The URL can be used to link to this page

Home My WebLink About22429-zFOI~M NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENt' TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 22429 Z Permission Is hereby gr_._t~. ~. ~,~..... ~~~.an~,/~ ~~ ......... : ....... ................. .......................... ,, to .............. ,~..~.,z.'Z~~ .......... ..~....~;.'...~.,~,~.~..~..~ ............ .......................................................... ~~ ~.~,..~....~,..../...V..;...¼ ......................... . OounlyTaxMapNo. 1000 Section ............ ,.~...~... Block ........... ~ ........... LotNo ...... .,~../,.~ ....... pursuant to application dated ........... ,~..,.~..,.,~ ................ ] g.....~,,, .,~,,,, and approved bythe Building Inspeotor; ~ Rev. 6/30/80 aCT I 8 1994 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM, ENT TOWN HALL SOUTHOLD, N.Y. 11971 ;:~ ,x'i ~ '.:' ~' ~. TEL.: 765-1802 Examined Approved ...~.'.'~.'.~/.'}ii , . · rmitNo.~.. ...... Disapproved a/c .................................... ' // (Building Inspector~ AP~L4CATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS .......... ~.~SURVEY ................... ~...~ C Il E C K .................... SEPTIC FORH .............. CALL .. . blAIL TO: INSTRUCTIONS : a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~ts 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 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. 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 Occppancy 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 removal or demolition, as herein described. The applicant agreei to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized ins. pectors on. premises and in building for necessaw(;C~P_'_~'~..~ons~ / ~ -- (SiEna'rare oT ffpplicant, or ~a'me, if a corporation) · ..:. (Mailing ad/dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / ?.. ..z?, .,.. x Nan',e ~f,?~r ofp;e,mises . X'""' .... '": .................... i':i : :-' ': I (as on the tax roll orlatest deed) Ii,is a c°:P°~gnatg)re ° f duly auth°rized °fficer' ' ~ title' offf'~ 'o}}i 'c;r') ......... ~uilder's License No...~./~..~...:£ ......... Plumber's License No ........ : ................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. Street House Number mamle[ County Tax Map No. 1000 Section ........ ~... ~...7... Block .... ~../ .......... Lot..,/.~. ............. Snbdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~ b. Intended use and occupancy .. " ........................................ 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration ......... Repair ............ Removal ............. Demolition ............. Othe, r Work.~',R~°. dS.. ~.~4'~.,~ ~ ese on 4. Estimated Cost .... ...... i .................. Fee ......................... ............ (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ..... Number of dwelling units on each floor ...... If garage number of cars ! ' If. business, co ' ' ' . 6. ,mmercml or mixed ioccupancy, specify nature and extent of each tyj)e of use ............ ~ ..... 7. Dlmensionsof,existingstmctures[ifany. Front. ~.~./ ..... 'Rear ..~ ~. ........ Depth.... Height , .t~. ~. ........... Num er of Stories . ./. ..................................... Dimensions of same structure with alterations or additions: Front . ,.'~.,~.z~..~. ........ Rear ...'~r?.,~...~ ...... D' ' ' ' ' ' ~ ' ' ; .... 8. ~mensmns of entire new constru:chon: Front . .~..F, .......... Rear ...o~. .......... Depth /{./zf~. ...... Height ....~. ........... Number of Stories .... / ....... ; ..................... : ................. 9. Sizeoflot Front,~...~.......i.......... ,,w,.~'[.~..~..~' ............... De~,t~ .-~.-~.~.~. .......... 10. Date of Purchase, ./. ~..~..~....I ........ ...". .... N_a,me oy Former Owner . .~..'./.~.,~'....,~),4,,r:,,5'.cf~ . . I1. Zone or use district in which premises are situated.. ,~.