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Home My WebLink About20599-z FO~-M 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-oN.o 205§S Z County Tax Map No. 1000 Section ......... .~...~.. .... Block ............. ~ .... Lot No .....~ .............. ~u.uont to opp,,co.o. ~o,. ....... ..z'.~......~... ................................ . ,9/...%o.d o,prov.~ by ,~e Building Inspector. Fee $,..~ ..~.. Rev. 6/30/80 ' v gOAK9 OF HEAI..TIt ......... ~"~' 2 8 '!992 TOWN OF SOUTHOLD SURVEY ................... · BUILDING DEPARTMENT CIIECK .................... : ...... TOWN HALL SEPTIC FOR~I .............. T~ ...... SOUTHOLD, N.Y. 11971 ...... TEL,: 765-180:3 Examined . .~.~.~ ~2 19 ~ Approved ............... 19~.,~. Permit No. ........... Disapproved a/c ..................................... (Pofflldin~spe~tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 's 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- Con. 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 ! be kept on the premises available for inspection throughout the work. :. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy hhve been granted by the Building Inspector. ,PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ing Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or ations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. pplicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to authorized inspectors on premises and in building for necessary itnspections. .... - (Signature of applicant, or name, if a corporation) v, (Mailing address of applicant) ,hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'owner o£ premises ..... ~ ! .I.~ .~.~. .... .~J..w)..v~...o~..~ ........................................... (as on the tax roll or latest deed) ~nt is a corporation, signature of duly authorized officer· (Name and title of corporate officer) [er's License No .......................... bet's License No ......................... · xc an s License No ....................... Trade's License No n of land on which proposed work will be done .................................................. '/' '/" Hamlet umber Street 'ax Map NO. 1000 Section ...~¢.~. Block ...~..../~.. ...... Lot...9 ............... m ..................................... Filed Map No ............... Lot ............... (Name) · lng use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy ..... ?..~.~...~L~....~.,~'~ use and occupancy ..... .C~a. ?~.. ~-?hCfi~.~.....~..E~.. ~.~..~..4%. / 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratmn ........ Repair .............. Removal .............. Demolition .............. Other Work.. ? .~, ~-:':'~ .... ,Description) 4. Estimated Cost ...... .'~ Q-~-'/O ~'~'1 Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 ............... Rear .............. I)epth . . 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 ....................................................... Size of lot: Front ..... .~..~...F-..'T:_ ........ Rear .....~.-...~.' .~ .......... Depth .?~: '..'.-: ...... -.~:..~... Date of Purchase .... .li:)~..C., :~..I...I.c).~.. .......... Name of Former Owner ................... , · ~' - . ..... ~..~. :~. o.~..,..~. .............................. Zone or use district in ~ htch premises are situated Does proposed construction violate any zoning law, ordinance or regulation: .. lY..~.< ...................... Will lot be regraded ...... .t¢?. ................... Will excess fill be removed fr~ro~mises: Yes No Name of Owner of premises .~.. !¢...~...5'.~?..'~.~ ...... Address LE3.-. '.?~. :~.~~. . ."~.~..i .~'. . Ph-ohe No..24 ~-. ~;b.'.'.~...~ .~: '~ .7. Name of Architect .. ~. ........................ Address ................... Ph.one i~o, ....... : ....... Name of Contractor 4'~IB. g.~?. S~..~..~..,..~...*~...~..'!. AddressClg.'.h~ .AP0v..~.r~. ~-~ ..qff-.., .-~'l~6'~e~ ,~ LI:: 7.e5.-. }.~2..~.. Is this property within 300 feet of a tidal wetland? *Yes ........ No..~ .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM 10. 11. 12. 13. 14. 15. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property fines. Give street and block number or description according to deed, and show street nantes and indicate whether interior or corner lot. .~P~itOV.,ED.__~ AS NOTE~ .'~:':7!7~: RtIILD!NG ,~IEPARTME~'T ; ~tli:NDATKx,' 'P~4O ~EQtJtRED ) ~C/tJGH ~RA~.~iN(~ & PLL]MgING ~ COMPLETE FOR ALL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES· N~ RESPONSIB~ FOR OESIGN OR C~STRUC~ON ERRORS STATE OF NEW YORK, S.S COUNTY OF ................. ........ .I~..\.C.,.~...~.C~.... '~.. ~-M ~.-T~:.{~... ................. being duly sworn, deposes and says that he is the applicant (Name of indMdual signing contract) above named. /.~. He is the ............... .~..o~.~.-~... ~....~. ~.wl?q~.c.~,..2~ ..................................... (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 thi~ application; that all statements contained in this application are true to the best of his knowledge and belief; and that tht work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... : ...... ! ......... (lay oI, . . ,~- .fir's= ,. '"///~ --'~// '/ Notary Public,..¢(-~d-...-'5~z..~.c/L-?.,.'......~...2 ~~County HELENE D, HORNE .., Nobly Public, State of New York * · ........... No. 4951364 (Signature of applican~ Qualified in Suffolk County Commission Expires May 22 19 __