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Home My WebLink About21036-Z FO~,M NO. · TOWN OF $OIJTNOLD 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-°N? 210~Z Permission is hereby granted to: ,~,'~i~'"'~";"; ........... ....'~.~......~.:..~., ....... a~..:...~ ....... ,o ....... ....... at premises located at ...J..~E.~.A~......J~...~..........C';~.....~,.~~ ........... ~-'~ 4-~ .~ .~..~ ......................... County Tox Map No. 1006 Sec;ion ......... .C]....,~... ...... Block ........ ..~...J. ....... Lot No ...... ..~...,.~. ......... purSuant to application doted .... I~:L.~..~...~.......'~...! ................... , 19..~'...'~.., and approved by the Building Inspector. Fee $ ~4~. / Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved (~ .~.0,J~ ~*- 19~..~.PermitNo. Disapproved a/c ..................................... ................. . ............... (Bui~-spcctor) APPLICAIION FOR BUILDING PERMIT ~ SETS oF survey ........ ~0. ~. c~c~ .................... SEPTIC FOEH .............. INSTRUCTIONS a. This application must be completely filled in by typewriter orin 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 Bui/ding 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 availab'le for inspection througliout 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 But]ding 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, ordina~uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for neces/a '~ -- (Signature of, a~l~ticant,~or ~4[n ,~ a corporation) l ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. t-r. ....................................... Name of owner of premises ........ ]qi~....%. M.~S., .~~..~.~.~[~ .................. (as on the tax roll or latest deed) l~hcant ~s a comoranon, s~gnature of duly authorized officer. . ? (Name and title of co,orate officer) .... ~' '~..~-:~:- ~ ~-~-~. -.~- Builder's License No .......................... ~- o02 ~* Plumber s L~cense No ....... Elcctri~ian's License No ....................... Other Trade's License No. BE CO,~P~..~ F FO~ C.O ~LL COtISTRUC'flON 1. Location of land on which proposed work will be'done ................... 7~. ~EO{fl~[M~IXgT8· ~ "[H~ '~,~ · · · ...................... I.~.~.~..,'-~ N .... ~ .... . ........ ~~, · ~o*. ~s~om~[~.- ma... House Number Street O~S CONSTRUCTION ERRORS County Tax Map No. 1000 Section ..... ~ ........ Block .... ~ I .......... Lot ..... ~ .......... (Name) !. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ~l ~..'.~ [ ~ ~.~ Intended u,e and occupancy ...... ~ t.~.'~-Im .~.~t ........... b. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ~..~..)~4~ ..... Other Work ............... 4. Estimated Cost ...................................... F ...~..~.~.: .?.'~. ................. (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 ...................... lC. Dat~ of Purchase ............................. Name of Former Owner ............................. 1 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 14. Nm-ne of Owner of premises [4~..~. ~.~..'~=...~. ,~.l.TJ'~!4.ddress .~4~..'T. ~h4'~.~...6~.... Phone No."~... ~..-. ~..:~..~.~. Name of Architect XA/~.~). ~ ~..g~. ;~..~...~-...- .... Address J~.~l.E~ ....... Phone No..~.6p. ~\ .~. ~O. 15. Is th±s property with±n 300 feet of a t±dal wetland? *Yes.. *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. TATE OF NEW YORK, 'OUNTY OF....-~g4 c~.c..~.q.. .... ~ [~-~.. ~...'...(-.L.L.L.L.L.L.L.L~...~3.~...~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) yore named. is the ........ ,~.~..~. ....................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perfo~ or have perfo~ed the said work and to m~e and file this ,plicafion; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~rk will be perfo~ed in the manner set forth in the application filed therewith. yom to before me this ...................... day of.. ,ta~ Public, . ~;..~.~5.,.. ~Y. ...... County , N~a~ Public. ~tate of NewY~ No ~9~3~46 (Signature of applicant) Qualified In Suffolk Coun~ ~mi~ ~es Oct~; ~, 1992