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Home My WebLink About20690-Z I~O~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~No. 20690Z Permission is hereby granted to: ...............,....'....~.... ~?/....~ ...... : ......... ~Z~.7 ...................... Coun~ Tax ~op ~o. ,000 Sect~o~ ..... ~.. ........... ~loc~ .... ~...~.... ...... ~ot No ........ /..~...:.L .... Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD r~ ~ JUN - 3 t::~i~ BUILDING DEPARTMENT ' i,,!~ TOWN HALL ~ ~ ...... :..,! SOUTHOLD, N.Y. 11971 TO~ b ' : : , : TEL.: 765-1802 ' Approved ........... 19 Permit No. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVE,Y ................... CIIECK .................... SEPTIC FO[tH .............. r:~: ....... MAIL TO: Date .x~'.O. ~6....~ ...... ,197~=' INSTRUCTIONS a. This 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 ox, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. e. The work covered by this 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 or Regulations, for the construction of bui/dings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) (Mailing address of applic/ant) bt · (Name and title of corporate officer) Builder's License No ...... ! ~. . q.q.q . li. ..... Plumber's License No ....... ~7/'~. ............. Electriqian's License No ..... ~.[./~. ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ..... Name of owner of premises ... JO.l~--~...D~.~ti~.,,~.~2~l.~. ................ .~?.P,R.0.~.D..~.~.~..0T~..D. ...... (as on the tax roll or latest ~' (a/~/~ RE ~ ~GqO& If applicant is a corporation, signature of duly authorized~ officer. FEE.' ./~ ~ BY:' ~'.~' N~I~ BUIWlNG DEP~MENT AT 765-1~2 9 AM ~ 4 PM FOR ~E FOLLOWING INSPE~IONS: ~. EOUNDATION ~0 REQUIRED FO~ POURED CONCR~E 2 ROUGH - FRAMING & PLUMBING ~ ~ ~ ~ O~,TRUCTION MUST Bf: ('O~; ETE FOR C.O. ,;z~ CC.,,~,~ RU('rON SHALL MEET Other Trade's License No ................. ' :?,~ m~¢ i~x,NTS OF 'file N,Y " , ,,,~ & ENERGY 1. Location of land on which proposed work will be done ............................................. :,~*~'*~-,.~ ~t:f~:~ ..... ....... ............ .................. House Number Street Hamlet County Tax MapNo. 1000Section ...~.Z~7.~.... Block ......... ~ ...... Lot .... [.~:[ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use anti occupancy of proposed construction: a. Existing use and occupancy ..... ~(...~...~(~ ................................... b. Intended use ana occupancy ....................... '"'~¢ ~''' ?:" ~'; ~i~' '¢ ........................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .. ~:. .......... Other Work ............... redo tw/~ _~ (Description) 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 ...~-.ffv ........ Height ... b~ 'f ......... Nu .4;~.. mber of Stories' . t ............ Dimensions of same structur~ with alterations or additions: Front . iiii i~. i~i !i i i i i i 'l~'~r' ii i~i~.' i~. iiiiiiiiii Depth ..... ~.t. ............. Height ..... ~.~r.~ ............. 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 ..... >0..t~.-~.r~.~;¢ ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... AdO. ......... 13. Will lot be regraded .. ~..O. ...................... Will excess fill be removed from premises: .... ~'~d ' '~5~I~ 14. Name of Owner of premises~d~' .f~...~. 4t~.~..~.... Address ?~-..f~taf~....L~.~. ? .... Phone No. ~J.-. ~/.~'..4 ..... ec ........................... Address . .~o.a.~...d. eT.F~.e~.~.¢:~... Phone No ................ Name of Contractorx)Otha. ~.Wt~4c .~/e. da:l~..,m,,~c. Address ~.5~'~ .~PS~IO~...~. Phone No.7'~,~.~./.g-~.~. ..... Is th±s property with±n 300 feet of a t±dal wetland? eyes .... ir... No ......... ~I_f yes, Southold Town Trustees Perra±t may be requ±red. 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. 15. STATE OF NEW ~'ORK, . COUNTY OF..~l:td~.,~--O..1o~..... S.S ....... UO.~t. .k4..t~lS~-J~.. eq// ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~bove named. le 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 Z