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Home My WebLink About18882-z l~m'm' NO. B TOWN OF SOUI'HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18882 Z Date . ..~ ...... , ~..9..0 Permission is hereby granted to: /~ ........ ...~.?..~ ~ ..o........~... ............................................ ..~.~ ........... ~ ............ ~. ...... ~ ................ ocated at ~.,..,~..... ,~. ..~....~'..~ .... at premises .. . ~ ......................................... County Tax Map No. 1000 Section ...... .(~.~-~.~. ..... Block ...... ..c~...?. ......... Lot No ...../. .................. pursuant to application dated ........ .....~...g,~.....~...../....~.. ........... , 19.~..~.., and approved by the Building Inspector. Fee $.~..~(,...~ Building Inspector Rev. 6/30/80 7~-1802 BUILDING DE~. INSPECTION REMARKS: DATE '~//~/~ ~ TOWN OF' SOUTHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOINN HALL $OUTHOLD, N.Y. 11971 TEL.; 765-1803 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEpT c' ; ................. Exam[nad..XO0.e.a .'Z.., I9 Approved ...~.ewj*.,~ ./. ~..., 191~ ~. Permit No. ~/.~. ~.. ~..~v..~. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS /hq ~, ¢_ {t/~ Date ' ' ( a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurnte 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- cation. ¢. 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 i:emoval or demolition, as herein described. The applicant agrees to comply with all applicalJIe laws, ordinances, building code housin-~, ' admit authorized inspectors on premises and in building for necessa,-, ins-ectio , ~ ,, co.~de, and reoulattons, and to ..... (Szgnature of applicant, or name, ifddo'rf~dr~fidr~)' ' ' ~ t%~O~, f~O ~--(Mailin~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises - '~--9C5) ~2- ~ (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. ,r (k.~ C ~.~ PI ber's L'ummense No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will b~ ~do.~e; tlouse Num bet Street, ' .................................... . ~,~ Hamlet o"nty Tax,,lap No. 1000 S,ctio. - ........ ; ........ Black : ' ~.~ ?~ ec-%~ .... Lot... / Subdivis on c ' ' ......... "' ' ................................. l~ilcd Map No. ' (Name) .............. Lot .......... 2. State existing use and ~ccupancy of premises and in tended use and Occupancy of proposed construction: a. Existing Use and occupancy . ~/t.., ~' h Inten~ed Use ........................ ~;'.,' '-'.' -' e:~, .................. and occupancy ,~ ~'" ,.7 :,,~,, .~: ..~... ~e...* ~, · · · ................... 3. Nature of work (check which applicable): New Building .......... Addition .......... AltcratiOa '~'~l,?t}, ...... . Tennis Court . . ,.t4~ ..... Accessory Bu~_ldzng .......... F4~ee ....... OtTi~Y I4ork. [~7.~ ........ 4. Estimated Cost . ; ....................... .... ........................... .... i (to be paid on filing this applicat!on} I. Number of dwelling units on each floor number of dwelling umts ................. $. If dwelling, ............... If garage number of cars ...... i .................................................................. 6. If business' , commercial or mixed occupancy, specTy nature and extent of each type of use ..................... · · ~ Depth structures 'if any: Front Rear .... 7. Dimensions of existing , .......................................... Height Number of Stories ........................................................ ............... Rear Dimensions of same structure with alterations or additions: Front ................................... Height Number of Stories .................... Depth ............................................ 8. Dimensions of entire new constru6tion: Front ............... Rear ............... Depth ............. Number of Stories ' Height ................................................................... · . , , of lot: Front ' Rear Depth .................... 9. Size ............ i ................................ Date of Purchase ' Name of Former Owner ........................... 1 I. Zone or use district in which premises, are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... ' Will excess fill be removed from premises: Yes ,.. ~ No. 13. Will lot be regraded .: ........ ! .................. :' Address Phone No . · Name of Owner of premises ~ame oi contractor .................... · ~ ' 'n feet of a txdal wetlauu: x.e,o ......... 15.Is thzs property located wxth~ 100 , · If yes, Southold TownlTrustees 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 rmmber or description accordhng to deed, and show street names and indicate whether interior or comer lot. : STATE OF NE~V YORK, , S.S COUNTY OF ................. ' being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above na~ed. I~ is the .......................................................................................... I (Contractor, agent, corporate officer, etc.) of said owner or oxvners, and is dqly authorized to pe,rform or lmve 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 mannler set forth in the application filed therewith. S~yom to before me this ; ............./t/ ,.. ....... day~f8 ....... '~. · . .~-<~ ..... · NOIARY ~:t~l~,~_.~.V~ Y~ (Signature of applicant) No. 4707878, S~olk C~ntD / Te~m Expires Ma~h 36, liP Gt~EIIWAY (vAO) (NO PUBLIC ~_AS T' ' 185 O0 STY FR //SE ,~.eo4e'lo,'E. N/F IRVING C LATHAM (FARM FIELD}