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Home My WebLink About16424-z FO~ NO. Il TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISF-S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16424 Z Counfy Tox Map No. 1000 Sect,on .... ./...~:'....,~,. ..... Block ....... ..~...~.. .... Lot No...)..~ .......... Building Inspector. Fee $.~. ............... Building Inspector Rev. 6/30/80 ~J RODERICK* VAN TUYL, PC, LICENSED LAND SUEV~E5 GREENPORT NEW YORK FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y. 11971 TEL.: 765-1803 Exa,mned 2~ ~' 19~'~. Approved~~/~.~ t{, 19~/ Permit No ] ~qe~q ~ Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY S0UTHOLD Date %. Y', /. , 19 a Ttus application must be completely filled m by typewriter or in Ink and submitted to the Building Inspector, wi sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showmg location of lot and of buildings on premises, relationship to adjoining premises or pubhc sir or areas, and giving a detatled descnphon of layout of property must be drawn on the diagram wtuch is part of this a~. cation· c. The work covered by tlus apphcatmn may not be commenced before issuance of Budding Permit. d. Upon approval of this apphcahon, the Building Inspector will issued a Budding Permit to the apphcant Such pe 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 unhI a Certificate of Occup. shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc. Regulanons, for the construction of buddings, addit~ons or alterations, or for removal or demolition, as hereto desert The applicant agrees to comply with all apphcable laws, ordinances, buildmg code, housmg code, and regulations, an, admit authorized mspectors on premises and m building for necessary ln~pechons __ .. .... (S~gnatur~of apphcant, or name, ff a corporation) (Mailing address of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electric~an, plumber or bulI ·, ~CX/./7~tq .............................. NaraeofownerofpremmesO//~;r' /oo0 -- ~'c¢7r". /.~¢,2. . ~]pq'/~ ~ .. /'~.~. /e~ (as on the tax roll or latest deed) C~/ If applicant ~s a corporation, s~gnature of duly authorized officer / ~-'q (Name and htle of corporate officer) ALL CONTRACTOR'S MUST BE SIIFFOLK COUNTY LICENSED Builder's L~cense No ..5~,/~f:?.,. . Plumber's L~cense No Electrician's License No Other Trade's License No Locanon of land on which proposed work will be done ....... House Number Street Hamlet County Tax/vlap No WOO Section ./~2, Block .,5'--. Lot. /.~ Subdivision Filed Map No Lot (Name) State existing use and occupancy of premises and mtended use and occupancy of proposed construction a Exmt~ng use and occupancy ~t~,~..6, ~ ;! ~.~ b. Intended use and occupancy ~--t~,~-- ......... 3. Nature of work (check which applicable) New Budding .... Add~hon ...... Alteration ...... Repmr .... Removal ......... Demolition . . . Other Work (Descnp. tio~ 7.0.0..: oo 4 Estimated Cost .............................. Fee ............................. (to be paid on filing this application) 5 If dwelbng, number of dwelhng units .......... Number of dwelhng umts on each floor ......... If garage, number of cars ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............. 7 Dimensions of existing structures, if any Front ....... l~,ear .... . ... Depth ......... Height ... Number of Stones .........." ' : ............ Danensions of same structure with alteratmns or addltlons Front ........... Rear .......... Depth ....... ~ ~,..; .... Height .................. NumberofStones .............. 8. Dimensions of entire new construction' Front ...... Rear ........... Depth ......... Height .......... Number of Stones ...................................... 9. Size of lot Front ........ Rear ......... Depth .............. 10 Date of Purchase ............. Name of Formel Owner ................. 1 1 Zone or use district m which preimses are situated ............................ 1 2 Does proposed construction vmlate any zoning law, ordinance or regulation' . .................... 13. WdI lot be regraded ..................... Will excess fill be removed from premises 14 Name of Owner of premises .... Address ........... Phone No ......... Name of Architect ................. Address ....... Phone No ........ : . ·. Name of Contractor .............. Address ........ Phone No 15. Is thzs property located wzthzn 300 feet of a t~dal wetland? *Yes ..... No .i~.] ........ · If yes, Southold Town Trustees Permit mag be required. PLOT DIAGRAM Locate clearly and d~shnctly ~11 buddings, whether existing or proposed, end. indicate all set-back dunenslons fro property hnes Give street and block number or descnptmn according to deed, and show street names and indicate wheth interior or corner lot. STATE OF NEW YORK.- . country OF . 5' S S ~ (Name of individual signing contract) above named being duly sworn, deposes and says that he ~s the apphcar, ~He is the ..... ~ .(z)~.~: ./~ ................ (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 application, that ail statements contained m this application are true to the best of his knowledge and belief, and that th work will be performed in the manner set forth m the application filed therewith Sworn to before me this ......... ~ .day of... Z~/~..7~.?~/~ .~r~.., 19 .~ 7 ~n ~ youths, Uo~,~ / (S~gnature of apphcan'