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Home My WebLink About22936-Z FORM NO.3 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) Date .... ../ .............................................. 19.11 N? 22936 Z Permission Is hereby granted to: ,333... e�7 .. .. J••••................. toy .. ... .. ................ . •'��(`GZ " ` ....I. ij llY7•• / ! ....�°�.........4.......... .. ..,............ ................................................................................................................................... ................................................................................................................................... ...........................................................................�.,.. at premises located aT........y.. .�....../.......�... .�.o ................................ ..................................................... ........ .. '•• .......... ............. y... County Tax Map No. 1000 Section ..... ... ........... Block......�................ Lot No. .............�..I ....... pursuant to application dated ...... ............................................... 19.. and approved by the Building Inspector. Fee 5.. . . . .......... /-�....................... ......... ... V0 — E Bulldinginspector Rev. 6/30/80 *�OF SOUI�O* TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE 1SAFETY INSPECTION REMARKS: due (ZieCAZ101SrY- &Vd-at - Co -;-L3/l55_ 6 DATE s�� INSPECTOR ✓ r FOUNDATION , ( 1st ) FOUIJDATIOIJ ( 2nd ) —I — 2. o^ ROUGH FRAME & PLUMBINGEF y yo 3 . m m I1ISULATIOPI PER N. Y. I ,, • • '� �_ STATE ENERGY - I i CODE 4 . —� I,' AL � * ADDITIONAL COMMENTIS : I4 5-2-3-o C O ism (� r �x M (� _ 9 V 5- , i l - 'Yl rte' m a • - y V O' m y ar,...wa.. �,>-;:ave.-.... ► ...,......- ,. � ;...;: ..,.., ..,,...,,s.:.. a.sis SWjy�. 2 2-9 3 (o TOWN OF SOUTFIOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: C � DATE � 3 � INSPECTOR BOARD OF HEALTH .✓ . . . . . . FORM NO. 1 3 SETS OF �L.1YS . . . . . ... . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . 'A'Y3 BUILDING DEPARTMENT C11ECh . . 3C'_ . . . . . . . . . . . . . TOWN HALL SEPTIC FORK _ . . . . . . . . . . . . . ` SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:0f I Flf �„ Y ly �r � CALL �5��' oC. Examined 199- S, t1A i L TO . • . . . • . . Approved . . . . . . . . . . . . .I 1¢� Permit No. . . . . . . . . . / . . . . . . . . . . . . . . . . . . . . . _ _ . . . . . . . . . . Disapproved.a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4� 417 ildi spe APPLICATION FOR BUILDING PERMIT Date . . . . . . . . .. 1(RC3 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 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 of 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i ections. ( ignature of applicant, or name, if a corporation) X53 0,L r-> 1:�tct 2D E- &l1oprc- (Mailing address of applicant) i\.•Y 1117-31 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. �ju�N ElZ ( NEw. . . . . . . . . . . . . . Name of owner of premises . . Y'!��'e�l. . . . � � 1�f. . . . . . . Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporate n, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. . . . . . . . by . . . DI`3'1� PlUmber's License No. . . . .'. . . . . .h' n'?`C .C.J, 1r &),Gr'pQ J Electrician's License No. . . . . .dG Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-a 0o P► N er N cc K R11JD � c y-r--> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . Mouse Number Street Hamlet //�77 -3 �Q County Tax Map No. 1000 Section . . . .7o. . . . . . . . . . . . Block . . . . . . . . . . . . . . : . . . Lot . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . I . . . . . . . . . . . . .....elf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . . v 51 � .�.�-. . . . . . . . : . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building Addition . . . .t. . . . . . Alteration . .t� Repair . . . . . . . . . . . . . . Removal . . . Demolition . . . . . . . . . Other Work . . . . . . . . . . . . . . S � $ (Description) 4. Estimated Cost y . