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Home My WebLink About13530-z BUILDING DEPARTMEI~T / TOWN HALL $OUTHOLD, N.Y. ~. ' BUILDING PERMIT ~~'~ ~HIS PE~IT MUST BE KEPT ON THE PREMISES UNTIL FUL~ C~PL~ION OF THE WORK AUTHORIZED) ~ ~0 z ~.,. .... ~~~ ............... ~.....,,.~' ~ ~/ Permission is hereby granted to: ....... . .O...~L..~~.,.....~.~?....zz_~o~ ..... .~..,,,......,c... ~'.,....-,..-.......:~.~.,.~ ~....~,,,_,,,,d~ ...................... .,'....'. ........... at p,~s,s ~ocot,d ot ....Z.'Z/...~ ............ .z~..~.......~..~.~.~..~........~..~ ................... ........................................................................................................ ~.~..~..~...-...~g.:~.. County Tax Map No. 1000 Section ..... I~.ZZ ....... Block ...~..~.. .......... Lot NO..~..../..-~... .......... ~r..o.t ,o opp,,co,,on do,.,, ..... Building Inspector. Rev. 6/30/80 lO JSC ~6, DATUM, 5URV£¥ [:OR N,~INCY F2~DMItV .. ~AYVIEW TOWN OF SUFFOLK cOUNTY, N~ SC~L.E, I"~ 40~ 1980 2.3,198'"'2 ' NOTE~ ~ :MONUMENT ee{ ~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 76§-1803 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 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 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 promises 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 ail applicable laws, ordinances,~0~i~ding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary~ ~/~/ · ~ 'S~~p~i~, ~r dame, if a corporation) x /. d o.o. . O .c././,,. . ..'g. ,. ( ( (Mailing addrdss of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises /~/~C y R/9-~/U////I~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No.4'.°Y.Tz[.15.~/.) ..... : .~...¢.Z .7../~' '/' C_ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .............................................. · · .. ..... ./. Z ........... .rfr. . . . /. . . ......... . v. /.¢. .w. . House Number Street Hamlet .... : . County Tax Map No. 1000 Section / Block Lot 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 ...................... , ............................ k ( k ppli ) B tiding Additi ' Alt ti 3. Nature of wot chec which a cable: New u ........... on. 'i ........ era on .......... Repair - Removal Demolition ' Other Work ' (D ripti ) 4. Estimated Cost ........................ Fee .... ] ........................... ~ q' (to be [paid on filing this application) 5. If dwelling, number of dwelling units .... .,=- ......... Number of dwelling un s 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 .... ~o. ........ Rear gO i ... De,,th ~.~.: 9 Height ..... ~ ....... Number of Stones ....... /. ................... : ........................... Dimensions of same structure with alterations or additions: Front r c ~ Rear ..~. Depth !/ ' Height t~ Number o4Stories 8. Dimensions of entire new construction: Front.....~'.~ ........ Rear .... . . ........Det.~ pth . ............ Height ...... O. ....... Number of Stories ................. ) .......... ~ .... ~'i ~",'- 9. Size oflot: Front ./t. gT./ ................ Rear.../..B../.,..7~. .......... jDep!h.. ~]3..~ .:..... 10. Date of Purchase .... .ro~..~. p ................... Name of Former Owner ................... I 1. Zone or use district in which premises are situated '-..~. 7. /~ .~pT~. '7'~ i - 112. WillD°es proposed construction violate any zoning law, ordinance or regulation:lot be ' ' ' i ' ' ' '/~' '~' .................... 3. regraded ................. . .... Will excess fill be removdd from premises: Yes. il4. Name of Owner of premises .............. ...... ~ddres~ . ~./ ............ Phone No ................ Name of Architect (~.~..//.?.~.P.~.9../'?:~.~.~.//?~ °°'. Ada/~essO 7'./.~.'.~ ' ././~7~.~... Phone No..~.~.7.~. ~.o.~ .... Name of Contractor .......................... Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property L}nes. Give street and block number or description according to deed, and she tv street names and indicate whether interior or corner lot. STATE OF NEW YORK, s.s COUNTY OF ................ __ __.-, , ................/..~.~k~ /~ c'z ....................... being duly sworn, del ases and says that he is the applicant (Name of individual signing contract) ' ' tle is the (Contractor, agent, corporate officer, etc.)' of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this application are-true to the best of hls knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ' Sworn to before me this · :'. ............... day of ....... ....... , i9. ~ ' HELEN K. D~ VOE ~'""~ i ' . NOTARY PUl]Lid, State of New York , , No. 4707878, Suffol~ Cotml~ lgllature of appllca~lt) I~lll [zOOe, s March 30, 19~'-~'