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Home My WebLink About19717-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/v~IT MUST BE KEPT ON THE PRE/~ISE$ UNTIL FULL COJV~PLETION OF THE WORK AUTHORIZED) Ne- 19717 Z Co-nm Tox Mop No. 7000 ~ct,on ......... ..~/... ....... mo~k ........... ./.. ...... L~ No ....... ~. ............ pursuont to opplicotion doted ....... .~..'~./~/.....;~., .................................. , 19.,~..., °nd opproved by the Building Inspector. Rev. 6/30/80 -"~1 lt~llll TOWN OF SOUTHOLD SURV.E,¥ ................... !1111 II~l / ?~J BUILDING DEPARTMENT CHr.-cK .................... ~J ~ ~---' [J~ TOWN HALL SEPTIC FORH .............. ~ SOUTHOLD, N.Y. 11971 ~~~ p TEL.: 765-1803 ~TI P?;. '-"~ .... ~ CALL~ ................. ~m~/~/~ ..... ,,~... / ~ ~, -- .-- .__.~ Z / ~,._ /~7. - ........... Approved ~ 7~ ~/ ,19 Pe~itNo Z~/Z~ [ fi/ ~- ---- .' 9¢ ............... _ _ ............. ~'~P'~W ~' '~ ......... .' '~'"' '~x: 'L.,...~ ~ ~ , .... ZZ~..Z.,..~./~..'TL .... ~...4 . / ~ . ..... INSTRUCTIONS a. Tins 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 appli- cation. c. The work covered by tins 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 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 Laws, Ordinances ar Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with aB applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insPections. ( ._ D Ch.....~..~.- ........... - (Signature of applicant, ornal~e, if a Corporation) .... .~.;~ ~-_./. ~,~.: z, .¢~.~..?,~.~./Lq .//~ v *~'(Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .~ .~:,?~?,~. ~. ~.~ .' H..<,-:,=..~:.-,-.,,~-,,'~-- ................................................ Name of owner of premises ...~. ~.(}...Q~.~Jm'l.,-¢14,~. ~, .~. .......................................... (as or,the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~ Zr/~7,~ ~ Location of land on wliich~roposed work will be ~one... ~ £'.~.~ ~ ~W..~ ................... ................... ..U../. .............. ......... House Number Stree~ Hamlet County Tax Map No. I000 Section C~ :~/ Block L> / Lot a. Existing use and occupancy .... b. Intended use and occupancy Subdivision ..................................... Filed Map No. ' Lot ............... (Name) " State existing use and occupancy of premises and intended use and occupancy of proposed construction: , 3. Alteration Repair .............. Removal .............. Demolition~~..~, Nature of work (check which applicable): New Building ......... .. ,A~_fliti~ ..... Other Work ............... 4. Estimated Cost .... .'~..'.~....-~.. ........................ Fee ..../?.-, .~.~. ............................ (to be paid on filing this application) 5. If dwelling, number 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. 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 ............................. 1 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 .,~-~', r.~ ....~ ...... x ............ Address ................... Phone No ................. of Contractor .t/./cZ...o~-~..ff'Zz~:~..~.'~. ..... Address ................... Phone No.. Name 15. Is this property within 300 fait 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. AP/I:'RII~/ED AS NOTED 765-~802 9 AM TO 4 PM~R THE FOLLOWING INSPECTIONS: ~. FOUNDATION ~0 REQUIRED FOR POURED CONCRETE 2 ~OUGH ~ FRAMING & PLUMBING 4 ~iNAL CONSTRUCTION MUST ~E COMPLETE FOR ALL CONSTRUCTION SHALL ME~ THE REOUIREMENTS OF THE N.~ STATE CONSTRUCTION & ENERGY NOT RESPONSIBLE FOR f~FS!G~ OR CONSTRUC~ON ERRORS STATE OF NEW YORK, COUNTY OF ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~Ie is the ......................................................................................... (Contractor, agent, corporate officer, etc.) )f 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. ;worn to before me this XELEN K DE YOE. N~ARY PUBLIC, State of ~ York ~, 4707878 Suffolk ~u~ a lmm Expires Much ~ 19 1~