The URL can be used to link to this page

Home My WebLink About17407-z ~0~ NO. ~ TOWN OF SOUTHO~D 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~ 017407 Z Permission is hereby granted to,: ...... ~....~..:.~ ............................................. .......... ~...~....~... ............. ../..../..~? ...... ........ ....... at premises located at ..... .~....~...~. ......... ~. ...... ~ ................................................................. County Tax Mop No. 1000 Section ........... ,~'~...~..., Block .............. ,~.. Lot No ........ ./.....~.... ..... pursuant to application dated ............ ~,./.."~..~.. ........................ , 19...~....~', and approved by the Building Inspector. Fee $~ Rev. 6/30/80 KING STREET 0 z o N.86° 43~40"E, ~J 117. 78 ' S.81° 50'O0"W' LOT '~ "MAP oF wILLOW TERACE SEC. ONE" sUFF, CO. MAP NO. 540-/' CERTIFIED TO , CHICAGO TITLE INSURANCE CO TITLE NO, 8708 -04616 DIRCK .VClNSE~ BRQ, W.~ standards fer title curver* al e~tablished t~ the L.I.A.L S. end epprm~ed and adepte0 fer ,uch use by The New Yerk State Lena Title AJsoclation. P.O. BOX 909 MA;ti ROAD SOUT~IOLD, N.Y. 11971 SURVEY OF PROPERTY AT OR'lENT TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. I000 - 026 02 14 SCALE I"= 30' AUG, 4 , 1987 87 - 630 '--, FORM NO. 1 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~.:..~7 .......... , 19 ..~ Approved ............. , ennit No. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ........ 3 SETS OF PLANS ............ SURVEY ..................... CHECK .... s pT:c:)o M ::::::": ....... NOTIFY CALL MAIL TO: · · 7 ..... INSTRUCTIONS a. Tlfis 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 publ/c street ~ areas, and giving a detailed description of l&yout of property must be drawn on the diagram which is part of tiffs appli cation. c. The work covered by tiffs 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 penni 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 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 tiff Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o: Regulations, for the construction of buildings, a.,d, ditions or alterations, or for 3emoval or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectorst[ .~':'0 ~°n~6premises~' 4,~ ~,,r TM ~ and.,~ in building for necessary insnections ....' o ,. ?. .,, t, or name, if'a c'o~'~o'rar~dn)' ' ' ' ' · ~ . ..... '~' __O..:. 0.~.. . ......... · '~. ".t ' '',",il ,:,,: '!,~: :.,u: (Mailing address of applicant' State whether applicant :is o[~;':J~:~el! a~e~t~, 'architect, engineer, general contractor, electrician, plumber or builder. ''" ...... ' ?;fff'dffOJf'~ ;f b'n'}~:~a': ~OOfl'.~ ............................................. · · "-----". D.:} ~O~1 !ITI~MO:~ 38 (as on the tax roll or latest deed) If applicant is ~llttl~Jo]llllkl4~ sl~)lllI)4#~.~101~ all~orized officer. ........... ~ .8. ~ .g~r~t ...... (Nag~l~n~raTl~l~ ffi~)4~ Builder's License No. : ~. (Jg.P. fq. ~-d~--~ .......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on xvbich proposed work will be done ................ ............ q .o. .... .tA. .... S .:.., ..... . , .... ........... House Number Street Hamlet/ ' ' ' ' County Tax/',lap No. I000 Sectio '~Q~'~ ' Block .......... Lot ... Subdivision .~./.A,~..~...'~--. ,~--~,/Or .~. ......... Filed Map No ............... Lot ............... (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy ofiproposed construction: a. Existing Use and occupancy ...................................... ~ .~ _,~..tll .81~. _ ~_- ~ ,.. ~- ~v'~i~_~~'~;i6/~ .... ' ....... b. Intended use and occupancy t ~.F~..~.]~..~ .......... ~ ..... 3. Nature of work (check which applicable · . . , ). New Budding .......... Addition .......... Al~e~'rltion ........ Repa/r .............. Rqmoval ............. Demolition .............. Other Wc~ ......... ~ ' (Description) 4. Estimate'd Cost ~ (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 ; ............... m.ness. 19q, liP.,~_.~,~_.~ ,~ t n y, specify natuKe and extent ofcach type of use .................. 7. Di 1~~.~.[~4.' uany: Front ............... Rear .............. D~pth ............. ' Ht De t r . 8. Di · e Hei ~~~4Num~er of Storie~ ' ............. P ............ si , ,, _ · ....... , ........ ~,,ear ...................... Depth ................ Date of Purchase ... : ...... ' ...... . N off O Zone o dist icl in whi h ~remi ......... amc ormer wner ............................ r use r c scs are situated .................................. D d ti vi lat i ................. ocs propose construe on o e any zon ng law, ordinance or regulation: ......... Will lot be regraded .... ~ ...................... Name of Ow f p is ' ' ' ' ..................... Will excess fill be removed from premises: Yes Nc nero rem es .! .......... Add P1 eno ' Nam fA hit · · ...... ress ......... ion Nam f Co .............. Add Phone No to e o ntrac r ....... ~ .................. Address ................... Phone No ............... 15 thi ty loc'a d ithl 300 ' .Is s proper te w n feet of a tidal wet:land? *YES .... NO.'... · If yes, Soul:hold ToWn Trustees Permit may be required. , PLOT DIAGILM~ Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate ail set-back dimensions from number or description according to deed, and show street names and indicate whethet 10. 11. ,"12. 13. 14. property lines. Give street and bloc interior or comer lot., STATE OF NEW YtO-RK./vFv //,-- , . (Name of individual signllng contract) above nanled. APPROVED AS NOTED / NOTIF~ILOING OEPARY~Nf AT 76B-1802 9 AM ~ 4 PM~OR THE FOLLOWING INSPEC~ONS: 1. FOUNDAT~N ~ RE~IRED 4. FINAL - ~~NMUST · ·. being duly sworn, deposes and says that he is the applicant hie is the ~ (Contractor agent corporate officer etc ) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make 'and file this application;that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be pcrlbnned in the manner set forth in thc application filed therewith. Sworn to before me this otary Publ,c, . .~~. ... County