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Home My WebLink About22457-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . SOUTHOLD, N.Y. N~ 22457 BUILDING PERMIT (THIS PERMIT MUST BE HEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORiTED) .......... .......................... Z at premises located at....~.....~...~.....(~... ................................................... ................................................. ~~~../.~...~.,...~.:..~: ............................. CountyTax Map No. 1000 Section ............2,,~.,..... Block .......... '~...,,,~ ........ Lot No.....~.. ...................... 19......~.... ,~.., and approved bythe / pursuant to appllc ation dated .............. .~....~../. ............. Building Inspec,~ Fee~..~.Z .............. Rev. 6/30/80 4 FORM NO. I .......... TOWN OF SOUTHOLD TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approve ., . ermzt No ..... Disapproved a/c ..................................... /,~ I~;~;J~: j' OCT 3 ! 19~ · AP~L)gATION FOR BUILDING PERMIT v October 3.1 I9 Date ............... , IN, STRUCTIONS a. This application must be completely filled in by typewriter or in ink and shbmitted to the Building Inspector, with 3 ~ets 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 appUcant. 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 sliall 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, additi6ns or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build'.m.g eode,.j~using code,.~agd regulations, and to admit authorized inspectors on. premises and in building for necessary i~~.,/ ..... ~~.": .~ .~..... ~ ....... .... ~7:'c)~ i~{?~ ' ' '~ ~"(S~ of pa plicant, or name, if a corporation) ...... ,~ Garrett A, Strang~ Architect .¥p3.n, ~9.a,4,.. P,..Q,139~, .1.412..5.o u.~b.a J,d. NY.... (Mailing address of applicant) BOARD OF HEALTH 3 SETS OF PLANS SURVEY CIIECK SEPTIC FOEH CALL ..... HAZL TO: State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Architect David De Fr'.est Name of owner of premises .......................................................................... (as on the tax roll or latest deed) lp applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... N.q~..S.e.J:..e .c.~.e.d... y.e.~... Plumber's License No ........ : ................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................ , ..... , .......................... Main Road Southold · ). 1.4.0.q ..................................................................................... House Number Street Hamlet County Tax Map No 1000 Section 7.Q Block.. 9.2 Lot 9.3 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises apt! intended use and occupancy of proposed construction: Existi~gus and pancy Funeral Home wit.h Accessory. .G. qr.o.~.e fl. I e OCCU .......................................................... b, Intended use and occupancy .................... , ............. . .............................. Repair .............. R~moval ...... Nature of work (check which!applicable): New Building.. ·. ~ ... Addition ..........XXX Alteration .. ....... Estimated Cost ....... $., .7 ~ .5.0.0, ..... If dwelling, number of dwelli;g units.., Demolition O t h e,r,,~o~[~ (Description) ........... Fee ..... .$..6.7..9.0. ..................... (to be paid on filing this application) Number of dwelling units on each floor · If garage, number of cars . 2. ~ If ' 'g fly h typ 6. business, commercial or mi ed occupancy, spec nature and extent of eac e of use .......... ...... 7,4. pth .2,4" 7. Dimensions et exmtmg structures, if any: Front .... n--, 74 H.eight .... ] .4 .......... NOmber of Stories ...... .O.q~ .......................... Dtmenmons of same structure! with alterations or additions Front 104 ' R-*, 104 ' ' Depth. i ..... 2.4 ...... i Heir, bt ...... !,4 '~ 17 ' ' ' ~,i ' ',"' ' '; .................... I ' " · .' ............ l~umoer o~ Stories .. J..&.. !~ ....... 8. Dimension~ of entire new construction: Front .............. Rear .............. Depth ....... Height ...~.'?. ......... Number of Stories .... i ............... i .......................... 9. Size of lot: Front ...... 80.1 ............. Rear ..... ] ~9 .............. Depth . .~..3.2;Q ...... 10, Date of Purchase . ........ . .................... Name of Former Owner ...................... 11. Zone or use district in which Premises are situated . .RO .Re~identlal Office 12. Doesproposedconstruet~onvlolate'anyzonmglaw, ordmance or regulation: .., ...... ~9 .......... · .... 13. Will lot be regraded ..... N.o. .................... Will excess fill .be removed from premises: N/AYes Nc 14. Name of Owner of premises p.q¥ ~.'.d..D. 9..F.r.&~, g.. Address ...S.o.u.~bg~..d. .I~¥:... Phone No. 7.~.5..'7.:~{~,5.0. Name of Architect 9.qr. .S.t.r. ....... Address . S. 9.u,t.h. 91,.d..N.Y.; .... Phone No. 7.6.5.= .5.4.5.5. Name of Contractor ...~9.t.I, .~O }..c.c./igC..Y.q~ .... Address ................... Phone No ........... 15. Is this property withifi 300 feet of a tidal wetland? *Yes ........ No..~ .... · If yes, Southold Town Trustees Permit may be required. ...! PLOT DIAGRAM Locate clearly and distinctly loll 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 whethex interior or corner lot, ;TATE OF NEW YORK, :OUNTY OF..$u ff.alk ..... Gorre%t A. S,t..rg.na (Name of individual si bore named. See A~toched!!l UNOERWRI~ERS CERTIFICATE APPROVED AS NOTED . ,-, ' BUILDING DEPOT ~.A,~- ~85480~ S AIV~ TO ~ P~TH~ FOI.LOWING INSPECTIONS: 8E COMPLETE FOR C,O. ALL CONSTRUCTION SHALL MEE~ THE REQUIREMENT~ OF THE STATE CONSTRUCTION ~ ~ODE8. NOT RESPONSIBLE DESIGN OR CONSTRUCTION ERROR8 S.S ...................... being duly swornI deposes and says that he is'the applicant lning contract) , is the Architect - Agent ~ (Contractor, agent, corporate officer, etc.) said owner or owners, and is dluly' auth. orized to perform or have performed the said work and to make and file this pplication; that all statements contained m this application are true, to the best of his knowledge and belief; and that the ,ork will be performed in the man,er set forth in the application filed therewith. worn to before me this ............... v ..... .... l cZ.,. · otar Public, · .... ..... I , (J roB£r,t,l.,~c~..~ ....................... , ..~ ........... N. OTARY PU.B,,U,,CF~, .~of N..Y.cc-_ V/..v: .-...-=. ,~..-... ~ ......... ' .... ~to. 4725089,.~dfolk Oouoty ~ (Signature of applicant)-