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Home My WebLink About20856-Z . . FORK NO. f 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) WN° 20856Z Dote.~. G!.. ...Airy 19.Y.2, Permission is hereby granted to- P...,r3at....9 . c;r to .to~ fA.......... . . at premises located at /.Q..~ M~ . . ,.....i..~..7./ County Tax Map No. 1000 Section ..fl Block .......7 Lot No. 1.0 pursuant to application dated .........A.1....... 19.,t....Z4nd approved by the Building Inspector. Fee e.t:...~.... Building Inspector Rev. 6/30/80 ICJ^:n I~ v54 1E NIC I /-al o 1. m a ?OUIIDATION (1st) I 'OUIIDATION (2nd) y ;OUCH FRk2•fE & ~ -PLUMBING N a m =IISULATION PER Y. Y. _3 STATE ENERGY II CODE CO r kj~ - H FINAL ADDITIONAL COMMENTS: m ty, t5,y-{ j (7~ x MQ` -04 7 r m ' y BO,1RO OF HEALTH FORM NO.t /3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CIIECK TOWN HALL SEPTIC FORK SOUTHOLD, N.Y. 11971 TEL.; 765 1302 NDT I F't E-xamined C,%LL, _ . , 19 . / rtnrC To: %PProvcd .~~J'y~ 60, 19~Permit No. Z Disapproved a" / _ . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 'a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- , tion. 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 :all 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 :all 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 udding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. :ze applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to 'mit authorized inspectors on premises and in building for necessary ins ections. (SSiggn~ture of applicant, or name, if a corporation) (Mailing address of applicant) Late whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame of owner of premises (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 1~ L` Plumber's License No . Electrician's License No . . Other Trade's License No. Location of land on which proposed work will be done. . /.D........ qg' AV 44) l/:......'socJ~Ho~~ ltousc Number Street • • • • • Hamlet County Tax Map No. 1000 Section Block ..7......... Lot . . . . Subdivision Filed Map No. . (Name) Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy: ~G..... b. Intended use and occupancy .-A lo, :,&-.C 3• Nature of work (check which aPPlicable): New Building Addition . . . . . . . . . . Uteration Repair Removal ' ' ' pthcr Work ..FbU4 . 4. Estimated Cost ~~-QO lq&OVr= S20UN-L) (Description) Fee lri Oo (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 • ' . Height Number of Stories Depth . Dimensions of same structure with alterations or additions: Front . , , , , • . • ' ' . • ' ' ' ' ' ' Depth........... Rear Height Number of Stories . 8. Dimensions of entire new construction: Front . Height Rear Depth ........Number ofStories 9. Size of lot: Front . Rear...................... De th 10. Date of Purchase p . : . . • , , - • - NamcofFonnerOwner 11. Zone or use district in which promises 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 Address Phone No. Name of Architect . • • • • • • . ...................Address ...................Phone No. . Name of Contractor Address . '5. Is this property within 300 feet of a tidal wetland? * .Phone No . Yes........ No.Y...... *If yes, Southold Town Trustees Permit may 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. 1 M!k'(\\Y~ EP f rl (G~u l t1 b{ "VA471EPI; IV 'ATE OF NEW YORK, )UNTY OF 5' J~~olti S.S t`S' g v . • • • • • • • • • . • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ove named. is the O: WAAA,( . (Contractor, agent, corporate officer, etc.) • said owner or owners, and is duly authorized-to perform or have performed the said work and to make and file this dication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in th ner set forth in the application filed therewith. am to before me this Jv?.Me day f.. ......w.~l...... 1 19.92 :ary Public, ~ o A G~- ` ROBERT I. SfATT,1 . ~ • k-CtC~` , NOTARY PUBLIC, State of N.Y. • • • • • • • • . • • • • • . No. 4725089, Suffolk Cou (Signature of applicant) Term Ekkpires kkY 31,19