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Home My WebLink About17431-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 017431 Z Permission is hereby granted to: _ ....... ....... County Tax Map No. I000 Section ........ I.~.']. ........ Block ........ J...~). ...... Lot No.....P./~,......:~....O.. ..... pursuant to application dated ..... .~...~....!....'~.. ....... , 19.~...~...., and approved by the Building Inspector, Bull'dTng Inspector Rev, 6/30/80 BLDG. DEFT, TOWN OF SOUTHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ....................... ......... ../.............._. _/._/ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: a. This application must be completely filled in by typewriter or in ink and submitted to the Buildihg 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 I/tyout of property must be drawn on the diagram which is part of this appl/ cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tlfis application, the Building Inspector will issued a Building Permit to the applicant. Such permi~ shall be kept on the premises available for inspection throu~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc5 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 thc Building 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 The applicant agrees to comply with all applica[~ie laws, ordinances, building code, housin~ code, and regulations, and tc admit authorized inspectors on premises and in building for necessa~A~spe~o~' spect' ns. (Signature ....... ot'*'~' "a~31ic~t, er _"_~° ' ' ' '~°'' · . (Mailing address of applicant) · State whethe~ applicant~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· N~oqq~ ~O~mmes: ~ .(.~/~/.~. 4 ............................. Y M ~ ~O ~T~3N¥1bl~lL~ ~r;~ (as on the tax roll or latest deed) Ir~n~s ~t~hl~i~t~r~o f duly authorized officer. (Name and title of co.orate officer)~ .,. ...... Builder's License No. t ..... ~ .... Plumber's License No ..................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on w rich proposed work will be dope. q~ ...... ~ .~.~.~.~ ........... ' House Number ~ / ! Str e Hamlet t CountyTax MapNo. 1000Section ....................f./t.T.. ........ .. Block /O Lot~)7~P~.~'/7..~..~./~Pl Subdivision ~ Filed Map No /?.~ ~ 2 Lot . .wT. ........ (Name) 2. State existing use and occupancy of premises and intonded use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ..... ~..~f~- ..................................................... 3.Naturc of work (check which ~ipplicable): New Building ' Actdition .......... AJte~;lr.~ t ....... Repair .............. Ren~oval .............. Demohdon .., ~ .... :... ::,. O~t~}ihi~W6?~2_.~. 1~'~.7'~'lut$/o~O o~- ~"'~I&T'/it)~ .~"t,~'-~" ~,,~ ,~gk/',~e,~r-r~;/'" ~eo~--'JoT'~ ~ ',, ' ~ ' (Description) 4. Estimate'd Cos ................................ Fee ..................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uniis on each floor ............... If garage,, number of ears .... .................................................................. 6. If business, commercial or mix6d occupancy, specify nature and extent of each type of use ................... 7. Dm~enmons of exmtmg stmctures,.~f an5': Front ............... Rear .............. Depth ............ Height ............... Nu!nber of Stories ..................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth ' IIeight Number of Stores ,8. Dimensions of entire new consimction: Front .............. '. Rear ............... Depth ............ Height ............... Number of Stories ............................................. 9. Size oflot: Front i n,,,, .. Denth . .. 10. Date of Purchase ...~/'./~/%]..,! ~ .-/.~ ............ Name of Former Owner /-/f,~.'../r..~,..~.'h.~>.../~. ...... I 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 ........ ! .................... Wil! excess fill be removed from premises: Yes Nc 14 N fO fp i ' Add PI N · amc o wrier o rem scs .., .................. ress ....... . ........... lone o ................ Name of Architect : Address Phone No Name of Contractor ' Address Phone No 15.Is this property located within 300 feet of a tidal wetland.* *YES .... NO .... ~If yes, Southold Town Trustees Permit may be required. ... i PLOT DIAGP, JLIVi Locate clearly and distinctly a~l buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~V YORK ILl i S.S COUNTY OF .................. APPROVED AS NOTED ~/~' ~ ' FEE: c~ NOT~V eUILmNG OE,~'rMENT 76~-~8o2 9 AM TO 4 PM rO~ THE 1. ~OUNDATION - m, ,ou [o co,c, ,t . ~3. ~NSU~T~ON ~ 8~ COMPL~ ~ CONSTR~N %~TE ~NS~ i BERGY ~ESION OR ~~N ERRS8 ............................ ' .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I He is the ..................... i .................................................................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perforn~ed the said work and to make and file this application; that all statements contained ill this application are true to the best of his knowledge and belief; and that the work will be performed in the mam~er set forth in thc application filed therewith. Sworn to before me tiffs ....................... day of...~ ............ 19 ,.. :' '5;,;;:.i,;.'::J ..... . No. 4707878, S~lk ~u~ ~