HomeMy WebLinkAbout18301-z r~oaas xo. s
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 ~ a 1 Z Date ~ 19.1.
Permission is hereby granted to:
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of premises located at'..~~.~.....~~.R.~S~...P~....~.~-..i~....5<tl.~~..........~~.`.~4~1~0.~:-a..........
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County Tax Map No. 1000 Section O.~ Block G..~.....p..gLot Na......C',.~.........
pursuant to application doted ~ 19.x[.1..., and approved by the
Building Irrnspector.
Fee J:...
Building Inspector
Rev. 6/30/80
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U _t II 3 SETS OF PL.1NS
FORMN0.1 SURVEY
t TOWN OF SOUTHOLD CHECK .
BUILDINGDEPARTMENT SEPTIC POart
.m....m...,.,,'s. TOWN HALL .
BLDG-D[Pi ~
TOWN OFSGUi'HOL~' .,OUTHOLD, N.Y. 11~J7I NOTIFY ~3
p ~ TEL.: 7G5-7802 CALL y . ,~P, yrI .
Examinud ~ .I , 19 r1A I L TO
\pprovcd ...:Q~,ts~,~.L3, 1921. Permit No./. ~..4R1:~
Disapproved a/c
\y/ (Buildin; Inspector)
APPLICATION FOR BUILDING PERMIT
Date Jv L.~...C.v..... , 15
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
ar areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appB-
~ation.
C. The work covered by this application may not t>e 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 Buildin; Department for the issuance of a Building Permit pursuant to the
9uilding 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.
Tile applicant agrees to comply with all applicable laws, ordinances, buIlding code, housing code, and regulations, and to
_dmit authorized inspectors on premises and in building for necessary inspecti
(Signature of appli n, if a corpora).. .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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Vame of owner of premises .lT..E"Q~/.-~Q• ~ f~-2 t e--( HJ I~~ L.! /lI G
(as on the tax roll or latest deed)
tC applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~:r~'.-'':-Q!i .
Plumber's License No . .
Electrician's License No . .
Otltcr Trade's License No . .
Location oC land on which proposed work will be done. , '
..I.7.5 .............~co ~?.~eW~..Q:~.. ~~~~....~cp 9'~ ~c7~-~-~ ~~}21~..
House Number Street. • ~ ~ ~ ,
Hamlet .S'o~j~(JrjL~
County Tax \lap N/o~. 1000 Suction Block , , , •f Lot .Ljr
Subdivision .....4: S=D~.~~.Lr.~l... .~'f"~1~.. Filed Map No .
(Name) Lot...............
• State uxisting use and occupancy ofQpremises and inten/du~,use and occupancy of proposed construction:
a. Existing use and occupancy l/.4Q[~~.~:~~..,1~~ ~E•
b. Intended use and occupancy . • • . • • • • • •
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3. Nature of work (check which applicable hew ~ }
Re air ~ Iluilding ,Addition . Vt tion
P Removal.......... " q
Demolition ..............190
4. Estimated Cost , , ,~,3vG (p~" scii ti • ~ •
• Fee......
5. If du~cllin~ (to be paid on liling this application)
„ nurnbcr oC dwclli
If g Pg units Number of dwelling units on each floor........ ,
Hci !tt c num er of cars red occupancy, specify nature and extent of each type of use.....:. , ,
7. Dirt cnsions of cxistinr~lstruct'tires, if any: Pron[ , •
Number of Stories , • Rear Depth . . • •
Dimensions of same sttucturc'nvith alterations or additions: Front
Depth. .fIcight. Rear.................
8. Dimensions of entire new construction; Front , ~ ~ ' ' ' ' ' ' ' ' ' • • • • Number oC Stories ~ ~ ~ ~ ~ • ~ ' '
Height Ntjmber of Stories , . • Rear Depth• • • . • • • • .
9. Sizcoflot: Front.....
]0. Date of Purchase Rear........... Depth........
11. Zone or use district in which premises are situated , ' ' ' ' ' ' ' ' ' ' '
1 Does ro osed construction ci, ' ' • • Name of Former Owner
P P olatc an}• zonin
l3. Nill lot be regraded g taw, ordinance or regulation: , , • • ~ ~ ' ' ' '
14. Name of Owner of prcmiscs . ' ~ • ' ' ' ~ ' ' ' '
1Vill excess fill be removed from prcmiscs: Ycs . N;
Name of Architect ~ ~ • • ~ • ~ ~ ~ ' ' ' ' ' ' ' • Address ...................Phone No.. •
Name of Contractor • ........Address ...................Phony. No.. ' • .
IS_Is this property located within "Address.......... .Phone No.
*If yes, Southold Tow 900 feet of a tidal wetland? *YES,?C,.NO....••
n Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whethc:
interior or comer lot.
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TATL OF X[R~'ORK, ' /
U• • y OF t1Fr!C~~ S;
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(home of individual sip ' ' " • • befog duly sworn, deposes and says that he is the applicant
rove named. ,nmo contract)
is the .N~m`•`-..~~/~~/.Zd.'.......
said owner or owners, and is duly authordttooparformnoroloavc pcrforrned the said work and•to make and.Gle•tltis
~hcation; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
rk will be performed in the manner set orth in the application Glcd therewith.
om to before me th//is
......c~.CP.Y""J • of. /).-erg...... . 19
ary Public .
ounty ~ ~ .
I "~~~~~v_~ s //'J" l \ (Si,nature o applicant)
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