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Home My WebLink About19336-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ~,UTHORIZED) ';73 6 Z County Tax Mop No. 1000 Section .......... ..~..~........ Block ............. ../.. .... Lot No ........ ~ ........ pursuant to application dated ..... ~..~.~.~. ..................................... , 19~...~.., and approved by the Building Inspector. Fee $....~,..~ Rev. 6/30/80 Approved...~/2t', .']~.. 19~'.~. Permit No. t/q . ..... , ..... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765.1802 Disapproved a/c ..................................... · "7 pector) ........ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ........ survEY ........ ..... CHECK ...... SEPTIC FORH NOTIFY: CALL MAIL ..................... TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink/md submitted to the Building Iflspector, with 3 :iq of plans, accurate plot plan t0~scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed, description of layout of property must be drawn on the diagram which is par~ of this appli- c. The work covered by tiffs application mai~ not be commenced before issuance of Building Permit. ~d. Upon approval of this application, the Building Inspector will issued a Bu' · o ' · . · :.I ~e kept on the premises available for inspection throuvqhout the w~t, ffdm~, Permxt to the applicant. Such perrmt ; z. No building shall be occupied or used in whole or i~n nart f- ~-'~-"' ur'· 41 l.ave been granted by the Building Inspector. ' ' y p pose whatever until a Certificate of Occupancy Ai?LICATION I$ HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the :,!:.hZ Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or · '..at:ohs, for the construction of buildings, additions or alterations, or for ~;emoval or demolition, as herein described. · .??licant agrees to comply with all pphcable laws, ordinances, building code, housing code, and regulations, and to :::: authorized inspectors on premises and in building for necessary inspections. ........... ?.ad.. ge..Cgr, p..' ................. (Signature o£ hpplicant, or name, if a corporauon) ........ ?: 0.:. B. qx.. iff. 6.5... 8. q q t. h.q l.d. ,..~... i. 1.9.7.1.... '. (Mailing address of applicant) " .i~ether applicant *is owner, lessee, agent, ,archlitect, engineer, general contractor, electrician, plumber or builder. ............ ~. /. Owner ; : of o~vner of premises Pud~e Corp. , ' '~ ( th 11 1 t d d) ............... · as on e tax re or ates ee ' .,:nt is a corporation~ signature' of duly auth~riz!ed officer. (Name and tit]d of corporate officer) ::hler's License No., ... ....................... 2:::mber's License No ......................... :2cctrician's License No ....................... Trade's License No ................ ~ ..... · :car:on of land on which proposed work will be done, Cox Lane Industrial Park Unit # ............ 2.2.355. County_ Road /48 Cu'tchogue, NY :{~,,se Number Street, ' ' ..... fi;in'l;( ........................ "' tyTa hl pN 1000S ti 8/4 · .,, :n x a o. ec on . · · Block ...... 1 ................ L 26 :;,bdivision ..................................... Eiled Map No. (Name) .............. Lot ............... Sl~te e ' · x~st ng use and occupancy of premises and intended use and occupancy of proposed construction: A. Existing use and occupancy .............. ~ew. Co~$tr~i~Q~ ....... .5v3.~) ,?.,'~*e~ ............ tnt nd,d and occupancy ............. ........ .................. · Nature'of work (check which applic:;ble): New Building ...... ,... Addition .......... Alteration .......... Repair ....... ' v ' ' ..... u' Rgmo ai= . ............ Demohtzon .............. Swimming pool. ............ ............... ..... .. ....... Acclessory Building · . Fence ..... Other Work ............ Estimated Cost ........ . ........................... · (to be paid on filing this application) '. Ifdx~elling' number of dwelling unit!s Number ofdwelling units on each floor If garace nun ber of cars ,. If business, commercial or mixed occupancy, spec fy nature and extent of each type of use .................... ' Dimensions of existing structures ifjany: Front Rear , · Depth Heieht ........... ;.Number of Stories Dimensions of same structural 'with alterations or additions: Front ................. Rear ......... Depth .................... . · Height .................... · . Number of Stories ........... ... .. . . ,.' Dimensions ofentire~new~¢onstmcti'on Front Rear Depth Height .... Numberlof Stories · Size of lot: Front Rear Depth ..... ) Date of Purchase '" ': Name of Former Owner Zone or use district in which premisles are situated ............................................ '..Does proposed construction violate ~any zoning law, ordinance or regulation: ..................... ..... ... .. ,. Will lot be regraded ........ ...................,' Wiil excess fill be removed from premises: Yes .... No. · '..Name of Owner of premises . 2gOg.~..C9.rpt ........ Address ~O..l}.qx..1.~6.5..8.qu.t.h.o.l. dphone No .... .-.1-BSD.. Name of Architect ........................... Address ...................PhoneNo. ................ Name of Contractor ... ~rav ¢on~truct:Lon Address 5.Is this property loc~tte~ within 300 feet of a tidal wetland.* *YES .... NO..~[. ~If yes, Southold Town T?ustees Permit may he required. PLOT DIAGRAM Locate clearly and distinctly.all buddings, whether existing or proposed, and. indicate all set-back dimensions from operty lines. Give street and block number or description accord.lng to deed, and show street names and indicate whether tefior or coruer lot. FATE OF NEW~qR~'~ ri . (Name of individual signing Fontract) ( ~ove named· ,' ~ (Contractor, agent, corporate officer, ere.) ' said owner or owners, ~d is duly afithorized to pegform or have performed the said work and to m~e and file this ,plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork w~l be pcrl~md in the m~ner sci forth in the application filed therewith. No. qT~BOB i A ~ X (Sign/ture ofapplicmtl OuMlfled in ~uff~k ~U~ ~ ~ ' ~ - . ~mml~lon Exp~es De~m~ ~ 1~