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Home My WebLink About16270-z Fou~r NO. 0 TOWN OF 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) /__ NO_ 16270 Z Date ....... ..~..~......~.....~ ............. ,19..?...7 Permissionisherebygrant~,, ~C~' i~ ,o ................................ mo ,~ ..... at premises I~ated at ........ ~ ].~ ................ ~ .... County Tax Mop No. I000 Section Ob 0 Block ~ J Lot No. ~ ..~ pursuant to application doted ............. .'5~.~....~.....~.. ............. , ,9~.~.., and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 DI.DC,~, DEPT. i'OW~.t OF $OUTHOLD MAIL TO: Examined ·----'~' "' 'i Approved . .~.~ .... ~.., 19~7. Permit No./. h Disapproved a/c ................................... (Building Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... · TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 76§-1803 CALL ................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 ~vhich is part of this appli- cation. c. The work covered by tkis 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 HEKEBY 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 necessfiry inspections. ......... (Signatttrtt~f applicant, or name~ if a corporation) - ~'O' ' '~' ' i~5'l~(i~ii~ address o f applicant.) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .~.~.eo:w~.cc,,. [...C~.~,,-.t>,'o-'r.o. ~ .... ~ .......................................................... Name of owner of premises .......... .~..t .]. ? J .~'x .& ......... .~. o.~ ~ ............................. (as on the tax rolI or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... .~.~.~.~ .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...9.0 .......... Block ....~..! ........... Lot....O..~. ............ Subdivision ..................................... Flied Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: sIgl oI~ puu o~m ol puu ~ao~ ,[us oql po~oj~od o~u~ ~o ~oj~od ol po~oqlnu XInp si p~ ~saou~o ao aou~o plus, j{ ('olo 'loo~jjo olulod~oo 'luo~ 'Iolou~luoD) ..................................................................................... oql st · po~uu oAoq~ lUUo[[ddu Oql SI O~ lUql SX~S pu~ s0sodop 'uao~s/[np ~u!oq ............ ~? ~ .~,¥~ ................................ · 1oI zouaoa xo ~o~olul ~oqloq~ ol~olpuI pue someu loo~ls ~o~s pue 'poop ol ~ulpzoo** uolldposop xo zoqmnu ~aoiq pu~ looals oA{D 'souu ~o~j suolsuo~p ~auq-los I~ ol~:~lpul'pu~ 'posodo~d xo guUslxo ~oq~oq~ 's~WPllnq I~ XllouBslP P~ AIZUOlO pazTn~az aq~*m ~Tmza~ sa~sn~Z ~o~ ploq~nos 'sa~ oN soX :sos[mona mo~j po~omo~ oq [IU ssooxo Ill~ ............................ pop~oz oq ~oI I~ .......................... ~'~'' :u°lluln~°:x°°ou~u[P~°'a~l~ulu°zXue°lel°lau°llonIlsu°°p°s°d°ids°°G 'gE .......................... ~ .......................... po;en;ls oa~ sost~osd qotq~ ut lolllstp osn ~o ouoz ' I { ~ouaO ~o~o~ jo OmUN ............................. os~asn~ 3o oleg ...................... qldofl ...................... ~o] ...................... luoId :lo[jo oz18 '6 ....................................................... souols, jo ~oqutnN ............... lqgtOH. ............... qldoG ............... ~o~ ............... 3uo~ :uollanslsuo9 mou o~[luo jo suolsuomlG ...................... souo~s, jo ~oqmnN ...................... lqSt~H. ...................... .................. aeo~ ~ luox~ :suolllpp~ Jo suo~le~o;lu. ~t~, ¢xnl9mls omus jo,suo[~uo~ .......................... ............................. souols, jo ~oq~nN ............... *H ' qldoG ...... i ....... ~u,~ luoJH :Xuu j[ 'so~n~omls ~u{lslxo jo suo{suo~{O 'L ..................... osn jo ~odXl qouo jo luolxo puu o~nluu Xj[aods 'Xou~dna~o pox[m ~o [~{~ommo~ 'ssoulsnq JI '9 ....................................................................., ' · · s~o jo ~oq~nu 'o~mu~ JI ................ ~ooU qouo uoj sllun ~UlllO~p jo ~oq~n~ ............... sllun ~UlllO~p jo ~*qmnu '~ul[io~p JI (uo{l~o[lddu s{ql ~u{Iu uo pied oq o~) (uou'dl~osoG) SURVEY OF PROPERTY AT SOU THOL D TOWN OF SOUTHOLD SUFFOLK COUNTY N.Y. to00-80- 01- 0,4 SCALE 1":; $0' JUNE 2~, 19B7 C. NO. 4966~ ;/NEERS RC, :P[CONIC iRO. BOX 905 54655 MAIN RO,AD SOUTHOL D~ N~Y. 1/971 87- 52 5