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Home My WebLink About11519-Z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 11519 Z Date , ..r.4:C�1.;: ./. ,...��?.., 19.(F� Permission is hereby granted to: �,o� P24 _...._. to ...... ..... ............................................................... ..---................. ................................ ........................... ..�'�x......�.� �.............. 1 ! ..(. Yv z.5..L................................. C at premises located at ...-3Z.�`C�......�.Cz .E74r�..1../?-10..................................................... ........................................................................................................ ................................................................................................................................................................. GG ........ Lot No. ......�...... County Tax Map No. 1000 'Section ......�1..l..�.... Block ........�.�..� ••!�!'G pursuant to application dated C=..............` .................., 19(�` ., and approved by the Building Inspector. i�el��'I`-1-- ov vn5,cr r,,:g-q LA d Fee $.(..................... .. .......... .. .. . ............ Building Inspector Rev. 6/30/80 FIELD_ � SPECTION DATE COMMENTS - { H � H _ FOUNDATION Ln FOUNDATION (2nd ) rq _ 2 . z o � Q1 ROUGH FRAME & E/1� PLUMBING y C 3 . x' � U INSULATION PER N . Y. y STATE ENERGY CSODE x a � r FINAL 0 . z ADDITIONAL COMMENTS : c, v H ' H H 4 0 0 - x a H . x d - H FORM NO. 1 •• TOWN OF SOUTHOLD BUILDING DEPARTI`dENT TO',,'%,' 1 HALL SOUTHOLD, r-.i.Y. 11971 TEL.: 7G5-12021 Examined .C,. . ` . . ., 19 f Application IVro . . . ..i . . .'. . . . . Approved . . `C . . ., 1 s4 . Permit No. ll f✓. � Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. ` . . . . . . . (Building Inspector) .l APPLICATION FOR BUILDING PERMIT Date . � ��. . . . . . . I INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Build Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan slrowing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giving a detailed description of layout of property must be drawn'on.the diagram which is part of this ap cation. c. The work covered by this application may not be commenced before issuance. of Building Permit. d. Upon apprc-.-al of this application, the Building Inspector will issue a Building Permit to the applicant. Such per shall be kept on the premises available for inspection throu-hoot the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupai sliall have been granted by the Building Inspector. APPLICATION IS I-IERE13Y MADE to the Building Department for the issuance.of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinance; Regulations, for the construction of buildings, additions or alterations, or for removal or demolition., as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code and regulations, and admit authorized inspectors on premises and in buildings for necessary in ecti ns. . - _ . . ... . . . . . . . . . (Signature of applicant, or name;lif a corporation) (Mailing address of applicant)% State whether applicant is owner, lessee, agent, arc'iitect, engineer, general contractor, electrician, plumber or build AJ. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises � �'�1 P 5 �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F�est (as on the tax roll or la deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oame and title of corporate officer Builder's`Li"cense No, . . , , , , • , , , Plumber's License No.. . . . . . .�! . . . . . . . . . . . . . . . . i - Electrician's License No.' / . . . . . . . . . . • , • , , , , • . Other Trade's License N'o. I. Location of land oil which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 6 '. . . . . . . . . . . . . . . . . e . . . . . . . 449.-. . . -. ..-... . . . . . . '�. - ( . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . .0 :(: . . . . . . . . . . Block . . ..� . , . . , , , , , Lot . .0 . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . .- . . : . . : Lot . . .—. . . . :. . . (Name) 2. State existing use and occupancy of preinisos and intended us- and occupancy of proposed construction: a. Existing use and occupancy • . 7. . - . low. . =- , Repair L? . . . . . . . . . . . . Rer�ovzl . . . . . . . . . . . . -li�I110i1i.0I1 . . . . . . . . . . . . Other '►y'orh _ (Description) EstivAi-A cos#-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) i. If dwelling, number of dwelling units . . . . . . . . Number of dwelling units on each floor . :�. . . If garage, number of cars -` .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i. If business, commercial or mixed occupancy, specify natu�nd extent of each type of use :776-L. . . . . . . . . . . . . . �. Dimensions of sting strictures, if any: Front . . . . • ✓. . . . . . . Rear . . . . . . . . . . . . . Depth , . . . . . . . . . . . . . Height . . ._ . . . . . Number of Stories . . . . .— . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . Depth . . . . . . .. . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . .. . . . . . . . . . . . . . . i. . Dimensions of entire new construction: Front . • . . ... . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . .. . . . Height . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ). Size of lot: Front . . . .v�.V. :. . . . . ... ... Rear . . . . : . . . . . . . . . De tlx � . .� �. . . . . . ). Date of Purchase . . . . . . . . . . ._ . . . . . Name of Former Owner �! i¢�. �P/1t S:�!i. . . . . . . . . l. Zone or use district in which premises are•situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ?. Does proposed construction vi late any zoning law, ordinance or regulation: . . .1... . . . . . . . . . . . . . . . . . . . . . . . . . 3. Wil].lot be regraded 0�/�� . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes N I Name of Ovmcr of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. : . . . . . :. . . . . Name of Contractor . . . . . . . . . . . . . . . . . .. . . . . Address . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions fror roperty lines. Give street and block number or description according to deed, and show street names and indicate whethe :tcrior or corner lot. ucens � _ c 11—O tt TATE OF NEW PORK, OUNTY OF . . .V 5t=X 4--K. . . . . S.S gg��-eg, • • • Cy• • • • /� S . . . . • . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applican (Name of individual signing contract) )ove named. eis the . . . . . . . . . . . . . . . ... . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi ?plication; that all statements contained in this application are true to the best of his knowledge and belief; and that th •ork will be performed in the manner set forth in the application filed therewith. worn to before me this . . . . . . �� . . . . . . . .day of. ChI . . . 19fj otary Public, tr�f�f;• '� . . . . . . . . . . . . �" NOTARY f U "C, State of New York �Qualif�Cd.m Suffolk County; COmMj_q_q nn'Frnir Rllarn6 on ,nu 7/" - "