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Home My WebLink About20331-Z FO~,M NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREAAISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~_ 2 0 3 31 Z Dot...~..~.~. ................. /...~.. ......... , ,,..~../ Permission is hereby granted to: ~ / ~.~ c/ ~*- / ~ ~ ./..;,.....~.....~.~.......~...~.~,~......, ............... ~~.~~~../..~..,/../.~_ ........................ at :rem'sas located o, ........ .,~.~-..Z~ ........................................... ............................................. ~~ ........ ~,,~rd..?....~..:.....~........:....~. ........ County Tax Map No. 1000 Section ....... ~ ............ Block ....... ~ .......... Lot No......~..,........~. .... pursuant to application dated .~...~ ............. ../...,~_~ .............. , 19..~../, and approved by the Building Inspector. Fee $ ...... , .......... Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971.. TEL,: 765-1803 Exmnined ................. 19... Approved ./r'~.. ~..y .... 19~/~. Permit No.. ~...~.,.YT. ,ff. / Disapproved a/c ..................................... Received ........... ,19... (Bnilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This applicfition 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 thronghout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sball 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ... ~/?.c:,.. ~?.. ,?. ~.,.4.. m/~..~¥:~. ~.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... .~.,,~,.~/...~?~..~.. ................................................ Name of owner of premises .... -~/~ /~' ............~ ~r (as on the tax roll ori~test deed) If applicant is a corppration, signature of duly authorized officer. ... (Nm ~t~(/And title of corporate 6fficer) Builder's License No .... />?.'7.07. ~..~..../-.~..-~. ..... Plumber's License No ..... ~.~.. ~..5/.-7 ~.. .......... Electrician's License No .....~. ?..~/.~.~.. ......... Other Trade's License No... ~. :~. ~'.v..?0:./.~. ....... 1. Location of land on which proposed work will be done .................................................. d ' . ~l.,.,~...~.:.~.. ~:'/. ..... ~. .... . .:~. .: . . ~.: .......................... , ............. ltouse Number Street Hamlet County Tax Map No. 1000 Section ~ Block 6/ Lot ~ '~ . Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy ........ : ..: ................................................ b. Intended use and occupancy ...................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... ,~lteration .......... Repair .............. Remoya,,[ ...... , ...... t. Demolition .............. Other Work...]'~et.~P ...... z/ ~3~*,~* ~'x, cgj lf/a,~ ~;,~/'~.4) .d~ (Description) 4. Estimated Cost .... ~..~'.~$~..c~.: ....... : .............. Fee ..... .~..~.',Y;c'~.. · (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 ............... Number of Stories ........................................................ 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 ...................... I0. Date of Purchase ............................. Name of Former Owner ............................. I I. 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 ............................ Will excess fill be removed from premises: Yes No i4. Name of Owner of premises .................... Address ................... Phone No ................ 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 ..... No .~i *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from )roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. OF NE~W ~,~,c_,,t...~ g g ?OUNTY OF . . . . . . . ."-"'~. ........ -'- ............ ' ?.d.c~..~, .~..~. ?.~. ................. being duly sworn, deposes and says that he is the applicant (Name~'~'~ ,,e ~,of ind~qidual signing contract) ~bove named. ,e is., ............................ (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 file this q)plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~vork will be performed in the manner set fo/rth in the application filed therewith. ';w°rn t° bef~-~)me this ~ [ ...... //.~~~.~ .2' . .~.. ..... 197/ qotary Publ' - ........ ! ..... Count /_ THOMAS F. DOHERTY Jl~. Notary Public Stste of new YOrk ......... ~ '"-' "~'~:~' '/27'' ........................ No. ~S~ ,.× (Signature of applicant) QuatJfiea in Sulfoik County TefTn E~pirel 12~11g~.-'"-