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Home My WebLink About21538-zFORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ......~....~,./...~.. .......................................... 21538 Z Permission Is hereby granted to: . ~ / ~ ,~, /'/~ J ........................... , CountyTax Map No. 1000 Section ......~..~.. ........... Block ...... ~ ............... Lot No. ,,,.~,,,,,~, ................. pursuant to application dated ~;~0 ..~.~ .................................................... 19 .............. and approved bythe Building Inspector. ' / ,/ Building Inspector Rev. 6/30/80 ~T' ' ' FORM NO 1 !!1 )~L.~.-J~*L' TOWN OF SOUTHOLO jJ L,J)I ' BUILDING DEPARTMENT I1{\\~ "~"~'~ o ~' '"'~' : SOUTHOLD, N.Y. 11971 ~LJ ~,l ..... = .... ~2g' TEL.: 765-1803 I 8~DG. DEPT. . · Approved ..~ ......... 19ff~. me~it No~.~ ~ D a is pproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOAKD OF' HEALTH ......... 3 SETS OF PLA;~S ......... SURVEY .................. SEPTIC ¥ 0 R,'! ............. t:o? I FY -' CALL ................... HA I L TO: Date .................. , iv 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 sti'eets or areas, 'and' giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit ~hall 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 i.~ ctions. / . -- (Signature of applicant, or name, if a~orporajff6~! ... ~3. ~.....C5.. ~..7~..~ ~~ (Mailing address of applicant) ]/~//q State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or buila.r. Name of owner of premises ~//(-~-- ~"~"~ ~ff~/~~ ' (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...~..C:L-a.~',~- · .,~.. ............ Plumber's License No ............... . .......... " Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ~ .q .0..' ................ ~_w.~...~. w. ~. a:. ~...~.?..~.. ...... .~.o..~. ~..~. e + ~. ......... - lfouse Number ./qh-~. Street Hamlet County Tax MapNo. 1000 Section ...:..~'.~ ......... Block ..... 3 .... ' Lot...~.3 .............. Subdivision ' Filed }.lap No ............... Lot ............... (N~me) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................................................... .. ~. ~,,~,~ ~,~ ~.~ o~=~ ...... ~5..~ ~.~. ...... ... .............................. '3. Nature of work (check which ~pplicable): New Building .......... Addition .......... Alt~r, ot:iortv..~....>. 2.. 4. Estimated Cost . ' tion) (to be paid on fihng this apph 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each fl · arage, number of cars .... l ......................... ' .. : ~,~w(,'c 'i ...... 6. If business, commercial or ml.x¢d occupancy, specify nature and extent of.each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height Nulnber of Stories ' ' Dimensions of shme structure with alterations or additions: Front ................. Rear .................. Depth ' i Height ' · Number of Stories ' 8. Dimensions of entire now consl;ruction: Front ~ Rear .............................. Depth ............... Height ' Number of Stories 9. Size of lot: Front .......... ............. Rear ...................... Depth .......... ............ 10 Date of Purchase i .'... Name of Former Owner 11. Zone or use district in which p~emises are situated ' 12. Does proposed constructionvi~late~ any zoning law, ordinance or regulation.. .-..,.. .....-.- ...... .. i.~" ' 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 i ' A~ldress Phone No Name of Contractor ~ Address ' Phone No 15. Is this property within lB00 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&n property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~:~ . NO'rIFWROII.15IN-G OEPARtJfl:~ ~T '.eT ~-~ 765~1802 9 AM TO'4 PM"~}R THE ~ ~ FOLt.OWING IMBPECTIONS: ' ~ 1. FOUNDATION TWO REQUIRED ~'~ FOIl POURED CONCRETE · ~ 2, ROUGH - FRAMING & PLUMBING ,"~'/INSULATION /<om / $ /rh L,. CONSTR CTIO. S"ALL i -/THE ~EOUIREMENT$ OF THE N.Y, STATE OF NEW YORK, ."'.S~ STATE CONSTRUCJ'ION & ENERGY COUNTY OF ................. CODES, MOT RESPONSIBLE FOR I DESIGN OR CONSTRUCTION ERRORS' ·. being duly sworn, deposes and says that he is the applicant (Name of individual signihg contract) above named. (Contractor, agent , cor'porate 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 ail statements contaihed Jn this'application are true to the best of his knowledge and belief and that the work will be performed in the manner kef forth in the application filed therewith. Sworn to before me this , State of NewYork . S~ nature ~c No. 4952246, Suff I~n.... ., ' ' (ig'natureofapplicant)