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Home My WebLink About16389-z · OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. No_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 638 ? z Oote ....~..~....~...~ .......... , Permission is hereby granted to: r~ , t~ · ....%~.$~ ................................................... ...... ,o at premises Iocoted at ....~....~..~...~......~.~.....~...~..., ............ ~d:l~.~ ............ County Tox Map No. 1000 Section ....... ..O....°l..~. ...... Block ........ .(~....'~.. .... Lot No ...... L...~.... .......... pursuant to application dated .... ~../d~..~.........~.~. ........... , 19.?...7., and approved by the Building Inspector, Fee $.~ ................... 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 e~ TEL.: 765-1802 Examin 3~07...~..~.., 19~..~. Approv~4~.~.~'..~ .~.., 19~..~. Permit No/.4..~.?.~..~.. Disapproved a/c ..................................... ................................ (Building Inspector) CALL ; ............. Ed, 8LDG. TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by ~ypewriter 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 shal~ have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the BuilJing 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE_,~UFFOLK COUNTY LICENSED Builder's License No ..... ~'~..~ .............. Plumber's License No ......................... Electrician's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... ~.~:,~O~'go .AY. ~.Q~ ~ ....... Name of owner of premises A~.f/~...~'.. 0~.~.l.~.. ~,.~[~.}~.J.~.~....,.,-..~' (~s o~ ~ t~x ~oil or ~t,sUa~,a) , lC~. If applicant is a corporation, signature of duly authorized officer. NOTifY L~LD~G O~¢ASTMffiT AT ALL C Other Trade's License No. , ..................... C%~.' 'A NOI,~-, ~ ' · '"" B~ RS. ,. o ,an on w cli.opo d wor wil done.' ...~¢.?.¢.~ ........... ~ ~K. ~$.s~ .............. G~oc~ c~ ................. House Nnmber Street Hamlet co.~t~,~ ~p ~o. ~0o0 S~ion ..... 7;l ......... mo~k ~ ~ot 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 .............................. b. Intended use and occupancy ..... Z (,,.~ .f{/O.~.~. ~...BT. ~..~.--/~...q-.O.~. ................................ Nature of work (check which applicable): New Building .......... Addition Repair .............. Rembval ............ Demolition ........ Estimated Cost ....'~....~.... ! ....................... Fee ....... t .......... Alteration .......... .... Other Work. J~'. ~ b~.~..~.. .... :" (Descrip~tion) (to be paid on filing this application) If dwelling, number of dwellingl units ............... Number of dwelling units on each floor ................ If garage, number of cars ................................................... ,.. ................... If business, commercial or mixe~d occupancy, specify nature and extent of each type of dsc .... if any Front Rear Depth D~menmons of ex~stmg structures, ........... ........... ....................... Nurober of Stories Height ................................................................. Dimensions'of same structure With alterations or additions: Front Rear '~ ~ ' ight ................................... Depth ....... ::.. :. . .r~:~.;.:,.. '... He ...................... Number of Stories ...................... '--8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ...' ............ Number of Stories ..... 9. Size of lot: Front .......... i ............ Rear ....................... Depth ...................... 10. !~3ate of Purchase .......... , ................... Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated 12. Does proposed construction vio,late any zoning law, ordinance or regulation:, ................................ 13. Will lot be regraded ...... ,. i .... .............. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises~.~f..~ ~I).~ 0.~/~*. ~/.3[/./~.. Address g~i .~.R.~-. .~.(4..T.~°~fl..~q~hone No..~..~/t(.: ~..~ AD.... Name of Architect ......... ~ ................. Address .................... Phone No ................. Name of Contractor ~.~./d4 ,[~. ~'~.~ t/3/~-~. ..... Address~.~!0,0~.'.~.~.. ~ .fl~.../~01~Phone No.~.S.~.'7 ~/ff. ~.~. .... ~5. irs this property Iocated!w±th±n 300 feet of a t±dal wetland? ~Yes ..... No *If yes, Southold Town Trustees Permit maybe required. PLOT D~AGKA~ Locate clearly and distinctly M1 buildings, whether existing or proposed, and. indicate ~! s~t-back dhnensions from property Hnes. Give street and block: number or d~scription according to deed, and show street names and indicate whether interior or corner lot. X STATE OF NEW YORK, i S.S COUNTY OF .................. ....x~.~f.lk&.~'~...~..'~.?.. ~.~.~. ~ ............ being duty sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) above named. He is the .......................... ~ ............................................... ~, corporate officer, etc.) 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; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ............... ~.¢;...dayof.. (Signature of apphca