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Home My WebLink About22534-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22534 Z Permission is hereby grant.ed to: /¢...~.~.¢..~:~../.~..~ ...¢..,..~.,._..~: ....... ./...¢....~ ........................... ~.,. ', ../...~'~ii iii.'~' .................................... to ..... ~ ....... ~....c.,4¥z.,:../..'~. ~.~....~i ............................. .... ............................................................. ~...,¢.~.~..../...~ ......... ~. ~:./.d.~.,¢... ...... ......... ~..~. ........ ,~.--./..~.e.'"'~..' :.ff.~.~ Building Inspector. Fee,../..~......~ Rev. 6/30/80 cb~ o '1, I t BUILDING DF. PARTMENT TOWN HALL ... I ii~.OW~ ~.~ .,'. $OUTHOLD, N.Y. 11971 . TEL.: 765-1802 E=nincd . . . .:. Approved ..... . , l 2'. ........... BOARD OF HEALTH 3 SETS OF~P.L~NS .' ..... SEPTIC FORM ................ NOTIFY; L/~Q O/'A ~ t~- CALL ./.LZT./.~.~..w-~. ......... MAIL TO: j~wOor~/r~ Disapproved ale ........ Date .tgi..... " INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to thc Building I~sp~ctor, with 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 p~blin streets or areas, and giving a detailed description of lhyout of property must be drawn on the diagram which is part of this appli- cation. . c. The work covered by tkis 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/'emoval or demolition, as herein described. The applicant agrees to comply with all ppbcab e laws, ordinances, building code, housing code, and regulations, and to admit authorized inspecto~ on premises and in building fonnecessa~ inspeetions~ - .... (Si.nature ot hpplicant~ ~)r name, if a co~'t~oranonY ' ' (Mailing address of applicant) State who}her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner or premises .~ l~.~.~$.).: .~..1~..Oq (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ;m;/r) ' ' Builder's License No ......................... Plumber's License No ' Electrician's License No ......... Other.Trade License No " · Location of land on which proposed work will be done; llouse Number Street, ' ' Hmnlet Count ax Ma o 1000 Section ............. BlOck .................. Lot ... ~" Subdivision · · ....... e ap No. ', (Name) ............. Lot .... State existing use and ~ccupancy of premises and intended use and occnpancy of proposed construc'tion: a. E. s,ng use and occupancy · · Intended Use and occupancy ........................... ,; ',,v ~' , . · , ,.. ~,~.~.~ ': ,~ ~', t .:,' ................... 3. Nature of work (check which apphc able). New Budding .......... Addmon. ~. ,,~$h ;E~.y~'t~.,,~i~,.-t ......... · "' v' . n ~ ,..~. ~,a?,~. :~.Swim~ing ooot..~.~ ........ Tennzs Court ......... Accessory Bulldzng .......... Fence ..... J~T W~ ........... 4. Estimated Cost....~,.ee~.. 4j ...................... Fee ........... (to be pa~ff~cation)"Ji .... f ....., ........... ' If garage number of cars ~ ' 6. If business, commercial or mixed o* :cupancy, specify natnm and extent of each type of use .................... .~.~ 7. Dimensions of existing structures, any: Front.. ~. ~ ........ Rear .....~ ........ Depth . .~. Dimensions of same structure with fiterations or additions: Front ............. Rear .. D~pth. ~. ................ . .[tei~t .J~.' ............ , , ....'.NumberofStofies ..) .... '¥~;.~L'''' 8. D~mensmns of entire new constmcUon: Front...l~.-.q.' ...... ~ Rear . 19.~-~[' ........ Depth~ ~ ........... Heieht ... ~.' ......... Numbe~ of Stories ..... 1.. ....... 9 Size o*'Iot: Front ~ ...... ar ......... , ......... 0. Date of Purchase , Name of Former Owner I Zm'e or use ~listfict in which :~remi~es' are situated ~c . ... · ' 2. Do~:s proposed Construction violas[ any zoning law, ordinance or regulation: .. ~ .... ............. , ....3 ...... :3, WUl lot be regmded .9~f, .~~ ........... Will excess fill be removed from premises: yes ~.'. No.. .4. N~e of Owner of premises .~1~. ~ '.M~gg.~ddress ..... ~tVV~,.~.~... P ·N~e of Contractor ........... ,~ ..... ' ....... Address ................... Phon~ No ..... 15.Is this property locate{d with.in lO0 feet of a tidal ill yes, Southold Town Trustees Permit may be required. PLOT DIAG~M Locat~ emily ~d dist~ctly MI boHd~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from propeny Hnes. Giw street ~d Nook number or description accorded to deed, ~d show street n~es and ~dicate whether interior or comer lot. STATE OF NEW Y.O, RJC.. o io COUNTY/OF .... ~ .~..~2.k2~. .... .....~'%~ ~...~~ .................. being duly s,vom, deposes =d says that he is the applicant (Name ofindividualsigniu contract) above nam'ed. ~ is thc (Cont~t~" '' ' corporate officer ere ) " of said owner or owners. ~d is duly authorized to perform or have perfo~ed the said wor~ and to m~e and file this application; that all statements contai~ ed in this applicatioo are true to the best of his knowledge and belief; and that the Wor~ will be perforated in the~er get forth in the application filed t mrewith. ' ~ ~.~ Sworn to before me this .. ................ . .... ,,. . ,. ...... ., ........... ~ ~A~v B'fi~h~, ~ ' ' ' ~ ......................... 765-1802 BUILDING DEPT. INSPECTION ]FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ] FIREPLACE & CHIMNEY DATE~INSPECT~