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Home My WebLink About16651-z !~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby grantq~,to: 'x -- .... ~.~./.......~.....~.~...~. ....................... - ................ ...~/..~.~..,......~....~,.....~..~.z.~..~ .... ,o .......................... at premises located at ...~..~..~...~:..?.. ........ ..C~..~...~..~.....~...~..~ ..........~.~~.~.....;.,. ....... County Tox Map No. 1000 Section .... ..o...~...~.'~.. ....... Block ..... .,~....~,. ......... Lot No.....~...~. .............. pursuant to application dated ..... .~....~.~,.....e,q,..~. .......... , 19.~..~.., and approved by the Building Inspector. ul ding nspector Rev. 6/30/80 3. Nature of work (check which applicable): New Building . .~?.~. ..... Addition .......... Alteration ,,. ~, ....... , Repair .............. Removal .............. Demolition .............. Other Work...~.. jc~../% .~ro,~t ~~ (Description) 4. Estimated Cost ...................................... 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 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 ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .................... .~ .................................. 9. Size oflot: Front . .. ,,friar...~; .......... Rear ...... .~.~...~.9 ....... Depth ...~.o ~. l..t~.0 ........ 10. Date of Purchase ..... t"~/' '/* Name of Former Owner ................ 1 1. Zone or use dmtnct ~n 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 15. Is this property located within 300 feet of a tidal wet~and? *Yes ..... No ~. *If yes, Southold Town Trustees Permit may be 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, S.S ' COUNWY OF ................. ................................................. 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, and is duly authorized to perform or have performed the said work and to make and file this application; that ail 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 ........... 4..~'. ......... dayof ..... .~...o--t~.. ........., 19 .~..~ Notary Public, .~...~.~-..,.~..~- .~//....d~. County BLDG· DEPT, TOWN OF SOUTHOLD ,. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OiF HEALTH ...... 3 SETS ;OF PLANS ....... SURVEY; ......... CHECK , ......... SEPTIC !FORM ............. : NOTIFYi CALLi ................ Approg~Permit No~ Disapproved a/c ....... ; ............................. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 2. State existing use and occupancy of premises and intended use and occupancy of p!oposed construction: a. Existing use and occupancy ........ ~ ...... t .... : ....................... b. Intended use and occupancy ..... 6'no.e~... Jt~-,~ ..................... ' ........ Other Trade's License No ....................... Locatinn ofland on which proposed work will be done. C' g' ~bo~ ./~.8, House Number Street H~mlet County Tax Map No. 1000 Section . .~..'~..---- Block . 4~ i j. ....................... , ..... Lot ................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) If applicant is a corporation, signature of duly authorized officer. ......... ........... (Name and title of ~corporate officer) · ALL CONTRACTOR'S MUST ,BE' SUFFOLK COUNTY LICENSBD Builder's License No .... I~..'Z.O. ~t~..~ .~ .~' ...... Plumber's License No ...... 1~. ~.'~, ~.P ....... Electrician's License No ...... ~e~.~..~ ....... 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 tol adjoining premises or public streets or areas, and giving a detmled descnphon of layout of property must be drawn on the diagram which is part of thru 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 )f a Building Permit pursuant to the Building Zone Ordinance of the Town of Southqld, Suffolk County, New York, and )ther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remora., or demolition, as herein described. The applicant agrees to comply with ail appliqable laws, ordinances, building code, h )using code, and regulations, and to admit authorized inspectors bn premises and in building for necessary inspections. (Signature of applilcant, or name, if a corporation) (Mailing State whether applicant is owner, lessee, agent~ architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~/J,)../~)......~. ~.'.~...~../~..~ .... /-¢~, .~,: ............................ (as on the tax roll or latest deed)