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Home My WebLink About19276-z I~OEH NO. 0 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- q ~27C Z Permission is hereby gra~t~dat~o: ,~/~ / / / ~ ' /~ ..................... ~t premises I~oted ot .:x.~.~~.~ ...... ~.~..~, ...................................... ........................................ County Tax Map No, I000 Section~/ /'~/'"O'""]' ......... Block ..... ..C~..~. ......... Lot No. '~'/"~'"~'":"/'"'"L~T-/~) pursuant ,o application dated ........ .~...~........~....~. ................ , 19.~..~.., and approved by the ~ Building Inspector. Building Inspector Rev. 6/30/80 OUNDA~ION (1st) OUNDATION (2nd) :OUGH FRAME & -PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FI;IAL ADDITIONA'L COMMENTS ~0 0 C FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD. N.Y. 1197'1 TEL.; 765-180:3 Approved .... .""~"."']., 19 .~.0. Permit No./ ...... ~... DEs.approved a/e ................. (Bnilding Inspector) APPI~ICATION FOR BUILDING PEFIMIT BOARD OF HEALTH ............ 3 SETS OF PL^NS ....... ::... SURVEY ........ ' ......... CHECK ';;X ................. SEPTIC NOTIFY~ CALL .................. MAIL TO: INSTRUCTIONS a. This application must be completely filled in by Wpewfiter or in ink and submitted to the Building Ihspector, with ~ 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 parr of this appli- cation, c, The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the B~ilding Inspector will issued a Building Permit 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 pursuant to the Building Zone Ordinance of the Town of S0:uthold, Suffolk County, New York, and other applicable Laws. Ordinances or Reeulations, for the construction of buildings, ad~ditions or alterations, or for ~:emoval or demolition as herein des b Th~ .applican.t agr. ees to comply with all applicable laws, ordinances bufld;,,X",~.,.~ h,,,,~; .... ,~ L , .. ch_ed. admit authorized mspcctors on premises and in building for necessary'insnec~/c~i~,~ ........ ".," ....ann regmanons, and to , , ....... ?, . - (Signature et app. licant, Or, name', i(a'.eo~t~o'rr~r~c~n') ' ' State wh~ther applicant is owner, lessee, agent, arc~tect, engineer,, general contractor, electrician, plumber or builder. ................... ®~ ~$~ · . · . ..... ~/.c./.¢ .......... ~. .................. ..~,e o~o,vner o~prem.ses ....... fl Il~'.',.~. C'a.~. t~. ~....b.'.~.,.~,-~.~,.-,..... ......... (as on the tax roll or latest deed) Lc appl'cant m a corporation, signature of duly authorized officer. · . (Name and title of corporate officer) Builder's License No ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ' · Location of land on which proposed w?k will be done: . ' . ....... - , , ............ - .......... a~t~/~,kt~,~..[O,l~!, ~ .~. ' s;~,, '"31 ....... ~ ............ Hmnlet ....... ..... ........ ...... .... (Name) o. . .................... S'ite ex,sun~ nsc and occupancy of prem,ses a~d ,~ended t~e a,,~ Occt~ancy of proposed construction: ~ O p y ........... ~ .......... , .................... , ......... [ ..... B. In'ended use and .ccunancv .......... '.~'k~,(~ ~.Tf,,~..,,="~' ~ '' - ~ ~ ' ........... ~ %V~' ~:~ ~ :g~)~:.-l.Y~.~}.. ...... L Nature'ofwork (check whi :h applicab{.e)f New Building .......... Addition .......... Alteration ........... Repair .............. ~bmovalj..~{.~.b~J'.~. ..... Demolition-. ............. Swimming pool../..[ ...... ....... ....... .... .. ;. Estimated Cost ................ ] ...................... ~ee ..................................... · (to be paid on filing this application) i. If dwelling, number of Uw~ ling un,tS ...... ~. .... Nt tuber of dwelling units on each floor .... If garage, number of cars .... · ~I~ ............................................................ 5. If business, commerca or mixed ocCupancy, specify nature and extent of each type ofus~ . i ......... 7. Dimensions of qxisCng sm ctures, if~any: Front. .. 3~ ... Rear ... ~ .. . De~th~ .~0 Height ...... [~ ...... Numberlof Stories ............. ~ .................................... Dimensions or,amc with ~lterations or additions: Front ...... ~ ....... Rear.. ~*~ ...... I, Zone r use dmtnct m wht fix premises are mtuated ......................... ~ ......................... 