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Home My WebLink About16115-z FOR]M[ NO. ,s 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) Permission is hereby granted to' ...~:.a~.~.~ ...... ~, .....~....,,~... .................... at premise, located at .,,~.~,~ ............ ~...~ ........... ~.~........~ .................. County Tax Map No. 1000 Section ...... /.~,~..~..'~... .... Block ...... ...~'....~.. ...... Lot No.....)...~..~.'....~-... ....... ~ursuont to app,co,ian dated ....... ....~.~....~ ................. , 19~.'/..., and oppro¥~ ~y the / Building Inspector. Fee ,...~..~.;...~ .......... Building Irks~ector Rev, 6/30/80 .................... Zone or use district in which premises are situated ............................................ Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ........................ : . . . Will excess fill be removed from premises: Yes Name of Owner of premises .~kdlxl.. ~ Uq. Itt~-...~n%~. Address . .~.T, .~'~,.v.'~]'~hone No..'~' .~...% ~ Name of Architect .~t'.t~:i~CL~t~C~.~.'~. 4~t~-~.Address 1~O~I~3.~..[~-~. ~...~.,. Phone No. Name of Contractor ~.,4i~.~/~lqg.,..Ab~l~..~.t?s · · Address . .~.'T,..~.L~ ,%O~f~'./7~(~Phone No. ~.~.~..v~. 7.~..~.4~.: PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro~ roperty lines. Give street and block number or description according to deed, an&show street flames and indicate wbeth, flor or corn r"lot. " .... ' .QfC. AMIAGA CONI4.L. Ihl, ' / FATE,OF NEWe.¥ORK, S.S ()UN'I Y OF..4 9..~-"(¢..~.g- ...... . ... .... I~ O..~t~r~'. ?...C.~..: ~ .................. being duly sworn, deposes and says that he is the applica (Name of indiyidual signing con~ract) eve named. ~is the ..... ~ ........................................................................ , , (Contractor, agent, corporate officer, etc.) said owner o~ owne~,'~d is duly autho~zed to perform or have performed the said work and to make and file ti plication; that all statements contained ~-th~ application are true to the best of his knowledge and belief; and that )rk will be perfo~ed in the re=ncr set forth in th~ application filed therewith. yom to before m~ this ........ ~ .......... ~ .day~~~.., .... , 19... claw Public, .~~~:..'....~CountY.' Of NeW Y n.*qhe~ m S,4 IR G0um] (Slgnatnre of applica~ ~%~..~ , !!.! ~ ~ .~,~ ~ BOARD OF HEALTH ...... ..... 3 SETS OF PLANS ....... '~ i i, FORM NO. I SURVEY .,. 5 ,,! I OWN s0oT.0 :::: ~i ~ .... ';r-~j'~"[~'¢¢? ..... ~,~ ~_-. * ~ BUILDING DEPARTMENT SEPTIC FORM ............. : ~.,~...~ TOWN HALL WN OF $OdT'O[D NOTIFY TO ,,- ........................ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . .~.., 195 J. Approved .~. ~.~.., 19~ ~ Pemit No. 1.6.~(~ ~. Disapproved a/c ..................................... .............................. (Bui~ing Inspector) APPklCATIO~ FO~ BOlEDING PERMIT Date ~ - ~ 19~ 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 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 br 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. (Signature of applicant, or name, if a corporat'on) · .5.~. ~'7.o..' .~.o..& .T~....'FO..:D..,..~..o..O.' .'d.-~..L~....~..':l. (Mailing address of applicant) I (ct -) [ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ........ ?..? .~..~.c%.. ............................................................................ Name of owner of premises ...... i . .B%~..~.: .... ~ ~ .... ...~...l?t...~../::~. ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's LicenseNo ......................... Electrician's License No ....................... Ot4~r TradeZs License No ..... .~ .~ ............. 1. Location of land on which proposed work will be done .................................................. ... 5. ~ .5..0..o. ............ .~. o..~..~.t....~..o..~.>..~..,..&.T,. ~ ¢ ....... .~.o..o.~.~ ............ House Number Street Hamlet ' County Tax Map No. 1000 Section . . ~ ~ ~- Block ~ Lot ~ ~', O ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~...~-h'... .. b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .~.~. &;¥4~27&l.r¢. Demolition r~N ........... Other Work ............... t-too ~- (Descfip~tion) 4. Estimated Cost ............ ? ..... : ................ Fee ...................................... · (t g thi ppli ) o be paid on illin s a cation 5. If dwelling, number o f dwelling lunits ............. Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................... ,...: .....,..~ ....................... 6. If business, commercml or m~xed occupancy, specify natture and extent of each type of use . .'. '... - . .. ........ 7. D~mensmns of ex~sting structures, ffany: Front .~2~;~..., . ....... Rear ....... ...... ,. .... Depth,..%~..~t .... Height ............... Number of Stories .... ~.. ~:~Li .'..' ............ ................. ,. ............ I)imensions'of same structure with alterations or additions: Front ................. Rear ...... '. ........... Depth ................... !,. Height ...................... Number of Stories ..... ~- ............... Dimensions of entire new construction: Front .......... ..... Rear ............... Depth ............... fteight ............... Number of Stories ........................................................ 9. Sizeoflot: Front ..... ~.~).'.g.ST/ ........ ..- Rear ..... .I.~.b,~.',, ........ Depth .... .~...'b...~..~ .......... 10. Date of Purchase ..... [ .~-..'71 .~...~. :-:..~.te. ........ Name of Former Owner ~--~P~-. · ~.F..tT¥.~.O.c.q .~..~.~. 11. Zone or use district in which pr~mises are situated ...... t~..~. I~..~-b~"~. ~ .............................. 12: Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... 'J .~,.~ .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~rl~.hO.. FWO~,~t~... Address ,Sg,'~']O.~.Q .~ .~o-Phone No.. ~* ~ y.~..'B..~.~.. Name of Architect bOf~. Pr.~.~..cv.~. O .~'.~..c,...... Address f4t~ .~.~¥¢..tq. F~PO~.~.... Phone No ................ Name of Contractor .~ .tn. ,. ~ l ~lq:~=~/z..:~::~..~. ...... Address . .~.~<~. ~. [c~,~ ....... Phone No ................ 15. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. G~ve street and block!number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ! S.S COUNTY OF .................. ............................ , ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......................................................................................... (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 this application; that all statements coniained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this i ................ ~ ..... day o'f ...... .~-r;~....... Notary Public, . ..... ?~..~.-.. ~.~. ~J...~.... NOTARY PUBLIC~ State of New Yo~k Term Exptr~M~rch 30,19 ~ / ...... 19 ~'7 County applicant)