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Home My WebLink About18503-z ~oHas xa s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~~EyyTION OF THE WORK AUTHORIZED) NO ~ ~ J U ~ Z Date ~.?~:`.t.~.~'-.~.:....~...l~e 19..4. Permission is hereby granted to: . 9::1::.................x.... ®0>2 ...ti.(~: ~...........,...J~.?.:.~..,......9.. ~ y. n ~ p JS~-4.Lfhr~ll........`'t/:.°...... ~ f~Ak.~.~....~-P:P:!.~^^:8~.......~...~~Z.VG.C.>;.G~....... t ...................................................................F.................. ....4.. ,,,,I at premises located at ..~n~~..~.~?..~~?.........i:!l.a^.^.:.. ~ ..........Gs`............................. County Tox Map No. 1000 Secti \~~.)...~(.(~~.4..........l. Block Lot No......7:...~........... pursuant to opplication doted ..4 U ~........~P 19~.~.., and approved by the Building Inspector. ~ ~ i Fee 5...~:5 n / ~ ` .......:5..~~.....~.n.:"~~.°...~:~ Building Inspector Rev. 6/30/80 t'2 ftJ I'2 (I {1tJ R ~ BOARD OF HE,~LTH • L5 ll l5 Il lit _l5 ~ 3 SETS OF PLANS ~If ~FORMN0.1 SURVEY SEP •B 1989 p! ( ! TOWN OF SOUTHOLD CHECK • • - • • • • - - q BUILDINGDEPARTI41ENT SEPTIC FOR.`I • TOWN HALL BLDG-i3EP'E. ~ NOTIFY 'f(ytfirr~~ np ~r;,;r~~r.u~ °.OUTHOLD, N.Y. 11971 CALL TEL.: 7G5.1802 r MAIL T0: P ~ i3~I 3U1 Examine o~~l:y:-YW-~ ~ 199 ~ Approved. ~,9-!~;~~!~; 1,$„ 199. Permit No.~ .g;~.3.~ Disapproved a/c .................................1<4~....' (Building Inspector) APPLICATION FOR 8UlLDlNG PERMIT Date 19 , INSTRUCTIONS a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets oC 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by this application may not be commenced before issuance of Buildin; Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any 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 putsuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable taws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspections. .............r.............................., (Signature of applicant, or name, if a corporation) ` .y~.y a". (Mailing address pi applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~_ . . Name of owner of premises /`F T (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . (Name and title of corporate officer) ALL CONTRACTOR`S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. ~'u?'n?!}! . Plumber's License No . . Electrician's License No . . Oilier Trade's License No . . 1. Location of land on which proposed work will 6e done . .~~.2.~~~0.~~t..~~ .....................~~ti~~~ House Number Street J Hamlet / County Tax Tvtap No. 1000 Section Block Lot • , , , , , . Subdivision Filed Alap No. Lot............._ (Name) State existing use and occupancy of premises and} intendte/d useT~~~~Ji occupa~/cy of proposed construction: a. Existing use and occupancy ~ ..~Y7.~ , , , i-!. w~l ' ' ~ b. Intended use and occupancy ~e~ 3. Nature of work (check which applicable): New Building Addition Alteration , Repair . Removal , Demolition Other Work , ~ (Deseripjion) 4. Estimated CosI . Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units Number oC dwelling units on each floor , . If garage. 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 . Hcigltt ...............Number of Stories . Dimensions of same structure with alterations or additions: Front Rear . Depth ......................Height ......................Number of Stories . 8. Dimensions of entire nett' construction: Front Rear Depth . Height ...............NwttbecofStories......................................................... 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. 1Vi11 lot be regraded . Nill excess fill be removed from premises: Yes No 14. Name of Owner of,premises ....................Address ...................Phone No.. ~5.~ . Name of Architect . . . ............Address ...................Phone No............... . Name of Contractor ..........................Address ....:..............Phone No............... . 15. Zs this property located within 300 feet of a tggiuudal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO~ DIAGILAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block numbe scription according to deed, and show street names and indicate whether anterior or corner lot, kPPR iIEU AS ~~~E~ DATE 9 ! Ci.P tl / ~D-$~ FEE~S•---- a3v.'V G.~• 765 t$02 9 AM TC? F~i+f FOR THE ft)LLOLti'itvC; 3NSF'ECi}t.i ~:o. ~ 1. FOUNDATION - TWO REQUIRED J Fi3R POURED CONCRETE II 2. ROUGH • FRAMING R~ PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST i BE COMPL£T£ FOR G.C ~ ALL CONSTRUCTION SHALL MEET II f ~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION ID ENERGY / f J,L`~~. / CODES. NOT RESPONSIBLE FOR 1 ~ DEStGN OR GONSTRUCTION ERROR . ~ ~ -1 ~ ~T x ,s n~~« STATE OF NEIV YORK, S.S 'OCi\'I'Y OF . • . being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) .hove named. icisthc (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl~ pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that i ork will be performed in the manner set fort}t in the application filed therewith. worn to before me this o otary Public, 4-/~ County l~ 6718~,SUf~kIkC (Signature of applica Term Expires March 30, t8~f