2. Does proposed constructic n violate ]any zoning law, ordinance or regulation: .... ~(~ .......................... 3. Wal lot be regraded ...... ..~.. ~, ~ ........... ..,. Will excess fill he ~em~ved from premises: ~ ~es..~. Na.. 4. N~e of Owner ofpremis~ s ~.~?.~.g.~.t~. ~ess ... ~'~6.~ ...... Phone No, . ~..~ .... N~e of Architect ' ...... ~' t · · ~ '~', .P ........ Address .... : ~ · I t 'r' · 'l ..... Phone No .... h ..... .~ ....... .5.Is this property.o~ted within 300 feet of a 'tidal wetland? *YES .... NO~- · If yes, Southold town Tlrustees Permit may be required. ~ PLOT DIAG~M [y,~l bu~Hd~gs, whether existing or proposed, ~d. ind~catc MI set-back d~ensions from ~ock number or dcsc~pfion accord~g to deed, ~d show street n~es and ~dicate whether Locate clearly and distinct roperty lines. Give street and ] ~terior or comer lot. APPROVED At DATE: e.I NOTIFY BUILDING DE 765-1802 9 AM TO , FOLLOWING INSPECTI 1. FOtJNDATtON 'FOR POURED CON 2. ROUGH - FRAMIN 3. INSULATION 4., FINAL - CONSTi BE COMPLETE FOR ALL CONSTRUCTION THE REQUIREMENTS STATE CONSTRUCTIO CODES. NOT RESPI DESIGN OR CONSTRUI NOTED PARTMENT AT PM FOB THE ONS. WO REQUIRE0 RETE & PLUMBING LICTION MUST SHALL ~IEET · OF THE N.Y. ~J & EN=RGY )NSIBLE FOR ,'TION EFII ;TATE OF NEW~D'R~" :OUNTY OF....~. ,~I~-~.[,.~ .. S2 ..' ........... . (Name ofindividu bore named. fe i~ the ................. I- 'f said owner or owners, and pplication; that all statement /ork will be peribm~cd in ti~e ;worn to before me this :Otary Pub~~ NOTARY P U ~B~I No. 52 7; - Commission E~ is duly :iuthorized to pe,rform or have performed the said xvork and to make and file this ; contain~2d in thru application are true to the best of his knowledge and belief; and that tt~e nannerset, forth in the application flied therewith. County · .................'~'cs"v'x ' beingdnlyswom, deposes and says that he is the appllcant signing contract) (Contractor, agent, corpbrate officer, etc.) qO. 3 26.45 U,S~ (4 PTH L I I'- O" NO. = 2,6.86 29.9 C.B,NO,6 T.~ I.E, = ?_ 3.~'? ~00% N ,% ~0 f~Ot4 ~o 5 x 0 11 I qO.3 26.45 ;.86 u§E (4 PT'H L I I'-O" NO. 5 ........ = 26.86 = 22.73 29.9 C.B,NO.6 T.O~ I.E. = 23./3'7 oo°/o N, Nature'of work (check svhich appticab(e)[ Nesv Building .......... Addition .......... Alteration ........... Repm'~ . ."~ .......... R~moval..~.~t,¥~ ..... Demolition ............. Swimning pool ............ Tennis Court ......... Accessot%~ Buzlding..( lr.~ . .Fence ....... Other Nork.. (? .. .... Estimated Cost .............................. .. ., ....rep ........ . . . . (to be paid on filing this application} / If dwelling, hUm her of dwelling units ...... ." ........ Number of dwelling units on each floor ................. If garaee hum bcr of cars ~.<' '.~.~. If business, commercial or mixed occupancy, specify nature and extant of each t~pe of use ......... · Dimensions of ex sting structures, if any: Front . .3 .~ ..... Rear ...... jS.. -J ..... Denth ~'0 ......... Hmght ...... .~ ...... Number of Stones .... ~.--, .......................... Dimensions of~.ame structure with alterat ons or add tions Front ... ~.'/.. .. Rear .... .'~'~.'.ii ' Depth ...... .~.~ ............. tleight ...... ).~i .............. Number of Stories .... '~. .... D mens ons of entire nexv constn ct on Front , ~. . -Rear( .1 _~.' Der, ih Height ............... Number of Stories.. [~...o....~,~i,):..(.C~. ?>.t.Q.~ .~'.]'./:'?'~i ~!C. ~' .¢.. t~;~ Size of lot Front ..... )~'~.?; . . Rca" ~.:;,S? DxeDth. (2'~0 \ .... Date of Purchase ....... ~t,'~.(u{./. l.c ............ Name of Former Owner .~ O [[..k, ~../..:.~iq .CYt ~ e-~ ..... Zone or use district in which premises are situated ...................................................... Does proposed construction violate any zoning law, ordinance or regulation: .... [r~.O,. .......................... 5Vill lot be regraded ........................... ,... Will excess fill he removed from premises: Ye~ .... No. ....... ?.ri f'.- 'J .q=V: .... Name of Owner of premises A/.~,v,,-.