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Home My WebLink About17209-z nosa~ xo. 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 Z ~ J Z Date ...?~c~ 19.~~ Permission is hereby granted to: . ..7 .:..~,~irr~r,,. .......,`.~~~......?.-s7 ........................./......p............................................................................................................. ct premises located ot ....1.~/...~~..~.~.~~~~G~~'.........~ ..~..~'~l'f'J•.....~Q.l County Tox Map No. 1000 Section .....,,.~..~~`~.r....... Block L~oit No .............f.......... pursuant to application doted .............:(./..~s~............................., 19.~(J., and approved by the Building Inspector. ~ Fee $...°~.'f.5... ~.,y. / Buiidl ctor Rev. 6/30f80 r D - L~fJ 1~( ~ BOARD OF HE.~LTH . FORMN0.1 3 SETS OF PLANS SURVEY .1UL 13 ~ggg ~ ~ TOWN OF SOUTHOLD CHECK . ~ BUILDING DEPARTMENT SEPTIC r•ORPI °I TOWN HALL 1'GtUfVOFSOti1'MO(ty SOUTHOLD,N.Y.11971 NOTIFY - ~ TEL.: 765-1802 CALL Examined.. ,19~~ MAIL To: TSpK 75~ Approved ...?/Y?........., 19~S.vPennit No/7e~09~ (EAgj'j" ~~.7~ y , Disapproved a/c /l / / ~i: ~Yj-I ~ing I ec/tor~) APPLICATION FOR BUILDING PERMIT Date J. . ~ 15 INSTRUCTIONS a. Tltis 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. e. The work covered by this application may not be commenced before issuance of Bui]ding 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. Tlie applicant agrees to comply with ail applicable laws, ordinances, buil ing code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp -ons. • (Sig r e of appl~ nt, or name, if a corporation) • (Mailing address of applicant) State whethe/r~applicant ips owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........4.1w tU ~aS-. r7- Name of owner of premises,~~.rt.t.... 1 /~!l~~ t? Q. ~ . (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. ..b.'c~?-~!-?:~i n+!.. ~*:?-Q.~-?~:ttrC-- Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done. ' House Number ~ Streets ' ' ' ' ' ' • Hamlet County Tax Map No, f000$CCIIO? Bl ck Y Lot.. ~ Subdivision ? 2,t~~T ~.y F.iled t<tap No. Lot . • ( ante) ~r State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~~!V~ • • • • . b. Intended use and occupancy • • • • • • • • • • • • • ,i... I • . • ' • • • • Rc Applicable): New Building , , , A~ttiration . • . Addition ,f~~r , azure of wort. check which ' . • , , O[ r 1V' f ..(:~~C~. , • P Re atr moval Demolition , t 4. Estimated Cost . ~.ZS~, I (Doscriptian) ..l Fee.......................... ^ I (to be paid on filing this application) f dwelling, nurnber of dwclhn' y ~ g units Number of dwelling units an each floor , , , If ara_c.numbcrofcars . g ed occupancy, specify nature and extent of each type of use , 7. H~mi Ys ons of ex shnalsotrucNt1uFes, if any: Front , " • • " " " b • • • • ,Rcar Depth . htberofStorics. Dimensions of same structure With alterations or additions: Front ~ • • ~ ~ ~ ' ' ' ' ' ' ' ' Rcar.................. e,pth . . . Ilcight Nurttber of Stories . 8. Dimensions of entire new conskruction: Front , Rear . ' ' ' ' ' Ilei~ht Depth . ~..NutnberofStorics. 9. Size of lot: Front .~I!~ Rear . 360r . . t Depth z:~...... 10. Date of Purchase 17• • • • • • • • • • • .......Name of Pormcr Owner ?4;?: ,~FS~oGf,~ s 1 I. ;Lone or use district i~ iclt~ remises are situated . ,(ti,"~3 , , , , ' ' ' ' ' ' ~ P I Does ro osed construction vtq ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' • ' • • • • • • • • • • • • • . p P late any zoning law, ordinance or regulation: . JUQ , , , , , , , , , , 13. dVill lot be regraded .A1(), , , , , • , , , , , \Vill exe ss fill be removed from premises: Yes No 14. Name of Owner of premises 5,f~!!I;AJS,o!d, , , , , ,Address ~ls','7}`; ~ , 0/2 12'3 ;tS'3S' Name of Architect Phone No. , , , Name of Contractor . ~ • ~ ~ ~ • ~ ~ ~ • • ~ ~ ~ ~ ' ' ' ' ' • • • Address ............/,f,9, , .Phone No. ?',S.y .3~fR $ j • v17.woQ~~.,. .........................Address...................Phone No.....~........~. IS.I:s this property looted with in~00 feet of a tidal wetland? *YES....NO.RC.- *;Cf yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alJ buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocks, number or description according to deed, and show street names and indicate whether interior or corner lot. ~ . I S~~I ~ ' suikus>N A'?trt~ IT ~ 5wA-ur.~tl . ~ I----a ~ w54 N€w FFwce ' ~ , ~Sr tw~ax: , ~ 1 L~~ Za; NEi~a rFNCt+' roar+wrKtr ~/o"N~aN i , STATE OP NE1V YORK, COUNTY OF..........~.C-..~ •S • ~ ~ ~ ~ ~ • ~ ' ' ' ~ "g-~ • • • • • • • . , . being duly sworn, deposes and says that ha is the a licant (ha~mc of individual si~nir Scontract) pP about named. lie is tltr . ~ (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 manner set forth in the application filed thercwitlt. Sworn to before me this i l 3......... .day ofd . .,1~. Notary Public, , , , , , ,l-`~!~ ,t~, fL. CIAA~:~.. County NOTARY PUBIIC, State at New York • . . No.~107878,Su9tolkCau~M~q (5i;nature of applicant) Term Expires Nareh 30,1 . .