching structures, if any: Front ...... /~-~. ...... F, ear. . .Z',2Z~. ...... Depth ;,,,~/,Z. .......... lleigbt .... /~.. ~/~*. ...... Nun,'~ bet of Stories ....~. ........... ' .... ' .......... ~ ....... ,~/..~ .......... Dinlensions of sh,te sln, cture ,, ith alteratious or ad'd':~/io'ns: Front ...,~..~. .......... Rear ./'5"..~-x~. ........... pep,, .... ..... ~. .......... l,e~¢,t .... /2//..~,,~ ....... .. ~.,~.of Stories... z¢'/~..~ i.~.=~.. ..... 8. Dinlensions o~deff/t,~n°" ew construction: Front....' 4.~r .... : Rear../...,m. ......... Depth . ."' .~. ........ l leigbt . .. t,~,~', x .......fl}Jd~.be.r of Stories .... ~j~'.z .t~t~/i5 ...................... .,~r,~ ............. 9. Size of lot: Ft'ont ..... F_,c~. [~*a,~ ......; . . Rear"....r,~.T?:/...; ........ De~th._.~;'2.~..> ................ 10. Date of Purchase ....... ,f'~O'~71~.~ ................ Nmn, qpfF.~rOwner .,~.ff~'.? .............. ...'. 1 1. Zone or use district in which premises are situated ...... t~'d~7. T.rf{-d. ....... ~ ....... ........ :' "' I2. Does proposed constructio~v~p~Jjate any zoning law, ordinauce or regulation: . ,r. z'.."' .................... : ....... ,. 13. Will 16t be regraded .... /.:~i .................. Will ex~es~ill hr.-reano¥.~xt,lrot} ~,re.mises:r~,-,, ~Y-~} Name of Architect ........................... Address ................... Phoh¢' No ............. _..... Nmne of Contractor Address ".'Phone No 15. Is this property witbio 300 feet of a tidal wetland? *Yes ........ = ~o; .'. [. .). .'[%' ' *If yes, Southold Town Trustees Permit may be reqeired. ' ' ; '~' "~'":' "' PLOT DIAGILAM '- ':' ' Locate clearly and distinctly all buildings, whether existing or proposed, ~md. indt~a.t~ al[:se~-~a~k djm:~si'0iii, fr6m property lines. Give street dud block number or description accordb~g to deed, and show gtreet names and indicate whether interior or corner lot.,.," ~ ..... ~. ~TATE OF NEW YORK, S.S :OU~C[Y OF ........ ~ ........ ~ ,...~5.,'Y. ~g D.. ......... '). ............... be~,,~ du,y swot,x, deposes (Name or ~n~iv~al signing contract) is the ..... . ............................. ......................................... ' .............. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that ail statements contained h~ this application are true to the best of his knowledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewiflL worn to before me tbls ....... ~~,' Oa~ o~ C~~. · ', ,, ~ ~ .... '~ HE~NEO. HORNE . . [ / ' (Signature of applicant) Quali{i~ in Surfak Coun~ ~ ~ ~mmission E¢ires May 22, 19