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Home My WebLink About18473-Z F08M NO. f ~ ~ ~ I ) TOWN OF SOUTHOLD V v ~ BUILDING DEPARTMENT ~ i-- ~ TOWN HALL ( SOUTHOLD, N. Y. ~O ~ ~e ~ ~ I (Q. A ~DX 6~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 18 4 7 3 Z Dote Q~P~~!~'1.:t.~i~.......! 19. Permission is hereby granted to: n to a-:-........................................~:c-.....~.... . ct premises located at 1~~-...........!`'.~....!~".:.......5~`."~.~-.......... Counhj Tax Map No. 1000 Sect' Block .....~..7........ Lot No.....i~0'..~ pursuant to application doted F'!~~.........t~..g........, 19 and approved by the building Inspector. Fee /..l Building Inspector Rev. 6/30/80 _ Lgaco ( ~ °K BOeIRD OF HEALTH o~-( 7GZuST~~ 3 SETS OF PL.1NS FORM NO.t • SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORP1 TOWN HALL • vDUTHOLD, N.Y. 11971 / ' TEL.: 7G5.1802 CALL. r. ;?~1~~ Examin• .r.i., 19~t ,t, L T0: Approve . ~ ~ 19'~ Permit No. ~ ~ of Disapproved a/c ~ i aus 2 d aes ~ l~ BLDG. DEPT (Building Inspector) TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT _ Date ~~..~J......., 15~ INSTRUCTIONS a. Tltis 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 streets Jr 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 Southold, 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. ( gnature of applicant, or na~e, if a corporation) ~t? o. I~ r~~ 6zs~~,r~~ • Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..........~~.~1~~-~-- Name of owner of remises ~ • • • • • . • p !-91 . ~ (as on the tax rol r latest deet~PPR VEn A$ NOTED IC applicant is a corporation, signature of duly authorized officer. ~ OAT& 4 t 8 P q 1 8~.~, FEES-_____•_-_ RY • G. L..~ • • • • • ~ • ~ • ~ • • • • " " NOTIFY BUlLOING DEPARTMENT AT (Name and title of corporate officer) Q~ ~ 765-1802 9 AM 7p a P, t` M FOR THE Builder's License No. ~v w FOLLOWING INSPECTIONS. ••••••••••.••••~-a~~?~~~`t~A_ 1. FOUNDATION 1WOREQUIRED Plumber's License No. ~l ` ~ FOR POURED CONCRETE t'~. C~,~ ~ 2. ROUGH -FRAMING & PLUMBING Electrician's License No. .`S` ~~~~Q 3. INSULAnoN • • • • • • • • • • • • • • 4. FINAL - CONSTRUCTION MUST Other Trade's License No. ` BE COMPLETE FOR C.C ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. 1. Location of land on which proposed work will be done . STp1T~, CONSTRUCTION , 3. FNEACX COO~B. NOT RESPONSIBLE FOR (louse Number Street. ~~~NERRORS...., Hamlet County Tax Afap No. 1000 Section .~~j Block O Lot Subdivision Filed ~fap No. (Name) Lot............... State existing use and occupancy of premises and intende//d use and Deco/panty of proposed construction: a. Existing use and occupancy ..l. G.~ . d~1~ l~~jc b. Intended use and occupancy r~~~~~~• • • y~~~~~i: 3. Nature of work (check which applicable): New l;uilding • Addition Alteration Repair , Removal . Demolition., Other \Vork . (Description) 4. Estimated Cost .....B.0er.0`~ Fee (to be paid on fling this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor . ICgara;e.numbcrofcars 6. If business, commercial or mixed occupancy, specify nature and extent of each t 7. Dimensions of existing structures, if any: Front . . Rcar ypc of use . Height Depth . • • • • • • • Number of Stories . Dimensions of same structure with alterations or additions: Front . F:car Depth IIcight . " " " " " ' • • • • • • .......Number of Stories . ' 8. Di~r~ of entire new constnuction: Front Rear ...............Depth . Hci;itt Number of Stories ~ ~ ~ ~ ~ ' ' 9. Size of lot: Front....~o~~ Rear ....aoo.~~........ Depth ..~L?~-.~~....... 10. Date of Purchase . ...............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: ...1S.~d . l3. Will lot be regraded , Yti{R , , , , , , . , • • , , Will excess fill be removed f;om premises: Yes' ~ 14. Name of Owner of premises r~1o • • ce...,~~ r.r., k.p ' • • • ~ • • Address ~ou~yay?, , , , , .Phone No ~!4 .-,7,~ , ~ Name of Architect . . . . . . . • • , • , • • ,Address Phone No. Name of Contractor . .............Address ...................Phone No.............:. . IS.Is this property located with in 300 feet of a tidal wetland?' *YES.?~;.NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM , Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from property Gnes. Give street and block number or description according to deed, and show street names and indicate whet}±e: interior or corner lot. 1=F~2t~~rrt~~ f y~ STATE OF NE1V YORK, ~ S S ~u 9L COUNTY OF ,'~"1~jj ~ v fName of individual sib in; contract) ~ ~ly sworn, deposes and says that he is the applicant above named. U (Contractor, agent, corporate officer, etc.) ~ • • ' ' • ' ' ' of saith otYrl~, ~,pw.ners, and is.duly ;iuthorizcd to perform or have performed the said work and to make and 61e this application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in [hc application Glcd therewith. Swom to before me this ~ .......day of . 19 ~.y Notary Public, , ~ x.~........ R:V~r....... County H0.EN K DE VOE Nl1BIRY PUBLIC, Sn[e of New Yetlt ' 1b. 1701878,SuNolkCoeM9 (Si nor re of applicant) Term Expres Much ~,1a•-i./