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Home My WebLink About21961-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Date 3 ,' ,~,,~ 21961 Z ...................... ~ ............................... ~9.....~.~.: Permission Is hereby, granted to: ~....,~....~~...~.. ~.~,,,,: .~.~,...~.....~.o.Z ................................................... ..£~.~.~..: .......... ~..7.. ....... ./r. .................................... to...~~ ......... ~ ........ ~c~ ......... ~.~....~.~).....~.....z~ ................. ...~.,..~,~... ............. z~ .......... ~.z.. ........ ~ ........ ~. ........ ~.~ ....... ~ ........ CounlyTaxMapNo. 1000 Section ....... ~',.,/, ........... Block ......... ,,~.,.~.... ....... LotNo ......... ~,~ .............. pursuant to application dated ........... ~.//.¢~..././ ................................ 19,~,../~',.C)~/' ...... Building Inspector, F~ S......~ .... and approved by the ~ ~n Ins eotor ............. ~ ............ ~;T'"'T'"~; .............................. Rev. 6/30/80 · 3. Nature of work (check which applicable): New Building . ~ ........ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .... : ......... Other Work .............. ...'~t .~.rj)/O ,,o~ .'"" . ~ (Description) 4. Estimated Cost (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · 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 .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of shme 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 .......................................................... 2. Size of lot: Front ...................... Rear .................. i... Depth .......... ' ............ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 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 ....... '. .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ............ ~... Name of Architect ........................... Address ................... Phone No ................. Name of Contractor .......................... Address ................... Phone No ................ 15. I~ 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 fr~m property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW.~f-ORK{~, .{" S.S COUNTY OF..~ [.~ .~7-~ .l.~. · (Name of individual signing contract) above named· being duly sworn, deposes and says that he is the applicant He is the... . . ................. . ......................................... . .............. (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 application filed therewith. Sworn to before me this ...... .~..-: ~, .~..-'.. '...da : .... i, 19 ;oiaryPublic,~~~County y. //~ CLAIRE ~,. NOUIry Public, State of New York ' . ~ ........... -7.,,~/~. ~ ~ .......... No 487950~ · ~. ~ / / / / '(Signature ~)f apphcant) ~ Qualified in Suffolk Cou0ty /d~L" ' / . / / / .. CemmJssion E~pires December S, 19.~ / TOWN OF ~OUT;qOLD Examined ........... , 19~ Approved .... .~.>..~. ..... , 195 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 e" it No. Disapproved a/c ............................ · ( .ildiflg0Insp ) APPLICATION FOR. BUILDING' PERM T HAIL TO: INSTRUCTIONS ; a. Tiffs apl~lication must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 s¢~s of plans, accurate plot plan to schle. Fee according to schedule. ~ · b. Plot plan showing location df lot and of buildings on premises, relationship to adjoining premises orlpublic streets o/' areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- c.4tion. ~ c. The work covered by tins application may not be commenced before issuance of Building Permit. : d. Upon approval of tins application, the Building Inspector will i~sued a Building Permit to the applicant.I 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 9f 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 Southbld, 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 her~in described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -- (Signatur9 of applicant, or name, if a corporation) (Mailing address of.~ap~licant) . State whether applicant is owner, !essee, 'agent, architect, engineer, generai contragtor, electrician, plumber or builder. Name of owner o f premises ~.0/~ .~iAj(~'- (.-.~t/lbJ ' ' D~ ;~B"P'# ' ~'~': ~ ! tas on the tax [oll or late~oqtfl~8~,) Bui~DjNG DEP~ART~iENT'A, If applicant is a corporation, signature of duly authorized offioer. ,7EE-1802 iOiAM TO 4 ~M FOR TIlE .i FOLLOWING iNSPECTIONS' : · ~ ' 1, FOUNDATION - TWO REQUIRED (Name and title f corporate officer) Builder's License No. 7~I '- ~'~ .~. Plumber's License No ..... ~'.. .......... Electrician's License No. ~ Other Trade's License No. ~ FOR POURED CONCRETE 2. ROUGH - FRAMING,& PLUMBING, 3. INSULATION r P ~,~ 4, FINAL - cONsTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION M~ET THE REQUIREMENTS.OF iTHE N.Y. STATE CONSTRUCTIOI~ & ENERGY CODES. r;ol RESPONS;BLE POR DES Gr C0NSmUgnO ERRORS 1. Location of land on which proposed work will be done... ~ ................. , t. ,,...,.; ..... , ......... .7..o..'.' ..... 5.0 ........ House Number Street Hamlet County Tax Map No. I000 Secti6n ............ Block .~ .... ' . Lot...~ ..... , .......... Subdivision . .. ........ I ' Filed Map No. Lot ...... ... 2~ State existing use and occupancy iof premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~ ~/~ b. Intended use and occupancy ' .: ...... '....- .