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Home My WebLink About19777-z FOBM NO. ~1 TO~VN OF SOUTHOLD BUILDIHG DEFAI~TMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_* 19777 Z Permission is hereby granted to._~ ~ ~ .... f.~:..~ ...... ~.:. ........ ~.~.~... ~..~ ........ ~.~ ...................... ~... .~..~z...~.~....~..:.l. .:....!..!..~..~..~.. ,. ,o ............. ~ ~rem, e , ate ....~..~.~...-~.~.~....~.. ~ ' .~.,~t.~.~ .~c~ V" ~ County Tax Map No. 1000 Section ..... ~...~...J. ........ Block ...... ..~.....~ ....... Lot No....L.~.. .............. pursuant to application dated ...~......L.O, ....................... , 19..~.L., and approved by the Building Inspector. Building Insl~ector Rev. 6/30/80 3. Nature of work (check which applicable): New Building ' Addition J Alteration Repair ............. L Removal ..... ,~ ........ Demoli!ion ............... Other Work... ~.. ......... 4. Estimated Cost..~..~.~.q ............................. Fee...?.g.~. ............................. · (to be paid on filing this application) 5. If dwelling, number of dwelling units ~ Number of dwelling units on each floor.. If garage number of cars 6. If business, commercial or mixed occupancy, specify vature and extent of each type of use ....%'7 .......... · ~,~ ~i ~. _/~ ' · · '~ · ~'~ 7. Dimensions of existing structures, if any: Front..?¢~.. ~. ....... Rear ..... ~. 7 ...... Depth . .%~.q ......... Height .[.q:J.. " ' I '. ' ' ......... Number of Stories ................................................... Dimensions of same structure with alterations or additions: Front . ~ ¢1,1~, .~. ........ Rear .................. Depth ...................... Height ...................... Number Of Stories ...................... 8. Dimensions of entire new construction: Front ...~0~.¢tt~ ...... Rear ............... Depth ............... Height ............... Number of Stories ......... ,...,~_. ......................... · 'VT ' "/2.."-~ ~ff FT tt ~T 9. Size of lot: Front ~.9...: ............ Rear . .c~ ¢ .......... ,"~, ...... Depth ...... .~ ..... 10. Date of Purchase . .~.~2 I~..~. l~. ~.'~. .............. Name of Former Owner . .~. ¢.Xc~'. ~ dr4... ~. I-¢¢¢&1--. ...... 11. Zone or use district in which premises are situated ..... ~ :-..~ .C~. ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...IV.~ .......................... 13. Will lot be regraded ... ~ ~,9~.; .................. Will excess fill be removed fr, om premises: Yes 14. Name of Owner of premises . l~¢l~.~r.~ .T.t ~-t[~'q.. Address ,f~o×. ~C/.~..~.,. I~-.~.tt44Phone No..l:jJ~..~.,7-/.~0.~,. t.f. Name of Architect ...~.. ~.~.. ................. Address .... ~L. WI.~ .......... Phone No .... ~4~l,Y,~. ...... Name of Contractor .. 0..t~.O .~y..-.~..010..eCq. t/..~1~.3 Address .... 5.6~.1~e__ ........ Phone No .... .~.&..1¢. ~ ...... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..v~... · If yes, Southeld Town Trustees -Permi~maybe require~ - PLOW DIAGRAM 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 description according to deed, and show street names and indicate whether interior or corner lot. NOTIFY ~[JlLOING DEPARTMENT AT 765,1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. 1. FOUNDATION 1~'O REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING 3. INSULATION 4. FINAL CONSTRUCTION MUST ~E COMPLETE FOR CO ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY cODES. NOI RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OFoFNEW YOR~ ~ ~,~ , ~.,, S ·...~.-,.\..-~-. .... COUNTY '. ~o. kul. C~- .... [ ..... .-'~. ['~f .................. being duly (Name of individual si~nin~ contract) above named. ? sworn, deposes and says that he is the applicant He is the ............ .O..~q. ~ ..................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tltis application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /") It'~ /.,,<q'.///.da -- ' kOr[['0' ..... 199. t taryPubIic, ':~~...~County~ ~ BLDG. DEPT. TOWN OF $OUTHOLD Examined. . .1.~ ..... 19 Approve ......... Disapprovod a/~ ............... BOARD OF HEALTH 'FORM NO. 1 SURVEY ...... ~. .... TOwN OF SOUTHOLD CHECK ~E-.~ ...... BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD~ N,Y, 11971 ~ P2:-5 ~ TEL.: 765-1802 CALL · MAIL TO: · Permit No../.c).-/.~..~.. ~.~ (BuildTng Inspector) APPLICATION FOR BUILDING PERMIT. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to schle. Fee according to schedule· b. Plot plan showing location Of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covere.fl by this apphcatlon may not be commenced before ~ssuance of Buildmg Permit. d. Upon approval of this applic&tion, the Building Inspector will issued a Building Permit to the applicant. Such permit sl~all 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 shall 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 Building Zone Ordinance of the ToWn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cod~using code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections,///~ . ........ (Signatu..~/6~pli~,~or name, If a c??poration) (Mailing address of applicant) State whether applicant is owner, essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. , .................................................................... owner of premises... :t ........................................... '(as on t~e tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· ----- (Name and title of corporate officer) . ALL CONTRACTOR'S ~fqST.,Bg S[JFFOLK COUN*¥ LICENSED Builder's License No ..................... Plumber's License No. , ~ ,~; ................. Ele trician's Li e No ~[ ~ C cens Other Trade's License No .................. 1. Location of land on which proposed work will be done~ ................................................. House Number ~ Street Hamlet County Tax Map No. 1000 Section ...... .~. l ......... Block ~ Lot t ~... Subdivision ~ Filed Map No Lot !Name) 2. State existing use and occupanc~ of premises and intended use and occupancy of proposed construction: Ex~sttng use and occupancy .i. · b. Intended use and occupancy I ............ ~..t~.~..~,..~ ...........................~i?~ ~~ '