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Home My WebLink About18145-z >POiiras xa ~ TOWN OP 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 ° ~ ~ 14 ~ Z Date ..:~/`-~..1, 19. Permission is hereby gra ted to• ~.3.~..~. ~ ~ f... t0 ' ~ ...~~g~4.~i.______7""""...... .......Q~" ..d-.~.C.lr~Fi ................0.......................... ~J'~....... at premises locoted at ..~...~'~..~.~.....~~1~e~""$%""'......... y ~y t~ Caunty Tox Map No. 1000 Section ......../...G~.......... Block Lot No.......1 pursuant to application dated ......~~g 19..~, and opproved by the Building Inspector. ao Fee $...~."~lj.~~5~ 9 Buil for Rev. 6/30/80 4 i. _ v i {r',~C~ ~~'~,If~.~,, BOAaD OF HE~ILTH ~~,~.1\~ i,~i=~ 1~ 3 SETS OF PL,1NS ~.~s~.'x.<~` E ~ ~ ~ FORM NO. 1 SURVEY . X11 ~ 9~ ti j) TOWN OF SOUTHOLD CHECK . !II BUILDING DEPARTMENT SEPTIC r•oart gk -._-.....a.,,,,,,,,,~d TOWN H A L L f3LC7G.0E3'T. SOUTHOLD, N. Y. 11~J71 NOTIFY TOWN OF SOU7HOLt7 • .'~:."'"'"m""'"~.~.~..°w.-~..~~.».~ TEL.:765~1802 CALL Examined 19 MAIL T0: ~~~FJ ~o, /j /iYY~~-T r,~I~~l. G - ~~vTf/mLb _ Approved . d........, 19 Permit No. ~`5 Disapproved a/c ildin~spector) APPLICATION FODUR BUILDING PERMIT ~~i Date 0:~" • . ~ 15 INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 part 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 Building 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 Southold, Suffolk County, New Yark, and other appIicab]e Laws, Ordinances or Reculations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildin code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp ions. (Signature/ oi' applicant, or n me, if a corporation) ..10,~'60../~Den,~/;~zYve~~/t?4. ;(~~~r,1r~~a l/~j'_~/ ' (Mailing address of applicant) Stat~~e77whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. l/6?.?G~/Z- . s Name of owner of premises ~~:°~a.nrz~}~ v ~/~o~; r-~~.~s.~.~ „l2q (as on the tax roll or latest deed) _ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .>!.'''t.~!~`~ Plumber's License No . Electrician's License No . . Outer Trade's License No . . I, Location of land on which proposed work will be done. . /y3/oO~,er/r,l~ayd<G°~'A'7.a.l:m~: o~i~c~~s~ny~ ~orrrh~~a House Number Street...... ..............Hantlct „ , , County Tax Map No. 1000 $eCCIOn ~ ~ BI'ock Lot . Subdivision Filed t,tap No. Lot . (Nance) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy I azure of work check which r P , • • • Re applicable): New Iluilding , Addition ~Uteration . Re air moval Demolition ...........:a_.;;,)tGr'(W. ~`tk 4. EstimatcdCost~~B~ (Description). ^ ' ' .Fee . Qo be paid on filing this application) ^ • • . ~S units . . Number of dwelling units on each floor............... If ara_c.numbcrofcars { 6. If businless, co nmer oaldor mixed occupancy, specify nature and extent of each • • ~ ~ • • ~ • 7. Dimensions of cxisUng structu~cs, if any: Front , type of use . . Height Rear Depth...... ...........NumberofStorics. Dimensions of same structure with alterations or additions: Front • ~ • • ~ ~ ' ' ' ' ' Depth...... ' .Height. Rear.................. 8. Dimensions of entire new construction: Front , ' ' ' ' ' ' • • • • Number of Stories . . Hcigitt , Nu~~nbcr of Stories ' • • • Rear Depth , , , , , , , , 9. Size of lot: Fronta2a-~F.~,!¢ .olac'',~!+:. ~`~.,~a/ gear 6.9, a e7 ~ . . ...................~~f/.e . 10. pate of Purchase Depth "f~'~~'~I••••••••••••••.....NameofFormcrOwner?,;~?• SP e~.a?s • l 1. Zone or use district in which premises are situated ~ • • ~ • ' ~ ~ ' ' ' ' ' ' ' ' ' ' 2. oes proposed construction violate any zoning law, ordinance or regulation: ~-n • ~ ~ • ~ • l3. Nill lot be regraded , , , , ,Will excess till be removed from premises: Yes No ame of Owner of premises .C Name of Architect , , , ~..otr/lAVS1N ~ oho (~av~iar. Address 6...:...... , ~o Phone No.'7,6s;=.~fs~!F . Name of Contractor ,?vw / ~ c~~ ' ' ~ • ' ' ' ' • • Address . .................Phone No. , , , , , d. ,f; , X. .....Address . (jP 29."? . .Phone No.G,rr,'G, 3/', 7: IS.Is this property located with in 300 feet of a tidal wetland? *YES....N01•::. *If yes, Southold Tows Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alj buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block',number or description according to deed, and show street names and indicate whether interior or corner lot. NoQrt/~~~ ~~>'r.~w2,a. - I - 1 i d ! q En~~ G~Gv Z / t r_ V r- / ~ ~ r 0 e ~ Aaa ~ ~ ~~;l/",Vid ~/,yC ~ 6p /oo j _ , STATE OF NE1V YORK, I S, COUNTY OF 'S ...........i (1\amc oC individual si nin ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant g g contract) about named. lie is the (Contractor, agent, corporate officer, etc.) ~ • • • • • • • ' ~f said owner or otvncrs, and is duly lauthorizcd to perform or have performed the said work and to make and file this -pplication: that all statements contai~jcd in this application are true to the best of his knowledge and belief; and that the ,vork will be performed in the manner set forth in the application filed therewith. ~wom to before me this _ •...........~.9.. .day off/.~.~~...........,19 rotary Public, ZC U(/e'~.... County _ HELEN K. DE of New YorN ' ' Term Fx~ues Mar~3~0E a~ No.47fA87t9,SuHolktlouniy (Si;nature of applicant) D 0,19 ~ -