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Home My WebLink About16615-z FORB[ NO. ft TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*_ 16615 z Permission is hereby granted to~ ............ . ,o ot premises located at .,..-'],..O..J,.-~.7...~.~......~ ......................... County Tax Map No. 1000 Sectton~ ......... .~. ........ Block ..... ..~...~. ........ Lot No....1 ............... pursuant to application dated .....~...~....~. ................. , 19.~..']., and approved by the Building Inspector. Fee $.~... ................. Rev. 6/30/80 SECTION TttRU date:--- ~ s~l~: re---~'. ," --1 dwn.' NONE ~,;0DEL: MANUAL VENT (AUTO. OPTIONAL) TOP OF RIDGE 12 3¼ 8'-5 9/116'" 12 PURLIN 2'-0" R. PIPE GIRT TO GLASS BRACE LINE t .ASHING BY OTHERS · 9'-1 9/]6" wEATHE ALUHII B~RCA~ DS-B GLASS WALL 2'-10" BENCH BENCH OR C.M.U. BENCH 3'-0" 3'-0" 3'-0" FTG. 10'-3" -- CONT. CONC. FTG. 12" x 20" SQ. SECTION THRU SUN VALEEY GLASS-TO-GROUN D, CU RVED-EAVE MAIN O: 30 '0 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... ~ '. TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Examined../Q eJ?:c-v .~. Disapproved a/c ..................................... .................................. (Building Inspector) Date ! .~...~..x~.,, 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 tl~is 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 cod. e, and regulations, and to admit authorized inspectors on premises and in building for necessa~ons..-(~ ~'J¢l' .... ~:-~ .......-~ (Signature of applicant,Xor~aYne, if a corporation) ~ .~ V, (Mailingaddr¢ss of applicant) ~ c "xwoLd,. ¢o \ \u State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleciriciaB, p~umoer oro ilder. Name of owner of premises .... ,. .[~... .QO.~. ,. .C%. /.FI~ ........... (as on the fax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's LicenseNo ....................... 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 .... '~l.~,~..~ ........ Block .... ".[.'-- ........... Lot .... .~.,.~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ' Addition iv/' ...... Alteration .......... Repair .............. Removal .............. Demolition ... ~ Other Work ............... 4. Estimated Cost .x.~....'~ ~ ~ ~-~, O O Il ~ .- (Description)x, ................................ (to bXe paid on filing this applicat~) ' 5. If dwelling, number of dwelling units ....... ' ........ Number of dwelling uhits on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each ~ype of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ... ' ...... Depth ............... Height ............... Number of Stories ..... oQk ................... : ............... .. Dimensions'of same structure with alterations or additions: Front .......... i ....... Rear .................. Depth ...................... Height ........... \ .......... Number of Stories ...... Dimensions of entire new construction: Front ..... N..~3~, . .... Rear...~..X..Z~.. Height ............... Number of Stories ....................................................... Size of lot: Front ...................... Rear .................... Depllk ................. 10. Date of Purchase .~,3.~)k3 ~ k.~.'.-h,°.J.3f~kc~.t.9.qq.b~ .'.~ Name of Former Owner .... '.'$5~.~.<~..~.. ! 1. Zone or use district in which premises are situated ....................... ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..!....~...C). ................ i ..... 13. Will lot be regraded ........... Will e~cess fiji1 b.e removed from premises: Yes ,M,No 14. Name of Owner of premises i'.~i4~ib~-}~i[i~.' 51 i i i.. Address ~.Cl~.~..¢f~'~Cl .k~.. Phone Nd.-'l.{o~'.'-.'~.(5.~,C~ .... Name of Architect Address ' Phone No Name of Contractor ........ ~ ................. Address .... ; ........ : ......Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *~es ..... No .)g'... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dhnensions from property lines. Give street and block number or description according to deed, and s~ow street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ' above named. : .' . . ~ I'~,I,;~ ~. ~. . ......... Heisthe .................................................... .[h~ · · ., ~,.[... (Contractor, agent, corporate, owner or owners, perform or perf,: ~ '(oj ~e and file this of said ~d is duly authorized to have ~d a. id~¢tk:and application; that all statements contained ~ this application are true to t~ ~$s[~gf gis ~go~ledge~ ang~bglief and that the work will be perfo~ed in the m~ner set forth ~ the application filed the ~$,~ ~ ~ ~ ~ l,q~, *~ D* i~ Sworn to before me thi~ ~.~r;.k~;~ .............. ........ -' , $ota~eublic, ..~ ....: .................. Coun~'"'['~a ~~% ] ~ · ....... . ~.J~*~,~ ~ ~ lSignatu~ m applicant)