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Home My WebLink About21749-ZFORM TOWN OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) N-° 21749 Z County Tax Map No. 1000 Seotion ........ ,c:~...~. ........ Blook ..........?.. ............ LotNo ...... ./.~.~..~.... ........ pursuant to application dated ............ .~'...~../.-~,.,Y'.. ............................. 19.~..~... ..... and approved bythe Building Inspector. Fee $ _~.~.~. ~.~ Rev. 6/30/80 EUGENE BUTTA & GAl/ GUTTA FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 I TOV?!";g~ TEL.: 765-1803 Disapproved a/c ' ............................. : ...... ...}... _ . . (~lding~pector) ~PPklCATIO~ FO~ BHIkDI~G PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. CHECK ................... SEPTIC FORH ............. HAlL TO:~ ~- Date . ... ~5v'. .......... 19 .~. 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 premises, relationship to adjoining premises or public st?eets 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 South01d, .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. . --' ~ 4~ignature of applicant, or name, if a corporation) (Mailing address of~pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~'~.?~ .C .................. '.. ':'~ ........ Name of owner of premises .~/. ........ (~; ~)~i t'~e' ;a'xi]t~lir;~)~.'CJ ~ ~ ........ If applicant is a corporation, signature of duly authorized officer. ,~7- (Name and title of corporate officer) Builder's License No....~?..~./~77.~. ...... ' ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............... *,,.;.. ~' ' ' .. ...... "~ r.~'~ ............. -¢' · ................ ................ ............................. o ~..%~5. ' . ~ . , ' ltouse Number Street Hamlet ~ county Tax MapNo. 1000 Section ...... ~.~ ........ Block ..... :~ ...... i... Lot..4r~r~ .......... Subdivision , ~c~ / - .~,~.3~ ~t ~,~ 'Filed Map No. Lot ......... · ' '.~' (Na~i)'Z ................... i' 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy :~./.)?..3 ~v,~/...~765~(~': b. Intended use and occupancy .x..~9¢ ~5;q}. - ,~,, ,~' f. %.~ ..................... . ........... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work .q~..,!~e~qQ,. ..... 4. Estimated Cost . ff~ ((Descr~tion) (to be paid on filing this application) 5. If dwelling, number of dweiling units ............... Number of dwelling units on each floor If garage, number of cars ................ ' ................ 6. If business, commercial or mixed occupancy, specify nature and extent of.each..t~.pe of use .............. 7. Dimensions of existing structures, if any: Front...............Gi' / Rear .-..~-.- ........ Depth ~'6 ' ....... Height .... ~, ......... ~umber e f Stories .... .~ ..... ' .............. Dimensions .............................................. of shine structur,, with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories 8. Dimensions of entire new construction: Front .... ' ..................... Height Num .... ' ......... Rear ............... Depth ..... ............... ocr or stones ........ 9. Size of lot: Front .. ,fP'd '" ' Rear '~;'~: '3' ........ ' ............. -;;;-' ';d-,v ............ 10. Date of Purchase '~r~'f~'/~'_~ .............. ~' ............... Depth ..Z~(.: ..... ........... ~,~,r.~ ............... Name of Former Owner ~$',.,.'~ .... ?,)7 ,',".":;'" 1 1. Zone or use district in which premises are situated.. ' ..... : '~Y:' '~ ~ ~'¢~'~ ~"'*'~': 12. Does proposed construction violate any zoning law, ordinance or regulation: ., .~.c~. ................ ' ' ' 13. Will lot be regraded ....... ; ................... Will excess fill be remov,ed from premises: Yes 14. Name of Owner of premises ~e-~ < ~ ......... Address ~5~ ~.,':~;~:4'~.. ~.~ .~,~e No. 2j~.~ :~z~.. ~. Name of Architect ~,v;<,~-.~'.~z % ~/.,o~'~- Address ................... Phone No ................ Name of Contractor , r, , ~ ................... Address .. .............. Phone No ................ 15. Is this property w~thin 300 feet of a tidal wetland?'' *Yes ........ No.~.-C. .... ~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 property lines. Give street and block number or description - ' according tu deed, and show street names and indicate whether interior or corner lot. ?.? ¢ STATE OF NEW 't~O,,l~,,,/, COUNTY OF..: .5'¢.~¢. ;/.A.-. ..... S.S ...............................(Name of individual sigmng contract) ' ......... being duly sworn, deposes and says that he is the applicant above named. He is the .................................. . ................ ~ ...... ~ ............................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, 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 flied therewith. Sworn to before me this ........ /..'.'~. · .' -/~--~- ..... day of..,~..~../~.~..~..~..Z~.. .... ,19 f3 ~ . ~0~ ~u~ac, ~tate Or ~ew ~ /, ,/~ / ,~ . ·. ' ~afi)ieo in Suf, o,k Coun~ ' }' ' r .......... r..- ......................... ~ ~miss~. ~ Jan,. 8' [~ ' ~ ' (Signature of applic~t)