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Home My WebLink About16953-zTOWN 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) N~16955 Z ' Permission is hereby grante~cL~: % , .~ ~ .....-~.o..a....=...:..~C ...... ~ .............................. ~ ......... .~......~..,~..,....L~ ~.~.~ ................... , ~ ................. =,,~,,,,~=~.~ ~,...~l.~.~ ...... ~.~....~ ............ ~.~ .................................. County Tax Mop No. 1000 Section ....... .~ .............Block ................. pursuant to opp' car on dated ~ ....... ~..'~ ..................... , 19.~...~..., and opproyed by the Building Inspector. Building In.~ector Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY ~' TOWN OF SOUTHOLD CItECK :~:.~/q~' BUILDING DEPARTMENT SEPTIC FORM ~,",.,.', TOWN HALL NOTIF¥ $OUTHOLD, N,Y. 11971 TEL.; 765-1803 CALL ................ MAIL TO: Approved .. Permit ......... Disapproved a/c ................................... ~ ~¢[~ (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 Inspc. ctor 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 Ordinanc~ 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, .amtwegulations, and to admit authorized inspectors on premises and in building for nece~/7 (Signature of applicant, orj~me, if a corporation) / (Mailing address of apl~'cant) '-// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.er. Name of owner of premises .<~. b..~-d~W..~..~..~..¢t/.~.J. ...~.~. ~'~ / .......... ..... ' ..... (as on the tax roll or latest dee~0~[ If applicant is a corporation, signatnre of duly authorized officer. DATfi: (Name and title of co,orate officer) , NOTIFY ALL CO~TRACTOR~S ~OST Bg SOFFOLK COO~TY LICENSED 76~1802 9AMTO4PMFO~E Builder's License No .......................... FOLLOWING INSPE~ON8 ~. FOUNDAIION ~ 8~RED Plumber's License No ......................... FOR ~ED ~ON~ 2, ROUGH - ~MINO & ~BING 3. INSULATION E]~ctTJc[an's license Ho ....................... 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. Othc; ~mdc's ~[cens~ ~o ...................... ALL CONSTRUC~ON SHALL ME~ THE REQUIREMENTS OF THE N.Y ]. Location ofla~d on which proposed work wile b~ done ................. S'TATE' ~NSTR~CTIO~' '~ERG~ .... ........................ O[SK~O~ ~O~$ROCIIUN ERRO~ .... House Number ~ Street Hamlet ,0oo c,,on ........ 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. xi ting, e oc ,pan V ...... ................. b. Intended use and occupancy ................ ~. ~ ~.. ~ ' · .;~;..,~. ............... 3. Nature.of work (check which applicable): New Building . i...' ..... Addition .......... Alterations, .......... Repair .............. Removal .............. Demolition ......... - Other W~lff..~..~. ,44.¢:....~-~'A~... ' (lJescrip.tion) 4. Estimated CosC~?~. ..~fr~.~.~..~. .................... Fee ...................................... i " (to be paid on filing this application) 5. If dwelling, number of dwelling flnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ! ................ :. ~ ................................................ 6. If business, commercial or mixed occupancy, specify natm~c and extent of each type of use . ~ ................... 7. Dimensions of existing structure§, if any: Front ............... Rear .............. Depth ............... Height ............... Number'of Stories ......... ~; .......................... : ................... Dimensions of same structure wilh alterations or additions: Front ................. Rear .................. Depth .................... i' ' Height ...................... Number of Stories ...................... - 8. Dimensions of entire new construction: Front .......... ' ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........i ........... Rear ..................... Depth ...................... 10. Date of Purchase ........... ! .................. Name of Former Owner ............................. 11. Zone or use district in which preynises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordina ace or regulation: ................................ 13. Will lot be regraded ......... i .............. .z... · · Will excess fill be removed from premises: Yes No 14. Name of Owner of premise~O~.¢~'P/'~..l.r~Address ...... <:~.,d?~ .~..~.... Phone No. ~.~.~.-.~...~7.3:-.)..~./..~ Name of Architect .......... i ................. Address ................... Phone No ................ Nmne of Contractor ......... '.S~A.. ~ ........ Address .... : .............. Phone No ................ I5. Is th±s property located within 300 feet of a ¢±dal wetland? ~¥es ..... No ..... *If yes, Southeld Town Tru Locate clearly and distinctly all property lines. Give street and block terior or corner lot. ~tees Permit maybe required. PLOT DIAGRAM buildings, whether existir g or proposed, and, indicate all set-back dimensions from tumber or description according to deed, and show street names and indicate whether ~. ~'. "~ (~'~ Uf individual signing contract) above named. ' being duly sworn, deposes and says that he is the applicant County ~ w.~L__w_.,~ ~ -" ~ -, ': :' . (Contractor, agent, corporate officer etc ) of sald.gw~p~' ~r o. wgers and is duly authorized to perform or have performed the said work and to make and file this apphcahon; that all statements contai,ned m this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before ~ne this [