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Home My WebLink About18213-Z roast rra s 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) N 18 213 Z ate ....&~1..~' 19...1. Permission is hereby /grouted - yJ, , 1 ..alit to of premises located at .....,~.rP..w~.,7..'~........~~,/ ~t~.~T..~ . .........................................................................qq...................................................................................... County Tax Map No. 1000 Section .......!6..l.......... Block Lot No....,1 pursuant to application doted ........~p..,(...~ 19...~ond approved by the Building Inspector. 04 Fee $....~0... ~:y ...~f ~8uildi nspector Rev. 6/30/80 r,_ ~+°"t B0.1F.D OF HE.ILTH 3 SETS OF PL,1NS FORM NO. 1 E. ~ SURVEY ~ TOWN OFSOUTHOLD CHECK t! ` a i9~~ ''E BUILDING DEPARTMENT SEPTIC r• Dart . ~ tf~~ ~ J~ TOWN HALL ~ ~;,z BLDG. ? SOUTHOLD, N.Y. 11971 NOTIFY y3~ _ 7~6 ~ r~°°"~~- TOVvn' OF Su•~+~u.-e~~~; TEL.: 7G5-1802 CALL / . 19.Q.~ MAIL T0: C•xamincd . ~ • . • • • • Approved 6~~~ 19 .~crmit No..~li.°.~~3~ Disapproved a/c Y...1:!~!'~!. ~ui - g Inspector) APPLICATION FOR BUILDING PERMIT Date C/..O I5 INSTRUCTIONS a. Tltis 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 this appB- wtion. 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 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 Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE [o the Building Department for the issuance of a Building Fermi[ pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construe dditions or alterations, or for removal or demolition, as herein described. Tite applicant agrees to coi~ icab'le laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on rc ~~~il-or necessary inspections- j17 M (Signature oi' applicant, or name, if a corporation) x}311 Cl1N(! • „,A:!PiJa: I ~ ;(i,, (6lailing address of applicant) State whether applicplrRtt,~lL~S@C,a~^er~;}4{c~itect, engineer, general contractor, electrician, plumber or builder. Name of owner of prep~ll/ er ./.~U.~!Ei sI..~ . YIM ~ ~11TEMJ~ 3T~' ' (as on the tax roll or latest deed) If applicant is a corpor ~1y4i4thdiliad officer. ^O ~ ~ ~ ~ ~ ; / (Name and title of corporate officer) ~ n i~,0~ S O O Builder's License No . ? CJ,\ . /nom SnN~~ Plumber's License No . Electrician's License No . Outer Trade's License No . . 1, Location of land on which proposed work will be done. ~3, Z~ ~~-r.~.,~ y~ Clouse Number gqStreet. Hamlet County Tax\1apNo. IOOOSection ~.l•••••••••• Block Lot Subdivision Filed AfaP No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~p~,,, • • • • • • • - b. Intended use and occupancy r•`` • "rte" 3. A'ature oCwork (check which appiicable): New Building Additi rVteration Repair Removal , Demolition , Other lyork . (Description) 4. EstimatcdCost ......................................Fee..~,or,.3,,OQ...........,. ito be Paid on filing this application) S. If dtvclling, number of dwelling units Nttmbcc of dwelling units on each floor.............. . IC garage. num bcr of cars . . 6. If business, commercial or mixed occupancy, spcciCy nature and cstcnt oC each type oC use ~ ~ ..,....r...... 7, Dimensions of cxisung structures, tf any: Front , . ~0. , , Rear ?c'~........... Depth ,~O`,'........ . Height ...............NumberofStones.,..,................................................... Dimensions of same structure with alterations or additions; Front Rc Depth . IIcight ......................Number of Stories .~Z-......... , . 8. Dimensions of entire new construction: Front Rear Depth . Hcigltt ...............Numbcrof5torics..............:.,...............................•...... 9. Size of lot: Front Rear . cp h . 10. Date of Purchase - t-G Name of I'ormcr Owner ~ ...z~i./.~'~ S'~'/, , . 1 1. Zone or use district in ~vhicli premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Hill lot be re;raded ............................Will excess fill be removed from premises: Ycs No 14. Name of Owner of premises .Address Plronc No............... . Name of Architect ...........................Address ...................Phone No............... . Name of Contractor . .Address , ................Phone No.......... . IS.Is this property located wiChin~00 feet of a tidal wetland? *YES..,.NO.... *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 black number or description according to deed, and show street names and indicate whether interior or corner lot. or?TE:~~~~~r a/~~ t~w~i~~`i~" 765-180? 9 AM TO 4 PM FOR THE FOLLOWING tNSPECTiON3: - T. FOUNDATION TNApRE , FOR POU14Eb CONCRETE - 2. ROUGH - FRAMING a hdA1MNO 3. INSULATION 4. FINAL CONSTRUCT1pN NR1dT BE COMPLETE FOR C.O. ALL CONSTIRICTION l11M1 MEET THE REOtIMEIiAEfIT= Or 1qi Rir. STATE CON1sTR1,1MIpN CODES. NOf RiFl1/~~ It011 DESIGN OR CONSTIIIJC'f1pQ~M iL~TL• OF \E1V YORK, S.S :OUNTY OF . • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant - • . • . • • • .(Name of individual signing contract) hove named. , 'c is the (Contractor, agent, corporate officer, eicJ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in dtis application arc true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application Glcd thcnwiUt. worn to before me this r- ~taR' Public, ..?1.. E.1 ~ ,lJ~:-........ County ~i " " ,4 NOTARY M~1~~ Sta~ta of~Nnr YaM L` . • • • . ~ 1707B~8.SuRWkCoeNy Si;nature of applicant) Term Expires Merch 30,11 ~