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Home My WebLink About16312-z FOU~' NO. Jl 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) Permission is hereby granted to: ................................................ .....~.:~..,....!..!~.;~..~.. ........ at premise, Iocoted at ..~...o..~.~. ..................................................... County Tax Mop No. 1000 Section .... ..~....~....~'.. ...... Block ....... ...~....~ ....... Lot No ......J....~. .............. pursuant to application dated ....~d~.~:9..~..,......~ ................... , 19.~..I..,~"~'~ Building Inspector. Fee $.~...:..~. and approved by the Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... ~l~:.~r"~ "'~ \\/I ~ *~ 3 SETS OF PLANS ....... j~ ......... ' 'FORM NO. 1 SURVEY ......... ~ ...... ~;~ TOWN OF SOUTHOLD CllECK .......... /i I11~3-19~t,i~I BUILDING DEPARTMENT SEPTIC FORM ............. ~ ~ ~ TOWN HALL uk .......... ~j[;~;~[~;"r' ........ ~'": ~ 8OUTHOLD, N.Y. 11971 NOTIFY TCW "op'S¢)~'~ '~O[ O T~ . -1 3 CALL ............. Examined ., 19~7. Disapproved a/c ..................................... ....... (Building Inspector) APPLICATION FOR BUILDING PERI,lIT Date ................... 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Pemnit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to th~ Builgli/a$ Dcp~tm~nt for the. i~u~,cc of a B~lding P~rmit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Otdln~ee~ 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) (M ailing address of applicant) (Name aRd title of corporate officer) - ALI, CONTRACTOR'S MU/i/ fig SUFFOLK COUNTY LICENSI~D Builder's License No .... f)..O../~. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plqmber or builder. ... t'~ ~t ~. K '/ ' ~,~OV~;',/AS Name of owner ofpre~nises O.~'~.l. g ~ .... ~ .~'. ,,.~ ..... t ........... : .... ., .................... ~' ' (as on the tax roll or laJ~g~eed)~_2 B.P ~ If applicant is a corporation, signature of duly authorized officer. D~, ~ ~v ~ FOLLOWING FOt~NOA~O~ TWO 1. Location of land on which proposed work will be done..~. C~ES NO1 ~,~3~LE .... .................. :dz o.86., .... ......... ............ llouse Number Street }Ianilet 000S c on ......... .... ............. .... ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: 't bt Dtended use and ccc ~pancv ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........ Repair ............ Removal .............. Demolition .............. Other Work.. 4 EstimatedCost....~..~'~0~.(..~.1> ........................................................... ....... Fee " (to be paid on filing this application) 5. If dwelling, number of dwalling units ............... 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. Dimensions of existing structures, if any' Front ............... Rear .............. Depth ........ : ...... Height ............... Number of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nmnber of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ..................... 10. Date of Purchase ............................. Name of Former Owner ............................ 11. Zone or use district in which premises are situated .................................................... : 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ..Yes No 14. Name of Owner of premises S./{~/.t~t~. ~.~.S./~. ~t.. A ddress~.~.~. ~. t'.~.~..$'.~.~.~..'~.. Phone No Name of Architect ........................... Address ................... Phone No....: ............ Name of Contractor ~r't,0~'~//.0 ~/(../~.~lqq!..~ ...... Address~.~. ~.J(. ~ff./a. j~..t4~.:.. Phone No. ~;~.~ .'7.~. ~.~.~.. 15. Is ~:h±s property located w±th±n 300 feet of a t±dal wetland? ~Yes ..... No ~... *IX yes, Southold Tox, m Trustees Perra±t may be requ±red. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-back dimensions from e whether 1111¢~. r~JlV¢ ~/tlt~t~t allU blOCK numuer or oescnprlon accoram ro aeea ~a sno~ ' street nines an~ ~ __~- ~ .... NEW YORK. ~ . COUNTY OF ........ . ......... S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, m~d 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 ............. ~ ......... day of ..... ~ .......... 19 ..~.~ Notary Public ............ County HELEN & DE NOTARY PUBLIC, Sbt~ ~f t4ew York .......... No. 47o71r/8, Suffolk Co,My ~' (Signature of applicant) Te~m [xpi~ Mefch 30,