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Home My WebLink About20500-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. NO_N? BUILDING PERMIT rrH,s P~RM,T ~UST ~ ~PT ON ~H~ p~£~,s~ UNT,. COMPLETION OF THE WO"K AUTHORIZED) 20500Z D~,, ..... ~.~ ................................. , ,~.~ Permission is hereby granted to: ................. ~/o, ............... ~.'~...~... .~... ................................... at premises located at ....~.~...Z.~.......~.....~.~ .................................................... County Tax Mop No. 1000 Section ...... ./..~...~,,. ..... Block ....... ~ ..........Lot No ......... ~..~.. ......... pursuant to application dated ........ ~./...~:;~. ................................. , 19~and approved by the Building Inspector. Rev. 6/30/80 ~'4AR 2 0 1992 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ................. : .................... ' APPLICATION FOR BUILDING PERMIT BOAgD OF HEALTI1 ~ SETS OF PLA~IS SURVEY ClIECK SEPTIC FORH HAIL TO: INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ars of plans, accurate plot plan to scaiei 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., e. The work covered by tttis application may not be cbmmenced before issuance of Building Permit. ,. Upon approval of thls application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall be kept on the premises available f6r inspection throughout the work. e. No building shall be occupied olr used in whole or in part for any purpose whatever until a Certificate-of Occupancy mil 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 uilding Zone Ordinance of the Town 6f 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 described. he applicant agrees to comply with ail applicable laws, ordinances, building code, houging code, and regulations, and to ~mit authorized inspectors on premises and in building for necessary inspections. (Si~arfature of applicant, or'name, if a corporation) · .. ~.Q..../p~.....5.z.z....Z~... ~.~.~.~. y...qp..35 (Mailing address of applicant) tare whether applicant is owner, ldss~ e, agent, architect, engineer, general contractor, electrician, plumber or builder. ;amc o OWner o remises ................... (as on the tax ro or latest deed) 'applicant is a corporation, signature of duly authorized officer. (Name and title of corporate >fficer)' Builder's License No ........................... Plumber's License No .......................... £1ectrician's License No Other Trade's License No ....................... Location of land which proposed work will be d'~;e on t~';o .~,~o,~ ~-,'w ..~. 5.~..o.~e fig ........................... : ......................................... se N b St ............ u um er ~:reet Hamlet tyT M pN Coun ax a o. I000 Section .... Block ...... Lot ............... Subdivision .......................... Fil ...Dcoadwa~e~ ~ov~.... ed Map No ....... (Namd) ........ Lot ............... State existing use and occupancy of p~emises and intended use and occupancy of proposed c0n~th~dt~fi~',';) ' re' i denh'a l a. Existing use and occupancy .... .~. .................. . b. Intended use and occupancy ............... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work I:::~'I, OC~: 4. Estimated Cost ~1~o- ~t2.00. ' 1~' (Description) ................................ Fee 2.~ 1.9 ID If dwelling, number of dwelling [ (to be paid on filing this application) 5. units ............ · If garage, number of cars .......... 1 .. Number of dwelling units on each floor ................ 6. If business, commercial or mixed occupancy, specify nature and extent o 7. Dimensions of existing structures, if any: Front....15,/.~ leach t>pe of use ..................... ........ Rear .............. Depth ............... Heiglit ............... Number of Stories with alterations or additions: ......................................... Dimensions of stone structure Front ................. Rear .................. Depth ...................... Height .................. Number of Stories ..... 8. Dimensions of ent re new construction: Front.. INd..Pr ......... Rear .......... : .... Depth ... Height ............... Num~ber of Stories .... 9. Sizeof et Front ]c3 ~q' ,, ' ......;3.';,';) ................... 10. DateofPurchase O,QT q 1°~.0~ ''.' .................. Depth ..l.~...ff...O. . .. 1 I. zone or use oistrict in which premises are situated, r~ijd~, f'fol/ . ' ....... 12. Does proposed construction violate any zoning law, ordinance or regulation: D O 13. Will lot be regraded .lfl.Q.. ~.~t{~~ ................ Will excess fill be removed from premises: Yes 14i Name of Owner of premises .~... ~. (~...ggU.l::j~../~jx/NAddress I.~; 7.0..~Sto..N'. I~.~ .... Phone No.."/~ ~': gO ~'~... Name of Architect ........................... Address Name of Contractor ................... Phone No ................ ......................... Address ................... Phone No ......... i5. 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 all set-back dimensions from property lines. Give street and block number or descriptima according to deed, and show street names and indicate whethe,r interior or coruer lot. ConSfr ce ct spliF a(I nce. 1to 2.'4 ePr- nle q h FOLkoW~NG ~1~ ..... ~ FOR L FOU~DAT~ON '~VO FOR POURED CONCBET~ NSU&AT~o~ 4, FINAL ,. CO~STRucTto~ ALL CONSTRUCTION SHALL STATE CONSTRU~ION & ENERGY CODEs. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRoRs FATE OF NESV-YOR-i~ fl/ SS - ................................. ~ ~ being duly sworn, deposes ahd says that he is the applicant (Name of individual signing contract) ' ' ' eve named. (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly authorized to pcrfo~ or bare performed the said work and to m~e and file this ~lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be perfo~cd in the manner set forth iu the application filed therewith: om to before me this ......... .... - Qualffi~ in Suffolk Coun~ ~ ~ ... . . ~