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Home My WebLink About16681-z ~'OB,~ NO. ~ TOWN OF $OUT~OLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_16681 Z Permission is hereby granted to: "7 ........ ~";~'~'~~,,,,~ C2~ ................................................. ..?~..~,....~..~.~ ..~ -' ........... ~..~.~,...~.....,,-, at premises located at ...*~..~.~..~. ....... ..~.~.....~., ........ ~.~.~ ......... County Tox Map No. 1000 Section ..... /....~.....~ ...... Block ........ l....~. ..... Lot No......~..~.. ............ pursuant to application doted-'2.1~..(.~,-~,~.....!.l ............. , 10..,~....~, and approved by the Building Inspector. Fee $.~*~.:.,..~ Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... . 3 SETS OF PLANS ....... FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ Approve..~... l.'I., 19~7. Permit No. 7.(~.(o. Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~).*~¢¢'- ./~ ....... , 197.Z 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 alt applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary _inspections. ~ ~(S!g.na,~r,,e_ of applicant, or name, if a corporation) ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... ...... Name of owner of premises .~ .*~q~... ~....~~'. ......... ~'q~'{~P~..' B'~'{' 'J ~'~/'~' (as on the tax roi1 or latest deed~ . If applicant is a corporation, signature of duly authorized officer. ~OT~ ~LD~ 9E~T~T AT .............................................. FOLLO~NG (Name and title of co,orate officer) - ~UNDAT~ON ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... ~OUG~ Plumber's License No ......................... 4. Ft~AL Electrician's License No. ~[ C Other Trade's License No ...................... ~ 1. Location of land on ~vhich proposed work will be done. ~' ~'~ ...................... ...... House Number ~ ~amlet County Tax Map No. 1000 Section ./~.~ ........... Block . .l~ ............. 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 .......... .~.--QTh,e,,l~ ................................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . ,~ ........ Alteration . [ ........ Other Work~.'. ,,~.0T../: ...... Repair .............. Removal .............. Demolition ........... i' ef~Z,-~-'fD e scrip,tion ) 4. Estimated Cost ...................................... Fee .......... i .................... (to be ipaid on filing this application) 5. If dwelling, number of dweiling units ............... Number of dwelling uniis 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 ............ i ..... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... · ..... Rear ........ i ....... Depth ............... Height ............... Number of Stories ............................ i ............................ Size of lot: Front ...................... Rear ...................... !Depth ...................... Date of Purchase ............................. Name of Former Owner .i ............................ Zone or use district in which premises are situated ......................... i ............................ Does proposed construction violate any zoning law, ordinance or regulation: ~....! ......................... ,~. Will lot be regraded .. ~. ...................... Will ex_cei~'fill be r/moved from premises: Yes No Name of Owner of premise~/4,/-*c-~:~.~), m~J.. Address(~g-,,~~hone No. ~..c~.Zzf.~: Name of Architect ..... ~. .................... Address ............... ! ....Phone No ................ Name of Contractor .......................... Address .... : .......... i ....Plione 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. in~iicate all set-back dimensions from sho' v street names and indicate whether property lines. Give street and block number or description according to deed, and interior or corner lot. ~ ..( ..... ' i. ¢ and says that he is the applicant td file this nd that the (Signature of applicant) STATE OF NEW YORK, S.S COUNTY OF ............... ,_. .... .~..t9 ........... .~. ~>/r~ a~ o<~/~, / being duly sworn., depo k4,/ g ......................... (Name of individual signing contract) P'~.;, ~ .,-:-.,: ....... above named. ! +j" ~ .' ,". -~ He is the .............. d~. ¢¢.x,¢..c¢.. ~ ..... ' ........................... '.ti '....,,,~ .,..,.. ,.... (Contractor agent corporate officer,'~fc01 !~.':.U ! '! . · . ' i of said owner or owners and ~s duly authorized to pe[form or have perfonued'the said work an, d to m~.~e~ application; that all statements contained in this applic~[tion are true to the best of'tiis! knowledge:~inl:l work will be performed in the manner set forth in the application filed therewith.- ' ' Sworn to before me this ....... ,~../.~ ......... day of...~~d..., 19 .a~.2 . UnOA d. COOER / ....... r~otaq~ Publio, State of New YoH~//r rm r..xplre$ Deoelttber 31, '~9-/; ~