The URL can be used to link to this page

Home My WebLink About22795-ZFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMEN/ TOWN HALL SOUTHOLD, N.Y. N-° 22795 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE W'~RK AUTHORIZED) Permission Is hereby granted to~,.~ ~, . ......... ~ ....... ~.~.~ ................................ ........ ~..~ ....~.~.. ~..... ~..-~ ............ at~rem,~s,~at~a, ........ ~ ............ ...?.'//.~...:..~..~ ........ .~....~ ................................... COU~ TaX Map Nam ~ 000 S ~,io~. , m i~J .......... BI~ ...... ~ .......... LOt NO ..... ~i~i (~ ......... pursuant to application dated ...... ~ ................................ ] ~ ).Y~, O~d opprov~ by the Building Inspector, Fee $.., .L..Z~.....O._.~ ........ Rev. 6/30/80 I)isappraved a/c ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~OWN HALL SOUTHOLD, N.Y. 1197] TEL.; 765-180:3 BOARD OF IIE^LTII ......... 3 SETS OF PLANS SURVEY CIIECK .................... SEPTIC FORtl CALL ~ .................. HAIL TO; . ~t'fii~i, fig h~pector) APPLICATIOrq FOR RUILDtblG PEFIMII 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, accnrate plot plan to scale. Fee according to schedule. b. Plot plau showing 19cation of lot and of 6nildings on premises, relationship to adjoining premises or public sti'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 8. 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 issned a Building Permit to tile applicant. Such permit sbal~ be kept on tile premises available for inspectiou throughout the work. e. No building shall be occupied or used itl whole or in part for any purpose whatever until a Certificate of Occupancy shall have been grouted by the Bnilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for file issuance of a Building Permit pursuant to the Buildiug Zone Ordinance of the Town of Sonth01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal ql' demolition, as herein described. The applicant agrees to co~nply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecfions. ........ /L4 .' ............... - (Sign'dture of applicant, or name, if a corporatiou) .. ~: .o...~..o.q.. ~.~.(., .~..~.~.+~.~.,.~:¥:. l.t.~. ).t.. (Mailing address of applicant) State whetber applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .S'~.? r~..~...P4..~... J31~p..w. .*'.;. [.rt..z= ................................. (as on the tax roll or latest deed) It' applicant is a corporation, signature of dnly authorized officer.· (Name and title of corporate officer) Builder's License No .......................... Phmlber's License No ......................... ElecHician's License No. Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. llouse Number Street ltamlel ComHy Tax Map No. lOOOSection ...:[~ ......... Block .0.~ ' Lot...~2.'./. .... Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) hate existing use and occupancy of premises and intended nsc and occupancy of proposed construction: Existiug use and occupancy ' .~.~.~[ ~e~ ~2.~.~. ....... }t.. ~.~t ~7 ...................... 1 · . . ~ .............. , ,.~*-,t, Jc). l'~cw l)un,Jmg .......... Additign .......... Alteratlou .... : ..... Repair .............. Removal .............. Den,olition .:."L..~...' ......... Other Work ............... - .. -. (Description) 4. Estimated Cost ~ ~ ..................................... · Fee ..................................... (to be paid on filing ti,is~ application) 5. If dwelliug, number of dwelling units ..... t2 ......... . Number of dwelling units on each floor ................ · Il' garage, number of cars ........................................................................ 6. If business, commercial or mJ~xed occupancy, specify natnre dud extent of.each type of nsc ..................... 7. Dimensions of existing structures, if any: Front .....'¢/..~. ......P, ear .... .q/-/ ....... Depth....~..~. ......... lleigbt ..1'~. ' Number of Stories ]. .............. .... ...................... Dimensions of shine stmc.tur, e with alterations or additions: Front ....e./..~. ......... Rear ...cl.'L( ............ Depth .... ,~..c(. ............. lleigbt ..../.If'. .... ' ...........~ Number of Stories .... { ..... ' ...... 8. Dimensions of entire new c6nstmction: Front .............. : Rear ............... Depth ............... I Ieigbt ............... Nnmber of Stories .......................................... / ............ Rear..) ~.a., .':/,/~: ........ Depth .. l- t 0 ............... 9. Size of lot: Front . C'9, O,~..~..' ...... / 10. Date of Purchase .................... ......... Name of Former Owner ............................. l 1. Zone or use district in which premises are situated ....... . ....... ....................................... 12. Does proposed construction rio}late any zoning law, ordinance or regulation: ............................. 13. Wdl lot be regraded ...... ¢'~{ ................... Will excess fill be removed from premises: 14. Name of Owner of prelmses 9{-~.._. Y:'..~."P.a..r:'.'.'.'.'.'.'.'~t, O-, ..... Address ................... Phone No.,9,/.~-. :%Q~"7'fn~./.~-"$"~ Name of Arcbiti~ct .......................... Address ................... Phoue No ............ .... .~4e~.'bet-~.c~& .......... Address t.t,'~X-C-L,a,,b, AP+iL, ~. Phone No. '2 .~.V..'-..5'.~. 67.,.. Name Contractor tS. Is this property witb±n 300 feet of a tidal wetland? *¥es.~.~No..e...~. .... · If' yes, Southold Town Truatees 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 comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. ........... '~.,~VQ~..'l~l/~p <20. t, ex ................ being dnly sworn, deposes m,d says that he is the applicant (Name----of individual siguing contracO above named. u~ i~ tb~.., ....... C.~C~. O~ ................................................ . .............. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly antborized to perform or have performed the said work and to m~e and file tiffs application; that all statements conlained in tiffs applicafion are true to the best of his ~mwledge and belief; and that the work will be performed in tim manner set forth in tim applicafion filed therewith. Sworn to before me this Nota~ Public, .... Cotmt JOYCEM.~INS' ' · (Signature of applicant N~aW Public, State ~ N~ Y~ No. ~952246, S~ Term Expir~ June 12,