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Home My WebLink About22772-Z FORM NO.3 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) Date. 19. NG 22772 Z Permission Is h,errebVgranted to: to ~..1~"...<.. +..'9....... 1 11 . .;~i...........1 7. ...d„r}.......... 1.. ....::...~y~~........a~~s'",,, . . at premises located at..~`~~.....//~f County Tax Map No. 1000 Section r Block IGl.......LLot No. tea pursuant to application dated J4.z tf 19. and approved by the Building Inspector. Fee$.~~ Bui Inspector Rev. 6/30/80 FIELD INSPECTION REPORT DATE COMMENTS V H FOUNDATION (1ST) j I 11 ii Ifiii 1 n FOUNDATION (2ND) - I--=----II ~ N I~ II O ROUGH FRAME & II u PLUMBING Iii II NI III jj =aaeeeeeessaaccsssas--s~~eexss=a ~eeeee -oa---=oesasse__ss-r--saas=savs==ama_e-a-se- II II y INSULATION PER N. Y. u e y STATE ENERGY II e Ii CODE u ii u n u ==sssoasss=sossasasa~-seems=~~ M NNI II Iit II II II I If r FINAL 1I¶I- ~i v6 III JL II , -=veeeo==aeseeee=oaaa-ars--- ~:emcee--asaa -aa=-eeeasssesesaeessaeaa==e=s =aaaaae_-___=_===aaae=-__ ADDITIONAL COMMENTS: ----a '==as--aegis _-----e =___-___====-es=====----=====a== ` 1 ~\v N N x r\ x~ r°a ro H I OAkU Of IILALTII . rORM NO.1 ] SETS OF PLANS TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CHECK TOWNI -IALL SEPTIC r i SOUTHOLD, N.Y. 11971 pp TEL.: 765-1802 t OCALL lxf Examined ~G' I NA TO: Approved No. 4°? F 7 .7vZ y ....~~U.Q-. . Disapproved a/c . . . . . . _ . . . . . ( ddin pcctor) APPLICATION FOR BUILDING PERMIT Date 1M INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Pee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street 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 Budding Permit to the applicant. Such permi 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 Occupanc, 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 tale Tovvfn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for tine 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 it admit authorized inspectors on premises and in building for necessary inspections. SAS Ic~*~, ZS EASE =r+GORPof~I~TE~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises RPNCE-?,T. , ,.A, ,GOODA%V. r- (as on the tax roll or latest (Iced) If applicant is a corporation, signature of duly authorized officer. ( (Name and title of corporate officer) Builder's License No . Plumber's License No . Electrician's License No. F~.v 4• $U99..'-Vr%C Other l rade's License No. 1~A\,NTE~,- , Dl~y~ a ORR I. Location of land on which proposed work will be done. .....Nj~ . . . . . . . . . . . . . . . Ilouse Number r\-6ss Street M/!\r4 1Ze~. Hamlet \.',NV qrC1 Comely Tax Nlap No. 1000 Scction 2 Block ....6............ Lot. 59........... . Subdivision Filcd Map No. Lot . (Name) Slane existing use and occupancy Of premises and inteuded use and occupancy of proposed construction: a. Existing Ilse and occupancy e'en STar`G) G \ b. Intended use and occupancy 3. Nature of work (check which applicable): New Budding Repair Removal ' . ' ' ' ' ' • • Addition Alters[ on _ Demolition Other 1York~. 1~ews . ,U~O• 4. Estimated Cost (Description) Fee 5. If dwelling, (to be paid on filing this application) If garage, nnumber of of d cars welling units Number of dwelling units on each floor , , . , , , , • 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions 01'existing stntctures, if any: Front Height Number of Stories . Rear Depth Dimensions of same structure with alterations or additions: Front . Depth.........., Itcar.................. Height Number of Stories 8. Dimensions of entire new constntction: Front . lleigltt Rear Depth Number of Stories 9. Size of lot: Front • • • • • • 10. Date of Purchase Rear....... Depth Name of Former 11. Zone or use district in which premises are situated Owner . 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded . . . . . . . . . . . . . . 14. Name of Owner of remises . ' ' • • • Will excess fill be removed from premises: Y s No p knti?f.C..Ii,.C'pFAe~A1tEclress `.~}1\... Q No. 2.. V 4y t ~tt`+ -`t Name of Architect Y>E one Address ..................Phone No. Name of Contractor . . . . . . . . . . . . • • • • • . Address Phone No. . . L5. Is this property withi n 300 feet of a tidal wetland? *Yes tIf yes, Southold Town Trustees Permit may be required. No.. 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. OCCUPANCY OR SCE lF0TE USE IS UNLAWFUL REQUIRED WITHOUT CERTIFICATE OF OCCUPANCY AP RO q S NOTED DATE'6 B.R # 7 r7 f FE, FAY: 1`41FIFY BUILDING DEPA AT 765-1802 9 AM TO 4 P R THE FOLLOWING INSPECTIONS: 1. FOONDATION - TWO REQUIRED FOR POURED CONCRETE - 2 ROUGH FRAMING & PLUMBING ,v. FINAL CONSTRUCTION MUST RE COMPLETE FOR C.O. All, f ONc,,TRUCTION SHALL MEET :r 11FO IIREMENTS OF THE N.Y: CONSTRUCTION & ENERGY t'~ S. NOT RESPONSIBLE FOR f S:Ie','tJ OR CONSTRUCTION ERRORS I'ATE OF NEW YORK, OUAY Ol S.S C.. Name C of .i ivn ; . t. 'con€ traV 1 being duly s% orn, deposes and says that lie is the applicant ( ndividual signing ct) Jove named. is the (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 plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the uf: will be performed in the manner set forth in the application filed therewith. ,om to before me this Pg. &j0CE day of r.., 19 tary Public, ~ County .WILKINS Notary Public, State ate of of Now York ~ . . . . . . • . No. 4952246, Suffolk Count / Term Expires June 12, 19 Zk (Signature of anplic Intl uo~ A 20