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Home My WebLink About22626-ZFORM NO.$ TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORJZEDI N? 22G2G Z Permission is hereby granted to: P.O. Box 41 ~attituck, N.Y. 11952 to .......... P~P.L. ~.S. ~.. ,..~ ..~ .X. ~.S. ~.Z. ~.~...0.~ ..~,.~...;..L.~..~ ,L..L..T~.~...aa.aeeb~a, ~Oa ~,, ~ .S,~ .................. ACCESSORY SRI~.D. at premises ocated at !.5..5. ~K.I..D...~........S~?. ............................... .G...~..[..~...o.~.T~...N..,X ........ County Tax Map No. 1000 Section ......... 3.4 ............ Block.....03 .................LotNo. -45 ...................... pursuant to application dated ......... .~..a..r..c..h.... !.~; ~. .............................. 19.....~.,5. ....... and approved by the Building Inspector. F~ ~ 55.20 This replaces BP ~20666Z Rev. 6/30/80 MAR: 4B m ?LOG. DEPT. ':_' '__? "~' ..... OF _OL OLD FORM NO. 1 TOWN OF SOUTHOLD W...t ~ .L, ,W TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH ........ 3 SETS OF PLANS ........ SURVEY ................. CIIECK .................. SEPTIC FORH ............ CALL ........ , ....... HAIL TO: Disapproved' a/c ..................................... // · (Buildino InspectS) PPLICATION FOR BUILDING PERMIT Date... · INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with. 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 st?Bet or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appk cation. c. 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 penni shall be kept on the premises available for inspection throughout the work. e. No building shall b..~ occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc: shall have been granted bY tt, e Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal c~temolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building!code, jaous~flg code, and regulations, and t( admit authorized inspectors on premises and in building for necessary i~st~eti~s. ~ ..,/~ ' . __ .(q~ ,~ ~,~l~(~ignalure of a~6plicant, or thame, if a corporation) i (Z,7' 9 ' r- , -' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. .... .......... .' .............. .: .................. . ........................... Name of owner orpremises ... b/~.V.[.I.). J).l~.~./J.l~ ~ VA e ROVED AS N*OT*ED (as on the tax roll or latest d ~ , .~ If applicant is a corporation, signature of duly authorized officer.· DATE: ,_'~/I,5/q~ la,P.# ~ (Name and title of corporate officer) Builder's License No ..... .~ ?..$~..~.~. ' Plumber's License No ......................... Electrician's License No ....................... FEE.'~ ~qS, ~/')I]¥:OEP~.~RTMENT AT' NO;~IFY BUILDING 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - T1NO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULAllON 4, FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O,, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF 11'1E N.Y. Other Trade's License No ...................... .... ' $ :AT -~#8 & GY House Number Street Hamlet Subdivision Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constructioni a. Existing use and occupancy ...~.. (~(~.../~,k C4(.c.. ~ ' . ...................... b. Intended use and occupancy ....... ~. ~-'2 .~/.LQ (~:~. ( / 0 f.~. ................ ..................... i · 3.Nature of work (check which applicable): New Building .......... Addition .......... Altera..tion ~_ ~.. Repair .............. Removal .............. Demolition .... : ......... Other Work J.)/~L~¢.tv. t.'/./.a..&/... (Description) 4. EstimatedCost...~.O..O.<)... . ... Fee..~.J-.~..~.. (to be paid on filing this application) 5. If dwelling, number of dwelling units ., .dP..~( ~. ...... . Number of dwelling units on each floor... ~ ~ ~tc~..: ..... . If garage, number of cars ........................................................................ 6. If business, commercial or mixed, occupancy, specify nature/and extent of.each ty~pe of use ....... '~v. 7. Dimensions of existing structures, if any: Front... ~I~..., ...... Rear ... jt.~ ........ Depth. ii Height ...... [.~. ~. ...... Number of Stories ...... 0 p:.[.l~ ........ ' .... ' ............................... ? ,~. Dimensions of shine structure with alterations or additions: Front ................. Rear .................. Depth .... ] .................. Height .......... : ........ ;., Number of Stories .......... ~. 2 .......... 8. Dimensions of entire new construction: Front .............. : Rear ............... Depth ............... Height ............... Number of Stories ........................ , ................................ 9. Size of lot: Front ........ .~.O.: .......... Rear .......... &.O.[ ....... Depth .... l.'-/.d.~. ............ 10. Date of Purchase ............ [.q. 0..¥ ............. 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: ..... /~..0 ..................... 13. Will lot be regraded ....... ;. ~//'0 ............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~)~-~/., ~.. O.~ Z"~.~5 ~.tf//-~ddress ~-.?~ y!/.~'fff~. ,..~.,.e. ~ .t~0. Phone No.-//.~'~ Name of Architect ..... , ...................... Address ..... :x ............ Phone No ................. Name of Contractor ~.~, ~.-f. 0.~/~. .5."/0.d~.~ ..... Address'?.~/P.q ./~.l..cts. f~//~T7-~.. Ph ,one/~W~. ~.~ ~.-.~.'-!/(..' .... Is th±s property w±thin 300 feet of a tidal wetland? *Yes ........ No.u- ....... ' ~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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. 15. STATE OF NEW~J/OR~K.,. °- S COUNT,Y .OF, ~:5:~,...gtS:. e::. 0~,:2 {/q[,. ,"7' .. ~,: .77.-~'. d .~..~. ~/~...~. '~. ,:~..~..~. ~'..C'~. - Y~-.O:~ '- ..... being duly sworn, deposes =d says that he is the applicant (Name 'of individual s~ing contract) ~bove named. te is the ........... ' ....................................................... (Contractor, agent, corporate officer, etc.) ~f said owngl *r .own*m.~ i~ ~ly authored to perfom or have perfo~ed the said work and to m~e ~d file this ~pplication: that all statements contained N this application are true to the best of his ~owledge and belief; and that the ~ork will be perfomed in the m~ner set forth ~ the application flied therewith. ;worn to before me this .......... ~.~5 ......... day of. ~C L* ............ 19~C , ' Q ............ ...... ~ ~ ~' of H~ Y~ ' ~ .... / ~'~ ..... ~2~ .......... 5 .... .~. ~.~ ~ / ~ · (~gnature ofapphc~t)