The URL can be used to link to this page

Home My WebLink About22458-ZFORM TO~M OF $OUTHOLD BUILDING DEPA~RTMENT TOWN HALL $OUTHO!.D, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N£ 22458 Z CounIyTox Mop No. 1000 Section ........ ../'~....~., ........ Block ......... ~, ........... Lot No. .~...... ................... pursuant to application dated .........,~...'.~,,,~.~ ................. 1 9,, ,~,,..~..'...., and approved bythe Building Insp~_ r. Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTM.ENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PL,XNS ......... SURVEY .................. ClIr'CK ................... SEPTIC F 0 RI'I ............. Approved ........ · Disapproved a/c ........................ . ........... ' ................. - ~PP/LICATION FOR BUILDING PERMIT .... / Date ...O.c.t.o.b..e.r..3.1 ..... 19 ?.4 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 5ets 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 commenced before issuance of Building Permik 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 cod*~,~housing code, and regulations, and to admit authorized inspectors on-premises and in building for necessary inspectio~ ~' - - (Sig(nature of applicant, or name, if a corporation) Garrett A. Strang, Architect . yg.i.rl..Rgp.~,.. {~...O.,1~ 9 ~..1.4 ] 2..5. Qu.tkQl d. NY.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Architect Nameofownerofpremises David De Friest ........................... (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 .... N.o..t..S.c. 1. e..c.t.e.d.., y.e.t... Plumber's License No ......... ................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. Main Road Southold 51320 .......................................................... HouseNumber Street Hamlet County Tax Map No. 1000 Section .... 7.0 ............ Block ...... O;~ .......... Lot .... p.4. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .. $ J-/q.gl, e. F.qmil ¥..Res£.dence..v~ith. Acce~.~Qry. ,G,Q r ag.e. ............ b. Intended use and occupancy . . .S .i.n.g 1. ~. [:.qm i J- ¥..R e $ £.d.e n ¢ e ....................................... 3. Nature of work (check which applicable): New BuUaing .......... Addition .......... Alteration ......... Repair ....... ~ ...... Removal ...X.X.X,X. ....... Demolition .............. Other Work .............. .... (Description) 4. Estimated Cost 5,000.00 .$ 51.00 (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 ........ .2~ .............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ...... 3.0. ....... Rear ..... 3.0. ....... Depth .... 2.2. ......... Height ..... ] Z' ........ Number of Stories ......... 1 ~ ............................................. Dimensions of same structure with alterations or additions: Front ....... 9 ......... Rear .... 9 ............. Depth ......... 0 ............ Height ......... .0. ........... Number of Stories. , 0 , 8. Dimensi~t~newconstruction: Front ............... Rear .............. 'I~i;t~l'i.iiiiiiiiiii'.i Height ............... Number of Stories ........................................................ 9. Size of lot: Front 80 . .. Rear 80 255 .... ...................... Depth .................. 10. Date of Purchase iiiiiii.~71(iiiiii.i .... Name of Former Owner ...H.e.n.r.y..F.i.s.h..e.r ............. 11. Zone or use district in which premises are situated .... R..O...R.e.~ .i.d.e.n.~. ~9.1' .O. ,f f.i,qe. ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~19 ..................... 13. Will lot be regraded ..... N.o.... ................. Will excess fill be removed from premises: N/AYes No 14. Name of Owner of premises ~.q¥~..d..~.q~..F.r.~q~.t;.. Address .. ,$9.uAh. 9.1.d. fi.Y:... Phone No. 7.~.5..':'~10,5.0. ..... Name of Architect .G. qr..r 9.t.t..A.:..$.~.r. 9p.g' ..... Address .$. 9.u,~.h. 9}.d. .N.Y.: .... Phone No..7.6.5. T .5.4.5.5. ..... Name of Contractor .. Not ~q~.l~.cti~0 .Y.q~ ............ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No..X.~ .... *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. See Attached!!! APPi~O¥£O AS-NOTED ,85-1802 9 AM TO FOLLOW~¥G t~gP~CTIONS: ALL COi~ISTRUCFiON SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY CO,KS. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRS8 ;TATE OF NEW YORK, :OUNTY OF..surf.q1 k ....... S.S ...... G.q.r .r.e.~.~...A....S, ~..r 9p.~t ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. Archite~t - Agent is the ......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi]e this pplication; that all statements contained in this application are tru,, to the best of his knowledge and belief; and that the 'ork will be performed in the manne~r~,t forth in the application filed therewith. worn to before me this / / .......... · ...... ....... NOTARY PUDL,~C, §ta.~e..oJ~.y ' (Signature o'l applicant) No, 47250S?, Term Expire~ May 31,