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Home My WebLink About17004-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017004 Z Permission is hereby granted to: ..~~..~....~..~.....~..: ........... ......~...~...t.~..~. .............................................. ,o ....... %..~......~.L.~......~..~...~/..-..~...~.. ~.~.. ............................................................ at premises located at .,/..~...~.~.~,~,.,....~-~:~,.~.........~ ............ ,.~.~ ,~,.. ..................... County Tax Map No. 1000 Section ....... !.~..( ......... Block ....... ..~....~ ....... Lot No ......~>~.~..)..~ ........ pursuant to application dated ..... .~.......~...~ .......................19.~.~.., and approved by the Building Inspector. Rev, 6/30/80 'FORM NO, 1 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN HALL ,SOUTHOLD, N,Y, 11971 TEL,: 765-1803 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... CHECK SEPTIC FORM ............. NOTIFY CALL ................ MAlL TO: Examined ..... ~Y~..(~J.'~., 19~..~. Approved ..... .~ ~ ).'~J., 19g.~.. Permit No. !.~. 9.9 .~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on pre~nises, 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 autliorized inspectors on premises and in building for necessary inspections. ...... ..................... (Signatnre of applicant, or name, if a corporation) ¢,o ?~o~ t~ -,-~.~4~, ~q,c~_..r,~~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, .architect,.engir!eer; general contractor, electrician, plumber or builder. ........... L. .aq ........................................................................ Nameofownerofpremises ..... .~.~..~'%.'" ~ ' ..../-'.... .~.&-'..~../~..~. .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done., . .:..;.. ...... '~ .................................... .... ....... .... i".'i ....... ..... - ....... House Number Street : Hamlet County Tax Map No. 1000 Section ...~:~5_~..../..~./.... Block ..... . .'~....~. ...... Lot ...... ~-'-'-'-'-'-'-'-'-~...3...~,./.. 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 ..................................................................... b. Intended use and occupancy .......................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Rem?al .............. Demolition ............. Other Work .~'..FQ.~/~..(.'~0~c'.../~ --~ -.~ (Description) 4. Estimated Cost ............................. Fee .... · ...................... ~ ' (to be p~id on filing this application) $ If dwelling number of dwelling ~nits Number of dwelling units on' each floor If garage, number of cars ..... , .................................................................. If bumness, commerctal or mined' occupancy, specify nature and extent of each type of use u . ............ 7. Dimensions of existing structure~, if any: Front ................ Rear .............. Depth. .............. Height Number of Stories ' Dimensions'of same structure with alterations or additions: Front Rear Depth i Height Number of Stories '. 8. Dimensions of entire new constrUction: Front .......... . ..... Rear ............... Depth ............... Height Number of Stories 9 Size of lot: Front ~" Rear Depth 10. Date of Purchase ........... i ................. Name of Former Owner ............................. 1 1 Zone or use district in ' ' ' ' · whmh premmes are s~tuated ..................................................... 12. Does proposed construction wolqte any zomng law, ordinance or regulation: ................................ 1 3. Will lot be regraded ......... i .................. Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises ... q ................ Address ................... Phone No ................ Nme of Architect .......... ~ ................ Address ................... Phone No ................ Nmne of Contractor ' ~ .... Address .... : .............. Phone No. 15. Is this property located Within 300 feet of a".tidal wetland? *Yes ..... No ..... · It! yes, Southold Town Trustees Permit may be required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block umber or description according to deed, and show street nam~es and indicate whether interior or corner lot. "'- ,-/~--~ ? iAPPROVED AS NOTED FOLLOWING INSPECTIONS. STAT~ OF NgW YOgi, 1. FOUNOATtON . ~O REQUIRED FO~:~URED CONCR~E CO~Y OF '. ............. 21 ·ROUGH - FRAMING & PLUMBING ........................ 3, JNSULATION ............. bein~ duly sworn, deposes and says th=t h~ is thc applicant (Name of indMduM, s~ COnt~NSTRUCTiON MUST ~bovc named: ~ C~MPLETE FOR C.O. ALL C~NSTRUCTION SHALL MEE~ ~ Js the ................. T~. ~UIREMENTS. ~..T~E. N.Y. ........................................... STATE 'CONS~o~ a~po~ate officer, etc.) of said owner or owners, ~d i ye perfomed the said work and to m~e and file application; that all statement6Z6~h~d' ~t~Ts"~l~ff~'~'~ue to the best of his knowledge and belief; and that the work will be perfomed in the m~ner ~et forth in the application filed therewith. Sworn to before me this ........... .t ......... of.i... .......... ount, . ~0. 4707878, 8ufl0l~ C0ua~9~ (Signature of applicmt)