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Home My WebLink About19392-z ·ORM NO. S TO~N OF SOUT~OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ......~. ................................... 19 ....... Permission is hereby granted to: .... ~~...~..~.;~.....~...~.... .......... ...~.~.....~.~_V~...~.~... .~....~.,~..:.....L~..~.~..t. .............. , ~ ..... ......................................................................................................... ~ ........... ~;~::;:~..;~ ...... at premises located at ../...~...~'..'~.......~'~......~.~....C~ ...... ~.....;....~- Co~n~ To~ Map No. ~000 Section ~-/~ moc~ . ...~ ~. Lot No. ! ~ pursuant to application dated ..~'?.~....../....O.. .......... , 19..~..D.., and approved by the Building Inspector. Fee $..~'~ ..~/..~.....'~.. ..... Rev. 6/30/80 ;~ ,4 ,~EANETI'E N. 3'9o $5 30. ,'. G o.L,DIEN (.$ 209 · 40 ~JFFOLK COUNTY DEPARTMENT OF HEALTH SE, aT/ICES Y I)WEtl lNG ONLY F. NO. ,,T':J'-.~c~ -z7 dislx~,l and water supply facilities for this have been respected b~/this Department and/er Bureau of Wastewater Mana~nent o S. N/o/F · ANo Z E.B.~O'bI$ V' t A-NNA ~. f. s R ov~S~~ Z09.38 0 'N AREA = 23,566 SQ, FT. CERTIFTED TO,' " 'TICOR T/TIE GUARANTEE COMPANY NORTH FORK BANK & TRUST SOUTHOLD SAVINGS BANK STEVEN FOSTER NANCY FOSTER ,SURVEY. OF PROPERTY AT' SOUTHOL D TOWN OF SOUTHOLD SUFFOLK COUNTY v N,Y. I000 - 075 - 03 - 14, SCALE I" = 401 NOV.. 3, 1986 Sept. 11, 1989(found. loc.) Feb. 13, 1990[FINAL) APRIL 9, 1990 ! wofer line] fORS ELEVATIONS ARE REFERENCED TO ASSUME. D DATUM P.O. BOX 909 MAIN ROAD SOUTHOLD ,N.Y. 11971 ~rci:~c3~e;t in accordance with the minimum st,, ,~.. c~s far title surveys as established by the L. LA. LS. and approved and adopted I'or such use by,t~ha. New York State Land · LIC. NO. 49668 REVISE lO-ir-es (PROP, HSE ) FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 TEL.: 765-1802 Examined..~.~..~..../.~. ..... 19 Approved . .~.~1',..]..~ .... 199.~ Permit No../. Disapproved a/c ..................................... .............................. . . (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ....... sURvEx : .............. cuEcr .~.'1 (2 ........ SEPTIC FORM ................ NOTIFYg CALL ..................... MAIL TO: . . . . ...... BLDG. DEPT. TOWN OF SOUTHOLD a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Ihspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is parr of this appli- cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit gaall be kept on the premises available for inspection throughout the work. s~alle'haveN°beenbUildinggrantedShallbybethe°CCupiedBuilding°rinspector.USed in whole or in part for any. purpose whatever until a Certificate of Occupancy 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 ~:emoval or demolition, as here/n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ~pections. '. ~ ' '(~i~,!~pl~l[cant~ ~)[ name, if a cort~o'r:;r;o'n') · · · (Mailing address of appliear~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latestkteed) If applicant is a corporation, signature of duly authorized officer. ................. co;,;ra;e ;racer) (Na~e a~ci title ~)~ .................. Builder's License No..,.O.qW.O.'~ ~. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done; tIouse Number Street. Hamlet " · County Tax Map No. 1000 Section ........ BlOck ............... Lot .......... Subdivision ..................................... Eilcd Map No ............... Lot ............. (Name) · - Stzte existing nsc and occupancy of premises and in tended nsc and occnpancy of proposed constrnction: · A. Existing use and occupancy ...... B. Intended use and occupancy....Q~X~&~....~_).\..~/~... ~.~ .~4~. ~.~ ..... 3. Nature of work (check which applicable): New Building Alteration ' .......... Addition ..................... Repair ........ ~ ..... R~moval ............ ;. Demolition .............. Swimming pool. .............. Tennis Court ......... ^c!cessory BuildJ. ng .......... Fence .~---~. ·Other Work; ........... 4 Estimated Cost .5~..~-..~. ~ Fee '' i (to be paid on filing this application) 5. If dwelling, numberofdwellingunits..,............ Numberofdwellingunitsoneachfloor ................. Ifgaraee,. number of cars ....... ' ..................................... ......... .................. ' ' ~ of use 6. If business, commercial or mixed occupancy, specify nature and extent of each type ...................... · Depth 7 Dimensions of existing structures if any: Front Rear : '. ............ Height ............... Numb4r of Stories ........................................................ Dimensions of same structure witll alterations or additions: Front Rear . . Depth 4 Height Number of Stories ............. ' ' ' Rear Depth 8 Dimensions of entire new constructmn: Front .. . · · · · Heieht ' - 9 Size of lot: Front ~ ; Rear Depth lO Date of Purchase ~ Name of Former Owner use district in which premises are situated 11. Zone or ..................................................... 12 Do up d ti ' I 'e zoni law di eg I rich: .... · es pr use construe onvloat any ng ,or nanceorr ua .................. · ..... .-. '. ' will excess fill be removed from premises: Yes No 13 Willlot be regraded i ...... 14 Name of Owner of premises ' . .' .... Address Phone No ........ Name of Architect Address Phone No · · Name of Contractor ; ' Address . . ..,.. . Phone No ................. IS.Is this property locatled wlthln'300 feet of a .tidal wetland*. *YES .... NO .... Permit may be required. · If yes, Southold Town iTrustees i PLOT DIAGRAM Locate clearly and distinctly all Icuildings, whether existing or proposed, andAndicate 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 comer lot. NOTIFY 13OIL.DING DEPARTMENT AT 765 laO2 9 AM TO ~ PM FOR THE FOLLOWING tNSPEO'!ONS 1 FOUNDAflOIV , T[NO~REQU RED FOR POURE~ CONCRETe 2. ROUGH . FRAMING & PLUMBING 3. INSULATION m 4. FINAL CONSTRUCTION MUST OE COMPLETE FOR C.O.) ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF~ THE N,Y. STALE CONSTRUCTION & ENERGY CODES. N~ RESPONSISLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW~Y ¢I~_ ~ ~, . (: q COUI'iTY OF... ~ ........... ~,, __ ~ "'." .... ................... f individual sign;lng contract) above named, i being duly sxvom, deposes and says that he is the applicant (Signature of applic:mt) Fee is the ' ' · ' ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to pe,rform or have performed the said work and to make and file this application: that all statements cont¢ined in this application are 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. S~vorn to before mc this ' ............... ./.4 ...... day o Notary Public .... ~. (_,.....t~_~. ..... County