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Home My WebLink About19140-z lvO~M NO. ~ 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) No_ '~914,0 Z Permission Js hereby granted to: ........ ..................... ...,~..~.-.a.~. ....... .O.~?,.t,......'~/o.~,.~,,.,.....~. .... ~,.~~..,..~..~,: ...... J..!..~.,~.~ ....... ; ~ , ,o at premises located at ....~R~...~ ............................. ~ ............... County Tax Map No. 1000 Section .... J...,.~...,,Z~,, ....... Block ...... .,~.,.,~ ......... Lot No....,~..:..,L~.. ......... pursuant to application dated ......... ...~. ,~...../...~...'~. .............. , 19..~.~,T~., and approved by the Building Inspector. Rev. 6/30/80 FORtVl NO. 1 TOWel OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ............ 3 SETS OF PLANS SURVEY ..................... CHECK Exa,nincd ....~ ...I.., 19~.o. HATL TO: Approved .,...~/'~'~..'%:.{.., I9 ~.O. Permit No. J.(~./,~.0 ~ ~A ~j . ' ..................... .................. ' ..... ...................... . .. . . · ............... /~)~ ~7. o~ ............ · ................. :'Z ......... ~ ~ I9 / ~ L T ~P b~ " ' ;~'. ~ .. ............. 5 f~S~ T/ [~t umg inspector) APPLICATION FOR BUILDING PERMIT INSTRU~IONS . ~l~ . , a. Tl~s application must be completely filled in by Wpewdter or in ink and submitted to the Build~eetor, with ~ sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pl~ showing location of lot and or build~gs on premises, relationship to adjoining prem~ or pubEc streets or areas, and -' ' - cation, o~vm= a det~led description of layout of property must be drawn on the diag~m which ~ of t~s appE- c. The Work covered by t~s application may not be commenced before issuance o~ Building Peril - ' d. Upon approval of this application, the Building Inspector will issued a Building Pc~it to the appH~t Such pe~it shall be kept on the premises available for inspection throu~out the work. e. No bullring shall be occupied or Used in whole oran part for any purpos= whatever until a Cg~fi~of Oc~up~cy shall have been grated by ~ BullriNg Inspector. APPLICA~ON IS HEREBY MADE to the BulldOg De ~ment fi ' Budding Zone Ordmanc~ of the Town of S~,,t~a ~ ..... ~ ~r th~. ~ssuance of a Bmld,ng Pe~,t ~uant to the Reeulations. for thu eonst~ction of u.;,~ ..... 7S]f. Smxo,~ ~ount~, ~ew Xo'rk, md other applicable h~. Ord~ce$ or -- - ,-~u~umgs, au~ltlon~ or alterations, or for remova r f]l~ applicant a-recs t mnlo'~),u ~,, - . ,. ,'~. . . I o demohtion, ~ ~ desc ' .a~;..--.u_~_ '~. 0 CO_..~.~ _..~. ~,s aPpllCaDle laws, ordinances, bufld~- cod . . . nbed. ~,,,,~ autnunzea mspectom on premlsus and ~ buHd{n, r ........... :_ ~-~ e. housin~ code, and ~Ilons, and to .. ...... . . . . . . (Signature ot applicant, or name, if ~ eo~g~n) ' Slat= wh~t~er npplicant is owner, lessee, ~ent,'~ehiteet, engineer, general contractor, eleetrieian, plum~er or builder. w e rp e se ~ / . . '~ ~ ( s on the tax roll or latest deed) Ir npplic=nt is a eOmor~tion, signatur'~ o~duly authorized officer. t officer) Builder's License No. ~5t~'t'~-c~ Plumber's License No Electrician's License No ....................... Oil rT dc'sLi N ' Location of land on which proposed work will bc done: Ilouse Number Street. ..' .... ' ..................... HanlJct ' ' ' ** Co,nty ,Xlap Nol 1000 S ction ./ :' · .5. ~lock ?, Subdi ision ............ ' ............... Lot ............. (Name) ~ilcd Map No Lot :' x~stmg .se and occupancy of premises and intended use and occupancy of proposed construcdo~ b Intended u*e an~ occupancy .............................. ; ......' ...................... 3. Nature of work (check which app!icable): Nexv Building .......... Addition .......... Allcratmn Repair Rbmov;al Demolition ' ' ' pool Court · · · ~. ..... Agcessory Buzldzng .......... Fence . . O~her Work. ~.~.~/~..~-... 4. Estimated Cost F~-~.-f... i ... '''..i ' -'' ,I (to be paid on filing this application) $. If dwelling, number of dwelling u0its .......... ; .... l/umber o f dwelling units on each floor ................. If garage number of cars 6. If business, commercial or mixed Occupancy, specify natnre and extent of each type of usc ...................... 7. Dimensions of existing structurcsiifany: Front Rear Depth Heieht .............. Numb,er of Stones ...................... Depth ,' Height Number of Stones S. Dimensions of entire new constmktion: Front Depth ............... Rear ............ Hei-ttt Nu nb!er of Stories 9 Size of lot: Front ' Rear 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 re,'raded .:. i · ' ' ' ' · " = ....... , .................. W,II excess fill be removed from prem,ses: I t Name of O~vner of premises ~ Address Phone No Name of Architect ' ' Address Phone No Name of Contractor i · Phone No ,~'.. ' ........................... Address ............................... ~,.. 15.Ts this property locatled within lO0 feet of a Cidal wetland? -~¥gS .... NO .... m[f yes, Southold Town [Trustees Permit may he required. PLOT DIAG RAM Locate clearly and distinctly all buildkqgs, whether existing or proposed, and. indicato all set-back dimensions from property lines. Give street and block n~mber or description according to deed, and show street names and indicato whether interior or comer lot. ' APPROVED AS NOTED FEE: NOTIFY BUILDING DEPARTMENT Al: 7BB-1802 ~ AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING $. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y· STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEXV YORK. COUNTY OF ................. ..................... being duly s~vom, deposes and says that he is thc applicant · I d n ~ ac above named. I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly huthorized to pe,rform or have performed the said work and to m~e and file this application: that all statements contaided~ in Iris 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. .? StVOm to before mc this . ~. 4707878, S. ff01k Ceuntyo. '(Signature of appllca~t) lerm E, xp~res M~rch 30,1-q -// .