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Home My WebLink About17327-zTOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 0~7327 Z Permission is hereby granted~......~.,,~,.~to: ~...;:F~ -:-_Z~7 ..-~;)~.~ ........... .... ~...:..~c.. ...... z~.,,..:~.)..,./..:/.~.......-~. ~.,z. ~ ........... ...... ,o ....... ................... County Tax Map No. 1000 Section .... .x~,..~...~.. ........ Block ........... ..?.,. ...... Lot No .......~....~... .......... pursuant to application dated ............................................... ..~.../.~.. , 19..~..., and approved by the Building Inspector. Fee $ ~.."~ ~ ~' ' Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~°OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~.~./Z ......... , 19~..~ Approved ..... 19 .~.Permit No /7,-fl 5Z7./ Disapproved a/c ..................................... · ............................................... . .... /(Buil~tfg Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ...~.. ............... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: ll.~l , BLDG. D£PT. low. OF soumokp Date ................... 19... INSTRUCTIONS a. This 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 l~yout 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/'emoval 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 inspectom on premises and in building for necessary, inspections. , e- .... ~ ~ ,< (~ ~'~ ~ i (~" ~ '~ ffchnt, or name, if a corporation) g .... (M ppli · ~ ...... /~ ...... ailing address of a cant) State whether ap~]icaiit is _owner, less~e,ragent; architect, engineer, general contractor, electrician, plumber or builder. .............. ' ....... ~.,~..Z~tt~.~,O~,~ ~io~,.~ r". iC.' ......................................................... Name Of owner oI premises .. , ....................... ') ° : ~"' '~ . ''~ ~ %r . ,' ' ', ~ (as on the tax roll or latest deed) If applicant is a corporation,~ign'atui'e' of dij]y authorized officer. ..... ::~.,.: ........................ (Name ~ntl htle ~f corporate afficer) Builder's License No...5 .~...~.1~....¢~.. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... ~/~./z.. z/~././~./(~-<. }~.~ ............. ././l.cd.¥v .~ . ... , ................... House Number Street Hamlet County Tax Map No. I000 Section . z/~.. Jff.~/~TM ' Bl°ck '/'d:~/] ~. 7/~. '.~- ..... Lot · - .~- ."6 ............ Subdivision ................ (iq'a'~) ................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of'proposed construction: /9, a. Existing use and occupancy ....... ?...r)?~v...._ _~'~ ..... . ............ ........................ b. Intended use and occupancy ..... .x~fw~e .... ./f~ .~ . .-w>.. ..... .............................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work.....~ff<C-~..~. ~- (Description) 4 · ', · Estimated Cost ........ ', · ~ .................. Fee (to be paid on filing this application) 5. If dwelling, 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 existing structures, if any: Front ........ . ....... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensioo~.Of ~e~J~cture with alterations or additions: Front ................. Rear .................. Depth ...; .. P... Y~.J~. ...... i.. Height ...................... Number of Stories ..................... 8. ' ' ' ' ' Front Rear Depth Dimensions of entire new construction ............................................. Height .. ~qun~ber of Stories . . ~' / ..... ,~ ..... Sizeoflot' Front ' /,3 O '& ...... -J~ ................................ 9. . ~,,' . "A",) .... ;;'.L': ...... Rear .... 'LTT?. ............. Depth ..1~2...~.~. ........... 10. Date otrurcnase ~,../.i~.;/.6 ............. Name of Former Owner ~I.A~'.'O./.J... f:-., .~./--~. ....... 11. Zone or use districVin ~h'ich pr~mises are situated.. ~D O. I2./.'/. O.A-,t'~ ................................... 12. Does proposed construction vio[ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded . ./¢..c? .... .............. Will excessfill be removed from premises: . Y~s ~ No" 14. Name of Owner of premises ,';:PO.,~A;t°/'l. ~1.7.49~.gz7. Address'~..~/.~: (.~../f../~-4ff, fP./~.,.. Phone No..~. ~.~..~..~/.0~. Name of Architect ........................... Address .~.~..27//70 £,/;) ..... Phone No ................ Name of Contractor .......................... Address ................... Phone No ............ : .... PLOT DIAGRAM Locate clearly and distinctly alli 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. : AP 'IIO ED AS #01'ED / FOLLOWING INSPE~ONS: I, FOUNDAT~N . ~ R~UIRED FOR POURED CONCfl~ 2. ROUGH. FRAMING & P~MBING 3. /NSU~TION 4. FINAL CONSTRU~ON MUST 8E COMPL~E FOR C.O. ALL CONSTRUC~ON $HALL ME~ THE REOUIREME~ OF THE N.~ STATE CONSTRU~ION *& ENERGY CODES, N~ RESPONSIB~ FOR D~;GN OR CONSTR~C~ON ERRORS STATE OF NEW YORK, COUNTY OF ....... [S.S .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... :i ................................................................... : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul}( authorized to perform or have perfonued the said work and to make and file this application; that all statements contained in this application are true to the'best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this NOTARY PUBLIC, State of New Yo~k . · .... .~. ........... . No.~4707878, Suffolk County ~'. lerm ~pires Marchl$O, 19.--;lg-/ O~ - (Signature of applicant) '¸%, ' "~ ':~ :, ?",~, FI~ED IN tHEOFFICE O~ TH~ C~BK OF ,... , JACKSONS L ", ~, ' ' -," :",' COUNTY ON i~n~_~.,___~. "~~NM , ~,,.,.> , ~.~ ..... .., ~,.' , . .,,,,.,, ,, . . ., ,.,..,,,.. ,' . ~.. .... , ., ~. ~;~,'~,,~ ~,,.~. ~ .~..~:: .-~-'." ..~, .:.:% ,,~. .... .. ~. :....,,,~ ''" ' '. ' .: ::.~ ' ~,~ ~f~/~V~ :"' ~ .;.';:Y-'?2'? dd~ ~ ~.. ¢.¢¢A2tONI , . ' '' ': REVISION5 , '"'""'"'[ ' YOUNG __ YOUNG ' .,., . .... .,. , .. ~ ~ ,, :, JULY IS~ I$ ?5. 400 OSTRANDE ,AVENUE, RIVERHEAD. Nfl YORK ; .... ' '.;" ' ','"'. ' AUG, 21, 1975 .:~,,; .: }..' , · ,, .... { . ,.: ,, . A~.t}ENW. YOUNG .'. . . :; .... ,~URVEY F'OR: , - ,, - '-, , . ' "M~Ett~N ,~,'? .:' ~ ' ~ :' /I . , ' THE ~ ~'' ' ~ "".,,. ' ' .... ' ''"'MX~TTITUE'H - ' "'~" SOUTHO~ O