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Home My WebLink About16362-zTOWN OF $OUTHOLD 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~. J 6 3 6 ~ Z Dote ....~.~.T.....~...~... ......... , 1~.~.-/. County Tax Map No. 1000 Sect,o]~,:....~...~....'....;' C~ ') ...... · Block ....... .~..~... ..... Lot No .............. ~ :j'''.~.. ........ J pursuant to application dated ...~..~.....~.......)....~..~ ........... , 19..~...~..,-- and approved by the Building Inspector. Fee $. ~./..t ....... ~ Rev. 6/30/80 mt Examin~ ApF BOARD OF HEALTH 3 SETS OF PLANS FORM NO. I SURVEY .......... ~ It TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL .%?-., 19~.. ? . .~..Z.., 19~.7 Permit No. I/~ .~ .k..~..'~'. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 admit authorized inspectors on premises and in building for necesI '~ ~ (Signature of applicant, or name, if a corporation) ?.o: ,:-...,e .... (Mailing address of applicant) o- (Name and title of corporate officer) - ALL CONTRACTOR'S MJ~ST~.B~E S. UF_.FOLK COUNTY LICENSED Builder's License No.. ~~ · ~'e'"/rq4~ ..... Plumber's License No ......................... Electrician's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. .................................................................................... Name of owner of premises b* ~ :~..~..':..'~.-...~.,~...~.:'~'~.....,~.~.~..~.~ ./.Z7 . ..... (as on the tax roi1 or latest ~¥~ ~[ ~ J ~ ....... If applicant is a corporation, signature of duly authorized officer. Other Trade's License No ...................... 1. Location of land on which proposed work wdl be done ................. ~a*b GCS*i~?J~,(.*3(~ k ~755~ .... ..... tm ....................................... ~. . , ~t~ .. House Nmnber Street Hamlet County 'fax Map No. 1000 Section . ./.O...;~. ........... Block . .t~..,~". ............ Lot . . .~..~../ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~. :' .~o~.&....~..~e"~c../.~. · ~..-{ :'.~..~<'. ~.~ff-~. '.. ~.: . .~.-./. ................. ,- ........... b. Intended use and occupancy ..... .~'./' ..... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ..... ,_.... Repair .............. Rem'oval .............. Demolition .............. Other Work...'.~..~.,~/..~'..~.... ~ :, t~'.~ (Description) 4. Estimated Cost ............ ~ .......................... Fee ................ ! " (to be paid on filing this application) 5. If dwell}?gn,unmUmber o f dweliin~.~nits . . .~..~..~' ........ Number of dwelling uni. ts yn each .ftc.or ................ Ifgarag , berofcars ... i'~ ............................... : ........................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....A(./.,~. ............. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. ~ Number of Stories Depth ................... I. · · Height ............................................ Dimensions of entire new construction: Front .......... ' ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .i ......... :.. Rear ...................... Depth ...................... 10. Date of Purchase . . ~t~. ........ Name of Former Owner ~,.~./.~-. ~¢..t~x..~?..~'.'.'.'.'.'.'.'~'. ..... 11. Zone or use district in which p~emlses are situated .................................................. 12. Does proposed construction vidlate any zoning law, ordinance or regulation: ....~.~, ......................... 13. Will lot be regraded ....~.~. i' ·; ............ i .... Will excess fill be removed~ from premises: Yes No 14. Name of Owner of premises ~.~',.~. t~.~.'~.e~/./~... Address .~'?.'.~..~g.~.~/. ~. ~:~.~.,~Phone No. 7~/.~7.~.~..~. · · · Name of Architect ..... .~f.~..~g'..~.w ...............Address ................... Phone No ................ Name of Contractor/~ te~:~q~¢~-~..~,t, rw.~...~.,.. Address .... : .............. Phone No ................ 15. Is this property located:within 300 feet of a tidal wetland? ~Yes ..... No~... · If yes, Southold Town TrUstees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed,I and. indicate all set-back dimensions from show street names and indicate whether property lines. Give street and block number or description according to deed, and interior or corner lot. ~ STATE OF NEW YORK, , - COU,,NTY ..... ·..~~ · .ff~~.( ................... being duly swm n, 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 ownem, ~d is duly authorized to perform or have perfom~d the said work and to m~e and file t~s application; that all statements cont'ained ~ this application are true to the be~t of his knowledge and belief; and that the work w~l be performed in the m~n~r set forth in the application filed therewith. Sworn to before me this : · / . a~OlkCo, No4?~5151' ~ (S~gnature ofapphcan )