(,L'wi~'.,l~:Lp.f,ke.,A~tS'ress ... [x~.0-}] !'[-V.t.( . . Phone No ...... Name of Architect ........................... Address ................... Phone No .... ~. .......... i Name of Contractor .... .~ [~(%',. ,~ I.,.ki,.q,s.q.x.... Address . .15~')J[ 0. ~%qt.~ .... Phone No.. J:' ~.{. 'i .~'[ 7(. :'.. 5.Is this property loc&ted within 300 feet of a tidal wetland? ~YES .... NO~. *If yes, Southold 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 roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ttehor or comer lot. APPROVED AS NOTED NOTIFY 8L.HLD~NG OFPAnTMENT A~' 7~5-1802 B A~a TO ~ F,[~ FOR THE FOLLOWING 1. FOUNDATIO~J ~YO F(EOUIRED FOR POURED CONCRETE 2~ ROUGH . FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION 8HALL MEET THE REOUIRB~BNT8 OF THE N.Y. 8TAT~ CONSTRUCTION & ENERGY OOOES. N~ RESPONSIBLE FOR DESIGN OR ~ONSTRUCTION ERROR8 rATE OF NE~V~'ORk( I)/ ,.' OUNTV OF... $.k)c. .... s.s fiX'.{{B%¢..~= .'~.. · , ~- ~e f.cc't~ . being duly sworn, deposes =d says that he is the applicant (Name of individual signing contract) ' Hie ~ " 2 IS - - (ConCepcion, ~EenL corpbrmtc oFFicer, elco ' s~id owne~ oF owners, ~nd is duly ~udmfizcd to peZFoFm or Imv~ p~rFo[m~d tim s~id work ~nd ~o m~e and ~I~ 'pli~fion; lh~f ~ll sl~[elnents conl~in~d in tiffs ~pplic~fion ~re Into ~o llic bes~ oFhis knowl~d[c ~nd belief;mid flmf ~rk will be performed in the m~ner set forth in the application filed thereby(th. yom lo before me this , ,' - .[ ......... .:1o.... .... .. .c;,,.c] ¢ " ' ........ '"'""' -- N RO~RT J,~CCARTHY ~ ........ , .... OTARY PUBUC, STATE OF NEW YORK (Signature of applic~O C~mmissio. ~pi~es <~ FORM NO. 1 TOWN OF SOUTHOLD DUILDING DEPARTMENT TOWN IIALL $OUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined · · · .x~..~.,~ ,, 19 9!.O. Approved .... .'~ · .~.?., 19~ .0. Permit No.~.~..~..~..~...~ Disapproved a/c ............. ~.. (Building Inspector) APP£1CATION FOF1 BUILDING PERM/T BOARD OF HEALTH 3 SETS OF PLANS SURVEY CItECK SEP'rlC NOTIFY~ CALL MAlL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building lflspector, with sets of plans, accurate plot plan tO-cole. Fee according to schedule. b. Plot plan showing location ofilot 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 whicliis part of tkis appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. ' d. Upon approval of this applicat~ on, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises vailableifor mspechon throughout the work. e. No building shall be occupied i or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by tim Buildin~ ' Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southokt, Suffolk County, New York, and other applicable Laws. Ordinances or Regulations, for the construction of buildings, additions or a terations, or for removal or demol tion ns h ' ' The applicant agrees to comply with iall apnlicab]e laws ordi ...... r_...,~._~i .... ' ere.m described. admit authorized insuectors a, ,~,-o~,;,,,~ --.~': ,_ . .... , ....... ,. uuuuu~g,~:ooe, hOUSing cone, and regulanons, and to ~ ~-- v ....... ~o :~uu m uuuumg ~or necessary mspec¢o~.,.,,, (Signature o~ applicant, oi: name, if a c'o~[~o'r~t~c~n) ' '"'/ " ' ' . : -- (Mailin= address of applicant) qtate whether applicant is owner, lessee, agent, arckitect, engineer,, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) }f appl'cant ~s a Corporation, signature Of duly authorized officer. (Name and title of corporat4 officer) - " Builder's License No ' Plumber's License No Electrician's License No Other Trade's License No ...................... Location of land on which proposedlwork will be done; 11 N be ' St ' ' ' ' ouse um r reet, l'lamlet ........ County Tax Map No. 1000 Section ........ . ....... Block .............. Lot.. .'. " Subd,v, ion ...... .......... ,ap No. ' ......... :'" (Naute) .............. Lot ............... State existing use and occupancy of ~rcmises and in,tended nsc and occt~pancy of proposed construction: ^. Exist:±ng use and oecun.qncv ....... ~. fiq.C..~.~,.k .... , B. Intended use and occupancy .............. t.k,?.~j.(..~?.ff..( .... .,~A~¥¥;£;,..yt~.~.~-A.i~,,0U;.~;l¥~,ffig ......