~.. ~ ................................. i. i. 12. ocs proposed construction violate 'any zoning law, ordinance or regulation ., ........................... I3. Will lot be regraded .../Q/f..~.,~ .j.~ ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ./.~/).~o,~../~. ¢,~ g//,,~ ~.x:Address c~.~.~,a/'Z~/'.~'.),. ~,,,{ Phone No .~,~(.."..~.,~..~.-~... Name of Architect .. d/f.°../~..Z-..! ................ Address ................... Phone No ................ Name of Contractor fd, d. (;A/ 4,'~ i Address Phone No 15. Is this property within 300 feet of a tidal wetland? *Yes ........ ~...--~.... *If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, 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. '~, ~ -- APPBOVED AS NOTED ~ ... NOTIFY' Ell,flLDiNG DE~ ~ _ 765-1802 9 AM TO 4 P~c~'~-R THE --- -- FOLLOWING INSPECTIONS: Oc 1. FOLJNDATION TWO REQUIRED ~ ].yf/ _ , FOR POURED CONCRETE ¢'0~ ""~r-~a~--I$0--), 2. ROUGH. FRAMING & PLUMBING -- / I' 't ~ 4. FINAL. "CONSTRUCTION MUST Gn ?l / ~ [ 1; 8ECOMPLETEFORC.O. [I. CONSTRUCT,ON S.^L ]U ~ ~ STATE CONSTRUCTION & ENERGY / I1" J. ' CODES. NOT RESPONSIBLE FOR '~ J j.~ DESIGN OR CONSTRUCTION ERRORS S TATE OF NEW ~ORK,~ ~ · / c ~q COUNTY OF .......... ~'~- .. ....... /~ ./..~.gC'. PC[~Q ../~ ~ .~.~..'4Z- ........... being duly sworn, deposes and says that he is the applicant (Namg of individual/signin~ contract) above named. He is the .......... ~ ........ i ................................................................. (Contractor, agent, corporate officer, ets.) of said owner o1' owners, and is duly huthorized to perform or have performed the said work and to make and file this application; that all statements containled in this application are truq~to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Swum to before me, Xhis Notary Public ~ ~...~-'F~.~. ~W ~ - ., N?. 49_,51.3.8.4- ~.. ~ ~ IT (Signature of applicant) uualirie¢[ in [5 ulloll( t;eunty Commission Expires May 22, 19 ~ 4. Estimated Cost G-7- c.xd... (to be paid on filing this application) Ifd ' fd 5. welhng, number o welling units ............... Number of dwelling units on each floor .......... If garage, number of ears ........ · ..... 6. If business, co..mmercJal or mixed occupancy, spec/fy nature and extent of each type of use 7. Dimension, s o,ol,existing structures, if anv. l~'rc~nt ~ '7 ~ /' '7 -' ' ...... '/, ')' ~ ........ Height, ~.~... . Num,-~- ~%:-~ ..... 'Y~' v .......... ~*ear . .~./. ......... Depth. ~../. · Dimensions of same structure with alterations or additions' Front ~2:<.~' ~ ..... ' ........... ~ ......... ;'~'~ ............. Number/of Stories..'¢.,-gr/-AZ'2... , 8. tJlmensmns olentlre new construction: Front..~. Z .......... Rear . .~'.~. .......... Depth .~/~. Height ....o~.: ......... Number of Storie~ ... /. 9. Size of lot: Front ~. o-O ' ' I0. Date ofPurchas~ ./. P....~. .............. 2 .... Name of Former Owner ....'.~/~....,~3/. ~.' ~.' .~}~ 1 1. Zone or use district in which premises are situated... ,~.: ,~.: ................................. 12. · ...... Does proposed construction violate'any zoning law, ordinance or regulation: .., ............................. 14. ' ' ' ~' '? b' ' ',D .... ,.,.;..:. Will exc. ess fill be ,removed from premises:,_ Yes No , ~une o[ .uw,ner o~ prem~.ses . ,.?~.~../. t/.~. ,~ ~-1 ~.x-Address d. 2.~. f'~A~z ~.~,~-.2 ~,~ Phone No ./~/ ~ame m ^rchitect ~ o/J.,~ ..~ ' ........ 7 ...... ' ..... ...................... ,xuuress ................... Phone No ................ Name of Contractor . C,,<. · &"4/. g .................. Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ ~...-;-m.... · If yes, Southold Town 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~ number or d,d_escription according to deed, and show street names and indicate whether interior or comer lot.__ .-715'¥ ' . ..... FATE OF NEW ¥ORK,~ .1 e e OUNTy OF . ~ ~-° (Name of individual/signing contract) ore named. (Contractor, agent, corporate officer, etc.)