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Home My WebLink About19792-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- 19792 Z Da,e ............. .~ ................... , Permission is hereby grant, ed to: ~ . ,~ ..v...~..~.~.....~.~.,~....~.., .......... ~~...~:...~..,.....L4~.~..~ ........... ~ ......................................... ..,,..,.,.~ ......... ~.,,,.,-,~......~ ,~...~.,~.,,.~ ................ .,~ .................................... County Tax Mop No. 1000 Section ...... .~....~.'~..~ Block ......(~,.~. ........ Lot No...2./. ............... pursuant to application dated ........ ~9~,~. ....... ............. Building Inspector. and approved by the Building Irtspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~xamincd. · '\pproved . . .~..% .~. .... 19 ~t. Permit No./. .~.7.? .~...~-r. (Building Inspector) APPLICATION FOR BUILDING PERMIT IIOARD OF HEALTtt ......... 3 SETS OF PLANS .......... SURVEY ................... Cl~EC~ .... ,: ..... ~ .... ~,~-~c ~o~,, .. ~.~.. c^~ . 3.~,5.: Y2 Y. 7 ....... HAIL TO: INSTRUCTIONS a. This 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- ~tion. c. The work covered by this application may not be c'bmmenced before issuance of Building Permit. d.~ Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~a/l 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 all 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 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 taws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors premises and in ...... ~,. Z .ff..c_..~ ............ on building for'necessary inspections. (Signature off/,C)pplicant, or name, if a corporation) .73. (Mailing address of applicant) tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ~;~m2,-~.... 'ameofownerofpremises ~ .~. cr ........ (as on the t.a¢ roll or latest deed) 'applicant is a corporation, signature of duly authorized 0ffice~'. " (Name and title of corporate officer) Builder's License No.. ~kfcO'-A-'~ ................ Plumber's License No ......................... Electr c an s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · .. ............. House Number Street Hamlet County Tax Map No. 1000 Section ...O. ~..*].~. ....... Block . ~..~. ...... Lot .... '.~../{ .c;2:x.. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................................... ¥ -~.,,~. J ~,q'..~, ~. ............... b. Intended use and occupancy : ~~ , .:., · '''''~ ' ' ' t,' '~'~rL'"~k~) ............ ~ ~ ? ,~ ~.,t.', ,;, .. ~ ~,~e..~ ~u~ 3. Nature of work (check which applicab e) New Building ...... Addition .......... .6~[it~9n ~ ....... Repair ~ ' · · · .............. Removal .............. Demolition .............. Other ~,V~t6.~'..~--Pt-;4,4~ .. . .~C~. 0.0 '~ o'0 (D ripti) esc on 4. Estimated Cost . ~ (to be paid on filing this application) 5. If dwelling, number of dwelling qnits ............... Number of dwelling units on each floe · If garage, number of cars ..... i ............... r ................ 6 Ifbui rcial mi di cify .... nd' ..... 7' Di s n;ss, comme or xe occupancy, spe nature a extent of each type of use ............. · mens ons of existing structures', if any: Front ........ Rear D ' ' Height N robe of St rie ..................... epth ............. ............... u r o s .......... ' Dim sions fsam tructu '~h alt tion oradditi ............................................. en o e s re w~ era s ons: Front .. Rear D pth ' Height Nt ber fSt 8 Dim ion fenti tru~tio F ...................... m~ o o es ..................... · ens s o re new cons n: rent ............... Rear ............... Depth ............ ight ' He ............... NuN her of Stories .............. 10. Date of Purchase ! ................. Depth ..................... .................... ' ....... Name of Former Owner ........... 1 I. Zone or use d~stnct in whit remmes are s~tuated ............. ' ..... 12. Does proposed construction viola e any zonin, law ordinance or regulation: 13. Will lot be regraded .... ~ ° ' · ............................... ........................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... ! ................ Address ................... Phone No ................ 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, Southold TQwn Trustees Permit may be required PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-bac ' ' property lines. Give street and block nfimber or descriotioh accorr..= *,, ao~ .... ~ ..... k..d~.ensjons, from interior or comer lot. - ~ ~--o ...... , a,u ~.ow street names ana lnalcare wneth~r FOLLOWING h'J: ;~ ", C I. FOUNDATION FOR POUF{ED 2. ROUGH ~ FRAMI~G 3. INSULATION 4. FINAL CONSTRUCTION t~HJST BE COMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE C~STRUCTION CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NEW YORK, 1 'OUNTy OF ................ S'S-i .... E/ ~'/"~. , ( .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing :contract) )eve named. .