The URL can be used to link to this page

Home My WebLink About16578-Z IvOB~ 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~16578 Z Permission is hereby granted~o: ..~.~...~.~......ff.../.~ ............................ _ ...~.~...~..z, ......................................... ~....~~~_~......~...~: .............. County Tox Map No. 1000 Section ../,.. ,~,...~ ...... Block ........ ~ ...... Lot No..~,...,,~,,., ...... pursuant to application dat~ .... ~....~.....~..~. ......... 19~and approv~ by the Buil~ Inspector. Rev. 6/30/80 Uq BLDG. DEFT. , TOWN OF SOUTHOLD ( Approved ~.~.. ,~_~ ..... 19ff ./. Permit No..~.~ ~.~ ~ BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL ................ MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... ~. · .~. ·: .... ~..~., 19 .g'. ? INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and givin$ 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 alteration~r~3r fov-r~i~o.z_al or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,(~building,g6de, h~sing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ii~_..~ (Si~plicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... .d)..c~./.o. ,~..'~.. ................................................................................. Name ofownerofpremises ....~A-4/.r?/.~.~.. . .~..Tz:.A~.~t.,~q..,.~.. (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 MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done[ .... ~..,~..I-.. ~/./~.~. t. ................................ ... .............. . .......... .......... ............. House Number Street Hamlet County Tax Map No. 1000 Section .../. ~..~ ........ Block ..... .~. .......... Lot..~...~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~...~--4./~f~m.,'<~. .................................... use and occupancy .... ~)Irrb. ?.'...,~!.~.~ (1 ..... /2 ~ · .~.... ........................... b. Intended 3. Nature of work (check which applicable): New Building .......... Addtit~n .......... Alteration .......... Repair .............. Removal .............. Demolition .... <[. ........ Other Work ............... ,~L ~ '"~ (Description) 4. Estimated Cost ...................................... Fee ........ ' ............................. · (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... /t ....... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... ~..o. f ...... Rear .... q.r~ ....... Depth . .. ,2-:~,. ~ ....... lteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ........ CC..' ...... Rear ....... .c.) .z ........ Depth ......... .O.. t. ......... Height .......... ~..t ......... Num her of Stories ......... O. ........... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ..~r~..~....~q,-.~. ~:,~..~.r.~.~.. Rear ...................... Depth ............ , .......... 10. Date of Purchase · · ./.~?..?<'. ........ Name of Fenner Owner ~...W.,~,_,.,~ i 1. Zone or use district in which premises are situated .... J'.~?...~.~:': w-:e4~.,. ................................... ~ 2 Does proposed construction violate any zoning law, ordinance or regulation: ...~..'-:'. ...................... ~.. i3. Will lot be regraded ..... ~..~. ...... ,, ........... Will excess fill be removed from 3remises: Yes 14. Name of Owner of premises .~tt.*~.: '.~q.w.l~../0'c'~4~..~Address .. ~.4~7.<,'0..:,',~. ~.. ..... l'hone No...'~:; 7. r ~5:'./. .~. Name of Architect ....... Address Phone No Name of Contractor ~. ............ ' ................................. /.~..~'~&o.,,J..~..:".~q-.d.~erx .~':~.. Address ...Z .~-~:-.~.-'.'!°./ ~ ....... Phone No. z.>---- ........... ;5. Is thJ. s property located within 300 feet of a tidal wetland? '~Yes ..... No .0:3... · Jgf yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. ;TATE OF NEW YORK, . ,, :OUNTY OF...~..O,..F.~,..o.~. ...... a.a ......... contrac-,~.5,~ ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing .bore nanled. i..: is the .... .O..o~.../y~.. '~"X ................................................................. (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~:plication; that all statements contained in this application are true to the best of bis knowledge and belief; and that the :'ork will be performed in the manner set forth in the application filed therewith. ,worn to before me this ....................... day of. ....................... ,otary Public,.. ~,-~../~....~.~.~.~:~e,.. .... County ,, ......... p954': ....... ' ....................... NOTARY PUBLIC, State et ~' '~ ',. (Si~pplicant) ~,1~ 47078111, h~ '7"o~/,%, oF--- ~ocJ-r; ,:4