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Home My WebLink About20186-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 20186 Z ,. ............................ to ..... "'" ~ ' ~'/ ...~*~.~.~......~ ........... ~.'.,~..~.....~......~...~....~ .......................................... at premises located at ...... . .~...~..~.....]...~..~~.....~..~. ........................................... County Tax Map No. 1000 Section ......... .~...~.. ...... Block ...... .~... ............ Lot No......~...7.~... .......... ....... ~ ~.~.. pursuant to application dated .... ~ ............................... , Ig..~.Z, and approved by the Building Inspector. Fee $ .............. ..~ Rev. 6/30/80 · ~. ° o 0 , t~O om ~r-;~ · oo .! _.? FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 · I BOARD OF HEALTIt .... ~ .... 3 SETS OF PLANS .......... SURVEY ~ ...... SEPTIC FORfl .............. Disapproved a/c ..................................... . (Builflin~, Inpctor) APPLICATION FOR BUILDING PERMIT t,O, LP¥ C^LL ......... NAIL TO: Date " 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 applicafion 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. ¢. 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. fhe applicant agrees to comply with all applicable laws, ordinances, building code~h~us~code, and regulations, and to :dmit authorized inspectors on premises and in building for necessary in'pectins' ,~[k~ '~-~)~.~a~t -- (Signatfffe--- of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ./-~Gt/IAc't~ .~. ~....O./..[p'~,. (as on the t,ztx roli or latest deed) If applicant is a corporation, signature of~duiy authorized officer. (Name and title of corporate officer) ' .... .7.80. Bmlder s hcense No. .. .............. .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................ a ............ ' ......... ~ '' llouse Number Street Hamlet Coanty Tax Map No. 1000 Section ~0~ ~ Block ~ Lot..~. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. lntendeduseandoccupancv Stafi~._.~, (~ ~BiJ~CC ~ ' ' ,-'' 3. Na'ture of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............ o.. Remo,val .............. Demolition .............. Other Work./,..~ZI4. C.~... 4. Estimated Cost <3 t~l~ ~Description) ............. ! ................. .... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling-Units ...~. ........... Numb'er of dwelling units on each floor ........... · If garage numberofcars .. :.~ ...................... ' .... 6. [ busin.ess, commercial or mixedioccupancy' specie× nature and ~ten}'o'f'e'a;~'t~;;';f'l~ie' i i i i i i i i i i i i i i i i i i i i i 7. tJimenstonsofexisting structure~ if any' Front (~. Rear f>.~. Depth ~.~ ...... Height . .~.0. .......... Number of Siories i ~ii ....... i.' ............... Dimensions,,%,f same structure with alteratiolls r~r additions. ~r'o'n~ " ~' [4 ........... ~ J,~; '~ ~ .............. Depth ~t~g : . ~,tO ............... q- .................. .............. ~. Height ...................... Number of Stories..[ .~, ............. 8. ,D,i~.n.e~sions~of~entire new constm, ction: Front. ¢./'t '174 ........ Rear.. ¢.L/ .......... Depth ~-~ ............. ne~gnt .. d:,~.. ........ /. Number of Stories ..... r.4--.. ,, ......... ,. . 9. Size of lot: Front QO. j ~ {~{~0' ............ ~. .... t~-~t~ ................ 10. Date of Purchase ...... ~/2/~'.] ....... . ......... Name of Former'Own;} '~?.~d~O ~ ~ ........ i ........ 1 1. Zone or use district in which premises, are situated.. ~. ................................................. 1 2. Does proposedconstructmn wolate' ' any zomng' law, ordinance' or regulabon:' ./L'.O. ............. ,.. .............. 13. Will lot be re,,raded Ad' 19 ' . . o · · '_w..:. · · ~ .....tx. t ...... Will excess fill .b,e jrenjov~eDd,from premises: Ye.~s , No 14. Name of Owner of premises .~. ?o~· · · · · · .......+L°'~cc~ [°~. [~ F Addra~q_~_~_q'?*JU?Z'C6~/]t',3ozd~0 Ir-4... Phone No ............... 6~/6-?~"~ -/lot/= 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, South61d T6wn 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 blockn'Bmber' or description· according to deed, and show street names and indicate wheth.er interior or comer lot. ~r~ ........... '~' '~ ~ ~ FOR THE L FOUNDA%~ON . '~O REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUM~ING 3, INSU~TION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.~ STATE CONSTRU~ION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN O~ CONSTRUCTION ERRORS ;TATE OF NEV~'YORK[~A'-~ /]~' S" (Name of individual signin~ contract) ..... bore named. ~ (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly ~uthofized to perform or have perfo~ed the said work and to m~e ~d file this Pplication; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the :ork will be perfo~ed in the m~ner s~t forth in. the application filed therewith. worn to before me this ~ ~u~l~ In Surfak C~U~ ~ ? ~. (Signature of applicant)