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Home My WebLink About21638-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N- 21638 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ..........~.~ ....................................... 19~',~.... at premises located at ............................................................................................. County Tax Map No. 1000 Section ......... ~,~...~).. ...... Block ........... ~ ......... LotNo ....... .,I~.../~ .......... pursuant to application dated ......... ~. ,/.'~...,~.. .................................... 1 9. ~.-~- ....... and approved by the Building Inspector. Fee $.~.,....~ ./~...... /~' Building I/nspector Rev. 6/30/80 Examine,l;.'.... ~kpproved . ., 19... Permit No..~,/~. ,-~. ~/ / Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BO,lED OF HEALTH ......... 3 SETS OF PLA~;S .......... SURVEY ................... CIIECK .................... SEPTI'2 FORH .............. NOT I FY: CALL ................... HAIL TO: (Bu~ing J~fspcctor) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sts 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 r,areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such penmit hail 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 frail 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 .uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all appl/cable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necess~llf~inspections. · - (Signature of applicant, or name, if a corporation) .. :a:... ...... ' ' (Mailing addre~ss of applicant) ;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... 6., o .w.-r-R../~...'La...~. ................................................. - ........................ 4amc of owner of premises ....'~.~.O...v,~.. ~.l.{)...~. ........ h. gt0e. r. ........................................ (as on the t~t roll or latest deed) f applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) · . · 7y..4./- Builder s Lmense No ............ . ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .... .......... .43.. .... ............ House Number Street Hamlet County Tax Map No. 1000 Section ....... ~..O. ....... Block .... Z ........... Lot...~-..~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed c'onstruction: a. Existing use and occupancy ~./,.'-} &(-t-~ ~(~/~tax t ~"2<~ I~)c~J -t:7_ .............................................. ,~,~,. '~",' .' ~.~,,~.J~r ......... b. Intended use and occupancy ................. ' - '"--' ...................................,.,,.-....,,.,...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterati°-~5 't~ ;~ ' ' ' Repair ........ Removal ........... Demolition ............. Other Work. ~..~.. Z,7.q C (Descrption, 4. Estimated Cost ., Fee ' f (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · If garage, hum her of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D/mensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. $izeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 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 ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 3fi0 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether e. xisting or proposed, and. indicate ali set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. lCK, T APPRO~O AS NOTED ~onrv eu~vr~ o~'e~ 7~6-~802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: ~ FOUNDATION ~0 REQUIRED FOR P~URED CONCR~E 2,RO ]GH ~ FRAMING & PLUMBING ff 4 FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CO~STR~c~ON SHALL ME~ ~ THE REQUIREMEN~ OF THE N.~ STATE CONS~u~oN & ENERGY ~ ....... ' ....... CODES. N~ RE~NSIB~ FOR ........ ~IGN OR ~U~ON ERRORS ;T^TE OF NE}FSrO~I{/ S S ' ....... .,~.~.~'~/~. Z~,...(-~ .... & ........... being (Name of individual signing contract) bore named. duly sworn, deposes and says that he is the applicant [e is the ....... ~ent, corporate officer, etc.) ............. f said owner or owners, and is duly authori:~'N~trr~rform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. worn to before me tlxis . . ........... o,...:'¢- ~at~r, of applicant) \ SURVEY FOR: TSU/VEHIDE ~R~G~KI ~ Z/LA AR~GAKI ~UFFOLK COUN~ D~ARTMENT OF H~L~H SERVICES LOT ~0 2~, "PEBBZE BEACH FABMS" FOR APPROVAL OF CONSTRUCTION ONLY AT ~ST ~R/O~ o~r[ SEPt I0, 1979 ~WN OF SOUTHOLD sclc[ / '~ 40' DATE ~HS REF. NO. SUFFOLK COUNTY, NEW YORK NO 79-50/ ~:'~NU~ % SURVEY FOR · TSUIV£HIDE Af&~G,~Ifl ~ L/LA SUFFOLK COUN~ D~ARTMENT OF H~LTH SERVICE: LOTTO 2~, "PEBBLE B~ACH FOR APPROVAL OF CONSTRUCTION ONLY IT ~T ~[0~ OlrE S~ I0, ~N OF SOUTNOLD SCALE /'~ DATE HS REF. NO. SUFFOLK COUNTY, NEW YORK NO 7g-~0/