The URL can be used to link to this page

Home My WebLink About17177-z F08M NO. A 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~ ~17~7~ Z Dote 19.~~ Permission is hereby granted to: II n~ P?YL/ru K ll' I.XJI,o~,~Ln,~ ~93.i::~S.~a." ~ ~ u 1l-..54./-, o ~7-.s.-,1 c.~.~,0, o~..o ~~p~ ~ ~ to r ...~:.~.s.a ~ ~ 8S'... 5........5~.~.~.....`.~: ...................~'~..~:?~st::~..................... of premises located at . . . . . . . . . . . . . . . II... . . . . . . . . . . . . . . . Caunty Tox Map No. 1000 Section .....b.'t./......... Block Lot No....~..~ pursuant to application dated ...........~..~,.fl.Y.6R....~~..~ 19.b. g.., and approved by the Building Inspector. Fee $ °~1/..... Building Inspector Rev. 6/30/80 x C' /i2 ' ~ ~ G z ~ ~ ~ y~ N ~ ~ z~ D ~ f ~ a r r h~ /37.ae _ O W duo ~)z NCfi ? ~ ~ ~ \ p ~Tt Z w ~ -~-8~+' ~xv K z? Z p p C7 'a n - - - W~oO POST T n1 ~ ~j2.4~.woaa fEUCS A y -f- i". i-- ' GAG~~y A4DN Ova 2m N ~ D m ~~sy YQ4 ~ N i ~ Z C D Z IV' _ ' ~'O Z' „i G) co ~ ~ 'v 'nmb2D0 I .'O ~O ACZC/f7s2 op m OU~i rmi0~ o ~NnC 'n~~Q p y~< 'a to A tmm zro» ~ c ~ t11 tlMf~D~1 ~ym~'~~~~ ti-~ N 70 Z~~ z C R Om~ ~J,. ® , r'U v ~ ~~~xm y Z m ~ J w a : x r W; o,i;Pl~! ` 16h l , ,R ~ , y~ tµ n a ;i..+r. ti ~ ~,,~r. I ~ ~ ~ 11.. ~ ~ rrl, ` ~ ` .~J ` .t t ~ ~ \ ~ h 4 ~ ~ , n l ~ R ~p ~ 0 1 ~ Q X11 ~ ~ C ~ « - ~ o~ , 1 . ~ , ~3 .S'pN~i c"% ?/~~I,N ~'CS fGJri/'d/7~ ~t ` • ~ ~ ~ l ~ `I ~ ~ v ~ ~ ~ ~ ~ ~ y 1) ~ ~ ~ ~ ~ ~ t~ I+l •y• ~ 1'. BOARD OF HEALTH ' ~ ~ ~ 3 SETS OF PLANS /Y.......... FORM NO. 1 SURVEY / ? . TOWN OF SOUTHOLD CHECK .J:~.`~1~ . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.:'.765-1802 CALL MAIL T0: ON~tK tii /7~'Ak'Si Examined ,~~~JJ~.t!1'IR• .1~..., 19 ~•g f~,C~S`Ll~N,ti'$'w APProved y, 19g~. Permit No. ~.7 .fir. ~ %2-~i'.S L ~U/3~7' sT / Foes?-n:~e,!,14.i~._IU..Y„ /13S7S' } i~.4 r .9~,.,I~~ r g _ ~ ~,i~ f ~ - Disapproved a/c ~I ; . 1C Ii ~uN 2 a i~aa (Building Inspector) BLDG 06I,.t APPLICATION FOR BUILDING PrRMIT T//OWN OF SUUTHOLD Date .V. UN. ~ ~ 15 °~ct ~ 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 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 ins ns. (Signature of applicant, or name, a corporanon) f,' 7~-/aJ' L ovt;•~ sr Rns2~s'r /.~/~C-~. ~ /l 37s' (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O. . Name of owner of premises UNN//eA/?IJ!~¢k'i4K,$% ~~SLT~dlY.F1lN••.•...•,•••••,•,,•,_,,•,,,,,,..... (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. . ~ ~ /p wN`t-~• •j`~• Plumber's License No. ....lV. • • • • • • • • Electrician's License No. ...jr~,~. ~ ~n • • Other Trade's License No. • • • • • • • • • • • • - - 1. Location of land on which proposed work will be done . . s~s2 :r...~a .Uw Tr.. ~.7......~~~,~~ .~o,~.T . House Number ~/~,lStreet Hamlet County Tax Map No. 1000 Section • • • • • • • • • Block ~ Lot . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 'S //I/~1 L~ 1~'~ ~Y.. • . ~._~'.~L L 1/Y~ . b. Intended use and occupancy 3. het aii of work (check whiRemPplicable): New BuildingDemolit • ' Addition Alteration , , , , , , . . P 4va1 , . ion Other Work ..l!~i~/.V~~.... . (Description) 4. Eistimated Cost .......Y... I ~/S, UO Fee ~ Z .5',t3o........................ . ~ (to be paid on filing this application) 5. If dwelling, number of dwelling I'iunits Number of dwelling units on each floor . If garage, number of cars ..............i................................................... 7. Dimensions of existing structure occupancy, specify nature and extent of each type of use , , , , , , , , , , 6. If bgusiness, commercial or Nubs, if any: Front , , , , ,Rear .Depth , , . Hei ht ber of Stories . , Depth . , , , , , • • ith alterations or additions: Front Rear . Dimensions of same structure w Height . Number of Stories , . 8. Di ~ensions ~ e tire new consction: Front . Rear Depth . , . .Q Hei ht ......~t........ Nu 'ber of Stories , . 9. Size of lot: Front......... Rear Depth 10. Date of Purchase Name of Former Owner 1 1: 2;one or use district in which pr~rnises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded . ..............Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...I, . . ......Address , .........Phone No............... . Name of Architect . . .Address ...................Phone No............... . Name of Contractor , .....Address . .Phone No..... . 15.IS this property located within 100 feet of a tidal wetland? *YES...,NO.<.. *]:f yes, Southold Towr} Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all'', buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block pumber or description according to deed, and show street names and indicate whether interior or corner lot. c' ' ~ I STATE; OF NF,~y YQRIC, C S.S COUNTY OF..,,,.,o(~...... • ' ' • ' ' ,Q ~ N • :V'~•~'aN• (~N• • • • • • • • being duly sworn, deposes and says that ho is the applicant (Name of individual sigmpg contract) aboYe named. i He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly, authorized to perform or have performed 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 manneriset forth in the application filed therewith. Sworn 1:o beof~ore me this Notary Public , • , , , , , , , , , , , , County CANdICE A. ANELLO NOTARY N BLIC, State of New York , . p. 31.488A$77 . . Quanrlad~ In Naw York eountyg (Signature of applicant) 'Commissloq Expires Feb. 2, 19,,,„,~,