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Home My WebLink About15979-zTOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, 14. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15979 Z Permission is hereby granted to: .....'~...*.. ~...~7.~C..~... ............................................. ....~..~,,...~:.~.;....t/..1~. ~. ...... at pmmis,~$ Io~ated at .................. : ........... : ....................... County Tax Map No 1000 Section .... ...C~.~....,D~.. .... Block ...... ,C~....~ ..... Lot No ..... ~..~.'~., ....... pursuant to application dated ..~.....--~.'~.. ................. , 19.~..7.., end approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 Examined .~ I~ Disapproved a/c FORM NO I TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL e..OUTHOLD, N Y. 11971 TEL., 765-180:3 CALL MAIL , , 19~>'~PerrmtNo / BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date - .. , 19z INSTRUCTIONS~ a. T~nsapphcati~nmustbec~mp~ete~y~ed~nbytypewnter~rin~n~}md~ubm~t.~at~th~eBuddmgInspe~t~r~wi~· sets of plans, accurate plot plan to scale. Fee accordmg to schedule' ' '. b Plot plan showing location of lot and of bmldmgs on prenuses, relattonshlp to adjoining premmes or pubhc str. or areas, and giving a det~led descnphon of layout of property mnst be drawn on the dmgmm whmh is pa~ of t~s a~ catmn c. The work covered by t~s apphcatmn may not be commenced before ~ssuance of Budding Permit. d Upon approval of th~s apphcatmn, the Bufldmg Inspector will ~ssued a Building Pem~t to the apphcant Such pet shall be kept on the premises avadable for mspechon throu~out the work. e. No bmldmg shall be occupied or reed xn whole or ~n p~t for any purpose whatever until a Ce~fficate of Occupa shall have been granted by the Budding Inspector ~PLICATION IS HEREBY MADE to the Bulldog Depmtment for the ~ssuance of a Bmldmg Pemit pursuant to Building Zone Or&nance of the Town of Southold, Suffolk County, New York, ~d other apphcable Laws, Ordinate Regulations, for the construction of buildings, ad&tlons or alteratmns, or for removal or demolitton, as here~n descn[ ~e apphcant agrees to comply w~th ali apphcable laws, ordinances, bu~dmg code, housing code, and regulatmns, ant admit authored mspectom on premmes and m building for necessaw ~nspect~ons .... (S~gnature ~phcant, or nam~ a corporanon) (Marling address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlt 1. ro. r ..................... NameofownerofpremIses 00,'.JJl (x,~m. Qoe ~o,E( C -- (as on the tax roll or latest deed) If apphcant ~s a corporahon, signature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's L~cense No ,,.~ ~ Plumber's License No Electrlc~an's License No .. Other Trade's License No .. Locatton of land on which proposed work will be done ....... House Number Street Hamlet County Tax Map No 1000 Sechon .~. -~ Block . ~ Lot . ,~ ~".. Subdw~ston Filed Map No .. . Lot . . (Name) State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction a Ex]stmguseand°ccupancy (~--~q-'~ ~4r'x~°--ic!~'x~,~ ',-- ............e 3 Nature of work (check which applicable) New Bufldzng Addition . . Alteratml~ ... Repmr ... Removal ..... Demolition . Other Work. (Description) 4. EstlmatedCost . ~.C~.o.. c:, c:~ ........ Fee .... ~5--..q~.q:>. ......... · (to be paid on filing this apphcation) 5. If dwelling, number of dwelling units ....... Number of dwelling un]ts 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 Stones ............................ D~nensions of same structure with alterations or additions Front ......... Rear .......... Depth .. Height .. Number of Stones ............ 8. D~rnenmons of entire new construction Front Rear ......... Depth ......... Height .... Number of Stones ................................... 9 Size of lot Front .... Rear ............ Depth ........... 10 Date of Purchase .............. Name of Former Owner .................. 11 Zone or use district in which premises are situated ............................. 12 Does proposed construction violate any zoning law, ordinance or regulation' . .Ixl. ~ ................... 13. Will lot be regraded ........... Will excess fill be removed from premmes' Yes No 14 Name of Owner of premises C-or ~>~-r,3-' Address .~J~- o'~-~..~,w~oJc~?hone No ......... Name of Architect ...... . .......... Address ............ Phone No ............ Name of Contractor~,zc-~¢.,:r:k .~,,-a~rs'r~ Address~c~p:5,5-~",?yo,~.-r})o~c~ Phone No. r)Zo.~'~..~...0,c4. .cb.. 15. Is this property locate~-'withzn 30~ feet of a tzdal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLO~F DIAGRA~ Locate clearly and disbnctly all bmldmgs, whether existing or proposed, and indicate all set-back dxrnenslons from property hnes Give street and block number or descnphon according to deed, and show street names and indicate whether interior or corner lot APPROVED AS NOTED * NOTIFY I~JILD~NG DEPARTMF~NT A~- 765-1802 9 AM TO ~ PM FOR THE FOLLOWING INSPECTtONSi: FOUNDA'riOi~ TWO '~QU1RED FOIl POURED ~ONCFti~'rE ROUG~ f:,;l~e~NC- a PLUMBING 3 tNSt JLATIC" THE REQttlF:;''.'vi~N''r~ C.~' I't1{~ N Y 3TATE OF NEW YORK, S.S 7OU~Y OF (Name of individual signing contract) lbove named OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ·. being duly sworn, deposes and says that he is the applicant te is the ...................................................... (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file flus ~pphcation; that all statements contmned hq this application are true to the best of his knowledge and belief, and that the ~ork will be performed ~n the manner set forth m the application filed therewith. ~worn to before me this .......... ; dayof... ~ ......... 19~7 ota. Publlc ..... County ~ ~,. el~ NOBIRY FUSLI~, ~ ~ Nlal_ N~_IT0787& 8aflolk CalmlY. ,g (Signature of apphcant)