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Home My WebLink About16644-zTOWN 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_l 6644 z Permission is hereby granted to: ................ ....q'....'.~.~.,~.~.,,~ ........................ ~- "~~, ~o.~. -'-,, ,o ~.~....~.....~..~..L:..~ ....... ~~. .............. .,~ ,, ~,, ,~,~., .b.~L~.~.~.~,.~...~..~.~..~:....~.-~.~.. County Tax Mop No. 1000 Section .... ..1~....~....~.. ....... Block ....... ~..~. ........ Lot No......~..~ ........... pursuant to application doted ..~.~...~T~.,~. ................ , 19..~..~..., and approved by the Building Inspector. Fee $...~.L..~ ..... Building Inspector Rev. 6/30/80 Examined .~..~.~.., 19~. ~. Approved ~. ~'~f~ .~....~.~.., 19~.'J· Permit No.J.~.(~ .~.~..~... Disapproved a/c ..................................... ................................. (Building Inspector) APPLICATION FOR BUILDING PERMI' BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK - ' ........ BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL 8OUTHOLD, N.Y. 11971 NOTIFY 7~~Ak]~~~''~~ TEL.: 765-1802 CALL MAIL ~ Date. .... I..O.. :.~.{ ..... 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 building for necessary/¢5kpections. admit authorized inspectors on premises and in ' ' :~'" ': ' '~~ 'c;;';;a't;~ .... (Signature of applicant, or na~e, if a p ' ) .............. :... (Mailing address of applicant) State whetherjl ~ / ;applicant~ C<e_~r lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......',., .... o. ..................................................... Name of owner of premises ~[N.~, .~¢.tq.q-V ~.~.~ .eT... ~.,.~.t%.X} .C--..['x .......................................... (as oh the tax 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 License No ....................... Other Trade's License No..[.[).(¢. ~..~. t-~.~ .... 1. Location ~.Ja~w~ic~ .proposed work will be done~ ................................................. .... X. ~ ¢,-~ ................ .G'., L. k.*..~ ~..'b..~.,.~.~ ......... .E.,,,s. ?.4.....t%,~.,¢.o. ............ House Number Street Hamlet County Tax Map No. 1000 Section ...... ~..~. ........ Block ..... .~. .......... Lot .... .~. ............. Subdivision ..................................... Filed Map No. . ~..0.~.~ ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~. '~.\\ .~ .... ~->~..~......-~.~ fO .%-.~'. ................................. b. Intended use and occupancy .... .~..O.,..~? ...... ~-~.~..c<.\.~.~-~>.~.....~...e.~...Cm..er_. ....................... 3. Nature of work (check which applicable): New Building ... ' Addition .......... Alteration ... Repair .............. Removal .............. Demolition ......... i .....Other Work .............. 4. Estimated Cost .... .~g.[ .~..O..O..'.~.--~. Fee ....... . . ~ " (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ ......... Number of dwelling uhits on each floor ............... If garage, number of cars ..... [ .................................... i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each iyp,e of use .... .I~. ~ ........... 7. Dimensions of existing structures, if any: Front .... .q.~5, O ...... Rear ... L ~'~.,..~.~... Depth ... I O.o. *.,.O... Height ... I~.& ......... Number of Stories .... I ..................... i .............................. Dimensions of same structure with alterations or additions: Front ...,~& t%~ ...... Rear .. ;-~ .~. ......... Depth ...~N~.~- ............. Height .... .1~..N ............... Number bf Stories ..... } ................ .... 8.Dimensions of entire new construction: Front ...~..&.~..~... .... Rear ...~..,~..¢:x..~: .... Depth ...~.,~..~%ar ..... Height .... .D.~. ........ ~lumber of Stories ...... t ....... / ........... i.. 9. Size of lot: Front.. ...~1.~, .O. ....... ' Rear .... t~ .5.. ~. ....... !. Depth' .............. .... [~ .o.,~ ............. 15 .......... 10. Date of Purchase ...}4.1% ......... i. iiii ....... Name of Former Owner: .... ~. I~, .................... I 1. Zone or use district in which premises are situated ....................... i .................... .......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..! .............................. 13. Will lot be regmded ..... l~ .~ .................. ~ Will excess fill be removed from premises: Yes 14. Name of Owner of premises.,.,.. ................. Address ............. i ......Phone No ................ Nmne of Contractor ..................... Address ' I Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~.. *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 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, ................................................. being duly sworn }Ge~oses and say,that he"is ~he ap plicant (Name of individual signing contract) . I above named. (Contractor, agent, cor orate officer, ¢ of said owner or owners, ~d is duly authorized to perform or have performed the~ said work and to m~e ~d file this application; ~at ¢1 statements contained in this application are true to the best of his knowledge and beilef; and that work will be perfo~ed in the m~ner set for~ h~ the application filed therewith. Sworn to before me this ............. d~.: ..... day of... ~ ............ 19 Nota~Public, ..~..~.~~... County ~A~ ~8tl~ ~ ~ ~w Y~ (Signature of applicant) . ~ 4707878, Suffolk ~un~ le~ Ex,res Ma~ch 30,