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Home My WebLink About23888-Z FORT[ NO. f 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° 23888 Z Date ....OW........................................ 19Af. Permission is hereby granted to: . .ter........ .... ......�.. ... .: .::..e 4 4- ........................................ to . ' .: ��...... . ' ..... ... . .. ..✓.' . .. .............................. ... ... . . .. ..:...................... at premises located at ...��.. ►��. .... . ..... ..................................... ............................................... ...C :.L . ................................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section .........fU.��..... Block ...........:....... Lot No. .... ...2........ pursuant to application dated .............. 7......................., 19,44-., and approved by the Building Inspector. FeeS..`.. .. .. .... 7� . .. .. ..................... Bu ng Inspector Rev. 6/30/80 z sti P z Tadt Environment East, Inc. 3075 Indian Neck Lane P.O. Box 190 Peconic, New York 11958-0190 516-734-7474 ,38�S5 - �c17-c ti to Vill � - D r—IELD—INSPECTION—REPORT COMMENTS==_== — _=____=______________________ F-0UNDATION ( 1ST) u I n 2UNDATION (2ND) u u u n Z u { I � � ROUGH FRAME & ITS if PLUMBING n u n ZuSULATION PER N. Y. ;! u n STATE ENERGY CODE if II n I if n II U II II 11 II I'i 11 II p II II II ii ' II FINAL II ii ADDITIONAL COMMENTS: I z I I i i I - I z I I BUILDING DEPT. INSPECTION [ZFOUN ATION 1ST [ ] ROUGH PLBG. ATION 2ND [ ] INSULATION Nfi [ ] FINAL REMARKS: h�, DATE l -INSPECTO BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CIIECK . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 N GT I FY Examined . . . . . . . . 19 9 .� CALL . . . . . _ . . . . . . . . . . . . . MAIL TO : Approved . . {/ . . . . . . . . . . . . . . . . . . . . . . . . ., 19�. Permit No. Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . _ (B ildi , Inspector) 1` $� APPLICATION FOR BUILDING PERMIT Date . .. . . .��.. . . . 19 1� 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 inspections. i09��?oN.M !�!T. . . . . .INS. . . . . . . . . . . . . (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 L. ,5 P A Q, J: . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If ap ican"(Name t' natur of duly authorized officer. and title of corporate officer) Builder's License No. . . .r�'S. . . . . .� , . , , • , , , Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . .r2,-155 b. . . . . . . . . . . . . . M �,,► �d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cu-. . .oto �. . . House Number Street Hamlet County Tax Map No. 1000 Section . . . 1 d. `p. . . . . . . . . . Block . . . . . . ? . . . . . . . . . . Lot . Subdivision . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot (Name)i . . . . . . . . . . . . . ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . �-.k$RhR`f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . L-I RAC R,t, . , ,y�l.� , E*I,&R. . „ 3. Nature ofwgrk (check which applicable): New Building . . . . . . . . . . Addition Alteration Repair . j/ Demolition Other Work TO RePAvk ext5Tti.16epORCt+/6+ovP 'pri• •r4ov'r•l 5[pE OF OL4> CCAURccc-t EC_.t'" escr . . . . No 1NCr'eAsE IN Se2E -'iusT e:pht-tL OF eu-sSTw6, ,�/_ (Description) 4. Estimated Cost . . . . . r7t- -e.err! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee (to be paid on filing this application) 5. If dwelling,number of dwelling uni�sl./.'`�.. �• , , , • , . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars . . . . . . .�!6 , . 6. If business, commercial or mixed occupancy, specify nature and extent of each type.of use . A-1 a,IzAe-Y; ' ' ' ' 7. Dimensions of exi4ing structures,if any: Front . . . 3 '-. Rear . . .3.`.I': Depth . S Height . . . .(-'.5. . . . . . . . Number of Stories . . . . . . . . . Dimensions of same structure with alterations or additions: Front j�q�•CF(, ti1E Rear Depth . . . . . . . . . . . . . . . . . . . . . . Height . Number of Stories . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . Rear Depth Height . Number of Stories . . . . . . . . . . . . . 9. Size of lot: Front . . . . . .I.:�.� . . . . . . . . . . . Rear . . . . . , tj . . . . . . . . . .Depth . 417. . . . . . . . . . . . . . . . . 10. Date of Purchase . Name of Former Owner 11. Zone or use district in which premises are situated . . . . . .t;Omm la 2a C.tAL- 12. Does proposed construction violate any zoning law, ordinance or regulation: . . 13. Will lot be regraded . . . . . . .N.p. . . . . . . . . . . . . . . . . . Will excess fill be removed from premises. • • •Yes • No 14. Name of Owner of premises CI?T:. FRS •14t3.i h XAddress Mc C� N ,� Cufr,.kq j� Ph • Name of Architect . . one No. .1 3 4"�3.0-�� Name of Contractor Cl1. . Eb N ' ' ' ' ' ' •Address . . . . . . . . . . . . Phone No. . Address ?M('LQ-fRC Df4<4 . . . Phone NoTM.-.I.` .*i; . 15. Is this property within 300 feet of a tidal wetland? *If yes, Southold Town Trustees Permit may be required. � � � ' • No. . . . . . 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. TATE OF NEW YORK, As . . . . . . . . . . . . . . . . . (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant ,ove named. isthe . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, gent,corporate officer, etc.) said owner or owners, and is duly aut o 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 =irk will be performed in the manner set forth in the application filed therewith. .orn to before me this . . . . . . NA . . . . . . . . . .day of. �. . . . . . ., 19 Mary Public, G,l.�?L-- . . . . . Cou ty`� ELIZABETH ANS!NEVILLE . . . . . . . . . . . . . . . Notary Public,State of V Avv York (Sign of applicant) � No. 52-8125850,Suffolk Co Terns Expires October 31, 192 j ;'--X tS7 �-iG • 1 Coq J O l S7S- T Ec o TO m i , to QRpr t''��U b. I S• s J uv C L3T70 OF THE ST'►•tE��