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Home My WebLink About20048-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEP~IT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK ^U'I'HORIZED) Ne 20048 Z Pe~ission is hereby grgnted to: · ~.. ~...../...,......~~.,.. ....... ., ,,m,., ,~.,, .t .~.~..~~....~::~~2~:~ ............ ...................................... :~..~~ ......................................................................... C~nw Tex ~ap No. 1000 Section ....... ~ ......... Bilk ....... ~ ........... Lot No ...... ~,:...~... ,u...., ,o ~,,~,,o~ ~,~ ......... Building Insp~tor. Rev. 6~30/80 !!,.\ JUL 2 11991 Examined ~.~.~...~. ......... Approved . . '7/~.. ....... , / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ 19¢../ 19J~/Permit No..~'~_~..~....~~ Disapproved a/c ..................................... BOARD Of' HEALI'II ......... 3 SETS OF' PL.'t;JS .......... SURVEY ................... CIIEEK .................... SEF/IC F 0 R,'I .............. ,,0, IF'! CALL HAIL Date ......... '~ ......... 19... INSTRUCTIONS " a. This application must be completely filled in by typewriter orin 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 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 Ord:nance 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 ag applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in.building for necessary inspections. - . ,~ ~ ~,/~ (Signature of applicant, or name, if a corporation) · ........... ............................ ~ ,~ '~' 7 (Mailin= address of ~pplicant) State whether applicant zs owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .................................................................. (as on the ta?x 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 ......................... Electrlcmn s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. '.~."..~.:..~.../?.d.~.~.-'...~.."~..~../,~..~....~1..t~....~.~..~. ?..t~...~.q~.... ' ........... tl m Street Hamlet l, / County Tax Map No. 1000 Section ~.. Block ~ ~-~.. Lot ~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of propo,~ed construction: a. Existing Use and occupancy ..... ~...~..~.../.~..~-7 .~.. ', .';~. ~ .~'~....~...<~.~tY.,.f'J~O~ .......... 2'7 ......... b. Intended us: and occupancy .... ~..,~]'A~...,~....'~....~. ~ .~>./~ .~....~..~~.. .... 3. Nature of work (check which applicable): New Building .......... Adddl~ .......... tMteration .......... Repair .............. Removal .............. Demolition ~ ......... Other Work · .-...~...~...~. ~ (Descr/ption) 4. Estimated Cost ...................................... Fee ....................... (to be ~afd 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 ............... Nttm her of Stories ......... 'f'/~'~ '~'t~ ................... "~" ..... ~, ..... ' ..... " 9. Size of lot: Front ...~. ~:'.~..~_....~.~.~a:...~--~..... Rear .... .~..~? ...... ..~..~-..~'.. Depth . .q~..~..~J. .... ',---',---',---',---',~...~.../~'/ ..... 10. Date of Purchase .7.[./g'"/.~/ .................. Name of Former Owner,~..T"./.~/c~.~...~...-..~..~. ,~. ?..o. f'l/ .... 11. Zone or use district in wh{ch premises are'situated ./. ~. ' 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... , .............. 13. Will lot be re2raded /t/~ W" c .... ' .... : ..... .............................. 111 ex ess Illl oe removed from premises: Yes No 14. Name of Owner of premises ~.~../~. ?.~. (.~./~...7'.~.q£~. Addres~.~¢~.. ~'lT~-f~t/~.,.~. Phone No..~lg.-. ~t.~ Name of Architect .......................... '~ Addres~ Jf't~ ~ ~.5'.~..r'.-..~.)/... Phone No ................ Name of Contractor ......................... Address ...... {t~ .~;l~.. J.... Phone No ................ 15. Is this property within 300 feet of a tid 1 wetland? *Yes..'o ..... No ......... · If yes, Southold Town Trustees Peri,it may be required. PLOT )IAG RAM Locate clearly and distinctly all buildings, whether e>~sting or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description ~ccording to deed, and show street names and indicate whether interior or corner lot. ' APJ~OV, ED.A$ NOTED FEE: '?,,.~L~7:::;;~BY: ~'-/~ NO~ B~L~O DE~ AT 765-1802 9 AM ~ 4 PM FO8 ~E FOLLOWING INSPE~ONS: 1. FOUNDATION - ~ REQUIRED FOR POURED CONCR~E 2. ROUGH - FRAMING & ~UMBING 3. INSU~TION 4~ FINAL CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRUC~ON SHALL ME~ THE REQUIREMENTS OF THE N.~ STATE CONSTRU~ON & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CoNsTRu~ION ERRORS TATE OF NEW YORK, 70UNTY OF... S.S ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ ~ )-- ~ ~ )ore named. e,s the.. ....... ....... ~corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file-this 'plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in thc manner set forth in the application filed therewith. yom to before me this (Signature of applicant)