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . If garage, number of cars . Number of dwelling units on each floor . . _ . . . . . . . . . , •� • ' ' ' ' ' • ' 6. If business, commercial or mixed occupancy, specify nature and extent of•each Ipe of use 7. DimensiorT.Qf 1 existing structures,if any: Front . . . .4J.5.-LC; + Rear ,�0. gI n Hei ht . . . . . . • . . . . . . . . Number of Stories . . . . . . . .� I • • . . . . Depth . . Dimensions of sarp.e structure with alterations or additions: Front J1 ' Depth . . . . �O—. . . . . :QI.—� . Rear . . ��—.4? .I. . . . . . Height Number of Stories . . . . . . . . . 8. Dimensions of entire new construction: Front `s Ream;-.�, , , , Depth . � - v �� Height . . .1 ... , . Number of Stories . �; ' ' ' 9. Size of lot: Front . . . . 1�.AQQ. . . . . . . . .... . . Rear . . . . I Q 3. .4Jr: . . . . . . . . Depth 1¢rJ. . . . . : . . . . . . . . . . 10. Date of Purchase Name of Former Owner ' 11. Zone or use district in which premises are situated . . . . . . . .D,7Ttzt �,1, l c� 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . .!�- 13. Will lot be regraded `P . Wille ce s fill be remov d fro re 14. Name of Owner of premises;C1� ��US� Yes N Name of Addre ` 3 .� ! �. '7 '?.�4a1�. . . Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Addr ' NQ.'�"►`�?�' . Phone No. Name of Contractor . . " " ' " " ' . ' • . • . 15. Is this ' • • • • • • • Address . . . Phone N . . . . . . . . . . . . . . . property within 300 feet of a tidal wetland? *Yes, , , , , , , No- . � *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or,proposed, and,indicate all set-back dimensions from property lines. Give streeeet an Nocck number or description according t �deed, and show street names and indicate whether interior or corner lint- NEL i EEK IOD i V 2A,o o ��Ow tJ' a STATE OF NEW YORK, COUNTY . . . . . SS being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . . . . . . . . . . . . . . . . . . . . . . . . . - �M O-Lj�j� : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 beffore me this qday of. . . . . .3. . . . ., 19i�� 4Notary Public, . . . . . . . . tIEE-t—L- arolr��.\. . . . . . County Q10YARY PUBLIC, State 1 New York No. 30Nas n018 / .,� Qualified in Nassau�� _ . . Commission Eapiras � 7 . . . . (Signature of applicant) 14a- ACRE �. r N- -ro &SACH 77 it Om 4 Uf-.a,rt'•-,rt?M a erasion or ec�driiod .7 i Ar to th•ti lvrvev,, a viclx6on Q� ` i Sarrro�729 the New Y Etats t t Cx es of this urveY ttNp f+oe the tapd sury of s traced acus P.�o,�ER r Y to be a vm Ln 'hal Y. be to be a vnt+d us oof+r. Gkrarente" �ptrd•11i1b11t P=1 to the ott tot vrlmnl l+he Sw W" '/� � •.„ eeSv:-� M hia haktW 10 trb I\lz ter• �, ':etittAien lialaa MfartiAfl lits l — aiiJQnM+t of the lodr1Q kv,4' W's are Iml Srwak•"a A 7— to t Souo�_ o, N. Y. cod, `%err 4-- ,, °' �!_c�f:!Cr 7 `�� cq,. r M o- �;llY Vf y�r� � r tog c 7a leenr;ed Zan L/ rt3 • d _r'. tl�tj .lCtIJC�Jd 1�r''�+;- QQOl 1(l wit �!AGK t�o� `► ' co 311 04 t L 4200 Imo' t- I4�� fC'Ir/ a 1,51-6 pkT. I -O Ir 4 9's ecx TjrM'- Tr— IrLf 04 40 Ar- _ , ll of rc .10 } `. Js OCCUPANCY OR USE IS UNLAWFUL • t�- tom-, � � — � � tiJ WITHOUT CERTIFICATE OF OCCUPANCY � - __ — - - _ — __ _.� r __ .-• - - _I l .....-._-_- --___._..._.._ •--_ 4l�f lam) 2x !%�T�.�c'�=� �`�"`�� 1 1 c� -#�z , -.-L.,J_ I A 0 RED AS NOTEDFit { 7r BY. j ; � O� r� lFv !�#G DEPART AT ; �'' s 785-180 2 S AIS! TO # PM R THE { 'Z)to F J,O i { M vt c .! �_ i '- � i FOLLOWING INSPECTIONS: Icy,, a'~• � { � � � �� # 1 1 EREQUIRED FOR POURED CONCRETE } -- ^ — �} t"1 _ s # •5�j 2. ROUGH - FLAMING & PLIIIVIEIi�G # t � vffv � I ' 3�� 3. INSULATION } FINAL,L �;ONSTRUCTION MUST 4.s s BE COMPLETE FOR C.O. w } t ALL CONSTRUCTION SHALL MEET # THE REOIUIREMENTS OF THE N.Y. I I — — STATE CONSTRUCTION & ENERGY G — { CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. Fc u N fD,4,T,1 0 tom! UNDERrYRITERS CERTIFICATE F=1 ._. REQUIRED