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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 5 4 ~ Z Date 19.9
Permission is hereby grant to: ,~.p
~ ~
to ~
at premises located at .~,r..~~~ ~.....~~~....2'1.....~`li
.....................................L.c~i~.~
County Tax Map No. 1000 Section .....,C.~ Block ...........(?........Lot No .........1.7f.(
pursuant to application dated 19.Y,l...., and approved by the
Building Inspector.
D®
Fee $~!.~,i.......jL'^p
.....~.(1r r.G ..~.i~'
~eL~
Bu ng Inspector
Rev. 6/30/80
_ ~
iBOAR? OF HEALTH
3 SETS OF PLANS
FORM [V0.1 SURVEY
TOWN OF SOUTHOLD ChECK ~..~.~.7~ J .C~DiPO?..... .
BUILDING DEPARTMENT SEPTIC £ORPI
' TOWN HALL
SOUTFiOLD, N Y 11B71 NOTIFY
TEL..765-1802 CALL
Exatnined.~.°~ ........,19ay p
Approved 4/~ . . 19~~ Permit No. rrt• 3 •
JUL 2 g ~,ggg
Disapprov .
11 D'AS tNtED• " .
..flMTE:..9 ~P. * ~l~.J yLg SLOG DEPT
+..,.........r~..... TOWN OF SOllTHOLD
0
NOTIFY ~ INti DE~
78b-1802 8 AM lb ~ PM FOR TN[ (Bu ing Inspector)
fOLLOWiNG 4NSPEC7fON5. APPLICATION FOR BUILDING PERMIT
1. FOUNDATION - TWO REQUIRED - a ~ -
fOR POURED CONCRETE Date . - - 15 r
2 ROUGH -FRAMING & PLUMBING
3 INSULATION INSTRUCTIONS
4 FINAL - 'CONSTRUCTION MUST
a.86ii1dl~pFi~I;tCtiQRifrt{~t be c~o~~~m~~pph~etely filled in by typewnter or 1n ink and submitted to the Building Inspector, wrti
set~pifi~S~B~~#ot~ki994-koaSFh#d. Fee according to schedule
'11y{E p~1O~1H~i,,q~Q~Ca
cTNF1~ b~'Yot and of buildui~s on premises, relationship to ad}omm~ premises or public stre•
or ?t~9~~a>~~i
$~~QtyNSi1CQS ~~~`LY_`on of layout of property must be drawn an the diagram which is part of tlus~il
catiG{daES Vtt
IC1S ation may not be commenced before issuance of Building Permit.
d.D~lT~i^BtAl~nlynhrafinn the Building Inspector will issued a Building Permit to the applicant. Such peri;
shall ept on the pre s available for inspection throughout the work
e.~ u O ~ o sed m whole or m part for any purpose whatever until a Certificate of Occupan
shall hAgg-tlgOpggl~tMi~y jltiP~ju~Ri~~specior.
sA o the BuIIding Department for the issuance of a Building Permit pursuant to t
Buildi~, Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulggqqqqti ~ Q('_bgildings, additions or alterations, or for removal ar dcmohhon, as herein descnbe
The a ~ ~ 1 ~++9~jj~'~apphcabZe laws, ordinances, building code, housing code, and regulations, and
admit ~NlQ~'~t1~~1N
N~IIs$~d in building for neceCSSary inspections.
BE COMPLETE FOR C.O J¢ cv r r,-''~~ii,, nc~ SKI-; e~ni~ .
ALL CONSTRUCTION SHALL MEET (Sigrlat~Jre of apphcanNor name, if a corporation)
THE REQUIREMENTS OF THE N.Y ~ t
STATE CONSTRUCi7ON i ENERGY ~o.~?.'P.-?~~... ~s~C~R1~.~~.1.1,9:7f
CODES. NOT RESPONSIBLE FOR (itlaAmg address of applicant)
DESIGN OR CONSTRUCTION ERRORS
State whether applica(n~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
II.. ,i, '
.
Name of owner of premises ......w.t I ~ !.~.m...~~n'».~T .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(A'ame and title of corporate officer)
Builder's License No. ~ ~+....I. rte. a 9.) . H Z •
Plumber's License No . . .
