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Home My WebLink About16098-zTOWN OF $ou'rHOLD 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°- 1 E~ 0 ? 8 Z Date ......... ....~.~.../...~ ............... , ~..~..'7 Permission is hereby granted to: .....'7.~..~...C.~ ........................ ~ .................... .... ~.~....~.:..~..,......~.L~.~. ....... ~ I ~:....~..~,~....~.. ~ .... at ~°~t~" ~ ~-d. . ~ .. . at premises located ............................ ~ ........................... ~ .......................... County To× Mop No. I000 Section ..... ~/...(~....~. ........ Bilk ........~......~.. ...... Lot No.....~...~..:....~.. ...... pursuant to application dated ......... ..~.....'~....~. .................. , 19..~.~..., and approved by the Building Inspector. Building Inspector Rev, 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... Fom.o. ~ SURVEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT ~;;C ~o~ ............. TO~N HALL SOUTHOLD, N.Y. 11971 TEL.: 765-~803 C~Z; - ............... .7. Examined...'~.d-/r~.....I.., 19 Approved...~ e~r:*:E~..~..~.., 19~. 7. Permit No. ! .~..O.?.~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT · 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 a Certificate of Qccupancy 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, Ordinanc6s 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 necessary inspections. $:.~,,.~.,-;..Y,.,,~..~.,~-,-~.,,, .~ ............... (Signat~ of applicant,~o~ name, if a corporation) · ¢.o..w.. ~.~...~o,~.k;,. 1.4 .u..y. )~ .~..~. ~. ..... (Mailing address of applicant) (Name and title of corporate officer) Builder's License No .................... Plmnber's License No ......................... Electrician's License No ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build6r. ...13,,.,.,. [ X~.,-: ................................................................................ .................................... ' .... .~..5/..:...'..T ......... Name of owner of premises .~.~.e I. ~ (as on the tax roll or late~b4eed)b//~/ff If applicant is a corporation, signature of duly authorized officer. Other Trade's License No ...................... 'I'H~ 1.Location of land on which proposed work will be done. a 0.q $, x ......................... ~,~.. ~, ............. ~~m..: ............. House Nora her Street Hamlet County Tax Map No. 1000 Section .... )·9. ~ ......... Block .... 3 ............ Lot .... ( .~.r .~. ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended rise and occupancy of proposed construction: a. Existing use and occnpancy .~.~>.~-,~. o,~..e,~_~. J.X..~...t-o.~.. 0.5..~.r.e~.[ O. ~.3..'~ .............. b. Intended nsc and occupancy ... o.a,o.~. ~ ~. c ~.r~ .-T..C.c. e,.o,,....~>.,.'w.. ~¢~.e.~ .................. 3. Nature of work (check which applicable): New Building .. ' Addition.. i ....... Alteration ..., ....... Repair .............. Removal .............. Demolition ........... .. Other Work....~ .~.~.._ ~/ (Description) 4. Estimated Cost ........ 3../~ ~.9 ....................... Fee ......... ~,-~'.,.O.~ .................. · (to be p~id on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unitslon each floor ................ If garage, number of cars .................................... .' i': ......i ........................... 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 ........ i ...... Depth ............... Height ............... Number of Stories ............................. i ........................... 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. Sizeoflot: Front ...................... Rear ...................... D~'pth ...................... 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: ..... 13. Will lot be regraded ........... '.... .............. Will excess f/~ll be removed frem premises: Yes No 14. Name of Owner of premises .~:>~.,r. ,~.t ............. Address .~.. ~.o. ~ .~..~.-rTr. rrt,~gl~one No ............... Name of Architect ....... ; ................... Address ................ !... Phone No ................ Name of Contractor~qe~ r., .r:. 1.k ~.~..~:e,J~'tqr~r:e.r~.~ Address~o~O.:Y'.~-7. ~...~9~'r~ol]~. Phone 15. Is this property'located~ithin 30~feet of a tidal wetland? *YesI ..... No ..~... *If yes, Southold Town Trustees Permit may_ be required. PLOT 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. ITATE OF NEW YORK, S.S 3OUNTY OF ................. ................................................. being duly sworn, depos~es and says that he is the applicant (Name of individual signing contract) .bore named. te is the .............................................................. i ...... ~! ................... (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 this pplication; that all statements 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. ;worn to before me this .......... · ~.~. ......... day of....~...e~ ............ , 1977. 4otary Public ...... ~ ~....~...t_~...~..,~.. .... County #Ellen K. 0£ V0[ (Signature of applicant) _ #0,$~07878. Suffolk