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Home My WebLink About20545-z I~OB.~ NO. ~' TOW~ OF $OUTNOLD BUILDING DEPART/~EHT TOWH HALL $OUTHOLD, 14. Y. BUILDING PERMIT .(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-N.° 20545Z Permission is hereby granted to: .~.~.~.~...L~..~ ........... ..., .~..~..~.....~.......x..~.. ............................... . ~ ....~.~....~:..1'...:...../.~..~.~.~ ......... .~-~ ...... .... County Tax Map No. 1000 Section ..~....(~.....~.. ......... Block ..... .~..~ ........ Lot No....~..;..L~....~. ........ pursuant to application doted ...... ~.....,~. ....................... , $9~..i.,., and approved by the Building Inspector. Fee $ ~.s..'.. / Building Inspector Rev. 6/30/80 i{t\i I'( U 1992 BUILDING DEPARTMENT LJ ~.,.,.~. TOWN HALL TOWNI~I'~"J"CF'-. ..,..* ........ -' ; SOUTHQLO, N.Y. 11971 ..... ~ ':i:~:': .,,": TEL.: 765-~802 Approved . ~. Disapproved a/c .... .............................. ............ . .................... . .. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOAgD OF HEALTH OF LANS SURVEY CHECK ./~-- ............... SEPTIC FOR:t ............. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 *ts 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 area's, 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 ttds application may not be cbmmenced before issuance of Betiding Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit .Sall 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 ~alI 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 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 regulations, and to :imit authorized inspectors on premises and in building for necessary inspe.~q, ons. C'"-x ~ ..... ...... --. <S~na/~ oJ ~plicant, o ~ne, ifa co~.o?tion) .... .~.~.. g.,.o~..e.~, ....~ ~ c~... (Mailing address of applicant) :tale whether applicant is ow.q.~a~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ©.~ .... - ................. .. (as on the t.ax roll or latest deed) : applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be ~;ne ......................................... ' ......... ... ~.~. ~- ..................... ."fi ~ .~els...go...~ ............ ~ .a~i ~o< ................ Ilouse Nam berStreet Hamlet ~ounty-~a~ Map No. lO00 S~ct,on ....... ./.' ~ .... Block .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ... . a. Existing use and occupancy ............................. v. ........................ b. Intended use and occupancy ...... ~.~'. ~ .xQ........ · 3.Nature of work (check which applicable): New Building .......... Addition .......... ?alteration ........ Repair .............. Removal .............. Demolition .............. Other Work...~. ~..... d ~ost'~.. ~ (Description) 4. Estimate ' . ............... Fee .................................... (to be paid on filing this application) 5. If dwelling, units ............... Numberofdwelling units on each floor .............. . If garage, number of cars .............................................................. 6. If business, commercial or mixed, qcy, specify nature and extent of each type of use ...... , ............ 7. Dimensions of existing structures, if an xt .,.: ....;... Rear .............. Depth ............. Height ............... Number of S .. .............................................. Dimensions of same stmcturz with alteratio oas: Front ................. Rear ................. Depth ...................... Height ............ Number of Stories .............. '. ...... 8. Dimensions of entire new construction: Front ....... Rear ............... Depth .............. Height ............... Number of Stories .................................... 9. Size oflot: Front ...................... Rear .............. Depth ............. ~ ....... 10. Date of Purchase ............................. Name of Form, 'ncr ............................ 1 I, 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 rem 14. Name of Owner of premises-J'tloAe. [q,..~ .~..5 ...... Address .................. Name of Architect ........................... Address ................... Name of Contractor .......................... Address [5. Is this property within 300 feet of a tidal wetland? *Yes ........ No..~.. ~If yes, Sou~hold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether ~xisting or proposed, and. ind{cate all set-back dim~ ons from property tines. Give street and block number or description according to deed, and show '~ther !nterior or corner lot. ' ~..o/.O premises: Yes ~ me No ............... No ............... 'ATE OF NEW YORK, S.S 3UNTM OF ................ · (~.' .~ .~.~. '.0... l°t/~.. ', ~ ~ .............. being duly sworn, d0poses and says that he is the applicant (Name of individu~ signing contract) ore named. is the ................................................................. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~lication; 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 the manner set forth in the application filed therewith. om tO before me this ....... day cx_./M..2~t / 19 ~ of./~ .......... ... HELENE O. HOla;NE _ ' : ; .............. Quallfieda"'~in Suffolk Coun~ ~' ~ h-(~igna lure of applican t) Commission F_.~ires May 22, 1 89' 00" ~ LOT I MAP OFELIJAH'SLANE ELIJAH'~ LANE ~;~ ~"