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Home My WebLink About22091-zFORM NO.~, TOWN OF $OUTHOLD BUILDING DEPASTMENf TOWN HALL SOUTHOLD, N.Y. N__. BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~,e ...... ~..7.....~,~ .......................... 2209~. Z pursuant t° application dated .......................................................... ~ 9 ................ and approved by the Building Inspector. E~ ...... .~.~,,~,~. Rev. 6/30/80 #722 RHODE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-11102 Examined ..... I / Approved ................ 19 Permit No.. . Disapproved a/c ..................................... J3 SETS OF PLANS .... ~ ..... ,/SURV£Y ............. / ..... CIIECK .............. ( ..... SEPTIC FORH ...... INSTRUCTIONS a. This 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 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 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 eohstru~tion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant .a§mes Io comply with all applicable laws, ordinances, b~}ilding code, housing code, anc.!,,(eguiations, and to admit authorized inspectors on premises and in building for necessa 21~bec~o/~. - ' (Signature ....... o--'~ ~a~lila'nt, o'~ '; ~o'r3ffra[~n~-' ' ' fiff. -' .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... ,~.. c.43. e.a. ~. . r'L ................................ ~. ............ Name of owner of premises .. ~.t C...C¢..~/..t~....[~.:...~..-~./~-.~Z~.t....~..r.q....~.. E7¢..t~..~. ....... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......... ........... .................. ( me and title of co/pbrate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade s Lmense No ...................... I. Location of land on which proposed work will be done~/.~ ....... .~.~..~....~.. ~."7. ..... .~. (~) o. .<. . . . . . ./-/ ..... . .o. .-v. . . . . . . ./. q //. 7. /. . . House Number Street Hamlet County Tax Map No.f/.~ ~ /A '°°° Secti°~.J~' ''7'6sl°ck ..... ' '~' ' '.;z-' ~' ' ' ~.ot ........ .-~....-7. ...... Stbdvson /~.]~'--'~--~.~-t-~.-c-.h~k~.a~i~'~'~.O,.e.6~.,~.-~.,., Filed Map No.__.. ,, __ ,,~.,.'~.~...~..~.,., Lot ..... ,~ ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex sting use and occupancy . .~.('~.. / 1/~. ~.~.. ?~/O gOt' ~ b Intended use and occupancy f{J 3. Nature of work (check which applicable): New Building .......... Addition ..... ~n_ ..... ~.~... Repair .............. Removal .............. Demolition ...... ;,.~.>... ,-, (~r/'__ ~ ~ (.~ __.:> ~ (Description) 4. Estimated Cost ~ [-/(~. ~-at ~ ~ ¥ C'~ ,- 5. '~ ,;' ~ ............................. vet ......... ~ ..................... (to be paid 5. If dwelling, number of dwelling units ..... (0/!.O. .~,, _Number o f dwelling units If garage number of cars (U.~..ff..O ...... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............... ---,- 9. Size of lot: Front tt~(7 / Rear ~..' ~-'/ ....... ~'Ji~ .... '-L~k~: '? ......... 10. Date of Purchase ......... {.~.~.~-..~'.' ............. Name of Former Owner ......................... '.... 11. Zone or use district in which premises are situated ..................................................... I2. Does proposed construction violate any zonin,, law ordinance or re,,ulation' r 13. NW, ill lot be regraded ........... /.L!.O ......~ .... Will excess fill bea:emoved from premises: Yes 14. amc of Owner of premises .iff..~..d O.Z~. c~. / .... Address /.T~. '~I/.~..t'J~'~ff..~t~/?l~hone No~./~..':7.~o.V.. ~.O...-q-/ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ i5. 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 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. APPROVED AS FEE: _ , BY.' ~ NOTIFY BUILDING DEPpM~~ 765~1802 9 AM TO 4 FOR THE FOLLOWING INSPECTIONS: ;. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUI','5;~G ~ FINAL CONSTRUCTIO~i ,.ofiJST gE COMPLETE FOR C,O. AI.L CObJSTR[ICT/ON SHALl, rviEET '[H~ RFO{JJRF. MENTS OF T~E Sr.C.TE CONSTRUCTION & ~::?EF4GY CODES NOT RESPONSIRL ~ DFSt(~p,; OR CONS/RUCTION STATE OF NEW4/,DRK, ~ ~ COUk~r~ OF.. ~Q~...~ff:..q/~J-~.... ~/ ' ·.. t~. ~v4.~.....~v..~..~:4.. . being duly sworn, deposes and says that he is the applicant (Na~nj~ of individuaLz~ni~ ~bove named. /V ~e is the .............................. (~. ~A~. .................................................. (Contractor, agent, corporate officer, etc.) ff said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the /ork will be performed in the manner set forth in the application filed therewith. worn to before me this /~ ' . ~5~ '~'day~'~' .¢....~/.. ,19<~ .................... ' // ' - s t, ..... ..... ........ NOl~AJ~tr e ~B.[}C ' ~ -uflolk Cou:~'' /~ ./ (~ignature of applicant) Ni(~t7t[089, $ ~' D 0 ~r 7 ,9. . .~: ..H .LC .),tCgYm j F..:O-'q Z U