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Home My WebLink About17179-z F013M NO. A 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) ~ N 0 ~ 1.717 9 Z Date 19.~. 41 Permission is hereby granted to: .....w.:......K.:.~ ~ 4 ~.s~s'..........~~'a ~ Y 1.9..E s.......... to ..~M:..~r....~ ~~~......~:~......~...~...~.~.4 of premises located at .~.~4.~..e~.~ ~...Z. County Tax Map No. 1000 Section ~..g B!l)ock Z::....... LLot No... pursuant to application doted ..........~..r~Y.l3L...Y4 19.~.Q., and approved by the Building Inspector. Fee $.c~,.~.::~~.... . ding Inspector Rev. 6/30/80 BOARD OF HEALTH R ~ O 3 SETS OF PLANS . FORM NO. 1 SURVEY Z 7 11u0E~ TOWN OF SOUTHOLD CHECK ....Q•. ~ . 1~ BUILDING DEPARTMENT SErTIC FoxM TOWN HALL TpNNOFSOUTFiOLb SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL .......p MAIL T0: R/\ 2 aE/S•~S`~'~Y~ Examined . ~~1.!!y!d4 19 ~ tg7. Approved ..30 1988. Permit No. I7 I.?.Y'ZZ.. ® ~5•~~r Disapproved a/c . . ~'~2?/8$'. ..t.t~! . (Building Inspector) APPLICATION FOR BUILDING PERMIT , Date 15 . INSTRUCTIONS 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 layout 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, additions or alterations, or for removal 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 necessary spections.~ (Signgt ~ of applic , e~ name, if a corporanon) z iss ham ,.~1~.~...1./.~3s......... ( ailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................~:Un~~ . Name of owner of premises ~ ~ ~ (as on the tax roll o latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ' Builder's License No. ~a-'~f."• . Plumber's License No . . Electrician's License No . . Other Trade's License No . p p a'.?? 1. Location of land on which proposed work will be done. •Q • • ~O U d ~i- /.cJ..e,.~•~• House Number St''rl!eet Hamlet County Tax Map No. 1000 Section ~`t........ Block Lot , Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of pre/mises~a~nd intended use and occupancy of proposed construction: a. Existing use and occupancy /~i~i -r"u'<" . b. Intended use.and occupancy Addition ....f' era.. 3. Nature of work (check which applicable): New Building a R Repair Removal , Demolition e 4. Estimated Cost . X506 Fee .°?~.•..r'...)... Y'' ~ 5fE i (to be paid on~l~figr:th~B~PR~jF~1yon) .r 5. If dwelling, 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 . Number of Stories . Dimensions of same structure with alterations' or additions: Front Rear . Depth Height Number of Stories . 8. Di ~ensions of entire new constru tion: Front Rear Depth . Hei ht Nnmh~r of Stories . 9. Size of lot: Front Rear Deptt, . 10. Date of Purchase Name of Former Owner . 11. Zone or use district in which prerises are situated . . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded l .................Will excess fill be removed from premises: Yes No l4. Name of Owner of premises . ...............Address ...................Phone No............... . Name of Architect , . Address ...................Phone No............... . Narne of Contractor ......Address .Phone No..... . . 15.Is this property located within 100 feet of a tidal wetland? *YES....NO.iI: *If yes, Southold Town ~frustees Permit may be required. I PLOT DIAGRAM ' Locate cleazly 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, apd show street names and indicate whether interior or corner lot. I / l'U //mil - I~ - .t~"i1 ...R J i ~ I . I! / l uV USA ~ /r _ _ to ~y" J. ~ V a~.•j' STATE OFNEW YORK, S COUNTY OF . (Name of individual si~nin~ • ' ' ' ' ' ' • • • • being duly sworn, deposes and says that he is the applicant d contract) above named. [ieisthe ~ (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 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 s$t forth in the application filed therewith. Sworn to before me this a.~.... y .........,19~~ Notary Public, ~I Count HELEN K DE VDE •ry2~cZ i~ NOTANY PUBLIC, State of New York ~~~L / . No.4707875, Suffolk Cou Term Eaplrea March 30,18 ~ (Signature of applicant)