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Home My WebLink About22160-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_0 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 22:t60 Z Permission is hereby granted to: ................... ............ ........... .......................................... ~ .......... ~. ............ ..................... ~¥....~.¢.....~.~.....~..:.~; to ............ ~.x.~.~ ....... ~ ......... ~~ ........ ~....z¢..~..~.~....~.~.~' ~' ....... .................... ~..~ ....... ~..~...: ................................................................................... ......................................................................... ....~....~..? ........... ............... Y... .............................. Counh/Tax Map No. 1000 Section ........ ..~...¢ ...... Block ........ ../. ............... Lot No.../... ,~., ................... pursuant to application dated .................~./~, ..~. .................. 1 9 .... and approved by the Building Inspector. ~ee~...~....~. .... Rev, 6/30/80 BLDG. DEPT. TOWN OF. $(3UTHO~D Ex~ nined ', , . . ..... Approved ..... ~/-~r~. ..... 19 .~.~. Permit FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Disapproved a/c ..................................... ; //-(Buildi~ o pector) · ' APPfi-IC/ATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. 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 al/applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. --' -- (Signat,u~r%of appli~nt, or name,j,f~ corporation) .~ Z~..z~ ~ ~ ~,..¢/....././~. .......... (~ailing a'd~re~_~oof applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of p remises.f~.~. ~.:. ~..~ ...................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. &PPIIOVEI) &$ NOTED .............................................. FEE: _,...d_~ ~ BY' (Name and title of corporate officer) NOTIFY 8UILo~NG D~[~A~JOENT AT 765-1802 9 AM TO 4 ~ FOR THE FOLLOWING I~JSPECTIONS: t. ~OUNt}ATIF, N TWO REQUIRED FO,q POURF? CONCr'~ETE 2, R()U(q~: rrJ'-i"t",~G & PLUMBING 4, FINAL ~(.'~.',,RUCTION ~U~T AgL CONSTRUC[ION SHALL I. Location of land on which proposed work will be done.~ ........ ' .......~H6 ,~Q[~R~M~N;TB. ,~F · TN~, ...... .... House Number Street D~~s'fauc~N o,m, 000 ...... .... 7. ..... .... Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Subdivision... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of'proposed construction: b. lntendeduseandoccupancy. ~ ~gf~,,,~,;. 3. Natureofwork(checkwh]chgpplicable)' ' ' New Building .. ... Addition. ......~[~' '. .,....... Repair .............. Removal .............. Demolition .............. 4. Estimated Cost ~ I (to be paid on .fiJittgl;lli~.al~plication) 5 If dwelling number of dwelling units Number of dwelling units on ~'' ~ :~*~ ....... '~'~ If garage number of cars " ....... ' .... 6. If business commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. ~mensmns of exlmng structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .............................................. . .......... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction Front ................ Rear ............... Depth ............... Height ............... Number of Stories ......................................................... 9. Size of lot: Front .......... ! ............ Rear ...................... Depth ....... _~ ....... ~' 'fi_~i' ' 11. Zone or use districtFrffwhich premises are situated ........................... ? ...................... , . 12. D°es proposed construction vi~late any zoning law, ordinance or regulation: .~.d?.. ....................... 13. ,W, fll lot be regraded ...... .,.. _~.:Or ............. ,_. ,.,Will excess fill be removed from premises: Yes Name of Architect i · · ...... : .................. aaaress ................. Phone No .... ~ ....... Is this property within ' ,300 feet of a tidal wetland? *Yes ................ · If yes, Southold iTown Trustees Permit may be required. PLOT D~AGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~YOR;K~ , / .S .........~'~'.*Q. -G.. 8./.-L.q. ...... .~.: · ·, ~/~./- ~ ./~,.. 'being duly sworn, deposes and says that he is the' applicant (Name of individual signifig contract) above named. , He is the ............................. .~..~... ~ ' (Contractor, agent , corporate officer, etc. ) I of said owner or owners, and is duly, authorized to perform or have performed the said work and to make and file this application; that all statements contaibed in this application are true ~o 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 //~ ' ' ............. [ ...... , .q k "- -.~ 7~/Z.._~-.' ."~.".~'..':'~.. ~,Z...-"~.. County , · ....... No/~?25.lJS!),.8. il"o.* l~U~ (Signature of 'tetra Explre~ MsI,IJ,, ~ ~