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Home My WebLink About20161-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK AUTHORIZED) Ne- 201 61 Z Permisslorl is hereby~G~c? ~: ./ ..... ~..~..~~ ....... ~./..,. .................. · ........ ~'"'~"'"~"."~'"':'"'"'-",i~ /~ l/ ....... '~"'"~ .................. ~' .................................................... at premises located at .......~...../..~.~.......~..~........~...~.~.. ..................................................... County Tox Map No. 1000 Section .... ~...~..~.. ........ Block ................... Lot No. pursuant to application dated ................ ~. ............................. , 19..?./~...., and approved by the Building Inspector. Rev. 6/30/80 · ~4.4~. · 8 87'o1'~0~ W t VAC)WT ) W AREA · 32,327~. q. ft. SUR VE Y OF PROPERTY A T MA T TI TUCK TOWN OF SOUTHC' D SUFFOLK COUNTY, N.Y. 1000 - 108 04 - P/07.2 Scale I" = 40' Oct. 13, 1988 Sept [ 1989 ( ~ou~Z loc. ) 909 fAIN ROAD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTIt ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. . (Bulling Insp~r) 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 ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ati6n. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessaT~p..~Z(/?~/~///_,- ~{~ignature of applicant, or name, if a corporation) .. 5./.:. . .:. . ¢.c. .~ .:./ ~. ........................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame o~ o,~ner o~remises B.'.q!~..~.X:,.~..~.~.X ~ E...O~&.~..h .................................. (as on the t~ roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) u- · .5.~1.?.. BIder s License No .................. Plumber's License No ......................... Electrician's License No. Otbcr Trade's License No ...................... Location of land on which proposed work will be done.. ................................................ .3. ~ .:.... ~ .~.c..h e.b...~.. ~.x.~. llouse Number Street Hamlet co,,,ty Tjx Map No. ~000 Sect~o~ . .l.¢..~ ............ ~lockO. ~.:'. k/~..:~.... Lo,..7: .~. g ......... 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 Bui/ding .......... Addition .......... A~teratio% .......... Repair .............. Removal ....... Demolition . '' - ............ Other Work . .~.~../2. t~' .~ ..... 4. Estimated Cost r~OO, Et:3 ?.~ 6o (Description) .................................... Fee . . .~z.,~,., ................................ 5. (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............. · If garage, number of cars ...................................................................... 6. If bus ness commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Num bet of Stories ................................................... Dimensions of same structure w th alterations or add tons: Front ............... Rear ..... Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... .... Hezght ............... Number of Stories Depth . .. 9. Size of lot: Front ...................... Rear 10. Date of Purchase ...................... Depth .. ..................... .................... ......... Name of Former Owner ............ · ................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................. 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... ·If yes, Southold Town Trustees Permit may be required. ... PLOT DIAG IC4M '. Locate clearly and distinctly all buildings, whether existing or proposed, anti. indicate all set-back dhnensions from property L/nes. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. 5 ~ C 5 ~V~,/ AI~PR0~EO AS NOTED ~ FOL.Lf)WiNG }NS~ECTIONS: ~. FOuNDATiON ' ~0 REQUIREO FOR POURED CONCRETE 2 ROUGH - FRAMING & PLUMBING 3. ~NSULATION 4, FINAL CONSTRUCTION MUST ~E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CC,DES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ou,,,rry OF ...... '.~.~..\ .~. .... S.S ........ .... 9 ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ore named. s the ........... a ~a, ~ ~ (Contractor, agent, corporate officer, etc.) ....... said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ,rk will be performed in the manner set forth in the application filed therewith. om to before me this ...... ~-~' · --'~- ...... · .fi. day o f,,,,~)..~ ~ ..... ................................. ~_~'1~/~L l~a~ (Signature of applicant) /~'(~ --/~0 ~' ~ -~,~ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET ~ VILLAGE DiST~ SUB. LOT TYPE OF BLD. "I- / ' / J ' ~ - - --../, PROP. C~SS / / V U ~ ' I '~ LAND ~ IMP. TOTAL DATE ' -= .. FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH : MEADOWLAND BULKHEAD HOUSE/LOT TOTAL /~ Extension Foundation Basement SLAB Dinette Kit. COLOR TRIM Extension Ext. Wails ~), _~ , ~"',~... LR. Extension Fire Place ~ ~ ,~.~C/ * D.R. J Patio BR. ,~ Porch Dormer Fin. B. Bath Floors Interior Finish Heat Woodstove Attic Rooms 1st Floor Rooms 2nd Floor Garage Driveway O.B.. Pool Deck Breezeway BUILDING DEPT. INSPECTION [ ] ~AMING [ ]'FINAL REMARKS: DATE ~/L ~//~ L INSPECTOR