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Home My WebLink About16912-z ffOBM NO. It 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) Ne_ 1 6 .~ 1.2 Z Dote .. ./. ./. .~... ~ ...................................... . ,~.~ Permission is hereby granted to:_ _x /) ~/'/'~ ~ /~ · · --~..~.~,,,.~_~ ~. ~ ............................................ ...... ............ ...... · '~'~ ~. tp __ ed ............ ~ ......................... ~1~ .............................................................................. County Tax Map No. 1000 Section ........... .~......~..... Block .......... ~.. ........ Lot No .....,,/.~.iT../.. ..... pursuant to application doted ................ ~./..~. ............................. , 19.~.~,, and approved by the Building Inspector. Fee $ ......... Rev. 6/30/80 Disapproved a/c ..................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,°,OUTHOLD, N.Y. 11971 TEL.: 765-1802 ,,l [,, OF P1,AN,q SURVEY .......... CIlECK .......... SI~PTIC FORM ............. : NOTIFY CALL MAI ;o':' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink ~azs~o~i}~~il~n~tor, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 94: ~.,O~ ~ ~ ~' b. Plot pl~ showing location of lot and of bulldogs on premises, relatf~fishS~*~-h~J~ifl~p~s ~ibEc streets or areas, and giv~g a detaled description of layout of property :must be drawfl'oh~th~'~~h is pa~ of this appli- cation. c The work covered by this application may not be commenced before zssu~nc~ ~ddmg Permit. d} Upon approval of this application, the Building Inspector will issued PB6~}~b~e~~uch pemit shM1 be kept on the premises available for ~spection ~roughout the work. e. No bulldog shall be occupied or used in whole or in p~t for any purpose ~a~¢~ntil ~~ccup~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~tment for the issu~Bce'~fja}~l~in~P~auant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d ~th~r ap~'l~c~le ~a~, ~f'd~ces or Regulations, for the construction of bulldogs, additions or alterations, or for removal-~r dmolit~nr.as*'~re~ described. The applicant, agrees, to comply with all apphcable. ..... laws ordinances, bufld~g code, l,~ 3_'h°us~g,:, i~J~"and~ '"t~ regulations, and to admit authorized lnspectom on premises ~d m bmldmg for necessaw 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. Name of owner of premises ...... .,.. ...... ......................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) ALL CONTRACTOR'S ~UST ~B~ SUFFOLK COUNTY Builder's License No.../.~. ~/./f./ ........... LICENSED Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet ..... ' .. l.q:.! ......... 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 proposed construction: ri.cz,. a. Existing use and occupancy .................................................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ' Addition ' Alteration . Repair .............. Removal ............ Demolition ; Other Work ............... ~_ i (Description) 4. Estimated Cost .................................... Fee .......... ............................ ' (to be ipaid 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 mixed occupancy, specify nature and extent of each type of use ............ i ........ 7. Dimensions of existing structures, if any: Front ............... Rear ....... ....... Depth ............... Height Number of Stories ' Dimensions'of same structure with alterations or additions: Front ......... : Rear Depth ...................... Height ...................... Number o~ Stories ...................... 8. Dimensions of entire new construction: Front .......... . ..... Rear ........ ! ....... Depth ............... Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... !Depth ...................... 10 Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ......................... i ............................ I2. Does proposed construction violate any zoning law, ordinance or regulafion: ..A"~ ........................... 13. Will lot be regraded ....... _Z'G~. ~ .................. Will excess~fill be removed fromnremises: Yes . No Nm-m of Architect ... ,~ ............. ~ ......... Address ............... ! ....Phone No. ' 15. Is this property located within 300 feet of a tidal wetland? *Ye;s .~<.. No ..... *If yes, Southold Town Trustees Permit maybe required. PLO-f DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 1. FOUNDATION Fo POUW)M 2. RouO . 3, INSU~ 4, FINAL BE ~M~ ALL CONS~ THE STATE C0 8. DESIGN Off ~TATE OF NEW YORK, 70U'NTY OF ' S,S : ................................................. being duly sworn, depoies and says that be is the applicant (Name of individual signing contract) tbove named. I :[e is the .......................................................................................... (Contractor, agent, corporate officer, etc.)! )f said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this tpplication; that all statements contained in this application are true to the best of his~knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this HELEN K. t)E ~ *' .... NOTAR! PUBLIC, State et New.I_~ r ~/ ~ (Signature of applicant) No, 4707878, Su~o~ ?e~m Expires Hla~h $0, l~