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Home My WebLink About17478-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017478 Z Permission is hereby granted to: ..~..,.~ ~ ~......?...~.~:~ ........... ;~T ...... ; ..,, ~u~ ~ ~ ~ ~ ~.i.~ .......... ~ ....... ~ ......................... .~. ................. ..... ~.:.~..,.~..,.....~.~..~.L.~..~..,..~.~.. ....... ............................................ ........ ~...:.....~~ ............... County Tax Mop No. 1000 Section ..... .J..~c~.?.. ....... Block ...... ..~...L ......... Lot No ....... .J....~. ........... pursuant to application doted ...... ..~~....~ ....... , 19..'~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 *" ~-" ~'~;t'~%~[i ~"~ OIO:~A FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1802 Examined ~.~..~..., 19~ Approved~~.. ~.., 19~7. Permit No. 1.~.~ ~.~ .~. Disapproved a/c .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF/PLANS SURVEY f¥,~! .... ~ ............. C~ECK .~.arE.. 1 .-/.[~ ............ SEPTIC FORM ................ NOTIFY CALL ..................... a. This 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 or areas, and giving a detailed description of l~yout of property must be drawn on the diagram which is part of this appli- cation. c. The 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 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 Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, a.d. ditions or alterations, or for xZemoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nece~saryjnslzections. ,~ ,,/ (SignatTffre OI appticant, or name, if'a'c'o~lJo'r,4d~n')' ' ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..P~k,.~%..¢..c~. ............. Plumber s L~cense No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........................ ~. ............. . ........... House Number Street Hamlet County Tax Map No. 1000 Section /.o~. 0c~ Block o/ Lot.. Subdivision ..................................... Filed Map NO ............... Lot ............... (Name) 2. State existing use and occupuncy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b- lntended use and occupancy...........~O.t'.'t'~. ....t~,/.. 3. Nature of Work (check which applicable): New Building .......... Additio .......... Alteration Repair .............. Removal .............. Demolition ............. Other Work .............. ~-'-O C_] ~ (Description) 4 Estimate'd Cost ' ...................................... Fee ....... I ......................... (t4 be paid on filing tbis applic'ation) 5. If dwelling, numberofdwellingunits ...... Numberofdwelhn units on each floor .......... If garage, number of cars .......................................i ................... ' .... iry 11 .......... 6. If business, commerciai or mixed OCcdpancy, spec nature and extent of eac type of use .......... 7 D .... structures if any: Front Rear Depth Height Num [~er of Stories ................... 1 .......... Dimensions of same structure with alterations or additions: Front I ......... ' Rear Depth Iteight .................................. 8 ............................................ Num bei' of Stories ................... · Dimensions of entire new construction: Front Rear ' ' Height Number of Stories .................... ~ .......... Depth 9. Sizeoflot: Front ...... i '... :.....~.. Rear .................... i'' Depth .... I0. Date of Purchase ......... ~' '~" "2 .~. ......... Name of Former Owner ....,~/. ~ ~ .................. · · .. .T;.?..~.. .......... 11. Zone or use district in which premises are situated . 12 Do pos d ction iolate ............................................ · es pro e constru v any zoning law, ordinance or regulation: . ~ ......................... 13. Will lot be regraded ............................ Will excess fill b~ rze, m6.ved frg~ pr~mises: Yes No 14. Name of Owner of premises/r.'//.~.,M.,e..~...~.,'.~.2: ~...~.~.4C.~A. ddress4~..~./~..v?. Name of Architect .................... .~. .....Address ............ i ...... Phone No ................ Name of Contractor ......................... Address .... I Phone No ....... 15.Is this property located within 300 feet of a tidal !wetland? *YES. .NO.X. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all 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 s~ow street names and indicate whether interior or corner lot. STATE OF NEBt--Y-ORI~ ,q /)/1 COUNTY OF..c~. ~S-S ... c,% , __ .... ' ...................... oemg duly sworn, deposes nt ~.r~ame oIindividual signing contract) above named. tcontractor, agent corporate officer etc : "11~ ........ "?~t'' of sald owner or owners, and is duly authorized to perform or have ~erfnrmo~l apphcatlon, that all statmnents contained m this a--licatio ............... work will be perforated in the manner set forth in the application fi -d *~ ....... ~*~- g and beli~n~the Sworn to before me tt~is