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Home My WebLink About22757-zFOI~M TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_ 22757 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ~-~ .~.. ......................... at premises located at ............... ~,,,~-'~ ....................................... Counfy Tax Map No. 1000 Section...~,~ .......... Block ...... ~ ............LotNo...,~......~,.:.,~,. ........ pursucfflt to appllccltlon dated ......~., ,~..~ ................................. 19...~,~and approved bythe Building Inspec?:/ Rev. 6/30/80 , ? , FO~M NO, T · ' .... ~ TOWN OF SOUTIIOLD BUILDING DEPAHTIVlENT TOWN tlALL SOUTIIOLD, N.Y, 11971 TEL.: 705- I.~ ~'~ Examined ......... ' Disapproved' a/c ..................................... ?~ ..- . . . (l~liug ~ector] gPR ~ 5 1995 CHECK CALL · .... HAIL TO: Date ' . .......... , '~ INSTRUCTIONS ' a. Tiffs application must be completely filled in by typewriter or in ink and submitted {ti '/he i~uildlr}~ Inspector, with sets of plans, accur.~te plot plan to scale. Fe,: according to schedule. . ,' b. Plot plan showing location of lot and of buildings on premises, relationship to ~idjdlnlng pre~nises oi' public sti'eet' or areas, and g. iving a detailed description of layout of property must be drawn on the diagram which is part'of thts appb cation. , ¢." The work cow;red by this application may not be commenced before Issuance of BQtldnlg Per~iL d. Upon appro%'al of this application,, the Building Inspector will issued a Building Pertfll{ t0 the appltcarit. Such permit shall be kept on thc premises available for inspection throughout the work. '-; e. No building, sha 1 be occupied or used in whole or in part for any purpose whatever tffittl a Cei'tific.4t$ of Occupancy shall have been granted by the Btdldi.g inspector. APPLICATION IS HEREBY MADE to the Building Department for tile issuance of a ~t{~Idthg permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a~l~lieable La~/s, Ordinances or Regulations, for ll~e construction of.buildings, additions or alterations, or for removal or denio!itioa; a~ herein described. The applicant ag;ecs to comply with all applicable laws, ordinances, building code, housih8 k0d~; and fegulati s, and to admit authorized inspector~ on prt!afises and in building for necessary iOsl:~qtions~ ~ 4 . .-~ . ~t~fn //~ · , . (Signature of appli~i/nt; or name, if a corporatidn) (Mailini ~d~i?ess of applicant) //-J ~ State whether applicant is o,',ner, lesse rchitect, engineer, generaJ contraeiiSr, electrician, plumber or builder. Name of owner of premise,~ ........................... ('as on the tax roll or late~t ttccd~ If applicant is a corporation, siguature of duly anthorized officer. ' (Name a'~d title of corporate officer) Bu'lder s License No Plumber's License No ......................... Electric an s Dcense No ....................... O,her Tr de's Ucense No. 5 ..... Lochtion orlana on which proposed work will be done. Itouse Nmnber Street ttamlet ' ' hty Tax MaP No I000~ fi BI ck ' Co. , . ec on {..; ..... o · · · ' Lot Subdivision ........ . .......... ' .................. '. Filed Map No. Lot (Name) ,, Slate ex/sling use anti occupancy of premises and iulended use and occupancy, of proposed construction: ~ d ~ ~ o¢~pallC~ ...... ' · Nature of work (check which app cab ' ' : ' lc): New lluddmg .......... Additioh .......... Alterati,9n Repair ............... Removal ......... , ,.. ,, .... Demolition,: t Other Work.,t~.~J~..'' . . Estimated Cost .... ~, ............. .t ........... Fcc ............................ t :' (to' be pai(t on filing this application) 5. If dwelling, number ofdwqlliilg units ............... Nmnlmr of dwelling units oil each floor .............. lfga ge lb of ca . 6 Ifbusi wrci I ' ixeloc ii I l~'tyleol ' I '/ I Y xtcltof acl ' 7 Di nsionsofexisti~g if Eton ' ' R De! ti IIeight ........ ....... Number of Stories ......................... ! ........................ Dimensions of shine shnctme with alterations or additions: irront Depth ' lleight ......... i ........ Rear ..... ... ~ ........ .................................. ' ........ Number of Stories ........ 8. Dimensions of entire new constmcllo1: Front ............ ; Rear .. ~- .... pti .... llcight Number o£ Stories ' 9 Size of lot: Front ~ P, ear · ' ........ , ............. ; .................. ~ . l)eptb ..................... IO Date of Purchase ~ Name of lrmlnel' Ownei- 1 1. Zone or use district in which premises are situated ................... '; · · i .......................... 12. Does proposed constrnction violate any zoning la~, ordinance or regulation: . I ..................... 13..Will lot be reg aded ...... : ..... · ............. Will excess hll be removed from premises: Yes i"4'( 14. Name of Owner of premiseg'/'flg~.fffd, P.. ~',.$~,ff22... Address ....... Pbpne No ....... ,. ,.... ~... Nanle of Architect ......... i ...... "..., Address .... ' ' Name of Cont;'mtor ! ' '? .... ~.. · .............. .......... Add~ess' -, ~. ..... , i ji,. Phone No: .. '"" 15,., I;?, ,, this property within 300 feet of a tidal wetland? *Yes.,...... No ..... ,.~.,- " · If yes, Southold Town Trustees Permit may be r~qui, red.i PLOT DIAGR.AM .. Locate clearly and dlsl.nctly all buildings,'wbether existing or,.l~roposecl.~ a~ld?indicate al set-back dimens otis from :,c. merty lines. Give street, a ,;bblock numbcr'or, desei'ipti0n according.to deed, affd'show street n0mes and indicate wheti~er ~O TATE OF NELv__Y~)I7 .O/-' ....... sa3s that he ~sqhe apphcant (Nanm ofimlvi'l, ~ signing colmact) x (' -(C;ntrac;r;r~gent Cml)orate officer ere) "," '''~ · . ~zc' ' ~ . ' :' ami t~ make,aqd Sa~d olvllcr Of owfler~ hid is dtdy u tu perform or have performed Hlorsatd wolk ', , '( ' ', , hcalmn: that all statemc,-,?s ~gq~aincd in this application are, tzue to the best ofl~is knowledge and belief; and that the will be perforated in thc:, harmer set :forth in the application filed therewith. ........ .,, N~a~ Public, State of New York '-, · ............................. No, 4879505 , ~, (Signature of applicant) Qualified in Suffolk ~u~ Commission Expires De~emb~ 8, 19~