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Home My WebLink About20047-Z I~OIt~ NO. · TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20047 Z ~0,o ~..~.. ........................................ , ,~./... _ -, ~._~ ~.,.~,.,.~ ~ ................ at pram',, I~at, a, ..~..~~~~....~...~ ................. ~~... L~.~.E ~ ~./ A~o~ ~'~ ...................... ~...~...~.~..~.~ .................... Z. ..................................................... ~,w ~,x ~,, ~o, ~ooo ~.o. ........ ~.~ ..... m~ ............ //... ~t No ......... ~ ........ pumuant to a~lication dat~ .....~.~ ................................... , 19..~ and app~ by ~e / Building Insp~tor. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. 11971 .; ~~.~r~.,~.~ ~. j . TEL.: 765-1802 E - , TO.~N~. ~.,~J: S O U TH O L D xamr, .a ' 'f",~7 ....... ~' Approved . .~.,,~. ......... 199//. Permit No....~...~..~.. Disapproved a/c .................................... : /' (Buil~,6o Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALI~H ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: Date ......... / .......... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 this application may not be cbmmenced 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 or Regulations, for the construction of buildings, additions or alterations, or for removal_or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances, building code/fi/using code,/nd~gulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~//~,, //j////// _/ .....J~~/~" /(~.,,,.'~'~ ,.~.,...,.... ,.., ...... ,,.r~.. (,-,t.,-'~.. ......... · ' ' . ..... . ..... I' '.Y' ' . -- (Signature of applicant, or name, if a corporanon) .I¢.Z. X&. ./FY (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ::. ~I'X.~./'~'. ~..~..~.//~..Y..'~....~.: 12/?..]'./.~/ ........................... ,~ ' (as on the t~x roll or latest deed) If applicant Is a corporahon, signature of duly authorized officer~ (Name and title o£ corporate officer) Builder's License No. Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No..: ................... Location of land on which proposed work will be done ......................... : ........................ ....4'.ff. . . 44.r. . ?. .<< 4 .,v'/. q . . .................................. House Number Street Hamlet County Tax Map No. 1000 Section /2'~ Block // Lot... '~ . Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of propo~d construction: a. Existing use and occupancy b. Intended use and occupancy .................................................................... · . - Addit'on ...... Alterati~n~ ~.: · ...... Repair , .... Removal .............. ' (L~eScrlptlon) 4. Estimated Cost /O"~ Co .......... Fee ..../--(. ~. ......... ~[ 1~' '~' '~' ''t ........ ............................ (to be paid on filing this applica ion) 5. If dwelling number ~cfard;elling un~$ .... ./ ..... Number of dwelhng a e number of ...................................... ' ...... If gar .g , . .............. ,, snecify nature and extent of each t_.y]?, of use 'i' '.','.~"t37/'/,5:'~'~ 6.' If bus]ness, com~nerc~at or m~xeu u~,--v,-.~,, ~ -'/,O~' ' Rear :~.~.° ~ l~eptn ~ ..... /..'".' ...... 7. Dimensions of existing structures, if any: Front. ·..~.: /. ........... ii ..... M~ioh~ ~ ' . . Number of StoNes . ·: ............................. Dimensions of same structure with alteranons or addmons: Fron .................' ........ Depth ...................... Height ...................... Number of Stories ...................... Din~ensions of entire new construction: Front ............... Rear . ' ........... *. Hei,,ht N~uml~er of Stories ........... '~'.-1 = ............. -' ' oo . r /~.. ........ L)ep .................... 9. Size of lot Front ... ~.y~.Z~,.. .......... Rea .. 10. Date of Purchase "'/'///'*/'ff'/' ................. gq£.5'ld~w/'./t~. .(- .......... . ..................... ........... ............... '>ii/' l 1. Zone or use district in which premises are situated · 12. Does proposed construction violate any zoning law, ordinance or regulation: ....." ..... Yes ,, ~ Will excess fill be removed from premises: 13. Will lot be re=raded .... d .... .;' ' '- .... ¥'2;;' 14. Name of Owner of premise~t'~.f- .~,/(~ .2'.~.g'q .4t..g~./..~g-ddress~'~w~);,~;' ~v'~'h~-~;,' ' ,,~.__~ ~r,,'" . ........ tect . Address .................. r,u,= .... Name of Arch~ ...................... ' ' ' ' Name of Contractor ......................... Address · · 15. Is this property within 300 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 tines. Give street and block number or descriptioi~ accOrdin~ to deed, and show street names and indicate whether interior or comer lot. 76B-'lfdO2 9 AM TO 4 PM FOR THE FOLLOWING ~NSPECTIONS: ~, FOONOATION ~O REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONSTRU~ON MUST BE COMPL~ FOR ~0. ALL CONS~ON 8~ ME~ THE REOUIR~E~ ST~ CONS~ON & ~GY CODES. N~ ~S~IB~ ~R DESIGN OR C~U~N ERR~S STATE OF NEW YORK, S.S 2OUNTY OF ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ]bore named. te is the ................... iContractor, 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 ............. ....... .... .......... NOT~ PUBLI~, ~e r~ Nevi I~o. 4707878, SM'folk County Term Expires M~rch 30, I~