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Home My WebLink About23165-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD. N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AU~T~ORIZED) Date .....~ ...... ..7... ........................ N_0 23165 Z CounlyTax Map No. 1000 Section ......... Z./..~Block ........ ../....~.... ....... Lot No. .. ./...,~.... ............... pursuant to application dated ...................... ..'~.../..~ ...~.....~....,10. ~...~ and appro' ved by the Building Inspect~or...,., Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL URVEY /...-.,C II E C K .................... SEPTIC PORH .............. CALL HAIL TO: Disapproved a/c ..................................... ~iR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS ~ a. Tiffs application must be completely filled in by typewriter or ii, 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 tlie diagram which is part of this appli- cation. c. The wo,~: covered by th,? applicatign may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building P~nnit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building ~hall be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the BulldOg Dep~tment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appHcable ~ws, Ordinmmes 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 eode,~d regulations, and to admit authorized inspe.qt~,~premi~es and in building for necessa~s~ons~ ~ ~ / } - ' ......... '~ "' .... '' ~7~;( ;~C;nt, or ,lame, ifa corporation) >'q ~ ~dq ~, ,,~ ~ ~ ?c,, ; (Mailing address of applicant) State whether applica~'~.~:~O~fi~*~hC~ , architect, engineer, general contractor, electrician, plumber or builder. ............................ ~ 3. ,~ ..... ./ ~'g~a JJ,~ ~O~;~U~'~'~af/);~ j ~;~ (as 6ff fhe tax roll ~ latest deed) If applicant%~B~a~j~t~f ~'~utlionzed officer. (Name Bud title of Co~po[a~e officer) Builder's License No ............ : ............. Phunber's License No ......................... Electrician's License No ....................... 1. Location of land on w~icb proposed work will be done..c~...c~...~h .... : ........... House Number Street Hamlet County Tax Map No. 1000 Section .../],~,~. ......... Block,/~ ............ Lot ./3 .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use aud occupancy of proposed construction: a. Existing use and occupancy ...~ .................. , ................................. b. Intended use and occupancy .......................................... ' .'; ~:'. :';. -'.'; · .... . .......... Nature of work (check which applicable): New Building .......... Addition .......... Altera~, ......... Repair .............. Remova;l .............. Demolition .............. Other Work"..~-r-.~. (Description) (to be paid on filing this application) · '.. ~. Number of dwelling unit~ on each floor .............. 5. If dwelling, number of dwelling units ...... /. · If garage, number of cars ....... 1 ...................................... , ........ ................ 6. If business, commercial or mixed olccupancy, specify natnre and extent of each type of use .................... 7. Dimensions of existing structures if any: Front Rear Depth Numl~e~ of Stories ' '~" t ..................................... Height .................... './,~L .......................................... . .. Dimensions of same strt~cture withialterations or additions: Front ................. Rear ................. Depth ...................... i Height ..... '. · .' .............. Number of Stories ..................... 8. Dimensions of entire new construc[ion: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 3. Size of lot: Front ............ ......... .RT.r ...................... ?;ptb ................... /..¢. ... 10. Date of Purchase ..... Name of Former Owner ................ 1 l. Zone or use district in whicb premises are situated ..................................................... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........... , ............ ,... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ................... Address ................... Phone No .............. Name of Architect ............ i ............. Address ................... Phone No .............. Name of Contractor ........... ............. Address ................... Phone No .............. 15. £s this property within 300 feet of a tidal wetland? *Yes ..... ~.. No ......... · If yea, Southold ToOn Trusteea Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bt{tidings, 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. APPROVED AS NOTED _ NOTIFY BUILDING DEPal~l~OtF-J~r~A~ 765-1802 9 AM TO 4 P~ FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION · TWO REQUIRED FOR POURED CONCRETE ROUGH - FRAMIHG & Iq. UMBING 3. INSULAYIOH 4. FINAL - CONBTRUCTION MUST BE COMINAatE FOR C,O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE Nfl, STATE CONSTRUCTION & ENERGY CODES. NOT REBPONBIELE FOR ........... ,L.- P above named, ioontraot) being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) sf said owner or owners, and is duly aI~thorized to perform or have performed tile 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 bo performed in the manner set forth in the application filed therewith. Sworn to before,~z~ ~me thi~- ,. Notary Public,~~/'. ..................... "~ ~'. County · . 9LA,RE t. OLEW i ~" .otmy Public, State of New YorJ~ · ."'.~//.~. ....... · . ' i (Signature of applicant) Camm ' 'iHO LE I ~"a STORy ~ 2.00' FRAME HOUSE 40.£~ ,'D rVE 76.5 .,',' ;:: R_[ 278.26,. ,,~ TOWN OF , SOUTHOLD ' '"'"" ~"~ MAP OF r ,', z 2, > r- '" ,:,c° o O > ,: __. ::o c° m~o > '- m c r Z)> < '-I ~' X o -I ~ o C r- ~ ~.~o C z ~ ~ ~ ~ ~ zz 4 CREEK ESTA'T E $ 5