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Home My WebLink About18743-Z roan xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ ~ /1.e~1~r-~dv`-e SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 18 i 43 Z Date 19.1.4. Permission is hereby granted to: ro ....rte i~(~~r~n,;.. at premises located at .....wt.c~.r?.~~.........~!l!f......:./.~..~.~• . ...........................................................................c.................................................................................... County Tox Map No. 1000 Section Block Lot No...........-~~............ pursuant to application dated ......../.~~,cl 19~f~.., and approved by the Building Inspector. pO Fee S.•••/7~.•. .?.~D §dilding I t r Rev. 6/30/80 ~ O BOARD OF HEALTH•.•,.--..•. 3 SETS OF PLANS . FORM NO.1 SURVEY . ~ ~ TOWN OFSOUTHOLD CHEC[. • BUILDING DEPARTMENT SEPTIC FORM &.OG. DEPT. TOWN HALL SDUTMOLD ~ $OUTHOLD,N.Y.11971 NOTIFY; TEL.:7G5.1802 CALL p MAIL T0: Examined ~ 19 ~fl ~,//2 Approved 19~. Permit No.~~7f'cl. . Disapproved a/c ( iildin^ Spector) APPLICATION FOR BUILDING PERMIT Date . 15 . INSTRUCTIONS n( - a. Tltis 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 [he 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 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 unfit 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 of ~ui~dings, additions or alterations, or for iemoval or demolition, as herein described. The applicant agree~~~t~jplr~Fif~'t11 a applicable laws, ordinances, building code, ousing code, and regulations, and to admit authorized inspectors o premises and hi building for necessary ' cY n , y®` ` atp ~ (Signature of applica t, or name, if a corporation) ~tT ;iil~ a.a • e"l".e ~ S~E~`r2 S' S' - ~ (/OS . t. ~..~Iqu..~-1g~. . .i..q..... , , ,ri a ~ (Mailing address of applicant. ra, .I ~~'h'' State whether `~N~Ai~~t~ts~c~wnerM ksset agent, architect, engineer, general contractor, electrician, plumber or builder. i' ~ ; O. W.n!~.(~. .ll~jt'+~'A~M , r Name of owner~~rr. mtyR,ft2 ~ "~~',ry1~24NSk.f...„R~~~tf12d...a:. O12S 'F3.r~ t ~p 1"N l'v" " ~ (as on the tax roll or latest deed) If a licant is a ~ N ~ qr'. r - 3 pp a011sdM~lion~~~re etf,duly'autfiorized officer. At)i'- . a:11~JRH,".'~O1't'~ :r.'~. . (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Outer Trade's License No . . I, Location of land on which p/ro~tposed w(o~1rk will be done; ...~:5..~ ~0... l~:lf#ri9..~'.d:. ~VTcHo9V~ House Number Street. Hamlet ~Z County Tax ilfap No. 1000 Section . ~ 9 Lot , , , Subdivision Filed slap No. Lot . ..(Name) State existing use and occu anc of remises and intended use and occu P Y P PancY of proposed constntction: a. Existing use and occupancy r~ : • ; • • s S d.Q~ , ~ 2 - . b. Intended use a , , _`---1~~ ~,Mp ` ` a v lOc- nd occupancy •••.J/ 3. Nature of work (check which applicable): Net wilding , Additicn MAlteration • Repair Rpmaval Demolition t ..............Swiatctin0'~.~ ~ • , • Tennis Court Accessory Building..........Fehce .......Other Work:...i~.. 0 4. Estimated Cost ...........'f i5O. ~ Fee • . (to be paid on 61ing this a 4t 5, IC dtvclling, number oC dtvclling units Number of dtvclling units on each floor . If garace. number of cars . . 6. If business, commercial or mixed occupancy, specify nat re and extent oC each type of use 7. Dimensions of existingtructures, if any: Front ~ Rear Depth • . , , . . Height /.tl Number of Stories ~ . . Dimensions oC same structure with alterations or additions: Front Rear . . Depth FIcight Number of Stories . Dimensions of entire nett' construction: Front Rear Depth . Hci;ltt Number of Stories . 9. Size of lot: Front Rea- Depth 1Ge Date ofPurchase .................Name of Former Otvner . 1 1. Tone of use district in tvhiclt premises are situated . . ' l2. Does proposed construction violate any zoning law, ordinance or regulation: • • . 13. 1Vi11 lo[ be regraded ..Will excess fill be removed from premises: Yes . . 14. Name of Owner of premises 1`.~~PSO. Su411,cyS~6. Address S'HGtJ.C C.~$ 4,5~.~ ...Phone No..7 Y9~ 91.~r1 ~Ct . , Name of Architect ...........................Address • Phone No................ . Name of Contractor .................:........Address • Phone No..... . IS.Is this property located within 100 feet of a-tidal wetland? *YES...~~0~~• *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly ail 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. AP ~C !1" NOT1~1~'~^' 766-18pyt9 ~ ~ ~ ~ FOLLOWING INSPECTIONS: T. fOUNDATIpW TUIp 2. ROU(3PNOIIRfERDAMC ~ BARED 3. INSULATION 4. FINAL CONSTTiUCT1ON MUST BE COMPLETE FOR C.O E REQ(NR~r~ ~M~T STATE CANS ~ CODES. NOT ION ~~MEliGY DESIGN OR CONS7R AORS STATE OF tiE1V YORE, S.S COUNTY OF . • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant • • _ (Name of individual signing contract) above named. He istlte (Contractor, agent, corporate officer, etc.) oC said owner or owners, and is duly authorized to perform or !taut performed the said work and to mane and file this application; [hat all statements contained in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ' Swom to bciorc me this ' ~.~........day o~~f//..(n.~./ , 19 l~.d Notary Public, • . n,. N4: C-l~... County .~/l ~~F :r4Wt. ' HI].EH K DE VOE _ • • • • . ~H~4io~878;~tlolk~~~y~,~ (Signature of applicant) Term Expires Much30.19••-1t .