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Home My WebLink About17429-Z FOB, B[ NO. 0 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PEP, MIT MUST BI: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N~ 0i7~29 Z Permission is hereby granted to: .... ~...~.....~...~....~ ...~......u....:~.;....!.i..~.~. .............. ,o .~...~~.~~~(~.~.~.?...~.~t.~.=~/.~..~.~L~..~..r.~)~..`~. ....... at premises located at ..1...~...0....~... .~. ...... : ......... ~ ............. County Tox Map No. 1000 Section ...... ..(~...~..~.. ...... Block ...... ..C~...I ......... Lot No .......0...~.'~.. ......... pursuant to application dated .... '~.~J~~......~ .............. , 19.?..~.., and approved by the Building Inspector. Building Insl~ctor Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ Examine~,,)~.~.'~., 19~..~. Approve~.'-~- · · -~'- ·· }.~-, 19 .~.. Permit No. 17.~..~..~... Disapproved a/c ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT CALL . i ............. MAIL TO:~f~ q~ . Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 seis 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 avai/able 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 agr~ees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized Lnspectors on premises and 5Ja building for neceag~n_spect~'~s. ,,tx ~ r'--, '' (Si~jt~ie'o't 'a~Olich~t; ;r~r~e', .. 99.6..b.ip.c.q! .n. Av.e,..H.q lbr.o, qk,. NY ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... qe..n.e.r.a.~...C.o.n.t..r .a.e.t.o.r. ....................................................................... Name of owner of premises . .Agw~.Tg. In.c ............................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............. (Name and titl'e~/' corporilXe,-3officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.. N.o. ne. Rgquir~cl .... 1. Location of land on which proposed work will be done...Aggay. Bu,£ldin.t3 .............................. ...... /.7.o,~7..Vo. 6,'..~.f~..3. ,.... ~ ........... ~'.Htlmmal. A.v.s, . Sr~utholzt ..................... House Num bet Street Hamlet County Tax Map No. I000 Section '/~) Block -'-.--.~- · { .......... Lot.. .~.. Subdivision ..................................... Filed Map No.... ~. .......... ~') g) Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: '. Existifig use and occupancy 'F'ert£'l'izer"Storoger'-- ..... ~%'"r~Ok~ ''' -~'~'''"~Mt''/'~'Z''n'q'~' ..... .... a ..... . ......... b. Intended use and occupancy .. JO .~. ~' .............. ~ ....... / 3. Nature of work (check which applicable): New Building ' Addition ...: ....... Alteration .......... Repair .............. Removal .............. Demolition J!I32 ......... ~.. Othe~l~.~.~ .......... ~ (Description) ! 4. Estimate'dCost ~50,000 . . Fee .... ~,.~,3~i '"'~'* ' (to be ~'t ' ' ~ 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 . S.¢orag.e. ........... 7. Dimensions of existing structures, if any: Front.. 50 ..... } ..,... Rear 50 ............ Depth. 25.Q .......... Height . .50 ........... Number of Stories . .L.. ~ .................................................. Dimensions of ~I~hde structure with alterations or additions: Front .5.0 ............... Rear .5.0. ............... Depth 2.50 .................. Height ..... 1. 5 ............. Number of StoNes ...1 ................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............... . ......................................... 9. Size of lot: Front . 353. ................. Rear..2.1.3 ................. Depth . bS.Q ................. 10. Date of Purchase ............................. Name of Former Owner ............................. 11. 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 ...'/o · ...................... Will excess flu be removed from premises: . Yes 1~ 14. Name of Owner of premises Ag~ay..Iuc ......... Address Box..4.~33. ~.y. ro¢~a&bone No ................ Name of Architect ~1.1¢O. K~ll~.o.y,~e. As.s. 9.c... Address ~.1..7.~.h...Ay.e...N.Y.C.. Phone No. 2.1.:~:¢.6;Z.--.Q475.. Name of Contractor .......................... Address ................... Phone No. 15,Is this property located ~tithin 100 feet of a tidal ~etland? *¥E$ .... [IOgX.. · 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 show street names and indicate whether interior or corner lot. STATE OF NE~,,~YQgK, COUNTY OF .~(~ ....... S.S ....~. ~([; t~r~.~..t~.. [~.~.~..({ ................... being duly sworn, deposes ~d says that he is t~e applicant (Name of individual signing contract) above named. He is the .................................................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the Work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this .................. ~ ..... dayof...~ ............ 19~ Nota~ Public ..... ~:'2J - u.~ ....... County