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Home My WebLink About22895-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) a TO .................. . ..XT;...,--T... _~. ........................... 22895 Z / CounN Tax Map No. 1000 Section ...... //....~... ..... Block ............ ./../.. ....... Lo?~o...../..~ ...................... pursuant ,o application dated .................... ~'/~'"...~.,,~....~.~. ...... 19..~....~....., and approved bythe Building Inspector. Rev. 6/30/80 .......... '~i'r~ Inspector " ......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ^pprovedl,? mermit Ho.,2. ~lin,, II~ ' ' ~LICATION FOR BUILDING PERMIT V INSTRUCTIONS BO\ED'OF HEALTH ..~-~3 SETS OF PLANS .......... ..'SURVEY CIIECK ........... a. Tiffs 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 sti-eets 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. Upou approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection thronghout the work. e. Ho building shall be occupied or used in whole or in part for any purpose whateve~ until a Certificate'of Occupancy shall liave been grauted 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, Hew 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, h0usirm cod0/Jand regulations, and to admit authorized inspectors on premises and in building for necessary inspection~t~/// ~ ' (Signature o~' applicant, or name, if a corporation) . ./;. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... t,&,~ c .__~x) t/.J .5 K,-~-.-- '~ . (as on the tax roll or If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Bu Ider s Lmense No .......................... Date ......... , . Plumber's License No ......................... Electrician's License Ho ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ·/4..77.o.'. .................... .' .............. .M. . T.,.c. ............... . House Number Street Hamlet County Tax Map No. 1000 Section ... }( .~.. '..Q.O. ...... Block ..... 1./.-. ~0... i... Lot...O. 1.~.°.0{~..O. ...... Subdivision .... j~.L./,-,.~..V~...c~. J~. ................. Filed Map No..I.'.~.. ........ Lot. (Name) . : ..... 2: State exisfing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupan~:y .,... ~. t'.N6:./.C.F..~.,B [ I/. '1'..ff--_~.tx~/o.~_f4, ' OrdF__ t4/19 ........ :,c ,~*~,~':i ~%~h ................... " b. Intended use and occupancy .5;a.,?l~ ¥ ~'~ ~" v~ ~'> · ................... ¥~'~ ;~ffy~: · ~;, 5.~ .g,. :~ /?XI~I ................. · 3.Nature of work (check which ~ ' agphcable): New Building .......... Addition .......... Alteration ......... Repair .............. Rem6val ....... Demolition ;. .. Other Work .F'.~5,. ¢~. · ~' / ZO~)'~'two ' ..... ,~'2 C' ~ (Description) 4. Estimated Cost ...... l ..... ~ .................... Fee .. ,o~ i ' . (to be paid on filing this application) 5. If dwelling, number of dwelling }mit~ ....~/A. ......... Number of dwelling units on each floor. . · If garage, number of cars ..... [..>'/~ ............. · ..................... ' ............. 6. ~fbumness~c~mmerc~a~rm~.xed~dcupanc~specif~natureandexte.n.t.~f~eachtv;e.~fuse~ ' ' ' -, ~.'fi~.',. ........ 7. Dimensions of existing structure~, if any: Front.. ~./~ ......... Rear .............. 'l~e~th' Height ............... Numiber of Stories .............................................. Dimensions of shine structure wiith alterations or additions Front ii ~/~i i i i i ....... Rear .................. Depth I Height .'. · · Number of Stories ' ' 8. Dimensions.of entire new~.~}straction: Front .............. : Rear . ./.' ~. 7..,'. 4.7. ~ Depth . ./~..~ ,oo. ?..~.~ Height . . .~.,.o.o...ff.~5,T/~.' ?l~umber of Stories ... ?./.~. ........... ' ..... 9. Sizeoflot Front l(-dJ.,O.O ~¢~1': Reart [~.7.,~7 F~;~"' .... ~',,;~ bvTz~'J'~-~;~"'~)/~'~ 10. Date of Purchase .... ....... . ......... Name of Former Owner ./gAg t~. ~. i .';.q .3-'. .~ [,Y .65 ....... 11. Zone or use district in which premises are situated f~.$':z: D ~.>o7'~/4 t_~ ' ' ' 12. Does proposed constructmn wolgte any zoning law, ordinance or regulation: ..M..O. ........................... 13. Will lot be regraded . .Ad. I~...~. ! ............ . .... ,... Will excess fill be removed from premises: Yes 14. Name of Owner of premises Id,,t~14-(..~.~./b¥~.y..~.~.o.%~r.,. Address . f.O..~.~. ~. ~ ! ~q,y~. .... Phone No..~.? IL. ¥~'/. 6 ..... Name of Architect .......... ~ ........... Address ... Phone No. Name of Contractor ......... ' ............ Address ................... Phonic . 15. Is this property within 300 feet of a tidal wetland? ~v ..... ,~ .N?i.' .............. . If yes, Southold T:own Trustees Permit may be 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 i mmber or description according to deed, and show street names and indicate whether interior or corner lot. ~ -------~~ APPROVED NOTED -, I FE.P: 35' 765-1802 9 AM TO 4 P~FOR THE FOLLOWING INSPECTIONS: I 1. F~DATION 'B~O FOR POURED CONCRETE ' 2. ROUGH - FRAMING& PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHA~ THE REQUIREMENTS OF THE STATE CONSTRU~ION & 'CODES. N~ RESPONSIBLE DESIGN OR 1'7.'7o¢7 / STATE OF NEW Y~&~(~I COUNTY, OE .... ...... dAJ:f.~.S..../~.'....]~L:g-L,O~..]J~'.~ ..... ... ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing c.ontract) above named. . : : Heisthe....... .................. ~"4 ..... 0 ........................................................ . ~ i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulylauthorized to perform or bare perfumed the said work and to make and file this application; that all statements contaibed h this'application are {rue to the best of his knowled e and belief' and h wor ....... g , t at the k wgl be perfumed In t~er ~et ,forrh In the applicatmn filed therewith. ' Swum to before me this ~ L/ . ' . ;gnai~re ;f appl~iant) MAP COUNTy ON SURVey FOR:. :, ~LTE~ ,~.:e,aL£,Kr ~ aUqREY L. -~CH~T'r