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Home My WebLink About20511-Z FON,,M NO. · TOWN 01: 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) N-°No. 20511Z Permission is hereby granted to: /-~ ~ ~...~.~.....~./. ...................................... ~...~..~~.~ ....... ~ ........ ~~ ...................... ~ ~, ,r..~.e. ,~.,ed ~, ..¢~~~,.~...~...:......~ ............................. ~ ........... .................................................... ~~~ ......................................................................... County Tax Map No. 1000 Section ...... ..//..~.?. ........ Block ..... f....~... ......... Lot No ....................... application dated .... ./..~../..;.~.~.....: ................................. , 19~;;~./...., and approved by t~e Building Inspector. Rev. 6/30/80 : - 3 1991 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . (Building I~tor~ APPLIGATIO~ FO~ BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLA;tS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ....... FLAIL TO: Date , 19 INSTRUCTIONS a. This application must be completely filled in by typewriter orin 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by th_is 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 [~all 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 hall 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 3uilding 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. ?lie applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State ~vhcther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .../~flp,.c,, .~. ........................ '~ .................................... - ........................ " Xame of o,vner of premises . .~'. ¢,ff~.~.7~,.~...~..~t Y.< ... ' .. ~o-,-q r/.-.~...4'/*,~..~'.: ................... (a e t~ roil or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of coa~Orate officer) Builder's License No .......................... Plumber's License No ........ : ................ Elcctr c an s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................... llouse Number Street Hamlet Comity Tax Map No. 1000 Section .../.~..& ........... Block ...~. .............. Lot.;~l~..././~././i... 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 .~a~,~ /~,.~a.~:... ~':~ O~ ....................... "' :,:d ; : " '; ,~' 3 ''~ '~ ~,,~..i,1 ...... b. Intended use and occupancy ........................................ ~,~, .': ]..' .-,d .'..; ~ 91~%; O ......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ~c~,~ 2~-, ~.,-~-.-.. (Description) 4. Estimated Cost..~."o.o .............................. 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 ............................. 11. 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 ........................... Address ................... Phone No ................ Nan~e of Contractor .......................... Address ................... Phone No ......... ....... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Tru.stees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set~back dimensions from , properW lines. Give street and block number or description according to deed, and show street na~es and indicate whether interior or comer tot. rATE OF NL;E~YO~ ou,,crv 9 ...... .cz L3c.. .'.IC- " .-.%.. (Crr . . (N3me of individual signing contract) )ovc named. 765-1802 9 AM TO 4 PM FOR THE FOLLOWh~% !HSPECTIONS: "L FOUnDATiON TV40 REQUIRED FOP. ;~O~RED CONCRETE 2. RO[~LN · FR~M~H~ & PLUMBING 4, F~ ~:>,- CONSTRUCTION MUST r~ CO~PLETE FOR C.O, Ail CONSTRUCTION SHALL ME~ T~ REQUIREMENTS OF THE N.Y. S'~T~ CONSTRU~ION & ENERGY CODES. N[~ RESPONSIBLE FOR ~FF,!GN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant : is the ................... ' ' ' (Contract~'corporate~ officer, etc.) ......................... said owner or owners, and is duly authorized to peiform 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 )rk will be performed in the manner set forth in the application filed therewith. 'om to before me this N~a~i~or~8I~n~l~t~ ~ '[Signature of applicant)