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Home My WebLink About19548-z FOR,M NO. S TOWN 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) 19548 Z Permission is hereby granted to: · ..; ............ .... .~..~...~ ............ .)..~ ............................ ' I ...~.~~..,.,~:.~.,....L..~J..~. ........... , ~ ! o · at premise, located at .....~..~...0. ...... ~..~ .... ....... ......~ ........~)' · County Tax Map No. I000 Section ..... "~..'.~.7' ..... Block ..... .C~..~.. ...... Lot No. L/ .................... Il e.,J a-_,,~ ,~_.J .. 19..~....D.., and approved by the purSuant to application dated ..f~..~..¥...-=..~r..; ............................ , Building Inspector. Building Inspector Rev. 6130/80 FORM NO, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL Examined. 19 TEL.: Disapproved ale ............ ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS CUECK . NO?Ipy ~ CALL MAIL : a. Tiffs application must be cbmpletely filled in by type~vriter or in ink hnd submitted to the Building. IhstacCtor, with sets of plans, accurate plot plan to scale. F~ a~ing to schedute. b. Plot p[~ showing location of lot and of buildNgs on premises, relationship to adjoining premises or public stree or areas, and gives a dot.led description of layout of property must be drawn on the diagram which is pan of ins app. cation. c. The work covered by tNs application may not be commenced before issuance of Budding Permit. ~. Upon approval of this application, the Building Inspector will issued a Building Pe~it to the app~c~t. Such pe~ shall be kept on the premises available for Nspection throu~out the work. e. No bulldog shall be occupied or used in whole or in p~rt for aoy purpose whatever until a Ce~ificate of Occup~c shall have been granted by ~e Bulldog Inspector. APPLICATION IS HEREBY MADE to the BuildNg Depmment for the issu~ce of a B~Iding Pe~it p~uant to th Building Zone Ordinance of the Town of Southold, Suffolk County', New York, ~d other applicable ~ws, Ord~ces c Regulations, for the Construction of build.ss, additions or alterations, or for iemoval or demolition, as heron desc~bec The applicant a~rees to comply with all applica~le laws, ordinances, bufld~g code, houses code and 'utations, ~d admit authodge~ ~specto~ on prem~es and ~ build~g for necessa~ inspectio . ~ (S~gn~ture of~phchnt} gr ~am< if a cor~drlriS~)' ' (Maihng address of app~c~t) State whether applicant ~ o~r, lessee, agent, 7chitect, engineer, g~heral, contractor, electrician, plumber or builder. ...,. .. ........ ., ........... ........ (as on the tax roll or latest deed) .......... If applicant i~ a corporation, signature of duly authorized officer. Builder's License No ........................... Plumber's License No ......................... Electric',_nn's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done; ,; ........................ .c. Z ........... f:. ouse Number ..... , Street, ' ..... ./. Hamlet ........ County Tax Map No. 1000 Section ..... ~ ....... ~ Block ..... ~ ......... Lot..../d. ' SubdiviSion ..................................... Eilcd Map No. ' ....... :' ' ' (Name) .............. Lot... " $tZtee.' ' ~ . ' .......... x~stmg use and occupancy of premises and intended usc aud occupant, or ........., .~, . /, ,0~ E' ' , P,gPu,eu cunstroct,on: A. Existing use and occupancy ........... B. Intended use and occupancy.'. ........... .~e.t~A~,_ ........................................ pli · · · 3. Nature of work (check which ap cable): New Building .......... Addition ....... Alteration Repair'. ... R~moval Demolition Swi."maing pool..' ...... Tennis ~;;;~ -.. Accessory Building .......... ce _~%-..Other Work; ..... .- .... 4. Estimated Cost . .~. .......................... Fe .~ ........................ ' ~a he paid on filing this a~plication} 5. If dwelling, number of dwelling units ............... Number of dwelliug units on each floor ................ If saraPe numberofcars ....................................... 6. If business, commercial or mixed occupancy, spccif~ nature and extent of each type of use ........ ~.~ ....... 7. Dimension~of~cmqngstmctures, ifany: Front..~,~L... Rear .~t.~.~ .... Depth ............... Hm.ht ..... ~. ~... Number of Stone~ ................................................ Dimensions of same structure with alterations or additions: Front .............. ... Rear . ................ . Depth Height Number of Stories ............. 8 Dimensions of entire new construction: Front Rear Depth . Hcieht ................ Nun~ber of Stories .............. ;-. -~- ................ ..;'3/'.L.; t)')t' ;~:4~' 9. Si2~l~t:~ ~t .... .'~.. ~. .... ,), ........ Rea." ..... ~..~...~. .......... Depth I..,~.~'tl~.,././., i~ .~. 10. Date or Purchase ...l&/3/./.~ . Name of Fo=er Owner ~'.~.~t~-~fi~-~ ~.~ 11. Zone or use district in which premises arc situated..~cd~C.~. ~ .~ ...... ~. .............. 12. Does proposed const~ction violate any zoning law, ordinance or regulati~ .. ~ .' ........................ 13. W Hllotbereg~ded ...:::___~~__~,~:.Willexcessfillberem,vedfrompr~: _ . 14. N~e of Owner of pre~i~~_~....~ddm~ ~,~ .~,q~.Phone No~/~ N~e of Architect ~.. ~. :~.~~... Address . ~.-~.~/~t/~{Phone No ................ N~e of Contractor~M/~. ~ ............ ~ .... Address ................... Phone No ............... I~.L~ ~ki~ property located vlthin 300 feet of a tida~ ~etLand? *YES .... NO .... *If yes) Southold To~n Trustees Permit may be required. PLOT DIAG~M Locate cle~ly =d dist~ctly fll bu~dMgs, whether existing or proposed, =d. indicate ~l set-back d~egsior.: :: propmy ~nes. Give street ~d block number or description accordMg to deed, ~d show street n~es and ~dicate inte~or or comer lot. ,! ApppovFD.~.e ~.-v-:-9 . FOR ~{}~', 3 IN~LJLA] ff}N 4. FINAL CONSI Rd¢": BE COMPLETE FO~C OF ~ONSY~U~ION & ENER(~Y N~ RESPONSIBLE FOR ESIGN OR CONSTRUCTION ERRORS STATE OF NE~V YO RI4~- .t - ~ (Name o£individual signing contract) above named. lave is the ......................... . .......................... ,';t;') ....................... (6ontractc~r',~ co;porite officer . of said owner or owners, and is duly authorized to perform or have performed the said ~vork and to make and file tls application; that all statements contained in this application are true to the best of his knowledge and belief; and that t: work will be performed in the manner set forth in thc applicatiou filcd'~therewith. Sworn to before mc this ............... /¢. ...... day of ..... 7'2..,m<.. .......... pub,,c ........Count HELEN K DE VOE , NOTARY PUgLIC, State o! New . No.fl?07878, Suffolk County,c,. lelm ~pues Msrch 30, 19 (Signature of applica,n TO.'