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Home My WebLink About19619-z l~rOuM NO* · TOWN 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) Ne- 19619 Z .... at ....premi~' /--'se$ located at ....... .~.~..~..~....,..~~~........................"~-~ ................................ ~.o,.o..~..~.../~ .......................... .................. ~, .......... ~..r..~7 ........................... Co,,ty Tox M°p No. 1000 S,ctio, ........ //..:Z.. ..... mock ........... /..~... Lot No ......... ./..Z. ....... ~,,~o~, ~ o~,,~o.o, do,ed ..... ././..~ ...................................... Building Inspector. Rev. 6/30/80 TIlE OFFSI[TS (OR DIMENSIONS) SIIUWN I-IEIIEON FIIOM [lie $11,OCIURES I0 TIlE PHOP£1tlY LINES ARE I:OR A SPECII-IC I]UR- POSE Al'ILl US[: AND TttE~£,rORE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTI-IOLD, N.Y. 11971 TEL.; 765-1802 BOARD OF tlEALTH ............ 3 SETS OF PLANS ............ SURVEY ........ SEPTIC FORM ................ NOTIFY ^LL ......... MAIL TO: /(Bu, ng l p to ) APPLICATION FOR BUILDING PERMIT. INSTRUCTIONS Date . Ja.n ~ ·, · ,~, .......... , 15.91 a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to thc Building Inspector, with 3~ s of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pld, n showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tlxis appli- 3.O11. ¢. The work covered by this application may not be commenced I~,.,fc~re issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~uctl a Building Permit to the applieant. Such permit fil 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 O¢gupaney tll have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~suance of a Building Permit pursuant to the ilding Zone Ordinance of the Town of Southold. Suffolk County. New 'Y.tirk, and other applicable Laws, Ordinances or gulations, for. the construction of buildings, ad,d. itions or alterations, or f6t removal or demolition, as herein described. · applicant agrees to comply with all applicab]~ laws, ordinances, buildin~code, housing code, and regulations, and to nit authorized inspectors on premises and in building for necessary inspcctJ~s. ?,~rrironmen~ ~ asr, Inc. 3075 IndLan ?,Took Lane ...t'e.a~ ~L~,..~g. D-19~B ....................... ' · (Mailing address of applicant} itc whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Raym ~nd Cr ~uch .mc of owner of premises .......................................................................... (as on the tax roll or latest deed) ~ppli ancan'~,~5~t./O~signat ute o f duly au thorized officer. officer) Builder's License No ...... ~5.$fl.~ ............... Plumber's License No ......................... Electrician's License No ....................... Oilier Trade's License No Location of land on which proposed work will be done .................................................. ~. F~?rth S~reet New Suffolk }louse Number : Slrcet~ ' ' Hamlet ~ " ~ fO ' 17 ' Coun~y Tax Map No. 1000 Section .... %1~. . ..... . .. .. BIpck......,....,,.,. Lo~,., ................ Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) % S[a~e e~isfin8 nsc and occupancy of premises ~nd in~cndcd use and occupancy of proposed cons[ruction: a. ~xisfi~g usc and occupancy ......... · ........................................ · · b Iht d d One ~f~(~Y ~W~gg with fence · . endc u~e an occupancy ....... ' ....................... · ature o wot w i a ca e · ew Building ..... ' ..... Addition ...... ~.... Repair Re/no al ' · ' Demolition Other W~k ,~ ' tim apphcation) 5 Ifdwelling nmnber ofdwellin~ units ~ ~: (to be paid on filing ' · " ' .. · ....... Nut '" ' ' oneach floor If.garage number of cars,... ,i ........... nber of dwelhng,,unlts ........ . ....... 6 ll'busine'ss mixed occupancy .... : ..................... ' .......... contmercial or. specily nature and extent of eactf ....... i ' * ......... i ' 7' Dimension's ' ,type of use · of existing structures irony: Front P, ea~: .............. ' ~ ' ' ' ' Height ........ , ....Nm~nl~crofStoriea ''' ................. ' ....... .. Depth..,........ .... Dimensions of same structure With alterations .............................. or additional Front '" ............ ' ......... ~ ' ' Duptlt .' lift,Iff agar 8 ......................... Number of Stories . Dimensions of entire new cbnst~ction: Front Rear ...................... Hmgltt ............................... Nm~ber of Stories Depth ............... 9 Size of lot: Front i Rear 10' Date of Purchase" .......................................... Depth .................... ,.. ' ' ......... ' ...... Name'of Former Owner I 1. Zone or use district in which premises ar0 situated m, ~,~ ,~, ,,~,'~ ~'~ -. Does proposed Constructmn omi,ate any zoning law. ordinance or ragu orion' . .I'{.q ...... i ............. ~3, Will lot be reeraded , ,I~, ' ,,. · .... , .... ~ .... 4, NameofOwneroferemises~lAT..mond 0~:r,o,aeh ... ~'~5.~ ~t~s{~enlovedfrontprem~ses. Yea No Name of, Architect '. .... .... ?,ii ............... ,'Ta, a, ress~;'~· Su¢.~otk.,..Iii'---c,. Phone No73~,-.6.7.7~3: ....... Name of Contractor ~?] ~x,r I. ??rlC. e ~1~' ~.~%'/'I rS~' ~.~.ress 30"P~ 'Infl'1.atl. 61k..~B ~hone No ............... : < ] PLOT DIAGRAM . ' 'L Cate ciearl,y and distinctly all ~uildings, whether existing or proposed and, indicate al s - · · ' '" roperty lines. G~ve Street and bl~ck ~umber or de~r. ri.*i .... - ........ I et back ,danenalona from ~terior or corner lot. - ....... ~- ....... cormng to acco, ann snow str, eet names a~d~in~icat0rwhe,ther F /~ ' ~' - 765,~1BO2 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: 1. FOUNDATION . ~O REQUIRED FOR POURED CONCRETE 2, ROUGH., FRAMING & PLUM~[NG 3. INSULATION ' 4 FINAL *~ 'CONSTROCTION MUST BE ~OMPLETE FOR ,' ALL CONSTRUCTION THE REQUIREMENTS O~ THE S~ATE CONSTRUCTION & ENERGY CODEs, NOT RESPONSIBLE FOR DE8IG~ OR CONSTRUCTION ERRORS is the ;aid owneror owners, and is duly a being t)hly sworn, deposes and says that he is ,the applicant ~corporatc o£ficer, etc.) ' . ~pe,rform or have performed the sa,d work and to make and file this licaiion; that all statements contained in this application are true to tim b6st of his knowledge and be!i~f; and that the k will be performl:d in the manner set ~rth,in the application qted therewith. m to before mc this ' ' ..... ........ .... , , '~1~ ...~., County . No. 52-8125850, Suffolk Co~ ' Term ~ires October 31, 1