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Home My WebLink About21529-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN ~ SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNT1L FULL COMPLETION OF THE WORK AUTHORIZED) Date,, ...~.~./......~':.. ............................................ ] 9 .~..~...... 21529 Z Permission Is herebygranted to~ /? /~ t CountyTax Map No. 1000 Section ....... ..~.~;!~.~.. ..... Block ....... ~ ............. Lot No...?~ ...................... pursuant to application dated .........~. ,~,. ................................ 19.~'..~-~., ..... and approved by the Building Inspector. ...................... Rev. 6/30/80 ;AAP or- PI~C)pL-~Ty ~ITU&T~. LUTL 14 OLzUL- TO\~/N oJ'- ~Ot~TIJOLb, Nl-Iv ?LALL- · 40': I" ~ -/qo ~u~q~.~T Ji '7: ' 5rfi)?l~l OF SOUTHOLD / ':, ~ 2 ~tt~3SOU~HOLD' N.Y. 11971 ,' t~-r~,,- .'~-;/ 1 L..~. _ . . .-._~. '~EL.: 765-1802 E.,an,ined '.. ' 7 ' Z-- Disapproved a/c ...................................... . ................. ' ............... _ · ~ /(~Buildig~Inspector) APPLICATION FOR BUILDING· PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS./~.. ! . c. Ec~ ......... ~ .... SEPTIC FOR~! ............. CALL .................. NAIL TO: a. This apPlication must be completely filled in by Wpewriter 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 sti'eets 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. ¢. 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 buildh~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~ling code, hous/tug code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary inspll~ ~' -- - (Sion~t~re of applicant, or name, if a corporation) (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 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 ...................... ,- ~ -- · ca,ion of'a' ' ..... ~/o ~ ~r ~, ~,~,~ ~ .co i nu on which proposea work will be oone ........................... '~, ...................... . . . .... . . . .&. . . . .. ......... :..; ............. 2. . : ............. - House Number Street Hamlet v County Tax Map No. lOOOSection ... :~..~.'..~,,. .. ..... Block -C~ ' Lot. I Subdivision Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupapcy of proposed construction: a. Existing use and occupancy ................................................ . .................. b. In tended use and occupancy ......... .~.~.T..'~t~.. ~7 .................................. · Repmr .............. Removal ...... . ........ Demolition .. Other Work.. ~..~-..~.~ .~... 4. Estimated Cost {. . ' . ~, (Description) ....... F 'eg!" i', ~- · ?' $ If d 11 ' (to be paid on filing this application) · we my, number of dwelling ufiits.. ~ · N mb o£d If g rag b f c I ............ u er welling units on each floor · a e, num ero ars . · usln ss, c n e cia r mx.xe ccupancy, spec atur en~ofeach type of use .................. ............... Depth .. ...... b~r of Stories ......... ' ......... - ............................. * ........ th ......... Dimensions ofsi~me structure wt alterations or additions: Front ................. Rear .................. Depth .................. '. ne~gn~ ................... ,.. Number of Stories ....... ' ' &i .............. 8. Dimensions of entire new constru on: Front ............... Rear .. ............ Depth .Height ............... Number of StorieJ : . ,' ............ ' ............. ~. Size ofiot' Front . i- ' R " 10. DateofPurchase t.~"]{t' . ~;" 'kZ' ........... Dept~,q-r ................. '- ' ...... ~ ....i ........ ' ......... ~alI~e m eormer Owner .... .T.. yf: ................ 11. ~one or use district in which prentises are situated ...... !~./~'.0.......; ......................... 12. Does proposed construction vioLa/e any zoning law, ordinm~ce or re ulation' '13. Will 10t be regraded r2,4~ -.. g ............. : .................. ....... ~ '~'~ ./. ~ · · .~.! · · ~ ·.. wm excess fill be removed from profiaises' Yes I4. Name of Owner of premises . ;P[14 6'¢~..t~, .~..~.//...~.~0. Addr .... /~/.~JLeo7 ~,~-, o pl, ,,4 I~ Name o , ~:~ .t.t;n ~.,~. . :¥W6~. .~O.~..'FIT~j .~, .... hire ' ' ' ' ' ' ' ' 'lt. · F~, . . f Arc ct ........... ~ .......... . .... '. Address ........ [. .... Phone No .¥ ' . Name of Contractor J . .. * a~ ........ 15. Is this property within 30,0 feet of a tidal wetland? *Yes . . ,~n,_~ No .... i *If yes, Southold ~o~n Trustees' Permit may be requir~d~ '"''~ ....... .... [ PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate all set-back dimensions ;rom property, lines. Give street and block n' ~mber or description according to deed, and show street names and indicate whether interior or corner lot. ~TATE OF NEW YOR~,~-, OUNTy oF .. !2,; btk kE .......... (.c (Name ofind vidual signin contract) tbove named. 7~5-~802 9 A~ ~ 4 P~ FOR THE FOl.[OWiNG INSPEGTIONS: 1. FODNDAT~ON '~O REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING ~ PLUM~NG 3. (NSULP, T~OI~ BE COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE ~EQUIREMENTS OF THE N.Y. STATE CONST~CTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONS'rRUCTION ERRORS · · .. ....being duly sworn, deposes and says that he is thq applicant (c ffi ) .................... ontractor, agent, cor'porate o cer, etc. f 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 contai~ ed in this'application are true to the best of his knowledge and belief; and that the r s'et forth in the application filed therewith. ,ork will be performed in the worn to before me this No, 4725089 otary Public, (Signature of applicant).