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Home My WebLink About21319-z FORM NO. fl TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N~? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3~3~g Z Date ..~ ........................................... , 19....,~..'-~ ....... .~...~ ...... ~ ...-.... ,o ~, ~,,.,,., ,~,., ,, ..z~..~ ..z~_,....~. .................................................... ............................................... ................................................................................ co~.~ ~ ~ ~o. ~ooo Se~,o. ....... ~ ......... ~=~ .... ~ ............. Lo, ~o....ZZ ............... ~uildlng Inspector, ,e, ~..~.. Re~ 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOAKD O~ ~ALTIt ......... ] S~TS OF PLA~S .......... SURVEY ................... ClI Cr .... ......... .... SOUTHOLD, N.Y. 11971 TEL.: 765-1803 NO?I FY: . .~/./.~.. ' ~:''L ' '''~'¢ ' i "~' ~ .... CALL Examined .......... ,19.f.~. i;j),].!./)<.',(:;}!i:::":,i!~';~'~ HAIL TO; ................... .................... Approved ........... , 19 Permit No. '( ~nn ~ ~ ~QW~ · P ) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Ttfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se~ts of plans, accurate plot plan to scale. Fee according to schedule. I b. Plot plan showing location of lot and of buildings on premises, relationship t6 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 i~sued 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The appl~cant agrees to comply with all applicable laws, ordinances, building code, housing co, e~, a.nd regulations, and to admit authorized inspectors on premises and in building for necessary inspec~~,~-'?. ~. -- , ,,. ~.. ,~ ..~, (Signature of applicant, or name if a corporation) (Mailing address of applicant) State whether appli~a, nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' l tct4AP-_.D A Name of owner of premises ......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature o[ duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electncmn s L~cense No. Other T ade s Lzcense No ...................... Location of land on which proposed work will be done ................................. :. ................ 't 8'o F ACa Ro D ouraoct) ' House Number Street Hamlet County Tax Map No. 1000 Section ...:....O..4-.~. ..... '. Block ..... .~. ....... i... Lot.. l/ . Subdivision.. Filed Map No ............... Lot ............... (Name) Stat~ ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b, Intended use and occupancy . /Q .3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .... . Repair .............. Removal .............. Demolition . ' ..... ·..: ......... Other Work ............... ' ' Si .' .... F (Description) 4. Estimated Cost ...... i~' ' ' ee .. ,,~..., .... (to be paid on filing this application) 5. If dwelling, number of dwelling, units ..... .~...~. ...... Number of dwelling units on each floor ................ · If garage, number of cars .... ; .................. If bumness, commercml or m~xe.d occupancy, specify nature and extent of.each type of use ..... ?.?( ~s, if any: Front ............... Rear .............. Depth ... ' ......... 7. Dimensions of existing structur ~'.'~ t ' ' Height ....... St. t. ..... Number of Stories ..... ~ ....... ' ............... Dimensions ofshme~s!ructure with alterations or additions: Fro~[ ............. ii" R~ar 'i.i'.. i '.." . 8. u~menmons o~ e,nt?e new construction Front · . ' Rear m +~, ~'~' ~ ' ' ' ne~gnt ...... 'r ........ Number of Stories .......... . ......... 10 Date of Purchase ....... l~.!&D fF [~.~.{~. · · ...... ' ......... Name o ormer Owner .................. 11. Zone or use district in which pr~mises are situated ....... ~,E~.l.O./~/,.. ..................... i ~ ....... 12. D°es proposed construction vioiate any zoning law, ordinar~ce or regulation: ........... .~..O. .............. 13. Will lot be regraded ....... ~.'i' · ,/.M.ed. .............Will excess fill be removed from premises: Yes 14. Name of Owner of premises . [qtC~dAgp.. ~: .ELE.~..~¢Address .I~Q..B~E{t~..~. t~ ...... Phone No. ~.Y..7 ': 16~5'-.,...' Name of Architect ~ ' ..................... Address ................... Phone No ................. Name of Contractor ......... i ................. Address ,..~--,--~_. . Phone No ' ' 15 ' Is this property within 300 feet of a tidal wetla~'d'~' '. ''.'.' ~o ......... ' ' i *If yes, Southold Town Trustees Permit may. be'required~ '" '. ... PLOT DIAG RA/Vl Locate clearly and distinctly all i buildings, Whether existing or proposed, and. indicate all 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. LO ! PI5 NC, · ' ED AS NOTE' NOTIFY. BUIffDING ' DEPARTMEt~r AT 765~1802 9 AM TO '4 PM FOR THE · FOLLOWING INSPECTIONS: I. FOUNDATION '- TWO REQUIRED FOR POURED CONCRETE 2, ROUGH o FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MUST SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY . CODES, NOT RESPONSIBLE 'FOR DESIGN OR CONSTRUCTION ERRORS STATE OF N~P,~L'-~ I I/ i ' ' ' .......... ''~' ........ ~" ..... .... being duly sworn, deposes and says that he is the applicant (Name of individual signin :contract) above named. Heis the....... .................. ~ ~ '~ (Contractor, agent, corporate ......... officer, etc.~ ............................ of said owner or owners, ~d is duly authorized to perfom or have perfomed the said work and to m~e and file this application; that ail statements contaiffed ~ this'application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner s~t forth in the application filed therewith. Sworn to before me this No'ta~Pu'blic, ~~ ~~C~Co;nty "~ , ~.~ ~ -- . : ~ ~/ ' . . . ~ ~'" 2 1993 TO,,vN 0 F. OPZC.,d(,K..YA_~z.~Y,._-, ~,C,LAI'4D 5U P. VEYO.~5