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Home My WebLink About15983-z lvO~wr NO. B TOWN OF $OMTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT a'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted tq: · [~ .... ...~..~2.~..~ ...... ~.~.......~......: ................... ....... o, premises located at ...~'~,.,.~,,,~..~,.0.. ....... J~..~.....,~,,,, ............. ~~ .................. County Tax Map No. 1000 Section ...... .(D.b..L.. Block ...... ...~...~ ........ Lot No......~....~. ........... pursuant to application dated .... ~ .... ~ 19~..'~ and approved by the Budding Inspector. ....eM.. Rev. 6/30/80 Z Examined ~.~ /'/. ,19~ ~ Approved . .1- [ Disapproved a/c BOARD OF HEALTH ...... 3 SETS OF.PLANS ....... FORMNO 1 SURVEY ~ ~J~t~ [~.~.~~'/ TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC ~0RM ............. : TO~N HALL NOTIFY SOUTHOLD, NY 11971 CALL ..... ~_-.~ ....... ~- TEL.. 765-1803 MAIL TO: ~,~ ~~ (Bufldz~ Inspector) APPLICATION FOR BUILDING PERMIT , 19~? Perrait No / ~,-c} g~ Date ........ 19 INSTRUCTIONS a Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w~i sets of plans, accurate plot plan to scale Fee accor&ng to schedule. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premmes or pubhc or areas, and giving a detailed description of layout of property must be drawn on the diagram winch is part of tins al: cation c The work covered by tins application may not be commenced before issuance of Budding Permit d Upon approval of this application, the Building Inspector will issued a Budding Permi,t to the applicant. Such pe~ shall be kept on the premises available for mspectlon throughout the work e No budding shall be occupied or used m whole or in part for any purpose whatever untd a Certificate of Occupa shall have been granted by the Bmld~ng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as hereto descnl The applicant agrees to comply with all app, hcable laws, ordinances, budding code, housing c~_ode~nfl'reg)gai~lons, an, admit authorlzea inspectors on premises .~nd m bmldmg for necessaw lnsp/cStlons -------"/ (Marling address of applicant) State whether applicant is owner, lessee, agent, arctutect, engineer, general contractor, electrician, plumber or bud, .. O ne-r--. . ..... m 3.'ov. ,.'..0..a.s. .'r .... (as on the tax roll or~[est~deed),2,.~ , , BY' ~ ~'" ~'' If applicant ts a corporation, mgnature of duly authorized officer NOlq~'W 8UtLOq,l¢ OEP~,RTM~NT Al' (Name and title of corporate officer) ALL COItTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ... -..." Plumber's License No Electrician's License No Other Trade's License No .... .q'g?qo I Location or land on xvluch proposed work wilI be done House Number Street County Tax Map No 1000 Scot,oh ~ ~ [ . Block 70151802 ~ Aaa rD · ~4 6OR THE ~UND,' 'rf~ ~O qEQMIRED 4 ~ '.~,I COdS~h~CT~O~ ~UST ~ 3~:~~,'~OC~ ~, ~NER~ g o3a nqq. i .... . . Hamlet 2 Subdivision Filed Map No Lot .. . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction · ' ' ' AJ4 ~% l a Existing use and occupancy e ¢~ t ,c -' .... b Intended use and occupancy "'- ~ .-~,..,,....~ ......... 3. Nature of work (check which apphcable) New Budding ....... Addition ....... Alteratlo~l~,_ .... Repair . . . Removal ........ Demolition ........ Other Work. (Descnphon) 4 Estimated Cost ~..~oo ................... -- 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' .................. 4~. ~t,~q~"k~lr~. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~. ~_,_I~ -~ 7. Dimenmonsofex~stmgstmctures, lfany Front . lQ./31 . . Rear ...k).~... ~{~)~p[~'.~ Height ~ ~rl-t:w'~ ..... Number of Stones t:~ ~, . i ' ~) [~ .... Rear DLmenmons 9f,s~ ~ture with alterations or additions Fro,t . ........ Depth . .'~. I~.~'. .... Height ........ Number of Stones ................... 8 Dimensions of entire new construction Front . .10.~ ... Rear . .k)~ ....... Depth . .~ ~t ..... Height ........ Number of Stones .......................... _ ....... 9. Size of lot Front . ~c,~ {~'-['", Rear . ,~1~. [:7.~T' ..... .,,, Depth . .I..~ .......... 10 Date of Purchase .. *t.q'7',.~ ..... ~,NameofForme~iOwner--~.td_J~Oq$~,rl ~¢O_[JCq .... ~ 1 Zone or use district in which premises are situated.. ~ Wt.~.q~.r'.¢.~:x I, ....................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation k~*.T' t2.~c,_~:'.e., o.~ ............. 13. Will lot be regraded . ,-. ,. l,,hO..-x .. . Will eacess fill be removed from premises Yes ~N 14 Name of Owner of premlses~Ol~5~t'txo~-,~.ttl~b0 ~ddres~,~<:~ ]~l~_~t-rf, Jc{o~..cl .e-.-Phone No..'~3.q(-. Name of Architect ............. Address ............... Phone No ........... Name of Contractor .-~ ~ VO.tl~2.. ....... Address ............... Phone No .............. 15. Is this property located wzthln 300 feet of a tidal wetland~ *Yes ..... No .W~... *If yes, Southold Town Trustees PermJ_t may be required. PLOT DIAGRAM Locate clearly and distinctly all buddmgs, whether existing or proposed, and. indicate all set-back &rnens~ons rrm prope~y hnes. Gwe street and block number or description according to deed, and show street names and indicate wheth, interior or corner lot. STATE OF NEW YORK ..... COUNTYOg. .. . d_~/2..~/~__,...~ .7'~',~_,/.~).~/ff, o.y( ~-4~. being duly sworn, deposes and says that he is the apphca, (Name of individual signing contract) above named. He ~s the ~ ~2~ ~'~l' C,-~ ,, h Oat,.~ e~[~) (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 th application, that all statements contained m this application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth m the application filed therewith Sworn to before me this .. ... day of .. Notary Public, .. ~.~'-"~ ........ County ' ......_____~.~ ~ ~ ~-~ _.~S~gnature of apphcan