~ isthe I (Contractor agent corporate officer etc ) .......... said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 'plication; that all statements contained in this annlicati,,- . ~ ........ true to the best of Iris knowledge and belief; and tliat the ork will be performed in the manner set forth in the application filed therewith. yom to before me this ............. /'2 .~., dayof i )taryPublic, .....~..~.. : ounty Ill I*ubllo0 8Iate of N~IlIt~ ......... ' · · · ...... No. 4879~0'5 . (Signatur~ of applicant) _ (lualifled In Suffolll Coun~ Ll] LIJ O' OS 0 VO~J 3 2~A I ZkJ ~OS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 9.1. · , 19cll. Permit No./. .~..7.? ?::..'~'r \pproved . . .~..% ~ ................................ (Building Inspector) APPLICATION FOB BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CtI£CK .................... SEPTIC FORH .............. 335.. CALL HAIL TO: Date ........ 19 Y./ INSTRUCTIONS a. This 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- ~tion. c. The work covered by this application may not be c'Dmmenced before issuance of Building Permit. d4 Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~all ,be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occupancy mlPhave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btfilding Pennit pursuant to the ~ilding 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. i~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary inspections. _ . .... ............ (Si,~nature o~fplicant, or name, if a corporation) (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. amc of owner of premises . ~ . .~..c,. ................................................. (as on the t,.'~ roll or latest deed) applicant is a corporation, signature of duly authorized officer. ,' (Name and title of corporate officer) B rider s L cense No.. ~'-¢tCt-rx~ ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................. ................... /~,~o 9.~ ~< o ' House Number Street Hamlet * ......... County Tax Map · . ~.~. ....... Block . ~. No. 1000 Section Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing 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 Repair Removal Demolition i ........... ,~ ' (Description) 4. Estimated Cost ........ . .................... Fee ......... I ............................. (to bi paid on filing this application) 5. If dwel.ling, number of dwelling units ............... Number of dwelling units on each floor ............ If garage number of cars · · .. 6 ' Ifbusine'ss ........................................................................ · , commercial or mixed occupancy specify nature and extent of each 7 Dimensions of existing structures if any: FrOnt tyoe of nsc ..................... Height Number ............... Rear .............. Depth ............... of Stories Dimensions of same structure with alterations or additions: Front pth ................. Rear .................. De ............... Height ........ Number of Stories .................... 8. Dimensions of entire new construction: Front ....... Rear .............. De ....... Height ............... Number of Stories . · i i pth ........ ................... l*ear . . ..... I Depth .......... 10. Date of Purchase ' Name of Former Owner 11. Zone or Use district in which premises are situated.. , ' ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .!. 13. Will lot be regraded .................... Will excess fill be removeH from premises: Yes No 14. Name of Owner of premises .................... Address ............... i ....Phone No ................ Name of Architect . .' .................. Address ............... l Phone No ................ Name of Contractor ................... Address ....... Phone No. 15. Is this property within 300 feet of a tidal wetland9 *vo~ ~ ............. · If yes, Southold Town Trustees ' - ....... i'' No ......... Permit may be required. PLOT DIAG RA/Vl 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 descriptioh according to deed, and show street names and indicate whether interior or coruer lot. ?ATE OF NEW YORK, S.S (Name of individ ua/signing contract) Dye named. OATL- .-2 FEE _,~_.~"_', .,:;'_' F(>Lt, GV',,'L 'G ',.. , ,, ! FOR ~O 2. ROUGH FR~-~,i~ ~ & ,-~ ~ ,. ;.,G 3. INSULAflON 4. FINAL CONS'H~UC'D~ ~N BE COMPLETE FOR C,O ALL CONSTRUCTION SHA,LL THE REQUIREMENTS OF ['rHEN STATE C~8TRUCTION &j ENERGY CODES. NOT R~SPONSlBLE FOR DESIGN OR CONSTRUCTIOg ERRORS .... being duly sworn, deposes a id says that tie is the applicant s c .................... C~./ (C ag corp fficer, e ) i ' ontractor, ent, orate o tc. said owner or owners, and is duly authorized to perform or have performed the saii work and to make and file this ~lication; that al/ statements coutained in this application are true to the best of his Enowledge and belief; and that the rk will be performed in the manner set forth in the application filed therewith. om to before me this ............ t..~.( · ...)...day 9f. . . ¢-. ..... ?C~. county C~IRE ~ Public, State of New Y~ ' ' ' No, 4879505 ~ Qualified in Suffo k CounW mi~ on E~es D~mber _)