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Home My WebLink About16461-Z l~OB~ NO. B 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~- 16461 Permission is hereby granted toL , ~..~.....~.~..~.~ .............. ................... ~.&g~e... ...... ..~~....~.. .......................................................... ............... ............................................................... County Tax Map No. 100~ection '"1 ....... '~ ..... Block ........ .~.. ......... Lot No ..... ,~...~. .......... /9. pursuant to application doted .... ~/~~ ............. .~. .......... . 19~..7. and approved by th. Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD _ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..... i .~-'~. ....... 1 ~..:. 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~/fi)ode, housing code, and regulations, and to admit auth°rized inspect°rs °" premises and in building f°r neces:~ irvii~n~~a,~q,~t ,~ ~~~(~a.tio.~) .... /. . ./. ,.?. .'. ........ (Mailing address of applicant) State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .................................................................................. Name of owner of premises . .'~...~...~..~..~'..~Y... ,J.~../'.~. ~ ............................................. (as on the tax roll or latest deed) If applicant is a corporati6n, 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 License No ......................... Electrician s L~cense No ....................... Other Trade's License No. 1. Location of land on which proposed work will be done. ................................. M. . . ........ .d. . Z,b. . ¢. . . ( ........... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No. Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.f.]..~.~'-..A~..ff ' b. Intended use and occupancy .... .~..t~..~. ....... ~.~ t 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .. ~ ......... Other Work .............. ~, ~ / ,~ ~ ',3~ (Descriplion) 4. Estimated Cost .... ......................... .... ..... ................. ' (to be paid on filing this application) 5. If dwelling, mmlber of dwelling units ...ff ......... Number of dwelling units on each floor .~.~Z.. ~. If garage, number of cars ....................................................................... 6. If busi mss, co n nercia or mixed occupancy, specify nature and extent of each type of use ...... ~ ~ ~. ~ ......... )...,... 7. l)m~ensK~ns oI ~xls~ing structures, if any: Front .... ~.. ~ ..... Rear . l ~ . . ~ ....... r)epth ~.~.T~ ....... Height . . .}.~ ~.q 0/. ..... Number of Stories .. ~ .... ........................................... Dimcnsions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimcnsions of entire new construction: Front ............... Rear ............... Depth .............. Heigbt ............... Number of Stories ....................................................... 9. S~zc of lot: }~ront ....... Z ~.~..~ ......... Rear .... ~.~ .............. Depth . ~¢ ............... 10. Date of Purchase ....... g( ~/~ ............. Name of Fomer Owner .~/~.~. ~~ ...... 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ..... .~.~ ............ ....::. Will excess fil~ remove0 from premises: Yes 14. Name of Owner of premises .Z~~. Name of Architect ........................... Address ................... Phone No ............... Name of Contractor .......................... Address . Phone No ............... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..~.. *If yes, Southold To~ Trustees Permit maybe required. PLOT~IAG~M prol 'rty I ~ es. "' ' r ~t d block number or descfit~fiofi ~c[o~i~g to fleed, and show street names and indicate wbetbc interior or corner lot. ~ t. ~ H ~ ~/ ~ - STATE OF NEW YORK, COUNTY OF ............ S.S ................................................. being duly sworn, deposes and says that he is the applican (Name of individual signing 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 th/ application; that all statements contained in this application are true to the best of his knowledge and belief; and that th work will bc performed in the manner set forth in the application filed therewith. Sworn to before me this .................. *: .... Y .... ' ........ Notary Public ....... /.~lc~,Jz,h~/..~.'.".... r-cl..~:..t4. YDs.: County sm~ pusuc, st~of ~.Y ~. · .................... -. · · ~. 4707878, Su~ lCob~ (Signature of applicant