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Home My WebLink About23453-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./..r NP 234531 Permission Is hereby granted to: ��f.... ✓ (,. l✓- -f................................. ,, _ t0 ....... 4............ ....../ ?r�....... .......... ........�� ...... „<.?...... ��'.. ................................................................. ................................................................................................................................................................. ........................................................................ .. ....... ............................................... at premises located at....... ' ...../�� l ..Aw' .. ..: .�... .......................... . ..................................... ............ County Tax Map No. 1000 Section ..... /.............. Block....Q........... Lot No, ....../10.............. pursuant to application dated ...111 .... .. 19.. �W..... and approved by the Building Inspector. Fee$ ` ............ ...... ... �) . ............................... Building Inspector Rev. 6/30/80 -FORM NO. I 3 SETS OF PLANS : . . . . . . . . . i . . . . l� U TOWN of SOUTHOLD SURVEY : : , . . ... . . . . . .. .. . BUILDING DEPARTMENT CHECK . . . . . . : . . . . . . . . . . . . . . . . . . TORN HALL SEPTIC FORM . . : : . . . . : . . . . . . . . . . MAY - 6 ��''.. { S UT 1 LD N.X. 1 1971 1996 L_> ; v l o • a TEL: 765-I002 NOTIFY: . �•BLDG. DEPT. CALL _.__.. .'Q.WNN OF� OATH : . : : . : . . . . . . . . Exanined....._. / :; 19.�.,__� 2 MAIL TO: . I;�l: . . 19� Permit No. J. `��..... .��Q.� ..Cc D/�rR...Z.. .......... Disapproved-a/c ....^.............................. ...................................................... ... ,r ... .. .... / l (Buildi spector) -APPLICATION FOR BUILDING PERMIT . . . . . . I9q6. INSTRUCTIONS t a. 'Ibis application mast be corrliletely filled in by typewriter or in ink and submitted to the Building Inspector wit 3 sets of plans, accurate plot plan to scale. Fee.according to sciwdule. b. Plot plan showing location of lot and of buildings on premises, xelationddp to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram wirier is part of this appliG-rtim. c. lbe work covered by this application may not be comnenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant: Sudi permit shall be kept on tfie premises available for inspection throughout the work. e. No building shall be occupied or used in wtrol.e or in part for arry purpose whatever until a Certificate of Occup<rncy slr<•rll have been granted by the Building Inspector. APPLICATIUN IS U=W MAUL to the-Building.lkTorrtment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the 'Ibhm of Southold, Suffolk County, New York, aril other applicable Laws, Ordina ncesr.or Regulations, for the construction of buildings, mWitionn or, alterations, or for rernvvnl or demolition, no herein described. 'llre applicant agrees to comjily with all applicable laws, ordinances, building code, housing code, aril regulations, and to adnit authorised inspectors on premises and in building for necessary inspections. .. `: . .....................: (SiWrature of a •,cant, or name, if a corporntioO (Kiiling acklress F appl c nL) 1,03 State wlwtbei applicant is owner, lessee, agent, architect, engineer, general contractove f r or builder tL..................................................DATE. .....:?:# . ...,. ... .M.o2 � GORE& LL FEE: •'s BY' Nine of owner of premises ... ....... ...... ................IJQTIFX 9�U,RIN�.DEP/'!R MENT AT . (as on the tax roll or latest deed) 766-1802 8 AM TO 4 PM FOR THE• FOLLOWING INSPECTIONS: If applicant'is a corporation, signature of duly autlxnri7ed officer. 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ......................................................... . 