HomeMy WebLinkAbout18716-z rosat xo. a
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 O J. 8 7 6 Z Dat® 19,.1..
Permission is hereby granted to: ~
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to ~~~.......?..~.......rte...--.......~.....~~..%~.~.
at premises latoted at :3Z37~ ~.;~~.~4....T............I.~~~~.fA.T~I.......~~!?fr.~.........
..~~+s.~r:..................................................................,...............
County Tax Map No. 1000 Section .,.......,.~..~'f....., Block ..............f~..`.... 9qLot No.........7.............
pursuant to oppllcation dated 19.f~/.., and approved by the
Building Inspector.
Fee $.,~x;I...
Bu ding I c or
Rev. 6/30/80
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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
Date ..~~,1.~.8 19 A. 8.
~p o
.
PLEASE TAKE NOTICE that your application dated ~.~3 19 ~P~.
.
for permit to G~~-~.¢f.2~C& P~,I!. '
...............................at
3 2 3 ~o o„- ~ ~
Location of Property . /.,.5'.,v'~... F~...~~ ~y'~d?1eG
ouseNo. ~ Street Hamlet
County Tax Map No. 1000 Section 77."..... Block Lot .
Subdivision Filed Map No. Lot No.
is returned herewith and disapproved on the following grounds ..44?~... e~~-G~~. ~ ,Q. `
. c~'~~.../D. d.~. !l.,`~ Q~f~orr..... r3-sG~~ccrt.~.~....~~0-~..... .
- ..".:f ~ r
~B ding Insp ctor
RV 1/80
BOARD OF HEALTH
3 SETS OF PLANS
FORM N0.1 SURVEY
TOWN OFSOUTHOLD CHECK
- BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL
Examined ..d:/~ O......., 19 V." MAIL T0: ' • . • • • • • , • • • • • . •
Approved 19 Permit No........... .
Disapproved a/c ~ll!~/(Y~...... ~ D
Bt.OCFq. DEPT.
TOWN O SOUiHO4D
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
~ 2 c?G.
Date 19 8~
INSTRUCTIONS
a. This application must be completely filled in by typewriter 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, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature oP applicant, or name, if a corporarton)
• (Mailing address of applicant) ~ S~j
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises A~~?~~.~........~~ ~•/Die oE',~S
(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 . .
1. Location of land on which proposed work will be done . . .
3`Z5~7e n d~~ .
~.~1.'..~~...~....PAu~s....~7..~
................f'ce~~v'~e
House Number Street • • • •
Hamlet
County Tax Map No. 1000 Section Block ~ • , • , • , • , , Lot .
Subdivision 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 /ZCSi.U~~G~ r~,.~;~• lplfi,1;' .
b. Intended use and occ~cy~ G~~---• • • • • • • • • • • . st., , , ~ ;i,. , , , , , , , , • • , , .
~ I
3. Nap re of work check whine?pplicable): New Building Addition Alters i n , ,
( ~~~cG~= .
Re air rhoval Demolition Other Work ...r.. , , , , , , , , , .
(Description)
4. Estimated Cost.......... Fee......................................
(to be paid on filing this application)
5. Ifdwellin number ofdwellinl••.•.,....'...
gg g g, g units : Number of dwelling units on each floor .
If ra e, number of cars .
6. If business, commerciai.or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions, of ex$ting'stfuctuY`~'~,?if any: Front ...............Rear Depth .
Height #;f Nump~,{ of Stories .
Dimen' ns of st e)yi'
; ~ ~1 . ~I~;~lterations or additions: Front Rear .
Depth, }:.~<<r;Height ......................Number of Stories .
8. Dime . s of entire new cons, r~A~t~on: Front Rear ...............Depth .
Hei 4 gti~;€'3~.~,~ L'.rJ~~mbe of Stories .
g .
9. Size f
}ott~'POn't', ~~~w-„ Rear Depth . .
10. Date of Purchase ...................Name of Former Owner , .
11. Zone or use district in which premises are situated . . . .
12. Does proposed construction viblate any zoning law, ordinance or regulation : .
13. Will lot be regraded Will exc ss fill be remoxed from premises: Yes No
14. Name of Owner of premises ~ /;~1~/%,~q,~/o~~ess , (/,Ycj~ry~J~'hone No. f~6:~~.`Jr.7~.
Name of Architect . ................Address ...................Phone No...... , , .
Name of Contractor .Address . .Phone No .
15.Is this property loclated within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly sal buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. i
~Od/J~l`p N(~ ~ PG'IZ' ~1~'(Ck1~ ~'1'TAGI~'E.D
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STATE OF NEW K ~l T~
L/
COJ~'NTY OF ! S'S C/~
. Ut~~.(.?~~.... . , .~1 ~Rq~S
• • being duly sworn, deposes and says that lie is the applicant
(Name of individual signing contract)
above named.
He is the ~ ~ -
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is du~y authorized 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 wit be performed in the manner set forth in the application filed therewith.
Sworn to"before me this
...day of 14~V
Notary Public, i~ County
CLAIRB 4~ o(~Yerk , " D ~ ?m-~ -
Nouty PubNo, St
No. 46
Quallfled in 8uffolkCourHy (Signature of applicant)
' Commission Expires pecember 8.1
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