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Home My WebLink About18749-z YOB~M 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) N 18 7 4 9 2 Date ..../.~a3 19.~~ Permission is hereby granted to: at premises located at .:3.:> !~~(;;~./f..~......~ Via.. County Tax Map No. 1000 Section Block Lot No.....~'..(............ pursuant to application dated 19., and approved by the Building Inspector. Fee $..~~..a/.. O.~ uil g nspecto Rev. 6/30/80 4.. JAN 1 T 1990 64gG. C1EPT. ~p AgpWN{O~F{S~UQ~U,TH04p k~'~` " 1v _ "l 1 I Vu~/~'~f\ ~ ~l' ~U~ LQ Cl~l'LCQ/1.bLf Yl.~ ~ ~ UV ~ua~dti~~ i vtn~~c~ -b- ~,Q,rr v,~,a„~ ~ v - f~ w~ ~ o~vo~,N, ~ ~ ~ t-~ C~~ ~ ~ ~ Q q~d~~ Q^~~u~a~ ~o ik `6V " ~ ~ ~ ~ BOARD OF HEALTH 3 SETS OF PLANS •FORM NO. 1 SURVEY - . TOWN OF SOUTHOLD CHECK - • • -~'•~j3~ BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 MAIL T0: Examined . 199 ~ Approved~~ ~Y D AS NOTEp 19 . Permit No... • . • • • ~i r ' ~ I ` s Disappro ~ ~ s I9g~ ~ 1 ~ DATE: ~'L~ ...s.p a ~~f` ~ ai I`'s ` JAN 17 1 t ' FEE:• SVi • , ~~~?~..,,.~.i1=u x=ip~P;.......,(~~~-'.~ w ll??~~ NOTIFY 8 " IL G DEPART IT ®•i ry ~?lNrd t'JF wOU1 ~ PLC) 765-1801 9 AM TO 4 PM FOR THE T..,.""- FOLLOWING INSPECTIONS: liiuiiti~ ,t,.:,,...:.~or; 1. FOUNDATION - TWOREQUIREO AppLICATION FOR BUILDING PER~A17 FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING Date 19`7 3. INSULATION 4. FINAL - CONSTRUCTION MUST INSTRUCTIONS BE COMPLETE FOR C.O. ~C r~lkl~e letely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se ~ 1 Fp1aTi!'I~o .Fee according to schedule. C t1ESl pc lot and of buildings on premises, relationship to adjoining premises or public streets ' or a~rge~sNa~ ~ ion of layout of property must be drawn on the diagram which is part of this appli- ca~c~.~ _ 4:3.4=. o, Tfie word~covered~y flus application may not be commenced before issuance of Building Permit. F Hf ~,,Ippan-appravai~Mfltxhir,a lisaY-ion, the Building Inspector will issued a Building Permit to the applicant. Such permit sh~~~~ lie~~ ~It tl~et~ rr~~i~~Is d`V$~aTb~~~or inspection throughout the work. 7~;' i "~u~l ~ ~~l~no~c~i r used in whole or in part for any purpose whatever until a Certificate of Occupancy shalrl~~~~ ? h~~k ed ~~~a~~~pOInspector. AP~LI1C1A1_'IfI€{AIt:F$E$Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Bu~diRr'~t8-mhle 6Pc#'ll!?~Rlf~ t~fR~NI~ of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oz Re~ul~tid#IsQ~blNthe construction of buildings, additions or alterations, or for removal or demolition, as herein described. Th@ a~IjYlhi 4ant- ag4•dL~$bRkKt~i~ X11 applicable laws, ordinance uilding code, u g code, and regulations, and tc a:.?mitE3kaf1Q11AP~T~:)~&~?s?en premises and 4~-build±**.g for necessa• specticn ' ~~n ALL CONSTRUCTION SHALL MEET ~V, z' Y`.~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION ENERGY ~ ~ D9 (Signature of applica t, or name, if a corporation) CODES. NOT RESPONSI"='.L~.F, S}}I~OCy'RI0)G P'flnli~FTO-?<~( DESIGN OR CONSTRUCTION ER ORS I 7 ................1.. t ~ k:y ~ • ~,•i q~Yi I"• • d c~•~• (Mailing address of applicant) State'' ,,w``,he``ther applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~W N.c.