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Home My WebLink About17878-Z POEM 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) N Q v 17 8 7 a Z Date ....~~r.~::S~l............' 19...1. Permission is hereby grant o: ro ~ ......5~,..,.,o..ac~r~rr...~...fz.~i.s.Q1.....e.:er~..1.~.....~:sth!%n-,~.....v)'!:R..~ f ct premises located at ...1.~r~....!~Y..`~4~^~5d:!......~1.4.R:i.~....~.~L1.fA?'~!::~ County Tax Map No. 1000 Section ~-?r-....... Block ~........p. gLot No.... pursuant to application doted ..~~M~44~... 19,A...{., and approved by the building Inspector, v Fee ~ B ding Inspector Rev. 6/30/80 } m r ap a ~ ~ ~ m ~ ~ ~ 1 N o z per} ¢ ~~z c~ r n ~x_ Z Nm~ ? w V Qa¢p f ~ -i a ~1 IIi! v lL O J fn W ~ 0 ~ Q a LL N ~ (n Z in ~6LE~ n~v °y b J ~ ~ ~ t~ J y~~,' ~ ' 4 J ~ O O ~ `Iv o /.gig p ~ ~ Q i O ~ ~ ~ ~ v LL' J O D _ LL. ~ ~ ~ ~l ~ ~ ~ 0 0 ~ ~ o ~o ~ ~ sue' ' ~ o ~ or J~ ~ z p~, o N o ~ ~ ~ ~ ~ ~ r U!1 r~ ~ ~t f~ 4 0 `V ono=crr sa N ~ --~~1=e•~s sz ~ V M„~BZ.Ei/Y Z ~ e~ ~ 2 ° 3 ~ ~ ~ ~ o ~ o O~~O° 00'Ti t' 37 P~ V J U ova!=~_~. .~Ti.L/ U O O ~ ~a'M ~ Q ~ ll) a O b~'rvaa'~~ ~r~Ny~ d'~1~d 7 . , I~} Q ~ \ o ~ ~ a2 <op.., O ~ Q I~ n' a cZ"'v (1 ' \ 'l ~I~Vllvll// ~Q w v( \ W Q Q°~ g O ~?»zv W .lt~~l1~ a Q J W N O ~~OD`'oOV ~7 ~ -.J N~ ~ N N O m ~ V 60Ai:D OF HEdLTH 3 SETS OF PL.1NS FORM NO.1 SURVEY TOWN OFSOUTHOLD CHEC(: BUILDING DEPARTMENT SEPTIC Foa"I ' TOWN HALL . SOUTHOLD, N.Y. 11971 NOTI PY ! ~ , ; TEL.: 7G51B02 CALL ..:~J'~..~~0.`.: . MAIL T0: Examined ~n.1e;Li, f....., 1945. \PProvcd ci.l cT~\. 19~~. Petmit No. I ,7 7• ~ ~ ~~2~1:1r~/I/r ~ ~f/_ DisaPProveda/c tel. . ~a.- (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . ~.5.........., 15~y. INSTRUCTIONS a. Tlus 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- wation. c. The work covered by this application may not be commenced before issuance of Bui]ding Pet7rtit. 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 h1ADE 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. The applicant agrees to comply with all applicable laws, ordinances, building code, housin¢ code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. _ (Signature of appli r name, if a corporauon) • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......P.c•d .v l.~ Name of owner of premises ~ 1 "v ' ~ ~ ~'~%'L ......................f.......... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized offices (Name and title of corporate officer) Builder's License No. ny~.,v . Plumber's License No. ...6:~:-: ~Y. t'.:~.......... . Electrician's License No. . ct^'.: C . Other Trade's License No. ..~'c-r: 1. Location of land on which proposed work will be done. . Elouse Number Street. Hamlet County Tax hlap No. l 000 Scc[ion ~°i'Z ~ ~ • • • Block . ~ , , , , , , , , , hot C ! 3 ; Subdivision Filed Alap No• Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy o n:.. ~ ~,..!,7:...~"~. ; /i.:~ s . b. Intended use and occupancy ~ : ~y 1 . 3. Nature of work (check which applicable): New Building Addition ~Uteration Repair Removal Demolition ~3 ~ `~:2 Other 1Vork . (Description) c.%..,.::..i c ~ Fee . 4. Estimated Cost . (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each ?oor . Ifgara^_c.numbcrofcars 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 Depth . Hci_h[ ...............Number of Stories . Dimensions of same structure with alterations or additions: Front Rear . Depth height Number of Stories . 8. Dimensions of entire ne~v construction: Front Rear Depth . Hcicttt Number of Stories . 9. Size of lot: Front Rear ...`/G Depth ~ ' 10. Date of Purchase 2.?~..:r.4' .Name of Former Owner ~ .E ~ ~ ~ ~ 1 Zane or use district in which premises are situated , h', ; ~ ~ . 12. Does proposed construction violate any zoning law, ordinance or regulation: e~!.~ . 13. 1VIlI lot be regraded 1Vi11 excess fill be removed from premises: Yes No 14. Name of Owner of premises ~f':'t^:'.'..'j 7i Address o°!' !.'.%~!:'?.'?:~:~°'d'hone No. ? , Name of Architect ...........................Address ...................Phone No....... . Name of Contractor 4:^.':" °'z ...............Address J~ rr.~ .........Phone No.. J:a . ]S.Is this property located within~00 feet of a tidal wetland? *YES....NO:~(.. *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. S~ E i! r.~ ~ Eo S~ ~ ~ E~ /f/LJ P~• Jf' ~i'rn u/• T v -v r.'rAiLKC D G." r. . . APPROVED AS MOTED ~~.t~~a....~ ~G"' ,~~G~ Q~ t DA~ 3 r ~ B.P. +,~,~i„ . t..]s+-.x.ci _ C3 FEE: f d ~ BY: lV .1_ . - NOTIFY BUILDING DEPARTMENT Ar 765.1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. t. fOllNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH .FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMNLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY COPES. NDT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATI: OF \EN YORi;, S.S BOUNTY OF . _ 'Tha~~:t n5 , , ,/1;t,ac,?;.z,, , , , , , , , , , , , , , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Le is the ~.:`L.Ualr` (Contractor, agent, corporate officer, etc.) f 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 arc true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. worn to betorc me this . ~ii ..............day of F,Z'/~~' Urt~j~/......., 19 F?f ttary Public, `•'.F~-~ c./L ~~!~unty DAVID C. CREATp NOTARY PUBLIC, State of New York ' ' ' ' ' ' ' ' ' • • • • • • • • ' ' ' ' No. 4834451 (Signature of applicabtl Qualified in Suffolk County Commission Expires February 28, 1990