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Home My WebLink About16397-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO. 18~77 Z Permission is hereby granted to~ ..~.~.~......~.~....~ ....... ~ .=1~,.~ .~~..~ ~....~.....y.,..../../..~.~-... ...... . ro ..~...~..~ ........... ~...~ .............. ~~..~ pursuant to application dated~ -- ~......~...'] ......... 19.~..~..,---- and approved by the Building Inspector. Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... /OWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM .... : $OUTHOLD, N.Y. 11971 i~fl4~..~.. TEL.: 765-1802 Exam ., 19'$..~. Appr~~.~..~..., 19~.~. Permit No.! .~..~..~...'~.. Disapproved a/c ..................................... NOTIFY CALL ................ MAIL TO :765 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 necessary i~ns. pect~,~. ~ __ ,~ (Signature of apt~ca~t, or name, if a corporation) (Mailing address of applicant) (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 ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~?/t~.~. ~ .¢./~0./.5 4 .~.~ ~/.~ If applicant is a corporation, signature of duly authorized officer. FOLLOWING ~NSP~CT~O~g: ~NOA'r~oN ~O g~ COMO~ t~1% ~0~ C 0 1. Location of land on which proposed work will be done ................ House Number Street Hamlet County Tax Map No. 1000 Section .. ] ~2 ........... Block ... J .............. Lot..~.h ............. 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 ....t~..../:'~../~///-,.~'.. ......._ ........................... b. Intended use and occupancy . ~ ......... ~¢~ ~le}b ~.¢¢ ~,g) ............................ 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... .Repair .............. Removal .............. Demolition .............. Other Work ..,~-. ~?rM..c~..~... (Descriplion) 4. Estimated, Cost ..... .fi:., .d~.. ........................... 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 "7 6. If business, commercial or mixed occupancy, specify nature and extent of each type ofh~e ~ [ .'..: .......... 7. Dimensions of existing structures, if any: Front. .'~. ; Rear .... Dep!h~ ~ Height ....... .~ ,, .... Number of Stories .... .-7. ~ i .7':'~. ~. .......... ' ........... ' .....~ .............. Dimensions'6i satire ~tructure with alterations or additions: Front ......-7-~W77...: ....... Rear ...~fT~... .... Depth Height ~ Number of Stories -' 8 Dime sions fenti tru tion: Font '-------- R Depth ~-- . n o re new cons c r .......... . ..... ear .............................. Height ............... Number of Stories ...................................................... 9. Size of lot: Front ...~.d?~9... ! ............ .Rear.../. ~ ............. Depth . ./...~i~*.'. ............ 10. Date of Purchase ...... ~ /~.~.D..., ................... Name of Former Owner ............................. 11. Zone ox use district in which pr~mises are s~tuated ..................................................... 12. Does proposed construction v, idlate any zoning law, ordinance or regulation: ...~..c_p .......................... 13. Will lot be regraded ..... ./~..~Q~O ............ ~..~ .... Will excess fill be removed from premise, s: .Yes ~ 14. Name of Owner of premises~,~;q~.~..J~.~.J./..d,O?:<-~... Address .~..<~. ~.(.~.. Phone N~-~.6~.~.2'~..-~.~..'O Name of Architect ·. I ................... ..................... Address .... Phone No ................ Name of Contractor ~- r---- ........ ~ ................. Address .... : .............. Phone No ................ 15. Is this property locatedlwithin 300 feet of a tidal wetland? ~Yes ..... No~... · If yes, Southold Town TrUstees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly at buildings whether existing or proposed, and, indicat~ ail set-back dimensions from property lines. Give street and block number or description according to deed, and show str ,et names and indicate whether interior or corner lot. ~ ' STATE OF NEW ~YORK, _ i~ ~ cou v ..... (Name o~dividual sighing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... i ................................................................... ! (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 all statements cont3ined 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 ther.ewith. Sworn to before me this i IRiS R, BE~lA .......................... '~4~ (Signature of applicant)