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Home My WebLink About17694-Z lrO~ NO. ~ TOWN 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) 017694 Z County Tax Map No. 1000 Section .... ~...."~.... ...... Block ........... ~ .... Lot No ....... Z ............ pursuant to application dated .... ./~,/./.....~:~... .............................. , 19 ..~..., and approved by the Building Inspector. Rev. 6~30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... Disapproved a/c ..................................... ,..,, _ ~ ~ · ..............................................~,~...._ .~,..7~:' ~J'~'~ APPLICATION FOR BUILDING PERMIT Date .. INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, ~ith ~ 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 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 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 a0y purpose whatever until a Certificate of Occupanc) shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance o£ 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, ad. ditions 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 nre_nlises and in building for necessary inspections.~. - · °'""'" ,, - ,~ ...... ": ....... ~'r~ o~ apda .............. .......... -- . (Signat nt, or name. if a corporation) r~. ?~..lh~v%,a'-: ', ......... · ~I ~* k~n ~ ': *.~ ,'' ~(Mailing address of applicant) State whs~i~i~t is o~i~tl~see, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .~. ~,;.,.~,,,~.~.~,'.?:~. r ............................................................. Xame or ~. ~,,.~<. ).'Sx..~.vh~..4... 5....$..o.~ .~j .~ .x ........................................ O.:) ~¢'1 3~ t ~c)') ,~ (as on%/he tax roll or latest deed) applica''~'~ '~aa~t%~':l~l_~ laOg~l;;'~O:) ~ '~ If ~t~~l~' diuly authorized officer. ....... .'tO~l~ ~ ~Wi~r'a~rm~o3 Builder's License No .... I..~.? I. ~.~ .... b.~..-~.· .... Plumber's License No ......................... Elcctrician'sLicenseNo......~-g~,-,. . .... ~$Sl~..t ,... Other Trade's License No ...................... ocat,on of land on which proposed work will be done. q. .S.'.S: .S.... R &... 5o..o.% Z... House Number St reef\ Hainlet $~' " .& .-2 County Tax Map No. I000 Section Bl~ck Lot. Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) \' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~c ..... ~ ....... ~. .~. ~ ~Q~ ...... b. Intended use and occupancy ..... ~e~t... V~.,~... ~ g.S ~.~gP ~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alte, ra~n .......... Repair .............. Removal .............. Demolition .~.X.5(.'~",... O~he~ ~o~..'...' ....... (Description) 4. Estimate'd Cost ................................ ee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .] ............. Number of dwelling units on eacb floor ................ If gara"e,~ number of cars ...... , .............................................................. 6. if business, commercial or mixed occupancy, specifE nature and extent of each type °f use ........... 7. Dimensions of existin~structurcs, if any: Front...q,~ .O,.. ~,~ O.. Rear . .2.'0.. · .~. · .'~. · - Depth . Heinht . ~.~.....-...c~... ·~. · · Number of Stories ..... ~ .... .~ .......................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Ileight Number of Stories ..................... . 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... ...... , .1. . i-. .7. 91 ........ HeigLit .......... ~...,Number of Stores ...... ; ........................ J ........ :, ....... 9. Size of lot: Front ... ~c],. .............. Re.~ 2[ O c~ .... Depth 10. Date of Purchase ..... $'l Ih./.~ .'~.'7 ........ '' ~a~e ;~'~o'r~e'r Owner ...~z'~.l[t'$ .................. 1 1. Zone or use district in which premises are situated ..................................................... 12. ,D,,o, es proposed construction violate any zoning law, ordinance or regulation: ............................... V, ill lot be regraded .... ~' .................... Will excess fill be remove0 from ~,.,rl~is~,¥ ~ Yes No'x_ 13. Name of Owner of premises }'~.i fc}X~.~ ~ ~. ~-c"/i~ J Address ~.D. -o) ~ .~ ^,.9. ~5, Phofie No.'~'t X Name of Architect . .~'q~. e,..~.~.t.hC..~, .~ ..... .~... Address . .S,2~ .,.~...L/~ ....... Phone No. S.t.%: Name of Contractor~C.ce~- *. 1 .~ Jq ~ .k~.qv.&. W~ .<0. 0.,fi. Address . ,~ ~.. · · ~.-.~ ........ Phone No. ~Sf~, 15.Is this property located uithin3OO feet of a tidal *,*etland? *YES .... · If yes $outhold To~n Trustees Permit may be required. · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property Lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. FOLLOWING INSPECTIONS: I. FOUNDATION FOF~ POUND CQI~CIIITE 2. I~H - F~AMIN~ & PMJMIIN~ 3. INSULATION 4. FINAL CONSlllUCTION MU~T BE COMPLt: fie ~ ALJ. ~ IHN. L MJtrt COOE$. ~ ~ POll DESIGN OR CON~FRU~i~01I STATE OF NEW YORK, S.S COUNTY OF/q,// ............... ........ .~..~ ./~ ~. : .................. being duly sworn, deposes and says that he is the applicant (Name ~findividual si~nin~, contract) above named. Itc is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this appIication; that all state~nents contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fortLi in the application filed therewith. Sworn to before mc this ............ ./.¢ ......... day of ..... ~ * *~* ............ i9*~*- HEL~ K. D£ VOE NOTARY PUBLIC, State ot NO. 4707878, Term ~xpires Msrch (Signature of applicant)