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Home My WebLink About20190-ZTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: '~ ~ .......... ..::.....?~......~~....~..~.~ ro .......;,. .... / ...... , .......................... ?. ...................... r ................ 77.... .....'r ...... /'--7' :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Building Inspector. Fee $...~...~ Rev. 6/30/80 OWNER TOWN OF SOUTHOLD P~OPERTY RECORD CARD F~QRM Ex~ OWNEI~ RES. ~//~ SFAS., VL LAND IMP. AGE NEW NORMAL Farm Acre Tillable 1 Tillable 2 i STREET FARM VILLAGE DISTRICT SUB. W ~ ,.~ , ~ # ~, T~pE OF BUILDING J IND. / CB. MISC. LOT Tillable 3 House Plot Total Wood,and '~ ~7 Swampland Brushlqnd ,,~ ~ ~ DOCK TOTAL DATE REMARKS COMM. Est. Mkt. Value M. Bldg. Extension Extension ?£ Foundation Basement Ext. Walls Extension Fire Place Porch Breezeway Garage Patio Driveway Porch Bath Floors Interior Finish Heat Roof Type Rooms 1st Floor Rooms 2nd Floor Dormer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH ......... 3 SETS OB PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. Approved, Disapproved a/c //';";~~'~ '~' Cch - .................... ................................. /' - ' °ct~ c3 ~/-~o~ APPLICATION FOR BUILDING PERMIT Date - 19 INSTRUCTIONS a. Tkis 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- cation. 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 ;hail 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 3uilding 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. F!~e .applicant agrees to comply with all applicable laws, ordinances, building code, housing code.and retaliations, and to mm~t authorized inspectors on premises and in building for necessary insp ~__2__ -- (Si~nat%re of apnlica~; (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. Q.~..~..~..~.... Name of owner of premises ..... .~..(4 ~...~]..... ~.. :~.~ ~-./.-~.../'/~....: ..................... (as on the twa roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~..~..~.C~....~. ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ......................................... ' .... ..... ........... ............. ltouse Number Street Hamlet County Tax Map No. 1000 Section ...... .~.-- .~. ....... Block ...... ~.... Lot ..... ~ '~2L Subdivision ..................................... (Name) Filed Map No ............... Lot ........ ~" 2" f"~.'~%~ ~ .. State existing use a y of premises and intended use and occupancy of proposed construction: ~ :, {. mcupancy - and occ,mancy .... .~../~.~...~. ~ '~ ~../~..~<.. . ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work O.~. ~-7../?. 4. Estimated Cost 3_z~_~O r-J'0 (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling 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 type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... ~umber of Stories ........................................................ Dimensions of same structur~ with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size oflot: Front ........ / ............. Rear ...................... Depth ...................... I 0. Date of Purchase ..... ~./~- .~'. ........ ......... Name of Former Owner .... ~).~-7~/0r~. ~ ............. I I. Zone or use district in which premises are situated ................................................ . . .. .-.-. 1 '~. t: ~ct;o,l vlc, lalr o:,~y zoning law, ordinance or rcgulation: .................. 13. * ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .$~..,9!q.. ~.. Address .Z~ca2. GE.6Y).~2~hone No ~.~ZiY3 Name of Architect ........................... Address ................... Phone No ................. Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? ayes ........ No..~.. ..... · If yes, South01d Town Trustees Permit may be required. PLOT DIAGRAM I.ocate 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 to deed, and show street names and indicate whether intefiororcornerlot. ,~_&._ ~'~L'I:~D ~'tJ'~l/~l/, "E OF NEW YORK_ _ qTY OF ........ .~..~9.~. APPROVED AS I H)TED FEE: NOTi~ B~ DEPART~NT AT 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ~0 REQUIRED FOR POURED CONCRETE 2. BOUGH - FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.Z STATE CONSTRU~ION & ENERGY CCDES. N~ RESPONSIBLE FOR DESIGN OR CONSTRUC~ON ERRORS S.S ................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~rned. (Contractor, agent, corporate officer, etc.) L or owners, and is duly authorized to perform or have performed the said work and to make and file this .~,~t all s~atements contained in this application are true to the best of his knowledge and belief; and that the . .d, erformed in the manner set forth in the application filed therewith· ~ ~r:lcre me this -. ....... ~.~,. ~ ..... dayof ..... ' ..... ,19 .~.( · '~L' WL~u nty ~'~'x" ALI~a.N B. FELDMAN, INetary Public State of New York No. 03-118472~ Oumlified in Bronx County~ Commission Expires ~.{