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Home My WebLink About19054-z · 0~ NO. ~ TOWN OF SOUTHOI.D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA41T (THIS PEI:U~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO/v~PLETION OF THE WORK AUTHORIZED) No- '~ 9054 Z Permission is hereby granted to: ~..~...,,~,.~,,,,~,...~.~..~.....~ .......... ........... ~o .................................. ~.. ......... ,.~ ........ CTl~ .... D" ................. County Tax Map No. 1000 Section ..... .~.,~,..~,, ........ Block ...... ,~,,~, ........ Lot No..,~.:,.-1 ................ pu.uon, ,o opp,,cat,on do,~ ............ .~.%.~. .................... , ,,.~,.., ond opprov~ by ~, Building Inspector, Building Inspector Rev. 6/30/80 9 Si fl .............. um ero cs ...... · ze o ut: Pront ....... · ........................ · ........ I0 D fP h~ ' ' ' R nrc o utc e ' ' ' ......... Depth · 11. Zone or use distr;-~ '.'~ ~.],:.' ;. ..... . ................ Name of Former Owner ......... . . 12. Does ..... -'-, ,- ,',,mca premises are situated ........... , ..... ' P,wPosea construction rio,-* ...... ' ' ' ' .' .................................. ' 13. Will lot be regraded .; .......... ~ ........ ,-,,'- -'-¥ zoning law, ordinance or regulation: ..... .kJZl ......... '. '. Name of Owner of premises ...... ' .. %Vill execs: fill be removed from premises: Yes . .. Nanc'of Architect ..... . .............. Phone No .... ...... Ad es, ......... ho.e .... ' ' 15.Is this property located vithin !00 feet of 'a''~'~dal ~,,et'laud? ---~YE$ .... NO~.. ~1£ yes, $ou~hold TO~n Tru.~ee$ Perrai~ may be required. PLOT DIAGRAM Locate dearly and distinctly all build/ngs, whether existing or proposcd, and. indicate ~I set-back dlmcnsions from property lines. Give Street a.nd block number or description according to deed, and show street names and indicate interior or corner lot. whether 765 1802 9 A~j~-TC ~z ,:-,: :,~ FOLLowING INSP~c~ Io,,~ ' 1, FOU~OATiO~ T'A,-~ FO~ POURED CONCRETE .... ~ cu 2. ROUGH . FRAMING & PLUMs~h9 ' 3. INSU~T/~ 4. RNA[ . CONSTRUcTiON MUST 8E COMpL~E FOR C.O A~ CONSTRUCTI~ SHA~ MEET ~E REQUIR~ENTS OF THE DESIGN OR ~N~RUCTtON ERRORs STATE OF ~EW YORK, COUNTy OF ....... S.S . ~ -' / · N · '- ~ ' ' : ' ' · ........... being doly s~vom, deposes and says that he is the applicant abovenam-cd(. amcofmdlvldualsgnmgcontract) ' '"" : - , TOWN HALL " $OUTItOLD, N.Y. 11971 ~ TEL,: 7G5-1802 ^ppro,.ed .... Disapproved a/c ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANs ............ SURVEY ..................... C~I~CK ...................... SEPTIC FORH . ............... HAIL TO: INSTRUCTIONS - b : i a. Tiffs application must be Completely filled in by tTpewriter or in ink and submitted to the Buildir~-pcctor, with sets of plans, accurate plot plan to scale. Fee according t~ schedule. b. Plot plan showing location of lot and of bulldogs on premises, relationship to adjoining premi~ or public streets or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which h~ of t~s app~- cation. C, The Work covered by t~s application may not b~ commenced before issuance of Building Peril - ' d. Upon approval of this application, the Building Inspector will issued a Building P'e~it to the appel Such pe~it shall be kept on the premises available for inspection throu~out the work. ~. No bulldog shall be occupied or used in whole or i~ part for a~y purpose whatever until a Ce~ifi~ of Occup~cy shall have been g~ted by ~e Bulldog Inspector.. APPLICA~ON IS HEREBy MADE to the BuildMg Dep~ment for the issuance of a B~lding Pe~it ~u~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable ~. OrdM~ces or Regulations, for the const~ction of bu~dMgs, additions or alterations, or for removal or demolition, ~ ~ desc~bed. Th~ applicant agrees to comply with all ppi~cable laws, ordinances, bufldMg code, housin~ code, and ~ons, and to (Signature of ~pplicant, or ~a~e, . ..................... ..... State whether applicant is owner, lessee, agent, ~chitcct, engineer, general contractor, electrician, plumber or builder. ......... ......... Name of owner of premises . ~. ~ , S e . . ......... ...... ; ............ (as on thc tax roll OrJatest deed) , i,,~ , ,~ ~. If applicant is a eo~oration, signature of duly authorized officer. B ldcr s Lzccmc No ........ Plumber's License No.. ...... 1 ? ,. ;* )~',., ~, "~:, ~ c~o~',b {) - :: 4 FINAl. CONSTRUCTION MUST OHlcr ~adc~ ~ccnsc No ................. BE 6OMPLETE FOR C.O .' ' ALL CONSTRUCTION SHALL MEET Location of land on which proposed work will bc done: THE REQUIREMENTS OF THE N.Y.' ' ' STATE CONSTRU~ION & ENERGY ............... ~d~ ~e~ ~.~ . /LCO~ES. N~ aESPONSmL~ FOa Hamlet 1000 S ' County Tax Map No, ection ............. Block ........ Lot .... Z.~ /~/ ~u vifion ................. ''"~ · ............. ~ ...... Riled Map No. (Name) .............. Lot ......... ' State exhting u~e and occupancy of prcmi~c~ and intended use and occupan&y of proposed construct/om u~e and occupancy ' b. Intended ',: 'j "'.'.' · ~ ............... ~e and occupancy ' ' STATE OF NEW YORK, COUNTY OF ................ S?S ' '~~~' · ~ .~' '~.j '.~- ~ ............ being duly sworn, deposes and says that he is tho applicmnt / · . (Name of,nchv~dual s~=m0g contract) above named. ' Heisflte :' " " ' < ~,,-i, (Contractor, agent, corporate officer, etc.) of sam owner or owners, and m duly authorized to pe,rform Or have performed the said work and lo make and file this application that all statements contai~ed in this app ication are trne to toe best of his knowledge and belief; and that the Work ~vill be performed in the manner ~;et forth in thc application filed therewith. / Sworn to before mc this ] .... ..... HELEN K. DE VOl[ No. 4707878, Suffolk ~o/ ' Term ~r~ ~c~ ~ 1~_ /~ (Signature of applicant) 3. Natura of work (check which applicable): New Building ......... · Addition.. . . .. . ,Utcratton ........... Repair ....... R~mov!al .............. Demolition .... · .Swimming p0o[ ............ , ronn :7.'.'::... ^e ossory .......... ............ (to bc paid on filing this application} 5 Ifd Ill b fd Iii ~it . Nt b fd h · we rig, nurn er o we ng u s ............... Am er o Wull[ng units on eac oor ............... Ifgarage number of cars ' If business, commercial or mixed Occupancy, spccffy nature and extent of each type of u~s~ ' 7 Di i f itl !!fang F i ' R i] D'epth · mens ons o cx s ng structures : rent .. ' , , ' '~ Height ............... Nutnbiur of Stories .............................................. ~ .... Dimensions of same structure with alterations or additions: Front Rear ' Depth ~ Height NumbcrofStodcs S. Dimensions of entire new construction: Fron~ ....... Rear ......... Depth .......... Size of lot: Front ' . , Rear ~ Depth Date of Purch:~e ................ ............ 1 .......... Name of Former Owner Zone or use district in which premises are situated Does proposed Construction violate any zoning law ordinance or regulation: Will lot be regraded · ~ Will excess fill be removed from premises: Yes No Name of Owner of premises ' ' Address Phone No ' Name of Architect ' ' Address Phone No ' Name of Contractor ........ i ' . .... Address ............ Phon~...No ..... ~1,. ......;.. :. 15.Is Chis property lo~'at~l~.~l''s,~i~:ia'i.'~ lO0 feet of a :t~i~l'a'l.' wetl. a.d? -YES .... NOX.- ~'If yes, "SoutholdTown' B'Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ~uildings, whether existing or proposed, and. indicate all set-back dimensions from .prop.erty Hnes. Give street and Mock nlumbcr or description according to deed, and show street names and indicate whether interior or corner lot. i~POpet~..{