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Home My WebLink About17137-z gosas xo. s 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 fl ~ 1713 Z Z Dote ~kf~-....~..t 19..Gi.. a Permission is hereby granted to: ACdIK_-o~ ~ iV. . ~ .r ' ^ to . ,~Q~. ~iJ 2 ,p~ ct premises located at ..~.ai.~.~.~......~Qh.'.1....I'.:41.,....... Caunty Tox Map No. 1000 Section ......C',?.~?.../...... Block .....o.~........ Lot No......s~ pursuant to application doted ......~..~I.ti....~.~~ 19..8., and approved by the Building Inspector. Fee . uiiding Inspector Rev. 6/30/80 j ' BOARD OF HEALTH n FORM N0. 1 3 SETS OE PLANS . V SURVEY ? U ~ ~ ~ ~ ~ TOWN OF SOUTHOLD CHECK • • •'f . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY BLDG. Derr. , SOUTHOLD, N.Y. 11971 CALL • • ~~-j - • z ~ ?IDWN UFSOUTHOLD TEL.: 765-1802 ' ' ' ' ' MAIL T0: 7~ 1~. Examined .~.<.!~na-?-1..., 19 Pg 4?~'_~~-~'~ ~ ""~erV~L~ Approved . ~,t..s~x. 19~'~. Permit No. ~ 7 ~ ~.~.Zti. C~r/~~r Disapproved a/c ~v .a -o .e.~ a..~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19 INSTRUC"1'IONS- 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 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- ~catio i~1~11CiMEiFi'dAil~ e~ov~~~ppl~~ion may not be commenced before issuance of Building Permit. dg~ oi~y~s rppjj,Q~ the Building Inspector will issued a BuIlding Permit to the applicant. Such permit shall]~~cep~~$;evanla'8ile~Kinspection throughout the work. e~~*~Tq;)ilt~d~Sg~~all,rbe;occupie~#i~.used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildiyyn~~g~~ Inspector. A~'P~,ICATION IS HEREBY FADE to the Building Department for the issuance of a Building Permit pursuant to the Buildjng.Zone Ordinance of the ~~Wn of Southold, Suffolk County,~New York, and other applicable Laws, Ordinances or Regulations, for the, construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to complyt~ith all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premtses and in building for necessary inspections. .*3 k r ~ c.~~~v.s.~'1°. ~er.<ru.... ~sft~xra5........... st~i (Signahtt~f applicant, or ne, if a corporation) I, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ~~.~.z..,-: a. I ~.c. nor. ra.rsr'.a Y :.......................9......................................... . Name of owner of premises tn.-7.1.'S ....~4~ ®.71 . (as on the tax roll or latest deed) If applicant is a corporation, signature of 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. ~ir........ . 1. Locyaytion of land on which proposed work will be }done. ] . House Number Street Hamlet County Tax Map No. 1000 Section Block Lot . Subdivision Filed Map No. Lot..............: (Name) 2. State existing use and occupancy of premises andlintended use and occpupancy of proposed construction: a. Existing use and occupancy .~1~.n. P. n . Et~R.S w . o. d'.. ~j ~ ~ ~ 1 . II JJ .i.v~t.. v.rs7.h.~.c~~.~~n.ca1:.. b. Intended use and occupancy C.~a!~~• a..,..l~raG.KS i • ~•~•t•h• J 3. Nature of work (check which applicable): New Buildin Demolition .Addition : `I~ Other Work atr D S Repair Removal ~ ~„2 , , , , cription) 4. Estimat~d Cost ~ .a p. CJ Fee O U..................... . ` (to be, paid on filing this application) 5. If dwell ng, number of dwelling units Number of dwelling units on each floor . If garag ,number of cars i, 6. If burin ss, commercial or mixed occupancy, specify nature and extent of each type of use .C:Qm.n??: F.G d rw,.l.. . 7. Dimens ons of existing structures, if any: Front ...............Rear , Depth . Height Number of Stories ~ Dimens ons of same structure with alterations or additions: Front Rear Depth . ....................Height Number of Stories Dimens ons of entire new construction: Front Rear .......Depth . Height ...............NumberofStories...........................f....................,....... 9. Size of ot:Front Rear ......................',Depth 10. Date of Purchase . . . . . .Name of Former Owner , . 11. Zone o use district in which premises are situated i . 12. Does pr posed construction violate any zoning law, ordinance or regulation: N.~ . 13. Will lot e regraded Will excess fill be removed from remises: Yes No 14. Name o Owner of premises.-e~.v. ~ 5.o rti ...Address )~,r,~.~„~'os{~ one No . Name o Architect Address ~ ....Phone No . Name o ContractorSe~~, r~T .~~.nc,c,~~ stetv>_SAddress~3ay~55:' ~ot-T.r~a~~ Phone No. '.~F+a~.- ~.S~Sr.O. 15. Is thi property locate~ithin 300~feet of a tiidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO~ DIAGRAM ed. Locate c early and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property line .Give street and block number or description according to deed, and show street names and indicate whether ,binterior or comer ]ot. ' ,x "t''~ASNd'• ~ I fa?.•.;_ 1 I 7~ 4.l'~~~~. s rim ~ ~ I , FEf3 emu' V L . NOTIFY BL)tt C)~„ ~'nA~MV ~ ;~1 - 785~ i~ifr? aM FOh _ ~ , Fou.tr~wm,r ~nr3~~ +5; _ t. Fpl~~t~.ano~ ~REgw,...~~ fQR f'OURiU CG::.,.:7E 2. AOl1~GH FRRtdl/.~ rt, PUIOABfP.,~' ~ ~ 3. INSULATION _ ^ ^ ~ .~~~rod, rn«rc~) e„ frcr- 4. FIN~'t - COMS't'Kkt!~"*^ONMUS'r t I_ BE CQMPItTE FOR C. O _ ~ ~'~~o~~ `J' ALL C' NSTRUCTiON SHAT-E MIST Q o'~ K GuS-Io,,i wQr,~ ~•ehL~v,~ ~ -THE #~WJIRENIENT>j 0~ THE ~Y. J ~.J >13TAF'E ~"EN"~N, S ENER~ A ~ oh~ ~ ~.r.K r ro~tir-r L~\ y • ~ i I 1'S O VTPi ~ O ~'i STATE OF N$W YORK, S S COUNTY OF,................ . •••••••••••I•••••••••••••••••••••••••••• g y , pl~sesandsaysthatheistheapplicant above named. • • ' ' ' ' ' ' • em u sworn de o, (Name of individual signing contract) He is the (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 contained in this application are 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. Sworn to before me this ,r _ Not2ry~Pu~~~'~..~.7.'<<..~~:.'!~.°-..... County ~I 5, ~~,IIEi`I Kggb~~E loV ~wY~ i (Signature of applicant) ~ No.A701f178,Suffolk0au~ ~s ram ExWrea M,rcn 30, ts..,~/