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Home My WebLink About23790-Z /OB, M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~HT (THIS PERMIT MUST BI:: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 23790 Z Permission is hereby granted to: .~ ..A.-~ ..... / ...... ~~//Z..../...../../.~./. ..... t prom's. Iaea,ed a, ................................. .~_~ -~" ............... ~ ................... co~tv Ta× Mop No. lO00 S,ctia~ ............ ~...... mo~k................J~...... lot ~o....~. ............... pursuant to application dated ...................... ~......~.....~...../.~. ........ , Building Inspector. F.. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 )isapproved a/c ........ i ': !;: ! ' /fr~ (Building Inspect~r) - ' A~P~.ICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. CIIECK ................... SEPTIC POR:I ............. CALL HAIL TO: : ~, INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to thc Building Inspector, with :s of plans, accurate plot plan to scale. Fee acco?ding to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stNets arer;s, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 i~sued a Building Permit to the applicant. Such permit dl 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 .Il have been granted l?y the Building Inspector.. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the iIding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ; applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ,qit authorized inspectors on premises and in building for necessary inspections. · . -- (Sig~gature~,/,~t,,, of applicant, or name, if a corporation! (Mailing address of applicant) te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) ?plicant is a corporation, signature of duly authorized officer. (Name and title offcorporate officer) ' Plumber s License No. ,""'I .'~. Electrician's License No .............. Other Trade's License No ....... .~7.~I ........... .ocation of land on which proposed work will be done ............................ louse Number Street Hamlet ubdivision ........ . .... ' ................ ' ......... '. Filed Map No ............... Lot ............... (Name) tare existing use and occupancy of premises and intended use and occupancy of proposed constructioni Existing use and occupancy .... ' .................................... -. · Intended use and occupancy ................. Kcpa~ .............. l~.cmoval .............. Demolition . . ./~Mc- ......... Other Work .............. ... , (Description) 4. Estimated Cost ..... t ........................... Fee .............. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... · II' garage, number el' cars ..... ./' .................................................................. 6. Il' business, commercial or mixed occupancy, specify nature and extent ol'.each type el' use ..................... ?. Dhnensions of existing structures, if any: Front ..... ~ ......... Rear .............. Depth ............... Height ............... Number el' Stories ......................... ' ............................... Dimens ons of shine structure with alterations or additions' Front ~.. ~ . Rear .. ~...'~ ............ . 71 it . z 't~ ............... · Depth .... ./..':o° ............. Hezght ...... .z'.~. w.~' .......... Number of Stories ...... ~, ..... ;'.,.. ?~... 8. D mensions ofentire new construction: Front ...... ./'~ ; Rear ~ ~ . Depth .... /.'.~."-.oc7 '. . Height .... f.~..~. ..... Num~ber of Stories ........ .~ ................................... '.; .......... 9. Szeoflot Front ..... d~.'.?.~. ....... :.. Rear...~.~.,..~.D. ... i... Depth ...'tz/l*./~. ............ 0. Date of Purchase .................... · ........ . Name of Fenner Owner ............................. · Zone or use district in wi ich remises are situated - /3 ' I p ....... .......................................... 2. Does proposed construction violate any zoning law, ordinance or regulation: ...... /r/~. .................... 3. Will 10t be regraded ........ : .'¢J~,. ................ Will excess fill be remqved from premises: Ye~ ~,~ 4. Name of Owner of premises .fi, .O.~.[~.~..F~..h. .t~.., .... Address .~3q .O..~q~.Z~. ?..,~.~... Phone No..7..~?.7ZZ'./.7. .... Name.of Architect ........................... Address ...~.. lcgdfl..~.~q~ ...... Phone No. Name of Contractor ~Ot[t~ .~,~.~! ............ Address ..... ~q.O.¢~. fi) ......Phone No. ii i.' I.s chis property wichin 300 feet of a eidal werland? eyes ........ Ilo ......... · 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 · operty Hnes. Give stree~ and block number or descr/ption according to deed, and show street names and indicate whether ' APPROVED AS NOTED t~{~ BUILOiNG DE~A~~ 765-1802 9 AM ~ 4 PM FOR FOLLOWING INSPE~IONS: 1~ FOUNDATION. ' ~0 REQUIRED ' ~OR POURED CONCRETE A, ROUGH - FRAMING & PLUMBING. 3. ~. FINAL ~ CONSTRU~ION BE cOMPL~ FOR C.O. ALL CONSTRUC~ON SHA~ MEET THE REQUIREME~ OF ~E STATE ~NS~U~ON & ENERGY cODES. N~ R~NSlB~ ~R DESIGN OR ~N~U~ON ~RORS' TE OF NEW YORK, S.S rNTy OF ..... ~ P. t=~ .~. ','f---. '' .~. ~ ~ .~. t . .~.~.~..f~..q .g/f .. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) named. (Con tractor, agent, corporate officer, etc.) id owner or owne~, ~d is duly authorized to perfo~ or have performed the said work and to m~e and file this :ation:. that all statements contained ~ this application are true to the best of his knowledge and belief; and that the will be perfo~ed in the manner set forth in the application filed therewith. lo before me this .............. (..'. .dayof ................... · . ....... ;. ..... H[LENED. HORN~ ' " '' 5.''' ~ .... Nola~Publ~c, State of Now York · (Signature ofapplic~t) _ o, 4951 ~64 Oua[ified in Suffc