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Home My WebLink About17752-z_~IELD Ii:s:~~c.lo.~ p uA.E ~ ~osK~curs ~---~ . . .~ ,. ~. i ~ . . 3 ~ H - - y FOUt1DATION (1st) c FOUNDATI0IJ (2nd) _ m ~ 2 . z o L L P OUGH FRAME & , 1 ~ PLUMBING y H 3. ~ IIJSULATIOPI PER N. Y. y STATE ENERGY CODE x > ,_~ ~ r m 4. '~ FIiJAL 4 _ ~ z ADD L COMMENTS: x y ro x • ro . H ~ ~ H H ~ O C 2 ~ ~ M A ~ r y U ~ t t7 ' -me 6 ,~ roast xo. s TOWN OF SOUTHALD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TFiE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o U 1 i' ~P 5 2 Z Date ..~c~-Y,-u: ... ~1 ................. . 9..x.9 Permission is hereby granted to: ....i~: ~:.... ~:........K., s ............. ...... i~~. a...,~ :1P. ~ .............................................. ... . . ... . .. . . ... . .. . ... . .... .. .. .. ..,~ . f( ... ... .... . ... . ... . .. ...... - . y. . }... .... .... .~. . . ~..9 . .. .. ...... . . .. .. .... . . .. .. . ... . . . . .. .... .. .. . . . ...... . ct premises located at ...~.~.:/FU........(~~,.de".'~}.ISST..~-1e4...F.-~9 ..................... ... ... ... ........................................... aJ~:....,....~h~,:..1....~.er.............................................,............. .... . ................................................................................... ....................................................................... P County Tox Map No. 1000 Section .......I ~.I............ Block ........~..~........`.'. lot No.....°... ~.~........... pursuant to application dated ..~.•••••~•~•••••••••••. 19•P.•~•, and oppraved by the building Inspector, Fee $..~.~!.+2: Buil g Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OP HE.ILTH ~........ . 3 SETS OF PL~S ..~:....... SURVEY ........ ............ CHECK ...... Y.~ .............. SEPTIC FORM ................ NOTIFY CALL Examined .. 4^?M~.I.I.., 19 ~~ MA I L \pproved .4'MM~ .1.~. „ 19$~. Permit No.. ~ ~.~.S~.ZL- q Disapproved a/c ................................... ~~ yy-.~~ 1 .......... t (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS T0: -~ ~~,m a ~ C~=.~ ~ ~,~{' tA'i..t ~ tl'~ :, Date ..,~!!~?^"... 1 ......, 15 .~~..( 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 York, and other applicable Laws, Ordinances or Re;ulations, 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, housin; code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti`,oj~~n~~s~.~,~°. (Signat~i~re of applicant,name rporation) ,o fir, k 2~o C~~, ~ L/ (Mailing address of applicant) Y // ~'.3~ State whether applicant is owner, lessee,oagent, architect, engineer, general contractor; electrician, plumber or builder. Name of owner of premises ........... II!~~.".t"::...~:'ei~'! ........ ................................... . (as on he tax 11 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of,Icorporate officer) Builder's License No. ..~!A~~ti~~:~-~. ..... "~ g ~ Plumber's License No.,.{J:VY J ~' . ~:. `.~ • '~'= ..... 1. Electrician's License No. .... 1.~ ~ 5 .LL........ . Other Trade's License No . .................... . 1. LocationQOf land on which proposed work will be done. . J ~ b ... ~... ~............ L..... ......~.'.e%~.... House Number Str~et~ County Tax Map No. 100p0 Secr~tion`~.~.~..~/.(...... , ... . Subdivision . ° ~l~'~ , ~!! ..!'.!rv:act^^.~ ~0;':"•'~ • . '-. State existing use and occupancy of premises and intendcc a. Existing use and occupancy ......... ~"°~~'"~ b. Intended use and occupancy ...........