2. ROUGH o FRAMING & PLUMBING (Name mxl title of corporate officer) 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. Builders License No. ALL CONSTRUCTION SHALL MEET .... .... THE REQUiREK NTS OF THE N.Y. Plumbers License No. ......................... S•rATE CONSTRUCTION & ENERGY Electricians License No. -•'-"•""'• CODES. NOT RESPONSIBLE FOR "•--... DESIGN OR CONSTRUCTION ERRORS 00mr Trade's License No. .................... I. Location of lad on whidr proposed work will be done....'................................:.......................... .. ©. ......... I:....��. ......._ �k51 ., AA ! 1 o r✓...... F... House Number Street hamlet County Tax Map No. 1000 Section ...... Block .....L4........ Lot ...�.: :...... Subdivision ...................................... tiled Map No: ._......._. ... lot .....:......... (Name) 2. State existing use aril occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......� ..... !`:I ........................................ b. Intended use and occupancy .......... �. ...... f ... C�r.................................. ,tlF+w•�:G a7 LL.'�{iviv4:i`.",O.e�i?+"S s 1�?i'�! , 3. NaLure of work (dw& w+iiid► applicalule); Neu Ikuildiog ......... Addition Alteration Repair ..... Removal .............. DeanlitIon ....... ' Other Work •...• !v. .�f............. (Description) 4. Estimated cost ..1�.2,01 oao.. ... fee (to be paid on filing this'application)"' 5. If dwelling, nuber of dwelling tinits ...... lluber of dwelling uunit:s on earn► floor ............... If garage, nuber of cars •,• b_ If lxuainess, eannercial or mixed occupancy, specify nature and extent of ead► type of use................. 7. Dimensions of existing structures, if any: Front_.. .......... Rear .. Depth ................. Ife;glut ... ........... Nuiber of Stories Dimensions of same strucLure with alterations or additions; Front. Rear Depth ............. fleiglut .. MYiller of Stories ............................ 8. Dimensions of entire nets corustniction: Front ............ Rear ............... 'Depth ............ lleiit ............. ... Nnber of Stories .. 9. Size of lot; front ,.`� •- Rear .. �jZC� f- f�ptlr ... ...... I0. Date of Airdwse - �- ................ Name of Fonuer 11. Zone or use district in tAiiellpreauises are sii7uateil �•,.- .................. ... 12. flues proposed glostruction violate any zoning 1W. ordinance or regulation: 13. Will lot Ile regraded 0.. will excess fill be removed frota premises; YES 14. Na,ues of Ouruer of iureiuisea ./, O-K� ^� ..�r {'s+�G'�L• Acklress /. ./):I?!. p.,.�/.P�„Y,M:4f{(B:vlsluone No. :1.7.7 Name of Architect ....... ....,.... ... Address .........tA Phone tb. Nance of Contractor ��(;:7,...D Z z�,Nl�Q...Tom• i.... Address ��Q..�AA•2 -• f� ...• l�77 .. ,. •• .Phone Nn, ,. , 15, •Is this property within 300 feet of a tidal wetland? * YES ......,.., *IF YES# S(Xn'"D '.am '11i11S1 m tviar• MAY ne RCfi im). PLOT DTAGHAM locate clearly and distinctly all lxuildings, 4ledier existing or proposed, and indicate all set-back dimensions nd frou property lines,. Give street and block rKiiher or description according to deed, a allow street tunues and indicate ►,Aledker interior or corner lot,' X STATH OF NEW YOR (�` V SS COUNTY OF . . . .. • •�M•• .l- ••'�•2�y O ��. J.. being thily bworn, deposes and says l:hat he is Elie appl lcaor (Nuie of irdivicLucl signing conrrgt) alcove named, lie is rile ........... 1�Tq. (Contractor, agent, corporate•officer, etc.) ....... of said oiaier or curers, and is duly authorized to perform or leave perfonaed the said work and Co make and file this application; that all statements contained in Shia application are true to tlue luest of his knowledge and belief; aril that the work.«ill be performed in die manner set ford► in the application filed therewith, Sworn to luefore chi ROBERT 1. SCOTT.JR. • ••='ti•• ,,., ., of :, .-, -.•, 19��*f (p NOTARY PUBLIC,State of N.Y. No.4725089.Suffolk County Notary h1l ic,' ,..,.,,t,,,, Term Expires May 31. 195 J ..... . ,...fir. ... r .., ...... .......