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Home My WebLink About17142-z Fosas 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 ~ 01714 2 Z DoteG%~~Zrl~...........a.~..~ 19.1~~ Permission is hereby granted to: .p...L~,r.:~.........7..:..5..-.~ . ',~ir~ ~~a ~ / ct premises located at .......~./7'~./~.Q..~,IG*aA~•-/:zf/Tf+~-4•......~.,~/~•4•• ~/..../..li!.~~.?/~j........ ~./....~......d. 1 Caunty Tax Map No. 1000 Section Block Lot No p (9 pursuant to application dated G/~arf~+~ 19.CT.G'j and approved by the Building In~~s^^p''ector. Fee $:.o~sl..~..a.t~... Building Inspector Rev. 6/30/80 r ~ °=a °'°~"4 BOARD OF HEALTH D ~~~(~~~?~~~`~+~I" f ie 3 SETS OF. PLANS • • ~,K..,.......w,d....~ ~ FORM NO. 1 SURVEY q' r~ ~ i TOWN OF SOUTHOLD CHECK . . .~/l' J OI98S y BUILDT (~DEHARLMENT SEPTIC FORM ,...,~a.a.- ,.w ~w' ~ SOUTHOLD, N. Y. 11971 BLDG. D4Cf. r NOTIFY TOW{V OF SOUiNOt.D„~,_,,i TEL.: 765-1802 CALL C/'~iLra,L ,~5~..., 19 ~ MAIL T0: Examined , rlpprovedG/~iL!YSI..~.~..., 19~~7Permit No..d .l.(.. % v~ Z Disapproved a/c (Buildinglnspector) APPLICATION FOR BUILDING PER1411T Date ..~ot Vie. 15~.~ ~CE INSTRUCTIONS 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 the 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 4f 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 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housinti code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins ections. (Si ature of applicant, or name, if a corporanon) ('0 ~ 7S7 ~rrexf.l~~Ctgi~.. ~ X (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. gip. -0wtit r' Name of owner of remises ~ GT6'P.'E'~.'t 1 • ~1~!?P~...... r ~W~.Se-~. p .............i.•.... . (as on the tax roll or latest deed) If 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 . . 1. Location of land on which proposed work will be done. PN. ~ 7 Flouse Number Street Hamlet County Tax Map No. 1000 Section Block Lot . '3 ..............rte............... Subdivision Filed lvtap No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy ...'r....... P ( applicable): New Building Addition Alteration . Retair of work check whiRemoval Demolition Ot110r I (gar .~FNCE _ . , .at9 ~b Description) 4. Estimated Cost ...3°.r?.. Fee . 5, If dwelling number of dwellin (to be paid on filing this application) g units , , , , , , , , , , Number of dwelling units on each floor . . If garage, number of cars : . . . . r 6. If business, commercial or mixed occupancy, specify nature and extent of each t ypeofuse " 7 Hei~htsions of existing stru Nu es, if any: Front , . , , ; , , , , ,Rear , , , , , , , , , Depth . tuber of Stories . . . . Dimensions of same structure }vith alterations or additions: Front c th . ...height , umber of Storie Rear . /ea ~ Height • , . • • `ruction: Front ,/.Sgt , Nu "1• • s";'"'• `''fiber' ~'e?.?.~~~...... . 8, Dimensions of entire new cons nber of Stories . . ~ • • ' ' 9. Size of lot: Front ...4,(et$.. 1, ; Rear ...1!'3r,~ Depth ...L~C>7 ~ . 10, Date of Purchase (a$ ....Name of Former Owner .4g1ah~l~,,Et Loc.ea~~05... 1 I, Zone or use district in which premises are situated ,'~t~~elew~•,:.1 • 12. Does proposed construction violate any zoning law, ordinance or regulation: . h4 . 13. Will lot be regraded N1°........... Will excess fill be removed from premises: Yes o P D. 14. Name of Owner of remise ~tat~'~J. sWp.~Sq r,,, ,Address ~uK7S.7..P!?~~', , , , ,Phone No. 3$.(0~. . Name of Architect • • Address ...................Phone No. er 734 Srf48. • ante of Contractor . IS.:Cs this ro ert loc If es Southold Tow ' ' • Address .......Phone No * ated within 100 feet of a tidal wetland? *YES....NO.... Y .n Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly al! buildings, whether existing or proposed, and indicate al] 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. ~ Sao Ewa .u-~{~~.~. w..[ Ju foo' ' .(tie- (rN.u fe«u rv 5~o`.e~ C(~'A~J 36o r C So ) }~MrM 1200 ' Si F,F ~ ~ ~ , ~ ~ STATE OF NEW YORK, COUNTY OF S'S b • ~ ` ' ' ' ' ' ' ' ' ' ~ . , . 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 contai~ied in this application are true to the best of ]tis 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 . ....day of , 19~~r, Notary Public, 1`h-~ . ~ ,~U. (J,.~~ County DEVOE HELEN K , N0TIIRY PU%LIO, State of New York . No. 470187%,iSoffolk0ounh~ (Signature of applicant) Term Expires MArck 30,18...- /