HomeMy WebLinkAbout18197-z lOB,M NO, f
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)
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Permission is hereby grunted to:
...f..~........Al..:~:.....~.~.g~ 2:r:........
.................................................D...............................
of premises located at ..~~9..........~~..Q..'~'q...P.:n.....~.u".4.:........~.~
~-~::..~-~~$~.....,:c~~-~-
County Tox Map No. 1000 Section Block .~......p.. Lot No...a:..3............
pursuant to application doted .....~..~.irt:tA,,....~ 19.A.g.., and approved by the
Building Inspector.
Fee
Building Inspector
Rev. 6/30/80
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
q TEL.: 765-1802 CALL ~ .
Examined 19 ~ ! MAIL T0:
Approved I 19.9 Permit No. 1 ~ (9(0 •L• , I( ('1Cr/7 P,
Disapproved a/c I ~ ..,_~w.~ ..~\JJ
~
i JUN - i 198.9
1`
l.~ 4.I ~v...-..w-..a...
~ F71D6. DEPP.
• YO+NNOI~SOUTHOLD
(Bw din Inspector) E"'"°""°"°"° '
APPLICATION FOR BUILDING PERMIT
Date ....14.~.~........., 19~C.C~.
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 atreas, 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 spect~ ns. /~i
(Signature of applicant, or name, if a cor oration)
ailing address of applicant) ~~(YrpS.~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.
.~~sS.~..4..rL/J/V/IhIT,,,~F I~WELLt.~G~
.
Name of owner of premises 4•Cti./!!~'i?•rnt.l..h :!~(,/s~y.. /T~!7G~~.~:1.-~Y> .
U (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. TEA!!JA/J ~ • • I•$ • .C3v I L I~G (Z
Plumber's License No . .
Electrician's License No . -
Other Trade's License No . .
1. Location of land on which proposed work will be done. . , s~s• ,~~2G CAJ Ul- Ci~R2w~ ~AAf
j~
House Number Street • • • • • • • ~ • ' • • ' "
Hamle[
County Tax Map No. 1000 Section Block ..~.Z Lot .
Subdivision Filed 1,1ap No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of propoosed construction:
a. Existing use and occupancy . 1ZVy ~ N D • • Inr•c T' • • t?GJE L Ll•a!6..~ • /aG~(Cu Lj'V.(~A.l..~~~-.DGS
b. Intended use and occupancy ~F~~ C. ° 'Qi ~I" I`&~. ~'~~~f~
~ ~r
3. Nature of work (check which' applicable): New Building Addition Alteratio~,1 , , ,
_ Repair Reimoval Demolition Other Work , .a~?./-~?t~
~ (Description)
4. Estimated Cost .s~.'~° .Fee or,
5. If dwellin number of dwelli (to be paid on filing this app]ication)
g, ng units Number of dwelling units on each floor .
If garage, number of cars , , , ,
• r. ~ .
6. If business, commercial or mixed occupancy, specify nature and extent of eac~t type of use ,
7. Dimensions of extstin street
Hei ht g Nures, if any: Front Rear 'Depth .
g I':ii amber of Stories .
Depth . , , ~ With alterations or additions: Front Rear .
` ~ ....Height Number,of Stories .
unens ons of same structurestruction: Front ~ °=r_- . , _ ~ ).......Depth
i
8. Drmg@psrons of entire ne 2 Number of Stories , y,.' , : ' y
Hei li'T. .
9. Sizye,gf 16t: Front (P P.. `x'11. AC.c t2ta.~.'= Rear Depth .
.............................NameofFo er Owner
101. Zone or use district in which premises are situated ~~`...~~-S'~ }S G R-tc
12. Does proposed construction vfolate any zoning law, ordinance or regulation:. . . . . . . . . . ~ ,
13. Will lot be regraded ,/t!~2._......... i . ,Will excess fill be p~ve~~d>/from premises: Yes [die
14. Name of Owner of premises ~v.fl/~tde„~„R2, , . Address (~q><A/eG/G.~"GLT.t ..Phone No. a~"9~(.,5;~ , , ,
ame of Architect _
Name of Contractor J
l°ti/... • ~ ~ ~ • ~ ~ • • ~ ' ' ' • • Address ...................Phone No............... .
........NAAf T............ Address .......Phone No........... '
IS.Is this property lo4ated within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Torn Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all 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 whither
interior or corner lot. I
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COUNTY OFESu.~1.~1/G , , 11, S.S A~" ~~-y-"'-
Nam/e of individual sig~~ ~N ~ • ~ ' • • ' ' • • being duly sworn, deposes and says that he is the applicant
Wing contract)
above named.
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He is the • • ~I• • • ' ' ' (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly 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 bast of his knowledge and belief; and that the
work will be performed in the mann$r set forth in the application Gled therewith.
Sworn to before me this
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Nota~ry~Paucbl~icQ . !I County /~~~~~G~~. ~(/~~Lt~c./. .
Nota p;,y~p~'~OPER (Signature of applicant)
No.ry4822683~eofNewYgfc
Term Expires "s~olk County
December 8l 1i~
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