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Home My WebLink About16915-z FORM NO. ~ TO~VN 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) Permission is hereby gronte~d to: ~....~~......~~ .......... /~ ~.....~~....~(..: ................. .... ~~-~, ..... -..y_.~.~:;.,..:..~_.,., .... ~o.~~~ ........ ~~ ....... ~..~ ........ ~.....~~~. at premises located at ..x~..~.....~......~......~~......~ ........................................................ County Tax .,Map No. 1000 Section ...... l/.--,,~ ....... Block ...... ...~..~.. ....... Lot No ........ ~..¢...~.. ....... pursuant to application dated ..: ....... .~,,~,,. .................................. ,19. ,~,~, and approved by the Building Inspector. Rev. 6/30/80 r Approved ..... .'?..--.-% ...... , 1 ennit No. I~ORM NO. 1 TOWN OF: SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 SURVEY ..... CllECK SEPTIC FORM Disapproved a/c ..................................... (BStildin~spector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink CALL MAlL TO: sets of plans, accurate plot plan to scale. Fee according to schedule. ~' lX~i~gA¢"*' ~.:~ ~?'tv:'~ b. Plot plan showing location of lot and of build~gs on premises, relatioEaH{¢~jpj~i~,P~¢ises or pubic streets or areas, and giv~g a det~led description of layout of property ;must be dr~w~[q~[th~Yffi~gra~/fh:i~ji,a.t~p~ this appli- cation. :~ I~:r~ . . c. The work covered by this application may not be commenced before d. Upon approval of this application, the Building Inspector will issued ~ Buii~g~[~O~g~licant. Such pemit shMl be kept on the premises available for ~spection throu~out the work. , ~ , :... ' '~¢ t~O e. No build~g shall be occupied or used in whole or in p~t for any purpose.whateve~:uCtH :a'C$~Jificate of Occup~cy shall have been granted by the Building Inspector. ": ~ ~ ~.,t ~ .4., APPLICATION IS HEREBY MADE to the Building Dep~tment for the issuance of a Bmldmg Pem~ p~suant to the Buildin Zone Ordinance of the Town of Southold, Suffolk County New York, ~d other applicabl~[~s~ 9j~ces or Regulahons, for the constmctzon of bmldmgs, addzhons or alteratmns, or for removal or demohtmn, as hereto described. The applicant agrees to comply with all app~cable laws, ordinances, bufld~g code~h~ ~Q~{~,e~l~s, and to .................~~~.~..r~~~ ....... (Signatnre of applicant, or na~e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ;2~ ~f owner of prem ises.. ~. './.,/~.'//~:~../. ~./.' '~'' .~..-. · · .~. - '~. '~- · "~' '> ......................... (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 MUST BE SUFFOLK COUNTY Builder's License No .......................... LICENSED Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ....................... .,z ...................... /. .... ..... : .......................... ..... ..... House Number Street Ha~et County Tax MapM~/~/.~/.°.' 1 :/~ction/~. .... j ./[.~.~. ....... Block .... <~. .......... Lot'. .... ~,~ ........ Subd,vm,on .//~.~./..' .~.~, .~'~..(~r~~, . ......... Filed Map No ............... Lot .... . .-w.. ....... 2. State existing use and occupancy of premises and intended use and occupancy of p~roposed.99nstruction: a. Existing nee and occupancy ........... b. Intended use and occupancy .~..~...~..:... ~.~~.d'.~...~~.'...' ...................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition . 'i ........ Alteration .~: ......... :... Other Work ... Repair .............. Removal ......... . ..... Demolition ....... I · '''' ~ (DesCnplion) 4. Estimated Cost ............ /. ~.f~). ................... Fee .......... i ............................ : ~' (to be paid on filing this application) 5. If dwelling, number of dweUing units ............... Number of dwelling uniis on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ~ Depth Height ............... Number of Stories ........................... i · · · Dimensions'of same structure with alterations or additions: Front . .' .......... 1 ..... Rear ................... Depth ...................... Height ...................... Number off'Stories ...................... - 8. Dimensions of entire new construction: Front .......... ..... Rear ........ ! ....... Depth ............... ight b f St He ............... Num ero or/es ............................ ~ .......................... 9. Size of lot: Front .................. , ..... Rear ...................... iDepth .,~ ...................... 10. Date of Purchase ......... ~-//~'~ ~,,~.~ ......... Name cff Former Owner 'i .... ~'~'~'/~' 1 1. Zone or use district in which p~emises ar' e situated ....... ~f~.~,/~ ' 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ! .... ~.O ................... 13. Will lot be regraded ........... /~>'=~..; .......... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~ Address ~ Phone No .. Name of Architect ............ ~ Address ......... ','ii''! .... Phone No'. .............. Name of Contractor .......... .,,~...(r': ........ Address .... : .......... i .... Phone No ......... r. ( ..... 15. Is this property located within 300 feet of a tidal wetland? *Ye) ..... No ....~-~. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGKAM 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 inter/or or comer lot. ARPROVED AS NOTED . DATE: ~ B.P. # .~_~ NOTIFY ,~ILDING DJ~PAR~NI' AT 76~-18021 e AM TO 4 PM FOR l'l, ffi FOLLOWING INSPECTIONS: , 1. FOUNDATION . I'WO ~ FOR POURED CONCRE'ffi BE COMIq,.ETE FOR C,O. ALL ~UCTION ~,IAU. MELrT THE REGUIREMENI~ OI~ '~, Nfl. STATE CON~TRUC110~ & 'Ii~V DESIGN O~ CONS~U~ ~ STATE OF NEW YORK, :OUNTY OF ' S.S ................................................. being duly sworn, deposes and says that tie is the applicaut (Name of individual signing contract) Ibove named. ~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 ~pplication; that all statements contained in this application are true to the best of hislknowledge and belief; and that the ~vork will be performed in the manner set forth in the application filed therewith. ~wom to before me this HELEN K. DE VOE NOTARYNo. 4707878,PUBLIC' 8uflr01k~te Of Coun~/~New York ! (Signature of applicant) Term Expims March 30. lO ~ ~,