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Home My WebLink About17399-Z FORM* NO. 0 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~ 017399 Z Permission is hereb grante~ . ~ ~ ............ ...... Coun~ Tox Mop No. 1000 Section ...... ~.~.~ ..... Bilk .......... ~.~. Lot No ............. pursuant to opplicotion dot~ ........ ~.~ .............................. , 1~,~ ~ ~pprov~ by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTNOLD [~UILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.; 765-1802 Examined ..~l~. .......... , 19~.8 e/~ Approved . , . f..,, ...., 19-.. Permit No ....... Disapproved a/c ..................................... .... .............. ~ (B u~Ilding~spect°r) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY 'v7~1~' ~ ................. CHECK . ."~..~ ............. SEPTIC FORM ................ MAIL TO: Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter orin 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 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 removal or demolition, as herein described. The applicant agrees to comply with all applica}~'le laws, ordinances, building code, housin~dep~and regulations, and to admit authorized inspectors on premises and in building for necessary ir3~p.~l)tions. ~ , / // (Signature o~ applicant, or name, if a corporanon) (Mailing address of applicant) · State whether applicant is lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... o..~.~.~'P. .............................................................................. Name of owner of premises ......... .ff .............................................. (as on the tax roll or latest deed) If applicant is a corporapn, signature of duly authorized officer. ~'Y/;~ ..' ................ B rider s L,cense No .............. ,~. ........... Pluln her's License E ectncmn s L~cense No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ~0~.o. ............ ./_9..e ~ .g..pS.z.e.. ~. ¢.c. ....... ,dx'_; .,e...../7.. :~.c. ~ ..... House Number Street Ha~nlet co..,y Ta~ :,,.~ ~o. ,000 Sectio:, /~. ~:ock O~ Lo,.. OQSL--.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing ose and occupancy of premises and intemted use and occupancy of proposed construction: .P~.,.~.~z¢ 0). ~4~./.~.. b. Intended use and occupancy .............. . ............................... 3. Nature of ~vork (check which applicable): New Building ' Addition .......... /alteration ......... Repair .............. Removal .............. Demolition .... ~ ....... Other Work .............. (Description) 4. Estimate'd Cost ...................... Fee (to be paid on filing this application) 5. If~dwclling, number of dwelling units ..... ~ ....... Numbcrofdwcllngtnitsoneaclifloor ~ If garage numbcrofcars r'"~,'c)A~ ~..O,q~'.'/'/ ) 5"/x/.q-,4~ ............... 6. If business, comxnercial or mixed occupancy, specifynatureandcxtentofcacht eoft ........ . yp se ..-~ ................. 7. ~Jm~ensmnsofexlst~ngstmcturcs if any Front ..t~. ........ Rear ...2..,,?.J ........ Depth ...-7. O..~ ........ I. r .... Number of Stories t t5 VX e: ......................................... ~; . imensi/c~' ~i~ucture xvitli alterations or additions: Front ................. Rear ................. ; Depth ............. ........ IIei~t Number of Stones ..................... ~ Dimen~ *ofe~t~e ne~9 ~:onstmct on: Front ............... Rear ....... Depth .............. ~ :,Height .' .... . ..... ~... Number of Stories , . · S?z~?cff~ ',E~-'~art& ........ ~ / , ~ ~ , ' ........... ,~ .... [r .r..,. ''"',- ';;..: ......... R~.ar...7,.S' .............. D,p,h l u. ~ tJa~o~ ~'urenase 4;'~ l '~2.~ gS. ~, ' ' ' ~' ............ 1' :'~"~-'"-~'~":'~"-(~'./' ................. Name °f~F°rn~-er Owner ~.'cl]~..~.:.,JT~......~.~.ffltg.~· .... ~. Lone or use restrict in which remises ar ' t~a ........ t?../.e../......r~..~(3. · .......................... P e sltua.__ P~/~' dq ) ~'~ · 12. Does proposed Construction violate any zoning law. ordinance or regulation: . ~'L4. P. ........................ 13. Will lot be regraded ...... .x,,..~.~ ................. Will excess fill be removed from premises: Yes 14. ~ame of Owner of premises .7../?9.~'Twd.r.~. ~. ~'~/J2¢~. Address t~.~'{...~?4'~./.oq.. _, ..... ....Phone No.cq.~.ff:~v.o,).~,,l~.. rqame of Architect ,,~,~ Addre ~'o~ c,q~o¢/u~/,vg'~r"~, ~, ' ...... .... ' .... ~"/4 ................. ss ........ ~ .......... t'none ~o ............. p~ame o~ontractor ' · -/'~" - . Addr "- " ' ' ' . - ........... ess ................... t'non~ .......... i.. 15.Is th~.s property located ~ithin 300 feet of a tidal wetland? .... }lO .... · If yes, $outhold Town Trustees Permit may be required. PLOT DIAG RAM 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 show street names and indicate whether interior or corner lot. STATE OF NE~V YORK, COUNTY OF ............ S.S .......... 'Ni ...... .' ·; ~ ....~ ...................... being duly sworn, deposes and says that he is the applicant above named(. ameofmdwduals~gmngcontract) ile is the ........................................................................... (C ffi ) .............. ontractor, agent, corporate o cer, etc. if said OWner or owners, and is duly anthorized to perform or have performed the said work and to make and file this ~pplication; that all statements contained in tlii~ application are true to tile best of his knowledge and belief; and that the york will be performed in tile manner set forth in tile application filcd tlicrcwith. ;worn to before me this t4P. Eg K. DE rOE NOTARY PU~LIG, State ot New Yodl ................................... No. 47078'18, Suffo?k Couflty ~-~ Term Ex~)ire~ M~ch 30, 1~ L/ (Signature of applicant)