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Home My WebLink About17008-z FO]gM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEI~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLL:TION OF THE WORK ^UTHORIZED) N~ 017008 Z Building Inspector. Rev. 6/30180 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 Examined .q~.'/.~. ........ , 19t~ TEL.: 761-1802 ...... Disapproved a/c ..................................... ............................. APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: INSTRUCTIONS a, Tkis application must be completely filled in by typewriter or in ink and subn~itted t~ the~Bui!dinginspector, 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, relationshipJtq~.adj.eig2aggpremises or public streets or areas, and giving a detailed description of layout of property must be drawn on~tll~diag, v~ami:~ii~hai~t~rt/~O~t~d~Vlt~pli- cation. c. The work covered by this application may not be commenced before issuanc~ d. Upon approval of this application, the Building Inspector will issued a BuildingvP~t~ ~h~¢a~lg. 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 whfitl~r ~shall have been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuanCeS: a Building P~i~llpursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and othe~~tinances 6r 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 ~ode housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~ry, i,~pectio..ns. ./. 4~..2.,~...~.~,.,,<e~-~..,-,~-e..-~ ............... (Signature of applicant, or name,Tf a corporation) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or builder. ......... , Name of owner of premises .... .~...~..0., .~. ~....P~ ........... .~.T/q .~. · .~. · .~..~.~-~ ..................... (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 .... .3/4. ~. ......... / Other Trade's License No../. .......... .~ ...... 1. Location of land on which proposed work will be done .................................................. · .t.7..s.S ........... .... .... f. F.. ............. House Number Street Hamlet County Tax Map No. 1000 Section ...... Il..&.7(. ' Block .../..Z). ............ Lot. c~..~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.....~..~..A'~..~ ........ ~.C.?. V~....~.~.~.~.. .... '..~. ................... b. Intended use and occupancy .... ~ ..~..3".~.~..Z: .~. ..... ~-./?.~.~_.~. ............................ 3. Nature 0fwork (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ......... !... Other Work .~Tto.~..~ (.L. Cos .. ' ~ (DescripIion) 4 Estimated Fee ' (to be paid on fihng this application) 5. If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ............................................ i ............................ 6. If business, commercial or mixed occupancy, specify nature and e'xtent of each ~y~e of use ..... 7. Dimensions of existing structures, if any: Front...t,~,_~ ......... Rear . .',/~ ..~ ....... l~t'h' ii .~.>~ i .... Height .../(.~/. ... Number of Stories .... / ............ i, ........................ Dimensions of same structure with alterations or additions: Fronf ............ ! ..... Rear ................. Depth ...................... Height ...................... Number o~ Stories ..................... '--8. Dimensions. oft entirenew_ ! construction: Front. ...... ~ ....... Rear · ......... · .~) I. . . Depth . .~.~.~.. ..... _ Hmght . ./~ .... 6 ...... Number of StoNes ............ t' : 9. Size of lot: Front ..... .7.~..t ............ Rear .... 7.~i .............. Depth .... ~ .~ .~/. ........... 10. Date of Purchase ............................. Name of Former Owner 1 1. Zone or use district in which premises are situated tl~.-e,,$ .~.tM~.tff.~.~, 'i ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i...Ar.~. ..................... 13. Will lot be regraded ............................. Will excess fill be,removed from premises: Yes , 14. Name of Owner of premises ~;(oAt~ .J.P~c.6Ac~, Address .M4.~f~A~/t& ~' ~"- -, o"°~-~'l[ .................. r ....... i .... moue fqo.+. 1 ~ ........... Name of Ar hit ct Add ' Ph No c e .................. ress ....... ................. I .... one ................ Name of Contractor .......................... Address .... ; ........ ' . Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Y~s ..... ~ ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from and sh~w street names and indicate whether property lines. Give stre~et and block interior or corner ~. ~'.t 0 ~O S.S STATE OF NEW YORK, COUNTY OF ................. 765-1802 9 AM TO 4 PM FOR 1rile FOLLOWING IN~-'C'flON8: 1. I FOUNDATION ,* TWO RBIUIR~D i FOR POURED CONCREI~: I. ROUGH - FRAMING & PLUMBING · INSULATION : 4. i FINAL CONSTRUCTION MUST I BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET T.E .,Y. C~STRUCTION & ' ENERGY NOT RESPONSIBLE FOR 7!SIGN OR CONSTRUCTION ERRORS (Name of individual signing contract) above nan~ed. being duly sworn, deposes and says that he is the applicant He is the .......................................... ................................. .; ............. (Contractor, agent, corporate officer, etc,)i 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 manner set forth in the application filed therewith. Sworn to before me this HEI.ENILDEVOE . .. NOTARY PUBLIC, State of New ~rms No. 4707878, Suffolk CountYP- ,~ Term Expires Mlrch 30,19--/,4' ~gnature of applicant)