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Home My WebLink About18823-z !~0u~W NO. · TOWN OF SOUTHOLD EUILDIHG DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 18823 Z / / Permission is hereby granted to: . / ~.~...~/.~.~~ ................. .... .<~....~...~ ......................................... · . ..... ~~..W~.~....~/..~ ....... C/ ....... ...... ...... .... ~ ................................... "" ........ .~,,:"77 -: T~"'7, ............................ ' ................................... at premises located at ...../..~..~.~. ........ ....~.~...~ ..................................................... County Tox Mop No. 1000 Section ......... ./.~....~..... Block ........ ~..~... ..... Lot No ....... ..2.....~../.....6.. to application doted ........... ~1~. ............................. , 19....~....~, and approved by the pursuant Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 BOARD OF HEALTH .... SURVEY ~ ........ C.ECK i i. i... i. SEPTIC FORH TEL.: 765-1802 Examined ........ , Approved. · Disapproved a/c ..................................... (B~ild'n~sp~mr) APPLICATION FOR BUILDING PERMIT NOTIFY; CALL MAIL TO;.-, .. X..% , ;.- .~. /2. > .I .... i INSTRUCTIONS Inspector, a. Tlds application must be completely filled in by typewriter or in ink and submitted to the Building ' ' ' 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 stre. or areas, and giving a detailed description of lhyout of property must be drawn on the diagram which is part of this ap., cation. c. 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 pen shall be kept on the premises available for inspection throughout the work. c. No building shall be occupied or used in whole or in part fora.ny purpose whatever until a Certificate of Occupan shall have been granted bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Reaulations, for the~on.s, trk~cti,o.n.of 1)klildings, additions or alterations, or for x:emovai or demolition, as herein describ~ Th~ applicant agrges;~"~tttb[y~With'.~t~ applicab't~ laws, ordinances, building code housing code, and regulations and admit atith~5.ZedLirfsp'ecto1s~q~ tSren~i~es ;ind in building for necessary inspections. ~.~.~ ...... V ..... ~-~- -:- · ........................... ~ ~,~*,.~ ,,I ,: . .. , (Signature oi'[~pplicant, or name, ifa corporauon) '~ . t.,' *' ."~ ~' "' : (Mailing address of applicant) State wh~theI' ~p~iScant is owr~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ;~. ,.: <3x,-o~r,,.~'L~ ............ Name of o,vn~f 6£premis~s l ~. ~._X,) ~ ~ .~.~ ~;,~t-}, .~..~.. ' ," ; ~ ' (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. .... (ka~e ~d titid of go;jorate om&er) Builder's License No....Q~ .L.~>.~} ~...; ........ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No I. Location of land on which proposed work will be done: House Number Street, Hamlet County Ta× ~l.',p No. ,000 S,etion ...\.k.~. · · mock .... Q .\ .......... Lot...~.L(~ ........ ..: .~.~,..c?.. m, -7 ' Subdivision ..... ~..4. · ed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing usc and occupancy · --.''''''' ............ ' · b. Intended use and ~SL~ ~0o~~ ................... occupancy .. · ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..... ,... Repmr .............. Rgmo al .............. Ucmohtmn ......... -¢'z'' %~111~1P, ~[1]~' ', t/I .' · Tennis Court ........ 7 Accessory Building .......... Fe,ce ..~K~: . . .ot~o~k~.i.'./I[.t . · · 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garaae number of cars ....... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7 Dimensions of existing structures if any: Front Rear Depth ......... Height ............ Num bet o f Stories ................................................ Dimensions of same structure with alterations or additions: Front................. Rear.... ......... . Depth Height Number of Stories ........ 8 Dimensions of entire new construction: Front Rear Depth ........ Hm=bt ........... er of Stories ............ 9. Sizeoflot: Front .................... Rear ....... Depth ....~.%h.~ ........... 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 regraded .......................... W il exces~ fill be removed from premises: Yes .... No Name of Architect Address ............ Phone No .............. Name of Contractor ................. i ........ Address .................. Phone No ..... ~ ....~;.. 15.Is this property located within I00 feet of ~' tidal wetland? *YES .... I/O-/.TM. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro. property tines. Give street and block number or description according to deed, :md show street names and indicate whethe interior or corner lot. APFROV ED I,,S NOTED NOTIFY BUILDING DEPA~ FOLLO~NG INSPE~OflS: t, FOUNDATION - ~ REQUIRED FOR POURED CONCR~ 2, ROUGH - ~AMING ~ PLUMBINQ 3 ~NSULATION 4 FINAL CON~RU~ON MU~ BE COMPL~E FOR ,'ALL CONSTRUCTION SHALL ~H~ REQUIREMEN~ OF THE N.Y. ![7ATE CONSTRU~ON & ~ERGY CO~DS N~ RESPONSIB~ FOR ,'~ qh~ OR CONSTRUC~ON ERRORS STATE OF NEW YORK, S.S COUNTY OF .., ............ ~.. ,... ~..)..~.. :~¥x~.~ ................... being duly sworn, deposes mad says that he is the appHcar .. (Name of individual sigm-fffg contract) above named. I~ is the . .~'%.. 0 ~ .g'~..~.. ' itc.') '" ........................~(Coniractor, agent, co;t~orate 'o'f~'ice ;, ...................... of said owner or owners, and is duly authorized to pe,rform or have performed thc said work and to make and file th application; that all statements contained in this application are true to tile best of his knowledge and belief; and that Work will be performed in tile manner set forth in thc application ~led therewith. , Sworn to before me this , ........ day of .............. 19.., Notary Public . . County (Sign~ of applican.