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Home My WebLink About20921-zTOWbl O!: $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER'AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_N? 2092]Z Permission is hereby granted to: .............. ....~.~L..~.:..~....:/..~..t.~...t .......... . ,o ....~..~... ~....~.~L...~.~.~....~..~.....~...~ at premises I~ated at ...,,~ ........... ~.....~....~ .......... ~..~~ ....... County Tax Map No. 1000 Section ...... .~.-/.,.~ ........ Block ....... ...~...[ ........ Lot No, ...~.,,.~ ............... pursuant to application dated ,.~~.,~......~.....J ............... , 19.~...'~..., and approved by the Building Inspector. Fee $..~..~ .~..~'..~ .... Budding Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined (Building Inspector) APPLICATION FOR CU[LDING BOAF, D OF REA. LTl{ ........ 3 SETS OF PL,XNS ........ SURVEY ................. CIIECK SEPTIC FORH CALL HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with: sets of plans, accurate plot plan to scale. Fee according to sckedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street. 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. [1. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi 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 Occupan% 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with ail applicable laws, ordinances, build/irCg'hcode, housing code, and regulations, and t¢ admit authorized inspectors on premises and in building for necessary insp: ...... ~~. ........... .~.. ~.~~. --' : (Signature of applicant, or name, if C-corporation) · 2/. ..... . (Mailing address of applicant) t ! ~'>,' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0wnez' (Name and title of corporate officer) Builder's License No.. ,N. 9.n¢. ' Plumber's License No ......................... Electriean's License No ....................... Other Trade's License No ...................... Name of owner of premises .R. 9 .b.e?.~...C:..lV]a..1.l~z:gf.. g.n.d.. Ch~.%liF..~,. ~4~%lgr~t~. ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer. ~PPI~OVEO ~S NOT~FV BU~L,J!NG "::-' 765-%B,"'~2 9 AMI TC, '~ ~,, ;GF~ THE FOL, LO'~V NC:, 'NSOEC ~:,' 1, FOU~DAT:ON it,,, FOP; POURED 2, ROE!GH . FRAMING ~ PLUMBING 4. FINAL CONGTRUCT!ON MUST BE COMPLETE FOR 1. Location of land on which proposed work will bd done. ,.~ 00..~ao 8~, .Q~II~I~L,~IDIk~[RI~,¢~d~LL. ~ ..... . . . THE REQUIREMENTS OF THE N,Y, 500 Goose 0reek La.~e (.~.r.~,~.a.,~.e. ......... S. gTA~.I~o.~8.TeUCTtO~I, tA .ENEE~OY. tIouseNumber Street CODll[~de~!OT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS County Tax Map No. 1000 Section ....... ?~ ......... Block ..... 1. ............ Lot .... ./J' .............. Subdivision ............. .N/.A. Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . P~i~'a'be residence b. Intended use and occupancy Pz'iv'al;e ~'esidenee 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work .............. Split Rail Fence ~ ~9 (Description) 4. Estimated Cost ....... $2~.,.Q0 ....................... Fee ..... (to be paid on filing this application) 5. If dwelling, number of dwelling units .... 1 .......... Number of dwelling units on each floor ............... If garage, number of cars .................................................. ~ .'... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... 1 7. Dimensions of existing structures, if any: Front....~.9..: ~ ..... :. Rear ..... ~.91 .... :. Deptfi . ifi/~ ......... Height ............... Number of Stories ........................................................ Dimensions 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. Size of lot: Front ....... 75.: ........... Rear ....... 7.5.. ~ ............ Depth ...2.2..0 ................ 10. Date of Purchase .... J.JS~. ..... : ....· ......... Name of Former Owner . .S.a.7.~.o...&..Y..9.u.n.g. ............ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate Jny zoning law, ordinance or regulation: ..N. 9 ............................ 13. Will lot be regraded ............................ Will excess f'fll be removed from premises: Yes 14. Name of Owner of premiseslV[a,~-g~'.a.f. ,..R..&...P:.. Address P.: 9.,..B. 9.x. ~.7.. 1. .... '. Phone No..7.6..5. 7.2.1~.7...."~.. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes..~ .... No ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAG RA~ Locate clearly and distinctly al~ buildings, .whether existing or proposed, and, indicate all set-back dimensions from property tines. Give street and block number or description according to deed, and show street names and indicate whether' interior or corner lot. (,.[ L ~ ~ . ,~..ff ~ _ ~ : gTATE OF NEW YORK, S.S COUNTY OF.. $.u~foi.lr. ...... ............. .Rg.b.o.~..~.. 9....~...a.l.l.~...af ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) tbove named. te is the ....... 9.wY~gV ............................................................................ (Contractor, agent, corporate officer, etc.) }f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this .~-~ : ........... .. ' .............. ~.'~-' ~fi~---~-'-~ (Signat~e ~;ff~applicant)