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Home My WebLink About17758-Z ~B~ NO. It 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) NO- 01YY58 Z Permission is hereby granted to: -.....L~.....C.::.:.:...*~.......!..~.~ ................................ .~.~.~.....~..:~..:....!./..~.~.~ ............. ,~...~~ ...... ~L.~.....~~.....~~......~,. .......... .................................. .~.....~.. ................... .2. ......... ~ ................................................ ct premises located o, ...~,'~.~..,~,..,..~....~ ........ ~.~ ........................ County Tax Map No. 1000 Section ..... ~...~...,~. ........ Block .... ..(~...,.,3__.. ........ Lot No...,.~....~Tt... ............. pursuant to application doted ..... ..'~...~~.....!.( .............. , 19...~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~.~~ .... 19~.~. Permit No. ]..-/?..~.."~...~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: -- - - BLDG. DEPT. TOWN OF SOU~OLD Date /I INSTRU~ ,'TIO NS a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, ~vith sets of plans, accurate plot plan to scale. Fec according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises oi; public street or areas, and giving a detailed description of layout of property must bc drawn on the diagram which is part of ti~s applJ cation. c. The work covered by ttfis 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 permi shall be kept on the premises available for inspection throu~-~hout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanm. 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 th( Buildin~ Zone Ordinance of the TowrLp~ Southold Suffolk County New York and other applicable Laws, Ordinances o: Re~ulanons, for the constructton qff'bgildmgs, ad~dmons or alterations, or for removal or demolmon, as hereto described The applicant agrees to comply with d~l applicable laws ordinances building code, housing code, and regulations, and tc admit authorized inspectom on premises and ~ b. uilding for necessary~ ~ . (4Big'nature oi applicant, or name, if a corporanon) ? q ..z....,ff. . ~,, , ~,,- ~',;:¥t~ (Mailing address of applicant) State whether applicant,~s 4)wnetd~16Ss~?[~[~} architect, engineer, general contractor, electrician, plumber or builder. ......... , Name of ownE,~%?l~mises ....~. (..A(2/~.,.. ?-... ~..~..c~ .tr.._C... ~..~. ~..2~_~. .~..L-..o. ............................. ... ,~ ...... ~i b * ' ' (as on the tax roll or latest deed) If applicant is a corp(t~llO~giI~l~.$~li~uly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electnclan s License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work xvill be do-ne. ' // / & .cz-- ?. . . . . /c ,4/.¢.t:.. House Number Streetk~ Hamlet County Tax Map No. lO00Section /~ ~ 3 '~ B~?ck Lot. Subdivision ..................................... E~ted Map No ............... Lot ............... (Name) ~' 2. State existing .se and occupancy of premises and intended use and occupancy of proposed constrnction: Existing ... ~~ a. use and occupancy ~'.'~: ....................... ~zz/~ 7 ~ /d~,'~ & b. lntended use and occupancy ~/~TL/~ t&~/~(-~ ~t~ W~ ~/c)//v~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... /alteration .......... Repair .............. Removal./~/.2..~./fl~..:['.~.~.~. Demolition .............. Other Work .......... · (Description) 4. Estimate'dCost~e./.~.q"././. ~,~stgcv~9 ?~v' Sf,~r'~r~ (to be paid on filing this application) 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. D~menmons ofexisUngst~ctures, lfany: Front...~.¥ ......... Rear . ..~ ........... Depth . i/.'oc~ . .. Hei,'ht At.~°t'~v >' ~.~.... Number of Stories 7~zw o . ............... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... tleight ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Hmght . ' ....... Number of Stones ................................ 'c ' 'j~,~ ....... 3 ........ 9. Size of lot:. Front ...................... ~ ,e Rear ...................... DepthS--'?.'. 10. Date et Purchase .....,.,?.c./q/..../Z. ?.d.. .......... Name of Fenner Owner ..... t Z°.~./.<"..~< -'5'..'27. ·. ¢: .'~. ?--~ · · I I. Zone or use district in which premises are situated ............................. t-_... ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. ',;'ill lot be re~raded ............................ Will excess fill be removed from premises: Y? . N~o" 14. Name of Owner of prem~ses~..'-.,~...~ ,. ~. :~.c.c..~ ...... Address .~:': { ,.././'./Q,.~ .c~...y../...,).... Phone No.~.< ~ .. Y.~ .~...g'7.. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ................ .......... Address ................... Phone No ............ ~. · 15.Is this property located within'400 feet of a tidal wetland? ~YES .... NO.,I<.. · If yes, Southold Town Trustees Permit may be required. PLOT D1AG ILAM 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 NEW YORK. S.S COUNT5.' OF ................. .~, ~ ~/-c ,, being duly sworn, deposes and says that he is thc applicant (Name of indMdual signing contract) above named. lie is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or bare performed the said work and to make and file this application: that all statements contained in tbis application are true to the best of his knowledge and belief;and that the work wdl be perlormed in the manner set forth in ibc application lllcd therewith. Sworn to bctore mc tbis .......... // ......... of .... .............. 19 N'otarT Public ...... .z.~ . .~.71---.-.. '.~. -. , .,'~.) ·~ ..... County ,/~..~,,,,~ (Signature of applicant) NO~RYPusL;C~ate ottO. ,~rm E.x~res I'~,ch 3~ i§-'''~'y~'