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Home My WebLink About16313-z l~O~t~r NO. ~ TOWN OF SOLITHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. 1'. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~X~ e /~ ~.~.~..~..~.:.~...,., ..... .....%.. ~..~. .. !.!IC ~---... .......... ............................. ........ .~....~.....~.~.~ ...................................................................................................... Coun~ Tox Mop No. 1000 Section ..... ~..~.~ ....... Bl<k ....... .~..~ ..... Lot No. pursuont to opplicotion doted .... ~~....~. ............... , 19.~.~.., ond ~pprov~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORK FENGE GO. ROUTI2 48 MATTITUCK, NEW YORK 11952 Phone 298-4777 'FORM NO. 1 TOWN OF SOUTHOLD CliECK BUILDING DEPARTMENT gEPTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL BOARD OF HEALTH ...... ~ . ' 3 SETS OF PLANS ....... SURVEY .......... FORM ............. : · . 7.77 TO: Exanffned . .C~,..~.,~ ~.?..~..., 19 ~. 7 Approv V-~.~J~...~.., 19~. 7. Permit No. Disapproved a/c ..................................... (BhStfling Inspector) APPLICATION FOR BUILDING PERMIT 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 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 ~ 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 anthorized 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, plqmber or builder. Name of owner of premises .~7./~.~'.~,, ~. ~ ~ ~ ~ j , If applicant isa corporation, signature of duly authorized officer. FE~:~'~---MY: ~' ~' - NOTIFY ~AL,[~N(, D~P~F~TM~ AT ............................................... (Name and title of co,orate officer) , FOG.OWiNG ALL CO~TRACTOR* S HUST ~BE SUFFOLK COUNTY LICENSED FOij~OA~'~O~. T~sJO~fi(IUI~iD,,: Builder s License No...~.~. ................. PinmbCt's ~Jcense No ......................... ...................... ~;E CC:¢~Ok ¢:~ {: ~:O~¢ iLO Electrician's License No. Other Trade's License No ...................... I. Location of land on which proposed work will be done ................. .../o ................... '. 17'2 ¢;r D ...... t ............. ltouse Num her Street Hamlet County Tax Map No. 1000 Section/~ ....... B~ck .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises ~ intended use and occopancy of, proposed construction: a. Existing use and occupancy ............................. b. Intended use and occupancy ... e.~/ ................................................... 3. Nature of work (check which ~applicable): New Building ..... ' ..... Addition .......... Alteration ~ ....... Repair .............. Re'oval .... ; ......... Demolition .............. Other Work ........... i ~ (Description) 4 Estimated Cost ~ Fee " (to be paid on filing this application) 5 If dwelling ' ' ' Number of dwelling units on each floor . , number of dwelling units .............................. If garage, number of cars 6. If business, commercial or mi~ed occupancy, specify nature and extent of each type of use ..................... 7 Dimensions ' ' ' if any: Front Rear Depth · of existing strUctures, ..................................... ; ...... Height ............... Number of Stories ................................................. . ....... Dim sio of 'th alterations or add'tions' Front Rear en ns same structure wi ! ................... . . . ........... Depth ' Height Number of Stories 8 Dimensions of entire new construction: Front ~ Rear Depth Height ............... Number of Stories ...................................................... 9 Size of lot: Front Rear Depth 10. Date o£Purchase ......... ! ................... Name of Former Owner ........................... 11. Zone or use district in which p. remises are situated ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................ 13, Will lot be regraded ....... i .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .~ 0~q ~...7~.,~ tq~'<,Lt~JAddress ./0 ,b'.C2r. d~?..ff~./0(//~..Phone Nod~Tt~...a°~0. ~>.-~. ·. Name of Architect ........ ; .................. AddressA . .A ............... Phone No ................ Name of Contractor~J~Lo,0M. ~,7.0J¢~,,. ~.~..~.~.~.... Address~O D.&~ ~/~..~. S{4t/~'~.,.. Phone NoPf..~g.~. ~..~. .... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ~... · If yes, Southold Town T~ustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-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 ................ ~ b g d ly th t he i th ppli ............................ , ..................... tin u sworn, deposes and says a s ea cant (Name of individual signing contract) above nanled. He is the ..................... (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 all statements contlained 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 ......... ~ ..... aay o{... · · .--:"~. ~ ~ DE ~E ~ ~BUC, ~eof ~w Y~k ............ , lo ....... County z/~ 7 /// ~o ~, ,.~ (Signature of applicant)