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Home My WebLink About16484-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERAAI'I' MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) NO 1~484 Z hereby granted to: . , ..~.,o..~.~..'!..~ .......................... ; ............... '""' ..... ...~.~....~.:~..:..L.~.~.~ ........ ~o & ~ .. · ................... ............. County Tox Mop No. 1000 Section ....... ..C~..~ ....... Block ..... .~...~ ......... Lot No....~....~. ........... pursuant to application doted .... .~.~....~..~'~.. ....... , 19.~..7..., and approved by the Building Inspector. Fee $..~...~..:........./.,.... Building Inspector Rev. 6/30/80 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ' TEL.: 765-180:~ L: x a m i ~.~'Am-~..'~ .'~, 195 .~. Ap proved ~~ ~, 19 ~ ]. Pe~it No. I .~ ~ ~.q.5. Disapproved a/c ..................................... (Building Inspector) ~PPklCAIIO~ FOB B~ILDI~G INSTRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SUIIVI~Y ......... · CIIECK ....,. .... SF~P'r I C FORM ............. : NOTIFY CALL Date .... /./.q~./... ....... 19 4/. / a. This application mnst be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 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 street: 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 permi shall be kept on tile premises available for inspection throughout tile work. e. No buildihg shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupanc~ 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 th( Building Zone Ordinance of tile Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ 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 tc admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State/~v~aether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pl~inber or builder, ... ................................................................... ./ .. .- , \ , ., (as on tlle tax roll or latest deed)~ If applicant is a corporation, signature of duly authorized officer. ~ .............................................. '.:ry~ cy (Name and titte of corporate officer) . ~ ~.'~ ALL CONTRACTOR'S MUST ~ ~FFOLK COUNTY LICENSED ;()L~O~,q~ Builder's License No ....... ~.~;~ .............. ~OA'c~.~ Plmnber's License No ......................... f:~OG~) zlectmctan s L~cense No ...... ~. 4. ~NAL Other Trade's Liceuse No .... "ALL CO~T~OC~' Oe,~ $~A~[ MEET I. Location of land on which proposed work will be done'. ................ ~..Hgl~: ~$~k.~ ....... ..................................... House Number Street Hamlet ~P ~ not..~ County Tax Map No. 1000 Section .................. Block ............................ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of ~emises and intended use and occupancy of proposed construction: a. Existing nsc and occupancy ................ ~ ] .................. b. Intended use and occupancy .3. Nnture of work (check which applicable): New Building ..... '.. ....Addition .......... Altera~,~/~.,~ .... Repair . ............. Removal .... ; ......... Domolit:ou .............. Other Work ~/Vff .~ ..... ~ z (D illi ) 4. Estimated Cost . . ~ ..................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelliug units ............... Number of dwelling units on each floor ................ If garage, nmn ber o f cars ........................................................................ 6. If business, connnercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ........ ': ...... lteight ............... Number of Sto~es ................... .............................. ....... Dhnensions of same structure with alterations or additions: Front ............... :-, Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ......................................................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Foyer Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordifiance or regulation: ................................ 13. Will lot be regraded ....... ~ .... ~ ............... Wall excess fill be.~e~ove~r~r~j~es: Yes No 14. Name of Owner of premises ¢]JD.~/~.~ ...... ' ' ,,an . Name of Architect ......... ~ ..... ~ ....... Address ~. .................... Phone No... ~, .... , ....... Nmne of Contractor .~)t ~ ~ ~. ~ ..... Adares~.,:~ ff 76./~/~aone No. Cfg.':'l.'~ 7Z... 15. Is th~s property located within 300 feet of a tidal wetland? ~Yes ..... fro ~.. *If yes, Southold To~ Trustees Permit maybe required. PLOT DIAG~M Locate clearly ~d distinctly ~1 build~gs, whether existing or proposed, and. indicate MI s~t-back d~ensions from property lines. Give s~t ~nd block number or descfipgion a[cording to deed, ~d show street names and indicate whether interio[ or corn?r lot.~ ~'~ ~C~. ~b/b[~ ~ STATE OF C013 ,ISrfY OF. '.~. '. '.~. './~. '.~?, '.~.~. ......... being duly sworn, deposes and says that he is the applicant (Na~ne of individual signing contract) above nanled. He is ...................................................... (Contractor, agent, corporate officer, etc,) of said owuer or owners, a~d is duly authorized to per£onn or ha~e pcr£o~ed the said work and to ~ke ~d file this application; that all statements contained i~ thi~ applicatio~ ~re tree to the best o£ his ]mowled~e ~d belie£; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ELIZJ~ETH ANN NEVILLE Nota~ _P~I~Iic, State of New York (Signature of applicant) No. 52-81258~), Suffolk Co~l... Term Expires October 31, 19~ ~'