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Home My WebLink About16276-z FOII~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 16276 z Permission is hereby granted to: ot premises located at ...,.~..~..~. ........ _.~- ^ _ e----. ,~~''''J'')'~'''~''e~4~ ...... . ,~~ .............. ....................................................................................... County Tax Map No. 1000 Section .... ...(~.....~k-.~ ........ Block ......~....~ ......... Lot No.....L~. ................ pursuont to oppli¢otion det~l ............ ~.~ ................. , 19.~...~.., ond oppro¥od by the Buildlng Inspector. Fee $.,,, ,~...:...:~.... Rev. 6/30/80 BOARD OF HEALTH ...... 3 BETS OF PLANS ....... FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK ~../..~.3..P~. BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL . 27¢.~ .77.-- .. ~ 0 MAIL TO: Disapproved a/c ..................................... ~'~ / [.5 - (Braiding In'- _ .. ' spector) ~ ........ APPLICATION FOR BUILDING PERMIT Date .................. , 19... 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 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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ..................................................... · ' , ,.,, _... Nan~e of owner of premises . .'..'...~.T..~-../-~ .~. ......... .tC~...~.~.'. ~..~.. '. :~..': ............ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CO~TRACTOR'S HUSTLE .,,q. IJFFOLK COUNTY LICENSED Builder s License No ...... ,,~.~..~. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ...... ......... .......... ...... House Number Street Hamlet County Tax Map No. 1000 Section ...... q.~.. ........ Block .... .~. ............ Lot .... 13 ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy b Intended use and occupancy ~. ~.~ .~//'~,~ ....................... 3.. Nature of work (check which apphcable):' ' New Building · Addition .......... Alteration .......... Repair Removal ..... Demolition ......... Other Work 4. Estimated Cost ........... ? ......................... Fee ...................................... (to be paid on filing this application) 5. If dwelhng, number of dwelhngiumts ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ....... ' .............. 7. Dimensions of existing strnctur~s, if any: Front ................ Rear .............. Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ................. Relr .................. Depth . ~,! t9 ~' 't~ ....... ... Height ...................... Number of Stories ...................... Dimensir{fis ofe~tfl~t~ew construction Front ....... . Rear Depth Height Number of Stories' Size of lot: Front ' .... Rear .- ............. ~ ....... Depth ...................... Date of Purchase .......... ! ................... Name of Former Owner ............................. 1 1. Zone or use district in which prlemises are situated ..................................................... 12. Does proposed construct,on wolate any zoning law, ordlnance or regulation: ................................ 13. Will lot be regraded ........ ! ..................... Will ex~e~, fill be removed from premises: . Yes No Name of Architect .......... . ................. Address ~ .................. Phone No .................. 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No *If yes, Southold Town Tr6stees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly alI buildings, whether existing or proposed, and, indicate all s~t-back dimensions from property lines. Give street and block number or description accordin interior or corner lot. i to deed, and show street names and indicate whether / / .... FE.E.~~B ..... NOTIFY ~ILDI~ gEPAflTM~T AT ?B~ 1~2 g Ai~ T~ I ~ ~ THE FOR POUflEO ~UG~ F~AMtN~ ~t. INStILATIOi~ ~, FINAL CONSTRIJCTION MUST BE, COMPLETE ~O~ STATE OF NEW YORK, ~ ,ALL CON~T[tUCTION SHALL MEET I S.S THE REQUIIflEI~ENTS OF THE N.Y COUNTY OF ................. i ,G'TATE CONSTffiliCI'ION being duly swo cant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application; that ail 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 , · HELEN &DE VOE NOTAI~Y PUBLIC. $t~d:~ of New,York . Ne, 470787~, $~,ffdk lerm Exl~J.res March 30, 1~.~ i