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Home My WebLink About13807-z ~OBM NO. ~ TOWN 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~ 13807 Z Permission is hereby granted to: ............. .... to ................................................................. ~ ...................... ~ .................................. ot pr~mt~o, I~ot~d at ............................................................................................................................ County Tax Map No. 1000 Section ......... IJ...-L ....... Block ...... ).....-~... ....... Lot No ..... /..~..~..~.'..~.... ~urs~ant to *pplic~tion d~t~:l .... ~.......~........~...~.. ................ , 19..~..~.., ond ~pproved ~ the Eluildlng Inspector. Fee $..¢~/.,,~. ............. Building Insgector Rev. 6/30/~0 Approved . .,~,, ,O~,. ,e~..~..~. ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 .~,~. Permit No. J.~2.0.-]. · .~. TOWN,,,O~,'$OUT~IOLD Rece±ved ........... ,19.., Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .lq..a..r.c.h. ..........., 1~ .5.. INSTRUCTIONS a. Tins application must be completely tilled 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 authorized inspectors on premises and in building for necessary inspections, rD -- · .... (Signature of applicant, or name, if a o p t'o ) (Ivl?Jiling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .J.q h..13..P.....a .n.d.. k..~ .n.d.a...F....K.o. ~.a.l.s.k..~ ...................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done... V..a .c.a.n.t...l .afl. d. .................................. ·/,o.q.......................... p.].q 1 .~.u.l.e...L.a.n.e. ................ M.a..t .t.i.t.u..c .k.................... House Number Street Hamlet County Tax Map No. i000 Section .... 1.1.4. ........... Block ...... 1..2 .......... Lot..P../.0...]..3:.3. ...... S3u[7/83 bd~vision...d 9.h.q..a p.d..L..~ p.d.a...K9.w.a. ]' .s.k.i ........ Filed Map No ............... Lot . Y.P,.". .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy .... V. .a.c.a.n.. g. . .l.a.n. d. . .-. . . z. 9.n.e.d. . .p.e.s. l d. .e.n.t.~. a. )' & agricultura] b. Intended use and occupancy ....s ~jql.e...-. ?.e.s. 1.' .d.e.q 13. i .a.].. a. O .d..a. g ? .~ .c.u. ]..g .u.p.a. ]. 7..T.q . p ) .a.c.e...f.e.n.c..e .... 4' in height. ~-~~ 3. Nature of work (check which ~pplicable): New Building ' Addition .......... Alteration Repair ~ '2 ........... Removal .............. Demolition .............. Other Work.. Fe.nce s ...... ; (Description) $ 2Q Fee 4 Estimated Cost (to be paid on filing this application) · If dwelling, number of dwelling units .... 13 .......... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixled occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height Nu'mber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. ~... Height ...................... Number of Stories ...................... 8. Dimensions ' i ' · ................................ of entire new construction: Front ..... Rear ....... Depth Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ......... i ............ Rear ...................... Depth 10. Date of purchase ...1.2/. 8 2. 4 ................... Name of Former Owner . .Ge f f&e n ................... 11 Zone or use district in which plremises are situated "A" 12. Does~proposed construction viNate any zoning law, ordinance 0r regulation: ................................ 13. Will lot be regraded ... n. 9.. ~ .................... Will excess fill be removed from premises: Yes No 14. Name oi' Owner of premisesd..i. .K 9 .w.a. ]. s..k j ........ Address ................... Phone No.. 2. .9 .8:.5. 9. ~ .8 ..... Name of Architect ........ i .................. Address ................... Phone No ................ Name of Contractor ~ Address Phone No .. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc: number or description according to deed, and show street names and indicate whether interior or corner lot. NOTIFY U'IU ......,,~.~ ~EP.XRTMENT AT 7~5.1~02 ~'~. ,,',~'~ T(" ,! P~4 FOR THE [ C,l.J~ x .. - , 1. ' n'' "'~'" TWO REOJ RED 2. RO[V'~ - -n 3. I~1~,, . A 4. FIN~'~ C'~'"" ~'~ ',V~N MUST Bt' r ......'"~r '-r~R C. O, ALL Chh": '~" *CFION SHALL MEET THE RFc`' '~:~4r{M'rS OF THE N.Y. STATE Cr'NCTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ~ESIGN O¢ CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF. ...... , S.S ....k ~ ~ P3.. [ ~ ~g.k [ ~ ~ ........ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. SHei the qQ P~er ' [ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have perfomed the said work and to m~e and fil~ this application; that all statements contained k this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~n:er set forth in the application filed therewith. ~woru to before me this ~Sth d if ~arch ............. ? ...... ¢... ayo~ ..................... , 1~... Nota~ Public, · ...................... County NOfARY PUBLIC, State o[ ~ew York .: ............. No 4707878, Suffolk O[euntm (Signature of applicant) lem~ [xptras rerch 30,' 19~7