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Home My WebLink About16132-z FOrt, M* 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) Permission is hereby granted to: County Tax Map No. 1000 Section ........ !....0......~... Block ..... ..~.....~. ...... Lot No......~..~....'..~ pursuant to application dated ....... --~.~...C~.....~...!. ............, 19.~...~., and approved by the Building Inspector. Fee $...~?.. .................. BulJding Inspector Rev. 6/30/80 $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ., 19 ]F.7 ., 19 , 7. Permit No.] BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY ......... , TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL Examined . · ~.. · · · .~..~."-. Approved . .~,-?1~ .i~ .~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS CALL ................ MAIL TO: ~3LDG, DEPT, TOWN O~ ~OUT~OLD 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. ¢. 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 tiae Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ox' 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 iyrspections. /O ~ (Si=nature of applicant, or name, if a corporation) (MaiIing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ....................................................................... t., ...... .................. ~:~ 'i' Name of owner of premises /8/~Z-t9 ; .......... h',-" ~ '-' ~ '~ ...... ................ (as on the tax roll or latest deed). If applicant is a corporation, signature of duly authorized officer. .. .............................................. ~O"~¢~/ ;:5~.)~L1~5t4 G (Name and title of corporate officer) h' 5'~¥,O~ ?: ~,~v~ ¢O :' "-,Ot~ TH~i ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED ~-'~lh<~.'~..4 ¢I*.~,%*}JC Builder's License No .......................... ?,Ob',, ~'~ qu~ Plumber's License No ......................... ~'¢~,~ ~ :"" " ' qtJgS~ON Electrician's License No ....................... o '"- , ;.', ~ ~:* Other Trade's License No ...................... 'T~EALL ~,~((g-:. ifR~¢~NTS 1. Location of land on which proposed work wdl be done ................. ;.,~m .~¢~.~}¢1~.~ ....... House Nnm ber Street Hamlet Co.. y r= So. 00o , ock .................. rot ................... 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 .... ~.~/.~9~?~.C2~ ................................................ b. Intended use and occupancy ...... ~..~..5./.g2g::7~&..~. .............................................. 3. Nature of work (check which abplicable): New Building ' Addition .......... Alteration .... ,. ...... Repair .............. Rem:oval .............. Demolition .............. Other Work ~.0.~,~//2.~: ~ ~01/ (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, number of cars .... : .................................................................... 6. If business, commercial or mix~d occupancy , spec~y nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .... ..... ....... Rear ............... Depth Height ............... Number of Stories ........................................................ D~ensions of s~ structure With. alterations or additions'. Front ................. Rear .................. Depth ................... ~... HeiSt ...................... Number of Stories ...................... .... 8.Dimensions of entire new const'mction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ..... ~.~... Rear../ ......... .......... Depth ...................... 10. Date of Purchase .. ~ .~ ............ Name of Foyer Owner .... . ....D'I~ ~ ........... 1 1. Zone or use district in which p~emises are situated .............. ~. ~ ~ ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . ~ .~. ~.~.. ~.~~ 13. Will lot be regraded ....... c~ .... ~ ........... Will excgs~fill be removed from prem~6 Yes 14. N~e of Owner of premises ~.t.~ .U~.¢~. Address LT.~/~.U~ff~ Phone ~d. ~ ~ ~. Nme of Architect ......... .................. Address ~ ~z.~.~ Phone No ................ Nme of Contractor ........ . .................. Address ... f:~ ~.q ........ Phone No .... 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No .~'''' STATE OF NEW YORK, COUNTY OF ............. .... S.S ............................ ' ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the ..................... . .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann,f set fo~ in the application filed therewith. ' Sworn to before me this L / ] g2~,' / f-~~aau0~o}[ntl~ (Signature of applicant)