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Home My WebLink About16930-z FOUM* NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PE~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_169 0 Z at prem,ses located at .~.../.. .......... ~ ..... ~ ............. ./ ............................................................ County Tax Map No. 1000 Section ........ //.~... ....... Block ........ ~... ......... Lot No ............ .~.... ...... pursuant to application dated ...... .~...//..~ .................................. , 19...~., and approved by the Building Inspector. Fee $.~..~...~ Rev. 6/30/80 APR I 2 )D TOWN OF sOUTHOLD ......... _ ............................... TEL.: 765-1802 Examined ........ 19f~'. . · Approved..~./..fl'~.. ......... 19 .~. Permit No/~~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO. ~- 0~ ~ 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 part for any 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 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 inspections. .P.q: go . s.. ,.,.rko .M .9.'7.. .q ..-z .t.. (Mailing address of applicant) Stat~,~h~.her~gpphcant zs- owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Namg;o; ~W~r ~'f prem'ises ..-: ~).- ~.. ~O ~.~..~.~.l. [ ~l ~ ~. ~o.t ~.< .................... ~s on the tax roll ~est deed)v If apphcant ~s a 9orporahon s~gnature of duly authorized officer. (Nam~ and title of co,orate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICgNSED Buildek'k Eicense No. ' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.. , .~.]~7'7..<~..~O ......... 1. Location of land on which proposed work will be done .................................................. ............ .......... IM ............ . .C ............. House Number Street Hamlet kJ County Tax Map No. 1000 Section ..... I. 1.(--¢ ........ Block ...... } ........... Lot..'~.. ~..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..0. ~ p~.~c,.. ~J.r7., .~. ~...~.~. ~ ...... .. .......... .................... b. Intended use and occupancy .~ ~q t [.-7C .C.~..~. l..~e~, me.~. ,;:v J ~. t~,~.~ .~ b..o.'3qh. ~1..~-.~G..'~., ............ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alterat~ .......... Repair .............. Removal . ..,; ......... Demolition .............. Other Work. J'7. ~.e..r~.... ..~. )~. .~.~-- (Description) 4. Estimated Cost .... ~. . .(2) ..................... Fee ......... .(D. ~ ....................... i " (to be paiR on filing this application) 5. If dwelling number of dwelling units ............... Number of dwelling units onL each floor .......... If garage, number of cars .... ~ .................................... ~ ...................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type 9f use ..................... 7. Dimensions of existing structu~'es, if any Front ............... Rear ......... J. .... Depth ....... Height ............... Number of Stories . . . ~ ........................................ Dimensions'of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ~... Height ...................... Number of St. >ries ...................... ---8. Dimensions of entire new construct~on: Front ' Rear Depth .... Height .. ............. Nuinber of Stories .............................. ~ .......................... 9. Size of lot: Front .......... ............ Rear ...................... Depth ...................... 10. Date of Purchase ' . .... Name of Former -~- I ..................... 11. Zone or use district in which p~emises are situated .... 12. Does proposed constructmn wolate any zomng law, ordinance or regulation: ......... 13. Willlot be regraded ........ .................... Will excess fill be removed om premises: Yes No 14. Name of Owner of premises09~!~ .d~. IA).q~..C_q. rlq.~ Address ~'lo, r,--q ~e..~vlCJ ~P_hone No ................. Name of Architect ~ ~'J -- Address ................ Phone No 15. Is this property located'-~ithin 30~ feet of a tidal wetland? *Yes ,.... No ~.... *If yes, Southold Town Trustees Permit maybe required. . ; PLOT DIAGRAM l,ocate 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. STATE OF NEW YORK, COUNTY OF ................. i S.S (Name of individual sig~ing contract) above named. , RPPIIOVED AS NOTED _ FEE: ~l~.~---- BY: ~ NOTIFY ~BUILDING DEPA~' AT AM TO 4 'M"FO. TI -. FO,I. LOWIN. G INSPECTIONS: 1. FOUND, ATi~N - FOR POURE£) CONCR : 2. ROUGH - FRAMING ,& 4. FINAL CONSTRUCTION MU~T ~E ~U~q~LI:TE FOR O.O, ALL CONSTRUCTION SHALL 'THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY COt)ES NOT RESPONSIBLE FOR DF$tGN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant He is the ..................... i .................................................................... i (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 this .................. : ..... da · .-~Z-~.~. ~, · i. ~.~..~..0~. · .' ..... County Notary Public, . HELEN K. DE vOEi ' ,~.. ?. ,~ , , NOTARY PUBLIC, State of New York iL '~ ~" '" ' No. 47078'18, Suffolk COuMY ~ .... .~ L..~. Term Expires March $0,1L-...~ / ~ ~ (Signature of applicant)