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Home My WebLink About21102-Z FORM NO. f TOWN OF SOUTHOLD BUILDING DEPARTMENT \ TOWN HALL \\\Ifl SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) WN° 21102Z Date ...111ASS 119 E4- Permission is hereby granted to: ~s~...... ,P.`.-.......... Q ; . . . . . . . . . . . ` . -e to. ~ at premises located at .....n2.. A........ J...I.Q~................................................................... . County Tax Map No. 1000 Section Block ..,7 Lot No.Z~ pursuant to application dated ........ll.1z7 19.(?..? and approved by the Building Inspector. Fee i..~ BullI I or Rev. 6/30/80 lELD L:: ~~J ~i4i•1tNi~ Qp I mOx OUNDATION (1st) OUNDATION (2nd) a' TOUGH FRAME & -PLUMBING y n =IlSULATIO;t PER N. Y. I y STATE ENERGY CODE m a ~ FIaAL I\w O ADDITIONAL COMMENTS: s ' x \ b a ` a Fi • O m v -v a BOARD OF HEALTH FORM N0.1 J SETS OF PLANS Mm' TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CHECK NOV 1 ^ `nr0 TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 _ TEL.: 765-1802 ttO 74~:~~ C ALL Examined ./•,r/. , 19 ~~z P TO: Aee Approved 19P. Permit No.v-P//O . Disapproved a/c :.............G , (Bu'ding actor) APPLICATION FOR BUILDING PERMIT Date 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 insp ctions. ~c......... . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises o6e~ .7hP~G SG2..... . k&' . (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. NEf Plumber's License No. . Electrician's License No . Other Trade's License No . . 1. Location of land on which proposed work will be done. ~ w~..... hie. SOGL10/CL House Number Street p Hamlet p County Tax Map No. 1000 Section ......-`"9....... Block .....Q L.......... Lot ...~~1 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 ra m! it lvu 5 Intended use and occupancy HE )s 3. Nature of work (check which applicable): New Building Addition_ Alteration " Repair • • • • • • • • • • • • • • Removal . Demolition . . . . . . . . . Other Work . ~ 4. Estimated Cost (Description) Fee ...~.4r.... . (to be paid on filing this application) S. 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 and 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 Number of Stories . 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stones . 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 : . 13. Will lot be regraded Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Address Phone No............... . Name of Architect Address Phone No............... . Name of Contractor Address Phone No. 15. Is this property within 300 feet of a tidal wetland? *yes;,,,,,,, No......... *If yes, Southold Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all 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. AZIO-L 5006~ AP 0 AS NOTED DATE: ~-g B.P. Jt FEE. UY~ NOTIFY BUI DIN B G DEP.q 0i, 785-1802 A AM TO a PM F T AT f a s~ t t ,4g. OW'IN6 tN r ~?.CiE }~.:c OR THE `4.. r _4~yy Y it p qg i. if)!Ifl~t'>ntl. i U, w 6,}4~fri"i fnFS l~I~..iit wrn '!cinE:~h 2 NO K)Clk ,~1~ ~"ri' •4.] Y 1 t rt. k ~.!'~'i h Q. FINAI. CONSTRUCTION M a t BE COMP UST LETE FOG C.O. p, ALL 1~, 77 r ¢ tea THE CONSTRUCTION SHALL MEET r STATE CONSTRUCTION OF OF THE N.Y r CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS -TATS OF NEW Y R1 ~ S.S :OUNTY OF . I ( Q r•~S•C • • • I e r being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. 'e is the a W" r (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 this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. worn to before me this 1 I . ...day of.. ~1..., 19TC otary PubI C ECounty CLAIRE L GLEW Notary Public, State of New York J~vO . No. 4879606 " ic " • Qualified in Suffolk County (Signature of applicant) Commission Expires December 8,19.x/ SUFFOLK COUNTY HEALTH DEPARTMENT J eP se's P~l`C~ °°/~oF opt SINGLE F LY DWELLING ONLY o^ H.D. REF. NQ. A- 'IV DATE FEB 111947 v eti N o^'~ - THE SEWAGE DISPOSAL ANiT'IMATER SUPPLY FACILITIES FOR THIS y h y. e'er vp \ LOCATION HAVE BEEN IN`PECTED BY THIS DEPARTMENT AND FOUND TO BE S TI`SF GTO Y. f s e 0° Flo °^Cq Chlef of aSte ter Management Section ro 0, ' ° , 9^ LfsA :r' y SQi °F 3 s 9 TEST ROLE 0.0 n,• p rov soil ° ^ OJ !M1•v 'L I F p^ MARL rIy A l ytsv 'L`•, 4~ MARTEN i1.3 Q iQ/ ~Q O \ 4O SAND " 1 / 1; I Or 14 0 r O 1 ie O ~nn,l O OO. .s. op SO,-O(a O/O' R 1 OCS REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK I IEALTH DEPARTMENT-DATA FOR APPROVAL TOCONSTRUCT - ALDEN W. YOUNG HOWARD W. YOUNG vOO.uu°N.L c«ar«Ef1, AHO LANP.ullvnP• Al i t `SONDE" R WATCR. A- i LOT DIEPU_ L.N° SU.rIVOM. N.C•. LIC N°. Ia... I. LIC, NO..IO) f •M MIFF DO O T.. M I IREAC. DWELLINGS WITH Ioo r[p OF IN 0009_ E OE NO O r THIS v[vERA• SURVEY FOR: RNLI THAN EM TROPE E SHOWN uEREON _I wuiWMU[D .LII . . M .DDiuax r 414 WATER SUPPUEND SA STSTEINFOR MA RESIDENCE A FIGOF n . I... U. 4[ RRiOx FILLEONF D«ro[w TO rN(~PTMrENDaROS DISPOSAL ROP OF oF r THE SUFFOLK VfOLN C°UNAr DEPARTMENT 1iD. OF •xI rrr im[ ADxunox ROBERT WALKER 9 THERESA KEIRv~ PINK PINK Or MLLLrN SERVICES. P S A u[uuwr PAD L -t+~ C~ k Enas DA ,x° wMr[. P. xvI sL..ix• H IY mo[Ety ..w sunr[.oAS ~.m su, w O~ 'p us»nD uE. Pr„ oxs.Drrrm L uL .1 TEL TO K A rWD I u[ en AT GU N TEL SOUTHOLD R BE T a T [ L _ W...n[[a x uIm .umn sxn. I,ux Fl ST MER TLE C - - _ m,u yr L[ x r.r xw. TOWN OF OnI ITWn1 f1 an tq i n C en v