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Home My WebLink About16902-zTOWN 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- 16902 Z ot p.em,s.,ocot~ ot ..... ~.~ ........ ...?...~..../~ ...................................... County Tox Map No. 1000 Sect,on .~...~ Block ........... ...~.. .... Lot No .. Z~ ~ pu~uant to application da,~ ....... .~./~ ......... . 19.~and appr~ by the BuddJng Inspector. ~ee $ .... Rev 6/30/80 Exammed . Approved .... Disapproved a/c .... 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL P. OUTHOLD, N.Y, 11971 TEL.: 765-1B02 19ff:f ~mld ~fg Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19. BL[3G TOWN OF SOU~UO.LD.' Date .......... , 19 I~..~STRUCTIONS a. Tins application must be completely f'flled m by typewriter or in ink and submitted to the Budding Inspector, w~tl sets of plans, accurate plot plan to scale. Fee accordmg to schedule b. Plot plan showing location of lot and of buddings on premises, relatmnsinp to adjomlng premises or pubhc stre or a~eas, and g~vmg a detmled descnptaon of layout of property must be drawn on the diagram winch m part of tlus apt cation c. The work covered by t/us apphcatlon may not be commenced before issuance of Buildmg Permit. ~. Upon approval of this apphcahon, the Bmldmg Inspector wdl issued a Buddmg Permit to the appheant Such pen shall be kept on the premises evadable for inspection throughout the work. e. No budding shall be occupied or used m whole or ~n part for any purpose whatever tmtfl a Certificate of Occupa~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buddmg Department for the issuance of a Building Permit pursuant to ~ Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buddings, add~bons or alterations, or for removal or demohfion, as hereto descnb~ The apphcant agrees to comply with all applicable laws, ordmances, budding code, housing code, and regulations, and admit authorized mspectors on premises and in bmldmg for necessary mspect~;oA~s / ~ (Signature~Of~: or~hnam.~ (Mmhng address of applicant) Bullder's License No /.4~..I .%lek3 I'~.~. Plumber's License No. Electrician's License No Other Trade's License No State whether applicant m owner, lessee, agent, architect, engineer, general contractor, electnman, plumber or build. · .c..c..~..'rg~.-rc.~ ........... . ... ' ....""----"" Name of owner of premmes ~.[~ ¢3~. ~W ;;11 ~s~ 8.~:7~~ ' If apphcant is a co~omhon, s~gnature of duly authorized officer N~I~ BUILDING DEPARTM~I ~1 76B-t~2 9 AM ~ ~ ~ FOR ~E (Name and t~tle of co.orate officer) FO~ING INSPEC~ONS 1. ~DAT~N ~ ~RED ~. ~ON ........... 4. FINAL - C~~NMU~ BE ~ ~R G.O. ..... ~ ~N~ ~ ME~ ...... 1, Lecat~on of land on winch p~oposed work wdl b~ don~ .... DES~N ~ ~ ~' ~ ~3~ ..... ~ ,c. ~ ...... ~?~ ~5 ....... House Number Street Hamlet Co~a~ar~o ~000S~c~o~ ~ ~ ~o~ ..... ~ .. ~o~ . (q..L .... Subdiv]s~on ...- .......... Fded Map No .... Lot .... (Name) 2. State existing use and occupancy of premises and tntended use and occupancy of proposed construchon a. Existing use and occupancy . 5~A)(*,L C-.. ? .~'.~.~b.V .. ~..~.~.£.~.,.t~ ~L.. b Intended use and occupancy ') r~'v'- ~' 3. Nature of work (check which applicable) New Budding . .' .... Addition ...... Alteratlo.~n . ..._~.. . Repmr ........ Removal ........... Demolition ........... Other Work..rT.~-,/~. ~.~-.... · ~ (Description) 4 Estunated Cost"~.'/~.u.(2C .oO ................. Fee ............................... ~ (to be prod on fffl~ng th~s applicatmn) 5. If dwel~ng, number of dwelling umts .......... Number of dwelhng units on each floor ........... If garage, number of c~ ................................................... 6. If bus~ness, commercml or m~ed occupancy, specify nature and extent of each type of use ................. 7. D~ensions of exmt~ng structures, ff any. Front ......... Rear ......... Depth ......... Height ..... Number of Stones ................................. D~ens~ons of sine structure with ~terat~ons or additions' Front ........... Rear ............. Depth ............ He~t .......... 2 .Numb~[~~~~~ ~- .. 8. D~ensmns of entire new construction Front .......... ~e~ . .g~..~ ~~. ~., He~t .............. Number of Stohes .................. ~ .~~. ~. ~M~A.. 9. S~zeoflot Front ......... Re~ .............. ~ ~'~.~ ~. MA .,. 10. Date of Purcha~ ................. Name of Foyer Ow~. ~0~~ .~. ~t~A .... 11. Zone or use d~stnct m which premises are mtuated .................. ~ ~QO~: [t~ }~ C.O ......... 12 Does proposed construction wolate any zomng law, o~dmance o~ ~egula~on ........... . . .. ~ ~P.~f~.. 13.Wdl lot be regraded .................... Wall excess ml be rego~em~es: Yes No 14. ..~,,~ u~ ~.~ o~w~,, ~* ........... * ....... ~~11 ~'~t~t ...... Nme of ~ch~tect .................. Xaaress ....... ~..e~e ~d~"~ ...... Contralto, ..................... ......... .......... P~TDIAG~ ~- ~ , .~t~~'(*- Locate cle~ly ~d d~stmctly ~1 buddings, whe~er ex~stmg or proposed, ~dicat~ ~ s~¢a~g d~nmon~from g~qt n~es ~nd ~d~cate whe~er p~ope~ hnes. Give street ~d block number or descnphon accosting to deed, ~d show ~ :'~e~. ,it[, ~, ~; [~ interior or corner lot. '~. ~ ]~..~ ~ '. ~k.~.~'.~'f-"~ A } ........... being duly sworn, deposes and says that he ~s the applicant (Name of md~wdual mgnmg contract) 4hove nmncd. He~ the ,. ~.O ~T~AC ~d~ ................. (Contractor, agent, co.orate officer, etc.) )f smd owner or owne~, ~d ~s duly authored to perfom or have perfomed the smd work and to m~e ~d file ~s apphcatmn; that ~ statements contmed m thru apphcaBon are true to ~e best of ~s ~owledge and behef, ~d that the 0york wall be performed m the manner set forth m the apphcatlon filed therewith. ~worn to before me th~s.r ........... 5.,-~ .da~ o f · · -.,~.~/~Z- ~7/~- ....... 19 · .~. ~RE