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Home My WebLink About18419-z rosat xo, s TOWN OF SOUTHOLD BUILDING DEPARTML•NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° ~g~~~ ~ Date 191... Permission is hereby gro ed to: 4 ...........1~........ ~~..:....~........~i.~... ....7 . at premises located at ...~G..ll.~..:j.J.....C.~.a2.. County Tox Map Na. 1000 Section .......~c-a~.r......... Block gLot No..........~..... pursuant to application dated ..........~/.,r 19.~/..., and approved by the Building Inspector. Fee $....4:1...f~ B Iding ~ for Rev. 6/30/80 C s r 7~° ~1~~~ /f (Zj R-~htinr-~,z..j - ~ f w~~[. ; - --G^~o~ _ • M ~ ~ ~ w - - R - , ~ ^ J - - - ~ - - ~ ~1,,s c 0. ~ _T , , 4` c- ' ; s~ ~~~~-s j ~ - ~ L BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS , . SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORPf TOWN HALL SOUTHOLD, N.Y. 11977 N T_ PY 7, (~..y - TEL.: 765-1802 CALL 7 / l / , ~ MAIL T0: Exatnincd . ..°?y......., 19~G /C n Approved . ~~y~..... „ 1941. Permit No. !.Q .r~.9~ ~ ~ ~ u Disapproved a/c AUG 9 ~ B~Dr. v~PI: TowN OF souTrsOt_c, ,~G.. uil g Inspector) APPLICATION FOR BUILDING PERMIT Date . 19 INSTRUCTIONS a. Tltis 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 Reeulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicali~e laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspection . ,f , 9 (Signature of"applicant, or name, t orporatton) s'~. °Q~n~~_ ham.. . ' (Mailing address of applicant) State whether applicant is~/owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises / ~ ~~~.z°~!~?n: 1`....~~Of Lr -S~'~'~~ Z.,- (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) C Builder's License No. , I~~, . ~.U, ~ Plumber's License No . ~ ~ Electrician's License No . Otfter Trade's License No . . 1. Location of land on wlJt'ch roposed work will be done . . 5 5~ „won ~ ~ . (louse Number Street, Hamlet County Tax \1ap No. 1000 SeChO? BI'ttck Lot Subdivision Filed slap No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of p/ro/posed construction: a. Existing C L use and occupancy ,~1GG~ t w . b. Intended use and occupancy - . • • • • • /1 ~ ~ l ~ 3. Nature of wort. check which • ' ( applicable): New Building Addition Alteration , P Re air • „rpoval Demolition Other Nork . O`D (Description) 4. Estimated Cost......b o Fee.................................... S. If dwelling, number of dwcllin / (to be paid on Aling this applica ion) S units . , , .......l..... Number of dwelling units on each floor . If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions .of existing structures, if any: Front . . . . . Rear . , , , , , , , , , , , Depth . Height . ~Iutnber of Stories . Dimensions of same structure with alterations or additions: Front Rcar , • Depth .tl, . IIeight . . Number of Stories . . 8. Dimensions of entire new constnrction: Front . Rear . .Depth • Height Number of Stories . m 9. Size of lot: Front Rear .......................Depth . 10. Date of Purchase . , , , , , , ,Name of Former Owner • ~ ~ • ~ • 11. Zone or use district in which p~•emises are situated , . 12. Does proposed construction violate any zoning law, ordinance or regulation: • • of be re raded i.. , , , , , , , , will excess till be removed from premises: Yes Nc 14. Name of Owner of premises . ,,~y~ , ,f~t:"'~!~~•ddress . ,Phone No. . Name of Architect ..................Address •~~•••~•~••.•••...PhoneNo..•••••~~•••••• Name of Contractor . , , ...Address . ,Phone Na. . 15.Is this property located with in~00 feet of a tidal wetland? *YES....NO., *If yes, Southold Town Trustees Permit may be required. i PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc), number or description according to deed, and show street names and indicate whether interior or corner lot. I 'ti/~rR.r,~~ - sc D~ . she ..r~ . II STATE OF NE1V YORK, ~ COUNTY OF ; . . . . . . S.S ' ' • • • • • • being duty sworn, deposes and says that he is the applicant .•..••~~(Nam of in~idual~~~...~~. ing contract) about named. ~ He is the . fl??~l c~~~... (Contractor, agent, corporate officer, etc.) ~ ~ • • ~ ~ ~ ' ' ' ' ' ' of said owner or owners, and is dul y :tu[ltorized to perform or have performed the said work and to make and file this application; that all statements contained in this application arc tnrc to the best ofltis knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this • ......day of i-etir. ,~lrr,Q-k`.-; , 191. Notary Public . . ..~r~G~(/ County / ltNDAJ.000PER • Notary Public, State of NewYork';~ (rgnatureofapplicant) No. 4822583, Suffolk County Term Expires gecember 31, 79