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HomeMy WebLinkAbout18436-Z roses xa s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL fULI COMPLETION OF THE WORK AUTHORIZED) N 18 4 3 6 Z Date Y.... a q........, 19~'.~ Permission is hereby granted to ..1... J? a...~~s?~.~ .......~a--~"' ff~~~~ ''--nn__ of premises located at ...~~~........l.~rlr.l^~"'~^.... .~!')R,..........~~~ic~.L..4.:~.,,_........... County Tax Map No. 1000 Section Block ~1..'......... Lot No......~.I. pursuant to application doted ...A~ra~....~..~ 19.~.~, and approved by the Building Inspector. Fee 5..~..0.:... ....f.Sr~~ B ing Inspector Rev. 6/30/80 BOARD OF HEALTH D 3 SETS OF PLANS FORM NO. 1 SURVEY ...`~'.t}, , TOWN OF SOUTHOLD CHECK -'1~- ldoi • . . BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY FL:;G.UEPi. EOUTHOLD,N.Y.11971 CALL TOWN OF SOU7HOLD TEL.: 765-1802 MAIL T0: Examined ~.~?P ~ 9 l9 ~9 Approve~?P a9, 19g~. Permit No. ~ ~.3:~?.~: Disapproved a/c .111 . `~t~~:........ (Buildinglnspector) APPLICATION FOR BUILDING PERMIT Date 19... 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 Depaztment 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 inspections. / (Signature of app~canJt~r~~e, if a corporation) Li~vog fl sj (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~!l/,AQLC ~°~SEL.L`J ~ E r9V..Y............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. .CSIS/.N.~,~ Plumber's License No . . A/eNE AT Th'i5 Electrician's License No. ~.~."~!s Other Trade's License No . . 1. Location oC land on which proposed work will be done . . House Number / Street Hanilet / County Tax Map No. 1000 Section 1 Block ..........,l Lot .....~1......:.. , Subdivision Filed ivlap No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..1~f1/~~C"~" . b. Intended use and occupancy • /~~~,/O!/F , 3. Nature of work (check which applicable): New Building Additio . • Alteration . Repair Removal Demolition Other 1Vork . /C `}~O q~ (Description) 4. Estimated Cost . Fee . ` (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. Dimensions of existing structures, if any: Front Rear Depth . Height ...............NumberofStories.......................,................................. Dimensions of same structure with alterations or additions: Front Rear . 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 . ]0. Date of Purchase .............................Name of Former Owner . 1 1. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Wilt lot be regraded Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~(I,S.(!?QAYFPI,ddress /g~~/~.~5..LFJ!~E .Phone No..7 ~.`~::~9S.F. . Name of Architect .~/d 65.......~~~~~~, , ddress e? ~.t,.~nN ~!~".~F.. Phone No...~~7 /lam . Name of Contractor .................Address ~.siS ....Phone No............... . 15. Is this property located within 300 feet of a tigidal wetland? *Yes No *If yes, Southold Town Trustees PermitPLO~DIAGRAMed. 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, and show street names and indicate whether interior or comer lot. STATE OF NER' YORK, S.S COGNTY OF/ . ~ ~ ~ l/G(~f7 being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~ tieisthe........~7.~:~~~......... (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and Fite this =pplication; 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 set forth in the application filed therewith. sworn to before me this ........................day of.....................,19... _ Rotary Public . County - ~ ~ ~ (Signature of applicant) di i .