The URL can be used to link to this page

Home My WebLink About18566-zTOWN 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) No- 18566 Z Permission is hereby granted to: ..... ..~...~..~..,...~.~..~..~...~ ....... ,o ...m. County Tax Map No lO00 Section .... .0..~....~..... Block .... .~..~ ......... Lot No. ,...O.....~..,..Z-~ .... pursuant to application dated ..~.~..~ J./. ................ , 19~.~.., and opproved by the Budding Insp~tor. Building Inspector R~. 6/30/80 TOWN OF SOUTHOLD gHILDING DEPARTMENT TOWN HALL SOUTDOLD, NEW YORK 765 - 1802 11971 RLDG. DEPT. , , TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE../~/~./~.~ ......... NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING..~....VACANT LAND ........ Location of .I ~ ..... ~ ................................ HOUSE NO. STREET HAMLET Owner or Owners of Property.. Z~~¢'[[ ~ ~J~ co~ ~a~ .a~ No. ~ooo See~io~ ............ 078 Blo~ ~ ~o~ ........ Q%& Subdivzsion ....................... Filed Map ........ Lot .......... No. /.7A~..S-....Da~e o~ ~.~:~ .. ~ ~.~.~:~.~ ..... , ..... health Dcpt. Approval .~V...~[~ .... U.der~riEers Approval .............. Planning Board Approval ................ Request Fee Submitted: for Temporary Certificate ....... Final Certificate .... ..~. ......... ~ .................... 477 7~j~ v~ rev. I0/ 14/88 HEALTH BOARD OF 3 SETS OF PLANS ....... JFORM NO. I SURVEY ......... , OW OrSOUTHOLO C.ECK · .. TOWN HALL H7'7 - OHom ' ~,~ $OUTHOLD, N.Y. 11971 NOTI~ - TEL.: 765-1802 CALL 7~,; ~?. ~.. MAIL TO: ~2~ ~ K~,~ Examined ................ ,19... ~ ~ ,~ ~,".~ Approved ................ , 19... Pe~it No ............ ~ Disapproved a/c ..................................... (BuiMing Inspector) A~PLICAT~O~ FO~ 8UiL~i~ ~E~IT INSTRUCTIONS a. Tiffs application must be completely filled in by typewritei- o? in ink and ~ubmiited to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedQle. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app! cation. c. The work cov~red by thls 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 perm 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 untLl a Certificate of Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations. for the construction of buildings, additions or alterations, or for removal or demolition, as hereto describe The applicant agrees to comply wlth all applicable laws. ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary ,nspec~n~, (Mailing address of applicant) State wt~cther applicant is owner, lessee, agent, architect, engineer, general contractor, electnman, plumber or builde ............... .a. ...................................................................... Name of of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co.orate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No Plumber's License No N 9 o~ Electrician's License No Other Trade's License No N ~ 1. Location of land on which proposed work will be done ................................................ Itouse Number Street Hamlet County Tax Map No t000 Section Oo7~ Block 0t. Lot .0.~..~.. ,, Subdivision ................................... Filed Map No ......... , ..... Lot .............. (Name) 2. State existing Use and occupancy of premises and Intended use and occupancy of proposed construction: a. E.,is,,ng ,,se and occupancy . !. b. Intended use and occupancy .................................................................. 3. Nature of work (check which apphcable): New Building .......... Addltign .......... Aheratlon .......... Repair .............. Removal .............. Demolition K !,&~,~ ~t~\k~nV nfh,~ (Descnp.hon) 4 Estimated Cost z '~0~-~ .............. ......................... , ........ :... Fee ........................ · (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ~ ..... , Number of dwelling units on each floor .... If garage, number of cars ............. r .....i ................................ ---. ............. 7. Dimensions oL~xJstmg~i'ucturcs, Jf any' Front ...... ~-.g. ...... Rear ... ~.~. ........ Depth ....~.. Ne, p 'r .... ....... ...... .... '"" ............................... Diml~ ~pn~ of same structure with alterations or additions' Front ................. Rear .......... Dep~ l.../' '~ ...... Height ........ , .............. Number of Stones ...................... 8. Dun~ stnns ~rre new construction: Front ..... ,. ,' ........ Rear ....... ' ........ Depth ..... ; ......... Helg~ ..... ~ ......... ,Nunlber of Stones ........................................................ 9. Size~ ~{~t'~TDatt .. ....... ,.., .......... Rear ...................... Depth ..................... 10. Date ;,P.~"e' ............................ Name of Former Owner ...~.' ......... .k~. ............ I 1 Zone'or use district in which premises are mtuated .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ..('ll? .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises., .~{~.~.'n..I~.~,. ~.~lt.r. .... Address . .~..13.q, ~t~.,~ .~A.~.~:~.w. Phone No..7.~.~..-; .~.g3P...'-.'7'. Name of Arclulect ........ I.N.%o.~. .............. Address....~4~..e'9.-' .~.-~[A'~... Phone No ................ Name of Contractor ....... .~.0p.~. .............. Address ................... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .Y'.. *If yes~ Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ot proposed, and Indicate all set-back dimensions from aroperty lines. Give street and block number or description according to deed, and show street names and indmate whether mtenor or corner lot. being duly sworn, deposes and says that he IS the applicant le Is thc ....................................................................................... . · (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plicatlon: that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork wdl be performed in thc manner set forth in the application flied therewith. worn to before me tlus ....................... day of .......... ,19. - ! C~,THER:NE M, BURNS NOlnRY PdBLIC, Slate of New Yogi 4693093. Suffolk CounpJ ........ County ................ :::::::::::::::::::::::