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Home My WebLink About20347-Z ~vo~ NO. ~ TO~VN 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~ 20347 Z Permission is hereby granted to: ............... ............................................................................................... .... ~, .................. Block ...................... Lot No. ~--g"'- County Tax Map No. 1000 Section ~' ~-~ C~ (,o ........................ pursuant to application dated ~.....)....~ .......... , 19..~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 - BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 L.~ _~03~ TEL.: 765-1802 .'\pprov;d~.~..~-.~V~..~4., 19~J. Permit No a~q~ ~ Disapproved a/c ..................................... ' (Building [nspecto[) APPLIOATION FOR BUILDING PERMIT BOARD OF HEALTiI ......... 3 SETS OF PLANS ......... SURVCY ................... ClIECK .................... SEPTIC F O R,~! .............. CALL ................... HAIL TO:, INSTRUCTIONS a. Tltis application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 :ets 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 )r ares. s, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by tttis application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ha/l 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 hall l~ave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to :dmit autLionzed inspectors on premises and in building for necessary inspections. (Si=nature of albplicant, or name, if a corporation) (Mailir/gd,, address of applicant) 5late whether applicant is oxvner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ................................... ~3.~, L.4.~¥ ........................ ' ........................ ~:an,e of owner of premises ........ E .~. ~..~.'C.~-....~Y) o.J...o ~t..~.v~ ........................................ (as on the t.ax roll or latest deed) il' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ].~.,..~.t~.~....:...~..~.~ ..... Plumber's License No ........ : ................ Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ......... 2 :77.. ..... i ...... ........ ...................... llouse Number Street County Tax Map No. 1000 Section ...}~ .(5.~. .......... Block ..... ~.. ' Lot...~ .'~ .... ' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~..cs 5 .~. x'o .~. c~. 9 ..... g g.q .L...gO.w ~.'~7. %. ............................ b. Intended use and occupancy ..... ~ t<.5 $.O1 .~fi..G. ·- .... I.~.. ?..r.4 ~.o,~ .~.. i~.To.,. ~ ............... Nature of work (checl~-'which applicable): New Budding .......... Aqtdition .... ;~.q~,;~ Alteration ......... t ~ ~ ~ 4. Estima ed Cost ...................................... Fee ............. .1,...[: ................... (to be paidion ill[ng~ ~his 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 ............... Nmnber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... lteight ...................... Nnmber of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth .. ..................... 10. Date of Purchase ............................. Name of Former Owner ............................. I 1. 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 14. Name of Owner of premises ~= ~,.o_x-.3~.. ~1~9~,.~.,. Address . J~li.q.t~l'l ~.[¥~.J~ ...... Phone No..~.?,g ......... Name of Architect ................. .~ ......... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes..t ...... No..~ ...... *12£ 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 comer lot. TATE OF NEW YORK, S.S O UNq'Y OF ................. ........ ~. e--.o.q. ~.%....~.9 v~.~ ~'aO .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ove named. .' is the .......... ~'. . * ......................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perfom~ or have performed thc said work ~nd to make and file this [*l/cation: that all statements contained in this application are true to the best of his knowledge and belief; and that the ,rk will be performed in the manner set forth in the application filed therewith. om to before me this / ...... . ~. ~fil~ ' .. . . ........... Oual~ in Surfak ~u~ 9 ~ ' ' ' (Signature o f applicant) ~mi~i~ ~ res May zt. ~ = ~