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Home My WebLink About17270-z FOu~ NO. ~ TOWN O~ $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 017270 Z County Tax Map No. 1000 Section ...... ,/'...~.. ..... Block ....... ~'~.... .... Lot No ............ ~.. ......... pursuant tO application doted .... .~../.Z~...~ ..............................., 19./~.~, and approved by the Building Inspector. Fee $,,~*,~ Rev. 6/30/80 SURVEY FOR WILLIAM M. GREMLER 8, LOUISE D. GREMLER LOT B= "MAP OF PROPERTY OF A L. DOWNS" AT LAUREL TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK ~UNAUTHOIr~IZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLA;'~ON OF SECTION 7209 0FTHE GUARANTEED COMMONWEAL'[ Examined · 7~ .......... , Approved...?~. ........ 19t~. Permit No./~..~..~. 7.~../ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ CHECK SURVEY .[~....u~.~.~.~. :...: ..... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: .1~,~/~ Date ................... 19... INSTRUCTIONS a Tlus apphcatmn 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 16cati0rl d:f lot and of buildings on premises, relationship to adjoining premises or public streets 5or areas, and giving a detailed ~d~crlp~ion of l~yout of property must be drawn on the diagram which is part of ttris appli- ~cation. c. The work covered by t/tiS application may not be commenced before issuance of Building Permit. d Upon approval of this applic~tipn the B~ilding Inspector will issued a Building Permit to the app~ct)nt. Such permit shall be kept on the premises availab<l.e ~dr mspectmn throughout the work. e. No building shall be occupi~d/~[,l~s.~,d ~ whole or in part for agy purpoffi"~i~atever until a Certific~ Occupancy shall have been granted by the Build~i~. ifis'b~t0~. .' APPLICATION IS HEREBY MAISE=i~'>'lh'e Building Department for the issuance of a ]Juilding P6~rnit pursuant to the Building Zone Ordinance of the Town ~f!~Sbuthold, 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 ?de, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature · , ~ ~ :~ ~,',:'~ ~ State whether applicant is owner, 1 tractor, electrician, plumber or builder. Name of owner of premise..s ....L.~.~i 1~..~.. :~.--~/~--~-~: t'~) / A? ~? ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .... ~..~..~. '?..~... :~..iT.-.... J~ ~. ~. ~...]. ~ ....... House[~g~Number .... g .... f ................ /, Street 'e~a'~za ~' ~gb'e'h~;;,;;'' '~Y'~ ')~'~ ...... County Tax Map No. 1000 Section ...... /.*[. · . ' Block . .~.~' ............. Lot ..... ~..~ .... Subdivision.. ~,~ ~ ~ ~.q~ ............. Filed Map No ............... Lot ............... (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,. ....... .............................. ,,a . .................. , ...... 3. Nature of work (check which applicable): New Building .. ' Addition ......... Alteration pal ........ Re r ....... ~ ...... Removal .............. Demolition ......... !. Other Work ~i~) 4. Estimate'd Cost ....~..~'.O.O. ................. ~ ......... Fee ........ ~ .......................... (to he paid on filiag this application) 5. If dwelling, number of dwelling units ............... Number of dwelling u~its on each floor ........ If garage number of cars ...... 6 If busine'ss .................... ~ ..................................... ' .... . ........ commercial or mixed occupancy specify nature and extent of each t~ype of use 7 Di i f itl g§t if y:F ' ' · mens ons o ex s n ructures, an ront.., ? .... : Rear ...... ~ ........ Depth .... I ' ': .... Height ............... Number of Stories ....... ,. . .......... ' ....... ensions o same structure with altera o ohs r ..... Rear ....... . .......... 8. Di ··mens I ....... H ions of entire new construction: Front ............... Rear ............. Depth ........... eight ............... Number of Stories .............. ; ........... ' ' ' 9 Si ofl F ........................... · ze ct: ront ........ Rear ........ Depth 10. Date of Purchase ....................... ............................. Name of Former Owner i ........................... 1 1. Zone or use district in which premises are situated ...................... ~ .......................... 12. D°espr°p°sedconstructionviolateanyzoninglaw, ordinance or regulation: ..~ ............................. 13. Will lot be regraded ........... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ............. i ..... Phone No ................ Name of Architect ........................... Address ............. ; ..... Phone No ................ Name of Contractor ......................... Address ............. ~ ..... Phone No ........... / .... 15.Is this property ideated within IO0 feet of a tidal Wetland? *YES .... NO.M.. *If yes, Southold Town'Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sh, }w street names and indicate whether interior or corner lot. APPROVED AS NOTED / ' I FOR POURED CONC~ ~ ' 2. ROUGH - FRAMIN{~ & I~JMBING , ' 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREiMENI8 OF THE N.Y. STATE CONSTRUCIION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF ........... S.S .......................................... being d,u)y sworn, deppses and says that he is the applicant (Name of individual signing contract) ....... · above named. He is the ............................................................ ~ ............................ (Contractor, agent, corporate officer, etc.) of said Owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this applicatio'n' are t'rue to the best of his knowledge and belief; and that the Work will be performed in the manner set forth in the application ill'ed therewith. I Sworn to before me this Not ry P~blic .... ~: ~ ~tl~ [~ t~ ..... ~m~h~l~ (S gnature ofapphc~t)