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Home My WebLink About22674-ZTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HA~.L $OUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMff MUST Bi: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE ~DRK AUTHORIZED) Date..~.~.. ............................................. 19...¢..~Z. 22674 Z at r .~ ~ 0~ ' CountyTaxMap 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 SOUTHOLD, N.Y. 11971 BOARD OP H~^LrH ........ 3 SETS OF PLANS SURVEY ................. CIIECK ...... CALL ................. HAIL TO: a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ' 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 sti'eet 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 tiffs application may not be commenced before issuance of BuL!ding Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permi 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 Occupanc} 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances et 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 tc admit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on'the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. '" ..... 'titi ' ;} corporate omcer) Builder's License No .......................... Plumber's License No ......................... Electric'an s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .......... .~.~. ~.~.~..,o.o..~.~. .......................... ........ ............. .,ff .... .... : ............. . Itouse Number Street Hamlet County Tax Map No. IO00 Section ...;..Zff,~.~. ......... Block .... .~ ......... ,'... Lot ../- .......... Subdivision 4'~ ...... Filed Map No ..... .~.~,'~. .. Lot .... .d//~. ..... ........ . ........ ................ .... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...(?..].~.?.Z.. ) ......... .~. (?'.c...,?/.,,;..~.'.,(fl'..~.~ ............................... b. intended usc and occupancy ...... ' ,~. ?, -~.'~. ~ ...... ' ............................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....... ~.. Repair .............. Removal .............. Demolition · ~ Other Work(,., ............. · ~ ,~ .............. ~ ~' '(l~ription) 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 roi.xed occupancy, specify nature and extent of.each type of use ..... .,~..a..elf. ........ 7. Dimensions of existing structures, if any: Front ..... .~'.~.. ~.r... Rear .... ~..~..~.T.... Depth . . .~. $..~.T'. ...... Height ............... Number of Stories .... .~./.~. ?....~.~..,~.q .~.~...'. ~...~..~.,~. ? ?. /...5. .~Q ................ Dimensions of shine 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 .. ~. 5.O. ~. T. Rear o~ 03 ,PF Denth ..5~..,5".O M~J'7',° qS? 10. Date of Purchase .................... · ......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ~',.~ 12. Does proposed construction violate any zoning law, ordinaace or regulation: ..../~'..o .......................... 13. Will lot be regraded ...... ...,~.o. .............. Will excess fill be removed from premises: Yes 14. Name of Owner of premises . .~.%r.,?p...,~.a?.e.Z...~r. ~9.' Address ................... Phone No ............ Name of Architect ........................... Address ................... Phone No. Nam e o f Contract or . .Z.A..~.A .,q.~. ?.q~v. q..~..~'.r'.~f .,~.... Address XT~7. r~"/z~,~/,v£d ..... ~./~ '.~'. ~' ' .......... e~ s~,'~,*'~", rnone ~o ............... 15. I.s this property within 300 feet of a tidal wetland? *Yes ........ No..2~. ..... · 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 srreet and block number or descr/ption according to deed, and show street names and indicate whether interior or corner lot. FATE OF NEW YORK, OUNTY OF . . .~..~..~?..~A .~ . .. S.S ....... C,.-"TF.'..'~... 4.~..~.~..~.~. ............ ......... being (Name bf individual signing contract) ~ove named. duly sworn, deposes and says that he is the applicant -~isthe..,.. r_, or' - (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly autl~orized to perform or have performed the said work and to make and file this plication; 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 ' ~lJl; ....!:3 .'~...,,~....day of...B.~, rj.I ............ 19~.~.. .5,-,-¢C,,'- . ary Public ........................ : · .w~:~..U.",... Coumy MARION G. LATHAM ' ...~..: .~~ Notary Public State Of N~w York ........... No. 52.4649732. Suffo k Count~ ....... Term Expires ~i>ec~,~,~6,-r ~ ~,/q't~- (Signature of applicant)