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Home My WebLink About20091-z I~0~ NO. ~ TOWN OF ~0UTIt0LD BUILDING D£PARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT oN THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 20091 Z Permission is hereby granted to:, ~.....~..../~.....~ ................................. , ,,....~:~~..,...~./~.....,../..z~"~ ~, ~r~m,=,--~ ~....~.~ ........ ~~::~..~ ................................................ ...................... ~.. ~~ ................. co~ ,ox ~p uo. ~000 s,~,o, ....... /Z~ ....... m~k .......... .~. ....... lot Uo ...... ~..~ ........ pumuant to application dated ......... ~.../..(....,~... ............................... , Building Inspector. Fee $..~,,,,~ and approved by the Re~ 6/30/80 BLDG. DEPT, TOWN OF $OUTHOLD_ .... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Zxamined .~../, .~/. ., 19.t~/ 'ti*proved ............... 19 ~//. Permit No .z~...~ ~ 3isapproved a/c ..................................... INSTRUCTIONS BOARD Of' HEALTH ......... 3 SETS O~PL~NS . sURVE ........ c,l cr ................. SEPT:C roR, l .............. CALL . Jo2 ..q ........ HAIL TO: a. This app~icati~n must be c~mp~ete~y ~ed in by typewriter ~r in ink and submitted t~ the Bui~ding ~nspect~r~ with 3 ~ts 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 applicatibn 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 mil 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 nntil a Certificate of Occupancy ml~, 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 uiMing Zone Ordinance of the Town of Southold, Suffolk Count1~t~ew York, and/bth4Fa~pli:c~ble Laws, Ordinances or egulations, for the construction of buildings additions or alter~t~ons,X~r for regng~al 6~- de~it~'on, as herein described. he applicant agrees to comply with all applicable laws, ordin~ixces, blail~ting c/¢/d~, ho, fisinff'/code,,, and regulations, and to lmit authorized inspectors on premises and in building for necessary ~/spe~ti.~n~./, (STg~nature o)"appl-ieant~oi:'n~]~e, if a corporation) (Mailing address of applicant) .tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . (as on the t.atk roll or latest deed) "applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 0~'t,~. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... · Location of Iand on which proposed work will be done .................................................. llouse Number Street Hamlet County Tax Map No. 1000 Section ..... /~ .~ ./re. Block .... ~ ........... Lot... ~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) Stale existing use and occupancy of premises and ~ed use and occupancy of proposed construction: ...... ' ':' ,: :" .'~ :',D:~;~5~;i} ......... b. Intended use and occupancy ...................... ;..~, .... , ~.~ :: . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........ Repair .............. Remdva[ .............. Demolition .............. Other Wo~j~....'... , ~ 'l~D~scnptidn)', 4, Estimated Cost .. Fee .... ~' (to be paid o'p · fihng 5. If dwelling, number of dwelling u'nits ............... Number of dwelling units on each floor ................ · If garage, number of cars ...... [ ............................................. 6. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use 7. Dimensions of existing stmctures,,if any: Front ................ Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ......... Rear ......... Depth ' Height Number of Stories 8. Dimensions of entire new construdtion: Front ............... Rear ............. Depth ......... Height ............... N mbqr of Stones ........................... 9. Size of lot: Front {.g~.CP ' .......... ,j~l; ............ . · :_, ..... .,..., ......... Rear ....... .~.~. ........... Depth .., ,/. ............... 10. Date of Purchase . .e/~..,o/~"e%'.../'.q.~.~ ........ Name t~f Former Owner 11. Zone or use district in which premises are situated ......... ' ' 12. Does proposed construction violat~ any zoning law ordinance or re~ulatio'n'.' ' ' ' '~.;J, ....................... 13. Willlot be re,,reded ~ ~ · · · · · .~ ._ · >,. ............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premmes . ./,rfc 6,r,q*~.,~.4~. ~. ~ .~.-Address ~.~57 ~ .t~)~ .~.q~_~ ~.qq~'/'(-Phone No. ~..'~..q..e~Z ~.. f)... Name of Architect ............ i ............... Address ................... Phone No ................ Name of Contractor ' ........... , .............. Address ................... Phone No ................ [5. Is this property within 300'i feet of a tidal wetland? *Yes .. . · If yes, Southold Towh Trustees Permit may be requmred. -. 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 nurdber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. NOTIFY 8{Jl[.lff~iNG O~'PARTf~l~ 765~~802 9 AM TO 4 PM FOR THE FOLLOWING ~N~PECTIONS: L FOUNDATION '~O REQUIRED FOR POURED CONCRETE 2, ~OUGH - FRAMING & PLUM~ING 3. iNSULATION 4. FINAL CONSTRUCTION MU~T BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OR THE N.~ STATE CONSTRU~ON ~ ~ERGY CODES. N~ RESPONSIB~ FOR DESIGN OR C~ST~ION ERRORS TATE OF NE~ORI~,'[~> _. /d~-S .,~ g[ '3;.. ~ ~0 ~%~.~ ..... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ,eve named. ~. ~~ e is the . (Contractor,i agent , corporate officer, etc . ) ................. said owner or owners, and is duly authoriged to perform or have performed the said work and to m~e and file this ~plication; that all statements contained h~ this application are true to the best of his knowledge and belief; and that the ork will be perfomed in the m~ner set fort~ in the application filed therewith. yom to before me Qzis , A~ ~ Ne. 487950S ~ ' ' · .... - puyl.[~ {. 8[ff~. ',~ ~ / (Signature o[applicant)