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Home My WebLink About17202-z IPOHffi NO. D 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~ 017202 Z Date ~ t Permission is hereby granted to: 9~~ 4,J.. .~-fem............. ,f30~1' /11.3 /u"'~Jr ~Ga ,r.~G.~.... ..............s to ct premises located of ...../.5.~'..r~`..~.~.... . ,.~f....3f3 ..............................................C""`Z."' County Tax Map No. 1000 Section Block Lot No............~~'. pursuant to application doted 19.51., and approved by the Bu i l di ng~I nsp~ector. Fee $..r~:1...:. ,.~d C~~~ B Ing respect r Rev. 6/30/80 ~i. C~: C~ L1 \ ~ BOARD OF HEALTH . 3 SETS OF PLANS ~ pmt ~ Q~ FORM NO. 7 SURVEY - • • • JU~~ TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC roars . 6LDG. DEt`'i. TOWN HALL TOWN OF SOUTHOLb SOUTHOLD, N.Y. 11971 NOT I FY / - TEL.: 765-1802 CALL ...7~,G(, ; , , , , Examined 19~~ MAIL T0: . Approved 19 ~~Pennit No. ~7~?.O, 2 ~ , Disapproved a/c AP p ~ NOIfO (Bu' ding pector) DATE: ~ s.MN ~ LIGATION FOR BUILDING PERMIT FEE: ~ NOTIFY LO Q DE AT Date 765-1802 8 AM TO 4 fOR THE • • • • 15 . ~ FOLLOWING 1NSPECI'ION6: INSTRUCTIONS i. FOUNDAt10N TWO REQUIRED a. Tlp~q~{'Eompletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 `sets of gla~rallgyapp(pDttat84Ypd81Nt&e according to schedule. b _ b. ~lq{~g~Th(gFying location of lot and of buildings on premises, relationship to adjoining premises or public streets ,or areas4,aR~,gjying atDi8l6tS1P~I1B~'9l]~}~INNSiBf layout of property must be drawn on the diagram which is part of this appli- cation. RE COMPLETE FOR C.O. c. tOONStCRq@•60I)t t$HA¢ipli84~&Tn may not be commenced before issuance of Building Permit. d. nR$QUfREf~tTSs ~fplif~lfioh4•Yhe Building Inspector will issued a Building Permit to the applicant. Such permit ` shall be$~q~ot*%ONpNiaBntifLl~Q}{spection throughout the work. e. ~g1di11~ha~ o~Q~ed in whole or in part for any purpose whatever until a Certificate of Occupancy shall ha~gb0(d®ti>$'@N6"jRli~'D(N!(~il~~ctor. 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, housinti code, and regulations, and to admit authorized inspectors on premises and in building for necessary i ections. (Signa ure of applicant, o ame, if a corporation) (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..............~v~x~\~%~............I . Name of owner of premises c-JS~J.`J~~.`~.!-~~~..~•V,`Z~hQ,~~.,~.•,,,,,,,,,,.•,._•••••.•_•.,••• (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. i, (Name and title of corporate officer) Builder's License No. .Qw.'(.1~ . ' Plumber's License No . . Electrician's License No . . . Other Trade's License No . . 1 1. Location of land on which proposed work will be done. . !-~c`~u..~.'~.f~X' House Number Street Hamlet County Tax Map No. 1000 SeCUO? ~ 1... , . Blpck ..-r'~-, , • , , , , Lot , , , • • • • Subdivision F.ilednlap No. Lot............... (Name) State existing use and occupancy of premises and intended use and occupan__c\\y of proposed construction: a. Existing use and occupancy .:~C • ~ t..°G~.I~.. ~.Ql~l;1 `y• ~1Um~.... • b. Intended use and occupancy ~ • .~'1 • • • •~•l~.. ~_r~, , ure o wor check which Re air Rc ~PPlicable): New pudding , • . Addition r ' P moval py~op • Demolition Other 1V "f Y U ?±i'ts' . 4. Estimated Cost , , , , , , • , • . , . • • • (Description) . Fee (to be paid on filing this application) If arafc, number of cars ¢ um~ ~ ' ' ' ' ' • • Number of dwelling units on each floor . . . . g 6. tf business, co nmerco~a(dor mixed occupancy, specify nature and extent o ~ • ~ ~ • • • ~ ' ' ' ' 7. Dimensrons of exrsUng structu{es, if any: Front , , , f each type of use , , , , , , , , .Height Rear Depth............. • tuber of Stories . . ' ' u Dimensions of same structure with alterations or additions: Front . Depth . Ilcight . Rear 8. Dimensions of entire new construction: Front , ~ ~ • ~ ~ ' ' ' ' ' • • • • Number of Stories . Hcigltt Rear..,............ Depth Number of Stories . 9. Size of lot: Front /.~.~t,f,-'1, Rcar..,/.[J~,f'~•~~~~~~~~~,a 10. Date of Purchase . , • , , , , , , , ,Name of Pormcr Owner one or use district in which r P P emises are situated . , , «..~.,,¦:pJi~~.~ 1(~'~Y1+1'-~` o 12. 1 oes ro osed construction violate any zoning law, ordinance or regulati Ys ' 'pia...... . l3. ~VIli lot be regraded , ,will excess till b •v'7r•~1N• • ~ ' ' ' ' 14. Name of Owner of premisesJta~ , }~w ~ ~ ~ $}'pRt,4~ Y N Name of Architect ~ "1d{'P'" b-,Address Q~?'~-~,p7 ~•,~~r,~ ,,~~,~~A v'~:!?t.t ~+MAddress . Name of Contractor . ' ' ' • • • • • Q pYy)1'han~A,QNs~';,e, , , , • , • ' ' ' ..Address . , , i ~ ~ y 15.T.s this property looted with in~00 feet of a tij)y1~p1~~y~4ykggrgyr~ilCNOI:.~ *:Cf yes, Southold Towh Trustees Permit may be required. .9#?Il, rE~rs,,; PLOT DIAGRAM ~s;lr;vi ~s`srr~~,_:nr -t,~c,"~ Locata clearly and distinctly al buildin s, whether existin or ro ose _ _ " ' 9 ; °•''41 ` • ~ g E P P d, arl¢, i cafe ~ e- property lines. Give street and block'inumber or description according to deed,' ~ ~~~'`'~e~ ~r4aFk ~;tt}er}sions from interiar or corner lot. ~Q}+' ~sr,~ ~l~t~ ~icatC whether J. - , i i ~'h~a9" ' % ~ ~ - ' i I. , t I ,i ~ + STATE OF NEw YORK, S COUN'T'Y OF .S ...........f..... above named(Name of individual si~nirl ' ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant g contract) f Te is the I, i (Contractor, agent, corporate officer, etc.) ~ ~ ~ • ' ~ • ' ' ' of said owner or owners, and is dulyiauthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the work will be performed in dte manner het forth in fife application filed therewith. Swom to before me this ~Q.........day of.l 19 Votary Public, , , , , ~.~,4!.. f~., . i . ~~R-,l/~.. . Cotmty HELEN K DE VOE V ~ • . NOTARYPUBUC,Shtedf wYork Signature of a No. 4707878,SuftolkCouoty ( pplicant) Term Expires Msrch 30, t8,•.,,1L.9