The URL can be used to link to this page

Home My WebLink About21360-z FORM NO. O TOWN OF SOUTNOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21360,7 Permission is hereby gragted to: ~ .~'&.~~. './..~...~.~. ............ ,o .~~...~~: ...... ~::.~;~... .~ .......... ~','""--'~'"'"'~>;¥ ........ . -"'x'"'."::x .............. ': ........................................................ at premises located at ...,/........~..!.......~.......~..A~1;.~.~,......~.../.. ..................................................... County Tax Mop No. 1000 Section ....... ..~...~.. ......... Block .......... . .~.... .... Lot No ....... ../.'.....'~...~.. .... pur~uont to opplicofion dotal ........................................... , 19.~.'..--.~...., ond oppro¥od blt the Building Inspector. Rev. 6130/80 /- x,. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 __/ TEL.: 765-1802 ham ned .~/,~' ~' "r ............. , 19,,: )isapproved a/c ..................................... .. "(B~filding Inspector) APPLICATION... FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEA~Ttl ......... 3 SETS 0F PLANS .......... SURVEY ................... ClICCK .................... SEPTIC FOR:I .............. CALL . . . . , HAIL TO: *a. Tiffs application must be completely filled in by Wpewriter orin ink and submitted to the Building Inspector, with 3 t~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 - areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- .tion. c. The work covered by tiffs application rfla¥ no~ 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 ~1 be'kept on the premises available for inspection throughout the w~rk. e. No building shall be occupied or. used in whole or in part for any purpose whatever until a Certificate of Occupancy ~I1 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 :dding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :gulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. :e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit author/zed inspectors on p?~emj~e~'grld~in,btillding,..j .. for.. necessaryjstspectio~s.., -- ; ' (Si°nature of applicant, or namc~, if a corporation) (Mailing address of applicant) //qr-/~r ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · (as on the tax roll or latest deed) .~pplicant is a corporation, sign~tu? of duly auth~orized officer. ._ (Name and btl6 of corporate officer) Builder's License No ' Humber's License No ......................... Elccmcmn s hccnse No ~ Olhcr Trade's License No ...................... Location of land on which proposed work will be done ' Il ........ ouse Number Street Hamlet ...... ..z/v. ...... m .... gubdivision .............. Filed Ma o. . .... Lot .......... Slate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ' .. ~ ' ( .. ' ~.:,;;,. ...... ; ................. b. Intended use and occupancy ...... ~ ~ 3. Nature of work (check which ¢pplicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal ......... Demolition Other Work ..... 4. Estimated Cost . ..~..5'...~.. ese n · (to be paid on filing this application) 5. If dwelling, number 6f dwelling units ............... Number of dwcSlling units on each floor .............. · If garage numberofcars . .i ................ 6 If business commercial or mixed occupancy specify nature and extent o 'da'c'h 7 Dimensions ofexistingstructu~es if any: Front ....... : .... · ' Rear Depth Height Nmnber of Stories ........................................... D~menslons of same structure with alterations or additions: Front Depth ~ Height . · ................ Rear .................. 8 ................. i ......................... Number of Stories ............ ~,..... ...... · Dimensions of entire new construction: Front Rear Height Nupaber of Stones ............... , . . .............. Depth ............... 9'. Size of lot: Front '" .......... ~ ...... Rear Depth I0. Date of Purchase .......... ~ ..... : ..... ......... Name of Former Owner ............................ h pl' d ' 11. Zone or use district in whic emises are situate ..................................... ......... · Des proposed construction v ate ny zonin aw, or nance or regulation: ...... '... 13. Will lot be regraded ..... ' ' ' ............... N f 0 . · ........ excess fill be remove om premises: es o f P Add · 14. amc o wner o remises . .I ................. ·. ress ................... Phone No ................ Name of Architect ......... i .................. Address .............. Phone No ....... Name of Contractor ~ ..... ' ...... r · ........ , .............. . ....Address ................... Phone No .............. ... 15. Is this property within 1300 feet of a tidal wetland? *Yes ........ No..~ ..... · If yes, Southold iTown Trustees Permit may be required. J PLOT DIAGRAM' + Locate clearly and distinctly all 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 coruer lot. STATE OF NEW YORK, 'S.S ' DATE: ~ B.p, # ~/~ O NOTIFY 8UI'LOI~ DEPA~ 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING ~NSPECT~ONS: I. F;OUNDATION . ~0 REQUIRED FOR POURED CONCRETE 2, ROUGH. FRAMIN~ ~ PLUMB NG 3, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRUCTION SHA~ ME~ THE REQUIREMENTS OF STATE CO~S~U~ION & ENERGY CODES. aESPONSmLE t~f[~}.~. } .~..~9.0...IA.&. . .~. 0' &~ ~.9~ .[~ ~. .. being duly sworn, deposes and says that he is the applicant (Name of 'nd'v'dual signing contract) ~bove named. [ .. · le is the .................. , ....................................... I (Coniractor agent corporate officer ere ) ........................... ,f said Owner or owners, ~d is duly]authorized to perform or have performed the said work had to m~e and file this pplication: flint all statements contaihed M this application are true to the best of his knowledge and belief; and that the · 'ork will be perfo~ed in the manner ~et forth in the application filed therewith. .worn to before me this ' · I ........... ........ ........ No. 495224U, Uunm J / - ,u~ (S~gnature ora hcant LO'~ ~ 10" E LOT 25' i~uFF£ H, S. REF. 90-S0-62 AREA = 20,592 sq. ft. CERTIFIED TO, FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK TITLE NO. 80A - $ - 8530 HARTFORD FUNDIN¢3, LTD., LEE W. RODENBURG CAROL ROXANNE MALINAUSKAS SURVEY OF L. O ToF 30 SUBDI VISION.CEDA RFIEL DS FILED JUNE '~Z, 1990 FILE NO. 8966 AT GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 '- 05 '- PlO 01 Scale 1" = 30' July 11, 1990 July 30, 1990([obnd. loc.) Prepared in a~=co~'dat~e with the ~um ~~. LIC. ~0. 49818 by ~ ~ ~ ~oved ~d ~ted ~ ~u~ ute bY ~ ~w Y~ State L~ SOUTHOLD~:~/ 11971 8s- 521(30)