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Home My WebLink About19450-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PEPJv~IT MUST I~E KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N°- i 945C Z Permission is hereby gr,`nted to: ..... County Tox Mop No. I000 ~ctio,~.~.....L/.O. ......... Block ...... .1~..~. ....... Lot No....~...-~ ............ doted ..~.~...~..........'~.....~m.. ......... , 19.~...o..., ,,nd opproved by the pursuant to oppli¢otion Building Inspector. Rev. 6/30/80 'F.ORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY TEL,: 765-1803 CALL ................ ' MAIL TO: Examined, tr., Appr°ved 'C>' '~'' · · '~-'~' ' ' · · ] '~' ', 19 90' Permit N°' j' '~ · '~' '~''~' ' ''~' I/~[ ,~~~/ ~ i!L~' { ~' ,'. ~PLICATION FOR BUILDING PER~IT ............... Y./. INSTRUCTIONS ~ ~' /~, /qfO a. T~s application must be completely filled in by ~pewfiter or in ink and submitted to the Bulldog Ih ith 3 sets of plans, accurate plot plan to scale. Fee acco~ing to schedule. b. Plot pl~ show~g location of lot and of bulldogs on premises, relationship to adjo~g premises or pubic ~tmets 9r ~eas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of t~ appli- cation. c. The work covered by t~s application may not be commenced before issu~ce of Bufld~g Permit. d. Upon approval of this application, the Building Inspector will issued a Bulldog Pemit to the app~c~t. Such pemit sh~ be kept on the premises available for ~spection ~roughout the work. e. No bu~d~g shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Bulldog Depmment for the issu~ce of a B~lding Pemit pu~uant to the Building Zone Ordin~ce of the Town of Southold, Suffolk County, New York, ~d other applicable ~ws, Ord~ce~ or Regulations, for the construction of bufld~gs, additions or alterations, or for removal or demolihon, as here~ deschbed. The applicant agrees to comply with all apphcable laws, ordinances, bufld~g code, hous~g code, and reg~atiom, ~d to admit authohzed ~specto~ on premises ~d ~ bulldog for necessa~ inspections.~ ......... J ......... (Sign~e~t of applicant, or name, if a corporation) ....... .... (Mailing address of applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nm'ne of owner ofpremmes ............ ~.. r.- ........ - ................... ~'' ',~**~h',, l~It~:tt ......... w (as on the t~ll~r latest dee~ff If applicant is a comoration signature of dui- authorized officer ffP~ DATE: -. , s y ~ ~ - ~ J/~ ~ ~ FEE: ~ ~' ~ BY: Mr ~h~L- ...... ................................... ~ N~IFY BUILDING DEPARTMENT AT (Name and title ofco~orate officer) · ~ 765-1802 9 AM TO 4 PM FOR THE ALL C0~TRACTOR~S HUST BE SUFFOLK COUNTY LICENSED [OLLOWINGIN$PECTIONS: Builder's License No ......... '.'. ............... ' 1. FOUNDATION ~O REQUIRED FOR POURED CONCR~E ' Plumber's License No ......................... 2. ROUGH - FRAMING & PLUMBING 3. INSU~TION Electrician's License No ....................... 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O Other Trade's License No ........ ; ............. " ALL ~NSTRUCTION ~A~ ME~ ~ THE REQUIREMENTS OF THE N.Y. 1. Location of land on which proposed work will be done~ ff~/~ ~,.~~1~ &~ENERGY ........ ~ ....... ~'~E$,' ' R~' ' RESPONSIBEE ' F~ ' ' ' . /&f~,e~ PZ - i~ OR CONSTRU~ION ERRORS ................................................ jr. ................. : ...... - ....... House Number Street Hamlet County Tax Map No. 1000 Section ]/E ~ Z ~ ~ck Subdivision .................. ................ Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~'~ '~ b. Intended occupancy . f~fl .. . f .......... ;/ ..... ;~. · .... and 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .. ......... Repair .............. Removal .............. Demolition .............. Other Work ~.L~.~'.i.~.. 7';. (Descri¢Slio~) 4. Estimated Cost ......... .............................~-r'r' Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ....... Number of dwelling units on each floor..~J ~.. ¢ ...... If garage, number of c~s ....... ~L/: ~.' ........................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...ff:~. ~ ....... Rear .............. Depth ............... Height ............... Number of Stones ........................................................ D~ensions of same structure with alterations or additions: Front ~' ~t'. ' Rear Depth ...................... HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .......... · ..... Rear ............... Depth ............... Height . .. 4~.~ ......... Number of Stories ..... ~ .................................................. 9. Size of lot: Front .. ~.~ .~'). 7... Rear ...................... Depth ....................... .. Name of Foyer Owner ,~. ~ .-..&?~X ~.c~...~ ..... 10. Date of Purchase .... I 1. Zone or use district in which premises are situated .......... l~..~': .................................... 1 2. Does proposed construction violate vny z$n2~g !aw, ordinance or regulation: . .l~ .......................... 13. ~ill lot be regraded ...... ~J~..~ ..... Will excess fill be removed from premmes: ~ No 14. N~e of Owner of prem~ses~d~.~ ~,~Z</~,~w... Addres~.~.~. ~ ~ ~hone No.2 ~. ~.~. ).,. Nme of Architect .......... 2, .~ ............. Address .................. '. Phone No ................ N~e of Contractor .. ~¢~/~) JO. l ............. Address .~'/,,r,~.~. ~.'~ ...... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes .~'~- No ..... ~If yes, Sou~hold To~ Trustees Pemit maybe reouired. PLOT DIAG~M Locate cle~ly ~d distinctly ~1 buddings, whether existing or proposed, and indicate ~1 set-back d~ensions from' vrope~y ~nes. Give street ~d block number or description accordMg to deed, ~d show street names and indicate whether mtehor or corner lot. STATE OF NEW YORK, S.S CO U Nq'Y OF .................. · -~/t ~,~ ~Oi ~4'~ &-~..------ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) !te is the ~(_~¢,-¥--~ ~- ............. ' ........ (Contractor, agent, corporate officer, etc.) Jf said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this _pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ,york will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. or.. .......... , .............. (,'/~. · ..... County - Iltt£14 IL 0t ~0E ' '7 ......................... (Signature of applicant) NOTA~ PUBLIC, $tat~,01 ~ 4707878, Suffo,k County Term ,Exp~ce$ M&.'ch 30,19---,.&/