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Home My WebLink About20552-z lvO~ NO. ~1 TOWN OF $OLITHOLD BUILDING DEPART,/~4ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ~HIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) NgN? 2055~Z Dote .......................... , 19 ...3.~ Permission gronte, d to: ~ · ..**~** ~.~..)..~ ...................................................... .~~~....~.:~..:....t..!..~...~.~-..... _.,~,~....~~..¥~ ........ ~...; ........ ~ ............. ,;...; .......... .;:,.....~-; .................. at premises located at .,.~..~,'~.L~'Q ....... ~.~.~.~L,...,~.~,e~,...,~-~..g. .......... ...,~f,~.~ ........ County Tox Map No. 1000 Section ..... /....C~.....~. ...... Block ...... (~...-~'... ...... Lot No....,~...~ ............. pursuant to application dated ...... ~,.....~(..~. ................ 19~ and approved by the Building Inspector. Rev. 6/30/80 Approved FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 111171 TEL.: 765-1802 Disapproved a/c ..................................... (BuHdmg Inspector) APPLICATION FOR BUILDING PERMIT , " INSTRUCTIONS BOARD OF HEAI. Tll ......... 3 SETS OF PL.'~NS .......... SURVfiY ................... ClIEC. K .................... SEPTIC FORH .............. CALL ~ - HAIL TO: Date ...... ..... , . a. 'Tiffs application must be completely filled in by Wpewriter orin ink and submitted to the Building Inspector, with 3 ets 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 c~mmenced before issuance of Building Permit. ' . , d. Upon approval of this application, the Building Inspector will issued 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildin~ Depm'tment for the issuance of a Building Permit pursuant to the ;uilding Zone Ordinance of tLie 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 descr/bed. 'he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to :imit author/zed inspectors on premises and in building for necessary inspJ~tions. (Signature of applicant, or ff4a~eYif a corporation) (Mailing address of applicant) ~ ~sj~.-_ ;tare whether appLicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder] (as on the t~a[x roll or latest deed) ~'applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No h ~nx_7~x~~ Plumber's License No ' ~ ectnca s mcnse No ....................... OtLier Trade's License No ...................... Location of land oh which t3roposed work will be d'~ne... ...... , ......... .... 5: ......... 1 ..... llouse Number Street ~an~let ' Connty Tax Map No. 1000 Section ............. Block .................. Lot... Subdivisinn ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~ ..................... '.. .... / / b. Intended use and occupancy . ~ ~ / ~ F~/~ ,' ...... U '7 . . .... ' . ature o work check w c applicable): New Building .......... Addition .......... Alteration .......... 3 N f ( hih I R pal Remi al D litio Othe Wu k .~,.<~... 4. Estimated Cost. . (to be paid bn filing this application) $. If dwelling, number of dwelling lunits ...... ~ .... Number of dwelling units Ifgarage number of cars . · -' on each floor 6. If business, eom nercial or mixeh o 7 *'inensio~.sg~ex)stingstm ' " .... van~y'specnynatureanucxtent°feachWpe°fvse ..... ;..: ........ ~H.eight ........ Depth - --~ ........ auu.a or auoltlons: t'ront ................. Rear ....... 8 Di ions fentiren 'tn ' e~ ~t ...................... Nt.nber of Stories ............. ti F t R D pth '~ ........ · mens o ew cons lc on: rob ' · · ' ' ........ · · · ear ............... e .... ..,., .... ,,. Height .............. Number of Stories . ' I0. Date of Purchase ........... ~ .................Name of Former Owner ........... ' II Z d .... hp i 12' one or use mnct m whtc re roses are situated .................... ; .......................... · Does proposed construction violate any zoning law, ordinance or regulation: ..... .~..O. Willl t b d ~ .... Will ' ' ' ......... 13. o eregrade ....... . ...... 14 Nam f O f P ........... excess fill be removed from premises Yes Net · e o wner o remises ... ~ ................ Address .... ' Name of Architect ....... ' ............... Phone No ................ · · ·; ................ Address ................... Phone No ..... Nme of Contractor ......... ~ ................ Address ........... ~ ....:.. Phone No... [5. ~ Is this property within 300 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 al s t- - ' ' property lines. Give street and block number or descriptioh accordi,,, +~ ~ ....... 1 e back, .dm)ensmns from -.o ~u u~u, mm snow s~reer names ann maicate whether interior or comer lot. ' I -n~, ~, FEE: NOTIFY 8LI~LD~NG OEPA¢{TMENT AT 765-1802 9 AM YO z~ PM FOR THE FOLLOWING IN,>~ ECDONS. I, FOUNDatION TW(3'REQI JIFIED FOR POUt2ED CONCRETe5 2. ROUGI4 o FRAMING & PLUMBING 3. INSULArK)N 4, FINAL , - CONSTRUCTK)N MUST BE COMPL~TF, FO[~ C,0 ~ , . ALL CONSTRUCTION SHAI L ME'~T . ~,lJ'~ ST,~rE CONSTRUCI~ON & ENERGY ' '~~~/:~i~}c;~t;~:~ .... be'~es and says that he is the applicant ore named· . . ! . : is the ' .~ ' ' ' ~' ' : ' ' i (C tractor ag ' coq offi~ ..... ~ ............................ said owner or owners, and is duly afit mrized to perfo~ or have performed the said work and to m~e ~d file this ~lication; that all statements containe~ in this application are true to the best of his knowledge and belief; and that thc rk will b0 perfomed in the manner se~ forth ia the application filed therewith. om to before me this __ .......... ~.--(.~...da~of. ~5.'~.t.:....19~~ - , , No. 487950~