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Home My WebLink About17850-z I~,M 1~0. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_O C]~. 7850 Z Date ...;~..~......L~.. ............ , 19.~.~.. Permission is hereby granted t~_t_o: .......... ...................... ........ ot premises located at ......................... .,. ......... County Tax Map No. 1000 Section ...... ..C~.....~..,~. ...... Block ...... ...C~.....~.. ...... Lot No.....'~:...~...,...( ........ pursuant to application dated ....~.~..../...~. ............ , 19..~....~., and approved by the Building Inspector. Fee $..C~,..~.~., J Building Inspector Rev. 6/30/80 Approved 19 .~.~. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT l TOWN HAIL ~OUTNOLD, N.Y. 11971 TEL.; 765-1802 Permit No.l .~.~.~...~.. Disapproved a/c .................................. " (Building Inspector) APPLICATION'FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PL~NS ............ SURVEY ..................... CHECK SEPTIC FORM ...; ......... NOTIFY CALL ..................... MAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter 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=,,iv'moo 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. 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 Re-°ulations, for the construction of bui/dings, ad, flitions or alterations, or for removal or demolition, as herein described. Tb~ applicant agrees to comply with all applical~le laws, ordinances, building code, housin~ code, and r~gulations, and to admit authorized inspectors on premises and in building for necessary inspections. (S~gnatur. eot apphcant or name, ffa'corporauon) ailin address o appLicant, State whether, applicant is owner, lessee, agent, axchitect, engineer, general contractor, electrician, plumber or builder. Name °f °wner of premises - '~.~..~. G.Q .v~. · t~...c':..t-.b'...t.~...~.):5./..l~'72ba.. /~l,5, fl...CT~... (as on the tax roll or latest deed) lC applicant is a corporation _/~gnature of duly authorized~gfficer. ,- (~ (Name(~nd title of corporate ~office"er) Builder's License No- PlumbeFs License No ......................... Electrician's License No ....................... Otlier Trade s License No ...................... 1. Location ofland on which proposed work will be done. . . ' ........ ....... House Nunlber '' ..... ~;r~;, ' ............ Haxnlet ...... ' / County Tax Map No. 1000 Section ..... ~.3 ........ Block ...... w~. ......... Lot. ~ 4 , / Subdivision ..................................... EiIcd Map No ............... Lot .. (Name) ...... ,- · 2. State existing use and occupancy of premi,ses and intended use and occupancy of proposed construction: a'Existmguseandoccupancy . .[7..l.51 N .5.~..0 .~...-'.C77 ~t- g.~...o. ~7,,Vq C -- b. Intended Use and occupancy ~..I ). 3. Nature of ~vork (check which,, applicable): New Building., .... ' ..... Addition .......... Alteration_. .... ~... Repair .............. Remova1 .............. Demolition .............. Other '~:. ! (Description) 4. Estimated Cost '~ .0. Q'. O ..... Fee ~ (to be paid on filing this application) 5 Ifd · welling, number of dwellin units ............... Numberofdwellingunitsone ch floor ...... ' Ifgarage, number of cars .... j .................. : , a~ , . . ~'~" 6 Ifb ' ' ' ...... Od it' ' ................... ' ................ · usmess, COmmercial or mix occupancy, spec y nature and extent of each type of use ......... - ..... 7 Di i ' · · mens ons of ex~snng srructur s, if any: Front .... Rear .... ' .... '..',. De H igl mb ............... pth. e tt ............... Nu er of Stories ................... ' ............. Dimensions of Same structure W/th alterations or add tions' Front ar ....... D pth II ght '' ' 8 Dimeni nsof ntir ti-u ti F .................. L~umucro~tones ................. · s o e e new cons c on: ront ............... Rear ............... Depth . . Height ............... Number of Stories ................. 9. Size oflot' Front .z-J~--I o - '' ' '-' ''~-~ .......... ~: ....... · . ~ - ' .......... , ............ ~ear .... .,2~'"-- ~ ~ ,~. / -~ ~ - ........ I0; ~ateotrurchase .. i ............... u~ptu ..o~.,o-~..,..~ .... 2'~"' 11. Zone or use district in which pr~nises'a'r' 'st' .~;~ .... I~me.~o~_rorrner Owner .,4 .O S.4.~....~.~..~. ~ ...... e Itu ..... ~ .~ ! 12. Doesproposed construction vio,:late any zoning law, ordinance or re~ulatlon. /V ~ 13. Will lot be re-raa~n ~ ('-~<. , , o ' ........ '/' . · · .. .......... Will excess fill be removed from remises- 14. NameofOwnerofprem~ses~. a'Cp5(.~ ~<~/4t-/~-- r~.~,:.~ ~_, ...... P · Yes Nam~ ~ .... ~ ............. ,~uuress,.~ t .'4 .~..-'5~..Z Y..~?/. ¥.~mne No ........ ~ u~ arcmtect ......... ~ ............... Address ....... ' .... Name of Contractor . . ~ .......... ~ne No .... & .......... IS.Is this properS'; i;'e'~iJ,;'":::'."il;2"Afldress ': ................. PhoneNo ...... :elf yes Southold 'To~; u wxcn]-nJoO teet or a tldal ~*etIand? :eYES .... NO.'~j. ' · Trustees Permit may he required. · .. i PLOT DIAGRAM Locate cle~ly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give Street and blockinumber or description according to deed, and show street names and indicate whether interior or Comer lot. APPROVED AS NOTED 7(~5 1~{{);, 9 ,4~ rO 4 PM FOR THE FO[ ~. ()Lql~46 iNSP[~CTIONS. 1 ~(3tJ~DAltO~ . ~0 REQUIRED ~OR POURED CONCRETE 2.ROUGH FRAMING & PLUMBING 3.INSULATION 4. FINAl CONSTRUcTIoN MUST 8~ COMPLETE FOR C.G. ALL CONSTRUcTioN SHALL ME~ THE REQUIREMENTS OF THE N,Y, , STATE CONSTRuCTiON ~ ENERGY CODBS, NOT 'RESPONSIBLE FOR OESIGN STATE OF NEW YORK, COUNTY OF ............... ..... ab ,{Name of~ndiWdual signi, ng contra~,~'' ' '~ .... being duly sworn, deposes ~d says that he is the applicant ore namca, , ~ (Contractor agent corporate officer ) ' , , etc. of said owner or owners, ~d is dul~ authorized to pgrform or have performed the said Work and to m~e and file this application; that all statements contained in this application are true to tim best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ne~ set forth in the application ~led therewith. Swo~ to before me this .......... .day of ~ota~ Public ......... ,; ..... County NOT~RYPuoti¢, Sbte,ofNewYork No. 470787~Suffo~Couni rerm l~pites ~,ch 30,1~¢ (~ignature of applicant)