~ ...................................~.nq.~.~.............................................. Name of owner of premises"'~1'1.~~.~~... `--.°..~!!~/.~•':r'•~-~(~1~`~•.•••••••••••••••••••••••••••••••••• (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done . . . House Number g Street Hamlet County Tax Map No. 1000 Section ~ Block Lot S.°. . Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 4 a. Existing use and occupancy ~ ~Gc~~~ . t~ b. Intended use. and occupancy ~t. 3 Repair of work check whiRe1applicable): New Building Addition Alteration ' oval . Demolition ..............Other Work .'F.Fi1.~?G~...... . Z~~ D j, (Description) 4. Estimated Cost . Fee . ~ ~'J 5. If dwellin , number of dwellin ~ (to be paid on filing this application) units ~ Number of dwelling units on each floor ~ . If garage, number of cars ~ . ' d occupancy, specify natyre and extent of each Yy a of use . . .g Height ...3~......... Nu es, if any: Front ~5. , ......Rear Depth 11,x, • , • , , , 7. Drmens ons of exishna structu~ber of Stories ....:...Z . . Dimensions of~arpe structure ~yith alterations or additi~ns: Front •~/~.f(~......... Re ~r ...:?~L~........ . Depth „r,~., , • . , ,Height .....5 r . Number of 1Stories ...~./~'t`4. p 8. Dimensions of e/tire new const', • - i} ruction: Front Rear .....Z~....... Depth ~~r~! . Height ~ r19...... Number of S/t_ories . '~.~1, l s~: ~ . 'Depth ...l.l-I ~.°.1. . 9. Size of lot: N'ront ~..;).....'.W'.... Rear 110. Zone or use district in which ~$O • • ~ ~ • ~ • ~ ' " ' ' • Name of Former iJwner ~ W. e- . u . d ?-'•f• emises are situated ~ r.,... , . P, 12. Does proposed construct'on vrolate any zoning law, ordinance or regulation: • ~ . g ;~..~y p 14. Name of Owner of remises . ( ~ • • ' ' ' ~ • Will excess fill be removed from remises: Yes No p YG:{)4^.!~~Q.. Address 1,~...~L2~??~f .......Phone NoA.I!`6!3 H~1~.1P...~ Name of Architect ................Address f :.:.:.:Phone No............... . ..Address F~hon0' Natne of Contractor ~ • * ' • No P 15. is this property located within 300 feet of a tidal wetland.' Ye"s 1`Io`~.. ' *If yes, Southold Town Trµstees Permit may be reggw~ired. PLOT DIAGKAM ~ a-, za, ~ i • . ' , Locate clearly and distinctly al~ buIldings, whether existing or proposed, and•.yindipate.,all set-back dimensions from property lines. Give stree and block,,,,nn~~tuber or description according tq d d, nd w street names and indicate whether interior or corner lot. ~y'hQ,ti {°•4'W' ' A•e~- ~ ClU- ~fP/lA<, QtN T~'I YfvU',p, y~tEQ,ptilnLyK,pyq,~$ I'l IN lz-OA'~~ ~ ra,,a_ o~c_ t ~-l to • l 1 - - - - t~ I'f~N~ I~irowsG ~I~~ ~sln ~ ~ ~ ' t+ouS~ ~ G~2 ~ I~IN~ 1 ' ~ i a C ! ~ - - - - ~ _ U ~o ~ I . ~ (o' - - - ,~v STATE OF NEW YORK, COUNTY OF .W.~`?~~'~`~T~. , S.S ~-.•...."~1TX..~~~ ~ ~ .I~............ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 1' He is the (Contractor, agent, corporate officer, etc.) caf-sank-e~v~.-w~vr~ and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before~rlie this da o Notary Pl}bli~ ~C . ~~Cp County ~ . . QDWARDPAPANTONIO NOTARY POD~,iL' Srap+ ~r New YorM ~ (Signature of applicant) ~Qualihed m Westenester~~~~t~~~ Commis ion Expires