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Home My WebLink About16628-Z IPOB, M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6628 Z Permission is hereby granted to: ..... ..~.~...~.~.:.H...:..J..L~.~ .............. . at premises located at ..~.. .......... : ............................................. County Tax Map No. I000 Section .... ..0./...~. ........... Block ..... .(~...~'.. ....... Lot No..~L.-~r:... ............. pursuant to application dated ...... ~..~....~.....L.~ ............ 19.~..'1.., and approved by the Building Inspector. Fee $.,]...~..; .............. Building Inspector Rev. 6/30/80 ~ '[~., ,. , :- sourHOLD t Approved .,/5). ~ ). k, 19?7. Permit No. ~..[0.~.&...~..'~-T.. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 I)isapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSI'RUCTIONS 3 SETS F PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL - ............... MAlL TO: o. " a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of pl:ms, accuratc plot plan to scale. Fecaccordingtoschcdule. b. Plot plan sbt)wing location of lot and of buildings ()ti 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 appli cation. c. 'Ibc work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon aw)reval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permil shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used iii whole or in part for any purpose whatever until a Certificate of Occupanc? shall have bccn 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 o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described Tile applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary i~n/~/ection~. .. / 0 (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ........ ............................................................................ Na,ne of owm, r of prenIises .. ~_~(/.L..% ./.-7~."~....~...-.. /,f./J..,~..,~.~7.d7.' .~.~.'~..: .............................. (as on the tax roll or latest deed) If applJc;lrlt i5 a corporation, sign tt re of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Buildcr's l.icense No .......................... Ph,ubcr's License No. ' I lcctrician's l.icense No ....................... ()the] 'l rade's I h:ense No ...................... I Iouse Numbc~ Street Hamlet ('ot,nW 'lax Map No. I000 Section .... /.~ .......... Block ..... ~ .......... Lot.. ~ ........... Sul*dixi .ion .................................... Filed Map No ............... Lot ............... (Name~ Stale existing uso ltl oct panty of prenlises and intended use and occupancy of proposed construction: a. }]xi,;tingusc and<,ccupancy .... ~/~ ...................................................... b. l,,tcnded us~' and occupancy ..... /~.~.~.~.4.4 .~.e .~ ....................................... 3. Nature of work (check which applicable): New Bufldin~Addition .......... Alteration .......... Repair .............. Removal .......... (.~~ ........... Other Work ............... (Description) 4. Estimated Cost .... . .~.K/=.f-~iT.o.: ..~.. ................... Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ Ifgarage, number of cars ...':~.(~'q~. ...... "2-o X 2-0 .............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ....................... ~.~_~ Rear ...................... De~th 10. Date of Purchase . X/'f.~./.ff.? .................. Name of Former Owner . 1 1. 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 fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ 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 Town Trustees Permit maybe required, PLO~F DIAG RAHM 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 interior..or comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. .. ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~md is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained 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 ...... .~..Oy.~.. .......... 19..ff.? ~i~OTARY PUflllC, Stale of New Yoek .... No. 4707~/~, Surfak Coun~i,~ . ~., Term bm~s. ~atch 30