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Home My WebLink About20965-z · OB~ NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING, FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2096~i Z Dote .~.~.~../.. ......................................... , ~,--- Permission is hereby granted to:,,~ .........._~'-**/..~ ....................... ~ ~ .. ........ at premises located at .....,,~,,,:~/,,,~,,.,,~,,.,~,.:......~.,_...4~T~, .~'~ .................................... County Tax Map No. 1000 Section ........... ~.,,(~ .... Block ........ ;~, ......... Lot No .....~,, .............. pursuant to application doted ~..~...~.Z ......................... 19.~......~., and approved by the Building Inspector. Fee $.~~.... Rev. 6/30/80 '~!~ '~-x( TOWN HALL ~:,, .~;;, : : ' '-. SOUTHOLD, N Y 11.971 Disapproved a/c ..... .................. ' .. , (~ding~pector) . APPLICATION FOR BUILDING PERMIT BOARD Of' HEALTII ......... 3 SETS OF PLA?IS .......... SURVEY .................. ,.· CIIECK SEPTIC FORd CALL ................... ~IAIL TO: 'ti om' TOWN O~- Date ................... 19... INSTRUCTIONS , ~ a. This application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale· Fee according to schedule. , b. Plot platt showing location of lot and of buildings on premises, relationship to adjoining premises or pubIic streets ~r ~reas, and giving a detailed description of layout of property must be dra~vn on the diagram which is part of this appli- zation. c. The work covered by this application may not be commended before issuance ~)f Bui/ding Permit· d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ;hall 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 pu?pose whatever until a Certificate of OccupanCy ,hall 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 ]uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appUcable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr/bed.' ~he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to -dmit author/zed inspectors on premises and in building for necessary i~..~,,~..i~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~tate whether, app feaf~t zs ,owner, lessee, age'nt, ;architect enoineer general contractor, electrician, plumber or builder. amc of owner of p-ri.m?,s .., , . . .;,/ : ' , . , ,~ , (as on the tax roll or latest deed) f applicant is ~,c,6rpb~*~tlon, signature of dul~:~eth6rize~ officer. · (Name,and titlB of corporate officez);;~ Builder's License No . . Plumber's License No ' ic, ian's · ' Electr License No ...................... Other Trade's License No ...................... Location,,of land on which proposed work will be'done. . .( rs*' ... }louse Number Street Hamlet County Tax Map No. 1000 Section ...... 7.0..' ...... Block ...... ~. ......... Lot .................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended Use a. Existing use and occupancy ......... b. Intended use and occupancy Nature of work (check whi6h a Repair ............... Rem Estimated Cosl ....... If dwelling, number ~f dwellin · If garage, number of cars phcable) New Bu Id ng · · , AdditLa-, r;--. ~'~;': . "^1, ,' ,',~' oval .... . ;; ..... hA' ' , ...... i ' ' ....~" ~ DeL~L :~on .............. Other-~Work~H.~$.vl ,~. .... · , (~,~scription) ' Fee (to be paid on filing this application) units ' ' ............... Number of dwelling units on each floor If business, commercial or mix ...................................................... t °CCupancy, specify nature and extent of each type of use 'Deiii: Dimensionsofexistingstructu s, ifany: Front ............... Rear ...... ; ....... "' ........ Height ............... Number of Stories .......... Dimension of tmctur ith lte ti ................................ i"~ .... ~ .... s saints e w a ra ons or additions: Front ................. Rear ............... D pth 'e ! Hight N f' 8 Di ..................... e ..................... umbero Stories ............ ;.. ....... mansions of entire new cons etlon: Front~ Rear ............... De ...... ~. ight N .~b 9fSt ....... j ...... pth e · -. ............. m er aries ...... ' ....... 9 s fi k~.~ ~9.~. ~ ..... il'~ ...................... '. ~zeo ot. Fr0nt ..... . ........ Rea .... ,,~J.~V.7. , .. Depth ........ 10. Date of Purchase ........... . .~...~'X$~t, q:'t ......... ;n' ~ ...... ' ......... Name of Former Owner .................. ; .... 11. Zone or use district in which pr,, i es are situated ....................... 12. Does proposed construction viol 13. Will lot be regraded 14.. Name of Owner of premises .~ Name of Architect ......... Name of Contractor~ ~.g. '..~i ' Is this property within *If yes, Southold Locate clearly and distinctly all property lines. Give street and block interior or corner lot. ate hny zoning law, ordinance or regulation: ................................ · ~, .... ., .....Will excess fill be removed from premise .s&. Yes ' No .~.' .~'t;~.. 1~.'/~,..,,;~ Add/'hss$.l.%%,~ .O~t.~ .0~0 .....Phone No. ] .['.~. .................. Address .......... s. ~. ~..}~.?&. Phone No. . ' O0 ~eet of a tidal wetland? *Yes ........ No. &,~.. .... own Trustees Permit may be required. PLOT DIAGRAM' buildings, whether existing or proposed, and. indicate all set-back dimensions from lumber or description according to deed, and show street names and indicate whether /'ATE OF NE~.YOe~,K, . OvN-r¥ OF. ~¢~. ~ l i C, ..... S.~ CL~ o ... ......... ' ...... ~.T. ~... ~. q.y. ~. ~.~ ~'.. (Name ofindividualsignin contract) ~ove named· ....... being duly sworn, deposes and says that he is the applicant :is the ...~ ................... (Contractor agent corporate officer etc) ........................... eld owner or owners and :s duly aiuthorzed to perform or }lave performed the said work and to make and file this p ication; that all statements contained in this application ar~ tree to the best of his knowledge and belief; and that the ~rk will be performed in the manner se:t forth in the app ication filed therewith. 'om to before me this I , ' ............ ..... dayof ,o -' '7 ........ c-r r.~ . . . ,,~-( .'t~ .]. :'-. ~.ounty .., , · ' EDYTHEV. MUL[~N .J_~_ ~ '# '/~ -,;' ' ! ' "n Suffolk ou ¥l '. ' ~' · ~ Oualifiea' t~1 S~ I~ /~ ~ .... . · com~ saion e~,~r~,U,v ~,;'J .~ · ' ' . ' (Signature of applicant)