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Home My WebLink About17361-Z IPOB,~M NO. 0 TO~'N OF SOUTHOLD BUJLDJHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 017361 Z Permission is hereby gD~nt~ed tq: , ~, ~~~./~./.',.~ ....... ~ .~K..~ ........... ~.~...~.z~ ............. ../...~.....~ . _. _ ..~~...~..~.-. ....... .:.:..~.~..,.. ,o .~...~.~...~..~..~..'....~..~....~-m~..~.'.......~ .............. ot premises located at .....~,.~-- .~,...~......~.~::~ ............................................................ County Tax Map No. 1000 Section ....... .~.....-~.... ....... BJ~k ........ ~ ..... Lot No ...... ...~..,..~../.... pursuant to application dated ........ ..~/./.~ ................................, 19..~ and ~pprov~ by the Building Inspector. ~e~ $,./~ Rev. 6~30/80 BLDG. TOWN OF $oLrtl.lOLO Approvedz ~.~.. Disapproved a/c ..................................... BLDG, r~Et ?. TOWN OF,SOuT~OLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B0:~ ., l__Permit No ........... (Bwgldin=t~pector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY ~ ' 5~ ~ / · '" CALL ..................... MAIL TO: a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~o. 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 properW 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 ~emoval or demolition, as herein described. The applicant agrees to cqlti~~~ble laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectortl~n~l~e~l~ls~f~l~itl ~d'Building for necessa~'2~ stvec~o~l ~, / ______ · .~ ......... :,, , . ~.~: ./.&¢(/~..: .................. .--. ~, . ¥~1 .......... ' (Signature of applicant, or name, if a corporanon) ~i~!~", ~ ?~'! ;,' (Mailing address of applicant) State whether applicant is o~r'i~q~e~_,_]~k~,~,~t~h/$ect, engineer, general contractor, electrician, plumber or builder. 0U419.0-. ,g.. ~'~ "~"~ ' Name of owner ofpr~=~es..~, e.~,~.-~;; ~..F~.. ~e./~.r.: .r~..~....,:...~..~..0. ~.e.--. ................... .. ~,r ~o ~...'~,.,,:i~,& ,~ ~ (A on the tax ron or ~atest deed) I£ applicant is a corl:~llll~ si~n~orF~l~l:rtil~ auth~ri'~ed officer. ............... ~10~.· i~';'i '.., ~L; :~ .......... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ...~%... ~f~.gv?../y.3..&..A5~..~ .... .~.. ~.z...z.7.~T... ~0~..~. 0... House Number Street Hamlet County Tax Map No. 1000 Section .~.~ ............... Block O.I ................ LotO..~: .{ ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .O.'t:O..,5..7~., .~. ~...~t~ ./A/. " b Intended use and occupancy ................................. Nature of work (check which applicable): New Building ..... ~ ..... Adclition .......... Alteration .......... 3. Removal Other Work .... Repair .............. .............. ~..~.~j .......... ~ ~!,,~(i]e$ci~o n) 4. Estimate'd Cost..~.2. S-.0...~-v~r..b...C~. ~.C.C(p.,~..~.....~.. ?..~.. .... Fee ..... , .......... ina..-; ..., ~ ........... t''' ~.to be paid otng, t)!S~pp!i¢~tion)~ 5. If dwelling, number of dwelling units ............... Number of dwelling units on earn hoer ............. .o.. If garage, number of cars ........................................................................ 6. If business commercial or mixed occupancy, specify nature and extent of each ~ype of use ..................... 7. Dtmensmns of ex~sting structures, if any: Front ...... ~. ~. ...... 'Rear ....~. ......... Depth .. · -"a':~. ·t ....... Height .~} .... t~,a.......NumberofStories..,] ..................................................... Dimensions of same structure with alterations or additions: Front .O ............... Rear . O. ............... Depth . ~ .................... Height . ~. ................... Number of Stories . ~. ............. ~ ..... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ........ ... · .~.:., Height ............... Number of Stories .................................................... '. ~-~. 9. Size of lot: Front ...................... Rear ...................... Depth .... ~....: .~&. :~._,_,.,.. 10. Date of Purchase .~.~: .t.q.~? ............. ,. ,. Name of Former Owner ..p.&,V. ( .C~...~: .~tet~;I~I~. 11. Zone or use district in which, premises are situated. ,~ ~,-;..~.~'-Yii . .~../~..I..~...g../././d<~ .~. ~..Odb_..FLJ..~..t4_,_FL. .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ./~D ............................. 13. Will lot be regraded . Y~ ........................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~0./~.7-tj~ . .,ff..tSqv4..~...~.... Address . ~. ?.~.~.s...g~. ...... Phone No ~.ffT!/O.q..~:~'.. ·.~. 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 .... · 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 fro:n property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 76&-1802 I AM 1~ 4 IqM FO~ THE FOLLOWING 3. INSU~ 4. FINAL THE RE~~ STATE CO~~ CODES. N~ DESIGN OR C~~ STATE OF NEW YORK, COUNTY OF..~..c/~.~...~ ,~F~. ',f...~:~--; .~.~:~F.~F. A,-~-~..~../~.d'..~./~7q ~... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . ~::~4d..,~.4-~ .............................................................................. (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 wi/l be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... ...... Notary Public, ..?~..~...~..~.. County ./,. 6. --I~-~-- ~/] (Signature of applicantl-- Commission Ex~rms [