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Home My WebLink About21135-z IvORM NO. S TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALt. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Mop No. I000 Section .....~..~..~... ....... Block .....~'....~.. ....... Lot No ........c~...../.. ......... pursuant to application doted ...~,~.....~... ................................. , 19~...~ond approved by the Building Inspector. Rev. 6/30/80 N,Y. Licellsetl # 21,600-1tl Bigelow Contracting ?attl J, Blge, lOW. )whet * (516) 788-7117 P.O, BOX 274, Fishe~ l$1m~d, Ne~, York 06390 7B$~1802 ~ AM ~ 4 PM FO~ THE FOL.LOWI~G INSPEC1 g}:- COIV}PI,.F:~E FOF~ CO !iLL CON~?fHUC/'ION SHALL 't'~tE ~[:QUtREMENTS OF THE S'L~¥E CONSTRUCTION ~ ENERGY {,:O(~ES. NOT ~ESPONSIBLE FOB O[SIGN OB CONSTRUCTION ERRORS ttome Improvements · 3ig 'n Quahty/Low in Prices ~ 21,600,]11 Pa~! J, BIg¢low · :)wrier ~ (5 ] 6) 78~-7117 P.O. l$ox ~74, FiSh~,'$ Island, Hew York 06390 \qilHOUl' CERt. OF OCCUPANCY ~ ,-~.~ fi, Lo Ilome Improvements · ~ig in ~¢u~D 1 Bigelow ~onitracting ?aul J, §lgetow · l )whet , (516) 78/~,711 ? P,O, BOX 274, ?'iahe $ island, New Y{)rk 063,~)0 ,] ~L~CCU ?^~CY OFt USE iS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ltome Improvements, 3ig in Quality/Low in Prices Examined ................ , 19 ... FORM NO, 1 'I'J~/VN nF-..SQLLT-I~-Q.I=t~ BUILDING DEPARTM ENT.,7. SOUTHOLD, N,Y. 1197J..,- TEL' 765-180 BOAKD OF HE^LTl! ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEFIIC FORtl .............. 9,0r,,~[,pe rm it &pproved/-./..'~-%~.... ...... 1 No..c~.././.~,~.. / - Disapproved a/c ..................................... ................................ (Building Inspector) CALL ................... HAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS .. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~-~s of plans, accm:ate plot plan to scale· Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsLiip to adjoining premises or public streets .r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appti- ation. c. The work covered by this application may not be c~)mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr/bed. ~he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in. building for necessary insp, gctigns. d-' // ,q..,f *,¢/ -- (Signature of applicant, or name, if a corporation) ..'~.o: .~. 9~...o.7:~....F: .~.0.~. ~.4...-,.s.~4 .¢.~..0:¥...O. 6.~yp (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ......... .G.e.. g ......................... . ........................ 4ameofownerofpremises .d'....~..~..~..O..~..~. ..... .~. pc~Z~Ol, q S (as on the t~ roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and tide of corporate officer) Builder's License No .............. ." ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ................ . ...... · Location of land on whi'ch proposed work will be done. ' House Number Street Hamle t"'- County Tax Map No. 1000 Section ~)O .~. Block Subdivision ............................... ...... Filed Map No .... -. *~t'z"..,. ' ' Lot ............ ... (Name) : . State existing use and occupancy of premises and intended use and occupancy of pT0~oserl con~tructi0B: a. Existing use and occupancy .. ... > ,, ,, - b Intended use and ~ ~. ~ ~' · occupancy 3. Nature of work (check which ap.phcable): New Building .......... Addition Alterat(on' . ......... Repair .............. Removal .............. Demolition .............. Other Work ,8~)t'.o4)...,~/q.-... 4. Estimated Cost ....... . Fee : (to be paid on filing this application) 5. If dwelling, number of dwelling units I Number of dwelling units on each floor. If garage number of cars [.bumn.ess, co.mmercml or mzxed occupancy, specify nature and extent of each tyl)e of use ....... 7.~a~menmons ct existing structure~ if any. Front l~.~r - 'r~' ','),' ............... Height ............... Num her of Stories I Dim ' sofs '~ ........................................................ enmon ame structure wtth alterations or additions: Front ................. Rear .................. Depth .................... i Height ............ Nomber of Stories 8. Dimensions of entire new const etlon: Front ...... .2.ff. ...... Rear .... .q_.c/. Depth I ~.. Height .... ~q~ ......... Number of Stories J ..................... 9. Size of lot: Front ........... , ........ ':. Rear ........ Depth I0. Date of Purchase ~ ..................................... ........... 4 ........ ......... Name of Former Owner 11 Zone or use district in which premises are situated ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: r'/o ........... 13. Will lot be regraded .... r/9 ....: .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~....~.~. I>t)e~...~..~4,s.~.~?.. Address ................... Phone No ................ Name of Architect ........... · · · ~.2... ..........Address ........ Phone No . . . 15. Is this property within 300 'f of a tidal wetland· *Yes ........ ~ ....... ; ' · If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block nhmber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. ,lATE OF NEg~OgI~, , ~. I .OUNTy OF .~ .... , (Name of individual sig~ning contract) ~ove named. being duly sworn, deposes and says that he is the applicant is the · (Contractor, agent, corporate officer, etc.) said owner or owners, and is"duly afthorlzed to perform or have performed the said work and to make and file this )plication; that all statements containe~l in this application are true to the best of his knowledge and belief; and that the ork will be performed in tl~e manner se~forth in the application filed therewith. ,yom to before me this ~ ................... day of ....... 19. .... E~EEN'~: W~L" '~' · '; · "~ ...... NO. 01WAO50Ol~ :~ .... /.~ .... . .. ~ QUALIFIED N 8UFFOLK COUNTY- ~ ~" '~ ........... TERM EXPIRE8 OCTOBER 31, 10 ~ ~ . (Signature of applicant)