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Home My WebLink About19756-zTOWN OF SOUTNOLD BUILDING I:)£PARTM~NT TOWN HALL SOUTHOLD, N. Y. BUILDING PEILMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9756 Z Permission is hereby granted fo:' .... ~~ ........ .b...~.~ ................... ....... ~.~.~.......~..~.~ .................... ~......~. ............ .~r~....:_:., ........... ~.....;:.. ,o .......... ~-~.,_0.:.~ ~ .. v, ,~~'""t'Y~ ...... -'":":~' ............................ ,-~ / ~.: ....... P~' ................ i~,~ --,~--~"'"" .... ?;"-~'"'"'/~- ............. at premises located at ../.....~...'~.c~ ...... ..~:D,,...~...~..~....~ ............. .k'~.,g/]~b~&.....~. ................. County Tax Mop No. 1000 Section ....... ~...~.~:~ ..... Block ....... ..~....~. ...... Lot No.....~,~ ............. p, rsua,t to app,cotio, dated ....~.~.....~. .................... , 19.~.l..., and approved by the h / Building Inspector. F.. ,.~..~ Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~._ '../. .~ ..... 19C~.k Approve~ ~..~ ..... 19 9l · Permit No./..~.~..'~°..~.· Disappro ed a/c ..................................... (Building Inspector) APPLICATION FOR BIlII. DING PERMIT BOAgD OF HEALTH ......... ,3 SETS OF PLANS .......... SURVEY ....... SEPTIC FORH .............. NO?I FY = CALL ................... MAIL TO~ ~ INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 all applicable laws, ordinances, building code, h~g~)j~cgjle, agffqregula~ns, and to admit author/zed inspectors on premises and in building for necessary inspections. /~.~~.~______.__~ (Signature of applicanf, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ..................................................................... Name of owner of premises ....~,/~/./.4/..~.....~'~.~./..O~..~ ................................................ (as on the tax roll or latest deed) If 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 ...................... I. Location of land on which proposed work will be done ...... ~.~..7-7..TT-.( 7-gX C[~ ~ / ....... i. .q.? ...... .zT. /. . . . . .................................................... House Number Street Hamlet County Tax Map No. 1000 Section .... ./..~..~ ......... Block .................. ~/ Lot.. ~ .~. ............ Subdivision ..... .c~ .d~.../~..~.~...../~....~...~. .......... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... use and occupancy .......... ~.. ~ .C..~..~. ( .2-../. }.. ?...~..~. { ?..~..d. ~.t .......................... b. Intended 3. Nature of work (check wMch applicable): New Building .......... Addition . ..~.. .... Alteration ....... ~. Repair .............. Removql .............. Demolition .............. Other Work.. ..~2k/..~- '-~'- ....... ~ ~, i ~. (Description) 4. Estimated Cost .,/.~..~./I ....... ; .......... Fee ..... [ (to be paid on filing this application) 5. If dwelling, number of dwelling un!its ~ Number of dwelling units on each floor .... If garage number of cars d d fly h typ 6. If business, commercial or mixe ccupancy, spec nature and extent of eac e of use ...... , .............. 7. Dimensions of existing structures ,~f .... ' Fr,,nt 'k R,,~ · pth'. ..... Height ...... ~.' .... .. Numb{r of Stories ...... ' .................................................. Dimensions of.same s~ructure ~ltil~slil[~a~s or additions: Front ................. Rear ./.o..~: .~ ..7. . Depth ,/.7..~./~': . .11~?. l~'el'mh'~': ~ ~.-/ N, ,nh~, ,~e ~*,~ ......... 8. 'mensions of entire new construe~tion Front Rear . ~,~. ,3. . Depth Height ............... Numb r of Stories ............ , ............................... 9. Size of lot: Front ~.~...fi~.., Z,..~.,~' .~. ~ /..~.. ~.~r .......... ....... l ......... Rear... ~ ......... Depth .. ! ............. 10 Date of Purchase ' Name of Former Owner 1 1. Zone or use district in which premlses are situated ...... .~..q~'-F/f?.~..~. 1 2. ocs proposed construction wolat~ any zoning law, ordinance or regulation: ..... ~..Q .................... 13. Will lot be regraded ....... /¢?..I. 2 ......' ......... Will excess fill be removed from vremises: Yes (No~ 1 4. Name of Owner of premises ./2./.jr /..~...-~.,~.Z. (C. ~-Addres~ ~. ff. .47.o?.~.~..a.~../~?~l~one No... Name of Architect ~ .~?..r .o'~p...~..r~. ............................ Address ...... Phone No ................ Name of Contractor ........... I ............... Address ................ .~.. Phone No ................ Is this property within 300 feet of a tidal wetland? *Yes.,, .~... No ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bhildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nulnber or description according to deed, and~s~ow street names and indicate whether interior or corner lot. [ ( ~ I.0 15. STATE OF NEWJ/,ORK, / COUNTY OF ...............~ ~ ' -./'f/)./. ' -- !./.'/~.O...~..~.//¥~' 6' 6:- .... beit}g duly sworn, deposes and says that he is the applicant (Name of individual signin~'c'o~l't;~c'ti ...... above named. He is the ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly guthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to 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 flOTA~Y PUBLIC, State of New Yo~ (tc)~ '