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Home My WebLink About16808-zTOWN OF SOUTHOLD TOWN HALL $OUTHOLD, N. Y. (THIS PERMIT MUST COMPLETI( BUILDING PERMIT KEPT ON THE AUTHORIZED) FULL No_I 6808 Z Permission is hereb, at premises County Tax Map No. I000 pursuant to tion dated Building Inspector. Fee $, .'~...?..~.,: .~, .0., ..... 'ion .... ~.~. .................... , 19.~.~..., and approved by the Building Inspector Rev. 6/30/80 CONTRACTING · NEW HOMES_ BOX 79 ,/A.~ESPORT, NY 11~47 (.~16) 722.,1497 FOUNDATION { lstl FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L ti'DATE COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 7. ' BUREAU OF ELECTRICITY ~ 815 JOHN STREET, NEW YORK, NEW YORK 110038 Date Application No. on file only the electrical ~uipment ~ ~scribed be~w and introduced by t~ applicant ~med on the a~ve applicatio~ n~ber i~ t~ prem~es of Section Bilk Lot ~s examined on and found to be in compliance with the require.~ents qf this Board. FIXTURE OUTLETS SWITCHES FIXTURES FLUORESCENT OTHER FUTURE APPLIANCE FEEDERS RANGES SPECIAL REC'PI E R NO, OF CC, COND A W, G, pER ~' OF CC COND, 2/{) DRYERS FURNACE MOTORS COOK NG DECKS OVENS [~ISH WASHERS TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET OTHER APPARATUS: EXHAUST FANS DIMMERS }{0hl ~, lI, f,~, ~Y 'J,~ 74;i GENERAL MANAGER Per ~, This ce~ificate must not be altered in any manner; return to the vfflce o{ the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS cOPY OF CERTIFICATE MUsT NOT BE ALTERED IN ANY ~NNER. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~...c3~.. ! .~..., 19~..~. BOARD OF HEALTH 3 SETS OF./. LANS SURVEY ........ CHECK .......... SEPTIC FORM ............. NOTIFY CALL .]~3 ~.~q 2 ..... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF '~OUTPOLD Date '/? ~ 19~. INSTRUCTIONS a. This 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 premise, s 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- cation. ci 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 shell 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 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 buildings, addifions 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 to admit authorized inspectors on premises and in buil(~ing for necessary inspections. .... c.£,~.~d z~!).o.~. . .~ . . /~c. .......... (Signature of applicant, or name, if a corporation) ..... ~..~... 7. t..e .-~...~ .~.4~ ..~y/./.~.~:7. ...... (Mailing addre? of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · . ................................................................ Name of owner of premises . .~.~.~..~'7../~.~.'~'~ ..................................... b' (~ on the tax roll or latest deed) If applicant is a corpora~on, signature df duly authorized officer. .... .................. , (Name and title of corporate officer) - ' ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. .~. .~?.7 .............. .~,.~. ....................... .,c~, ............... : ............. House Number Street Hamlet County Tax Map No. 1000 Section . .{.).~.~. ........... Block ..... ~ .......... .... Lot....~. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: b. lntended use and occupancy ~';..~.~ ~(..]~... ' ' ' . ...... 3. Nature of work (check which applicable): New Building ' Addition ..../~.. .... Alteration ..../"f~. ..... Repair .............. Removal .............. Demolition .............. Other Work ............... i (Descriplion) 4. Estimated Cost Fee ! " (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business commercial or mixed occupancy, specify nature and extent of each type of use ...... 7. D~menslons ofexmtlng structures, ~f any: Front...7~. ......... Rear . .~. ~.." ........ Depth. i~..~.' Height ~.~ ~ ' ............ Number of Stories ....................................................... ' Dimensions'of same structure with alterations or additions: Front . .~../z..~ ........... Rear . fl.. ............... Depth ./.~,F_~..~[~ ~ ~ , ~. i.. Height o~..~. ~. ..... Number~f Stories . .~ ....... -" 8. Dimensions or enhra'new constrUction: Front ... ~.~..... ..... Rear .. ,7.. ~.- ....... Depth . ..~ ........... Height . .JZ.~.. ........ Number of Stories . .,2., .................................................... 9. Size of lot: Front ../r2V..t .... ] ........... Rear.·/..~.. f. .............. Depth . .~,.~O..~ ............... 10. Date of Purchase ........... .................. Name of Former Owner ............................. 11 Zo dist' t' whichp mis itu ted · ne or use tlC in re es are 8 a .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..ff.¢ .......................... 13. Will lot be regraded .... .~.,/2.,! ................... Will exqess fill be removed from premises: Yes,~ No 14. Name of Owner of premises/~rt~'b~t4/;~. ~/t~¢.~.... Address /:~J~. ~'rc/e~r ......... Phone No./']~17'~' ~"~r~A · ' ' Name of Architect . ~.~{~..?~.,. .... · ........ Address .l~i(~ Phone No. (/.itl .~. > ?..l. 7... Name of Contractor .'1PI, .~ ~,K.¢fl..f&/F~/y:)'g..~-/ ........ Address . .ff.c~. 7'.2. .~..~J>~.. Phone No. 7.2. 4..~'4/.f..~ ..... 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ~... · If yes, Southold Town TruStees Permit may be required. ~ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block: mmber or description according to deed, and shg_w.~treet names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ~.S ......~..P'~.~ K '~'/~' '~f'~' '/{' '~'~'~J ...... 'i ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. , He is the ........ ~ ............................................................. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly! authorized to perform or have performed the said work and to make and file this application; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this ................. ....... day of .i, .~. ~ .......... , 19 .~. Notary Public ........ ~.~.'7.."~-'A~-.....t>: ............. ........ iiti HB. EN K, DE VOE NOTARY PU~I~,, State of New Yo~k ,.. No,.4707878, Suffolk;County~-q ;erin ~pkes M~rch 30,: 19 pc,, ~-Tq. ......... ~. .. .~,4~_~__-~_~ I P L, AM, USE IS UNLAWFUL WITHOUT CERTIFICATE ~OLD':ff OF OCCUPANCY. ~uCC~p~/¢ of, j3 17 5 L, ,E,V A 1" I ~ Hl~,,t Hl(,e. H, A PPi