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Home My WebLink About20078-z I~OB,~ NO. ~ TOWN OF SOUTHOLD BUILDING DI:PARTMEHT TOWN HALL SOUTHOLD, N. Y. NO. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL coMp,~lON o~: T,E WO,K 20078 Z Dote ...~.~.. ............................................ , ,9.7/ Permission is hereby..g.,ra~ted ~: x" ~/ x~ ,..~...~,~...~...~ ............................................ ....,...~ .... , ....... /....~..-~........ ....... . o, p,.m,,,,~,,ed o,.~ .;..~. ......... ~..~....~~ .................................................... Co..~ Tax Map No. ~ooo S~ct,on ......... ~./.. ...... ,,o~ ......... ~.. ........ Lot No ....... ~ ............. pursuant to application dated ...... .~,,/..~.. ....................................... , 19..~.Z and approved by the Building Inspector. ~ee $...~.~ 211dl~'~nspector Rev. 6/30/80 BLDG. DEPT. Examir Approved.. Oq./fl .......... 197/Permit No.~..~. Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPROVED AS NOTED / .... ' ..... NO~F¥/Bt~t[b~NG DEPAk"fMENT AT (~din=~ect~) 765-1802 9 AM ~ 4 PM FOR TH~ppLiCATiON FOR BUILDING PERMIT sot LOWmr~ ~S~[CT~O~S: ~ mU~Dar~O~ tWO FO}~ POURED CONCRETE ~ ~ ~OUGH ,, FRAMING ~ PLUMBING INSTRUCTIONS gOAgO OF BEAt. Itl ......... 3 SETS OF' PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. Date ................. ~ , 197./. filled in by typewriter or in ink and submitted to the Building Inspector, with 3 g to schedule. of buildings on premises, relationship to adjoining premises or public streets of layout of property must be drawn on the diagram which is part of this appli- , not be c~mmenced before issuance of Building Permit. )lication, the Building Inspector will issued a Building Permit to the applicant. Such permit e. * rNo .bxdl.ding.shall~e.~_c&u_gied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall 1~;¢~ ~efi~hh'~b~l~b~,l~gFgL~/l~irg gfspector. ~O~N~~ MADE to the Bulldog Dep~ment for the issuance of a Building Pe~it pumuant to the Building ~o. nO~l~nce ~O~ Southold, Suffolk County, New York, ~1 other app~cable ~ws, OrdN~ces or Regulati~ ~lJt~{)~E~n of bu~d~gs, additions or alterations, or for removal or demolition, as hereN desc~bed. The ~.p~lgr~[~l~k~app~cable laws, ordinances, budding code, housing code, and regulations, and to admit~u~l~pecton on premises and N buildh~g for necessa, inspect~ ALL CONSTRUCTION SHALL ME~ ~Signa~ure of applicant, or name, if a corporation) STATE CONSTRUCTION & ENERGY (Mailing ad~re~;}~{i~;)' '~ ........ S DESIGN OR CON'RUCTION ERRORS tare whether appncant ~s owner, mssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nme of owner of premises 7~/ ~. Y~w (as on the t~-roll or latest deed) If applicnt is a corporation, signatur~ of duly authorized officer. (Name and title of co.orate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed ,work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... ~./ .......... Block .... 4 ............. Lot...o~. ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises a. gd intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ................................... '~rr, th',3 '~l~ ~5 ............... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration .......... Repair ............ Removal [ ............. Demolition ............. Other Work '...~;.~;/~!,~..:~[..... 4 Estimated Cost~'~O,1oo Fe (to be paid on filing this application) 5. If dwelling, number of dwelling unit~.. ~ < Number of dwelling units on each floor · If garage, number of cars ........ ~ ..... ~ ......................................................... 6. If business, co.mmercial or mixed occupancy, specify nature andextent of each type of use ..................... 7. Dimensions of existing structures, if any Front ........ Rear .............. Depth ...... Height Number pf Stories Dimensions of same structure with alterations or additions: Front ................. Rear .............. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrnctibn: Front ............... Rear ............... Depth ............... Height ............... Num bar bf Stories .. 9. Size of lot FrOnt R 10. ~ate o~ vurcnase ..............i ............... Name of Fmaner Owner ........................ 11. Zone or use district in which premises are situated /(e ;/~o~.~ .~-¢:.~.' ~ '" 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ,/~..O. ...................... 13. Will lot be regraded ...... /Lo I ..~, · ../ ....... Will excess fill be.removed from aremises: Yes X No 14. marne of Owner of premises......j..." '~z:/i~' .~.~. ?.? e.~.~... Address .. 9. ?.~ .~.~. ?:~.~.~..~.'.~.~?[/./~i~n'~e No.. ~..~ ?. ~ .~..J'-.~..~.. Name of Architect ............. I ............... Address ............... Phone No ............... Name of Contractor . ?.5~.~.~..Jrt- ~.~A',~-?~- ' .~:g'/~fi~.'?./'3. g~..~ ?'.' Phone No .7 b.~. ' .~..,~.. · · .i .... LC7;. ~. .... Address ....... ~... 15. Is this property within 3001feet of a tidal wetland? *Yes ........ No ......... · If yes, Southoid Town Trustees Permit may be required. .... ! 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 nuniber or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. STATE OF NF-~/Z-YOR_~,~"2 t// S.~ COUNTy OF ......... 5.o. (Name of individual sig~in~ c'ont~'adt) ..... being duly sworn, deposes and says that he is the applicant ~bove named. ?Ia is the ...... , .......... ! '~ :-" ...... .7 ................................................... ,: ~(Cont_?ctor, agent, corporate officer, etc.) >f s. md owner or owners, and is duly ~uth.~ .p. erform or have performed the said work and to make and file this ~pplication; that ail statements containOd m 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 the application filed therewith. . worn to before me tlgs. ............ .fl., .?'/ ry' , ~~/. ........ County ................ ".. :, .75 ........... (Signaturo of applicant) Qualified in