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Home My WebLink About18165-z Foaat xo. s 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 8 6 5 Z Date 19~y Permission is hereby gran ed to: of premises located at ...lo..G..~.~~..~......~-~i.........tE 'a...a-~,,E;...~:`~.7 Caunty Tox Map No. 1000 Section Block .........tQ........ Lot Na......,rG.Z..-`.... pursuant to application dated 19........, and approved by the Building Inspector. Fee k'2 Buil g Inspector Rev. 6/30/80 C\~ l ,i ~ et P , . ' OQ \c ~ - - ~ - ~ - - ~ - - 1 ~0 Off, - O~ c 0eJ\ aD~ 'l`'~~ 3~~ ~ o^ FO% F 'o,, y ~ ~i~p ' Fuo ti `~FO ~Lo ~L ss . ~O^ o •y^ a ••s"a ~u s, ; .G r. ,si r"~ ~O. 3 i u ~ J~ I 1 M I ~O 4' ~SO00 c ~~bop ~l4~OD02O AO" ~ 0 Cd s ~ 5a y P AP VEQ AS NbTEO ~:~h° ~ DATE: ~ ~ B.R N /t~~ NOTI s~DEPA 'ENT 7 O ~~G 786-1802 8 AM TO 4 FOR TF1Pi p,02 G~ FOLLOWING INSPECTIONS: aC~° QV . 7.- FOUNDATION - TiNO REQUIRED _ _ _ FOR POURED CONCRETE 2. ROUGH • FRAMINfs • PLUMBWG 3. INSUlAT10N 4. FINAL CONSTRUCTION MUST SURVEY FOR - BECOMPLETEFORC.O, FLORENCE FITZPATRICK AIL. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. 5TATE CONSTRUCTION & ENERGY TOWN OF SOUTHOLD Ce~F$, NOT RESWONSIBL`E FOR SUFF. CO.., N.Y. , GUARANTEED T0: DDS /GY6If1R %ONS7RUCTION ERRORS i $OUTHOID SAVINGS BANK SCALES I 4O SECURITY TITLE A GUAgANTY CO. - MAY 26, 1964 NOTE MONUMENT PROi~~ ENGI ER AND LAND SURVEYOR, N.Y.S. LIC. N0. I2845 RIVERNEAD, N. Y. BOARD OF HEALTH . 3 SETS OF. PL.INS•:::::::::::: FORMN0.1 SURVEY TOWN OF SOUTHOLD CHECK MAY 2 6198.9 BUILDING DEPARTMENT SEPTIC roRrf . TOWN HALL .t3L'uG, DFf'7~~ SOUTHDLD, N.Y. 11971 NOTIFY 7ny~INOFSOttu;C~L.L7 ~ TEL.:765~1802 CALL ,.._..._..a . Examined ..1~.~`.~........ , 19~ y MAIL T0: Approved ..~0~ 1~. Permit No..~d"~.lo..s~ ~ ~0~"° Disapproved a/c ..............................i%~• • • • • %v~~ . wild' d Inspector) APPLICATION FOR BUILDING PERMIT Date 15.. . INSTRUCTIONS a. Tltis 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 York, and other applicable Laws, Ordinances or Regulations, 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporatron) ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~j~ Name of owner of premises .~~?~~vC~ ! ~ "g (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. .,C2lN.!v F2r Plumber's License No . . Electrician's License No . . Otfter Trade's License No . . 1. Location of land n wi~ich proposed work w' be done. , , , , House Number Street ~ ~ Hamlet County Tax Map No. 1000 Section ~ Block , , , , , , , , , , Lot Subdivision Filed T<tap No. Lot . (Name) State existing use and occupancy of premises and i/ntended use and occupancy of proposed construction: a. Existing use and occupancy .y ,GUSiC t-+`~'(, 6 . b. Intended use and occupancy .........................................:...:f....~1~~~~. ~ i ( 3 Ref air of work checl. which,) applicable): New Building P • • • • • • • • • . Addition .Utcratio . Removal Demolition Other Nofk . iwC-~, , , , , ~ ~`i (Description) 4. Estimated Cost , T ~~S. Fee 5. If dwelling, number of dwelling units , (to be paid on fling this application) j • • • Number of dwelling units on each floor , _ If garage, number of cars , 6. If business, commercial or mired occupancy, specify nature and extent of each type of use , , , 7. Dimensions of existing structures, if any: Front . ,Rcar ~ • ' ' ' ' ' Hcigltt Number of Stories . Depth . Dimensions of same structure (with alterations or additions: Front • • • • • • ' ' ' ' ' ' Depth I . IIcight . Rcar . 8. Dimensions of entire new construction: Front , ~ • • ~ ' ' ' ' ' • • • • Number of Stories . Height Number of Stories Rear Depth . 9. Sizeaflot: Front .........1......... Rcar I,` 10. Date of Purchase ~ • ' ' ' ' ' ' ' ' • ' • • • • • • • • • • • • • Depth p"••••••••••••••..,NameofFormcrOwner r ' 1 I . Zone or use district in which remises are situated , , , , , , , , • • • • • ' ' ' ' ' ' ' ' ' ' ' ' ' ' 12. Does proposed construction viblate any zoning law, ordinance or regulation; ° p ' ' ' ' ' ' ' • • • • • • • • • • • • • Nill excess fill be removed from premises: Yes No ' 14. Name of Otvner of remises . j Nnmeoof Archit c d I ..................Address ...................Phone No............... . Name of Contractor . ' ' ' ' ' ' ' ' ' ' • • • Address ...................Phone No.............. . S.Is y is ro err loc•...•••.••„""'•.Address .......PhoneNo. I P P y ~ted within X00 feet of a tidal wetland) * • *If es Southold Towin Trustees Permit may be required. YES,.,,NO.... ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc!( number or description according to deed, and show street names and indicate whether interior or corner lot. I • I'~ I STATE O F ; 'E1V YORK, COUNTY $.S ~C`~~ • bein duI st (1\amc of individua tg I,yg contract) g Y vom, deposes and says that ha is the apphcant above named, i [Ie is the ~ ~ • ....~.......r (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is dulylautitorized to perform or have performed the said work and to make and file this ~Pplication; that all statements contained in this application are true to the best of iris knowledge and belief; and that the work will be performed in the manner ~ct forth in [hc application filed therewith. ~wotn to before me this ..........oZ/. ....day of.,...~a'~~......... \ ~~p~ ~ n ~ 19 rotary Public, , .~Y~!. , • • • • • , , , • County NEIEN K DE VOE I ~ • . N6TAkY PUBLIC, Stete of New York No. 4707678,SuNotkCou~y~~ ( ~ atureofapplicant) Tarm Expires htxruh 38,19.,~G