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Home My WebLink About20537-Z I~OK~I NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N N? 2o5a?z Date .................................................. 19 County Tox Map No. 1000 Section ......... ~..~...~..... Block ........... ~.. ....... Lot No ......... ~ ......... pursuant to application dated ..... .~..x,/..~.. ........................................ , 19..~...~:.., and approved by the Building Inspector. // B~ding Inspector Rev. 6/30/80 FORMNO. 1 3 SETg OF ?LA:~Z TOW, N OFSD~THOLD ~UR~£Y .---,~. ....... TO~.ALL s~T~c ~o~ .......... SOUTHOLD, N.Y. 119.71 '1 TO~&~ '; h:'~. ! TEL.: 765- 1802.~ m; .. , , 'k, ..~' C~___A_t,.l,..~-~.h°' ,P~. ~_ ............ ~ .. ~,,,; ..... 5 HAIL TO: ~ ,~.... No ~~ ...... '?" .......... .Xpprov¢d Disapproved ale ................. ...,..: FV,'~-~. · ......... .~ ................. . ............... t>%5.:; . (Budding In~ctor) ~ ' ' .',~'CX .,r:A~ON'FOR ~LD NG PERMIT :',,., 7- te ................... 19... "A. ~s appl~t~ must be completely filled m by ~pewnter or m ink and submitted to the BulldOg Inspector, with 3 ~ts'.~'~Shs, accur'ate ~lot plan to scale. ,F~e according to schedule. b. Plot plan showMg location of lot and of buildMgs on premises, relationship to adjoining premises or pubic streets areas, and givMg a det~led description of layout of property must be drawn on the diagram which is pa~ of this appff- ation. e. The work covered by tMs application may not be ebmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector w~l issued a Bu~ding Pe~it to the app~cant. Such pemit ~MI be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup=cy mil have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Build~.DeV~fnt fo~,issuance of a Building Pemit pu~uant to the ailding Zone Ordinance of the Town of Southbl~ ~uffflk County, New Yor~, ~d other app~cable ~ws, OrdM~ces or ~gulations, for the construction of bufldMgs, additioas or alter, ations, O~4.C$~6val or demolition, as hereM described. he apphcant agrees to comply with a~ applicS~le-)~s ordin~h&es, bui]ding code, housing code, and regulations, and to imit authorized Mspecto~ on premises and M bhildMg for necessa~ inspections. ....... ........... --' (Signature of applicant, or name, if a corporation) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ...................................... . .r~....~r~-~r .. ................ : ........................ .¢.. amc of owner of premises . . . .~....~.....~ufi~.....~. ?../77.~'~ . .~../~fi...' ............................... ..... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will e...., ~ ........................... llousc Number Street Hamlet Count~ T~ ,,Ia~ ~o. ,000 Sec,o. .'0~ B,oc~ .m~Lot 0¢ Subdivision /t'/'4[ ° Filed Map No. Lot (Name) State existing use and o,ccupancy of premises and intended use and occupancy of proposed construction: ~. E.~,s,,ng use and occupancy ...... m.~......~...::.'., ~'.'Z: ...'"~...~.~--' ,,~,~ ~'..~.. .................. ~ ..,.?'. ~ !t.? ....................... b. Intended usc and occupancy .................................................................... 3. Nature of work (check which applicable): New l~uil4J,~q~ ........ Addition ........... ,Uteration .......... Repair .............. Removal ............. [. Dmnolition )...x~ ........ Other \;ork ......... (Description) 4. Estimated Cost ..................................... Fee ... : .' .......................... (to bc paid on filing this application) 5. If dwelling, number of dwelling units ....~..~..~.'. .... Number of dwelling units on each floor ..... ~ ......... · If garage, number of cars ........ '.(~. ~.~'.....7~....~ .~.../~. ~...~...~..¢..('~.~' ................... 6. If business, commercial or mixed occnpancy, specify nature and e×tcnt of each type of use ..................... 7. Dimensions of existing structures, if any: Front....~...~. ........ Rear .., .~.~ ........ Depth . ,,.~ ......... Height '~&~' Number of Stories Dimensions of same structure with alterations or additions: Front , ~.O./v[4".,~. :.. Rear .................. Depth ...................... Heil,,ltt ...................... Number of Stories .............. 2 ....... 8. Dimensions of entire new constnxction: Front ..... .~..t~- ....... Real_,.. ............. Depth ............... Height ............... Num bet of Stories 10. Date of Purchase ..... d.~.~.O..~. ............. Name of Former Owner ............................. 11. Zone or use district in which premises are situated .... .~.':'..'~.~....~.ti~/.4P!~ff.7'(.~].. ..................... 12. Does proposed construction violate any zoning law, ordinance or regnlation: ....... t4(..O. .......... ---.--'.-.--,ex 13. Will lot be regraded ........ q'~-~ ................ Will excess fill be removed from premises: Yes N(.~/ 14. Nmme .,~....t,~. ]~.F'..~..~...~ . Address .~...t~. ~.. ... Phone No ................ of Owner of premises ............ Name of Architect : ~.. Address . .O6,....~.f?~....~.O..~. ..... Phone No. ~.~..~.-. ~J~..~.~.P.~- Name of Contractor .......................... Address ................... Phone No..2.~..'T.. [5. Is this property within 300 feet of a tidal wetland? ~Yes..~... No ......... ~If yes, $outhold Town Trustees Permit may be required. PLOT DI AG P,3~Vl Locate clearly and distinctly nil buildings, whether existing or proposed, and. indicate a/l set-back dimensions from oroperty lines. Give street and block number or description according to deed, and show street names 9nd indicate whether interior or cornerlot. --,'W '/ , ~' / ~"- ~ '- ~ . ~ NOTIFV ~O[NG OEPART~ AT 75~4802 9 AM ~ 4 PM FOR THE FOLLOWING iNSPECTIONS: . ~ J~'~ t*~ · ~ ~" 1. FOUNDATION TWO REQUIRED , [,. ,FO~ ~~ CONCRETE .... , ',x-",'~l ~ . 3. INSULATION ~ ~m~t co.smuc,~o~ ~us~ BE COMPLETE ~O~ ~.0. ALL CONSTRUC~I~'SHALL ME~ THE REQUIREMENTS OF THE N.Y. STATE CONS~U~ON & ~ERGY CODES. N~ RES~NSIB~ FOR DESIGN OR C~STRU~ ERRORS 'ATE OF NEW YORK, S.S '~',~' )u v OF ................. ' " ... ~....Ce.....~t'J/~.b'. ~ ............. being duly sworn, deposes a,d says that he is the applicant (Name of individual signing contract) we named. . . ~(~a[ractor agent, corpor~o eTficEf said owner or owners, an~ i~du~y afithonzcd to pcrfo~ or have perforated thc smd work and to make and file dJc~tinn; that ali statements contained in this application arc true to thc best o~nowledge and belief; and that file k wlJJ be pcr~o~cd ~thc manner set forth m tl~ a~fl~cat on filed therewith. )m to before me thl~ - · ~.' q~ ................ day of ................ 19. Public LINDA J. COOPER Notary Public, State of New Ye~k~ No. 4822563, Suffolk Count~ G~ ? ~ " Term Ex~ires December 31, 19 z~ County ~ .¢,2i~,~, (Signature of applicant)