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Home My WebLink About17875-Z lrOB,~ NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017875 Z Permission is hereby granted to: ,o ..~.....¥~..~...C.~::.~._~.~_', .................... i___,.'. ........... ~ ....................... et premises located at ...~.,~....~.........~..~..: ....... ~....~.....~'.....~~ ................. Block J ~. Lot No I ~ County Tax Map No. 1000 Section .... .(~..~,! .................................................... pursuant ,o application dated ..~~~¥.......'~-...~ .............. , 19..~..~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 AL k!AP SCALE ' 50'= ~': ~ = MO NUI,LENT 0 30' OF PROPERTY SLJRVF-YED SITUATE AT EAST MARION ,HO,-D, N..v. TOWN OF SOU VAIL 0 GL'A~..'.NTEED TO TIlE VALLEY OF NEW YOIZI4 · SUKVEYED · JUNE I~,1972 VAN TUYL ~: S,J~J N. 34'12'40"\V. - 198,3G . . AVENUE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL _ SOUTHOLD, N.Y. 11971 ,., TEL.: 765·1802 Examined ."~..~...~.'1., 19~.~. Approved .~'.'J.., 19~. Permit No..~ ."l.'~."}.~.~..'~.. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: --- INSTRUCTIONS m Tiffs application 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of th. is appli- cation. ¢. The work covered by th.is application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector ~vill 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 Cer-;ificate of Occupamcy 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 appIicable La~vs, 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 applicab~le laws, ordinances, building code, housing code, and regulations, and to adnai~t authorized inspectors on premises and in building for necessary inspec~j2's. ~ ,, ..... (Signature ot appilcant, or nafne, ii a corporanon) (Mailing address of applicant) State wt~ether.applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~..'Sr. ~. ~g'2~,?l (~¢/.'..,~:... ~.~'% . O....~.~. .... ./.~,'~_'~.~. ~ {ED If applicant is a corporation, signature of duly authorized officer. - -- -. 5 ~-' '~ i .:a 'cl ,; Pi'4 FOR ............................................. .' .-. 'r~ ~ ' (Name and title of corporate officer) = I ~-t: ~, ,,= <)~,~ two REQUI~ED foil POOFiEO CONCRETE Builder's License No .......................... 2 ~OUGH FRAMING & PLUMBING 3 INSULATION ~Plumber's License No ......................... 4 FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. Electrician's License No ....................... ALL CONSTRUCTION SHALl. MEET THE REQUIREMENTS OF THE N.Y. O£herTrade's License No ...................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSlBL~ FOR I. Location of land on wldch proposed work wili be done... ' ........ ;.. DESIGN OR CONSTRUCl~ON. EI~8os$... }louse Number ,' ..... i ' ' ' · .............. Hamlet ~ ' 'Sion ............................. Eiled Map No ............... Lot ............... (Name) ~-- ~te existing use and occupancy of premises and intended'use and occupancy of proposed construction: b. Intended use and occupancy .......................................... 3. Nature of work (check which applicable): New Building .......... Addition.,. ....... Alteration ......... Rep=ir .............. Rcmoi'al .............. Demolition ..... b:,/.. '.' .... Other Work .............. (Description) 4. Estimated Cost ...................................... Fee ..................................... (to be paid on filing this application) $. If dwelling, hum bet of dwelling units . r ............. Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6, If business, cmnmercial or mixed occupancy, specify nature and extent of each type of use ..................... 7, Dimensions of existing structures, if any: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... ' 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ --Name of Architect ........................... Address ................... Phone No ................ "-Name of Contractor .......................... Address ................... Phone No ............. ... IS.Is this property located within~O0 feet o£ a tidal wetland? :~YES .... NO .... *If yes, $outhold 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 show street names and indicate whether interior or corner lot. ' . ~gnar~re o'f a;plican t) *rk ~ill bc performed in tile manner set forth in the application filed therewith. /om i? before me this ..... ~.~ ........... day of ....... 19. rfp. . LINDA J. COOPER ~: ' - Nota~ Public, StYe of New Yo~ ~ No. ~22563, Surfak Coun~ ~/) Term ~ires O~em~ 31, 19 / ~ :T,\TE OF NEW YORK, _ ~~.~ . . ~...~ [ ~ ........... being duly sworn, deposes ~d says that he is thc applicant (N~c of individual signing contract) )ore named. , , isthe ; ~ '" (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly authorized to perform or have performed thc said work and to m~e and file this plicafion: Ihat ali statements contained in this application are true ~o the best of]ds knowledge and belief; and that the