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Home My WebLink About17113-z FOP~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017113 Z Permission is hereby granted to: .............. ~.~ ............ .~ ...... ../...~....-~. ....... ~.....~ ......................... ...~..~.....~...,.~.**~.;....u...~.~ ....... ,,, ,o ..~.~...~.....~~...~.~....~....~......~~ ...... ~ ........... :'"";'T"; ............. '~ .................. : ................. ] ...... ~ ........... : ...................................... ot premises mcatea at ..I...~..~. ......... .~.~......~.-.. ...... ~.~...e~.. ................................... County TOx Map No. '000 Section ....... ..(~..~,,~, ....... Block ........ ..~..~. ...... Lot No....,~..I .............. Building Inspector. Fee $...~...~.'. ............. and opproved by the Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... TOWN OF SOUTMO[.O CHECK [~U[LD[NGDEPARTM[NT SEPTIC FORM ............. : TOWN HALL NOTIFY 8OUTHOLD, N,Y. ~97~ CALL ................ TEL.: 7654802 MAIL T0: Disapproved a/c (Building Inspector) Date ........ ~2¢ .... 19~ INSTRUCTIONS a. Tkis application must be completely filled in by Wpewriter 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 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 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 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · M! idA., .; ........... .... ''' (S~~e, if a corporatio ) (Mailing address of a15plicar¢') State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .................... .............................................................. Name oi'owner of p,emj~es, W: ,. ~ .~'~ .~'.~. ~. · .~../~. 't.~. · ~.~. · ./~.~..~. · . .'(.~/'/?.~- '~.- · .~' · ~?/~" ......... "-~?, ,~ .~.,~,~ ~4~,~7~ >,'~ ~'t,'..~ ~ (as on the tax roll or latest deed) If apphcan[ !s ~ eor~a~l~.~L~y authorized officer. ......... · . [.. ¥. :4T$,:'~,:~; ........... officer) ALL CO~TRACTOR~S N~ST BE SUFFOLK COUNTY LICg~SED Builder's License No .......................... Plumber's License No ..................... : · Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ......... .~ ....................................... House Number Street Hamlet County Tax Map No. 1000 Section .... .~..~. .......... Block...~. ............. Lot..~.J ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy -~uG~t[e_ .~.O9t.~.~ /~)ff~etoc.~ ...................... b. Intended use and occupancy ..... ,,~.. ~/~.~(~.O,~. ..................................................... '...... Addition ' ......... Alteration .......... 3. Nature of work (check which applicable): New Building .... ~ . ,~ - - r Repair .............. Removal .............. Demolition ............ Other Work ' 4. Estimated Cost .... Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling ¢nits ....~ .[ ...... 'Number of dwelling units on each floor ................ If garage number of cars . 6. If ~iness commercial or mixed occupancy specify nature and extent of eabh trw of use . , 7. D~m~nsmn~ of emoting structures ~f any Front .... ~ :. Rear ~ D~th Hei'g~ ~7~ Num~er'of Stories .... ~ ......... D~enslon~~ure With alterations or additions Front,~k~'...~.. Rear .. . Dept : .................. ~.. Height ............. ~ ...... Number of Sto~es ...................... 8. Dim~si,O~a,of entire new consthction: Front ._~.~ . . . Rear ............... Depth ............... Height ~, ' ' Number of Stories ~ . 9. Size'5(lbt:~;ont'~ ~.7~. .'~;~ ~~ ....... ~~'~'~'~'~ ...... ~" 10. Date of Purchase . .~..~P4~.~ ............ Name of Foyer 6~;; ~5.. ~¢~ ' 11.. Zone or use district in which premises are situated...~.~ ~6~ f?.~. .... ~ .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ ' . .~.~ ~ .......... 13. Will lot be regraded ...~.O... ~ ................... Will excess fill ~e,removed flom premises: ~Yes No 14 Nme of Owner of premises g~t~k ['&,~h Address [~Z F~e ~ F~O~Be~ {~I/Ph~no M~ O~Ctte Nme of Architect .../~.& ................ Address ..... {~/.. {(?~Q.... Phone No ................ ~e of Contractor ... ~.. ~,~- ........... Address .... : ............. ~ P3~one No ................ 15. I.~ this property located ~tthtn 300 feec of a t$dal wetland? ~Yes .r~.: No ..... ~If yes, Souchold To~ True,tees Permit ma~ be requtred. PLOT DIAG~M Locate clearly ~d distinctly ~1 buildMgs, whether existing or proposed, and, indicate ~1 set-back dimensions from property ~nes. Give street and block I umber or description according to deed, ~d show street names and indicate whether interior or corner lot. FOUNDADO~ r~/uO RtOLJlRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR ALL CON~TR~ON ~HA~ MEET 8TA~ ~N~ & ~ERGY STATE OF NEW YORK, SiS COUNTY OF .................. [,&. ~.~.~. ~.~?.K..S.~..~f.~...~.~...... ! ................... being duly sworn, deposes and says that he is the applicant (Name of individualslgmng' ' ' contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly iauthorized 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 manner Set forth in the application filed therewith. Sworn to before me this Oommlo,lon Explro,~ iNov. 10, 1~9