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Home My WebLink About17210-z FORM NO. D TOWN OP SOUTHOLD 6UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N D i~ l~ Z Date 19. Permission is her by gran d to: ~~.7.~:~ ro ..~.e~l.. /~.ekGl~.li ......~rL.r....... 'f............,.........Wyk ......a~%~~............ ~ a at premises located at .........~..1..~`~f..`...../..1.•~~.r.~................rL~~y~ ............................................................................G~................................................................. County Tox Map No. 1000 Section Block Lyot No........... pursuant to application dated 19.~f.1, and approved by the Building Inspector. ~ D Fee i ~ B ding Inspector Rev. 6/30/80 BOARD OF HEALTH . ~ CIS ~ ~ . 1~~~.,,,,.,...~~='-°~~ 3 SETS O F P L.1 N S • • - • • • . . FORM N0. t SURVEY i~ a ~g~a { TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC PORPf _ .,.,.14-~ TOWN HALL . ~"""Ctt.CC~ Dt-4't' EOUTHOLD, N.Y. 11977 NOTIFY TOV)nv OF gOUiMtiLD •p TEL.• 7GG-1802 CALL . - Examined ../~i~~........., 19 ~pfp~ MAIL T0: ~ x ~ 5..~, I ~f• Approved ...i,ll.~........, 19 9C?. Permit No. ~7~DI~'~ 6 ~~~~i / -7 Disapproved a/c ~(Cf / uildi~pector) APPLICATION FOR BUILDING PERMIT Date ..~?.U,4y...1.~......, 15~~. INSTRUCTIONS a. Titis 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 shalt 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 bf buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu' ing code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary msp 'ctions. e - ~ ~~S?`-`........... . (Sig a ure of applicant, or name, if a corporatton) ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....4~'. oW~.E..2 . Name of owner of premises !~(Si ~tS (I~....~ ~ W 0 ~ . (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 9S~?7~:e:?.. 9?! .~~P~pS-~~• Plumber's License No . . Electrician's Liccnse No . . Other Trade's License No . . 1. Location q 1 ntl on which proposed work will be done . . I 5~ House Number ~ Streets ' • • ~ " " " " ' Hamlet 1 County Tax htap No. 1000 $t CtlOn ~ BI'ock ~ Lot . ,.~y~ , Subdivision ~8141~1~1~(, ~Y.I.LR.~r. ~/~C Filed Rtap No. Lot . (Name) State existing use and occupancy of premises and intended use and occu a P ncy of proposed construction: a. Existing use and occupancy ....L-t%• • • • • • • • • • • • • • b. Intended use and occupancy / ~ ( ~ ) ~1fGE ItIbN' X 1'ftl 3• Repmr of work check whi~h applicable :New Quilding , Addition Alteration Imoval Demolition Other+4~br~c 4. Estimated Cost . ~ ~ I ~Doscription) .....i Fee..................................... (to be paid on ding this application) 5. If dwelling, number of dwellr g c qg units , , , , , , , , , , Number of dwelling units on each floor . If ara~e, number of cars . . 6, 1f business. commercial or mr~ed occupancy, specify nature and extent of each type of use . o nsions of existin stru Nyres, if any: Front , , , , ; , , ; , , , , , Rcar Depth . g t~ Hcr Itt mberofStorics Dime D~ t nsions of same structure with alterations or additions: Front • • • ~ ~ • • • p h . l Ilcight . Rcar . NuntberofStories 8. imensions of entire new constnrction: Front , Rcar , Height , Number of Stories , .Depth . 9. Size of lot: Front 190 ,a .........................y............ Rear ...~.'ro Depth .`r<4°.......... r 10. Date of Purchase , , , , , , , , , , , , ,,'Name of Former Owner J :uJ/{;6lUQ"IC/. , R,•,H ONn p(/t>r 11. Zane or use district in which 'remises are situated . Jr;1<} , , , , , , , • . , • ' ' ' ' •7• oes proposed construction vt O olate any zoning law, ordinance or regulation: !1/,U . 13. 1Vi11 lot be regraded N.. will excess fill be removed from premises: Ycs No 14. Name of Owner of remises W ON • • , • • • ' • ' ' P ~ . P.~/3f#~ddress 1~X.7S.~ .OalEll7' ...Phone No. ?i- ~ - S! G Name of Architect .........I .Address HQ S ~ •k"' . Name of Contractor . ~ • • • • • • • • • • • Phone Na..~o+.`{ ,r'tf9P yes, Southold Tow "•Address ...................PhoneNo.... ."!'u!,,, IS.:Cs this property looted within300 feet of a tidal wetland? *YES..~.NO.~t~(.w *If 'n Trustees Permit roay be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc) number or description according to deed, and show street names and indicate w ether interior or corner lot. ~I j _ - NE w FEr.CC- ~,tRtGb 1 ~S''•3-1 17-3- I F---~/~W ~En1G~ I Pasr- •r w/R~ swrrdso"' Ana^~ ; 0 17v . 5wq,.r5ou ~ 1 • 1 I i 1 . ~i ~ / X157/!`l~' ~'etiIGE ~ i3~n s~~ r~4 I I a 130• I a ~ STATE OF NE1V YORK, ~ Q COUNTY OF N r~~~'C: ~ J`. WfhJ~Sq~ • • • • • ~ • ~ • ~ • '~nii • • • • • • • . • . being duly sworn, deposes and says that lte is the applicant (Name of individual sip jg contract) above named. He is ttte . ®W N2tr' ~ (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 contaitcd in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner $et forth in the application filed therewith. Sworn to bofore me this • .................~.J....day of. x.............,19. \btary Public, , . , . , .IBC-Qpi,v , , I ~ ,Q, !•!g(i . HELEN K, DEVOE County N~b~4D078 8 S~ulfolNCawi ~ • ~ • Term ExiresMerch30,19~ ~ (Signa~ofapplicant) -