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Home My WebLink About18221-z FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 18221 Z Permission is hereby granted to: /~ .~.~..~...L~.~ ............................... ~.~ ......... ,o ................ at premises located at ................... ~'"I 'T .~......1~. ~!.....:....~ ......... ~.~ .......... ~.~.~... .~.:. .... ~. ..~.~ ~,~. County Tax Map No 1000 Secton ..C~..~...~ ....... Block ........ .~.! ........ Lot No....~.~.~..~...~. .... ......... ...~.~......~ .................... , 19~..C~.., and approved by the pursuant to application dated Building Inspector. Building Inspector Rev, 6/30/80 BLDG. DEPT. TOWN OF SOUTHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11071 TEL.: 765-1802 Disapproved a/c ..................................... ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CIIECK ................. NOTIFY ~3'~"~ CALL ....!~.Z: .0. tq?...?....~.~x MAIL TO: INSTRUCTIONS ' a. Tiffs application must be completely filled in by typewriter orin 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 descriptibn of layout of property must be drawn on the diagram which is part of th.is appl/- cation. ¢. 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 throu?~hout the work. e. No building shall be occupie~l or used in whole or ~n part for any 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, housin~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · ~-' .... --, ~,~' ~t~,ll ...... or nam.e,-if.~corpora[lon) ........... ~m~..~,..~. ....... .~ (Mmhn~ address of apphcant) ~ , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed)AppRov£D AS N01£D lfavvticant is a corporation, signature of duly authorized officer. OATE: {*/16/~? B.R # (~ame and title of co~orat)c officer) ' " NOTIFY BUILDING D£PARTMENT , 765-1802 9 AM TO 4.PM FOR THE Builder's License No ........................... t~OLLOWING INSPECTIONS, 1, FOUNDATION TWO REQUIRED Plumber s License No ......................... ' FOIl POURED CONCRETE ~. ROUGH - FRAMING & PLUMBING Elcclrician's License No ....................... 3, INSULATION .. F~N^~ CONS~.UC~!ON MUS~ AU. CO.S~.UC~IOm SH^~ ME~r · tlouse Number .' ~, Hamlet ' pN County Tax Ma o. 1000 Section .............. Block ..... ); Lot ...................... Subdivision ............ Filed Map No., Lot (Name) ............................. · State existing.se and occupancy of premises and intended use and occupancy of proposed construcZJon: :. ~.,istmg use and occupancy........ . . . .. ~(~.UC~.. .em. ....9..uq b Intended use .%..~.L,k'V .~..~..%.~. · and occupancy ~.~J3 ¢_.~ 'l 3. Nature of work (check which applicable): New Building .... Addition ..... ter~tion ... Repair .... RemovaI , . ..' ..... i ....... Demolition · · · Other ~,~oi:k~'q~-.9 I 4. Estimate'd Cost ~ l ~ ~ O. ~' (D rip ........................... Fee .~. "' , '-"' [1' ~ (to bc paid on filing this application) 5. If dwe rog, number of dwellin units ............... .Number of dwelling units on each floor.. If gars=e, hum bcr of cars .... i ................ · ......... 6. If' business. COmmercial or mi d occupancy, specily nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ....... ' .................... ight ............... mb · · ...... Rear ............ Depth ...... He Nu er of Stet/es. · · · . Dimensions of same structure with alterations or additions Front ................. Rear Depth ...... ' ............. · nj ............ Number of Stet/es .... 8. D~mensions of entire new const ct on' l=r,,,~ · · . ei ht ......... Nu, ='='= ...... i ........... Rear'"i ' ........Depth Size of lot: Front ....... : ' · · .......... . ...... ~ ........ Rear ............... Depth Date of Purchase .......... , ........ · .................. i . ~ ......... Name of Former Owner ......... Zone or use district in which prqm~ses are s~tuated ........... ' ................... Does proposed construction vie ate any zoning law, ordinance or regulation: ......................... Will lot be re~raded ......... : ................... Will excess fill be removed from premises: Yes Name of Owner of premises i?O~o)g,e~...~{&t4~.t7,~ Address 9,,~r$' ~O~.q~....~-~n.. Phone No. -. .. ' ' ' . ."/~.'~ Nme of Architect .......... ! ................. Address ................... Phone No ................ , Name of Contractor .<e~.e4d&l'T~...~r.,MrdL. ..... Address 1,-,~t,,%AP~...t?~.t.~. Phone No ............ · .. 15.Is this property lees ed wlthin300 feet of a tidal wetland.* s~ygl; .... NO..~. ~If yes, Southold Town[ Trustees Permit may be required. ... PLOT DIAGRAM 10. I1. 12. 13. 14. Locate clearly and distinctly all [buildings, whether existing or proposed, and, indicate all set-back dimensions from property l/nes. Give Street and block Humber or interior or Comer lot. description according to deed, and show street names and indicate whether ........ being duly sworn, deposes and says that he is the applicant ~, orporate officer, e,~.) ' said o~ff~r,,6~t, lb'~¥~,3~?:h~q~'~l:3~:~ it~ht;'rized to pe.rform or have performed the said work and to make and file this ~plication: that all statements containc in this application are true to the best of his knowledge and belief; and that the ork wdl be performed in tile manner sc~ forth in tile application Hied therewith. .yom to before me this ............ ? ......... of ..... ,o ~tary Publ c .... ~ ........ i ......... County HELEN K, DE VOE ! ....... . . . . NOTARY PUBLIC, State of New ~ No. 4707878, Suffolk Ce~ntyo. lerm F. xp~es Mmch 30,1~I ZI )