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Home My WebLink About16416-z FOlr~C NO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 16416 z Permission is hereby granted to: ~' ' ~ ......... ,o at premises located at ..~./...~....~..C.....~.~,-~,..~ ........ ~~d~ ............ cou,~, To,~ Map No. ,0oo s,t,o~,<~.~..ff ...... B,ock ...... ~.~ ........ Lo, ~o. ~.// pursuant to application dated ....~.~..~......,..~..~1 / ........... , 19,~..,~,, and clpproved by the / Building Inspector. Building Inspector Rev. 6/30/80 FIELD i~S~~ECTiO~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BOARD OF HEALTH -/'~.... 3 SETS OF PLANS o.~¢~ ..... FORM NO. 1 SURVEY ........... TOWN OF SOUTHOLD CHECK ~- ~-~-~. .... BUILDING DEPARTMENT SEPTIC FORM..........o...J · TOWN HALL TEL.: 765-1803 CALL '%- ~- -1 ....... MAIL TO: Examined Approved%'~Jl,~l .~..O-., 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 wilt 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 necestsary inspections.. ~ ~Si=natu~ o'f applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plurn~b~er or builder. ..... ................................................................................... Name of owner of premises . .~.~ ~ P..v. .~..'0/.~.~..0"..,. ~.Q..~. ~. ,I.ff-.-./..~. ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL COIslTRACTOR'S MUST BE SUFFOLK COUNTY LICEIqSEU Builder's License No .......................... Plumber's ~icense No ......'~ ~p~.~je', .~. ~ .... Electrician s License No...J. .................. Other Trade's License No ...................... 1. Location of land on which.proposed work will be done ............. ' ..................................... ................... .... , .......... : ............. ltouse Number S~reet l~amlet County Tax Map No. 1000 Section ..... o04 Block . / .......... Lot ~e. // Subdivision ..................................... Filed Map No ............... Lot .......... (Nmne) 2. State existing use and occupancy of premises and intended hse and occupancy of proposed construction: a. Existing use and occupancy ......... -- - ''~..~ .... .~..~.I~... ......... -. i .............. b. Intended use-and occupancy 3. Nature of work (check which appJicable): New Building ........ Addition .......... Alteration .. ~.. *. ..... Repair .............. Remogal .............. Demolition .............. Other Work ............... ,; i (Descfip~tion) ........... i ........................ Fee .... ' ............................... , ' (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ..... / Number of dwelling units on each floor ...... If garage, number of cars ...... . ............. [ .................................................... 6. If business, commercial or mixedioccupancy,, specify nature and extent of each type ~f use ................ ..,.. 7. Dimensions ofexxstmg structures~ ~fany: Front ............... Rear .............. Depth ............... Number of Stories ~ ~ · Height ..................................................................... Dimensions of same structure wi~h alterations or additions: Front .... "' ''~ 7- )'. ~- .......... Rear . ..~/.~ .......... Depth ......... . .~T~..'. ..... J. Height ...................... Number of Stories ..... .~. ............... 8. Dimensions of entire ' ' Front .... q'.~. ?.~" ,~7~o" .... .o..q .r ....... '- new constmchon: .. · . .... Rear ............... Depth Height Number of Stories ~ 9. Size oflot: Front .... I.~.P. i7 ..... .. Rear . ./.~.~.:.'; .... De'oth ..-F.~.'~.~... . 10. Date of Purchase ....... /.~.g.'.~ ~ ................. N~me o f Former Owner .... ~...-~].~.r../4~..&5..,]~. ...... 11. Zone or use district in which premises are situated ..... .(-~.q~.~o .~-r ...... ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .,~ ......................... 13. Will lot be regraded ......... I .................. Will excess fill be removed from premises: Yes Name of Owner of premises .~.~tYctt ......... Address ./fPr~.tA*?..~.-. PhoneNo 14. Nanm of Architect .......... ' .... Address . Phone No. Name of Contractor ........ ~ ................. Address .... : .............. Phone No ................ 15. Is this property located ~ithin 300 feet of a tidal wetland? *~es ..... No .~.. *If yes, Southold Town Trustees Permit maybe 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 ~.umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, , S.S COUNTY O1; ........... ......... .~4f4-& ~?. z~g/A~. ~ . ................... being duly sworn, deposes and says that he is the applicant ('Name of individual sigoing contract) ' above named. Heis the ~,i (Contractor , agent , corporate officer, etc . ) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ahd 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 perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ................ ..... '... ........... ~ ~ [ DElE (Signature~ of applicant) $OL~ SUPPJ ('2).~!4 4lg. I;~,~ orl ¢--",+ tAu...-(4¢,., ¢1 t ~r water disb'ibutlng · 1 ~tem; piping .hall be ~f ~q~a K~Kor L =~91USED/NWAT£R ,Y SYSTEM CANNOT PLUMB~R CERTIFICA TION ON LEAOCONTENT BEFORE ;ERT/F/C, ATE OF O¢CI. IPANCY / / M,¢. F4¢., ,¢,'¢n' pr.., ' I nE"~fGN Off COM~TRUCTIO~ ERRORS, WITHOUT CERTIFICATE nF nC.C. IIPANCY U ~ I J,, T ,~ ~oo K~, , 11 LL