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Home My WebLink About22060-zFORM NO.$ BUILDING DEPARTMENT TO1/VN HAU. $OUTHOLD, N.Y. No- 22060 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: . ~. ~ ~z... ,,.(.~..../..~./... ~/.~. ~. ~ ~.: .......... to .............................................................................. .~.. ................ ~ ................................................. .... ~i .......... ~P~ ......... ~, ........................................................................................ atp,em,.,ooated at .............................. ?..~....~../....-.~... Z~..~....../..~ ............ ~ 'nt~' ',~'~'~'~ ~' ~ '"i ~'"'~il~"n ........ ~ '~,o~' ' '~' _'~' ' ~ i'~L'~:' ~1'~ '/' '/' '~'~.'~' pursuant to application dated ........................................................ 19 .... and approved by the Building Inspector. Fee,../~. Rev. 6/30/80 FOUleD TIOI! f2nd) 2. ROUGH FRAME &. .PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FI;;AL ADDITIONA'L COM~ENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ............... , 19 Approved ..... . .~/..~.~ ..... , 19~'.)7(. Permit No. ~....~)(o..~:c~. Disapproved a/c ..................................... . (Bflilff/ng Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. c^= ......... .ql...?... MAIL TO: INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets q? 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 hereAa des~cribed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cod~, apd rejg99/~tions, and to admit authorized inspectors on premises and in building for necess~p~tj~.,A- '~ />~/,' //,,,~ ~ _ ' .... .... -- - (Signature or appficam,/or name, iF~ corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~/4. ~. 5d2_ ............................................................................... 34Name of owner of premises . .~..~(?.~.4d...c?..,<..-2~.~./~-...47.~ .~...~.~..o..o.<~. ................................. (as on the tax roll or latest deed) XIf app,'cant is a corporati~,, signature of duly authorized officer. ¢' ...... (Name and title of corporate officer) & Builder's License N~. '~ Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... .~../~?. ~.o./~...&..~.. [..~.~..~ .a~... ~.~ y.~ ............. ...... ................... HouseNan, ber ~eet ~ Hamlet . ~ County Tax Map No. I000 Section .... ~ ...... Block ........ ~ ....... Lot .... ~ ........... Snbdivision. ~... ~L~[k ~ ~o .................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and in[ended use and occupancy of proposed construction: a. Existing use and occupancy ...~Y~ .... ~... ~q ~ y~ i.-~ ~...q F~.~Q.~ ..................... b. Intended use and occupancy . .~.o.~ ~.. ~.~...~.. ~.~?q.i.~...~ V~ ~[~ .......... 10. Y'll. 12. 13. 14. Nature of work (check which a~plicable): New Building .. ·~ .2~. · .t~. Addition .......... Alteration . ...... · Repair .............. Rembval .............. Demolition .............. Other Work .... Estimated Cost ............ ~ ..................... Fee ............................... ...... . , (to be paid on filing this application) If dwelling, number of dwelling lunits ............... Number of dwelling units on each floor ................ If garage number of cars i .................................................... 0~.,,g.5. ~... If business, commercial or mixed occupancy, specify nature and extent of each type of use ~.~,/~..~2....x~....~...~...~..~? D~menmons of exmtmg structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front . .. 7 ...... Rear ..... -~.o./. . Depth .... ~O.' ./. /P.' Number of Stories ~ Height ............. - Size of lot: Front ........... : ........... Rear ...................... Depth ...................... Date of Purchase ........... i ...... Name of Former Ow~n?,4~.,~ . - . ......... Zone or use district in which pr6mises are situated ,.,q(~..;zo ~,o.~/ ~5~~,J?..,..... ............ Does proposed constructiqn violate any zoning law, ordinance or regulation: ~..o ...... ~ . Will lot be regraded ....NS .... ' ";~a~' ' "' '~"~' ' ~ ...... Will excess fill be remo. ved from.prernises:~ _ _Yes ....... No NameofOwnerofpremises l.~/t /~ ~'~o O,~oC~Addres ) 5t~ ,,~ (~107 ~ '765~ gt~,,.3 ................. s ... ~' ....~ ....... P}ione No ............. Name of Architect .......... ! ................. Address ................... Phone No ................ Name of Contractor ......... ~ ................. Address ................... Phone No ................ 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 lbuildings, whether existing or proposed, and. indicate all set-back dimensions fi~Jm property lines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO~RgF~ ~.~qs,: :- S S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this application; that all statements contaihed .in this application are true to the best of his knowledge and belief; and that the work will be performed in tl~e manner ~et forth in the application filed therewith. Sworn to before me this ...... .... ........ $°tary Public'''' ~a~:. '~'~.'~:. County,r~, .