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Home My WebLink About17454-z I~OEM NO. ~ TOWN OF SOU?HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 017454 Z ~ , J ..-~. ,o. I! ~ ................................ ff. ............ .~..~.~. ......... located at ..~...O......~...J~..~..~..~...~....~,,q.~....~..~..~,... ~j~, ~ at premises zzi.~ ................. ~... Coun~ Tax Map No. 1000 Section ....... 0.~.~ ...... Bilk .......0..~ ....... Lot No .....~1 .............. ~,~,~,~ ,o o~p,~o.o. ~,~ ...... ~~ ......~.~ ......... , ~.~.~.., ~.d opp,o.. ~ ,h. Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 1 ~.------ " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~~..~?., 19 .~.~. Approved~~ .".'~.., 19~. Permit No..I.7.~..~..~ BOARD OF HEALTH 3 SETS OF PLANS SURVEY ..................... CHECK ................. NOTIFY CALL .................. Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ................. , 1.9... Date . a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street~ or areas, and giving a detailed description of l~yout 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 issuancb of Building Permit. d. Upon approval of tliis application, the Building Inspector will issued a Building Permit to the applicant. Such permil 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 Occupan% 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, a..d, ditions or alterations, or for ~'emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and te admit authorized inspectors on premises and in building for neces~ctions...~.~~.....~...~;%.... ~~.. . State whether applicant is owner,/~ee, agent, architect, engineer, gene-ral contmctor;"Elecfi'i61an, plum:l. ~ or builder. Name of owner of rem , . t r e x rou or latest ~le~d),,.,. If applicant is a corporation, signature of duly authorized officer. *:'.::q'. }.' ~', (Name and title of corporate officer) Builder's r cense No .... '.7..Z.'7. /. .--. / .4/. .' ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locatio ~onof. land . ...... ~ .......... on wi ch proposed work wil be done ....... ' ...... ........... House Number Street Ham Id,,{ County Tax Map No. I000 Section ..,k53 ........... Block ....~ ............. Lot..i,,9.} ...... Subdivision (Name) Filed Map No. Lot .; ........... 2. State existing use and occupancy of premises and intemled use and O~cy o{ioroposed construction' a. Existing Use and occupancy ............ . .............................. b. Intended use and occupancy 3. of W?r.k (check whic~hiappli.cable): New Building ..... ' ..... Addition .......... Alteratio~ .. . ......... 3<.' w~movaJ .............. Demolition .............. Other Work ~ 4. Estimate'd C~d~?-f~..' ' //' (Des~r~;tion) ~ .t~.' ................. Fee ..................................... i (to be paid on filing this applic'ation) 5. If dwelling, number of dwellifig units . · Number of dwelling units on each floor ............... If garage, number of cars ........ Ifb ik ................................. 6. usiness, commercial or m ed occupancy, specify nattire and extent of each type o£ use ............. 7. Dxmens ons ofexmtmgstmctUres, ifany: Front .... ; .......... Rear .............. Depth .............. Hm ht N' tuber of Stone~ ~m~ensmns olsame structurelwith alterations or additions: Front Rear Depth ~ IIeight ....................... .................. ~ .... , ..... Number of StoNes Dimensions of entire new construction: Front ................ ' .................... ............... Rear ............... .Depth .............. Height Number of Stories Size of lot: Front ............ ........................................... ..... Rear Depth Date of Pure rose ...... i ...... . Name of Former Owner one or use msmct ~n winch premmes are s~tuated ....... Does proposed Construction violate any zoning law .................... , ............................... , ordinance or regulation .............................. 13. Will lot be regraded ....... i,.. ~ ................ Will excess 14. Name of Owner of premises [ ~.~ --~, fiji be removed from premises: Yes Nc · ~ .......... ~uoress ................... Phone No... 2.~'~..r. Name of Architect ....~.,. i .......... Name of Contractor . ~.~.-. ~i .... ' ...... Address ............... ... Phone No ............... · · :.:..... Address . · .Z"..~: ,5':5'7 ......Phone No . ~.~0'--~./.,~.'. 15.Is this property lodated within aoo feet of a tzdal wetland.* *YES..~ Trustees Permit may be required. mil yes, gouthold To~n "' ' '" i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc number or description according to deed, and show street names and indicate whethe~ interior or coruer lot. 9. 10. 11. "12. 'PPROVE ASNOTED / Nml~ ~UILDING 788-1802 g AM TO 4 PM ~FOR THE 4. FINAL CONSTRUCTIqN MUST 8E COMPLETE FOR C.O. A~ CONSTRUCTION SHALL MEET ~E REQUIR~ENT8 OF ~HE ~A~ ~NS~N & ENERGY E ORS .......... ('~ ................ ~ .................... boin~ dtdy sworn, d~poscs and s=ys that he is t~c = cant ' ramc of ndwfd ual s gmng contract) above named. He is the ...................... : ............ I (Contractor agent corporate officer ) ........................... I , , , etc, of Said owner or owners, and is duly authorized to perform or liave performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perforated in the manne:r set fort ~ in the application filed therewith. Sworn to before me this ............. f ....... day of~... : ............ 19 Nota~ Public, ~ "' .......... County HELEN K, DE ~ ~ ~A~ PUBLIC, ~te ~ ~w Y~ ............... . ~.~7078~ S~Lk~up~q (Signature of applic~t)