HomeMy WebLinkAbout19885-z r08at NO
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°_ 19~~~ Z a~
Dote i99.1.
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Permission is hereby granted to:
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of premises located at ..w~.ss~~~.....~.~5'~f......~.~:Yl.~l......b.r`:t..s.........»`~:C.:^~:^:..~1lLl~--
.
County Tox Map No. 1000 Section ........~.1..~.......... Block .....b 1......... Lat No....s~•~
pursuant to appUcatlon doted 19.9. and opproved by the
Building Inspector.
Fee 5.~~:
Building Inspector
Rev. 6/30/60
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BO,1R0 OF HEALTti
FORM NO. 1 7 SETS OF PL 1:75 .
TOWN OF SOUTHOLD SURVEY _ .
BUILDING DEPARTMENT GIICCI: _ .
TOWN HALL SEPTIC FORtt . . . .
SOUTHOLD, N.Y. 11971
q TEL.: 765-1II02 t:oT I FY
Examined .....~~ag , 19 S CALL . .
h1AIL T0:
APProved a~. , 199 ~ .Permit No.. ~ S 'L, .
Disapproved a/c ~ _ .
lXl ([3uilding Inspector)
APPLlCAT!O"a FOR €3'.ai=Dt"d'u'^rERMiT - -
Date 19 .
INSTRUCTIONS
a. This 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 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
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
3uiiding 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
dmit authorized inspectors on premises and in building for necessary ~n cti ns.
....~~~u~.7:. .
idnature of applicant, or name, if a c~/orporation)
~(o /1(if!GS/fcf~Y ~~A/ C9rWl.~itl.C C~./{!/. ~~'~,30
(Mailing address of applicant)
jtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..................~W/V~.
flame of owner of premises ! 1 ! CG~f/~/2~ ~ ~C/SS
(as on t}te t:rX 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 . .
Electrician's License No . . . . . .
Other Trade's License No . .
Location of land on which proposed work will be done. , , . . .
House Number Street IIamlet
County Tax Map No. 1000 Section Block ...7 , , , , , , , , , , , , , Lot ~
A~ pp
Subdivision/.V~'•?Si9eC O:a~.VT ~L~/.f 0/?.~/~~y/~ Filed Map No. ,/~~6 39
...(Name) Lot l....... .
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy S/N~r.GE • y ~~~~~N~~~~--
b. Intended use and occupancy ..~T~~!¢'~~.~. • !~~?`~.."5.~~~,!¢~~ ~~Ol/G...
PI} ' /
3. Nature of work (check which a licable): New Building . Y , Addition , . Alteration
Repair
• • • • • • • • • . • Removal . . . Demolition Other Work ,
(Description)
4. Estimated Cos[ ~ ~j ~a ~ • ,
Fee......................................
g I (to be paid on filing this application)
5. If dwelling, number of dwellin ul
nits , . , , , • • , . Number of dwelling units on each floor .
If garage, number of cars ...'T~Q, , ,
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . .
........r......~...
Height / B Numd if any: Front ~ ~ r ar Depth z g .33
imenstons of existin structures er of Stories , .~itv~ , !!yI r7~` !C
en ons o same s ructure wit
p ~ alterations or additions: Front . . Rear .
• 1...........
8. DimensionZf entire new construe Height Number of Stories .
fiction: Front . Rear ....Z.~ ~ ?-5
Height Number of Stories . , N~' • • • Depth ~ , . • , , , ,
9. Size of lot: Front ,3~/•, ~ S.~L ~ .
Rear r3 7 Depth D..:: Z 7.~ . .
10. Date of Purchase , f~i~iC'./L,pZ7j,/9~'S'~ , , , , , , , , • Name of Former Owner ('t~ll'.yN. r.. ~~/I[,. , , . .
1 1. Zone or use district in which rcnlises are situated , , • , , , , , , , , . , , , • • . • • • ' ' ' • ' '
I2. Does proposed constructio99,, violate any zoning law, ordinance or regulation: ..~o
13. Will lot be regraded .N.q, ..Will excess fill be removed fr m premises: Yes
14. Name of Owner of premises . Kil!/9~t,S1,'T. G?e--lsi' ,Address .~'~.k!'"~'f~w~y~ Phone No..•,'~.~6 .7.f°7.:QH.7`~
Name of Architect
Name of Contractor Il • • ~ • ~ • ~ • ' ' • ' ' ' • Address ~~0~.v('irY..~{.'. Phone No.......... .
y ................Address.................. Phone No.
property wit in 0'
15. Is thisIf es, Southold Too feet of a tidal wetland? ,t " " " " " " " '
* Yes........ No.?,......
wn Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block nt}mber or description according to deed, and show street names and indicate whether
interior or corner lot.
I', ~
If
TATS OF NGW YORK,
'OUDfI'Y OF S.Sii
• • ' ' ' • • ~ • • • • •s • • e • • • • • • • • • . • • being duly sworn, deposes and says that he is the applicant
(Name of individual si ninCOntract)
rove named.
eisthe ~I'i
(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
~plication; that all statements contained in this application are trot to the best of his knowledge and belief; and that the
ork will be performed in the manner set, forth in the application filed therewith.
vorn to before me this
....day of 19.(.
i
Mary Public, , , I , • , County _
PueRa Stan
oi~iuewi
Yak .....~G~ . .
NR`'1132bW •SufldkCdtMy (Signature of applicant)
COmmisatan Fa~kea Aup, 31,1992