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Home My WebLink About23483-Z FO~,M NO. II TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 23483 Z County Tox Map No. 1000 Section ....... ../..~ .... Block ......... ~ ...... Lot No ...... ~ ............. to application dated ....... ~. ................................ 19...~,, and approved by the pursuant Building Inspector. Fee $......~.......~...~..~' Rev. 6/30/80 ]11 }4 ~)ii TOWN OF SOUTHOLD lJisaplJroved a/c ................................ ~ . .; , . . (Bu~i~ I~pector) APPLICATION FOR BUILDING PERMIT Date .... ~.~.. INSTRUCTIONS BOARD OF tiEALTII ......... 3 SETS OF PLAHS ......... SURVEY .................. CIIECK ......... ~ ......... SEPTIC F 0 Ri'l ............. a. Tiffs application must bi~ 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 accosling to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti-eets or areas, and giving a detailed description of layout of property mu~t 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 thronghout 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 Southbld, Suffolk County, New York, and other applicable Laws. Ordinances or Regulations, for the construction of bnildinga, 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 neqessaj~inspections..7'~ ~''~:~"'%' - . --' . (Signature of applicapt, or name, if a corporation) ,Yr....~,:...~..,7: .,O. ~ ~a. ~..j.~.`..' .... (Mailiqg address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general 'contractor, electrician, plnmber or builder. ..... .0...w..~ .e. r:-:.. ................................................... . ........................... Name of owner o£prem,ses..~r.V.. :~:. ~...3/./. eh.c.C. :.>.. :...~ ~:'.-5. ...................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly autboriied officer. (Name and title of corporate officer) Builder's License No .......................... I lumber s L ceose No ......................... Electrician's License No. Other Trade's License No ...................... I. Location of land ou which proposed work will be done ................................. :. ................ .~...' ..... ..Oo.r.~.o .... .~v.~ .... i.~.~.~~ ......................... '.: ............. ltouse Number Street flamlet Cotmty Tax Map No. 1000 Section.. · ;.~'/'~' .t. Block .... ~.~.. ' Lot Snbdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) 2~ State exisfing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existiog use and occupancy .... .......... .................... V,.~./..f..'. ',' . ~ , ........ . . , ,~, .;.'?L~;¥, ......... b. lutended use 'and occupancy ...."~.~.' ?. ~.~.....~... ~! .A~..~0~L)./.-g.. ~ ... ~..: .......... .......... ~ ..... ~ .......... +uuc,iulu): lqew DuuUmg ..... ~/. Addition .......... Alteration .... ; ..... Repair .............. Removal ............. Demolition .;...: ......... Other Work. ~e: ..... 4. Estimated Cost ';/~'P .f.O~ .~. ~,~...~...~.. (J~ ' '' (Description) 5. ~ . · (to be pa d on filin,~i('a~p !cation) 6.' If dwelling, number of dwelling units ............... Nmhber 0f dwelling units on eacl} fl~ .. 2.~ ~ . . 7. Ifgarage, nun, berofcars ................ . .....' ......................... ~';; ~}~"~ ....... If business, commercial or mixed occnpancy, specify nature and extent of.each type of use . .,~..:~:~ ~'~'. ....... Dimensions of existing structures, if any Front .... : · · 2 .......Rea[ .... .......... Dept ~ ..... lteight ............... Nmnber of Storles ........... ~ ~ ...................................... Dimensious of shine structure with alterations or additions: Front ' ....... · · · Rear Depth ..................... He g~t · Num'e .~ . ' ............... 8. Dimensions of entire new constmction: Fro ~t ..... (~...: Rear IO~ Depth 9. Height ... ~ ........... Nmnber of Stories ......... ' ............. ~ ......... Size oflot: Front ................... ~ ·. Rear ............. ; ........ 10. · ...... ' ....... .. Name of Former Owner 11. Zone or use district m which premises are situated ............. ' ........ ' '" 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. 13. - ........................... t4.NameofOwnerorpre,nlse / Z .. n ddress ..... . Will tft be regladed ....... , . ...~ ................. Will excess fill beremoved fr~ln ~emises: ~y~ Name of Architect ........................ Address ................... Phone No .............. Nmne of Contractor ... Address ' ' ' .................................... ' ...... Phone No ................ 15. Is th~s proporty w~th~n 300 feet of a tidal wetland'/ *Yes ........ Ro ........ elf yos~ Southold Town Trustees Permit may be required. ' · . PLOT DIAG~ Locate clearly and distinctly ~1 buildings, Whether existing or proposed, ~d. indicate ~1 set-back d~ensions from property lines. Give street aud block number or description according to deed, and show st?et nines and indicate whether interior or corner lot. -- APP, OYE:D AS NOTED / ~,~O*FtFY ~UIL.D~NG DEPART~T ?~,-~0~ 9 AM ~ 4 PM ~ THE FOLLOWING ~NSP~CTIONS; ~. FOUNDATION - ~0 REQUIRED FO~ POURED CONCRETE ' ~. ROUGH - FRAMING & PLUM~NG ~E CO~PLETE FOR C.O~ ALL CONSTRUCTION SHALL TF~E REQUIREMENTS OF THE S~TE CONSTRUCT!ON & ENERCv C{~DES. NO? RESPONSibLE FOR . . . ' J .~. [.C~e.. ¢~..~O.O [% ... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) ]bore named. (Contractor, agent, corporate officer, etc.) said owner or owners, ~d is duly anthorized to perfom or have perfo~ed the said work and to m~e and file this ~pplication; that all statements contained in this application are t'rue tO the best of his ~owledge and belief and that the .york wUI be performed in the m~ner set forth in the application filed tl~erewith. ;worn to before me this ........ . ...... . / ~- ~ ~ . , No. 472~9. SuffolkS'dfC' ' ~ . Term E~r~ May 31.19~ · . ·