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Home My WebLink About16278-z FOR~ NO. B 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) NO_ 16278 Z Permission is hereby granted to: ~ .~,..¢...~.~.~. ........................................... ......... ,o ........................................ at premises located at ....~..~'~.~.~......~ ........~......: ...... ~ ....................... County Tax Map No. 1000 Sec~ion'.......~..~...~. ...... Block ....... ..~....~. ....... Lot No..~,...g.. ................ pursuant to application dated ......... ....~....~....~.'~ ............. ,19.~.~..., and approved by the Building Inspector. Fee $. ~P~'~'...~. ............. Building Inspector Rev. 6/30/80 Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLO, N. Y. 11971 765-1802 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [] ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL REMARKS: · ~'-' '~_.. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK ~-:::::::: BUILDING DEPARTMENT SEPTIC FORM ............. : Examined TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ;~..-/.., 19~. 7. Permit No. ~. ~ .~ .'7.'~..~. NOTIFY CALL · .4~ ?~7 .... MAIL TO: Approved Disapproved a/c .............................. . ~ . ./~ ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filied in by typewriter or in ink anc~ ~ubmitted 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 ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ 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 oPappticant) (Name and title of corporate officer) ALL CONTRACTOR'S MUST J~E ~IIFFOLK COUNTY LICENSED Builder's License No ...... ,~..~. .............. I~.. Plumber's License No ......................... Electrician's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or lates~eed) ' f · If applicant is a corporation, signature of duly authorized officer. NOT~FY ~ILDING DEPArTMEnT Other Trade's License No ...................... T~ REQUIREMENtS C~- ~'P~: N Y 1. Location of land on which proposed work will be done .................. .~ ...d.7 ........... ....... .......... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~x[. ........ Block .................. Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed c6nstruction: a. Existing use and ocqupancy .............. t~/~-~.....~. ~ .................................... b. Intended use and occupancy ...... ~..~..~.Z~t.~. ............... ' ................................ 3. Nature of work (check which applicable): New Building ..... · ....~?~ddition .......... Alteration ........... Repair .............. Removal .............. Demohtmn . .,.: .......... Other Work .... ~ /~../~/ ~ ~(Descrip,tion) 4. Estimated Cost ......... /..,~.t_ t.: ..................... Fee .................................... ~ " (to be paid on filing this application) 5. If dwelling, number of dwelling! units ............... Number of dwelling units on each floor ............... If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ..... ................ 7. Dimensions of existing structures, if any: Front ................ Rear .............. Depth . '. ............. Height ............... Number of Stories .............. ' ........................ Dknensions of same structure with alterations or additions: Front ................. Real' .... ~ .....' ........ Depth ........... Hmght ...................... Number o tories ...................... 8. D~menmons of entire new construction: Front .......... . ..... Rear ............. Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 1 1~ Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vidlate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .,,., ..... . ...................... Will excess fill be removed from,p,.renlis~l~k-~,-, Yes .~ No 14. Name of Owner of pz~t~P/~st'?.e.?. .~.~.-Y~¢~'~... Address/~./. $Rlxrot~ Rb ([,~gb~eotnr~ i~g."~F~-r~ o o. ¢.1 .. Name of Architect ......... I ............ i... i. Address' .i ii i i i i i i i i i i ii i i iPhone No. ~O.S'..:'i~ .k?../'~/ .... Name of Contractor TffJ~ FO£,f..~:~.~ff, ......... Address .P,.0.,ZoZ ~f~../q/fT/7. Phone No ,Afar.".5(. f.~. ~. .... 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... No z~... *If yes, Southold Town Tr6stees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and~ indicate ail s~t-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~ ~._ STATE OF NEW YORK, COUNTY OF ................. S.S .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. ~ lle is the ..................... ' .................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dally authorized to perform or have performed the said work and to make and file this application; that all statements con~ained 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 befo[e me this ........... · ~..~ .......... day Of .... .~-f-~. ......... , 19 ..~? Notary Public ..... ~...~:..~..~.~.~.~t-~.g'.' ... Co~ ~ ,Et~ & ~£ ~0£ : f//. (Signature of NOTARY PUBLIC, State of New york applicant) . No..4707878 Suffolk Coufltyp.q lerm ~pires March 30,19~ '