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Home My WebLink About22084-zFOIIM TOWN OF SOU'[HOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. No- 22084 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ......... ~!~.~.~..~...~.:..//.~..~.. ( 73~ b~-~ ..~.(~ ........ ~.~, .................................... ;..~;... ,~. , ................ ~.~ .............. (< ............. ~ ............... ,o ...../~.~.c~L ....... ~.~....~. ....... ~5~.~ ......... ~....~.~,~ ................ · v. 6/30/80 ~.....~..~~, .......... ,~/.,.~, CounWToxMapNo, lO00 seo,on...../Z'...~... ...... B,o~k ......... ./..~ ...... LotNo. ,,,,~....,.'~,..~..,,.,'~,. ...... pursuant to application dated ........... .~..../~..../~'.. ......... ~. .............. 1 9...~.....~'...... and approved by,ne Building Inspector. Fee $..~..~.,.~ ..... ...... ....... ........ Building Inspector~,) ' MAY - 6 BUILDING DEPARTMENT I TOWN HALL SOUTHOLD, N.Y. 11971 TOWN/~LD T E L.: 765-1802 .... ', Approved ..... Disapproved a/c ..................................... BOARD OF HEALIH ......... --'"'3 SETS OF PLANS .......... --SURVEY ................... ..-'CIIECK .................... SEPTIC FORH .............. NOTIF¥~ CALL ................... HAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...~. 9.'9...~: ......... 19 .q.~- 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 construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .... ' · (Signature' of applicant, 6r name, if a corporation) ........... .t.7.. '.~ s..~. ~.~. ~...'~. ~. P.,~.-? K... '.~.~ .T3L'., .~.q'F..."%. :~?J.~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a c or po ration, signatu re of duly authorized officer. Builder's License No .......................... '~'/'~'~~ Plumber s L~cense No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. H3use Number Street Hamlet ~,~.~ ~ County Tax Map No. 1000 Section . ././~.. ........... Block .... ./~ .......... Lot...'-fi~....~-~ ..... Subdivision ..................................... Filed Map No .... ~ ...... Lot ...J~X".~.. ~.3:..~:-:.... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~-,~ ~ ~c COo*o~!-~% .- v-~ ,- -~-, ,,~ 6. b. Intended use and occupancy . $ .o,. ~.~.t .~.. 3. Nature of work (check which applicable): New Building .......... Addition .......... ~rti~ ~ ..... Cz_': Repair .............. Removal .............. Demolition .............. Other Wol~ >. ( ~ ~:~' .'-..e'~. F? , (l~[ription) 4. Estimated Cost ~4~ ~z %~. ~ ~ Fee ...................................... (to be paid on ~on) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each fl~--'.~ ......... · If garage, number of cars ....................................................................... 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 .... -~:~..w. ?7... Depth...3 ~-.. fi: .'U? ..... Height ............... Number of Stories ~'- ....... Dimensions of Jame structure with alterations or additions: Front ...~.: .~..~.~.. ...... Rear .................. Depth ...................... Height ...................... Nmnber of Stories ...................... 8. Dimensions of entire new construction: Front....5..,*///////.~...~. ..... Rear ............... Depth ............... Height ............... Num bet of Stories ........................................................ 9, Size of lot: Front ....... A..-y. ?..v-~.. .......Rear ...... .~?...~2 .......... Depth ...i.c:. ~...¥. ?.VT ........ I0. Date of Purcha~e ........ ! ??.? ................ Name of Former Owner q .9 ~-.~-..~7~ ............ l 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ~ ............. 13. Will lot be regraded ..... /%..0 .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises 2¥..~...~l?.q e..~.,,..'Y ..... Address .}??.~. Y..~?.~-'~.......~ ~-- .. Phone No. ).%~. --~?...'~.'. .... . Name of Architect ........................... Address ................... Phone No ................. Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes...~rT..., 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. · A FROGD AS NOTED 765-1802 It AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMEIING 3. INSLJI_ A~ION ,4 [h",;.~.L co,~,qrnucrtoN MUST F3[-_ COMPLETE FO~ C rD ALL CONSTRUCTION SHALL MEET THE REOOIREMEN'IS OF THE NY. STATE COI'4STRL.ICTION & ENERGY DESIGN OR CO~'JSTRUCTION ERPIOHM STATE OF NEW YORK, S.S COUNTY OF ·. :~ .~ ?..c-.~. ?..u.~_.... ·...~..tq,~. fi.~?.~.~z .c-...~..4 .c~....,5~~. ................. being duly sworn, deposes and says that he is thc applicant (Name of individual signing contract) above named· 4.~-is the ..... o 90. .~,...~?~-~... .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 'application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatior~ filed therewith. Sworn to before me this ,/ · ',r.v. /" .-" c¢4 ......... ~ ......... ~.z~..day of(~ .~ ............ 19... .- ........... (Signature of applicant) No. 4725(~9, ~ffoik Cow]b[ T~mt Expires May 31,19c~