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Home My WebLink About16005-z I~OB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N"_ 16005 z Perm,$s~on is hereby granted to: ./...~..-...o...~ ...... ~.~.~..a~...: ....................... ~......~.....~...~....~.,..~....¥.../.,.....~. o, p~m,,e,,=,,d o,.~..~.~ ....... ~...~.~...~.~..,.....~..'...:.~.~ .... County Tox Mop No ]000 Sect,on . ....(~...~. .... Block ...... .~.~ ......... Lot No .... ~:.~. ~u~o., to o~,,~o.o. ~o~ed ......... ~.....~X.~ ............. , ,~.~., on~ o~,~v~ b~ t~e Braiding Inspector, Fee $ ........................ Building Inspector Rev 6/30/80 Examined .~ .O~.~. I Approved Disapproved a/c . HOARD 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 TEL.: 765-1802 CALL MAIL ,19~geerrmtNo 1~.9o.~ ~7~T TO: APPLICATION FOR BUILDING PERMIT IN ST RUCTION S a. Tins apphcahon must be completely filled m by typewriter or m ~nk and submitted to the Buddmg Inspector, wi sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan sb. owmg location of lot and of buddings on premises, relatmnsinp to adjommg premmes or public sir or areas, and g~vmg a detmled descmphon of layout of property must be drawn on the dmgram which m part of tins a~ cation. c. The work covered by tlns apphcahon may not be commenced before issuance of Building Permit d Upon approval of tins apphcatzon, the Bmldmg Inspector will issued a Budding Permit to the apphcant. Such pe~ shall be kept on the premmes avadable for inspection throughout the work. e. No budding shall be occupied or used m whole or zn part for any purpose whatever untd a Cerhficate of Occup~ shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmlding Permit pursuant to Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphoable Laws, Ordinance Regulations, for the constructmn of buddings, add,huns or alterahons, or for removal or demohhon, as hereto descnL The applicant agrees to comply w~th all apphcable laws, ordinances, budcl,mg code, housing Kode, and regulahons, ant admit authorized inspectors on premmes and m budding for necessary msl~chons. , ~ // ~ /3 -07.3.7. 1//9.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or budi ..... Name of owner of premises /~';~. A/~'~; C~;~. ~/~.,~-~. '...~."... / (as on the tax roll or latest deed) If applicant Is a corporation, s~gnature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... Plumber's L~cense No ' Electrician's License No /"/ /¥ . Other Trade's License No ......... I Location of land on which proposed work will be done ltouse Nuin ber Street County Tax Map No 1000 Section '~ ~ Block Subdivis~on ~ Filed Map No (Name) Hamlet .... Lot State ex~stmg use and occupancy of premises and Intended use and occupancy of proposed construction a Existing use and occupancy /~) ~ ............ b. Intended use and occupancy ~ ........ · Lot Repmr ~ .. Removal Estmaated Cost 3 Nature of work (check which appl,cable). New Budding . Addition . Alteration ... ,. Demolition Other Work /7't~. ..... · 3. " (Descnp~tlon) 4 .... Fee ~ (to be prod on fihng thru apphcanon) Number of dwelhng umts on each floor 5. If dwelling, number of dwelling units ....... If garage, number of cars .......... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dnnenmons of existing structures, if any Front 4.. Rear ........ Depth. Height . .. Number of Stones ...... Dnnenslons of same structure with alterations or additions Front ........ Rear Depth ....... Height .. Number of Stones .............. 8. Dlmensmns of entire new constructmn Front ....... Rear ............. Depth . Height . . Number of Stones ....................... 9 Size of lot Front ........ Rear ................. Depth .......... 10 Date of Purchase ............. Name of Former Owner ............. 1 1 Zone or use district in which premises are muated ............ 12 Does proposed construction molate any zoning law, ordinance or regulabon .............. 13. Will lot be regraded ........... Will excess fill be removed from premises. Yes N, 14. Name of Owner of premises ...... Address ............. Phone No. Name of Architect ....................... Address ................. Phone No .............. Name of Contractor ................ Address ............ Phone No ............. 15. Is this property located withzn 300 feet of a tidal wetland? *Yes .~.. No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and. indicate all set-back dwnens~ons fron property hnes Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. ~ /I ROVED ai; NOTED 7651~2 q ~ r(. ~ :M eOR ~E FOu,~D~K~ 'CWO '~QU1RED FO~ POURer3 ~O~CPe ~ ~ RODG~ g~A~;N~ a P~UMBING STATE OF NEW,YORK, ,. ,. COUNT' ,,OF .. a · · ~?~ ,a'//-~('' - A D~ff'~Go-~'5-2' .... being duly sworn, deposes and says that he IS the apphcan (Name of mdiwdual signing contract) above named. neisthe ................... ................... (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 thi apphcatmn, that all statements contained m thru 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 tins day of . Notary Public .... ~ ..... N~ public, State M N No 4822563, Surfak Cou~ Term Expires December 31 .,19 .. County ~.. - (Signature of apphcani