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Home My WebLink About19783-z FORM NO. ~J 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~- 19783 Z Permission is hereby granted to: ..~.~.......~..~._& .................... .~ .............. :.y. ......... .~..~. ........ ,o .................................... - ~ .~. ~ .~~ at premises located at ....2...~..?...~.~. ........ .~. ......................................... County Tox Mop No. 1000 Section ..../...c~.....~., ........ Block .......~....~R ....... Lot No..~....! .................. · .~../...~ ., ~9.?../.., ond opproved ~ the pursuant to application dated .......................... Building Inspector. Fee $ ................. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved· f..~..., 1'9~ .1. Permit No.~'~.77..~....~. (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... 3 SETS OF PLfiNS .......... SURVEY ................... SEPTIC FORH .............. CALL .. .. MAIL TO: Date .................. , 19... INSTRUCTIONS a. This application must be corhpletely 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 may 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 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 purpose 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinan:es 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 dmit authorized inspectors on premises and in building for necessary in~sl~c~t!o~s~!__ .............. .............. --' (Si°nature of applicant, or namd~if a corporation) · (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,lame of owner of premises ..... .oT.e.\ .~.~' .L.. ~ ...... r4. ?....~ ..... . ................................ (as on the t.a:t'roll or latest deed) f applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electncmn s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ~../.??......o.j. ~.~e... ~ ~ ............ House Number Street Hamlet County Tax MapNo. lOOOSection ...1.4.~ .......... Block.................. Subdivision ...................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occqpancy of proposed construction:' a. Existing use and occuuancv ..j. ~ ~.~ . ~{ ~ b. Intended use and occupancy ..... , 4. EstimatedCost.J..~.,o.oo:QO.i ,, 1-'--'7,. ~. escnpUon) ~ (to be paid on filin~'~%'~p~l~a'ti'on) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ lfgarage, numberofcars ... ~ 6 Ifbusin rci lormix diocc'u;a~lcy ci~; ................................................... · ess, comme a e , spe nature and extent of each type of use ~mensmns of ex ng structuresiifa y: Fr R · mt~ n ont ............ ear ........ ~ ... Depth ....... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ~ ................. Rear .................. Depth ..................... i. Height ................... Number of Stories ...................... 8. Dimensions of entire new constru'ction: Front ............. Rear ............... Depth ............... Height ............... Numb!er of Stories ............... 9. Size of lot' Front I.oO ' . ~,~. ac ,,/ ..................................... I0. Date ofPu'rchase ...... 7: ................ t.o_, ~, . Depth 1 1. ~one or use msmct m which premises are situated . ' ......4-"?'~Lc'~?~i" '~f/d~ 12. D°es pr°p°sed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded , ' ............................... ........... · ................. Will excess fill be removed from premises: Yes No 14. Name of Owner o remises . · ~ ...... Address . one No. '. Name of Architect ........... ~ · ~ ............... Address ................... Phone No ................ Name of Contractor .......... , ............... Address ................... Phone No ................ i5. Is this property within 301~ feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold To~n 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 number or descriptio~i according to deed, and show street names and indicate whether interior or coruer lot. ;TATE OF NEW YORI~,.4 . .{ e c :ovmv ...... ' 'C)'AO~" r' i' "~"" ~ '~'g ~ ...... being duly sworn, deposes and says that he is the applicant '(~ame of individual sig' -- ~' 0. -- ... , ~ ' '~i2g~' ,~;;ci3 .... bove named· , is the ~'~ ~ (Contractor, agent, corporate officer, etc.) said Owner or owners, ~d is duly au[hofized to perfo~ or have perfo~ed the said work and to m~e ~d file this )plication; that all statements contained'm this application are true to the best of his kno ledge and behef; and that the W ' ork will be perfomed in the m~ner set forth in the application filed therewith. gore to before me this ......... ~.; ......... day. o%.~ ...... ,19 Ota. PubLic~ ~. ~.: .' t_ '" ' __ ' ' ' ' .. .... _iLL- ~7 -- O, 49613~ , Ouallfle~ 1~SU~k ~