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Home My WebLink About20330-z I~OB~ NO, 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJvtlT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20330 Z Permission is hereby gr~l~ted to: . ~.- -~-~,//'~.,...~~....~ ........................ ~.....~..z~.~ ............................ · ............................ :::::::: .... o ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ....... County Tax Map No. 1000 Section ....... ./....'~......~..... Block ........... Z .......Lot No ....... ?.....~... ......... pursuant to application dated ............ .~..:. ...................................... lg.z~.., 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.: 765-1802 Examine~i . Disapproved a/c ..................................... . ~uil~Inspector) APPLICATIO~ FOB BUILDING PEBMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... ' SURVEY ................... CIIECK .................... SEPTIC FOI~M .............. / 'FI-/CrL TO: Date .......... ' ........ ,19... INSTRUCTIONS a. This application must be completely filled in by typ~wr/ter or in ink and submitted to the Building Inspector, with 3 et.;s 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail 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 Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the 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 described. ['he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for necessary~ns~ctions. ... - - (Sig ,n, ature of applicant, or name, if a corporation) ....... 3. .... (Mailing address of applicant) ]tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~ .'~. A~..~1...~-..~-...'t~...~.~.....c~.....l~..x...r?~. ~..O....~X~..' . .~....Q.~. ).Z~....~-~.?---..~. ............. (as on the t~ax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~...r?~..'~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done..J.~.. '.~...~....~..~. ~..~-~..'.~'.~1. )...~.% .,~.. , .'~....'~.....) .......... ................................. .~,...~.7.7. \ .~?..~.~...~:_. t L ~..~-~/. House Number Street Hamlet County Tax Map No. 1000 Section ..... .}..E~..~. ....... Block ~'[ Lot ~":~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ~2.~. % ~ rD .~..~..~'g-..4~ .~. ....~.~...'~.'g.O(1 x~.~, 'r~ ¢.~-..:~:.~: ..... .~. · · b. Intended use and occupancy ......... ~.-~. ~. ,?'~. .... 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration .......... Ri~,~.air .............. Removal ......... 0~...C4~.~_ I'~'~'-~r4-~- 4-/'~C} ~'~'xDem°liti°nC~,-~/'~x_ .............. Y~--~__ ~..%ZL.~ Other Work ..... (Description)""" ' "'' 4. Estimated Cost -a~ .2,.5.~ ltd ~'-? Fee ~.~../. ~--~ff'/<~ ' ..................................... ................... (t ling this application) 5. If dwelling, number of dwelling ~nits .. )O. ~ ....... Number of dwelling units on each floor..k~.}~r ........ · If garage, number of cars ..... j ............. .k~.. J~ .............................................. If business, commercial or m2xed occupancy, specify nature and extent of each type of use ..... ~ ........... 7. Dimensions of existing structuresi if any: Front ..... .~...~. ..... Rear ..... .~...F'~ .... Depth ...1~..~ ....... Height ..... ~-~ ...... Number of Stories ...... ~ ~ ............................................. Dimensions of same structure with alterations or additions: Front .... 1,4~..~ ........ Rear ... ~.~P~ ........... Depth ..... bl~.k .......... '..i. Height ... k,~ ............... Number of Stories .... b~ ~ .............. 8. Dimensions of entire new construction: Front ..... h4 (~. ...... Rear ....... ~..&k .... Depth ...}--~,~.k. ....... Height .... ~ ~X. ....... Nu.nl~er of Stories ..... INI-.~ .... 9. Size oflot: Front ....... .~.~:~..[ .......... Rearkz .... '71 ~ ............ .................... De_p_th . ,{'"..,~...~'r .... .............. 10. Date of Purchase . [v~g.17~.. 7~d.l.~. 4.. ).~.(0.~. F.-Name of Former Owner .. ,7[~.~.~."~.~.~.. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: .......... ~1~ ................ 13..W. ill lot ~be~regrad? ...... /-k' ,.~.~t~ .............. Will e~,e~ f~S. b.~e ~r~ntRy. fd from premises: Yes 14. marne oI uwner o~[ premises 1~4'~ .W~¥~.3~ ~..,~-~.'b(.. Address [df~d~'~-~.'~....~c... Phone No~/~l t,,9 ~.,c)~ Name of Architect ........... .... Address l~t I ~ ~b'>_ Phone No ........... Name of Contractor I~l.~.14..~,~.$. O..1~.~-~ .~.'x~i ' ~,d&~ ................... ph ~ '~'~'l~.'~'cl' 15. Is th~s property wxth~n 300 feet of a tzdal wetland? *Yes ...... ~ ...... *If yes, Southold Town Trustees Permit may be required. . , ~ ~ , ~ . PLOT DIAGRAM Locate clearly and dmt~nctly all build~ngs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block r ~mber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. NO*I I[:Y ~UIt4'~X; ~>EPAR'r~IT AT ¥OL[ OWING ~NSPECT~ONS: '~. FOUNDATION ~/() REQUIRED FOR POUHED CONCRETE 2, ~GUGH - FRAMING g* PLUMBING ~. FINAL CONSTRUCTION MUOT 8[ COMPLETFI FOR ALL CONSTRUCTION SHAM. ME~ '~T~E REQUIREMENTS OF THE N,Y. STATE CONSTRU~fON & ENERGY CGDES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATEOF NEW~Y-OgKJ'~-, t'l~ ~ ~ :ou r¥ ..... ~.t~ .~a~./.4.. ;]~ .... ~Tk,k ~..(~,~. ........ being duly sworn, deposes and (N me of individual signing contract) bove named. ~ says that he is the applicant leisthe ...................................................................................... ~) .~...Y~...t/f.... ~ (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 contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner sdt forth in the application filed therewith. worn to before me this ............ t; ~ ........ day or~. 'rx'/,'~ .'.'.C,_ ...... ,19 . ."-. ( notary Yublie, State of NeW York · · .... No, 4879505 i · . ,. Qualified In Suffolk Copntv (Stgnature of apphcant) ~,~mm188Jon F..v,p ir e