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Home My WebLink About20663-zTOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*-N.° 20663Z Permission is hereby granted to~) . . ...¥~..~:'_~_~... Z~..~ ............... .+..L at premises located at ................................................................ .~..,. ........................................................ .................................. ~.~.~......~~....~...~.....Zd~ ...... County Tax Map No. 1000 Section ...Z~'7,,,,~,. ........... Block. ...,~,,,~,., ......... Lot No ...... ~,.~,, ........... pursuant to application dated .......... ~,....~......~....~.. ................... , 19.f~, and approv~ by ~e / Building Inspector. Re~ 6130/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined · ' '0' '/('~'a~' " ' .., 19 ~.~. Permit No. d .~.~..~...~.. Disapproved a/c ..................................... - . (P/fiilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF H~ALTII ......... ,3 SETS OF PLANS: .......... SURVEY ................... CIIEC~ .................... SEPTIC FORA .............. .. .L : .Td 5... HAIL TO: Date ............ , 19 . a. ·Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application ma~t not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit · ~ail 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 hall have been granted by the Building Inspector· APP.I.!CATION 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 applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and)regplations, and to dmit ~uthorized inspectors on premises and iv. building for necessary inspect~ns. / _ /7 // [ /~..~ -- ' ..... .'7''~/'''~ '': ..... / .......... V'''"~ ......... (Signatt3.re ~)~apphcant, or name, jfa corporation! · (Madmg address of applicant) / :tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builderi 0 bo rY . ,. ................................. ' fp ' o, ~--~ ~ame of owner o remlses .......... ~ . o . ;--· (as on the t.ax roll or latest deed) /'applicant is a corporation, signature of duly authorized officer. m co ora officer) · , . Builder s License No ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Locationoflandodwhichbroposedworkwillbed'~ne..~.<ff~..~.~,/~.-~..~..~.,/~r[ /q-~,<c]. Ilousc Number Street .......... ~ Hamlet Subdivision ..................................... Filed Map No ............... Lot ......... ; ..... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constrncfion: '3. Nature of work ( heck which applicable): New Building ..... Adl~ .......... Alteration ..... Repair .............. Rem:oval .............. Demolition ......... Other Work ..... 4 Estimated Cost ~,~0o0 °aL (Description) .............. Fee $ lfd ellJ b fd I //.~ ~. (to be paid on filing this application) · w ne, hum er o ivellinglunits ..... . ..... Number old,veiling units on ea r If ga age umb rof ' .c~. ' ch floo 6. If business, commercml or m~xed occunancv s-cc:,'- - . - - ' ................. -'~, ....... 7 -' ' et 'ting , ,' -, ,' ,,ynatureanuextentoteachtypeofuse "/Yff' .... · ~nnenslons exls structurqs, ifany: Front ............... Rear .............. Depth .. eight ............... Num, bet o f Stories ......... . ........ ' ...... Dim io sols tncture,,v)th ratio oradditi i .......................... ens n amc s ate ns one: Front " ' D pth ..... · ............ Rear ....... i He ght Nu nber of Stori \ ' 8 Dimensio oft tire ............ i es ...... · ns n new consta~ction: Front ........ 'R ........ ' ........ H igl~t Numb of Stories ....... ear ............... Depth .. 9. Sizeoflot: Front ........... I .... 10. DateofPurchase /o/g~ ; '' . ............ (; .................. Depth ................... ....... ,-[m ~v:uun prqmlses are situated ......... ' ......... 12. Does proposed construcnon violhte any zonin~ law etd ..... -,'f-~,'-; -' .......... ~/d$ ...................... 13. Will lot be re raded .... .x/ ~ ...... · .............. 14. Name of O~v,~ ,~r .... ;o2o' '~2 ,~- ' L;22 ' '03;:' ;2(4," w,u excess filL.be removed from premises: ~eD No ~.~m ..... ~ ...... Address ~'~q - Ph eN 7-. ....... ...... ................. Address ................... Phone N(~ ............... Name of Contractor . . 15. 'rs this property ~'t~i~'" .............. Address ..... ' 300 feet ;'ifa tidal wetland? ''*~e's'.'.'.'.'.'.'.'.' .Vhon,e~ ............... .'. No...~' ..... · If yes, Southold Tiown Trustees Permit may be required· -,' · ' ... PLOT DIAGRAM Locate dearly and distinctly all ,bu ldmgs, whether existing proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or descriptioh or according to deed, and show street names and indicate whether interior or coruer lot. FATE OF NEW YORK, ......... "!' "'~'~ ........................... being duly sworn, deposes and says that lie is thc applicant (Name of individual signing! con ti act) Ove named. . ~ is the ' ' (Contractor agent corporate officer ) ......................... sa. id owner or owners, and is duly aiHhorized to perform or have performed the said xvork and to make and file this flmation; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in thc anner se~ forth in the application filed therewith. om to before me this ' · ' Notary Public0 State of Now York ...... .% ~F~....'~TW. NO. 4952246, Suffolk CourlW_ - Term Expir? Juno 12, 19.,%~) . . ( ignature of applicant) -4