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Home My WebLink About17339-z aosai xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o 017 3 3 ~ Z Date ~ . 9.rF~ Permission is hereby r ted ' - ~w to . ..~d~ilr ~f~.....~ .!.cry!.... ~ ..7~ at premises located at Q~ / Caunty Tox Map No. 1000 Section ........~.~.:3... Block Lot No...f..7..r...~L.......... pursuant to application date . ~/J~ 19~~, and approved by the ~'GC ~~/~~e~S Building Inspector. oo~~ B d Fee $...Q..'!.~1 L~~~~ „ ~ii~rr.~ / Bu' ng Inspector Rev. 6/30/80 ' _ .....e_.._..,. c ~ BOARD OF HEALTH lul 3 SETS OF PLANS • , 'f•OnM NO.1 SURVCY ~ ~ TOWN OF SOUTNOLD C11t;CK ..1A i.~ . BUILDING DEPAt2TMENT srr7~xc ronM BLOC. DEFT. 70WN HALL TOWN OF SOU7NOLD SOUTHOLD, N.Y. 11971 NOCALL • = TEL.: 765.1802 C/ MAIL T0: Examined , . , , 19 Approved ~~-3.3/ 19~~Permit No.......... . Uisapproveda/c ..............................~~P.'{! ...~~Z (Bu ding pector) APPLICATION FOR BUILDING PERMIT / Date ~l I~ INSTRUCTIONS a. Tlus application must be completely filled in by typewriter 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 adjoining premises or public street 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. T'Ite 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 permi shall be kept on the premises available for inspection throughout the work. _ e. No building shall be occupied or used in whole or in pazt for any purpose wlxatever 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 tlu Building Zone Ordinance of fire Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described 'I'Ite applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ti admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State wltetlter applicant ' owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder . . ~~y ~ ~ o Vame of owner of premises !`?'.'t ~ t ' . V tay~c; ;r~!ti/,Y,~.~,1~; .-P.:~!~?R--........... . (3k on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST E UFI'OLK COUNTY LICENSED Builder's License No. ......~Q~,,,,,,,,,,,,, Plumber's License No . . Electrician's License No . . . Outer Trade's License No . . I . Location of land on which proposed work will be done . . house Number Street [-Iamlet County 'fax Map No. 1000 Section ,1..~ .3....... Block Lot rZ . Subdivision Filed Map No. Lot............... (Name) State existing use and occupancy ofp/p7remise~s and ipnt"ended use and occupancy of proposed construction: a. Existing use and occupancy 4 ~K-!~~!--~?:~!y~-;-¢r.~ . ' ' ~ b. Intended use autl aGC4tp~ncy 5,Y~/C~ ; , , , , . t 3. Nature of work (check which applicable): New Quilding Addition Altcrati n . Kepair Removal Demolition Other Work ./Y,-~C .e.-.~ . n ~ ~ (Description) 4. Estimated Cost . ~ . 0 • ~1 ~ ; OC~ Fee . ` (to be paid on filing this application) 5. If dwelling, number of dwelling units Nutnber 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 . Ileigltt Number of Stories . Dimensions'of same structure with alterations or additions: Front Rear . Depth ......................Height Number of Stories . 8. Dimensions of entire new construction: Front . Rear ...............Depth . Iieigttt ...............Number of Stories 9. Size of lot:Front Rear.......................Depth.... 0. Date of Purchase .Name of Former Owner 1 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13. Will lot be regraded ..Will exc ss fill r moved from pr es: Y s No 14. Name of Owner of premises~l„i2,~,~z~Address ~..-y { ~~MR~i~b~f~ {.t)ooCQ N y / f~a~ Natne of Architect ,7 ,Address 'hone No. g~ Name of Contractorl`t ~~,~->Jn.~g_, , , , , , , , , Address`~Q ~o?C.zf ~'L/ff~JVi~one No.w~-~~."4Ea:7'r7 . 15. Is this property located within 300 feet of a tidal wetland? *Yes No X *If yes, Southold Town Trustees Permit ma be required. PLOxI' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or cornet lot. PR~v~ )r ~ , AG Is -t i ~ ~ s b p~iuaT~ ~orib STATE OF NEWpYORK, S.S COUNTY OF ~4~1~^~-, ; ,p • • • • • • • • • • tehc-~y~. ~ d"`'`~`.-.`~~'........... being duly sworn, deposes and says that he is the applicant (Name of ind of idual signing contract) above named. Iieistlre -'k~:~...................................................... .(Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or ]rave performed the said work and to make and file this application; that all statements contained in this application are true to the best of his 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 n Not ry Public, ....n........:~~J,~~, , , , , , , , , County -~';CCfo~ Cit1--/~~ / l~d2G~,!2:L~`J .:~.!.~.1.~:P)'?'z'~.~-. NOt°'y~~g~q~~?~~ (Signature of applicar~) No. 4822588, SuHapt ~p~y~y a Term Expires Oeamber 81~ 18.E