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Home My WebLink About18401-Z lt*OIM NO, · TOWN OF SOU13'IOLD 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~ 18401 Z Date (~ ~ I .......... l ............................................ , i~. Permission is hereby granted to: , ., ~/,~ .~..o..~...~o~.~.......~..~._..../..~ ~....~...~..,..~..~,.....,...~.~.~. ,o ....... ..... ~ ....... .~.~......~~..~ ...... ~....../~~-~~.: .............. mt premi,s located a~' 't ......... , ~..'].,~.....~...,,~.......~,/~_~...~' .~..~.~.~.,..:..........~' ................. County Tax AAap No. 1000 Section .. ~... ' Block ........ ~ ......... Lot No.......~.?.. ............. pursuant to application dated ................................................ ..~-../~.. , 19~..~..,-- and approved by the Building Inspector. Fee $ ....... ./:~.. '~ Rev. 6~30/80 FORM NO. 1 TOWN Of $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL MAIL Examined...ffyZ .°~../ ....... , 19 .~.~. Approved ...... ~.~ ....... I ... Pe~it No ...... Disapproved a/c ..................................... ~[ C ~ ~1 ~ ~ ~ ~ ~ (Buildin~spector) ~O C ~ ~ "'~) ~ APPLICATION FOR BUILDING PERMIT - t INSTRUCTIONS TO: Date ................... 19.. a: Tiffs application must be completely filled in by typewriter 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 0fthis apPh cation. ¢. The work covered by tkis 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 permi 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 Occupanc) shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu/lding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buddings, ad~ditions or alterations, or for iemoval or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary inspections. · ~.~ .vtqor4..mtroi~r.~. ~ ._~..~. .......... f_Signature of applicant, or name, if a corpora/mn) esm~ ~ a~.~ ,~ .... .~%...c~. ~ ~?...~. ~ ....................... ' .... ....... ~ ~.~ .... ~ (Mailing address of applicant) State wheth=~. ~:i~j~/w'~er, lc,~a~e, agent, m:chitect, engineer, general contractor, electrician, plumber or builder. ............. . .C , . . ............................................. ...... Name of owner of pre,lites'.. ~ ~,~JO;.~ ~4(~-h}~l~-~.~.'.~. .~.../~. ~..~.~-,--, .................................... D~;tll~? ffi .~ ~" ~ ?~ - '*i~t C~:t (as on the tax roll or latest deed) Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work wi I be don, e ...... ' ' · House Number Street\, Hamlet County Tax Map No. 1000 Section .-7 Block Lot Subdivision ..................................... Fxiled Map No ............... Lot ............... (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.[ .~ 3. Nature of work (check which applicable): New Building ... ' ·. Addition Alteration .......... Repair .............. Removal .............. Demolition ...~. ........ :~/o~1~ .............. 4. Estimate'd Cost ,. ) t~ ,,.'~ (~ __ (DcscriptioT) .... / ....... ' .......................... Fee ..................................... (to be paid on filing this application) 5. If dwelling, nmnber of dwelling units ............... Number of dwelling units on each floor ....... ' If garage, number of cars ............................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .. ' 7. Dimensionsofexstingstructures if any' Front ~.%t o ta~ t ........... -. ...... ,, ,. ,. -' · ·, ............. ear . .:... ,.,a.. Denth 9'q ' nezgnr ............... Number of Stories .... ~..~. ..................... ' ' ' · , ..... o .......... Dimensions of same structure with alterations or additions: Front . ~'~ '. l~enr q ~ ~ Depth ~ c[ ............. Hei_~.t ............... 1 ............ ....... ~' ...................... Number of Stones .2, (-4~ ..... Dimensions of entire new construction: .............. 8. Front ............... Rear ............... Depth ............ Height ............... Number of Stories .............. : .................................. · · · 9. Size of lot: Front .......... Rear ...................... Depth ......... ' ...... 10. Date of Purchase ............ - ............ ............................. Name of Former Owner 1 1. Zone or use district in which premises are situated .......... ~.e,~.l.~.c~lt\~\ .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.~. 13. Will lot be regraded ............ ' ......................... ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises ./~./~.h. stt, c).~.<l .~ ........ Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ~n v r-sa~xe-~ar ...~.c5~,+ ...... Address ................... Phone No ........... 15.Is this property located vithln~lO0 feet of a tidal vetland? ~YE$ .... 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 comer lot. STATE OF NEW YORK, COUNTY OF ......... S.S 765-1802 9 AM TO 4 I~1 FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ~ I~OUIRED FOR POURED ~ 2. ROUGH. FRAMING · ~ 3. INSULATION 4. FINAL CONSTRUCTION ~ BE COMPLETE FOR CO. STAT CoNsmuc'n & !BMmGY CODES. NOT RE~IION~I~ FOR DEStGN OR CON~'RUCI'IOI ERROR~ ................................................. being duly sworn, deposes and says that he is (Name ofindividuai signing contract) above named. the applicant lie is t ~e ~ ---~ ' Contract_~or~ agent; corporate officer, etc.) of said owner or owners, and is duly au~igerform or~,bave performed the said work and to make and file this application: that all statements contained in this applicoation are true to the best of his knowledge and belief; and that the Work will be performed in the manner set forth in the application filed therewith. Sworn to before mc this