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Home My WebLink About17109-z FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .......~..~.,......~. ......... ~..~ ...................... ..~.~.....~z-~..._~...~...4. ...... ~...4~... ':~.~.~.....;~;..':1...,...././...7.~..~ ........... ;. ~ ........ ....................... County Tax Map No. 1000 Section ....... /.~/...~.. ......... Block ...... .~.,l .......... Lot No ...../..? ............ pursuant to application dated ....... ..~..~,~....'~.:. ...................... , 19~..~...., and approved by the / Building Inspectar. Bu-"Jlding Inspector Rev. 6/30/80 765-~802 9 AM TO 4 PM FOR FO~ POURED CONC~ ROUGH; TOWN OF'SOUTHOLD 19~...~. Permit No. 1."~/.~.~...".~. Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.; 765-1802 BOARD OF HEALTH ...._ ........ 3 SETS OF PLANS ........... J SURVEY ..................... CHECK ~ SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 a9y 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 apphcable Laws, Ordinances or Regulations, for the construction of buildings, additions or alteration?~, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable taws, ordinances, I:~ilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ?~pections.~ __ ... tz .. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ........ ~:~..~.> ........................ ,...~. ............... . ...... _ ......................... Name of owner of premises .~.~..O.c~.'~.' ?.~..~.k?. 'k.'' . .~x).~. i~ 9f'..~]°.~75-. t.~]\, i . . . .~.~; .X('.~.: .................. (as on the tax roll or lat~/st deed) If applicant is a corporation, si~n, ature of[duly~horized officer. .... ::?.. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ....................... · . Location of land on which proposed work wll},be done..5~... .............. I~;~e' ~4'u; ~r ................ ' Street ' ~ Hamlet ........ County Tax Map No. 1000 Section ..... / ./..Q ........ Block ..... [ ............. Lot.../.~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy ofjpremises and intend~_j~se and oqcupancy of proposed construction: a Existing use and occupancy ~(K"q' \del 'q...~. ¢z~.~-,~x.~,o,~ ....... b. Intended use and occupancy ......... .~....Q'9.~ ................................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Altera~.ion .......... Repair' . ............. Removal .............. Demolition ............ Other Work .T.~.~.%.% ..... .ff..~..- ~ i (Description) 4. Eshmated Cost o~o, co > (to be paid on fihng thru apphcat~on) Ifd N ' ' 5. welling, number of dwelling units ............... umber of dwelling units on each floor ............... If garage number of cars 6. If business, commercial or mixed occupancy, specify nature ant~ extent of each ~ype of use ..................... 7. lmenmons of existing structures, if any: Front ., ...... Rear ... .......... ......... Depth ............... Height Number of Stories Dimensions of same structure with alterations or additions: Front .......... i ....... Rear ............. ~D.epth .. ....L ................ Height ................... Number !of Stories ........ '" tJ,mens~ons of entire new construction' Front . ,~ ~. ': ............ Height ............... Number of'Stories"i.' .... ii"' v, ear ...... il ........ ~Jeptn ............... Size of lot' Front ., .. ',; .................. i ............................. ~oate of Purc .h,.as.e ~.~4 ..~.~ '1' I.~t ~ ............... N31jne o$' Former Owner i~'~.~.*.%0,¥ d..~' .4i-io~ [ ......... ' ne or use restrict in wmcn premises are situated .... ~ '--: ~' ............ :. · ~.,. .......................... Does proposed Construction violate any zoning law, ordinance or regulation: .. ] ./V..O. .....~" is ...... Will lot be regraded .... .x,. ........... e-~-J-- ....... Will excess.fill ber~emoYedofrom pre ise: Name ofOwner ofpremises~,X~ ~2 ,.~.'~ o.1!~ Address~..-.o ~'~ 'Q~e~'~ Name of Architect ........................... Address ........... i Phone No Name of Contractor Address ' . ............................................. Phone No ............... 15.Is this property located within I00 feet of a tidal Oetland? *YES .... NO .... · If yes, Southold Town Trustees Permit may be require~. PLOT DIAGRAM : Locate clearly and distinctly all buildings, whether existing or proposed, and. !ndicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shpw street names and ~ndmate whether interior or comer lot. 9. I0. 11. 12. 13. 14. STATE OF NEW YORK, COUNTY OF ............ S.S · (Name of individual signing contract) above named. being duly sworn, deppses and says that he is the applicant lle is the ' (Contractor, agent, corporate officer, etc.) of said owner'or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this;; application; that all ~stat~m~nts contained in this application 'are true to the best of his knowledge and belief; and that the:~ work will be pdrformed in fl~e manner set forth in the application filed therewith. Sworn to before me this 1 ota e. ....... County HELEN IL DE NOTARY PUBLIC, State of New Yod~ No, 4707878, Suffolk Count'/cO Term Expires Ma~ch 30,1~.-./