HomeMy WebLinkAbout17968-z !'08M NO. ~
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) C
Na 017968 Z Dote ° 19...~/
Permission is hereby granted to: ,
to ...~.fPl'~........ .G?,.~~ .1..
ct premises located at
Caunty Tax Map No 1000 Section Block ............6~......~.
yL-ot No .
pursuant to npphcation dated . 19P.. and approved by the
Building Inspector.
as
Fee S..
.
Build I for
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BOARD OP HEALTH
3 SETS OF PLe1NS
FORM NO.1 SURV CY
TOWN OFSOUTHOLD CFIECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
. EOUTHOLD,N.Y.11rJ71 NOTIFY
TEL.. 765-1802 CALL ...............y~ t
Eramtncd ~r,. 19t~ MAIL TO ; 1 I ~ VV-
Approved . c-~,•~........ , 1;~1 . Permit No
Dtsapproved a(c
C~ (Buildnspe or)
~f~~ ~ 4 It APPLICATION FOR BUILDING PERM{T p.
L 15~ f~ Date . , 15 .Q
2".CG OEFT
TOtM1i"J CF 5CUTHOLD INSTRUCTIONS
a Tlus appltcatton must be completely filled to by typewriter or in ink and submttted to the Butldtng Inspector, with
sets of plans, accurate plot plan to scale. Fee accordtn~ to schedule.
b. Plot plan showing locatton of lot and of butIdmgs on premtses, relahonshtp to adlommg premtses or public street
or areas, and gluing a detatled description of layout of property must be drawn on the dta~ram whtch is part of this appl
capon.
c. The work covered by tttts application may not be commenced before tssuance of Building Penntt.
s d. Upon approval of this apphcahon, the Building Inspector wtll tssued a BuIldtng Pentttt to the applicant. Such permt
shall be kept on the premtses available for mspechon throughout the work.
e. No building shall be occupied or used to whole or to part for any purpose whatever until a Certificate of Occupant
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Butldmg Department for the tssuance of a Btuldtng Peattit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and outer appItcable Laws, Ordinances o
Regulations, for the construction of butldmgs, addtttons or alterations, or far removal or demohtron, as herein described
The appicant agrees to comply with all applicable, laws, ordinances, bu trig ode, hou m~ e, and regulat ns, and t~
admit authorized mspecton on premtses and ~p tiaiI ~tno for necessary t do
~
=.a4;~
> ~ (Signature o appl nt, r a c rporauon)
~µ4;iGJ, t
• ,,tt r'`~a (Melling address of applicant)
State whether apphcant~ is•ov~iar, 1C~se~'„¢g'~54C;"$#~httect, engineer, general contractor, electrician, plumber or builder
Name of owner of premYSds i .;Cr~!~.~•!?'JT! ~e~oy~o.S'
, _ ir~T."wt?~ t~'ir`P}3`~~'~"t ( on the tar roll or latest deed)
If applicant is a cor'poratton, st~na_t..ur~~gf~d,~~anthnrr~ed officer
(Name and title o£ co orateppo~~fficer) '
Builder's License No ~.~/.Yk-,
Plumber's Ltcense No .
Electrician's Ltccnse No . .
Other Trade's Ltcense No . .
1. LocattQn of land on wlitch proposed work vill be ne. t.. • • _ , , _ • , • • , • • • . •
...I gq.~ .............l~o.... O.ln~ ~..!~At~loN.........
Ilouse Number Strcet Hamlet
County Tai ilf.tp No 1000 Section Bluck , , . , • Lot , .
Subdtvtston . Flied Ivtap No. Lot .
(Name)
State costing use and occupancy of premtses and mtt~enll(Iyd use and occupancy of proposed construction.
a. Existing use and occupancy ~ ~ ` .
U j'
b. Intended use and occupancy ..~~1-.1~ .I/ .
3. Nature of work (check which applicable). New Iluddmg Addition Altcratio ~y~
Repair Removal Demolition Other 1Voricj~~/~4~
(Descnphon
4. Estimated Cost ~.~4!: Q~ .Fee .
(to be paid on filing this apphcaiion)
5. If dwelbng, number of dwelling units 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 ...............NumberofStoncs.....................................
Dimensions of same structure with alterations or additions Front .Rear _ .
Depth Heigh[ Number of Stones .
8. Dimensions of entire new construction. Front . Rear Depth .
Height u birr of Stones ........~y r .
9. Size of lot. Front ~ , . Rear ...-1.~,~.~.~ Depth ~ . ~
10 Date of Purchase ~ oZ.-./ ~T~-.. .......Name of Farmer Owner w,~U.~q,~ .(~,t~O.wn1... .
11. Zone or use district in whicl1 premises are situated .
12. Does proposed construction violate any zoning Iaw, ordinance or regulation .
13. Will lot be regraded ............................Will excess fill be removed from premises. Yes i
14. Name of Owner of premises ....................Address ...................Phone No............. .
Name of Architect . .Address ...................Phone No............. .
Name of Contractor ..........................Address Phone No............. .
IS.Is this property located with in 300 feet of a tidal wetlaad? *YES.-.-NO~.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buddmgs, whether existing or proposed, and indicate all set-back dunensions frc
property fines. Give street and block number or descnption according to decd, and show street names and indicate wheth
intenor or corner Iot. /7
_ ,
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STATE OF NEW YORE, S.S
CO~U(,'I~TY OAF,( ~ /
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~~7 .b~ bang duly sworn, deposes and says that he is the applica
(Name of mdrvidual signing contract)
above named.
ficisthe
(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 ti
application; that all statements contained m tfus applicaton arc true to the best of lus l.nowledgc and belief; and that t
work wd! be performed m the manner set forth m the apphcauon tiled therewitli.
Sworn to before m~e/this
a~y,J~.~. ....'./.day o(~f ..~)~??cwr;~ 19 ~9.
rotary Public, .!.`!4tGat/.. County ! ~ ` '
NELEN K 1)£ VOE
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8t78 S~uttbutkt'~a~i (Sig t re ofapphcar
Term Expires Much 30,1