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Home My WebLink About16224-z FOR~ NO. ~B TOWN OE SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~16224 z Permission is hereby granted to: i~..~t.2.~.o.....~.~....~.., ....................... ~..l~~...~.:.~.:....u.~.:~? ....... ....... ..................................... at premises located at ...~../...~.~.,~?.......~..~..~:?....~ ........ ~~~.....~..:,.L~..%../.../...~....~....... County Tax Mop No. 1000 Section ...... .(~..~..~. ..... Block ....... ..~...~ ...... Lot No ......"~l ........... pursuant to application dated .......... ..~...~......C~. .................... , $9.~..~.., and approved by the l/ Building Inspector. Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... '~o.~ ~o. ~ S~RVE~ '..~.. ' ' '~'~i¢¢' TOWN OF SOUTHOLD CHECK ~5~ BUILDING DEPARTMENT SEPTIC FORM - TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~ ~. l .~.., 19'?. Permit No. ] .~..~..~.~ .~.. Disapproved a/c ................................... ~ ( BmTding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS NOTIFY CALL ................ MAIL TO: 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 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 inspec~ . ~ //.)..~ .~ ...... (Signatffa~ ofa~lgpli'~ant, or name, ff a corporation) . .:.:. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ .................................................................... Name of owner of premises...~'/f]~ ~...d..,. '.~..~ '~.'./~..~./~.~'7...-.~......~... :.~.~. Z,~7~.-.~. · .~. ...... (as on the tax roll or latest det~j:~O¥~D ~ If applicant isa corporation, signature ofduly authorized officer. ~TE: '7/]~7. B.P ~. .............................................. F~: ~£'-" ~V. ~/. (Name and title of corporate officer) . NOTIFY BOILD~NG OEPARTMfNT AT ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 76S-1802 9 A~t TO ~ ~ FOR THE Builder's License No .......................... FOLLOWING INSPECTiON,q; Plumber's License No ...... ; ......... FOFt POURED Electrician's License No ....................... &. INSLILATIO~2 al,, FINAL CO~STRLJCY ON MUST BE COMPLETE ~OR C.O. Other Trade's License No ...................... ALL CON,~TRUCT~ON SHA~,L MEET TI-rE REQUIREMFNTS Off THE N,Y l. Location of land on which proposed work will be done~ ................. 8TATE.~;ONS.~T~E.I'IOf~ & EN~B~Y · . · .../¢./. 7 f.0 ............ ............... House Number Street Hamlet County Tax Map No. 1000 Section . ~. ,~'.(O.-..~..~. .... Block .. ~.,/.,. ~./~ ....... Lot .~..~. '~' ',...~.t~.~... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: b. Intended use and occupancy · ~--~W~ ' , r 3. Nature of work (check which aplplicable): New Building ..... ' ..... Addition .......... Alteration .... Repair .............. Removal .............. Demolition .............. Other Work..~..~..~.~.t ~.. 4. Estimated Cost ........ ., ..................... Fee .............................. : ~ (to be paid on filing this application) 5. If dwelling, number of dwelling pints ............... Number of dwelling units on each floor ................ number of cars If garage, . ....~ ................................................................... 6. If business, commercial or mlxe~l occupancy, specify nature and extent of each type of use ...... 7. Dimensions of existing structures;if any: Front ~ Rear .... Depth .; ........... Height Number of Stories ' ' Din~ensions of same ~t/~ctu~ith alterations or additions: Front ................. Rear Depth .................... ... Height ...................... Number of Stories ...................... --,8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Nm~ber of Stories ........ ......... ....................................... 9. Size of lot: Front ........... ........... Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ......................... 1 3. Will lot be regraded ......... ! ................... Will excess fill be removed from premises: ("Y.e_s~.). No 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect .......... ................. Address ................... Phone No ................ Nmne of Contractor .......................... Address ................. Phone No.,,..L/ ........ 15. Is this property located jwithin 300 feet of a tidal wetland? *Yes ..... No *If yes, Southold Town Trustees Permit maybe required. ! PLOT DIAGRAM Locate clearly and distinctly all: buildings, whether existing or proposed, and. indicate all sbt-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 YORK, S.S COUNTY OF ................... ........ ..... /..t"/~./~'~./F./d / &'7. ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (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 al/ statements cont, ained fin 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 Notary Public, .......... UNDA J. COOPER // (Signature of applicant) I Notary Publlo, Stste of New Yor~/~/ No, 4822563, Suffolk County,~ Term Expires December 31~ 19 · 0 m 0 'q <~ 0 ~ ,,J. r:. 6' ~ 5 0 C2 Z -< Z