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Home My WebLink About17895-z !'O8M N0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMI7 MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 17895 Z Date ........~.!Y.~.are:c,~t......~ )9.x'..9 Permission is hereby granted to• ~............4r . : . . to ..4.r:s.11......~.....,..,.~t.Q.Q....A~~rf.~~.~d.2....~ .~...~~CA.~,...,~,~,,,,,~„ . ct premises located at . ~.3.3.~ S ........~~?^.:r...!!-~'1:.......~-°t-~....'V ' ' County Tox Map No 1000 Section ~ ~l Block ~ Lot No . 1 .ad..: ~ pursuant to application dated ..~~`~~4.. W 19.~~., and approved by the Building I//nspector. Fee S ~S•:•/ .C G' d-~, u ding Inspector Rev 6/30/80 BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL SOUTHOLD, N.Y 11iJ71 NOTIFY TEL.. 765-1802 CALL MAIL T0: Examined . ,~t~:_Gn!~. ~ 19~~ ' Approved 19~~ Permit No.~ S~~. Disapproved a(c . ..Q (Building Inspector) APPLICATION FOR BUILDING PERM17 Date ~e ~?ruGt r ( ly INSTRUCTIONS a. Tliis application must be completely filled in by typewnter or in ink and submitted to the Building Inspector, with 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 adlointng 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 appl catron. c. The work covered by tkus application may not be commenced before issuance of Building Permit. d. Upon approval of tills application, the Building Inspector will issued a Building Permit to the apphcant. Such perm, shall be kept on the premises available for inspection thrau;liout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otlier applicable Laws, Ordinances o Re;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein desenbed The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and b admit authonzed inspectors on premises and in building for necessa`~' inspections- . ! .o ~.K S.~ S k,':'? s, ,~iv c... ..T.G_i3 (Signature of apphcant, or name, if a corporauon) (Mailing address of apphcant) State whffether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder hN.SSe~.... p Name of owner of premises Pu d q ~....~O.C ~ . -1 (as on the tae roll or latest deed) If applicant is a co~rpyorati~ signature of duly author/sized officer. (Name and title o c orate officer) Builder s License No . . Plumber's License No . Electrician's License No . . Other Trade's License No . I. Lacauon oFland on which proposed work will be done. . S33 5..... /~a..r...!Qouo~ ..........Sy,v1~q/d Iiouse Number S[reet Hamlet V County Tai hfap No 1000 Section ....b. Bloe,k Lot ....~:3. ~ . Subdivision Filed~iap No Lot (Name) State e~istrng use and occupancy of premises and intended use and occupancy of proposed construction• a. Existing use and occupancy b. Intended use and occupancy ..~C°.~T-~•^.i•..~oqu.f ~i~gNr~ii,~ ~~p~ W - i .~Q~....... 3. Nature of work (check which applicable). New F3uAdmg Addition . Alierauon . Re air Removal Demolition .Other 1Vork S./.y!`~.. . p _ 4Dcscnptton 4. Estimated Cost ..~i..~.~~ . Fee . (to be paid on fiAng this applicaUOn) 5. If dw•e{lm„ number oC dwelling unus Number of dwclimg units on each floor............ . If gara;e, 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 Depih . Hci_ht ...............NumberofStoncs..................................... Dtmenstons of same structure with alterations or additions: Front Rear Depth IIctgtit ......................Number of Stones . Dtmenstons of entire new construction. Front . Rear Depth . Hei~lit Number of Stones . . 9. Stzeoflot:Front Rear Depth 10. Date of Purchase • . , ..........Name of Donner Owner 11. Zone or use district in which premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or rcgulation• . 13. Wdl lot be regraded ............................Will excess fill be removed from premises: Yes ? 14. Name of Owner of premises . ..................Address Phone No............. . Name of Architect • Address ...................Phone No............. . Name of Contractor ..........................Address ...................Phone No............. . 15.Is this property located with in 300 feet of a tidal vetland? *YES....NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. induafe all set-back dimensions fro property lines. Give street and block number or descnption according to deed, and show street names and indicate wheth intenor or corner lot. STATE OF 1EW YORK, S S COUNTY OF . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duty sworn, degoscs and says that he is the apphcai (Name of individual signing contract) about named. fleisttie (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to gerform or have performed the said work and to make and file th apphcauon; [hat all statements contained m ttus applicquon are true to the best of his )`nowledgc'and behef;and that tt ivark wdf be performed m the manner se[ forth m the application tiled therewith Sworn to before me this • ........day of .....~'C! G;1-c~ 19 ~y ~otaryPublic, i^VS-Q6:~..~ ~t: ~pG..... County NELENK OE+30E . NOTARYPIIflttC,Statea+NewYorli i~ a[ureofapplican Ne.4707S1fl. Saffu4N Caonty( Term Exmres A9xich 39, 19____i/l