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Home My WebLink About21539-zTOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.~ N~ ~1539 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ~~.~...~..Y....,. ..................................... ...~....~~~ ~. ........ ~..~ .... ..~-~.~~.~,.~..~....././..~/.. ............. , CounlyTax Map No. 1000 Section ........ ../.../...Z ..... Block ........... ./~,...~, ......... Lot NO ...... ~.t'..,~,,.'~... .... 19.,~..~...,, and approved by lh~ pursuaht to application dated ....../~..~. .......................................... Building inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ., Approved . <~.-" ..........19~Permit No. Disapproved' a/c ...................................... '. (Building Inspector) APPLICATION FOR BUILDING PEF~MIT BOARD OF HEALTH ........ 3 SETS OF PL.XNS ........ SURVEY ................. CIIECK SEPTIC FOR,~I ............. ~OTI FY; CALL .................. FLAIL TO: 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. 6. 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. ¢. 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 sha/l 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature 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 applicaht is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ~uil~er'~ ~ic~nse ~o... ,~-..~...¢~..T.. Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... i. Location of land on which proposed work will be done ................................. :. ................ ..... .................... ..... i.... ......... ......... ltouse Num her . Street Hamlet 1~9~_' ~ o,,n,y Ta ,ap ,ooosec ,on Subdivision ........ . ............................. Filed 3,1ap No ............... Lot ............... (Name) State exisling use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xist~ng use.~nd oc~upa~ey .... ~.~...~3f~!'~.(..~(.... kJ~:_~ .......... :'. ...... '~....,~ ........ .. b. Intended use and occupancy ..................... ' .................. ~ .......... ' .................. ,3. Nature of work (check which applicable): New Building ..... Addi · terati0n ~ Repair ......... ~... Removal.. ' .............. Demolition ..... : ......... Other ~rk/! ............... ¢~J~ ';~ / i (Description) 4. Estimated Cost . . .......... Fee .... I~ J g th] ppli ) ' I ' . (to be paid on illin s a cation 5 Ifd lli rd ~ it ~ N mb fd Ill ~'fl r' · we ng, numbero wellin un s ........ ._ ..... u ere we ng units on eec oo .............. · If garage, number of cars .... i ............. .r~ .... .. f ' Ad ify 6. I business, commercial or mi,x, occupancy, spec nature and extent of,each type of use ............... , ..... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. mb ' Height ............... Nu er of Stories ..................... wi Dimensions of shme structure th alterations or additions: Front Depth .. : ............ Height .. . ................. Rear ................. · . . '~ ................. :. · Number of Stories .......... '.; ......... 8. Dlmenmons ofenttre new construction: Front .............. : Rear ............... Depth ..... Height ............... Number of Stories ............. ' ........ 9. Size Oflot: Front .......... i .... '.'.. ~ k'ehr ........... i ......... Depth ............ 10 Date of Purchase ~ ' Name of Former Owner 11. Zone or use district in which prem:ses are situated ........... .j~J______________~. · 12. Does proposed construction violate any zoning law ordinance or regulation: 13. Will lot be regraded ....... '.i ........, ............ Will excess fill be removed, from premises: Yes 14. Name of Owner of premises . ~.~ [/~-..~r-. ~... Address..ti¢.~.. ·...7~.~. ?..~.. Phone No. 7.~ ¥.--. ~'~. Name of Architect ......... i.. ............... A~tdress ........ ........... Phone No./_ . . NameofContractor ~0(~...~/ ........ Address ~.o..c07~O¢-YO.-~ ~h,,,,~u~, ,?'~ }_~,' )'~'l'dP "' 15. s this property w~thin ,300 feet of a tidal wetland? *Ye- ( r~'h " ' ' · z yes, ~outho±a ~own Trustees Permit may be require .d'F-''~' .~ . I PLOT DIAGRAM Locate clearly and distinctly ali buildings, Whether existing or proposed, and. indicate all set-back dimensions from property I/nes. Give street and block!number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~-Y-ORK~.["_.?x 1~(' S S (.. i' . 'i' above named. I N~: iVY ~lt:O~G OEPAR~ 785-1802 9 AM TO 4 P~R THE FOLLOWING INSPECTIONS: 1. FOUNDATION - '~O REQUIRED FOR POURED CONCRETE 2~ ROUGH - FRAMING 3. INSU~TION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N,~ STATE CONSTRU~tON & ENERGY CODES. N~ RESPONSIBLE FOR being duly swor~~~t~E~licant Ile is the I ' ! (Contractor, agent, cor'porate 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 contalned 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 thi~ ~ .......... o,.,.._, :T, cA,.., ~o'tary Public.~. :: ..... '. ~... ~~~'¢~¢~ ~' , 1./ Count- ~llf Publto, Stal~ Of Newleol~ ,' ........... r r.~.~..'--=..-~-~...u..-~..,-~/.~..~.~ .......... NO. 4879805 i ' ' ' ture ' · - .OuagfledtnSuffolke...~ 04" , . . ~-4ture .otapphcant)