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Home My WebLink About16056-z FO~lte NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 16056 Z Permission is hereby granted to: .~~....~.:......~..~..~. ........... ./.~...=..~.......~.~......Ct~.., ............. ....~.~.~..~g~.~...,...~....q...........u..q..~..~..... ~ ,o .~...¢.. .................. '~ o .Te......O~......~.~_~ ~- .................... ~. ................ at premises located at ..~.'~.........~.~g..~.~......~..~...,. ...... ~ .......... County Tox Map No. 1000 Section ...... .(13..~..~. ..... Block ....... .~....~m. ..... Lot No .......~..L..~ ......... pursuant to application dated ........ % ......................... Building Inspector. Fee, ~....~f, J and approved by the Building In.~ector Rev. 6/30/80 6 8 9 II /4 sour~o~o (3% 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~A.44'~.1..~...., 19 .~.'/. Approved . .~.,t.&'~../..~..., 19 .~.'7. Permit No Disapproved a/c ..................................... (Building Inspector). APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: INSTRUCTIONS 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 whatever 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 to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in. building for riecessary inspections (Signature of applican& or name, if a corp~ation) (Mailing address of applicant) State whether app~ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ (as on the tax/?,JJ,,6r late~v~[~ AS If applicant isa corporation, signature of duly authorized officer. ~/~ ~KTE: B.P ~ (Name and title of corporate officer) . 12. G'-&._:__ ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED NOTIFY ~,OlLD~NG ~)EPA~TMfiNT AT ', 765-1802 9 A~ TO ~ t~ FOR TH~ Builder's License No .......................... FOLLOWING INSPECTIONS: FOUNDATIOh~ TWO R~iQU~RED · Phunber's License Nn ...................... ~'POUR~ COHCRETE ROLiG~ ~Ai~IN~., & PLUMBING Electrician's License No ....................... 3. 4, FINAL CO~STRIdCTA}Ai ~U~T Other Trade's License No ...................... B~ ~;OMPL~Tf. ;J;:OR ALL CON~TF{UCTION S~ALL [~EET l. Location of land, o~n w~ich prolfosed work will be/d~ne ~ ~ ~'1~ RIE~U~[~N~$ O~ '..D~. N.Y _ . - · ~;, ., ,~ / .......... Ii/' '~k:f,.~/,3.b'~ibf6gt:~,.'.~,'~'~me¥ ....... ......... Cou tyTa, ap o. 1000Sect,o ........ Block .... d.). ........ ........ ' Subdivision ..................................... Filed Map No. :... Lot ............... (Name) 2. State existing use and occupancy of pre?is.es and intended useand occupancy of proposed construction: a. Existing use and occupancy .~...~./~ .~t~..~.-- ~/'F/! /[Z .~~¢/t ~ , ........................... ............ .... ' ........... b. Intended use and occupancy ...~.....C~.. ~...~..~J~..~...~.'j..O.~. ~1 .~...f~~.: ...... 3. Nature of work (check which applicable): New Building ..... · ..... Addition · · .! ....... Alteration ,.,, .i ....... Repair .............. Removal .............. Demolition ........ i'' Other Work (,/(Description)" 4. Estimated Cost .............. .*. O Fee ............ " (to be paid on filing this application) 5. If dwelling, number o f dwelling units ............... Number o f dwelling unltS!on each floor .... .':-w. .......... If garage, nmnber of cars ........ "" ................................... i ........... 7- .............. 6. If business, commercial or mixed occupancy, specify nature trod exkegt of each type of use .... 77.. .... 7. Dimensions of existing structures, if any: Front./~?o0t.. ~t./~..//~ar ........ i ...... Depth .aJo~ .~. i~i Height ............... Number of Stories ............................. ~ ........................... Dimensions of same structure with alterations or additions: Front ............. i ....Rear .................. Depth Height ' Number of Stories -8. Dimensions of entire new construction: Front .......... . ..... Rear ......... !. Depth Height ............... Number of Stories ............................. ........................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Fenner Owner . .] ........................... 11. Zone or use district in which premises are situated .......................... i ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... FO ................ ' .... 1 3. from Will lot be regraded ............................. Will excess fill be removed premises: .,~ Yes Nmne of Architect ...... . ..................... Address ........ '. ....... !... Phone No ................ Name of Contractor . u 15. Is this property located within 300 feet of a tidal wetlan~l? *Yesl ..~... ~qo ...... · If yes, Southold Town Trustees Permit maybe required. ~ ~ .... · PLOT DIAGRAM , Locate clearly and distinctly all buildings, whether existing or proposed,-~nd, indicate all set-back dimensions from ~treet names and indicat6 Whether property lines. Give street and block number Or description according to d~e,d,~..g~.~d show Lnterior or corner lot. d ;~ OFNEWYORK, S.S ~ '~ ' ~ .Z' z. ,' ~ .~UNTY OF ................. .................................. .............. being duly sworu, depose and says that he is the applicant (Name of individual signing contract) bove named. Ie is the ........................................................................................ (Contractor, agent, corporate officer, etc.) ,f said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this and that the pplication; that all statements c6ntained in this application are true to the best of his knowledge and belief; ?ork will be perfoflned in the manner set forth in the application filed therewith. ;worn to before me this - ' ' ~ ........... ;;'1 C; 7;7 '} ........ lotaw Public, gal./t ~,i..~'2f4ff...r .,ff... i ~ ."f77,. .... County -- - · ;~-a-qc, ~tate of New Yom ................. klCCtm' '""'"", No. 4~9,~2 (Si~ature of applicant) Qualified ~a Sut~olk Coua~ ,~ r. ~/