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Home My WebLink About16590-zTOWN 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) N~16590 Z Permission is hereby granted to: ................. .~.~~. ...... ~.o~. ............................... ;/..~'~/. ''" ~at premises located a;~.~...,/l~~....~.- ..O~K~'-....-~-~ ...... County Tax Map No. 1000 Section ....... ..0...~...~/ ....... Block ....... ..~..~. ...... Lot No ......J...~.. ............. pursuant to application doted .... ..~..o~...~ ....... .~.~. ............ , 19..~.~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD CttECK BUILDING DEPARTMENT SEI:'?IC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM ............. Examined..~.~..~-., 19.~.'1. Approved .~.~..~.,, 19~,.~. eennit No..I..~..~'~'.{~.~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG· DEPT. TOWN OF SOUTHOLD Date .................. 19.. INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 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 appl cation. ¢. The work covered by this application may not ~e commenced before issuance of Building Permit. d. Upon approval of this application,, the' Building Inspect6r.will issUed ~ Building Permit to the applicant. Such penn: shall be kept on the premises available for inspection throughout the work. e. No building 'shall'~0'~ occupied Or used in'~vhole or in part for any~ purpose Whatever until a 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 the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additionJ~or alterations; or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit auth°rized inspect°rs °n premises and in building f°r necesi~?.i::~. J., .~~.. ...... (Signature of applicant, or name, if a corporation) o_ - ' .......... il~l'a;1;Jl;;1;'~; ;d~ress of applicant) State whether ~tpplicant is. owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises .... .~..~:.~./~./.~....~. .....f'....~.tf..~..~.~..~...~./. ,.....~.../~. f.l/.~..~..~.. .......... (as on the tax roli or latest deed) Ifapp cant 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 Lic6nse No ......................... Electncmn s L~cense No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ ...~..~)...'. · .~..~..~-. · .~.~.~..~./~/.4.~. · ~ . .5"~. ~...d.~...~..:. ..... ................... ..... House N'mn ber Street Hamlet County Tax Map No. 1000 Section ..... ~g.~. ...... Block d~ Lot... ~.~... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. lJxisting use and occupancy ......... ~.~.. ~.. ~m~?/... ~/-~-~. · b. Intended use and occupancy ........ ~.. ?? .l~.. ...................................... ·, ........... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteratigp .., ........ Repair .............. Removal .............. Demolition ........... Other Work./(.~g~..(_3..F~. ..... J (Description) 4. Estimated Cost ....... . ..................... Fee .. " (to be paid on filing this application) 5. If dwelling, number of dwelliffg units .: ............. Number of dwelling units on each floor ................ If garage number of cars .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of tacit type of usC ' . ...... 7. Dtmen, s~on~o~¥e~l}tmg,~?~}~O a y: ont ............... ~ear .............. ~eptn ............... Height ........... ....... N~b}r of Stones .................................................. D~ensions of sa~ stmcture~ith alteratmns or additions: Front ........ Rear .................. Depth . .'... i ;':{~.~.. ~..... HeiSt ...................... Number of Stories ...................... D~menaons of enhre new con~t~bon: Front ............... Rear ............... Depth ............... ~eight ....... ~ .... N~mher of Sto6eq .................... · 9.' Size;of lot: Front . '.... ~ Rear Depth , .... 10. Date of Purchase ., ........ Name of Fomer Owner ............... 1 1. Zone or use district in which Oremises are situated ........................................ ............... 12. Does proposed construcaon v{olate any zoning law, ordinance or regulation: ................................. 13. B, iI1 lot be regraded ....... ~ ..................... Will exccsa fill be removed from premises: Yes No 14 Nme of Owner of premises I Add Phon No Nme of Architect ........ , ................... Address ................... Phone No ................ Nme of Contractor ....... ~ ................... Address .... :.... ........... Phone No ................ 15. Is this property locate~ within 300 faet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town T~ustees Permit maybe required. , PLOT DIAG~ Locate clearly and distinctly ~1 bu~d~gs, whether existing or proposed, anti, indicate ~1 set-back d~ensions flom property ~nes. Give street ~d blodk number or desc~ption according to deed, ~d show street n~es and indicate whether Jmehororcornerlot. ~~~ ~ ~ ~o.o V ~ ~ g~a Vl~ A~ NOTI~ ~ILDING DEPARTM~T F~LO~NG INS~CTIONS: ~UNDA~IO~ FOR ~URED 4. FINAL. CO~STRUCT~ ~UST ~} COMPLET~ ~OR C O, STATE OF NEW YORK, S.S ...... ~g~ CONSTRUC~ & ENVY COU~Y OF ............... ........................... , ...................... being duly sworn, (Name of individual si [ning contract) above named. lte is the .................... ..................................................................... ~ ~ (Contractor, agent, corporate officer, etc.) of said owneLor owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ali statements co~ttained 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 , ............. .~..'.~... , .... day:of, d~ ........... '9ff.7 Notary Public .......... County (1 , ' ~LEN K. DE VOE ~A~BLI~, S~te of ~w Yo~ ............... . NO. 4707878, ~ffolk ~a~ ~ ' ' ~ ~erm E~pir~ March 30,1~/ (Signature of applicant~