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Home My WebLink About18540-z mse: xa s TOWN OF SOUTHOLD iU1LDiNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 18540 Z Date ....~'.a:~ .9~y. Permission is hereby g nted to: at premises located at ....r~..~~.~`~.....Gd(~~...~5?~!7.`.'~..~~~..~ . ~ L~!!1 ~C 1.C,..................................................................................... . County Tox Map No 1000 Section ....1~.7.... .Block Lot No..../..e~....... . pursuant to application dated ........91.?r.~- 19.~~.., and approved by the Buildingof Inspector. Fee S..e^•`~... `:1~.~ / 8 i~p Inspec r Rev 6/30/80 J HOARO OF HEALTH 3 SETS OF PLANS M O.t SURVEY TOWN OFSOUTHOLD CHECK , '/~UILDING DEPARTMENT SEPTIC FORA / TOWN HALL ~T ,SOUTHOLD, N.Y. 11971 NOCII'Y - .4~,•~ j p O TEL.. 765.1802 7` AIL T0: Examined ..9. a3 19 ~(~y / l/' /~3 Approved 9f ~ , 19 0!. Permit No. 1~,~".~~.~. Disapprovedaic $EP ~ 2 DEPT • • • • y • • •Av2~~ SOUTHOLD uildm^ nspector) • I APPLICATION F R BUILDING PERMIT Date 19 . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, 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 stree or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app t cation. c. The work covered by this application may not be commenced before issuance of Building Permrt. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pew 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 Occugan~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY b1ADE to the Building Depaztment for the issuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the coLi~t~t~~r>!~~e~iAigs, additions or alterations, or for removal or demolitron, as herein descnbe The applicant agrees tbb}t p y a applicable laws, ordinances, budding code, housing code, and regulations, and admit authonzed inspectors grnggelp~sesand xi i~Ple uig for necessa~~ ir/y/~p cti n . ~c-~ v~ j3Z . ign tore f pphc or na if orporatron) a ^r.' °'a $ fOFi 6~. ~ fir'' ` F • r iO~ J,,~ -ECOGt~~'i... 1 ~ J~)~i~'J, ~ " (Mmhng address of applicant) 3T?fl '~:•t, , ja4 h"f4 rot) a State whether a~rlicant fs dwner~~Ies~eielT a`gentha~chitect, engineer, general contractor, electnaan, plumber or builde ,y a + ! h n ~ / Name of owner d~tehiises =~'I~i t.q~ ~,•,Oi 1ft"''NC~'J ~*tl ~ (as on the tai olI or latest eed) ~ r~1 If a p is a c r 1ratyisiC o I^y d'u~fidrized officer. ~t11~7t rC.1 yn 1T' ' ~ ! . (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No C~ ~4.~il.C~:... . Plumber's License No . . ElecIrician's License No . Other Trade's License No . I. Location of land on which proposed work will be done . . .3A.3,~~......~.~~(~T..~~.4aN~.~.,.~. .~L~~. LP~tu2~,L House Number n Street ~ Hamlet County Tax Map No 1000 Section ~ ` Block Lot . • , , , , , • • • , • • , Subdivision Filed \1ap No Lot.............., fNainc) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,~L`!1!':'~ ..........................M~B.J ~IAyK,;3............... . i?e+!'sreA4 4g a ,7NAf4 Y~MnM b. Intended use and occupancy • ~ ~ 3. Nature of work (check which applicable) New Building Addition Alteration . Repair Removal Demolition Other 1York +~-4~?-; , escnplion) 4. Estimated Cost G G U Fee ~ (to be paid on filing this application) 5. If dtvelting, number of dwelling units Number of dwelling units on each floor . If garage. number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of ex ~,y res, if any Front . Rear Depth . . niberofStones c i with alterations or additions• Front Rear . ....Height Number of Stones . 8. nsi~~ o~e~tire new traction Front Rear Depth . ei~ t N tuber of Stones . 9. Size bf lot: F Rear De th ~ . ~3.• p 10. Date of Purchase? ....Name of Former Owner . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation' . 13. Will lot be regraded Hill excess fill be removed from premises• Yes Nc 14. Name of Owner of premises ..Address ...................Phone No.............. . Name of Architect ...........Address ...................Phone No.............. . Iv'ame of Contractor ..........................Address ...................Phone No . 15. Is this property located within 300 feet of a tidal wetland? *Yes 230 *If yes, Southold Town Trustees Permit may be rey aired. PLOfi DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dunensions from property hues. Give street and block number or descnption according to deed, and show street names and indicate whether :ntenor or corner lot. v ~s ~nnr~ n~ DATE: ~,p ~ D NOTIFY $ G OEPARTM q 765-580 $ AM TO d PM FOR THr~ FOLL0IMNG INSPECTIONS 7. FOUNDATION TWO REQUIRE FOR POURED CONCRETE 2. ROUGN -FRAMING dr PLUMBINf S. INSULATION" 4. FINAL - CONSTRUCTION MUD' BE COMPLETE FOR C O. ALL CONSTRUCTION >$fiALl MEN THE REQUIREMENTS OF TFIE tiY. 3TATf CON37Rl1CT'fON 11 ENERIjY CODES. NOT RESPONSIBi~ FOR DESIGN OR CONSTRUCTION ERRa1S ~TATE• OF NEW YORK, S S 'OL\T F ~Q ~ T 14.. ~.~~.5 being duly sworn, deposes and says that he is the applicant (:~amc of mdn'idual signing cdntract) oovc naincd. le is the (Contracto agen corporate officer, etc ) f said owner or owner, and is duly authonzed to perform or have performed the said work and to make and file this pplication: that all statements contained ui this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith worn to before me this - day o 19 otary Public, , .County ~ .67~~ ~yry ~~~Nxk~ (S nature of applicant) pp~m l~ilru Dii.'emba~& tg: