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Home My WebLink About16849-z FO~M' NO. 0 TOWN 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) NO_ 16849 Z Permission is hereby granted to: .... ~.%~.~.~:.~ ........................... '. ......................... ~t premises located at .../.,..~..~..~.....~.~.......~....., ......... ~-~~. .................... County Tox Map No. 1000 Section ....... L./...~.. ......... Block ....... .J.~ ........... Lot No..."].:.J ................. pursuant to application dated ......~..O,~.....*~J~ .................. , 19..~..~.., and approved by the Building Inspector. Fee ~ ~.., -/ Building Inspecto~ Rev. 6/30/80 Examined..'~ O4~..~.z...., 19~..~. Approved · .~...°-A~...:~:~.~..., 19.~.~. Permit No.}. .~'..~.~..~.. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC ITORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 MAILCALI' 70':' ' fi~ '~' Disapproved a/c ..................................... ................................ ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ............... , 19... 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 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, buillfing code, housing code, and regulations, and to admit authorized inspectors on prelnises and in building for necessary insp~q~ns. ~ ,~ ~ . , ...... (Signature of appl~ant, or namd, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises {~(( ~)~3~ .f:[.~....¢.~..~.( .~.~. ~o .¢.~: ......................................... ............ (a~ on th~tax roll or latest deed) If applicant i72g corporation, signature of duly authorized officer. ........ (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... O 1. Location of land on which proposed work will be done. .... .~l.g... Street Hamlet County Tax Map No. 1000 Section ...(~.~ ........... Block ...~...~.~ ....... LotZ.{ ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................... b. Intended use and occupancy Nature of work (check which applicable): New Building Repair .............. Removal ¥ Estimated Cost ..... [..~.0.0. y. .... ..... Addition ........ ...) .~terat:]on . i: ............ Demolition .............. Other Work.. c e~ ..... ~ ~(Descriplion) Fee · (to be paid on filing this application) ............... Number of dwelling units on each floor ................ If dwelling, number of dwelling units If garage, number of cars .......... ~ ............................................................. 6. If business, commercial or mixed occupancy, specify n~,~re and extent of each ~e of use ...g~-e...4..o.~.Lt.6.... 7. Dimensions of existing structures, if any: Front ..... ~.~..,~ ....... Rear ..... q~ ........ Depth .... Iq9 ........ Height [.~' Number o~ 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 o~ Stories ........................................................ 9. Size of lot. Front ........ ~ ............. Rear . .. 10. Date of Purchase ..... [~-. ~. .... ! ........... ii L~; ;}'F'o'r~ir (~v~l;;' . 11. Zone or use district ~n whmh~remlses are situated ................................................... 12. Does proposed construction violate an~ zoning law, ordinance or regulation: .~O ............................ 13. Will lot be regraded ......... ~O.l.~.. ~ .......... Will excess fill be rem.Dyed.from premises: ~e.s o $~ 14. Nme of Owner of premises .1~b;¢.~;¢..~9[~(9~Address .[q~l~.l?~t[~[~.. Phone No. ~..q~.°2 ..... Nme of Architect ............... [ ............ Address .... ............... Phone No ............... ; - Nme of Contractor .............. i ............ Address .... : .............. Phone No ................. ; 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ~... *If yes, $outhold To~ Trustees~ Permi~be required. ~ DIAG~M Locate clearly ~d distinctly ~I bufld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from property hnes. Give street ~d block numbor or description according to deed, ~d show street nines and indicate whether interior or corner lot. ,,,~F'~'Y ~oILD~NG DEPARTMENT AT uC)[.~ C~v'~,~ ~ ~N,,~PEC FION~, ~0 STATE OF NEW Y~QR[r' ~ L COUNTY OF .... .~.t&Tt-qrk 1~,' .............--"~/~.[-[,~[J~,. ~.,. ~. Lr~..i'Y.~.6~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing' co(tract) above named. He is the . ~ .... ~ f:., ...................................... ' or, ' ~' (Contract gert orporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; 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 fo!rth in the application filed therewith. Sworn to before me this ........... · ~?..~'. ........ day of .... (Signature of applicant)