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Home My WebLink About17611-Z FOB,M NO. It TOWN OF SOUTHOLD BUILDING DEPARTMENT Tow~ ~,., SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ ~17611 Z Permission is hereby granted to: ..~.~....~.~ Co.~.~-. ~. ~ ~ ~~ '~.. ~.~, ,o :, ~em,,e, ~,ed ~,....b.~......~.~...~ ......... ~.~.....~..'.~., ...... ~.d~.~.~ .... Count,/ Tax Map No. 1000 Section ,......,.C?...~...~. ........ Block ..... ..~,,.) ........... Lot No ...... ..~....,2m. .......... pursuant to application dated .... ~.~~. ...... ..~ ............... , 19.~...~.., and approved by the Building Inspector. Fee $..~..' ............ Building Insl~ctor Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 E. amin . 5.3 Approved .~..~..'t.'t.'t.'t.x.'5~D....(:¥~4'..,/.7:, 19~..~. Permit No. 4 ~. ~ ~ .~. Disapproved a/c ..................................... ~ ................................ (Building Inspector) d(t , ,~aq APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH._ ........... 3 SETS OF PLANS ........... SURVEY .................... CttECK ..................... SEPTIC FORH ............... NOTIFY CALL .................... HAIL TO: Date ?.o..'.'.ye..7..,..3.?.8.8. .... 19. INSTRUCTIONS a. This application must be completely filled in b? typewriter or in ink and submitted to the Building Inspector, with 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 strec or areas, and ,giving a detailed description of layout of property must be drawn on the diagram which is part of this app 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 perm shall be kept on the premises available for inspection throu~mut the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant 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 tl Building Zone Ordinance of the Town of Southold. Suffolk County, New York, and other applicable Laws. Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and: admit authorized inspectors on premises and in building for necessary, inspections. Gard:J. Iler ~ s Ba~ Coils t o COo (Signature of applicant, or name, if a corporauon) .... c. ,o.u.n.t.r. :c (Mailing address of applicant) 3-1958 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde: Builder (Name and title of corporate officer) Builder's License No...~I../~.3..59 ............... Plumber's License No..59Q.~?. ................. Elcctr'cian s License No...~.~.1.6~ ............... Name of o,vner of premises ....J.o?.qp.h. ~..O. ~.?.m?.3: .a. 5.~.~..a.r.d.i. ........ ~,~,,~' A~}/~/'~' ,,'~ ~r~ .... (as on the tax roll If applicant is a corporation, signature of duly author/zed officer. ~~ltl~'Nl~l~~ ' Al' ~.1~ $ ~ 1~ 4 PM FOR THE ~ elePC-¢TION$: I, ~ - 1~O REQUIRED 4, EINA~ GONSTRUCTION MUST AiL GON~TIIUGTK~ SH~L MEET 11~ N~UfflEMENI$ OF' THE N.Y. Other Trade's Licens~ ~o ...................... CO0~ I~ RIESPONSIBLE FOR ~. Location o£ land on wliich proposed work will be done ................ DE~I(~N~R P...ON817tUC~IO.NI~.R,R~).R.S ..... .......... .6.0..I~./gr.t.h..Rg.ad .¢o~'0,ty. R.ck...##8., .ar~hamom. o. quo,. ~o. u.tkq], .d,. ,blY, .............. House Number Street Hamlet County Tax Map No. 1000 Section . . ,O. 4~ ............ Block ...0.3:. ............. Lot .... .~.E. ........... Subdivision . . .A. 17 .~ .h.~.n'!o. r0 .o.q.u.~ .................... Filed Map No ............... Lot ............... (Name) State cxistin;: use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy . . . .1..f..a. r/1;j..],~. Cll//.e.'l l~n.g ............................................ b. Intended use occupancy Remove existing frame dwelling and shed a~a~-~u~&~ and ~'~ ' ''''~'O'"~' "(~'~;~':l~f*~'" "~'f''f~':'''''~'7'~')''.~'/, ~ V~ D,,~ ~"~ ...................... 3. Nature of work (check which applicable): New Building . ,-.~."~ .'~... ~'6rdition .......... ,'dte~'ation Repa/r .............. Removal ...y¢,~ ........ Demohtmn[/...y¢.s ....... Other Work ............. $.4.00 9.0.0 (Description) 4. Estimatc'd Cost ..... ~ .,,.0.0 .... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units . . .1. ....... Number of dwelling units on each floor ......... If garage, number of cars ...2. ¢.a2..,gt,.t.,~c.h~¢ ................................................... 6. It' business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front.. 3.0.,,7 ........ Rear . 3.O...?. ........ Depth . .1. L~. Height ............... Number of Stories ' ' ...... Dimensions of same structure with alterations or additions: Front ........ Rear Depth ...................... IIeight ...................... Number of Stories . 8. Dimensions of entire nexv construction: Front. ?O.'..7..~- ."' ......Rear....7.q'.. 7~.':.. i ~'p't;, 5~)' 'k~' ...... Height .... 2.¢.~ ........ Number of Stories '~ 9. Size of et: Front 100 ~ ,~ .....j.~)3,' '~6 ................................. Date of Purchase ' h'~' ...............~qear .... ~.-..( .............~e~thl~7..3.0../.1.6.6....~.5 ...... · · ': .... · ....... - ...... : ......... . .' .....................ij15155 13. Wil lot be regraded ~es ...... ...... Ob§'e' 'ti '&' 'Cg. Pfilbl~ ' 'wm exc~sx.J'ill~be, removed fram premises- Yes XN 14. Name of Owner of ,~remises P ^ ...... "b Ruotlc vlew t,~ ' ~ ' .....C ' t .......... ,~,~,c~a ne No Name of Architect 1 a~d'l _,, Gl"~'e'rl¢/ieh'~' '~T' g'6'~ ............... ..................... ; ..... ,~.u u ress .................... />hone Nn ........ Name ° f Contractor g~'r ¢i.n0r:.s..]~Y..Qqr; .s.t...q 9%ddress 35~Q. ]~.t,..4~. tee ~ ~ 7S5-5Er~0. 15.Is this property located within 300 feet of a tidal wetland? ~YES.~f..NO .... · If yes, Southold Town Trustees Permit may be required. Trustees Permit ... PLOT DIAGRAM enclosed. Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions frorr property lines. Give street and block number or descnption according to deed, and show street names and indicate whethe: interior or corner lot. .... ~ ......, ,~.[,;. ~,tm~T,')gS)'~t~[l'4 .J..l& .......... being duly sworn, deposes and says that he is the applicant . (lWame o~ ~'l~l~t~J~ in~:~o n t r a c t ) .... above named~ ~ ¢o~v3~,~nr~o3 ~AT~ He is the ....~ , ;': :.l~'U?~g ~ ~g~?~?. ......................................... .. (Contractor, agent, corporate oEficcr, crc.) ................... of said owner or owners, ~d is duly authorized to perform or have pcrfo~ncd the said work and to m~e and file this application: rhar all statements con[aincd ~ this application are true to the best o~his knowledge and belief; and that the work will be perforated in tile m~ner set forth in th~ application filed therewith. Sworn to before me this ............. .day of...Il '....~ ........... ]9~. / ~. 4707978, Suffolk Cou~gO Term ~oir~ ~z~ch ~O, 19~/ (Signature of applicant)