~ ........................................ .••• ~ H~nlet~.~• . Blpck ......11 .......... Lot ..~,/O ~~... . Filed Map No. .. g ~? ~'...... Lot ...~~ f I use and occupancy of proposed construction: 3 Ret air of work check which applicable): New Iluilding ... , "', , , , , Addition . , , ....... Alteration ( ..... .... p ....... , Removal .. . ........... Demolition .. , Other 1Vork .......... , .. . ~ • • • • • • . • , , • (Description) 4. Estimated Cost ......... ~.`~ .%.c7oco ................. . . Fee ......... . ........................... 5. If dwelling number of dwelling (to be paid on Filing this application) .~, g units ..... , ~ ....... Number of dtvcllin units on each floor .. , `, , , , If garage, number of cars ...... • • • • • g ....... business, commercial or mid Height , • 'ed occupancy, specify nature and extent of each type of use ..."', • , , , , , 7. Di mensions of existin stru Nures, if any: Front ......: `:.... , , Rear • • • ~ • • • • ............... Depth . mbcrofStorics ........................................................ Dimensio ~ar~structure with alterations or additions: Front De th ................ Rear.................. 'p ........ ". ... IIeight ........... v... t...... Nuntbcr of)Storics .......... a ...j ...... Nu~truction: Front .... ~'~ .': ~ ... Rear .....~ ~! ` o. ~`.. Depth .St`O ~ •a .y ... . itnjnsions of ent're new consinber o~ Stories .. , .. , ... ~. , .. , , , ,~, , , • , , • • , ............... 9. Size of lot: F ont ^.~....lQ!~..,~g. ~. z .. Rea;2 3. ' g9 b. o .......... Dep h ... 2 ~e . 10. Date of Purchase t~f,cal.,,u!nd,~e,~. • ~ • • • • • .. • ... . • /~~. •n~• ... ~I~?ne of Po cr Ow er ~ t „ 1 1. Zone or use district in which remises are situated .. , , , , , ,~{ , , ' ~' ' ' ' ' ' ' ! 2. Does ro osed construction vi p P plate any zoning law, ordinance or regulation: , !VQ, , . ,Will excess fill b emoved rom premises: Yes 1~ 14. NameooobArchit o fpremises ..'~ ~~„ • Address .{11t~~. ,~, ..~i+ot~.~..phone No.:7,~.z(-jaet.~;Q, . . ' ' ' ~ • • •~~ • ,- Address ~ .Phone No. Name of Contractor ... ~, . ,~,,,~;2.~q-~y, , , • , , , , , Address ~,p~ ~.~ ~/-.SB~f S` ... IS.Is this property located within i! °~'~`'~PhoneNo. *If yes, Southold Town Trustees Permit may bea requir detland? *YES....NO. .. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl4 number or description according to deed, and show street names and indicate whether interior or corner lot. I . zss; a it o ~ t ,~ o rQR tl t° X 5 0 o ffoVS~ ', o I L So o" 9 0 `o `1136,0 p -'~ 70 l~ 0 .~i-~ 1 oio~ III ~-a•r~e. fl t"CL. I% f/ ._ STATE OF NE`V YORK, ~~ 1 COUNTY OF .............. . . . S.S • ~ ~ • ' ' ' ' ' ' ' ' ' • • • • • • .... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. [le is the .................... ... . (Contractor, agent, corporate officer, etc.) ~ ~ • ~ ~ ' ' ' • • ' ' of said owner or owners, and is dull, authorized to p5rform or have performed the said work and to make and file this application; that all statements contained in [Iris application are ~truc to the best of his knowledge and belief; and that the _ work wdJ be performed in The manner;sct fort[[ in the application filed therewith. Sworn to before me this ..............~ ~. , .....day of .II.. ............, lh~,. Notary Public, , , , ,, , ~, AJ.2•,Ud,!!, , , Count Y ~-~[~~,, /~ ~....... TormREzn BL C 3W'nf yew Y~ ..... • • r ~ Y F•e`2~-r . ! :.. ~.... . No.4707A70,SuPIulkCounty k (Signature of applicant)