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Home My WebLink About17671-Z PO]!M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ ~ SOUTHOLD, N. Y. 'p BUILDING PERMIT p (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? G17671 Z Date 19(!.x/.. Permissionf here gran to: ~ Q ~o....~~ 6.~~ ..Y,~-.........~q~s~ . r..... ct premises located at ..Sf~..~.~A...L,.~~(t®~.s~r.•~[..I~r{~..~.3!:p.....-:..~A~..1.G~......7~....... ~~if'f.~lP.........~/............................................................................ County Tax Map No. 1000 Section ~~.~f Block Lot No. ~~..1~0.~~ pursuant to application doted .7 15L'~~Gl..., and approved by the Building Inspector. wt ~ D~ / \ Fee f.L.l.J/~ ,1Q ~ \ r B Iding for Rev. 6/30/80 _ r1ELD Z;:S:'ECTiU;7 ~~DATE ~I COMMENTS ~ - m ~ 3 v • H\ FOUtJDATION (lst) FOUNDATIOtJ ( 2nd ) - m~ 2. z ra o ~ ROUGH FRAME & `U PLUMBING 0 4 3. m m H IIJSULATIOP7 PER N. Y. STATE ENERGY CODE x \~I r H e 4. ~ FI;JAL z ADDITIONAL COMMENTS: x ~ ~ ~ x ^o ~ H C O Z x r H Z d ro H BOARD OF HEALTH D D 3 SETS OF PLANS FORMN0.1 SURVEY 2 TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL BLDG. DE SOUTHOLD,N.Y.11971 NOTIFY TOWN OF SO TEL.: 765.1802 CALL QQ MAIL T0: Examined 1~~~ • 19~s4 Approved /.X;~.~ r....., I9~KPermit No. ~?6 Disapproved a/c (BuDding In ctor) APPLICATION FOR UILDING PERMIT Date ...~~:.v27 15 $b 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 azeas, 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 inspector: on premises and in building for necessary inspections. A"b R . Noms.•],rnptewams~.+~- ~xm By;id~i+J;Iwc., (Signature of applicant, or name, if a corporatton) • (Mailing address of applicant) • State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. ~ tld>-r . Name of owner of premises ~QbR`rt....~+'!'Kg . (as on the tax roll or latest deed) If applicant ' a corporatio ig t e of duly authorized officer. ....~i.ca.... . (N an titl of corpo to officer) Builde s License No. 1330, I. • • ,F~.L.... . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which roposed work will be done . . • Sawa ~!1~}:wiN~.S~orss..CaN.d.~'S......~'r!P•. a.7 .............Sod/~,oll~...................... House Number ~ Street Hamlet County Tax Map No. 1000 Section Q.~..f.a0.(...... Block Lot...Con,~v, . ~.y.... Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises~an`d intended use and occupancy of proposed construction: a. Existing use and occupancy ~ R•'"•? b. intended use and occupancy .........5.'?''."•'e• • • • • • • • • • • • • • ,w• • • • • . ~i~~D~r1xa~ ~ ~_Att .8 ~~sdrtis:~e(1 te.iaa' ^ •~zr~m,)^, x 3. Nature of work (check which applicable): New Building Addition ~Alteri<Hon . Repair Removal Demolition Oth~~ s . 4~ cription) 4. Estimated Cost .....l..7QQe .o`.'! Fee . (to be paid on Filing this,application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . If garage, number of cars 6. If business, commercial or mixed occupancy, specify. nature anal extent of each type of use . 7. Dimensions of existing structures, if any: Front . Rear Depth . Height Number of Stories . . Dimensions of same structure with alterations or additions: Front Rear . Depth ......................Height Numbe~of Stories ~ . 8. Dimensions of entire new construction: Front ~ Rear. 7.5........... Depth ...S.......... . Height ...............Numb~r.ofStories.......... 9. Size of lot: Front Rear Depth . 10. Date of Purchase .Name of Former Owner . 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : r............ . 13. Will lot be regraded 3 .Will excess fill be Ty~oved from premises: Yes No 14. Name of Owner of premises Izdbrr"t". $7fir:9...... Address ..$o~ ~ vlr~........ Phone No. X65.- 75 7 . Name of Architect ...............Address Phone No............... . Name of Contractor (~l2-. AY+)d tv.3 ....Address . ......Phone No. `1.7.7.:0 S r5'/ IS.Is this property located within 900 feetyof~tidal wetland? *YSS....1.0.? *If yes, Sonthold Torn Trustees PIAT DIAG_y__be required. Locate cleazly and distinctly all buildings, whether existingRoArMproposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street n and indicate whether interior or corner lot. Sc~ M~ Zx8 j Dist C.c,q. Tn J Fx~sTl w 5 ,r ~cr~ 2x$ Tsces * • G s~C. in ~ ~ a~'d ~IM g ~4xy~ STATE OF NE1Y~(ORCf~ I ~ S.S COUNTY OF ~ilr~l~o 1. ~ ~ ~L • • • • • • • • • • • 'V""(: • • • • •~LGn~ being duly sworn, deposes and says that he is the applicant (Name of indi4idual signing contract) above named. He is the Contrac ent, corporate officer, etc.) of sand 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 ..~aa \,,~~.day of~ 19~~. ~ Notary Public,`~:t1~"~, l 1!.. County l~~~ll~~ igna of applicant) CearnNs~dE~Y s a~7L~ , 5 -o 3-6 _ ~ s'f: ~ ~ ~ ~ \ - M1 t ~ • ~ d ~ ~ ` ~ Z ~A ' o ~ - s. ~ ~ ~ _ a - ~ '1~~~ ~ ~ ~ 4 . ~ ~