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Home My WebLink About17031-z FOBAI NO. f 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) Nfl 017031 Z Date 19 Permission is hereby granted to: . a?,..,..~.~~,......lila..~........ to ........................................~.~a............................../........................................................................... at premises located at .....................~....r.L.................................................................. ...............................................~?~o~f~.......................................................................... County Tox Map No. 1000 Section Block .............jr.~...... Lot No........-~a.~......... pursuant to application doted 19~~, and approved by the ' Building Inspector. 4~ Fee S.~y~~~' ' . Buil g I for Rev. 6/30/80 BOARD OF HEALTH 3 SETS OF PLANS O FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK MAY'"9 ~ BUILDING DEPARTMENT SEPTIC FORM TOWN HALL BLDG. DEPT. SOUTHOLD, N.Y. 11971 NOTIFY OFSOUTMOLD TEL.: 765-1802 CALL MAIL T0: Examined .L1~. 19~~ P~, Approved . • • • • • 19~~Permit No. . Disapproved arc . ( ildin pector) .APPLICATION FOR BUILDING PERMIT q Date y'r'`.'~~..../......., 19~~ INSTRUCTIONS 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 pazt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe tics o}1s. ' (Signatu e of"applicant or name, tf-a-eetpara'rion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Name of owner of premises .~d7L7~1/O~• ~~-S (as~ orb the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. . f~t:~J?:~4'!+:!• • • • Plumber's License No . . Electrician's License No . . Other Trade's License No . 1. Location of land on which proposed work will be don~j~~:l`~ 4: ~-..~af1~/.1~~. ~Q+~!! v~.. v"r• House umber Street Hamlet County Tax Map No. 1000 Section Block Lot . Subdivision Filed Map No. Lot , . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of pr p ed construction: a. Existing use and occupancy /~~~,'dY/./~~%?!2~ • • • • • • • • • • • • . b. Intended use andoccu anc -~•.~y ,.a a .CSt?2. ~ ~ , 3. let air of work (check which applicable): New Building Additi 1 r~ . p oval , . Rem ~ Demolition ~i f ; . • .Other Work'. , . s Q 6 ~ pj)~%i (D,e ription) ~i~~ 4. Estimated Cost : Fee c~-.a~.~..',................~..: . (to be. ,aid on flli~g this a~ppli ation) 5. Tf dwelling, number of dwelling'~units Number of dwelling units on each ~a®`~,•. . If garage, number of cars 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use . 7 Hei htsions of existing stru Nums, if any: Front .Rear Depth . g berofStories Dimensions of same structure with alterations or additions: Front Rea . llepht Num.. Height Numbecr of Stories . . 8. I i'nmensions of a tare new construction: Front Rear epth . g ber of Stories . . . . . . ~f 9. ~iizeoflot:Front Rear...................... Depth 10. Date of Purchase .............................Name of Former Owner . 11, i!one 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 ill be removed r emises: Yes No 14, Name of Owner of premises ,~~r~J:LQ°n~^~, , , , , ,Address hone No.~ ~7.~~`~~/. . Name of Architect .................Address ...................Phone No............... . ame of Contractor .................Address ...................Phone No. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block,number Or y~sc 'pti ccording to deed, and show street names and indicate whether ~ interior or corner lot. I/ (i-1 ~ ~ " ~ t s' / D~" 1 1 F~~T ~ y~ o, ~ ~ o l ~ ~ ~ ~ ~~aN~ L STATE OF NEW R~9. ICS, ~~o% I COUNT F "~((~~~1~"~.~.. S.S • • • • •~•~•W t5'~•ww7`'•r•IV~jS• • • • ~~S• being duly sworn, deposes and says that he is the applicant (Name o11fff individual signing contract) above named. Heisthe Q.~!.N.~ (Contractor, agent, corporate 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 forth in the application filed therewith. Sworn to before me/t/h~yis .............~7 : l .....day of l ~r9- 19 ~S~ Notary Public . . . . County EL.IZAB AN NEVILLE ..~s~~~~~(a'Y.~'.. . NouryPublic, sofNewYork ~~(~gnatureofapplicant) No. 62.8126860, uHolk Co Term Expires Oct6ber 81,17