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Home My WebLink About18765-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18765 Z Da,e ...~.d. ~../. ........................................ Permission is hereby granted to; .. ...... .x..~.../...~.~__.~.......~...~ ............. ~t p~*~ ~t~a ~t ................................... ~ ........ ~ .................................................... ................................................................... .......................................................... Co~ r,~ uop ~o. ~0o0 s~,o~ ....... ZZZ ....... m~k ............. ~... lot Uo ........ ~.:..~. ~uildlno ~ ,.....~.~ / ~i~g Ir~tor Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ..... ././~. ~.. ................... , 19.~.. ~proved ....... ~X .................. . 19~... Permit No.X~.~Z~. .......... Disappro~e~_g~u ..... ~.~ ..................... ~ ................................................... AP~R~D AS nmEq / ~/~/~-- ~~ "~~'B:R'.'~~ ................................... ~...~ ........ NOTIFY ~U~*N60EPA~~~~ ~~ 766-~80~ ~ AU ~ ~ PU ~-"'~' ...... [~'"d)'~;~;~;i~di;~ p ................................. FOLLOWING INSPECTIONS: I. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. Application No ................................. ALL ONSTR CTION SHAL MEET '~'IE '~l~/~l~l'~ r~,st.~ c~f~. letely filled in by Wpewriter or in ink and submitted in tripl cate to the Building I~f~C~'~~l~n~te plot plan to ~ale. Fee according to schedule. ~ ~-~z~-~_~,_ _ . -- __ __--- __ .. _ _~D~°t ~ s~-~n ~t and of buildings on premises, relationship to adjoining premises or public streets ~'~l~°~~'~i~a~c~[i~'~[~r~~r~"g~-~i-~' ~'~h~ ~ --~,. ,,,~.,~, ~ ~,,,,,,~,,~=~=,~ ~-~uu.~u~Du.a,ng ~t.°f th,s apphcat,on. d. Upo~~T~lication, the Building Inspector will issue o Building Permit to the applicant. Such' permit ?ha I b~kept on the premises available for nspection throughout the work )A ' ' e. ' ~b'~ sha~'~~used in who e or in part for any purpose whatever until a Ce~ificate of Occupancy sh~ve~ee~rantq~y the Buildin[ Inspector. NOTIFY BUILDING OEPARTMENT AT ~I~E~ ~l~ the Building Department for the issuance of a Building Permit pursuant to the Bui~(~R~O~,~the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~l~~ con~of~ldings, additions or alterations, or for removal or demolition, as herein described. The b~~d~ly with ~11 applicable IQws, ordinances, bui d ng code, housing code, and regulations, and to ad,it ~~ ~s and i. bu IdJngs for n~essa~ inspections.~ BE CO~,PLETE FOR C O ........ ~'*'y ..... ~ .......~""~ ................................................ ALL CONSTRUCTION ~H~LL MEET (Signature ~ opplicont, or ndme, i~ o corporation) STATE CONSTRUCTION & ENERGY ~ CODES. NOT RESPONSIBLE FOR (Address of applicant) DESIGN OR CONSTRUCTION ERRORS State whether ~pplicont is owner, lessee, agent, ~rchitect, engineer, general contractor, electrician, plumber or builder. ....... ~ ............... . ................................ Name of owner of premises ~ ~ ./ ~e-~ ~ If applicant is a corporate, signature of duly authorized officer~/Jl -~-~ ~, (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 work will be done. Mop No.: ........................................ o r~o..~...~.~ ............ Street and Number ...~..A~......~.4./..~..Z~d...~.,~....,...~:.~.~.e~...~..~.~ ............................... ; ..................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~.~..W..~ b. Intended use and occupancy ....~././k).~.~..........-~..'ecgt...~7.....,~.e4~.. ......... . ........... + 10. 11. 12. 13. 14. Locate clearly and distinctl property lines. Give street and whether interior or corner lot. ,t ' Nature of work (check which applicable): New Building.. ................. Addition ...... i....~.~ ..... Alteration ................ Repair .................. Remavql Demolition .................... Other Work (Description) -e ... ............. i: ................... Estimated Cost ................... ; ......................................... r e ............................................. ! (to be paid on filing this application) If dwelling, number of dwe!iing units ............................ Number of dwelling units on each floor ........................... If garage, number of cars '"i ......................................................................................................................................... If business, commercial or~ mixed occupancy, specify nature and extent of each type of use ........................... I Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ ~ Number of Stories {]:~(~ Dimensions of same structure with alterations or additions: Front ......... ~,-.~:~.'~r;r~..~.:~.V Reor*~/..:z.Y;.../.' ............. Depth ................................ IHeight ............................ Number of Stories .~. ~. ~>-- Dimensions of entire new c. nstruction: Front ............................ Rear~,,...~.. ,,~,,..~....~ · D~pth ;:,..,.' ................ Height Number of Stories .......................... Size of lot: Front .............. 4 ......................................... Rear ....................... ..?:Depth ~.,., ............................ ~.~ ...... L.A .......... ~'"'t"~ ...................... Date of Purchase ............... ' ......................................... Name of Former O~e? Zone or use district in whic~ premises are situated .................................... , .......... ; .................................................... Does proposed construction ~iolate any zoning law, ordinance or regulation: ....... ~ ........................ : ................. Will lot be regraded ........ ~ ............... Will excess fill be removed from ~r6mises'; ( ) Yes ( )'No Name of Owner of premises ..~.~.~.~.~.~kddress Z~Z~.~.,-Phone No.Z~. .... Name of Archffect .......... ~ ............................................... Address ......... ~ ...................... Phone No.~...~..~.~.. Na me of Contractor . ~. ~ ~ ~ ............... Address ~.....~ne No. ~.~. PLOT DIAGRAM ~il buildings, whether existing or proposed, and indicate all set-~ck dimensions fron lock number or description according to deed, and show street names and indicat, 00':~ ~ ~ ~,,00, 91 ol~ 'N o ~ . ~ ~;,~///~1~ ,0Q ~E ~. '3,,,00,9101~ 'S / STATE OF NEW YORK, ii ¢ c COUN-Y OF ............................... iV ...... ] ...... be ng duly sworn, deposes and says that he is the applicar (Name of ~nd v dual s~gn ng contract) above named. Fie is the · , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fil this application; that all statements contained in this application are true to the best of his knowledge and belief; an that the work will be performed in! the manner set forth in the application filed therewit~ Sworn to before me this [ / ...... ~ ......' ....... ' ................ "'"' ....................... ," / (~ignature of applicant) HELEN IL DE VOE J~I*ARY PUBLIC, Sbte of . ~ 4707878, su~k tC~u~ nty~//