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Home My WebLink About16543-z FO~M' NO. 0 TOWN OF SO~'i~OLD 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_o 16545 Z Permission is hereby granted to: ~--~ . ~. ~....~..~.~.,~..a. .................................................. ..~...~...~...~....~....~..~ ..~~..~..q..:. ....... ~'T ........... '~ ......... ,:..._.~,....,~,,.....;:;,,...;.....~ ................ ;'7';'""2 ....... 7"'"";2 ...... at premises located at .,.~....~..~...~...~......°h~.....~.........~..~;// .......,,-... ....... ~.~ ........ I.-[.~..~--..I. ...... County Tax Mop No. 1000 Section ..... ..O.../,.,~.~,. ....... Block ........ .C~...~ ...... Lot No ..... J..:..~, ............ pursuant to application dated .... ..~..~.....!..(q ................. , 19..~..2., and opproved by the Building Inspector. Fee $.2.~..:.. '/ Building Inspector Rev. 6/30/80 FIELD 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL MAIL Approved O..~....°~Jx'+..... ).c}.., 19~..]. Permit No..~..~.ff. ¢..~..~. Disapproved a/c .................................. /~ : (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH .....~ 3 SETS OF PLANS .?. .... SURVEY .......... CHECK .......... SEPTIC FORM ............. : October 15, 1987 Date ................... 19... 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. e. 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 inst~ctions. .....8. ................ '.. (Signature of applicant, or name, if a corporation) PO Box 1033, Cox Lane, C:utchogue~lY (Mailing address of applicant) 11935 State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Engineer Robert Hicks Name of owner of premises .......................................................................... (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 CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electncmn s Lice se No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. 1275 Lands End Road, Orient NY 11957 House Number Street Hamlet County Tax Map No. I000 Section 015 Block 9 Lot. 1.9 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .O.n.e.. ?.a.m.~ .1.y. ?.e..s~.d.e.n.??...3...c.a.r...g.a.r.a.g.? ............................ b. Intended use and occupancy .QBe..family. r.esictence.,..3, car garag, e, pi~en, boat s.tge 3. Nature of work (check which applicable): New Building · Addition x Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost /)7500.00.. (to be paid on filing this application) 5. If dweliing, number of dwellingmnits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ..................... 7..~ Dlmertmons of ex,sting structures, if any Front. } .0 ............ Rear . .3.0. .......... Depth ... 2./4 .......... Q~d{ght 1.3 . (,Number of Stories .1.~ .............. : ..... . ....... :'Dlmenmo~.of same struc~re with alterations pr additions: Front .3.8. .............. Rear . .3.8 ............... Depth. ,'r. 7 ..........:.)~...~... · 9 3" . one , . Height ...................... Number of Stones ...................... --.8. D~menmons of entire nevf.oonstructlon. Front .......... . ..... Rear ............... Depth ............... Height ............ ~:.i Number of Stories ........................................................ 9. Size of lot: Front . 21:~'. .... .. ........... Rear . .211 ............... Depth ...%90 ................ 10 Date of Purchase : Name of Former Owner 11. Zone or use district in which prlemises are situated, tc.e.s. ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .n.q ............................. 13. 'Will lot be regraded . .n.c. .... ........... ~ ......... Will excess fill be removed from premises: Yes XNo N~me,of Owner of nremises Robert Hictqs Attrlr~ 1275 Lands End l~q~n~ N,~ ........ 14 ....... "i ................................................... ......... Name of~t .War. rer~ A.. Sambach ..... Address .PO..Box. %033 ..... Phone No.7S4-74¢g ...... Name of Contractor ........ [ .................. Address .... : .............. Phone No ................ 15. ]rs this property loeatediwithin 300 feet of a tidal wetland? *Yes ..... No ..x... · Jif yes, Southold Town Trustees Permit maybe required. ' PLO]' DIAGRAM Locate clearly and distinctly ali 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. STATE OF NEW YORK, S.S COUNTY OF../~uffoi. k ...... ....... .W.a.r.r...e.n..A.:..S.a.m.b.a. 9.h., ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Engineer He is the ' , (Contractor, agent, corporate officer, etc.) 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. Sworn to before me this ~ October 19 87 % 6 .day o~ .................. Notary Public, .(~f4.~c~7 ......... ~~ ......... County ~//~blLtAJ-) ~ . .~..~, ~UNDAJ. COOPER , , (Signature of applicant), Notary, Public, State of New York No 4822563, Suffolk County 0 ~ Term Expires December 31, 19.. i .