The URL can be used to link to this page

Home My WebLink About13216-z FOB,M NO. S TOW~ OF SOUTNOLD SUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 132t6 Z Permission Is hereby grantecl/~6: ...... at premises located at ...~...."~....~. c~ .~.,.~.....i~...(~...~., ....~..'. ~.9w~.--~J'~~. County Tax Map No. 1000 Section ..... ..~.,.~, ,,,"~, .... Block ....... ~;~,--~ .......... Lot No. P~: .,~' .,~ to application dat~ .~..~....t.~ .......................... , 19.~.~,, and approv~ by the pumuant Building Insp~tor. Building Inspector Rev. 6/30/80 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . .~ .~"~ . }. ¢-,-..., 19 Approved ..^~O.~. J..~-.-, 19 ¢?.tl Permit No. ) .... ~L) Disapproved a/c ..................................... ...................... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ~19... 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 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 pumuant 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?~e_re~t, described. The applicant agrees to comply with all applicable laws, ordinances, buil,d4ng code,_housing code, ~i~l ;r'eg~)3fftions, agd to admit authorized inspectors on premises and in building for necessary in~ff~tions./~ / // ///~//~, ~ ..... -' (Signature of applicanf_,/or_nan~, if a corporation) ''" f' £ ' ' (M'aili~i ~d~;e's~ olapp~,can ) V-'~--'t:£'-t}"'/'/ ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ?;.4 ................................................................ Name of owner ofpremises.........~x~XJSV..~. ...... .~.~.%~.~. ............................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... (3-- 1. Location of land on which proposed work will be done. 1.~.~. ~(~¥¥.~ .~...i...~f?~..~..~.~..~.x~. 4..~ ........... ...... ........................................................... House Number Street Hamlet County TaxMapNo. 1000 Section ..~.C)..~..~...i ...... Block ..~. .............. Lot...~. ~....~L~. ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. 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 . .~.~.~.'..C~.~r... ~ .... .~:.~.. ......... .~....~. · .~..~. · .?Affh. ..... ,9. 10. 11. 12. 13. 14. Name of Owner of premises .. Name of Architect ......... Name of Contractor ........ 3. Nature of work (check which applicable): Addition .......... Alteration .......... Repair .............. Rem6val ............ Demolition .............. Other Work ............... i 21' (Description) 4. :stimatedCost... . ....................... Vee ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... 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 ..... if any: Front Rear Depth · D~mens~ons of exmlng structures, ............................................. Height Nuinber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ...................... Number of Stories ...................... 8. [)imensions of entire new construction: Front ........... Rear ............... Depth ......... Height ............... Number of Stories ........................................................ Size of lot: Front ........... . ........... Rear ...................... Depth [)ate of Purchase . Name of Former Owner Zone or use district in which premises, are situated .................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No .................. Address ................... Phone No ............... ................... Address ................... Phone No ................ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli 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 interior or corner lot. , ~' STATE OF NEW~Y~K, ,~ ~ COUNTY OF...~7>b~.~..~..Lt~. .... , ' cx~ ; Mxr~ ,e--v,.~..Xt, s .vbL.~).~.~.~t~...,-.k~. &~,X~.. ~...VOL~....~r~. l~v~V3 .... being duly sworn, deposes and says that he is the applicant (Name ot%-~ndividual signing contract) ' above named. Heis the (Contractor, agent, corporate officer, etc.) of said owner or owners, 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 filed therewith Sworn to before me this Xx. da oflJ /D . Notary Public, ...../¢~...~..~.&..~...a~.. .... County /// / NOTARY PUB[.IC, State of Now ¥or~' // (Signature of applicant) j '\ No, 4707878, Sull01k Cotml~/ ~ FIAt` A. MENDEL'~ - MAY ~_,,, 1984 .... ~lCK VAN T~YL, F.[. ' ,~. ~, 7'~ LICEN~D LAND SURVEYORS ~EE~T NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT· OF HEALTH SERVICES. APPLICANT SUFFOLK SERVICES - FOR CONSTRUCTION ONLY DATE· H. S. REF. NO.. APPROVED: COUNTY DEPT OF HEALTH APPROVAL OF SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK P~L. ~OC)O . 097 5 I.~O 4. TOPSOIL '- fiXAtE' OF' SANi£.. GIP,.AVEL SEAL