Electrician's License No . .
OI}ier Trade's License No . .
1. Location of sand on which proposed work will be dote .
ii
~ ~ u , n ~ cl , ir"C u~^. a.S>,~ 2..~..... .
flouseNumber Street. Hamlet J
County Tai Atop No ] 000 Section ....I •p• ~ • • • • Block . , , _ , , , Lot .
Subdivision Filed ntap No Lot .
.........(Name)
State evisUn; use and accupuncy of promise1es and intent1ded use and occupandy of proposed construction
a. Existing use and occupancy Q ~an.l~e.h+.~l.co•~~Y' .~.r.d..r,.i~~-.S,I~ p..pTSa.pP.r:y'
b. Intended use and occupancy~~m.~.e.~tr..c.,oa1e.{'-. a.,^~ ~r'•i,c~(~"'-+:.5.1.~?+-?iT~• G1tii•G1U.vn~,
3. Nature of work (check ~shtch apphcable)• h'ew Uuddmg . , Addittcn • .Utera~n , ,
Repatr Removal . Demolrtron . , Other 1Vork r.~.e~~.
(Dcscnptto
4. Esttmated Cost ~~,0 ,O a . . . Fee a ~ ; V 6. .
(to be paid on 11mg thu apphcauon)
5. If du•eihng, number of dweihng untts Number of dweihng units on each floor , .
If garage,numbcrofcars
6. If business, commercial or mt~ed occupancy, spectfy nature and extent of each type of use .
7. Dtmenstons of extsttng structures, tf any Front .Rear Depth , , , , , , , , ,
Her_ht ...............NumbcrofStoncs....
Dtmens~orycRgf same structure wtth alteratrons or addrttons• Front ,.,..,.~I~~a~~~ i~~, , , , , , , .
Depth HetgYtt ....Number of Stones . . , , . .
Dimensions of enttrc new construction. Front Rear .......=.->f~ 1~.`~ depth=:; , , ,
Hercht Number of Stones A
9. Size of lot Front Rear n Depth ~ ."s.... ? 1! " •
10, Date of Purchase ......................Name of Former Owner ~ . ~ .
11. Zone or use district to ~vhtclt premises are situated .
12. Does proposed construction vtoIate any zoning law, ordinance or regulaGan ~ °:fJ
13. 1Vdi lot be regraded . .will excess 111 be rgtrtpve¢ frprr~ premtses: Yes
14. Name of Owner of premtses 1~!? ~''~.!7:1; .......Address ~?.a, r. !-~.~sr:'~Li.:'. Phone No .
Frame of Architect . , Address Phone No .
Name of Contractor=.cv ~.~r~~ ~e.ns~., S yy~ar:emS . Addressfja 5.5.5. ~.bast~:,s~~.. Phone No "~f~Sr.a,oCtt,S
iS.Is this property lo'tfated wiCHin~00 feet ofta tidal. wetland? *YES.._.NO~S..
*If yes, Southold Town Trustees Permit may be required,
PLOT DIAGRAhI
Locate clearly and distinctly all buddmgs, whether exuttng or proposed, and.~itldica>`~ a1I set-back dimensions fr
property lines. Give street and block number or descnptton according to deed, and show street names and indicate whet
inten'ojr' or corner lot.
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STAT[ OF NE\V YORE, S.S
COUNTY OF .
• being duly sworn, deposes and says that he is the applte:
(Name of mdn'tdual signing contract)
above named.
fietstltc
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the smd wort. and to make and rile t
apphcanon, that all statements contained m taus appitcquon arc true to the best of lus l.nowledge and belief; and that
work will be pertorttted to the manner set forth m the apphcauon fled therewith.
Sworn to before me ilia q
day~o/f 19 .~l•
Notary Public, , , ~ .7~ ~.J.~Y~-.. , . County ,
HELENKDEYDE (Signature of apphca
lkDTARY iR18UC State of New Yak
No, d707878~ Suffolk Courrfy
trap Fxpres Mcrch 30, ly