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Home My WebLink About21092-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, No Y. NgN? BUILDING PERMIT (THIS PEP, MIT MUST B£ KEPT ON THE PREMISES UNTIL FULL CC)/vlPLETION OF THE WOP, K ^UTHOP, IZFD) ..//.,~ ......... 21092Z Date .... ~,. ............................... , lg..~'~'~ ,o -/- ~; o . ~ ~.~ ...... ,.~~...~..~ ...... ~.~ ........................... ~~,.,,~ .............. ~t premises I~a~ at .,..~.~.~.~ ....... ~~....~....~..:....~ ........................... ......... ; ................................... ~..~~~ ....... .................. Coun~ Tex ~ep No. ]000 Section ....... ~ ......... Bilk .......... ~ ....... Lot No .....~ ................. pu~u~t to applJc~tio~ ~ot~ ....... ~/~ .................................. , lg.~Qnd ~pprov~ by the Building Inspector. Rev. 6130/80 FORM NO. I TOWN OF SOUTHOLD I~0\] i 3 ... BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ',, ~ TEL.: 765-1802 Approved ... ~. ...... 19 .~.'~. Permit No.~.~...d?~.~. Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: Date ...}0.~.~,.[3.) ....... 19 .c).~_ a. This application must be completely filled in by typewriter 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 streets or areas, and giving, a detailed description of layout of property must be, drawn on the diagram which is part of this appli- cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Perrflit 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 by 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 Southold, Suffolk Comity, 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. --' (Signature of applicant, or name, if a corporation) f:'~c~ ~ .¢.o. y,... ~.~.~.5 ..... .o..g.~ ~.~.z,. N..,Y. .......... (Mailing address ~f applicant) .) [ [c~ S'7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... : .................... .Ca ~.N~.g.&b... Co Bw~, AC.T.o. ~ ................................ Name of owner orpremises . .~-~.~.O t~ .~...~../4c.,.... g I .~. 5AK.~ .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth?rized officer. ..c~ ..~a..~..~. s.. ,~ .~...~..: ........ (Name and title of corporate officer) Builder's License No... ).~)..~..~..-..~...~.. ..... Plumber's License No... oQ~..~.~)-, .-..~.... (.~/~.) Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be' done .................................................. ........................ h.l v. t>.L. ~... Kb.,...C.,. ~, .,-f ~. ....... $o.v .-rSo~.t>. 9' :'¢: '~'' ........... House Number Street Hamlet County Tax Map No. 1000 Section ...~..~.q]q.. Block . .~....~. ...... Lot. ~ .... [ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ' ',3 O . '~'~;;~"~ '" ....... ~ ~ ""~'~ ~ ' ....... b. lntended use and occupancy ~.U~ J ~ ~.~.S. ~. ~&~..'.,.,...:,;..';:, ............ 3. Nature o. fwork (check which applicable): New Building ......... A ' ' · .A]~tmon .......... Alteration .......... Repair ............. RemoVal .............. Demolition . .V ........... Other Work ............... , (Description) 4.Estimated Cost . .~f. .'-~) ......... Fee ...................... .................... ', filing this application) 5 If d ell' numb ofdw lli g~ it l.~.~r~,~ N mb f d Iii unit chfl · w lng, er e n n s .... u er o we ng s on ea oor ........... If garage numbe of cars ...... · , r ..... i...; ........ ; ................................ ... . If business, commercial or mixedl occupancy, specify na[ure and ~.xtent of each type of use ................... 7. Dimensions of e~i~ting structure~ if any: Front .~-~. ~ .'~ Rear ~.o~.! - Depth..~i ....... ' Height ...qg..g ......... Number of Stories ... ~[ ................................................... Dimensions of same structure with alterations or additions: Front ................. Rear . ............ .. .. Depth i~ Height Number of Stories '., 8 Di f ti tn4 F pth · mensions o en re new cons ction: ront ............... Rear ............... De ............... Height ............... Number off, Stories ........................ -. . 9. Sizeoflor Front ~.C>~) o .Oi :' ' Rear J. qS;~,,.2![i:/ .... ~. ..'" 4'~'~ .,:.;~ .......... · '-- g.2.~.~ ................ I. .......... ~epm ~ .~a [, ~ ........ 10. Date of Purchase ..; .c~.~.~... i ........ ~ ......... Name of Former Owner ............................. l, 1.Zone or use district in which prendses are situated ~J~J,~Jx) .-lT.l ~ ............... 12. Does proposed construction viol~t6 any zoning law, ordinance or regulation: ..Is[iD ......................... 13. Will lot be re raded iM .O. i . ,. g ' ' ' 5~ ................... Will excess fill be removed from premises: Yes.. 14. ~ame of Owner of premises t..~.~.O .R,%I;; B IT/SA4~/~ ad,~ress ,,~ ...~te, --~/-t · · .: ..................................... z'none ~o. ii,0..~.~t Name of Architect . .Lkl~.~_D.. ~rggmC, .......... Addresff }O-.g3N. lgOJg J~. OJffl.,~-... Phone No. ~5{;~'-.~.C~ .... Name of Contractor .'];:~Lbl.~4g...~2~/~.~-..V.O.~. .... Address OI~.[,{~M'~4 INJ0r~.. .... Phone No. 15. Is this property with:Ln 300 feet of a t±dal wetland? ~Y~-'...:'~.. No ..... .... ~If yes, Southold T?wn Trugtees Perra±t may be requ~Lred. PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 765-1802 ~ AM m ~ PU FO~ THE FOLLOWING INSP[CT[ONS, ~, FOtJND~DOA~ TWO ~EOU~RED 2. ROUGH * FRAMING 8~ PLUMBING 3, INSUL.A~ION P,.o~J-b C. , r~ (j_~/ 4, FINAL CONSTRUCTION MUST · 8E COMPLETE FOR C.O. ' ALL CONSTRUCTION SHALL MEET ~ THE REQUIREMENTS OF THE N.Y. J STATE CONSTRUCTION & ENERGY STATE OF Ni~&W'~'~RK~]~_h /)/_ .. CODES. NOT RESPONSIBLE FOR COUiX~,y OF. g~. :1.~."~./. ~ ~5.~ DESIGN OR CONSTRUCTION ERRORS (Name of individual signim, contract) above named. Pie is the ................. ' i (Contractor, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements containbd in 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 tho. application filed therewith. ~worn to before me this , , ~" Notary Public, State of New - Qualified in Suffolk County r_~ ') ~ ~x3 (Signature of applicant) ~ommt~lon Exptree Deoe~ber 8,