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Home My WebLink About12786-zTOWN OF $OUTHOLD BUiLDiNG DEPARTMENT TOWN HALL $OUTHOLD, N. Y. (THIS BUILDING PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL OF THE WORK AUTHORIZED) Z Permission is I' t'o: at premises located at Couhty Tax MQp No. 1000 Section pursuant to application dated 19 ......... approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 Examined ................. 19 ... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Rece±ved .......... , Approved ................ ,19... Permit No ............ Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 regu.l_ation% and to admit authorized inspectors on premises and in building for necessary inspections. (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 .. ~eith..P... Purcell .................................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. N--~a.v..°.r.x.c.'. .~7.qc.h.°..°.~ Dist, -~:5,t S. -Pudqe C.orp.. W-Mo in RD. House Number 50900 Street ~4ain .I~.D o Hamlet Southold County Tax Map No. 1000 Section .... ~..7../~. ........ Block .... ~'~....~. ........ Lot..'./~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: 2-~'amilv ! occupants-.5 2-up , B-down a. Existing use and ocdupancy . . ~z ................................ ' ................................ b. Intended use and occupancy ·..2 .-F~rflily ....... ,.Occu[lall% s.2--u~; ~'-~Do~ ........................ : 3,: Nature of work (check which applicable): New Building .......... Addition .......... Alteration ... Roof.. Repair., .RoozE ...... Removal .............. Demolition .............. OtherWork ............... 4 Estimated Cost ""'" (to be paid on filing this application) 5. If dwelling, number of dwelling units. 2,-~.am± 1.y. .... Number of dwelling units on each floor .... One ........ 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 .3.27.~. :..6.i.n.:... Rear .3.27.?....6.5.9:.. Depth .4..i.f.t.:..8.i.n..... Height 26ft, Number of Stories ............... , · · ' -~WO ................................................. Dimensions of same structure with alterations or additions: Front .32ft....6ir~ ...... Rear ~3,HT .... Depth ~i~,~.,. 8-~1% ..... Height . .26fi_ ................ Number of,Stories..Two ................ 8. Dimensions of entire new construction: Front .20f.t,,. 7.ir~ .... Rear . 22 .F..T,..7. J,~3,. Depth .2.2FT... Height~pprox,. 6F~... Number of Stories ..... ~W9 ............................................... 9. Size of lot: Front ..fi9,3.8. .... . . 10. Date of Purchase .qCg.O~.e.r...1.9.'7.'7.' ..' i."' Rear .6..9.,.Q3. ............... De-thr .'3..3.8' .P.~.:. ........... , .......... Name of Former Owner . .s.%.1y.% .9..I~..t}.t..e,s.s.x.c..h .... 11. Zone or use district in which premises are situated .... .ig.qq........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. 1'I0 ...................... :... 13. Will lot be regraded....N°.. ·.......... ,......' .... Will excess fill be removed from premises: Yes XT~iXX 14. Ntune of Owner of premises .Ke&:e.h .Pm:zxell .... Address 5D.900. Ma£n. 1~].... Phone No..765.~:1.330 ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all b~ildings, whether existing or proposed, and. indicate all set-back dhnensions from property lines. Give street and block number or description according to dee t, and show street names and indicate whether interior or corner lot. ' Street~ Block%2 Lot 10 Sect-070 , ~, 2X8 Attached to ex~ isting StuBs 3/4in Sheathing Len~t~-24f~' 2 in STATE OF NE~RY>,/ COUNTY OF .~(. .... ~"'~ ........... ~~i . ~~-~ff~. being duly sworn, deposes and says that he is the applicant (N~m~ual signing c0ntrac above named. He is the ................... ~ ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or. ow'nero, ~d is duly authorized to perfom or have perfonued the said work and to m~e and file ~is application; that all statements contained ~ this application are true to t~e best of his ~°Wledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn t0 before me this ................... ay of ...... , $o~PubJic, .~ ...... - . .................. ~ ~ n~ ~/~'~'~-~ (Signature of applicant) /'v'IAp oF L..ANo IX4A~y DYLIKO NI ~V ~fOl~l< /-fi, L. ~