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Home My WebLink About17970-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) 017970 Z Map No lO00 Section .... //(~.,.... Block . ,/~ Lot No ... /...~... Coun~ Tax ..................... pursuant to opplicat,an doted .......... ~/~.~ ................. , 19 ~, a~ approv~ by the / Budding Inspector. Rev 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y ~07~ d ~.~..~ O~ TEL.. 765-180:~ E.,amme .......... 19.. /7q 70/~ Approved/. ~/~. 2~O. ...... I90~. Permit No ........ Disapproved a/c .................................. t Buo, gd,ng/~pector) APPLICATION FOR BUILDING PERF/IlT BOARD OF HEALTH ........... 3 SETS OF/~LANS ............ SURVEY--- .~ ................. C.ECK .O:~. h ................ SEPTIC FORM ................ NOTIFY CALL MAIL TO: [. TOW~ O~ sotrrHqu~ ,I Date ~' 2 ~' . ................... 19 .~ INSTRUCTIONS a. Tlfis apphcation must be completely filled ~n by typewriter or m ink and submitted to the Bmldmg Inspector, w~th sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showmg location of lot and of bmldmgs on premises, relatmnsh~p to adjoimng premises or pubhc street or areas, and g~vmg a de}ruled descmpnon of layout of property must be drawn on the dmgram which m parz of tlus appt cation. c. The work covered by }bas apphcatmn may not be commenced before msuance of Buddmg Permit. d. Upon approval of ttus apphcat~on, the Bmldmg Inspector wdl ~ssued a Buddtng Permit to the apphcant Such perm~ shall be kept on the premmes avmlable for mspectmn throughout the work. e. No bmldmg shall be occupied or used m whole or m part for any purpose whatever untd a Cerhfieate of Occupanc- shall have been granted by the Bmldmg Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to th, Braiding Zone Or&nance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulatmns, for the construct~prt~of Jomldmgs, ad.d~t~ons or alteranons, or for removal or demohnon, as hereto described . ~ ,.-- (S~=nature ot apphcant, or name, [fa corporauon) ,~ ~ t ~- t (Madzng address of apphc~t) State whether ~2p$~ca~t ~ ~wn~v,~egs~e~_. ag~t, ~ch~tect, enDneer, general cont~ctor, electncmn, plumber or budder, ff ............................................................................... Nameofowne[gfpremm;s' .... I.C}~..,..~..~Oz~e$ .... ~J~e ......................... e~. a , ,o '' ~' '"'. (asonthe tax roll orlatest deed) If apphcant zs a'eorgO~k[~n, mgnature of duly a.uthonzed officer. (Name and ntle of co.orate officer) Builder's License No. ~ ~ m ~ .& ....... Plumber's Ltcense No .... ~/J. ............. L~cense No . ..~/~ ........... Electrlclan's Other Trade's Lmense No. . ~/~ ............. I. Location ofland on winch proposed work will be done ·..2.93..r' ............... Z3.e?..o?... P.~ .............. )~ff: / .o.c.& ........ }louse Nun her Street Hamlet County Tax Map No 1000Sect~on /.]..~7tO..°. Block ........................ Lot...~-* /.,t7 ......... Subd,~,s,on P~.~m../.h,.Ze c~,,k £.~J.s Wed mp ~o..Z4. ~ .r.6 ~ot .... ~ ~.. (Name) 2. State exlsting use and occupuncy of premises and intended use and occupancy of proposed construetxon. a. Ex~stmg use and occupancy .................................................................. b. use and occupancy ....... .~<~we'-~'~· ........................................... . . . Intended 3. Nature of work (check v, hich applicable) New Building ......... Addition ....... Alteration ...... Repair ............ Removal ............. Demolition ........... Other Work. ~.. ~F~ (Description 4. Estimated Cost ...~ o. o (to be paid on filing this apphcatlon) 5. If dwelling, number of dwelling umts ............... Number of dwelhng units on each floor ........... If garage, number of cars ................................................................... 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ................... 7. Dxmenslons of exmtmg structures, if any Front ............. Rear .............. Depth ............ Hmgt~t ............... Number of Stones ............................................. D~mensions of same structure w~th alterations or addmons Front ................ Rear ......... i ..... D,:pth"~ ........ L ........... tlmght ...................... Number of Stones ............. 8. DlmenmJ ~nCire new construchon. Front ............... Rear ............... Depth ....... Height ............... Number of Stones ..... 9 Size of lot: Front /!~. ........... Rear /1~. Depth .~..o o. I0. Date of?urchase ............................ Name of Former Owner .......................... 1 I. Zone or use dmtnct in which premmes are situated .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation' . ...... /, .'~',q ................... 13. Will lot be regraded ........................... Will excess till be,r,cjnoved from premmes' Yes 14. Name of Owner of premmes .~ ~ ,.~.e .1~ ......... Address . ~.~.'~". 7"~.e~q.~. )it Phone No. ~'.~ .".-~. I~.6 ?. Name of Architect ..... ~q.~.~'.~. ................ Address ................. Phone No .............. Nm'ne of Contractor .... ,'M.q ~ .~. .............. Address Phone No 15.Is this property located within$O0 feet of a tidal wetlaud. ~If yes, Southold Town Trustees Permit may be required. PLOT DIAG RAM Locate clearly and d~stmctly 011 buildings, whether existing or proposed, and indicate all set-back dunensmns fro property lines. Give street and block number or descnphon according to deed, and show street names and indicate wheth interior or corner lot. 765-~802 $ AM TO 4 PM FOR THE :2 ROUGH. FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST gE COMPLETE FOR C O. ALL CONSTRUCTION SHALL MEET THE CODEs, NOT RESPONSISI~E FOR DESIGN OR CONSTRUCT/ON ERRORS STATE OF NEW YORK, S S COUNTY Of .............. ......... ............ (Name of mdiwdual slgnmg contract) above named. being duly sworn, deposes and says that he is the apphca tte is the .O...u~...~t, .~./~. ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tt apphcatton, that all statements contained mttns apphcation are true to the best of his knowledge and behef; and that t. WOrk wdl be performed in the manner sci forth in the apphcat~on filed therewith. Sworn to before me this ........................ ayof .... .'ota, Pubhc ..... ..... Count NOrART PUELIC, State of New ¥~rk 1'erin Exo~res M~rch 30, 19 ,,,1/ (Signature of applica~ JUN 2 5 1984 ,, . ~v~m~ ~.~..: , ,'...