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Home My WebLink About16103-z IPO~M' NO. 0 TOWN OF SOUI'HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 16103 Z Dote ~.~ ....... ............................... ~ '*-.. I~.~] . .... Permission is hereby grante~o: .~..~.~.,..~..~...~.J~.~ ....r./,~ ~...~..g....~ ................................................. .....Q~.~.,,~,~_..~.~.,...I..:.~.~ ....... ..~~...>..~. '... ~...~.~.~o~ .......................... County Tax Mop No. lO00 Section ..... /......~ ........ Block ...... .~...~.. ....... Lot No....J....~...:..~ ........ pursuant to application dated .... Building Inspector. Fee $,.~...~..~.,,~. ond approved by the Building Inspector Rev. 6/30/80 ii,i i~,,, ft[~: TOWN HALL ~UTHOLD, N.Y. 11971 B;~{;"7~!?~~''~''-'''~''~' [ TEL.: 765-1B02 Examined · ~..~'..~. ·., 19~ ~. Approved .~.~ .~ ~.., 19~ J. Pe~it No. ~ k ] ~ .~ ~. Disapproved a/c ..................................... ( Budding Inspector) APPLICATIbN FOR BUILDING PERMIT BOARD OF HEi~BTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... )WN OF SOUTHOLD CHECK ...... -'- - - DING DEPARTMENT SEPTIC' FORX ............. 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 Pbrmit 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE tb~ the Building Department for the issu~nce 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 br~aRerations, or fo~,removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildin~ c(lde,~ housing__ ..c°de' and regulations, and to admit authorized inspectors on premises an~i, in building for necessary inspections][/-g. · · ........... (Mailing, address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general dontractor, electrician, plumber or builder. · ~ ........................... g~.~,~g:~.&a ~OT.~ ....... .......... l'~ame or owner et premises .1~.~.. i../..~e. .... r ....... *- .....:....l ............... / (as on the tax roll or latest · ~-~:: ..................... ~tY, l~&.~~, · _ If applicant is a corporation, signature of duly authorized officer. ~, (Name and title of co~orate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Bnilder's License No ............... Plumber's License No ......................... ~3f COMp~ e~ E *-o~ C O Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .. ,~.~0 ............ ~ ~ ~.. k ~.p... ¢~ ~% ........... ~.~ rc.~ko~ ................ House Number Street Hamlet co,,, ,~ ~p ~o. ~000 s~c~o, .t~ff ........... mock .~ ............. [o~...~..t~.'.7 ..... ,,.----- ........ ............... ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing nse and occupancy . . .~[ O ......................................................... b..Inte.nded use and occupancy ..... r.-.v: .~ . . . ................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work .... ~71~ tJC.~' .... l~l ~ (Description) 4. Estimated Cost .............. Fee { ~ ¢ : ' (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, nun] her of cars ..... ~ ...................................... . ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each'type of u~e .. :.. .... : ............ 7. Dimensions 6f existing structure!s, if any: Front ............ · ....Rear .............. Depth ............... Number of Stories .... ~ ' ' ~ Height ................ . ............................................. . ........... Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Bepth r Height Number of Stories -'-8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height .............. Number of Stories ........................................ .~ ............... 9. Size of lot: Front .7-~6 .... w,/ ........... Rear .,.1.~ .... ~.. ........... Devth .. ~..~. ................ 10. Date of Purchase ..: I.~.."~.~..i .................. Name of Former Owner ~.. ~51~./...1~.~ ......... 11. Zone or use dmtnct m which premmes are mtuated. ,,~-d~~ .................................... 12. Does proposed constr~ction violate any zoning law, ordinance or regulation: ...L~.. .......................... 13. Will lot be regraddd ......... ?~. ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises 0~.~.~.~.~..~ .~... Address ~t ."z/,,~ . Phone No Name of ArcMtect ....... ."..~'~....~).. I:...~..~ ~. [~ddress .... ~,~o[(~. ll.~"hone No ................ Name of Contractor ......... i ................. Address .... : .............. Phone No ................ 15. Is this property located ,within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required, PLOT DIAGRA~ Locate clearly and distinctly ali' buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO~K, II_// '~ ~ COUNTY OF... ............. 0 ~:lkl ~...'] · ~a~4J..('~%~ .0..1%. ............ being duly sworn, deposes and says that he is the applicant (Nam% of individual sighting contract) above named. He is the ..................... ! ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners} and'is duiy authorized to perfbrm or have performed'the said work and to make' and file this application; that all statements cont'ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set for~th in the application filed therewith. Sworn t6 before me this Notars~ Public ...... ~,. Z...J)..~..~..t~.. ~A~ PUgLiC, S~e of No. 4707878, Suffolk .. Count~ ~.~. ~~.~.~ ' ~ "' V (Signature of applicant)