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Home My WebLink About22998-ZFOBM TOWN OF $OUTHOLD EUILDING DEPARTMENT TOWN 14ALL SOUTHOI.D, N.Y~ N? 22998 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted tg: .... ~.~..?~......~.: ....... ~ ............... Building Inspector. ~,...~...~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~~¢ 99~'~'~' SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................... ~ .......... ~L[GATION FOR BLIILDING PERMIT BOARD OF ItEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. HO? i FY; CALL ................... HAIL TO: Date ..... 2//a' q';"' INSTRUCTIONS a. Tiffs 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 st~-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. 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 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 beea granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t6 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, ~lding co/~, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary/fpf~bectim,~z.~ (Signatur~applicant, or uame, if a corp ration) · p.e 7.~..L. (Mailing address of applicant) State wti&ther2appljcant. ~ is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. ..... 2 .'.. i..' ..... ..... ............................................................. Name of owner of premises . .0ilL-g4 f~Cff...~.bt.'Eff-t4. I~.~..lq....t...O-,..fi~..I.5.Tj/,j.~....~'~..~/?.~ t~f. ('-,/.~..t~..t~.~ .......... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of coq~orate officer) Builder's License No .......................... Plumber's License No ..... ' .................... Elect lc'an s License No ....................... Other Trade's License No ...................... Location of hind on which proposed work will be done .................................................. ............... .z..5.,./~ .... .~.o. vrq'~.../~.'4~N~-.... ,'. l-:/.~.'~., cr~ .~N.... lIouse Number Street llamlet County Tax Map No. 1000 Section .... -...?--O . . . Block ..... .~. ....... i... Lot .... .~. ............. Subdivision . . . Filed Map No ........ ~ ...... Lot ............... (Name) State existing use and occupancy of prenffscs and intended use and occupancy of proposed construction: a. Existing use and occupancy' .)]/~.-~Pg'-_'_T.. ~. ¢/.~-../ b. Intended use and occupancy . . .~.~ P.~.TI ~...' ........................... , . ) ................. 3. Nature of work (check which applicable): New Building .......... Ad~t)on .......... Alteration .......... Repair .............. Removal ............. Demolition .;...~t ........ Other Work ............... · ~' o_~o' ' (Description) 4. Estimated Cost ... 0.~.: ..................... 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, commercia or mixed occtlpancy, specify nature and extent of.each type of use ..................... 7. Dimensions existing structures, if .... ~, ...... .. ....... Depth . ........ / Height ............... Number of Stories ..... i/.--.7. Z....~.T'O.~'? ~5... ................................ t. Dimensions of same structure with alterations or additions: Front .X~d'/~" ........... Rear .................. Depth .... .................. tteight ....... ,... ........... N' ' 'umber of Stories ........... ~ .......... 8. Dimensions of entire new construction: Front . ~//,~ ........ ; Rear ............... Depth Height ............... Number of Stories ....................... , ................. t ............. :. 9. Size of lot: Front ....Z.q[.'l, .~.O.~ ....... ... Rear ...2.0. O).Q :...; ........ Depth ./.~,.Q~.D......~... ~.~.0.:0... t0. Date of Purchase .1~/~.~...I.~..I.qq~..... ......... Name of Former Owner ~*~.]t. 0~/t~lA.~..*..~.~d/5..; .... 11. Zone or use district in which pre~nises are situated ....................................... .~..~..~..o~..o.~... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... : .......................... 13. Will 10t be regraded ...... .~.,~ ................. Will excess fill be removed from premises: ~ No 14. Nmne of Owner of pre~nises~t.~0,u..%C~t~-t~J't~.. Address .z.~..~¢¢tL~O~t~,./.~h~. Phone No.~Q.t°. .~.'!.'!.: .q:.~..~.L Name of Architect ........... .~.~..w~..M?.?~..,,,{. .... Address ................... Phone No ................ Nmne of Contractor ~ ~-.c.t e,j~./~&¢C~c-i~ ....... Address '] .t~J.~l~/~..L......~J(.~. Phone No.:r?6. 15. Is this property w:[thin 300 feet of a t:±dal wetland? ~'/~g¢..V'cJ~.g'Q~l)o ......... ~If yes, Southold Town Trustees Perm±t may be required. PLOT D1AGRAM 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. ~fftZo~q-f ')~,°r~ ' ° 2- O° AP_PROYED.,AS NOTED. Nora, ?~5-1802 g AM TO 4. PI~J"FON THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE ROUGH - FRAMING & PLUMBING IhSULATION FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. CONSTRUCTION SHALL MEET REQUIREMENTS OF THE N.Y. CONSTRUCTION & ENERGY NOT RESPONSIBLE FOR OR CONSTRUCTION ERBOR~ STATE OF NF_W YORK, o o COUNTY OF7~ ........ ...~J/.~-'. '?.,~ .... ~ .~.77..~fi].~...~..~ ........ ......... being duly sworn, deposes and says that he is the apph~ (Name of individual signing contract) above named. Itc is the...O.{~..~. · · .................... ......................................... .............. (Contractor, agent, cor'porate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manuer set forth in the application filed therewith. Sworn to before me this ......... .... ...... ., Notary Public,..~q~ .~.~. ~~..,~..'~...~County Qu~lffied In Ne.e. ~n~'y~ ~ 97 Com~ Expires March 30, 1 r (Signature of applicant)