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Home My WebLink About18372-z FORBf bO. ~ TOWN OF $OU334OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 18372 Z Permission is hereby granted to: ..~.z~......~.~....~.~..~:; . :..~,~.~ ~,~....,.....:.~.,..~..~ ............ ot ~remises located ot ..... ~.....~..~..~.....~.~.~.-~...-~/......~....~..~.~./.. .................................. County Tax Mop No. 1000 Section .......... ././7(. ...... Block ........ ../...~....... Lot No ...... ~ ............... pursuant to application dated ........... ~....,/..~./.. .............................. , 19.~..~., and approved by the Building Inspector. Rev, 6/30/80 I"4A, P Af'IE~!L,FC', r ..... !,: :~ LIGENSEO LANO SUrVEYOrS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT APPROVAL H.S. NO. 11- -..~0-1f.¢9 STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLk CO DEPT. Of HEALTh SERVICES. {s} APPLICANT SUFFOLK COUNTY DEPT. OF HEALTF SERVICES -- FOR APPROVAL OF' CONSTRUCTION ONLY DATE H. S. REF NO APPROVED SUFFOLK CO. TAX MAP DESIGNATION: DIST, SECT BLOCK PCL, OWNERS ADDRESS: DEED: L. TEST HOLE SEAL / Examined. ~.//../~. .... Approved .. ~/~./.... Disapproved a/c ...... BOARD OF HEALTH ...... " 3 SETS OF PLANS ....... 'FOnMNO. 1 SURVEY ......... TOWN 0FSOUTHOLD CIIECK ...,., ..... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N,Y, 11971 TEL.: 765-1803 CALL . ,/ (l~i'Iding Inspector) APPLICATION FOR BUILDING PERMIT ~ ,~../. Date ......... ,19 INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with; 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered by tiffs 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 permi shall be kept on tim 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 9 Certificate of Occupanc: shall liave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th. ,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 described The apphcant agrees to comply with all applicable laws, ordinances, building code, ho.using code, and regulations, and t~ admit antborized inspectors on premises and in building for necessary i~q~ctions. ~ - (Signature of applicant, o_r na~le, if a corporation) / State whetller applicant is qs)rner, lessee, agent architect engineer, general contractor, electrician, plumber or budder. o~r~&~. .. " (as on the tax roll or latest deed) Il' applicant is a corporation, signature of duly authorized officer. (Natne and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's Liceuse No .... 5~..~...-.....~T~...~..~lL~,<~ CO. I. Location of land on which proposed work will be done~ ................................................ ¢. 73.0. ........... .g/. ~sr4v....~ ./~. z... £o/~ ........ ~ .7-.0~. 0..c7 ~ o ~ l-lomfe NmnberStreet , ' 'I~I~n'nlet ............ /// /..-C.. ' ~ot.'. 6. C tyTM pN 1000S ti BIk oun ax a o. cc on oc... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. Stale existing use and occupancy of premises aud intended use and occupancy of proposed construction: a. ~isting,,se and occ,~anc~ Y~, /~ . ~.S~ ~qC£ ...... ~ . ..... -K. ...... ~..~. .................................. b. Intended use and occupancy CoflJS'7-,ff~t/--~7'ToW ~F -~"~/,,'~L/-, /'~/C~'7- ~7,.u ~ ~)--;;/;~' '~;g~"h-¢;,9 .... ~;q':3:~;~3~?--7' ............ 3. Nature oF work (check which applicable): New Building ..... ' ..... Addition ,. ~... .... Alteration .......... Repair Removal ' Demolition Other Work 4. [:st ated Co · Fee · (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ~.~...~. ~ · · · Number of dwelling units on each floor ............... If garage, number of cars . ~.~.~...~/L/~.~. o..~-~ t~/. ./.~.~ ~'...~.t~?. ............ .~,..' ............... 6. If business, commercial or mixed occupancy, specify nacre and extent of each type of use . ./..V? ............... 7. Dimensions of existing structures, if any: Front ~C~,.~../?/-,..4: .~.... Rear .............. Depth ........ ; ..... Height Number of Stories Dimensions'of same structure with alterations or additions: Front . .~'~ ....... Rear ................. Depth ...................... Height ....................... Number of Stories ..................... - 8. Dimensi~¢n$of,entire new construction: Front..[~.~ee-~.. .... Rear..(;~:¥/-~r~. ..... Depth .~.~.:~¢~. .... Height ~,J4~!~.~7.. ..... ~.... N~.~n~ber of Stories ......... '~ fi/¥~'~-e~ ............. '~ ...................... ~ ..... 9. Size of lot: Front ,. ~.ffZ. ~ ~ ~~ m,~,~h ' 10. Date of Purchase ~ .tp.. . [ ~ ~.. ~.t(. ~r~ ~¢ 1~,,,.,~,~. c~ ..... ..]'~F'~+pl¢ r~tV 11. one or use dmtnct in ~hich premises are situated .fl~:~. (A~. tV.7?/~ .L~... ............................ 12. Does proposed constr.u, ction violate any zoning law, ordifiance or regulation: ...~.O. ................... 13. Will lot be regraded alto .......... ~ .~.~ ......... Will excess fill be removed from premises;. ~ ~ Yes N 14. Name of Owner of premises ~-,..~?"A~.. ff. ?. ~/.~.,~:p~/Address ~77.~.o../~..ac~.-.t~. ?p. gp.. Phone Ng/,~.~fl.7.~. Name of Architect ~ .~ ~ . ,.t-. Address - vh,,,~ No~ . N n 'T ..... ~ .......................... ~ ..... , ...... m e of Contractor/~:~... ~t~{:~;~ ~. ~ (_~... Address~.~. 'J~.' ~t~hone NT~P fl?..~..~7.77 i5. Is this property located within 300 feet of a tidal wetland? ~Yes' . .... No .'-(.~. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ('~_~t~.% APP. ROYED.AS NOTED NbTIFY BuILO1NG O~PART~[~I~NTVAT 76S-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO RE~IREO FOR POURED CONCRETE 2. ROUGH - FRAMING & 3. INSULATION 4. FINAL CONSTRUCTION MUST BE'COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y STATE CONgffiUCTION & DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.S COUNTY OF ........ ,. ........ (Name of individual signing contract) above nanled. ·. being duly sworn, deposes and says that he is the applicant Itc is tim ........................ ' ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; that all state,Dents contained 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. Sworn to before me this ........................ day of ..................... ,19... Notary Public, ................................. County (Signature of applicant)