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Home My WebLink About22133-z;OitM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. No BUILDING PEI~MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ........................... 22133 Z Co,.,n~,Ta~Ma,,No. ,000 Seo,.on ........ ~ ....... ,,,o~,~. ....... ~ .............. Lo,,,,o. /..~...~ ........... pursuant to application dated .......... ...~....~,~...f~..f-~¢,. ...... ~ ............... 19.2.~... ...... and approved bythe Building Inspector. ee ~/'~ Rev. 6/80/80 Building Inspector OUNDA~ION ~ , [1st) OUNDATIO~'! (2nd) OUGH FRAME & -PLUMBING ~'NSULATION PER N. STATE ENERGY CODE FI:;AL ADDITIONAL COMMENTS ~ [4A¥ J 7 ~ ]Ifil' TOWN OF SOUTHOLD ,, .' ''-~ J~') BUILDING DEPARTMENT ~ .... ! TOWN HALL "-""~ ~' IJTHOLD TEL.: 765-1802 Disapproved a/c //(B lding Inspeotor) BLDG. TOWN OF SOUTNOLD ' INSTRUCTIONS BOARD OF HEALTH ......... '~CIIECK CALL . · "~ '. ....... ~AIL TO: a. This application must be completely filled in by Wpewriter 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 public st?eets 6r areas, and giving a detailed description of layout of property mu~t 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 shall have been granted l?y the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southbld, 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./~ /~ /') , .~. _~.. .. . .(Mailing address of applicant)/~./ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~me of owner of premises . ~){/.~.~ ~ ~-O. ~b?.~...-'7 ___ ' ' 7 ....... (~ ;~ ;~e';a~'~gli ;; 'As NOTED .... 'Y ..... If applicant is a corporation, signature of duly authorized officer. ' F~E:~~. ~ /-- : FOLLOWING ~NSPECT~ONs: ~u[[der's License No .......................... t. ~OUNDAT~ON ~ ~VO REqUiRED Ff)~ POiJ~:O CONC¢~ETE Plumber's License No. 2. aO~)G~ . :~.~K4~JG ~ .............. - .......... 3. ~N, A , ~ ~N Electrician's License No. 4. t-~, AL' CO~gvr~UCr~O~ · ...................... MUST ~3~ (.OM~:[.~IE FOR C,O. ALL CONSTRUCTION SHALL MEET' Other Trade's License No ....................... T~qE REQUIREMENTS OF THE STAT~ CONSTRUCTION & ENERGY 1. Location of land on which proposed work will bc done ........... CO~, · 'NO~' 'RESPONS~LE'.' g0~ ........... House Numbcr Street Hamlet No. ]000 '::. ......... ,]o k - - ' ot...dZt ........ Snbdivision .~/~. ~,. ,(.~/~.~. ~Filed Map No ............... Lot ...... ' ......... ' / (Name) ~E ~ 9~ O~ . Stat~ ex~sfing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ~~ :~/*y b. Intended use and occupancy ..... . · 3.Nature o~ work (check whicl} applicable): New Building . ~ ..... Addition .......... Alle[ation ... Repair .............. Removal .............. Demolition . .. · ....... ~her Wo~k'~ ........... Estimated Cost .......... ~2' ........................ Fee ........... . ~ ,,.. ?. . ] (to be paid' on ~ii~"~hi~ appl]~a'ti~)' ' ' If d Iii lli~g it ' mb 5, we ng, number of dwe un s .............. Nu erofdwellingunitsoneac ocr Ifg ' ' h fl · arage, number of cars .. 4 ......... ' ............... If business, commercial or miked occupancy, specify nature and extent of.each t e of u 7. Dimensions of existing structflres if .... ~,,,,,t ,, Yp se .................... ............. l~ear ...... Depth ............ Height ............... Nbmber of Stories ' . D~menmons of same structure] with alterations or additions: Front .................................. Depth · ' · · . i . He'--' ' ................. Rear .......... · "' ...... ' ....... s'" ;l..~[r"; ...... ' ........ ,-.NumberofStories -.~ ~' "' ??)2 ............... 8. Dlmenmonsofentarenewcontructioon......... Rear ..... /.Z: ...... Depth Height .... /' 7' ./. .....Number of Stories .' ...... Size of lot: Front ......... i, ......... ].. Rear ' ~ - 10. Date of Purchase .... ~ .................... D~nth · ,... g'q'~.~ ............ Name of Former Owner -~' ',')'~,~,~5~/ ................ 11. Zone or use district in which premises are situated ....... ~'~,,x .~'~. ' ' i ' Y"~'"'rvvt ~ .......: ....... 12. Does proposed conslruction v!olate any zoning law, ordinamx, or regulation: ..//~,,(7 ................... 13. ct regrad ' ' '. ...... '/Z,'2.~.;-: ..... Wall ex e removed from premi Yes 14. ~mee oitJwner olprem~ses ./~t~.. 64.4..t-:°,~.L/ ..... Address o7~,v~..O. ~/t"b'd~(~ .o{.~.... Phone No..~ .~.~ Name of Architect , ' ' · ........ , ................... Address ................... Phone No ............. .... Name of Contractor . ..... ~. ........... Address ..... ~',~.~ ~.' ...... P~o,n~, ..... ~,,~.' .... 15. I.s this property within: 300 feet of a tidal wetland? *Yes ........ No..~ ...... · If yes, Southold! Town Trustees Permit may be required. ....! PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate all set-back dimensions frem property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. i . . . ' 'I STAT~ OF NEV~ VOU~:, . S S C.OU~X Or/,b~.~E~../--.:.. ~' ..... .J.. (Na~e of individual signiog contract)" above named. He is the ., ........ ' (Contractor agent corporate officer ) ' i , , , etc. , ~,M-owner or owners, and m dulyI authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will' be performed in the manner set forth in the application filed therewith. Sworn to before me this I Notary Public Notary Public, Ste~ of No. 52.462al 15 Commicsion being duly sworn, depose~ and says that he is the applicant Signature of applicant) . 8 20' 1 i