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Home My WebLink About18790-ZTOWN 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) NO. 18790 Z ~,..~~....!...'/:.. ............ , ;,..t...~ Permission is hereby granted to:_ / . ~ , ~..~..~....:.~....~...~ ............... · ..~.~~.....~.:.'1.........!..!...~.~.~'.. ........ , .~.......!~ ............. ~.C'...P..~~...~..~....~ ........ at premises located at ...~...~....~....~'....~...........~...~.......~.... ........... ~~.....~t%R~.-.~ ....................... ....C..~.~.~........~...~:.~~~........~..~. .......... ~~.~ ............................. County Tax Map No. 1000 Section ...... .0..~...~. ........ Block ....... ..~.Le. ....... Lot No....~....'] ................ pursuant to application dated ....~..~...~.~ ................. , 19..~..~.., Building Inspector. and approved by the 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 FORH ................ D~saiT°ve~a~c ......... i'i .................... ........... (BLiild[ng Inspector) , APPLICATION FOR BUILDING PERMIT Date ..,19..- INSTRUCTIONS a. 'riffs application must be completely filled in by typewriter or in ink and submitted to the Building l~pector, with $ 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 i~ pan of tkis appLi- cation. e. 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 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 agy purpose whatever until a Certificate of Occupancy 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 applicable Law~. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, a~ herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessary inspections. .~v..~. ~..o ..~. q :..~.~.~..5.~..~.,, .f/?..~:~ +.& (Signature o/' applicant, or name, if a corporauon) ~- ~ (Mailing address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ame ofo,vner ofprem,s, ................................... (as on the tax roll or latest deed~ - ..... ' OAT : / (Name ;~nd' title of corporate officer) NOTIFY' BUILOING DFP~RTMENT Al -- 765-1802 9 AM TO a PM FO~ THE :Builder's License No FOLLOWING INSPECTION% 1. I:OUNDATtON TWO REQUIRED Plumber's License No ' FOR POURED CONCRETE 2, ROUGH- FRAMING & PLUMBING Electrician's License No :3 INSULATION 4~ FINAL CONSTRUCTION MUST Other Trade's License No ' 8E COMt~LETE FOR C e ALL CONSTRUCTION SHALL MEET I, Location of land on which proposed work will bc done: ~.~,~d 4'r~.~QUIREMENTS OF THE N.Y... ........ .. ¢ ~,r~.~ .or ty T ' Coun ax Map No. I000 Section ............. Block ................ Lot .... t ......., Subdivision Eiled Map No Lot ' (Name) '~ S[atc c-xlMlng use and occup~lncy of prem~scs and mtcndcd. ~lse and Occnpancy of proposed~ constructinn; o n~ Occupancy .......... t- · * *~ .............................. 3. Nature of work (check which applicable.): N~Building .......... Additian ..... i ..... Allcration ./~/~./.t/,/~ . Repair .............. Rl~moval · · ~'~ .......... Dcmolition .......... S~i=ia .poet ............ .... ~ ~ Tennis Court ......... Accessory Buiidlng .......... Fence .... Other ~ork~ ........... 4. Estimated Cost ...................................... Fee .[~ ........................ ~' ' '1 ' ' ' (to be paid on filing this appE~_:.~' n~ 5. If dwelling. ~umber 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. Dimensiogs of existing ~mctures, if any: Front.. ~ ~..~ ..... Rear ~. ~ .... Depth .~ ......... ~i Heieht ~ff~.. f/ .... Number of Stories ...... / ............................................... Dimension~ of*amc structure with alterationa ~r addition~: Front ... ~. ~ ...... Rear .. ~ .... ; Depth ..... (~ jt .......... Heist . .~ ./J. ~ .... '. Number of Stories ................~ ~ 8 Dimensions of entire new con~tmction: Front ~ Rear ~ Depth ........ Hc~l~t ............... Number o[ Stones ............................ ~ 9. Size of lot: Front .. ~.~q~X. H~ ....... Rear .... .~ .~.. ~ ........ Depth ~.. [.7~ ~. ~ .... ~0. Date of Purchase ............................. Name of Fo~er Owner [~,..~. ~ ~e~ .O~.~ ~ 1. Zane or use district in which premises are situated ........................... ~ ........................ V2. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~. ~ ............. ~ ....... · · 13~ W~i lot be regraded ...... ~ .......... Will excess fill be remgved~rom premises: Y s ...~N~... 14. Nme of Owner of premises ~: ~.. ~. C~ddress. ~ ~. ~l~4°~°ne No.. 7~ ~. -~ .... N~ne of Architect Address Phone No Nmme of Contractor ............... ' ' IS.I~ this property lo~at~d ~ithln I O~'Addressfeer of ................... a tiaal ~etland~Ph°ne~gS---;~O-~'N° .....,, ..... ~:- , ~ ~If 7es~ Southold Io~n Iru~tees Per,it may bo required. PLOT DIAG~M Locate cle~ly ~d dist~ctly ~1 bu~d~, whether existing or proposed, ~d. indicate ~1 set-back ~ensions from prope~y ~ne~. Give *treet ~d block number or deschption accord~g to deed, ~d show street nines and ~dimte whether interior or comer lot. /lcc t c- 5 a 7 -\ STATE OF NEW YORK, S.S COUNTY QF ............. .-.~. (Name of individual signing contract) above nar~ed. ~ is the ' - (contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or bare performed the said work and to mal;e and file this application: that alt statements contained in this application are true to the best of his knowledge and ~cf; and that the Work will be perfo~aed in the m~ner scl forth in the application ~lcd therewith. ' Sworn to before me this ,./ ......... -: ............. day of...~b~ 9~J~-.~ ........ 19. ~ JANE R MINERVA ,r~ /) D . .. NOTARY PUBLIC St~teofNewYork ~x~ZU [~- [ /a4U-~ ~ ' ................ NO 48531(J~, Suffolk County ,~ /-~' "- ' "'~ (Sig~m~e of applic~t) Commission Expires February Z~, 1~~ / / , ,£