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Home My WebLink About18440-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N~ 18440 BUILDING I~E~J~AIT (THIS PERMIT AAUST BE I(EPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORE AUTHORIZED) z ~ote ..... ,...~~.z~,...~..~..~. .... - / Permission , is hereby granted to:/~ ~.~.~.....~....~.**..~.. ........... ..~...~....~.:..~..:...,~.~..~..~..~..~ ........ County Tax Map No. 1000 Section ,.,.~..,~.,.~.. ........ Block .... ..(~..~. ........ Lot No. ,..J.~. ............... pursuant to application doted ~~***~......../.,..~. .......... , 19.~)..~., and approved by the Building Inspector. Rev, 6/30/80 OWNER.' SU~'V. CO. ' " , , HEALTH DEPT. APPROVAL I H. S. NO, / :), ~-: /~./ <-. .... / ,-- :/ ii 9 ?7 "~ · ~ ~ 40' =- ~ 7 I ~ ~ ~ the ~and su~'syor% ink~ ~a~ ~ ~OU':/vo~.p ~.~ ~o~mCK VAN ~UYL. P.c. {~~::~? '-'~/I' =} T~ST HOLE SUFF. CrO. DEPT. OF HEALTH SERVIC-E~ STATEMENT OF INTIirN~ FOR,,, ,, APPROVAL, OF , CONS~U~ION ONL~ SeZ~rl]', ,~r,'t ~ }5 ' DATE: ,,, OI~PO~L SY~EM8 FOR THIS R~I- ~nve/ H.S. REF, NO.: ..... - , , ',: ~AND~ OF SUFFOLK CO. DEPT. i 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 19 .~.. ' $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Ex'am p~...~.~., Appro~.~fT..~.cJ., 19 .~.. Pe=it No../.~.~. ¢.~...~. Disapproved a/c ............ (Building Inspector) BOARD OF HEALTH ...... ,3 SETS OF PLANS ....... SURVEY ........ SEPTIC FORM · fi.: MAIL TO: BLDG. DEPT. TO~IO F sOUTHOLO APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This 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 diagmm 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. e. No building shall be occupied or used in whole or in 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or nat%e, if a corporation) · . . U/F/~ .t..J~.i~. b ............ '" .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ O. .... ,: ...................................................................... Name of owner of premiles ...... ~Otg , , W/q~Z ?":: (as on the tax roll or latest deed) If applicanf is a corporation, signature of duly authorized officer. (Name aqd title ohcorp0rate officer) . ALL CONTRACTOR'S I~US~ ,BE SUFFOLK COUNTY .LICENSED Builder's License'No../.~'d.~.?..~....7~d.~../~..~-~/~.<~ (.vd ~ Plumber's License No...: ~ .~ .................... Electr-ician's License No ....................... Oth~r'Trade's License No ...................... I. Location o~land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..~ .......... Block ...... 0 ........... Lot..../.(. ............ Subdivision.. ~. ~O.x./~.O.~.. ~..~7./.~. ?.T.~ ........... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.t.~. ~-~-~...~..~R/! ./-)(......~/.o~.%7~. ...... ~r~ ...... ~;: ......................... b. Intended use and occupancy ....~'l~.&..~.e-...~.~t'7~1¢~.... / 3. Nature of work (check which applicable): . . .' ................ New Building . . . Addition .... Alteration .... Repair .............. Rembval .............. Demolition .............. Other Work...Z~ ~.. ..... ( ,& Fe, o~- ~E/oa~- ~,z,t[$ ~ .,-/,m~,/... __~e'g'~ (Descriplion) 4. Estimated Cost ....... ~ ...................... Fee ..................................... ~' (to be paid on filing this application) 5. l£dwelling, numbero£dwellinglunits ............... Number of dwelimg units on each fioor ................ If garage number of cars 6., If business, commercial or mixe!d occupancy, specify nature and extent of each type of use .................... 7 Dimensions · -.. . - t if any: Front Rear Depth . of existing structures, ........................................... Nulnber of Stories Height ............................................................... . Dunenmons of same structure with alterations or additions: Front ................. Rear ................. Depth . '. ~ l~ t ~ Height Number of Stories -,8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth .............. Height : Nun~ber of Stories ................... 9. Size of lot Front _. ?o'7 ./?-..~*~'-... Rear .~ . ~'.~'.,~F~- D~nth 10. Date of Purchase (~O'E). ~.~.~./.~.~. .......... Name of Former Owner (~o.~.~..~.o~.N .~..~r~.~p.~ I1~ Zone or use district in which pr~mises are situated...~l$Trg. J.~.~.. 7.'/..'~ .~.~.~..<~..~.~T!qg. 12. Does proposed construction viol. ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ~.0 ..... ~'~oJ ........... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises/eO?.~;. ~,....0/k"b~/ ..... Address ~,~.~.o..~ra.tr.~.~.:... Phone No. ~.a'~.-./~.,~.~r'7.... Name of Architect ......... 4 ................. Address ................... Phone No ................ Name of Contractor . ,' Address ' Phone No 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No .~... *If yes, Southold Town Trdstees Permit maybe required. ./ PLOT DIAGRAM Locate clearly and &st~nctly all: buildings, whether exmt~ng 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. ~e ~ ~0~,o~-~ , APPROVED AS NOTED , . DATE:'~['%~['~q Il.R# / N~I~ BUILDING DEPA~MENT AT 766-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: ' ? L ~OUNOATION ~O FOR POURED 2. ROUGH - FRAMING ~ PLUMBING 3, INSULATION STAT~ OP NE~YO~ ~ ~ b o 4. FINAL CONSTRUCTION MuST _ BE COMPLETE FOR C.C. COU~Y OF .~. [ ~ .... o.o ALL CONSTRUCTION SHALL ME~ .......... ..... t pp i ant (Name of individual signing contract) STATE CONSTRUCTION & ENERGY above named. ! CODES, NOT RESPONSIBLE FOR ~ OESIGN OR CO~TRUCTION ERRORS & ............................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul7 authorized to perform or have perfomed the said work and to m~e ~d file application; that alt statements contained h this application are true to the best of his knowledge and belief; and that the work will be performed in the m~ne[ set forth in the application filed therewith. Sworn to before me this l ........... ~ ......... day of~ .... ~.~ ~., 19 ~ - .... '.