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Home My WebLink About23168-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ................ · · .~'. -~..,,/~.. · .~.. · ............................ 23168 Z / Permission Is hereby granted to: ~. ~.~.~.....~.~.. ~., .................................. . ./.2../..~..~..~ ........ ~.., ........................... ..~..'r~......~. ............ ."..~ ........ ./. .......... Z ................ to......./...~.~.'.~ ......... ..~..........i....~...../....~......~ ......... ../.~z~ ........ ~./.. ........... ~./.../...~ ~, . ...... atp,~,ses,ecot~ot ............ ./.~......~~ ........ ~.., ................................................. Counh/TaxMapNo. 1000 Section ...... ZZ .......... Block ....... ..,~.,,.~.. ......... LotNo. ,.,~'~. ................ pursuant to application dated ...... ~ ................. Z ..................... 19....~..~ and approved bythe Building Inspector, Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMI:NT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 SURVEY ................... CIIECK .................... SEPTIC PORH .............. ,;cT,.: -$$-20 ................ c' . (~6~A~gquspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Tiffs application tnust be completely filled in by typewriter or in ink and suNnitted 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 givhlg a detailed description of layout of property must be drawn on the diagram which is part of this appli- ca,tion. c. The work covered by thi.s application 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 sl~all be kept on the preuffses available for inspection throughout the work. e. No building ~hall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupm~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to tile Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, mid other applicable Laws, 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, bui ding code, housing code, and regulahons, and to adnut author'zed inspectors on prenffses and in building for necessary inspections. (Signature of applicant, or name, if a corporatiou) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractoy; electrician, plumber or builder., ... Oeo.e.g. (. ................................................... .... pp ,ov, mtts .......... . Name of owner of premises ................. ~_'~_'~ 'm: ~'??? ' '~ 73 ~'7 ' ..... . (as on tile tax roll or 1~=~'~ .,~~'c ~: '.z. -~-"-' : . NOTIFY B(JILDING OEPA~ If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: 1,, FOUNDATION · TWO REQUIRED (Name and title of corporate officer) FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Builder's License No .......................... ~, INSULATION 4. F~/',ML - CONSTRUCTION MUST P,[ ~ Pl. :_ ~: FOR C,O. Phunber's Liceuse No ......................... At:" --.--, ..... ,,,-rK)N- ' !~;FIALL MEET .......... ('~F THE N.Y. Electriciau's License No ....................... S-~; ', :i~'~Fd,tCTlOh' & ENERGY Other']grade's License No ...................... D~: ..... .i O.i Cbt,~">'l~oC2tON ER!qORS I. Location of land on which proposed work will be done ................................... , ·" House Nmnber Street ~ Hamlet County Tax Map No. 1000 Section ... 2q ............ Block ,. ?. .......... ,... Lot: .OC.4 ............. Subdivision ................ (~.l'ai~i~) ................ Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy °f pr°p°sed c°nstructi°n: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .......... 3. Nature of work (check which appl cable): Repair .............. Remow 4. Estimated Cost.,.l..~..0,0...-~.., 5. If dwelling, number of dwelling unlits . New Building .......... Addi!ion .......... AJ.,~erat[on ......... , ....... Demolition ........... _ Other W~(..~' ./~.C4,3..e~.. .... .... (Description) ............... Fee ...................................... (to be paid on filing this application) ........... Number of dwelling units on each. floor ............... · If garage, number of cars .......... · of existing structures, ............................ lieight Number of Stories ............... Dimensions of same structuro wlthlalterations or additlons: Front ................. Rear .................. Depth ...................... i Height ...................... Number of Stories .................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............ Height ... ~ ........... Number of Stories ..................................................... 9. Sizeoflot: Front .............I ......... Rear ...................... Depth ................... 10 Date of Purchase i Name of Former Owner 1 1. Zoqe or use district in which premises are situated ................................................ 12. Does proposed constructjpn violat~ any zoning law, ordinance or regt lation: ................. 13. Wil lot be regraded ./,u ?.. l... · ............ , ' '.' r ', · lc ',$-: ' ~ .... ~.. , Will excess fill~be removed from premises: Yes ~ 14. ,,;amc of Owner of premises ...t~..~£.'~A.V.¢ {O.c.~_. Address .. (.7.g,S .~.e~. Pgff. l)CPhone No..'7..~,~7:~.~;'.'7...~... Name of ArcbRect ............ ] ....... ~ ....... Address ................... Phone No ................ Name of Contractor ' Address Phone No Is this property within 300 feet of a tidal wetland? *Yes ..... ~.. No ......... *If yes, Southold ToWn Trustees Permit may be required. PLOT DIAGRAM , Locate clearly and distinctly all bi property lines. Give street and block interior or coruer lot. ildings, whether existing or proposed, and, indicate all set-back dimensions from' nber or description according to deed, and show street names and indicate whether i STATE OF NEW YORK, S.S! COUNTY OF .................. ...... a...q~Ct ,C i ~q C2 .~ ..... i ................. being duly sworn, deposes and says that he is tho applicant (Nam~ of individual signing lcontract) above named. He is the ........................... ~ ~.~.~ ................................................... (Contractor, agent, corporate officer, etc.) af said owuer or owners, and is duly a~thorized to perform or ~ave performed the said work and to make and file this application; that all statements containe~d in this application are true to the best of his knowledge and belief; and that tho work will be performed in tho manner se~ forth in the application filed therewith. Sworn to before me tiffs .................. ;' ,., 19. Nota~ Public, ...... . ........... County i Tarm ~irea ~a~m~r ~, l~ (Signature of applicant)