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Home My WebLink About18129-zTOWN OF $OUTHOLD 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°- 18129 Z / Date ...~~ ~ ............................................ 19...~...~. ...... Permission is hereby grqnt~ to: ,~ ~.~.,~. //~ ,IP , ,. ..... ,.~.~.~.,~....,..,.,,...~,. ............. ././..~ .......... ,,, __ ....... ...... ...... at premises located at ..... ~..~.....~.... ................ ~...?,~t~.. ........................................................... /~.~ Coun~TaxMap No. 1000 Section ...................... Block ........ .../.. ......... Lot No. ~ pu,uant to application dated ............ ....~...~ ........................... , 19.~..., and approved by the Building Inspector. Rev. 6/30/80 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , SOUTHOLD, N.Y. 11971 . '.,~.,~..~.?. TEL.: 765-1802 Examined ........ 19... Approvcu .../ ........... , 19 ... Permit No .... Disapproved a/c ..................................... ................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL .... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 streets 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 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 permit shall be kept on the premises available for inspection throughout the work. ¢. No building shall be occupied or used in whole or in part for agy purpose whatever until a Certificate of Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housina code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp.~.~ -', ,, , ', :',~'~; ,n ~;'~ ~ ...... ~, (Mailin= address of applicant) State whether applicant ~s owndiv lessL6;c:i~ent~i~chitect, engineer, general contractor, electrician, plumber or builder. ....... . . . . .............................................. Name of oxvner o.~remises . ./f~..~..<~..~JC ~,:...~~.. · i'~. /, ) .... ~ "~ ~'~" (as on the tax roll or latest deed) If applicant is a e~qfat(~n~t~gnf/}lp, rgL~{~t~l¥~:}u~tJ3)grized officer. Builder's L~cense No.. ~ ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I Location of land on wlfich proposed work will be done ' ' ..de.sT.. ...................... . . ................... x. .,?. . ............ St H .... }louse Number reet, amlet County Tax Map No. 1000 Section f~ K , Block I .C~.d ............................... Lot ............... Subdivision ..................................... Eiled Map No. Lot (Name) ...........................' ' 2. State ex:sting use and occupancy of premises and intended use and occupancy of proposed constrnction: a. Existing use and occupancy ~...E~. (O--~-------------------~q..¢e-~- ............ b. Intended use and occupancy ................. . ................ 3. Nature of work (check wh ch zpplicable). New B" "'-- ' ' Repair -,, . · ,.um:~ .......... Addition ....... ,q~.~ ,~ t,e r~,~lo_.n ......... .............. v, umoval .............. Demolition ........... ~ ;,* ~ · . 0~'~ Work .'.~.~>~..¢~F.,.. 4. Estimatc'd Cost.. (Description) Fee 5. If dwelling, number of dwellin:g units / (to be paid on filing this application) ............ Number of dwelling units on each floor ...... ' lfgarage, number of cars ...~ ........... i." " · · 6. If business. Commercial or mix'ed occupancy, speciljy nature and extent of each type of use ..................... 7 Dimensions of existing structuies if any: Front He ght N ' ' ',, ............. Rear ............... Depth - · ............. umber of Stories ~[ ............... O~mensmns of same structure w.th alteratmns orI ~idttionsl ~ro&t ii ii ................................... Depth ' Height Rear 8 ............. ' ..................... Number of Stories .............. Dimensions of entire new construction: Front ..... ............... Rear ............... Depth ............... Heglt .. . x~,l . · · ............ ~su~Boer of Stories . 9. S~ze of lot: Front ... [: 10. Date of Purchase . .~.Z~..7...4~. · · . Depth .......... ............. Name of Former Owner .. de'P.M..~ ......... 11. Zone or use district in which p3emises are situated ............... ' ' 12. Does proposed Construction vi,,late an,, zo~: , -. . .~ ;~ ,-rig law, orumance or regulation. . ..... 13. Will lot be regraded .... i . · ............. 'm'ises' i '.~.~.~-'~ ~..~'/,~',f,/- s,.s fi[1 beycmoved from premises: Yes' 14, Name of Owner or,re ..... Wall exce ........... :-~-v~... Address~O.~,.ttrr-~ }0~..,./~. Name of Architect ............... Phone N- "P-'~O Name of Contractor ....... i ........... Address ................... Phone No ................ 1 '~ .................. Address ................... Phone No ........ - ....i... 15.Is this property oc~ted within~O0 feet of a tidal wetland? ~YES .... NO..){. ~If yes, Southold Towh Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED DATE: , ,, B.R# ,, FEE: I~Y: , NOTIFY 8Ui~.~ING OEPARTMENT 7864802 9 AM TO 4 PM FOR FOLLOWING INSPEC~Ti(~Ns: I. FOUNDATI0~J ~W'O REQUIRI~ FOR I~OURED CONCRETE 2. ROUGH - FRAMING & PLUMBII~ 3. INSULATION 4. FINAL CONSTRUCTION MU~ BE coMPLETE FOR C.O, ALL CONSTRUCTION 8HALL THE REQUIREMENT8 OF THE NY. STATE CONSTRUCTION & ~ENEF~V CODES. NOT RESPONSlBt.~E FOI[I OF-SIGN OR CONSTRUCTION ERROR~ STATE OF NEW YORK, COUNTY OF.. SiS .................. being duly sworn, deposes and says that he is the applicant (Name of nd v dual mgni~g contract) above named. Ilo is the i ' ' ~ (Contractor agent corporate officer crc ) '~f said Owner or owners, and is duly ¢uthorized to pgrform or have performed the said work and to make and file this ~'Pplication; that all statements contained in this appliciaion are true to the best of his knowledge and belief; and that the ,york will be performed in the manner s~t forth in the application filed therewith. ;Worn [o before me ...................... day of..i..'~. HELEN K. D.E VOE NOTARY PUBLIC, State of New Yolk ' . No..4707878, Suffolk Cou~t~ ' ..... grin ~piros March $0, l-q 7/: (Signature of applicant)