The URL can be used to link to this page

Home My WebLink About16477-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 164,?Z z Permission is hereby granted t_.o;_.~-~, .................... ...~.~.~....~..~.....C~.., ......... . at premises located at ..L~ ................................ County Tax Map No. 1000 Section ..... /..,C?..~.. ........ Block ...... ..(~.....~.. ....... Lot No......,~.."). ............ pursuant to application dated ..... .~..~..~I~r%.......'~,....~.. ....... 19..~...~., Building Inspector. Fee ,.,~,..~... and approved by the Rev. 6/30/80 .qy..~o BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 /EL.: 765-1803 Examined ~.~..~.V., 19 .~.] ~ Approved~~ ..~.~., 19~.3. Permit No. } .~..qP.~. · .~. ' Disapproved a/c ..................................... ~ - Jl ~, APPLICATION FOR BUILDING PERMIT NOTIFY CALL ................ MAIL TO: 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 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 au[horiz~d inspectois on plemises a~d in building for necessaw inspections. ............~ ~ t.~/ ~"S~z/'~a e~ ............ (Signature 6f'~pphcant, or name, corporation) · ' (Mailing address of applicant) A2. y//77d State whether applicant is_owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder· ......... O~..N?..~. ............................................................................. Name of owner of premises .. ~. ~{~.¢/..~.....~'7.~. ( S~ , ~ . - 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 Builder's License No .......................... [:O~ w~U, v': '~ "~'~ '~' Plumber's License No ........................ ,. Electrician's License No ....................... O~her Trade's License No ...................... ~ Location of ~and on which proposed work will be done. . .~7~r~ ~¢.~ - e ......................................... ~ouse Numbe~ Street . ~ml~t 2. State ex[sfi~ use and ~up~ey o[ ~[~ises and intanded use and occupancy o[ p~oposed construction: ~. :xi~O~se~do~eupanoF ... ~0~: .~..~': .... : ................. -. b. ~m~d .~ and ~.~an~ -:..~. C. .~ .... :~/.+~b... 6..~. ~.: .............. 3. Nature of work (check which applicable): New Building ..... · ..... Addition .... .../.. Alterati~n .......... Repair .............. Removal .............. Demolition ............. k~Other Work~f~¢~..~.~.~.-.~...'. 3.o? .~..i .~/lSfl~r (Description) i 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, 66rilin~i6i~al or mixed occupancy, specify nature and extent of each type of Use.....................~ ' 0' g f '~ pth ' 7. Dimensions fexisfin structu es, if any: Front ............... Rear ......... ..... De ............... Number of Stories ' ' ' ' Height ................................................ Dmaenslons of~same~,sfm:cture w~th alterations or additions: Front Rear ... De~.t~ · ........ -7. ......... '... Height ...................... Number of Stories ...................... Din~e~'ts~.~ir~w cons!ruction: Front ............... Rear ............... Depth ./~...5': ~.. ...... Height i'??. N mber of Stories -- Date Of Purchase ......... x~ .... e ~ .... r, Zone or use district in which premises are situated .... .,~,.o. ~.Tld'.q.~.Z~ ............ , ....................... Does proposed construction vi61ate any zoning law, ordinance or regulation: ... ~ .O ........................ Will lot be regraded .... ~.~., ..................../k Will exc, ess fill' be removed from premises: Yes 14. Name of Owner of premises ~. fl.../.~...~.k/.C.~.... Address .~.g./-/..~xJQ.0~y/g. t4/re..~..~. Phone No. q73. 7'~.~.f~.7 Name of Architect , . Address ~f'.~.,~.~ ~.qiq: Phone No. Name of Contractor ........ .................. Address .... : .............. Phone No ................ ' 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ~.... No ..... · If yes, Southold Town Tr¢stees Permit may be required. ~ PLOT DIAGRAM Locate clearly and distinctly al'l buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether: interior or corner lot. 9. 10. 11. 12. 13. STATE OF NEW YORK, ' ~ ~ h~ COUNTY_ OF. j~.k_ ~/..TT..._.,,~..~.~~ 5',5 ....... '...'./././.~l?/.r/9~',~..~.,/'~'"./..6.'.6;:r .............. being duly sworn, deposes and says that he is the applicant (Name of i~dividual sigl'ting 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 s~tatements contained 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 · · ~0~ ~2452~037 Stgfolk CoOaty ~ (Signature of applicant)'