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Home My WebLink About20468-zTO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 20468 Z Date ....~./..~. ........................................... , I~..,~...,-z- Permiss}on is hereby granted to: -- r ;~ ............ , ...~..~..~....,..~...,~:...~...zz.~ ~. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Co-nty Tax mop Ua. ~ooo Sec.on ....... ././.Z ...... mo~k ....... .~. ......... Lot No..d.~ ........... pursuont to application dated ....... ./.~..//...~..: ............................. , 19..~...~, and approved by the Building Inspector. Fee $ .............. Bu~ InspeCtor Rev. 6/30/80 BOARD OF HEALTH ........ ~o~,o.~ ~ SET~ o~ ~'~-,~,s . " su~v~.~ ......... :.::::::: · OWNo~sOUTHO~a c.EcK . . ~'~,~ o~A~ ;~ ............ · - SEPTIC M . .. '' - TOWN HALL ........... TEL: 765-1802 ~,.~.~a Z~/~. ......... ~ ~-~. · .......... ..... ........ · ............... [N~U~IONS a. Tlds applicatioa must be completely ~Ilcd in by Wpewdter or in ink 5nd submitted to the Budding ~p:~, sets of p~, n~curat~ plot p[aa to scale. F~ ~c~ing to scheduIe. b. Plot pl~ showing location of lot and o[ build~gs on premises, relationship to adjoining premls:s or pubic or areas, and ~iv~g a det~led description o[ l~yout of property must be drawn on the diagram which is pa~ o[ [~s app: caQon. c. The work Covered by t~s application may not be commenced before issuance o[ Bugd~g Permit. ~. Upon approval or this application, the Buildin~ Inspector w~l issued a ~uildJn~ Pc~i~ to the app~c~t. Such pe~ ' shall be kept on the premises avaQable for ~spcction throu~out the work. e. No build~g shall be occupied or used in whole or in part for apy purpose whatever until a Cc~ificate o¢ Occup~c ~h~ll have been granted by ~e Bulld~ Inspector. APPLICATION IS HEREBY MADE to the Build~ Dep~ment for the issu~ce of a B~Idin: Pemlt pu:u~nt to th Building Zonc Ordinance of t~e Town of Sout~old, Suffolk County, New York, ~d other applicable Imw~, Ord~:ccs ~e~ulations, for the const~ction of buQd~s, additions or alterations, or for removal or demolition, as her¢~ dcsc~bed Thc applica.nt agrees to comply with all applicable laws, ordinances, buQd~g code, housing code, and ~c~uladons, . admit authorized ~spectom on premises and ~build~g for necessawinspection~~~_ (Mailing address of appHc~t) State wh~ther applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. .......................... ~ .................................... Name of owner of premises .... W'k~l~ .0~.~;~ ~.g ...... i~e'~a~'~l; .................................... (as on or latest deed) If applicant is a corporation, signature of duly authorized officer. ........ ~ ~ tit~ of co.orate officer) Builder's License No .... [~ ..... Plumber's License No .... Electrician's License No ..................... 0lher Trade~ Llcenee No ..................... I. Location of land on which proposed work will be done: House Number ......................... Street. .................... Hamlet ...................... tyTa pN ti ' Coun x Ma o. I000 Section ....... I ......... Block ....... .......... Lot ....~../~ ,' bali ..... .... Su vision ...................... ~ilcd Map No. Stat amc) .......... Lot .. (N .... xi ti ............. d fp d e e s ng usc an occupancy o rcmiscs and intended usc an occupancy Orproposed constr.ction: A. Ex~st~ng use and occupancy ........... ~. ~t.~.,. . . B. Intended use and occupancy .......... . .... 3. Nature of work (check whsch apphcable): New Building .......... Additior~ ';,, ;t.!,.,'i~,.;'; .~ A~J{qrat,:oa .......... Rep r,. ............. .............. o.tio. ......... .... ....... Tennis Court ......... A ' ' '~~ ~ .ccess°ry Building .......... Fe~e .~.m~ W~q'rk; ~ .... 4. Estimated Cost ...... .~ 7P.~..~ ................ Fcc ...'~' ........ ~]~ ~ ..... S, Ii ~wmnn~, number of dwelling 9n{ts ............... Number of dwe{Hn~~SrT'. 2 ............. If garage, number of e~rs ..... ~ .................................................................. 6. If business, eommere~n~ or m~xe~ occuDancy, specify n~ture and extent ofe~ch type of uso .................... ' 7. D~mens~ons ofex~sting st~eture~,ifany: Front,,, ............ R~r , .; ............ Depth .............. He~gl~t .............. Number of Stories ...................................................... D~ens~ons of sam~ structure width ~lterafions or additions: Front ................. Rear ................ Dupth .................... ~,, }Ie~t ...................... Number of S[ofies ............. ~. ...... 8. Dimensions of entir~ new const~ction: Front ............. Rear ............... D~pth ~, ~ 10. Da(¢ o urchase ........... ~ .................. Name of Foyer Owner ......... ~.?~ .~..'~...~.;¢. 1 I. Zone or use district in which ' ' ' prqm sea are s:tuated ................................................ 12, Does proposed construction violate any zoning law, ordinance or regulation: ... N~ ........................ 13. W~l lot be regraded ..... NQ.: .... ' ......... . ...... Will excess fill be removed from prmi~:,~/~. 14. N~e of Owner of prorates ...~ ................. Addma ................... Phone No ............... N~e of Architect .......... i ................. Address ................... Phone No ....... ~ ........ N~e of Contractor ......... ~ ................. Address ................... Phone No .... ' ...... i~., · l~.~a ~ p<operty Located ~ithin'~0 feet of a tidal ve~Land? *YES .... · If yes) Southold To~ Trustees Permit may be required. ] PLOT DIAG~M Locate cle~ly ~d dist~ctly MI~ buHdMgs, whether existing or proposed, =d. indicat~ M1 s~t-ba~k d~en:ion~ prop~y Hnes, Giw street ~d blockinumber or desc~ption a~cordMg to d~ed, ~d show streei n~es and ~dicat~ interior or comer lot. COUNTY OF...5.u,E ........ ........ $;.o.-r.-C. ~)o~ ~.~o.~ ~.. ~ ..................... (Name of mdivxdual s~gnnlg contract) above named. He is tile '. . . 1, FOUNDATK)N TWO REQUIRED FOR POURED CONCRETE 2. ROUGH~- FRAMING & PLUMBING 3, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE' FOR C.O. ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CONSTRU~ION ERROR,S being duly s~vom, deposes and says that he is the applica:: (Contractor, agant, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file th~ application; that all statements contained in this application are true to tile best of his knowledge and belief; and that th Work will be performed in tile manner set forth in tile application filed therewith. NOTARY PUBL C, State o~ New York ............* Ro, 4707878. Sufl01kiCou~r?,~, (Signature o f appllcan! Term El(pires Match ~0~ ~45.00' t O0.~2~'~~. ~00.00' HA ~'I,YA TEFt " Et]l V/WA VH ~ O0 '00~ /~.,6t' ogO N