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Home My WebLink About20167-zTOWN OF SOUTHOLD BUILDING DEPARTMEIqT TOWN H~LL SOUTHOLD, N. Y. NO BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2 01 6 7 Z Dat. ....................................... , ~o ...........~~.~....~::~:;~"'?~'~.',. /~ ...... ~ ...... ~::....~ ........... ~~' o~ ~,~. ,o~o~ o~ ...../.~z~ ...~.~...~ ~...~ .................. "~"~5-~'-' ~' ............................................. County Tax Map No. 1000 Section ........ ./.~....~... .... Block ..... ~ ........... Lot No ..... ...'~......~.. .......... pursuant to application doted ..... .~.../...~... .................................... , 19.~/...., and approved by the Building In,pector. ~ Fee Rev. 6/30/80 FORM NO. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 .~.~ TEL.: 765-1809t Examined ....... 19 ~.( ',ppro e, .... ....... 19¢/.eermit No.. Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS ........... SURVEY ................... CIIECK .................... SEFTIC FORH .............. t:OT I FY ~ CALL ................... HAIL TO: . (Buildi~ h/spector) APPLICATION FOR 13UILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, 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 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 hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part fofhny purpose whatever until a Certificate of Occupancy hail 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 ;ullding 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 all applicable laws, ordinances, building cod~, hous~code, and regulations, and to dmit author/zed inspectors on premises and in building for necessa~ insp~,c-tions// , -' (Signatul~ of ap~m e, if a c0rporation) (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. f appbcant ~s a corporation, s gnature of duly authorized officer ~fi:;~ ~ ~~ · ' · NO'hFY BU)L.D'~NG D&PA~Ti~N"'f A"~ ............................................. FOLLOWb~qG (Name and title of corporate officer) 1. FOUNDATION ~Ot~ POURED CONCRETE Builder's License No .......................... 2. ROUGH - F/~AM~NG 3. ~N,qULATION Plumber's License No ......................... 4. FINAL CONST~qUCTION 8E CO~PL~TE Fo~'c.o. Electric'an s License No ....................... AiL CONSTRUCTiOhl SHALL MEET rl-~E: R~70[,JIREMENTS OF THE N.Y. Other Trade's License No ...................... S'~;~I'E COflS'fRUCTION & ENERGY -._ (~_ ~_ ~CD~,~. NOT RESPONSIBLE FO~ Location or ~and on which proposed work win be do~e... ! .~.q.~....°).'.~9.Cr...~..%'.)~.~.0~ ......................................................... ~.~: .%~ ..................... t louse Nun her Street Hamlet County Tax Map No. 1000 Section ..... ~.~..~ ......... Block .... ./~.~.-.??. ....... Lot...93.~..~.0. ?.o. ...... 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 b Intended use and Occupancy 3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration R ' i '. epa,r .............. Removalj .............. Demolition ............. Other Work ..... ~.. ~ ~,8.o.o.-: ' ?. &'~.." (Description) 4. Estimated Cost ..... : (to be paid on filing this application) 5. If dwelling, number of dwelling un!ts,, ..... ! ........ Number of dwelling units on each floor ...... ~ ........ · If garage number of cars t~ 6. [?sm.ess, co,retort, al or m~xed odcupancy, specify nature and extent of each type of nsc ...... .~.[.~ 7. tJlmens~ons ot e.xisting structures, if any: Front....~.o.~.<... Rear ~o4~,C lhcnth H.eight .... ¢1.)? ....... Number,'ofStories ..... .a.[.~.. ii ii ............... " ................. ~Dun~ns)ons o~f~sme ~s.t~ture with .alterations or a.,dcJi, tions: Front i....Iq:.d~'i(~ ' i 'Rear . :~too .~-.' .~.' ....... ..................... ~, .......... '. .............. Nmnber of Stories ..... ~L~.-.. . 8. Dimensions of entire new construction: Front .... ~."9.~. ...... Rear .. )oo ~.q .~. Depth .. J4..°. . ~.e.~. Height .... ~.l.~ ........ Number of Stories 3'! h- .......... ' ' ' 9. Slzeoflot: Front . I~ Fee-t'- ~ ~oo ,~-~'C ~. _' ' ~ ''~g~.z .......... no,~ ,,~D.~ , ' ~1'- '~ -' 'h'g,',,'d ..................... '~ ........ ~eptn ...~.~..o..?.~.~ ........... 10. ~ ........ c?ase .... ::..m~... ~,.109. .......... Na~me of Former Owner ...,~o..~.~. ~ .~.I?_.~?.S.~"/. . 1 1. zone or use oistrict in which premises are situated.. ~.{.~$ ;,'3mxi~ · . . ' .... i ' ' ' 12. Does proposed construction violate 'any zoning law, ordinance or regulation' .~q; ..... i'i ....... i ....... 13. Will lot be regrad'/d ' ~ · ' ............... ~ .......... ..... ,-.. · ..~ q ... ...... ~ ........ WH1 eXcess fill be removed from premises: Yes [4. Name of Owner of premises r/h~htF.~,.I .Fp~..fli~c..k.e.t%7-. ? Address ~.0..¢~, I~.o [ £,c%~q.¢,s,~ Phone No g.I,,- Name of Architect ..... I ..... Address ........ Phone No .. . NameofContractor .~.~e~-T. .~o~. ,' i ~i[i.s'c'x,oi' '"--- o d ~;- ~>" ~..~"~' ,::, '.~-,-;: ~" :.'.' ..... Is this property' w'it~in' 3'0'0" 'f'e'e't' ;'f' 'a' 't'i~'a?awareet?~'~'?'~' ~y'e'~l'.~'.~2 '~)7 '~NPoh.°ne °'~(b' '[~'~'q !~.l.~.. ~if yes, Southold Tow~ Trustees Permit may be required. ". PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-hack dimensions from ~roperty lines. Give street and block number or descriptioh according to deed, and show street names a~nd indicate whether nteriororcornerlot. ' /u 4 o/- FATE OF NEW YO.~tK, / ~ OUNTY OF .... ff'd'&O'f:~ff. .....S.Si ! , ......... /~' "~' ~'~' .... ?.//.~7..~. .... ................. be'ing duly sworn, deposes and says that he is the applicant (Name of individual signing ~ontract) ,ove named. ......... ' . sai~~ . ~ (Contractor, agent, corporate officer, ete'.) ~r owners, ~d is duly a~thorized to perform or have perfo~ed the said work and to m~e and file this plicatmn; that all statements containe~ ~ this application are true to the bes.t of his knowledge and belief; and that the )rk will be perfomed in the m~ner se~ forth in the application filed therewith. ~om to before me this )to, Public ..... g~~~ ....... x ' County ~ ff,~ * -- DaV~nOUlfiOLO . , . ~ H0, 03-8474200mmnx ~0, /(Signat~re of applicant)