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Home My WebLink About6490-z FOR,~[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER.'S OFF,CE 19 ........ Approved ............. .'.! ........... '.] ........... , 19.Z).... Pemit No..~..~...~...0....~ ........ APPLICATION FOR BUILDING PERMIT ~'~ Date .............. /~/~Z[~./,, .../~- ........... 19.f.~-'~......~ INSTRUCTIONS ~'J a. This application must be completely filled in bv typewriter or in ink and submitted in triplicate to the Building Inspector, witJ~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, andL- giving a detailed description of layout of property must be drawn on diagram which is part of this application. ~' 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 issue a Building Permit to the applicant. Such permit shall be kept onI 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ....................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... ~ 1. workwlll bedone Ma No /.~13;ZO/3Z.l(;.(,,~h.l/r,~J~.Lot No Location of land on which proposed . p .......... =. ..... ' .. . .~...-~.~......, ...... 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... 3.'- 'Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration.'......',....;.. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..~'...P,....O.~..0...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, commemial or mixed occuoancy, 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 ................................... ..... ^ ~- ~ ~c ~ /-Ix / ..... 8. Dimensions of entire new construction: Front ........ ~. ............ Rear ...... ~.. ................... Depth ......T. fJ ....................... Height ...................................... ; .......... Number of Stories ...... ,~ ............................................................................... 9. Size of lot: Front .......... ~.(~. .................... Rear ............. ,~...~. ...................... Depth ......... ~..~. .................................. 10. Date of Purchase ...... .,~..,~-~?...~.~'....iz/..~ ..... Name of Former Owner ........... ,~../...~../c'.A~..~.. .............................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ .~...Q ............................................ 13. Will lot berecjraded ..... y~.~..........~,, ,, ,~, -- ~.~ ,~. ,~ ~- ~ ~Wil-lexcess'fillberem°ved-fr°mpremises:'[ ],,Yqs , [ ] No 14. Name of Owner of premises ...... ~j~7J3~~`~{-)~V~-~/~3~1~ ...... .~.~..(...-/~,7~) (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone 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 wheth- er interior or corner STATE OF NEW YORK, COUNTY OF ...................................................... .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................................................................................................................................................................................. (Contn*ctor, agent, corporate officer, etc. J 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. Notary Public ...................................................................... County .......................................................... (Signature of applicant} · ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 649O Z Date ....................... .A~41 .....~8 ...........19~.~... Permission is hereby granted to: ~ll~;~z~. A.o...~tw~n .................................... .................................... .......... ~.~/~p~ .............................................. to hull&. ~w..~ne.. f~ ~]~ .. ~we.ll&n~ ..................................................................................... at premises located at ..lo:t:,..3Q ....... D~c:c~.~c...C~o~.e~ .................................................................. ........................................... ~.~g.~;~...~,¥.~ .......... P..e g.ctr~c .....~.~., .................................................... pursuant to application dated ................... JL])~;~], ....... .1.8 ............ , 19.~.~..., and approved by the Building Inspector. Fee $.~.. ~1~1 ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM S. Village '-~V"l~ Township~-~,/~ 9. 3. 4. 10. be ards Section ~ Lot No. Jt Private well Public water Public Water Comp~y name Distance to main Lot size: Width~w feet Length[~'~ feet (Enter on center plot below) Sewage Disposal System: A. 900 gallon septic tank: Precast~ Equivalent Block B. Leaching pools: Number Precas~__Block__Special__ If private well fill in blanks beloW: Tank capacity~-'Gals Pump G.P.M. Total well depth~'~ Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 8 10 12 14 18 gned CERTIFIES: "COnstruction. of authorized installations will in accordance with the Suffolk Department of Health's curre thereto."~ County Signed s~:and- Date~./ uwner or ~ux~oer FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plOd,Date S-15 Revised 4/1/72 L ,-3 &54°3z'30"w, SECOND A'~'E NU E hlAP OF P~OPE n,'T- ~,- SUR. VEYED FOP. '. [NE SUFFOL~ COUNTY CLE~ ~loN ~209 o~ mE NEW ~0~ STYli ® = CESSPOOL L_ j~, TO l~&t LL LANE C..'.'.'~A~ANTEE. D TO THE % "-' '"'"~ ' - -E -u,-., f Y T! TLE ~' C",UAqAN TY CO. I~U~TI S PLACE. FORUM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .~ I~ 19...~.... Pemit No. Application No. ~ '~ ~,0 Disapproved a/c ..................................................................... ~.. ...................... ..................... ( ui d~~ .......................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 diagram which is part of this application. 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 issue 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 buildings for necessary inspections. ............. ........... ................... (Signature of applicant, or name, if a corporation) ,~ , ',: ,," -- / /~ ...... ........... ........... (Address of applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~):~.!.[¢, _~C~.-..(~I~.~.~.~ ~t[~.4..,.,;~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No~o~...../~?..q/J?,../.~l~g~.Lot No ...... ~.J.. ............ Street and Number ....ZC'.~C~4~.,.._~_¢~.,..~..,~_'_~C.~..~.I.&. ..... ../~...~// .................... .......... / 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................. b. intended use and occupancy ...... .~(/~?~ .~.....~.~/~ ........................................................................................ 3. Nature of work (check which apolicable): New Building ....~ ...... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..... ~...~).) .0..~. Fee .......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................. Number of dwelling unit~ ~n each floor ......................................... If garage, number of cars ....... .~.. 6. If business, commercial or mixed occuoancy, sp~ify nature and extent of'each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Del~th ................................... 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 ....411r.~. ................. Depth .....~'..~. ....................... Height ................................................. Number of Stories ..... .'~ ............................................................................... 9. Size of lot: Front ............ ................. Rear ............ ~,~.~../. .................... Depth 10. Date of Purchase ..... .~;~,~.~f.~ ..... 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: ....... .~P~.~. ............................................ 13. Will lot be re~'aded ..... V~,~?-.-.--~ ....... Will exceq fill be removed_from premises; [ ~, Y.e,s · _ [ ] Np.. {Address) {Phone No.I Name of Architect ..................................................................................................................................................... {Address) (Phone No.) Name of Contractor . . ............... ~ ....... {Address) {Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildinge, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) ~ ,~ COUNTY OF ...................................................... ) ......................................................................... , ............................... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing ~:ontract) He is the ......... . ...... ~ ~ (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authoriz~o perform or have performed the sa d work and to make and file this application; that all statements contained in this application are ti'ue 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. Notary Public ...................................................................... County ............... . .'...~5~..~...../,~.~. ~?.....~ ......................................... (signature of applicant} L