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Home My WebLink About20590-z I~O~-M' NO. 0 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN? 205§0Z Permissionisherebygrant~ (~f ..z..~.....~.....~..~.......~. ........................... ~.....~.:..~.: ....... /../...t~.?... ................ at premises located at ...l.~.....;~. ........ {~.~ .............. .,..~ --% .~ -' ~ . ~ Counh/ Tax Map No. 1000 Section(~q(..~..~.. ........ Block ......(~...-~... .......... Lot No......~..~. ............. pursuant to application dated ..... ~......~-...~ ................. , 19.~....~1.., and approved by the Building Inspector. Fee Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ Examined· . ..~.: .jr..., 19 ~..;~- Approved .~....'~.? ..... 19c~ .2'r. Permit No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS g0ARD OF HEALTH ......... 3 SETS OF FL,~S .......... SURVEY ................... ... :- Date ..... .&. ....... 1 ... , 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 ptot 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 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~ued 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 applicant agrees to comply with all applicable laws, ordinances, buildir!,g code, housing coc~ and regulations, and to admit auth°fized inspect°rs °n premises and in building f°r neces:~.i~*..(7/?.' 7~ ......... --' (Signature of ap~lican ,t~-or narne, ifa corporation) (Mailing address of applicant) //~J5~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · . ................................................................................... Name of owner of premises . L~.~...C./.~....F.'. ~...,'~..C..~. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) · Builder's License No...~.~..~.~...~w.. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be'done ................ .-~,~......~x~......./jr .............. .../..3...z.S. ....................... . n .................... House Number Street Hamlet County Tax Map No. 1000 Section .... /..~:..~. ........ Block ...... L2 ...... Lot Z~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' ......... ..... ...... ' .......... b. Intended use and occupancy ........................... [~ ............ ~...... ......... 3. Nature of work (check which pphcable): New Building .......... Addition.......... :':l.~.~.h~q'~ ...... .. R pal Rem al D liti Otb W rk ·. e r .............. ov ..... , ........ emo on .............. er o .~..~..~.¢? ' (Description) 4. Estimated Cost .. . ~. .................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, ' ' commermal or m~xed Occupancy, specify nature and extent of each type of use ..................... 7 Dim nsionsofe i ti iifa F t ' ' R Depth · e x s ng structures nv' ,~ _. ron ........... .~.. ear ...... ;.: .................... Height ............... Number of Stories ........................................................ Dhnensions of same structure witIl alterations or additions: Front ................. Rear .................. Depth ..................... '. Height ...................... Number of Stories ............... . ....... 8. Dimensions of entire new construction: Front ............... Rear Depth. ..... Height Numbbr of Stories 9 Size of lot: Front ~ Rear Depth I0 Date of Purchase ~ Name of Former Owner 11 Zone or use district in which '" situated · prerr}mes are ..................................................... 12. Does proposed c .... onstruct~on wolate any zomng law, ordinance or regulation: ............. 13. '1 ' ' .................. W~ 1 lot be regraded ..... . ...... .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~..~,~/~'...~.~.t~f.tz. ,Address/~2~'.b,~../$ ~-,'~ Ph''~ ,, -*~_~. /O9~' No ............ Name of Architect a~d .... /-/O/t~t 4/Y ftY'7~ .~. .. ' · ' · Name of Contractor .......... k .......... Address ...... Pho~ No ........... 15. s thzs property w~thln 30~0 feet of a tidal wetland? *Yes ........ No.~.~ ...... · If yes, Southold To~n Trustees Permit may be required. .. i' 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 ndmber or description according to deed, andshow street names and ad,cate' ' whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ..... S.~ · '' ~z~-' .~/[.~.~)~-,~....! .................. being duly sworn, deposes and says that he is the applicant (Name of individual signinfi contract) above named. He is the...~ .,v,~ ~ .............. [ ........................................ (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this ~pplication; that all statements contaln~ed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith· gworn to before me this , ,,,, ,,.,,? !,,, ,,,, , ,, , ........... Qualified in Suffolk COunty ~ ~ (Signature of applicant) Commission Expires May ~2, 19 P, J./L ¢~\t , ": APPRqVED A TED ' ' "FEE:'' a'')'' ~,~''' ' '''"': BY:~ N~IFY BUILDING DEPABTMENT AT 76E-1802 9 AM TO ~ PM FOR THE FOlLOWiNG INSPECTIONS. ~,f, ~, UNDATION - ~O REQUIRED ', ~, :POURED CONCRETE FRAMING & PLUMBING : ' : CONSTRUCTION MUST ~MPLETE FOR ~,0 SHALL MEET' /r;: ~EMENTS OF THE N~Y~ ICTION & ENERGY ~uR~Y FOR .... ~ - D~SJGN pR CONSTRU~TIONERROR. ' LESLIE O. BAUER ,:','' AT LAURgL r, ', ~'~ , O~rE: JUL Il, ~UFFOLK COUNTY, NEW ~RK "'"'" ~0 0605 ..,,,..,,, ,~ .,.,0. ,...,..,.,,.,.,. o~~, ~ /