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Home My WebLink About22349-ZFORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLETION OF THE WORK AUTHORIZED) NO 22349 Z Permission Is hereby granted to: / / , \ . . ...... ~.~ ....... · ~ '~~ ~'"~ ........ . , ............. : ...... :.....~ .................... ................. .... ~ ....... ~~ .... ~ ........................................................................................... Coun~ Tax Map No. 1000 S~flon ...... Z~ Block pursuant to application dated .......... ~ ..................................... 19.....~ and approv~ bythe Building Inspector. Fee~.../..~.~ i~uilding Inspector Rev, 6~30~80 Examined Approved o' ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ,,.~ · TEL.: 765-180:3 BOARD OF' HEALTH ......... 3 SETS OF PLANS ......... SURVEY CIIECK ................... SEPTIC FORH ............. CALL . · .' ..... HAIL TO: '"~ ' ~ ~ ~ ildino spector) ~~' C/~,/~.r/~~PklCAT'O~ FOR BUILDING PERMIT Date .................. ,19... ~O STRUCTIONS a. Tlfis application m~e completely filled in by Wpewfiter or in ink and submitted to the BuildMg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accoMing to schedule. b. Plot pl~ show~g location of lot and of buildMgs on premises, relationship to adjoining premises or pubic streets or areas, and givMg a det~led description of layout of property must be drawn on the diag~m which is paa of this appU- cation. ~. The work covered by tMs application may not be commenced before issuance of Bu~ding Permit. d. Upon approval of tMs application, the Building Inspector will issued a Bu~d~g Pc~it to the app~cant. Such pe~it sh~l be kept on the premises ava~able for Mspection throughout the work. ~. No bulldog shall be occupied or used in whole or in p~t for any purpose whatever unt~ a Ce~ificate of Occup~cy shall have be~n grated by ~e Bulldog Inspector. APPLICATION IS HEREBY MADE to thc BuildMg Dep~ment for the issuance of a B~Iding Pe~it pu~uant to ~c Building Zone Ordnance of the Town of Southold, Suffolk County, New York, ~d other appficable ~ws, OMM~ces or Regulations, for the construction of bufldMgs, additions or alterations, or for removal or demolition, as hereM described. The appficant agrees to comply with aU appQcable laws, ordinances, bu~d~g code,~ousi~ co~, a~d r~gulations, ~d to (Mailing address of applicant) State whether applicant is owner, .lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. of ow=r of premises ................................. (as on 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. /7/~..~.~.~'.<~-.~ .7-/,-~O. ..... Plumber's'License No...~.7-...,_,,5'-.Oc.&,~'.~'.~..~.L'? ..... Electrician's License No., .~..~.7-.., .~.. &-.A~.,.~.:.~.~.O..' BLDG. DEPT. TOVVN OF $OtJTFIO[ L" 1. Locati0n ofland'on which proposed work w ll be done ~~ ~/fi~ ~Z~ House Number , Street /---- - -- ~Hamlef -- U ~/¢ ........ ~ Filed Map No ................ Subdw~smn ..... ~ .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrFgt~n:~ b. Intended use and occupancy .. ' .............. 3. Nature of work (check which applicable): Nr~',,~ Building .......... Add,ilion .......... A?te~,atian .......... Repair .............. Removal ............. Demolition .. J.~J ......... Other WOrk ............... '7..[~,"~ "*.OO · · (Dcscr/ption) 4. Estimated Cost. ~ OOO ~ Fee .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units / Number of dwelling units on each floor. -- ...... · If garage, hum bet of cars ............ o'~ .'-7. ~(,Q,,~- ................................................... 6. If business, commercial or mixed occupancy, specify noture and extent of each type of use ..... 7 ........ ,, ...... 7. Dimensions of existing structures, if any; Front .... ./P.~'.'..5~./. · .. Rear . .~.]..]~.: 55..// .... Depth . .~.~./..~..// ..... Height .... ~.~'. ...... Num bet of Stories ............ 5/'~ff~.' ....................................... Dimensions of same structure with alterations or additions: Front -- Rear Depth -- Height ..... -- Number of Stories ..... ~ ................ 8. Dimensions of entire new construction: Front . .,.~..~...~...: . .. Rear ,..-~--P..... ....... Depth , .,~'.~5../.~.?/... . · Height .. ....... Number of Stories .................................................. 9. Size orlot: Front ....... ./(4.69. ( ......... Rear ........ ./.c~..47./. ........Depth ...... .~,~?~-?.~ ..... 10. Date of Purchase .~.-~F~.....~..R,~./¢'.~'.,~,.... ......... Name of Former Owner .... ,;~]'~d~.. ............. l 1. Zone or use district in which premises are situated ........ 2~.. 7.~..~.) ............ . ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... d/.? ...................... 13. Will lot be regraded ...... ,..4A'. ~. ............/. .....Will excess fill be removed from ,pLemises: Yes ~-~ 14. Name of Owner of premises~'l/~/¢:~.~./~/4,~ .//./F,:~/...>-:~Addres~, ,0/z~l~.&~.~.,.~',>]~.~'.~"/P~bfle No... ......... Name of Architect .. ~/./~2./~,,0/~_~ff¢7'~,,5. ........ Address~d,~/~.. ~;~ ~:'¢,./5/~Acl~r?W.~. Phone No,_S/:~. Name of Contractor . .,q-(O..TT..'~.~-~di;G. ,.'7-4f,_.O ...... Address .......... : ...... :. Phone No ................ 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 Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ,._.?rT/eL/ C TZ/R W 7,:9 ,OW '-ff ~__-.,P/W2/~.D ,,~'~.4./.L5 --7"-N ~i ,,'~ T<: ~ i've, r; ~!~ THE '~f -,)iGH- FR,AM~NG ,x F{~q,i~L CONSTRUCTION MUST gE CO~dPLETE FOR ,,ILL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N,Y. STATE CONSTRU~ION & ENERGY CODES. N~ RESPON~IS~ FOR OES~GN OR CONSTRU~ION ERRORS STATE OF NEW_..yORK, ~ ~, ..... //.-/.r~/57.A-7/. ~.r~..77--~L- ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~bove named. (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 am true to fi~e best of his knowledge and belief; and that the :ork will be performed in the manner set forth in the application filed therewith. worn to bcfore }ne this