The URL can be used to link to this page

Home My WebLink About15871-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15871, Z Permission Is hereby granted to: ~. ,~ * , 11 "7 ~'~i;;;;;;~';~*~;~*;'~'i'iii~'~'i. . .. ... ............... ..~,~~ ....................... ;~i"~":.~i,.. .. _~............... ........ ........ County Tax Map No. 1000 Section ..... ,C).].,,O,, ...... Block ...... ~.....,'~., ...... Lot No. Building Inspector. and approved by the Building Inspector Rev. 6/30/80 E×amiued .~..¢...., 1972 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... , TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL,: 765-180~ CALL ;O':''~ MAlL , . .Q~...~. .... 19~,7, Permit No).~}7.~.~./..,~. Approved Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT IN STRUCTION S Date ....... ~ ....... 19o~. a. This application must be completely filled in by typewriter 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 what'Yet until ~ 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 t~) comply with all applicable laws, ordinances, build, d, jl~o-c~od~,~,~aousing cod~, and regulations, and to admit authorized inspectors on premises and in bu:'.!dLng-for necessary ~~,,~"~ ~ ~~.~-~_ .~.-~...-~ ..... / ~(S'~caI~t, or name, if a corporation) State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ........................................................... Na,ne of' ' owner of premises..g. '% ................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...V~/a. ........... i"; ~' ' ';;ai; ;~;; ......... (Name and titeo orp ) . ALL CONTRACTOR*S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... ~_ .. J. ]..qT-... ~....~ - Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No. ~..ZJ.~../3r.~ .: ~~,,~>~-e.~c~--_-,z~--~ ~--a~_~~X) 1. Location of land on which proposed work will be done .................................................. House Number Xl Street Hamlet County Tax Map No. 1000 Section ...~.~. ............ Block .... [.'..~.- .......... Lot...c~..~-. ........... Subdivision .... .~.. ~t ............................ Filed Map No ............... Lot ............... (Name) 2. State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... [:5).¢ ~,~---~-,..~' ...................................... 3. Nature of work (check which applicable): New Building ' .... Addition . · · * ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work..~.~-O,o,,g. ..... ~ (Description) 4. Estimated Cost .. x ................. Fee .......... ....................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling/anits .. ~./~ ........ Number of dwelling units ion each floor ................ If garage, number ·.r,~xl~/..m ....... '.. .............................. : ........ ,., ................ of cars 6. If business, commercial or mixed occupancy sp~i~ nature and extent of each typelof use.. ['q/~ .............. 7. Dimensions of existing structures, if any: Front .'~rt ........... Rear ........ i ..... Depth ............... Height ............... Number of Stories ............................. ~ .......................... Dimensions'of same structure with alterations or additions: Front ............ :. Rear Depth ...................... Height ...... ' ................. Number of Stories ...................... 8. Dimensions of entire new construction: Front . .[5~ ..... ' ..... Rear ......... ...... Depth ................ Height Number of Stories ' 9. Size of lot: Front ...................... Rear ...................... Depth ...................... ]0. Date of Purchase .............................. Name oLFormtr,Owner ...................... ' ....... ~l 1. Zone or use district in which premises are situated.. ~..~ra~,~qbc~ .~.~._ i...: .......................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ['~.; ........................ ]3. Will lot be regraded ... ~o .r:~.. ................. Will excess fill be removed from premises: Yes ~4. Name of Owner of pre~mis~fi, . .¥!~'~.'~.c,~o,.~[ddress .~~,~-.~.l...PhoneNo..~./~rf~--~.O~.. Name of Architect ...X.Xl,/l~. .................... Address ............ ~.. Phone No ................ .--- Name of Contractor .......................... Address .... : ........... 2.. Phone No ................ 25. Is this property located within 300 feet of a tidal wetland? *Yes! ..... No .'~.. · If yes, Southold Town Trustees Permit maybe required. PLO~p DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show Street names and indicate whether nterior or corner lot. \ >TATE O NEW y_onlc :ouxr¥ oF.. .... s.s ................. (Name of individual signing contract) ~bove namled. being duly sworn, deposes and says that he is the applicant ,is the.. · ; .... .... (Z).~T'~.~.(~.. ...................................................... (Contractor, agent, corporate officer, etc.) i said owner or owners, and is duly authorized to perform or have performed the sald work and to make and file this ppllcatio~; that all statement~ contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith· lworn to before me this ' ........ i ........ ~., .da of ....... 19B~. ~otary Public,*~.~' .~ . ~(~:x~, ~:, ,'~l. ........ County ~... . '.~t£H & Dt,VO~ (Signature of applicant) NOTARY PUBLIC, Stat~ of Itew Yetk . No. 4?07BT.8.,~$,i~folk Couffly ~