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Home My WebLink About18222-zTOWN 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) N~ 18222 Z Permission is hereby granted to: · .................. ot ~r::ises I:atT:' at '"'~~~ ....... ~:'"'i"i'iiiiiiiii'i .............. iiiii ........ County Tox Map No. 1000 Section ....... .~../,, ......... Block ...... ,,~,,. ,,~... ..... Lot No ...... ,~... ,~,, ......... pursuant to application dated ........... (~/..~..~. .............................. , 19~.~.., and approved by~ Building Inspector. Fee $.~...~ the Rev. 6/30/80 Examined. ~4~/.~ ......... 19 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH .. SURVEY ......... CtIECK ...................... SEPTIC FORH ................ NOTIFY CALL MAIL Disapproved a/c ..................................... (~ u ill, fig Inspector) .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TO: Bt. DG. DE(~]. LD TOWN OF SOUTHO .~ 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 shopping location of lot and of buildings on p'remises, 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 this appli- cation. o. The work covered by tbJs 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. c. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy s~hall 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. Tile applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspector~ on premises and in building for necessaW inspectS?ns. ~, ,0 . - ~(Signature ot apl~ioant, ~;/na'r~e', if'a'~orporanon) '' (Mai,in= address of alOticant) State wl~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. [f applicant is a corporation, signature of duly authorized offictr. amc an e of co rate officer) Bu,dc,'s L,cense .... Plumber's License No ......................... Electrician's License No ....................... 7~S-180~ 9 AM TO 4 I~1 FOR THE FOLLOWING INSPECTIONS: 1. FpUNDATION . ~ RE(]UIRED FOR POURED CONCRETE - 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF ~ N,Y, Other Trade s License No ...................... STATE CONSTRUCrlON& ENERGY CODES, Nor RESPONSIBL~ FOR Location of land on which proposed work will be done ....... ' ..... I;)l~$1,qN..O.R ¢ON.~I~P.~..~. ~ ERRORS '7. .............. ............... ;'~' "'treet,'": " tlouse Number S Hamlet .......... County Tax Map No. '000 Section ...... ~.f. ........ Block ..... .(~.~ Lot.. ~..~ Subdivision ..................................... Eiled Map No. (Name) .............. Lot ............... · State existing use and occupancy of premises ~)~ ,uteri, dod t~,P~ncy of proposed construction: b' Intended use and occupancy ............ ~. · · .~--... ~C~..~.'' 'j7 I· ';'~''', ....i .............. ....... 3. ature et work (check which ~pplicable): New Building ..... '.. Repair .............. Rernoval .............. Demolitiot;' ~ Addition .......... Alterat.~4~} ......... .............. Other Work. C~.DF.; ~..-... 4. Estimate'd Cost If d i ' rte be paid on filing th,s application) $. welilng, number ofdwellin units ~. · ..... Nnmber of dwelling units on each floor.. . Ifg ; ' araee, hum bet of cars ...... . . 6. usiness. COmmercial or mix, occupancy, specify natnre and extent of each e of use .... 7. Dimensions of existing structures, if any: Front .........Rear typDe .... h ..................... pth . . Heieht ............ Nu ~ber of Stories .......... dditi .......... ' lmenslons of same structure With alterations or a .................... Depth ................... ]... oas Front ................. Rear. . 8. ~menstons of'.enUre new construction: Front .. Heieht ...... , ..... · .......... Rear ....... 11. Z. one or use d strict in whicb',,..:~;~ ''": ......... rqameotl'ormerOwner ...(..4.~.~.[~..T].C~. f .... 12. woes proposeu Construction v o nE,- ,,,, ...... ' ;.' .................................. 13. Will lot be regraded i ...... :, ~,,,,ng mw, eminence or regulation: ...... ' .......... 14. Name of Owner of premises' ' I ................... Will excess fill be removed from premises: Yes No Name of Architect . ' ............. Address ................... Phone No .... ......... ~ ................. Address ........ Name of Contractor i . · .................. Phone No... - · ..... Address ... L' ' ih; ........ Phone No ........ -..... 5.Is this property localted 300 feet of 1' wetland? *YES .... NO.~.[ '' ~If yes, Southold Town Trustees Permit may be required. PLOT DIAGILAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block interior or comer lot. mmber or description according to deed, and show street names and indicate whether~ (l.~e~flint~{l,,icl. fi.:l,~il, afit}}~,)Q~jhi,r.~;.~ ..... being duly sworn, deposes ~d says that he is the applicant ~ove named, vo~3 ~ ;~0~1 flO~ ]JMI~O , (Contractor, agent, corporate officer, etc.) said owner or owners, ~d s duly a~thorized to perform or N~cafion: that all state neats containe~d in thi~ a--1:~2-: have performed the said work and to m~e and file thi~ " t,~ c~t on are true to the best of his knowledge and belief;and that the >rk will be perfo~ed in the m~ner se't forth in the application filed therewith. 'om to before me this l ................ f .... "' ta~ Public .... · ~ .... County HELEN ~ DE ~E ~A~ PUBLI~ ~ NIO/F THERESA FROHNHOEFER N 73° 1o' oo"' E 99.93' I,.. N/O/F ~,'r~N 73' 10' O0"E '~"~' 50.00' %%, THERESA FROHNHOEFER N/O/F PHYLLIS B. MALLGRAF AORIENNE B. OLIVER ROBERT H. BAKER i ~ '- 87.29' is 76' 2s' 3o" I / MECHANIC STREET SURVEY OF Pf? OPER T Y A T SOUTHOLD T (') W N _O F .cAr)l/TI-Id'ill_