The URL can be used to link to this page

Home My WebLink About16186-z FORM NO. lB TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16186 z Permission is hereby granted to: ~ o _ /~ ~ ,,~ ...... .............................. premises located ,~t ........................................................... County Tax Mop No. 1000 Section ..... ..(~....L~. ....... Block ...... .~...~... ...... Lot No......~.~.:..J.! ......... pursuant to application dated ......... ...~.do, L.m'~.~. ................. , 19.~...~..., and approved by the Building Inspector. Rev. 6/30/80 BOARD OF HEALTH . · 3 SETS OF P,L~zNS '.w~..'. Fo.M.o. SURVEY l TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTTC FORM ............. : TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined .~..~ ..... 19 .~.] Approved . .~ ....,19~ .~. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS NOTIFY CALL ~ ~ ........ MAIL TO: ~ '~'~.,~ 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 planto 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 Certific.ate 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, buil~..g'_)code, housinfi~code, and regulations, and to admit authorized inspectors on premises and in buitding for necessary ins 6~J~o'/~ ns. .... ........... ; .... i'; .... (Signature of applicant, or name, if a co porat'o ) .... t~4aiIing address of applicant) State whether applicant is owner, lessee, agent, architect, engjneer, general contractor, electrician, plumber or builder. .... ........ ; ................. /% ............................. Nme of owner of premises. ~ ././.).L~.....~....~.~.,7...J..~...,~.-/A. ~ ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUS~?/~FFOLK CO.NTY LICENSED Builder's License No ....... v .................. Plumber's ~icense No .... ../~7/4;1/~ ............... Electrician s License No.../.'//.z, .............. Other Trade's License No.../g./.././?. ............ I. Location of land on which proposed work will be done .................................................. ...In5 ......................... k/z/..}., . : ................ .:. .' . . . . , ............. House Number Street Hamlet County Tax Map No. 1000 Section .d)./...~..7..~...'7]. J.~../'/Block Lot ................... Subdivision .~./r~.//~ff..77...~.(iq. am~)~.d-.,.~..~..77. ~. Filed Map No. 5/~. ....... Lot../,~.~.7 ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ .'~.~.~.. ~<-...~.~.~. 7 ....................................... b. Intended use and occupancy ............................. .~- .......................... 3. Nature of work (check which applicable): New Building .. i..' ..... Addition .......... Alterat~9~n .......... Repair ................ :R~mpval .............. Demolition .............. Other Work~ ~-~-.[~..~ 6/ (Descrip~tion) 4. ...................... Fee ..... ........................ " (to be paid on filing this application) 5. If dwelling, numbqr of,dwolling un'its ............... Number of dwelling units on each floor ................ If garage number ofc~r~ 6. If business, commercial or mixed o~ccupancy, specify nature and extent of each type of use ....... ' .... . ......... 7. Dimensions of existing structures !f any: Front .......... ". ~.:. Rear ........... Depth .: ..... ) ........ Height . ' '/igqJl'/&'t~ a~l~h.'. . · Numbe'r of Stories .............. i'. ........ '.. ~" ~ . . lhm, ens~o}~s of san~[~n~lllli~th! zd~teratmns or additions: Front ................. Rear .................. Depth . %. : ................. H~!ght ....... Number of Stories .............. 8. D~mens~o~ns of ~lt~re new c9ta~stfu'Cttoh: Front ........... Rear Depth ... He~bht .~;....~.. .... · .... .,Numlser of Stones ......... , ..... . . ............. ~ '~" ~ r' ''' ........... ' .... Size of lot'. Front/.~./...~:. g.~,O.. ~?~..~.~l~/ar...~././. ....... ~. ..... ~.. De~th . ,,~.~. ............... Date of Purchase ./. ~.~,~ ..... i ............ ~ .... Name of Former Owner /--~.a....ff'f~.~ . ........... Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ........................... 13.' Will lot be regra/led ........ , .............. Will express fill,be removed fro, qm premises: Yes No 14. Name of Owner of premises ~ .~'../'~Ott./.O?..- ..... Address~.(,*.t'{.. ~...~fi...~..~.l.~.t. Phone No. ~4~...~.";..o~,..~. ~ Nan~e of Architect ............ ............... Address ................... Phone No ................ Name of Contractor ........... ............... Address .... : ....... ...... Phone No..,,,-- ............ [5. Is t:his property located wi'th±n 300 feet of a tidal wetland? &Yes ..... No~ ..... ~If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. gTATE OF NEW YORK, S.S 2OUNTY OF ................. .................. .. ·:: ..... . · ..... .................. being duly sworn, deposes and says that he is the applicant (Name of mdlwdual s~gmng: contract) above named. teis the . , ' (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly aBthorized to perform or have performed the said work and to make and file this tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner s~t forth in the application filed therewith. lworn to before me this : ........................ day of..: ................... , 19... qotary Public, ................... . .............. County (Signature of applicant)