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Home My WebLink About22064-zFORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. N~ 22064 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ....... /...~...~~../...~.~ ........... .......... ......Y.,.; ........ ~ ............ ~ ................................................................. ~ .................. ~ ........... , ................. ............ ~......~.~.~.~.., ........................................................................................................... ..................................................... .~.~.~..~...~o~..~.....~...Y...,. ....................................... oo~,-,V~ox~o~No. ~ooo s~,o~ ......... ~.~ ..... ~o~ ........ ~ .......... Lotto...~..~Z .............. pursuanf ,o application dared ........ ~/.Z.. ............ ~ ............ 19...,./... ..... and approved byfhe Building Inspeotor. uilding Inspecto Rev. 6/80/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c .... ~.I~.F..~...~ ............... . ..... //.-- o -- (Buildin~ Inspec~,~r) /LICATION FOR BUILDING PERMIT INSTRUCTIONS BOAgD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. NO?I~Y = . CALL .~22x ff~.5. ? ......... MAIL TO: Date .................. 19 a. This application must be completely filled in by typewriter or in ink and submitted to the Buikling Inspector, with 3 (¢ts 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'~pplicable'Laws~,'Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal o'i' demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building co6ei,.-housing 3ode, and regulatiohs, and to admit authorized inspectors on premises and in building for necessary inspections. ....... ............... (Signature of applicant, or nm'ne, if a corporation) ./?~. . ./v d.~/~e~. . /~.e . ~t~.~ X. . ~. /. (~. ~'t (Mailing address of applicant) z State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .O..z~.: .... ~/. ~.-s~.°-.C-. Name of owner of premises (fi~.d~,~,~./'~r~c~ z/.Cfd;Ck .................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done../~<:q;/..~/.o~.c~ ................................... ·/y. ~.~../.¥~.t. e4. ~.~.~. ................ ~.x..~/'f.'. ·//~ .~.¢. ............. - House Number ...............Street H~mlet' County Tax Map No. 1000 Section ..... .O.3.¢ ......... Block .... ~. ............ Lot..~.'./. .............. Snbdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~ ....... ?~ .... .*?d.~ ' .c~..p....................................... b. Intended use and occupancy ...f.z..~-XY'.C~.'.M...t:,~..7..'O? .................... .~r..~. ....................... 3. Nature of work (check which al ,plicable): New Building .......... Addition.. ' ..... ,.?, ~ ~ ~ .... Repair .............. Rem )val .............. Demolition .............. Oilier Work ............... ,, ,~ '(l~ptlon) 4. Estimated Cost... oa ~ ........................ Fee ................ ~ ..... (to be paid on 5. If dwelling, number of dwelling units .....~...t.~..), (_,.~ .....Number of dwelling units on efi~fl'flbo . .'~....~."(' · If garage, number of cars .. "i~ t¥o~"~- - . ................. 6. If business, commercial or mixet occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structun t, if a~y: Front... ~.. ~..~. ~?.~. Rear ..../x(,~. ~.$.?. ~.. Depth . ...z~.T. ~,~. ~.". Height ..../~..: ........ Nun'tber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................ i. Height ........ Number of Stories 8. Dimensions of entire new construction: Front ............. Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... i ......... ' ......... Name of Former Owner .............................. 1 I. Zone or use district in which pr6mises are situated .................... ................................. 12. Does proposed construction vio!ate any zoning law, ordinance or regulation: ................................ ]3. Will lot be regraded ......... ! .................. Will ex.c.?s fill be removed from premisea: Yes No 14. Name of Owner of premises~¢:~.,~.~. ~,'f.~n&.o.q .~-~.. Address ~,.o.q ./.~..q .~.,r:..~/.,~. Phone N0,-~..~.57.7. o~.q~. .... Name of Architect ...... i ................. AddressE.'k~ .~7./Z'! .~.~...~.~. .... Phone No ................ Name of Contractor ......... ! ................. Address ......... /./.5'. 7..~ .... Phone N~ ................ 15. Is this property within ~00 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required, j 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 pumber or description according to deed, and show street names and indicate whether interior or corner lot. NO~'IFY BUILDING OE~M~j~bt~'AT 9 AM ~ ~ ~OR THE FOL ,OWB~G ~NSPECT~ONS: hi: , ,, t r,~; OF THE jN.Y. CG )ES N(~I I~ESPONSIBLE ?OR DE ~IGN OR CONS[RUCTION ERRORS I Ll'~ame or inaiviauai signing contract) above named, i ' He is the ' · i (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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manneriset forth in the application filed therewith. Sworn to before me this ~ . ' , HELENE D. HORNE Notary Public, State of New York .... ;; ................ I No. 4951364 (Signature of applicant) Qualified In Suffolk County r~, z -- Com. mi~sion Expires May 22, 19