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Home My WebLink About20625-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN? 20625Z Permission is hereby granted to: . ' ..~ ......~....~..7~..z.~..~ ............................... o"~~-///',-,o..~/,. //~ ..... ;;L ........................................................ ZZZZZZZZ ........... ....................... County Tox Map No. 1000 Section ....... ..~.....~. .......... Block ...~.... ...............Lot No ..... ../....?.. ........... pursuant to application dated ....... .~../.~... ................................... , 19.~...~ and approved by the Building Inspector. Rev. 6/30/80 1992. BOA~.D FORM NO. 1 /2 S l~'I' S TOWN OF SOUTHOLD /-'~URVEY BUILDING DEPARTMENT ../~II [ C K TOWN HALL SEPTIC SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Exanrined ~ ~ · · ....., 19 .*.. /' Approved. 2- 19... Permit No...~.~..~..~, .~. ' Pisa P P r°v ed ~0~1~ ~.8. i~0?£D ......... ; ............. , .... ............ .. ' FEE: ~ BY, ' .. ~ / * I ~OUNDATK)N ~O~EQUiRE~PPL'~ATIO~FOR BUILDING PERMIT FOre POORED CONCRETE "* 2. ROUGH FRAMING ~ PLUMSING"~":' "" ' ' 3, ~NSUt ~6qo~: INSTRUCTIONS HEALTII ......... OF PLA~5 FORH .............. CALL .................. ~. flAIL TO: Date .......... a. '?.tti~?tf~ti'~fffi6fi?du~;tbe .completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ats of'~lanff,,(&'~'Sh'ftitfi:~ldit! plh'~¥~.sda~ii.r-lFee according to schedule. b.: q~lo~'qSllik/~glib~ih~,",lo6fftioSilbf%t and of buildNg~ on premises, relationship to adjoining premises or public streets ,r areas,,, a~d~ =l~g a ~e~ml~d~,,, ,~ ,~e~/~fl°n: . of layout of property must be drawn on the diagram which is pa~ of this appH- atiom ' ~ .... ,,~.~,,,~1 ,, - , c. The ~ork covered ey t~s a~phcatzon may not be commenced before issuance of Building Permit. d. Upon approval of this agplication, the Building Inspector will issued a BuUd~g Pemit to the appUcant. Such pemit h~l be kept on the premises avaQ~ble for inspection throughout the work. e., No buQding shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy hall hhve been granted by thc Building Inspector. ~PLICATION IS HEREBY MADE to the BulldOg Dep~ment for the issuance of a Building Pemit pursuant to the ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other appficable ~ws, Ord~ces or :egulations, for the construction of buQd~gs, additions or alterations, or for removal or demolition, as here~ desc~bed. 'he appQcant agrees to comply with a~ applicable laws, ordinances, building code, housing code, and regulations, and to ~mit authorized ~specto~ on premises and ~ bulldog for necessa~ inspections. _. . ........ '-:. ~-.¢ ... ~w .... : ..... ' (Signatur~f applicant, or name, if a corporation) (Mailing address of app{icant) :tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber 0r builder2 ~ . (as on th~ t~ ~o]~ o~h~es~ deed) (Name and title of corporate officer) Builder's License No .... ,~-¢--~ Humber's License No ........................ . El- '"9' L' N Location of land off which l~roposed work will be d'onc ............ . ' · Ilo N b St ....... use um er reet Hamlet Countyr x apNo. 000 ction ....... .'7..0....'.... B ock .... i/ ........... Lo, . Subdivision "- ............................................ ..................................... Filed Map No. - ~ ............. 17.thr ......... (Name) ...... State existing use and occupancy of premises and in tended use and occupancy of proposed constmc'tion: b. Intended use and occupancy 3. Nature of work ( l~eck which apPhcable): New Building ..... Addition .... ,'d' -' . Repair ......... ~.... RcmovaJ .............. Demolition ......... Other Work 4. Estimated Cost...~.~ ....... i... ' '- ¢Y..~ · i t ~,fl_...- (to be paid on filing this application) 5. If dwelling, numberof dwellingunhs .... :~. ..'J.IT, . . Numberof dwelling units on each floor. . ./.~[ ~ Il'garage number of cars ... ' ..... 6. If business, commercial or mixed o~cnpancy specify nalure and extent of each t i!f a ...... , use .................. 7. Dhnensions of existing structures ypc of , , ny. front ............... Rear .............. Depth .......... . .. DH.eight ......,. .......... Number of Stories ....... ~.... m~enslons olsflme strt Cture turn. L,,_ ~. . . .'d:9~ Z ........... ;, ........................... Uepth .................. u~ , .. , .... : .......... 8. Dimensions of cn t; ........ · · ]:.~,gu~ ........ ; ... · :~ ........ Number of Stories ............ ~ nuw consKIllC[lOni Front . . il l...0~.' h , · -_ H-;,,h~ .. . · t ...... '~xear ...... Denth . ~'" ................. mumberofStones ... ....... '- . ''~ ...... 9. Size of lot: Front ... ":"%~ .... ' .... i"2 Rear ................. Denth . . 10. Date of Purchase ... l~.~.c-./ . · .............. '' ''- ': ...... Name of Fonner Owner ~:;dT~-~ Y.-r~..'-~.~,~.~'-d.z 11. Zone or use district iu which premises are situated .... , . Does proposed construction violate any zoning law, ordinance or regulation ............. 13. Will lot be regraded ...... .% . ............. ...... .,Wd[exg,,ess fill be re,moved from vremises: ,, . Yes, No 14. Name of Owner ofpremises t.~. '~.t~Kdtlg'~ ~.~.'.~. p.:o,: I~. hqh-7one o~.. :~.q..7..t~,~.:.~,7..al. Name of Architect ........ ' · Name of Contractor ........ · ·.;. Address ................... Phone No ............. [5. Is this property within .~ ............. ~If yes, Southold o... Trustees Permit may be require~[''' · · ' .... ~ PLOTD~P~ ' ' ,',., Locate clearly and distinctly ~ [ldlngs, whether exi#ir'et~r p~'oposed, and, ind property lines. Give street and bloc , r or descriptioh ~cor~g t{~ deed, and show, all set-back dLmensions from interior or corner lot. ,; L~ ' and indicate whether ?ATE OF NEW YO~K,~,r-, ~ ~ t, ' ' ' ' 3U Y z_ o.o . - 'n: ................... ',~.~ ......... being duly sworn, deposes and says that he is the applicant ~ame of individual signing c~ntract) eve namcd. o f fl ) ........... ~ ontractor, agent, corporate cer, etc. said owner or owners, and is duly aut~horlzed to perfo~ or have performed the said work and to ln~e ~d file this flication; that all statements containediin this application are true to the best of his knowledge and belief; and that the rk will be perfomed in the m~n,e~set (orth in the applicat on flied therewith. om to before me this /' f ~. Memorandum from .... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TowN H^LL, SOUTHOL~, N. Y. 11971 765-1802 NAY 14, 1992 PLEASE CALL THIS OFFICE TO SCHEDULE FINAL INSPECTIONS II~IEDIATELY. THANK YOI/.