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Home My WebLink About16956-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) No_ 169B6 z Permission is hereby gronted to: ..... ~.~o~g,,,...~ ............. ~ .......... .... ~:...~..:~..,......u..t.-,...} ...... ~o...~.w......~.....~.....a~.~...~......~......e..~...*...~.~... U , // _ , at premises located at ...L~.~...~..(..~.........~t~.g-~.......~....-~ .......~.~....c:~...~..~4n~....~.. ) County Tox Map No. 1000 Section ...... .(~r..~...~.~....,. Block ...... ..o...~..'~.. ...... Lot No ...... ./...~..*../ ......... pursuantBuilding Inspector.t° application dated . ........................ ~..~~. .~. ............... , 19.~.,.~,, and approved by the Fee $..~ ............. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Examined...~..~.11..., 19~..~. Approved.....~...~.~. 1.1..., 19,t?. Permit No..]..~?..~.~..~ / Disapproved a/c ................................... ./. ...............................~ (Building Inspector) APPLICATION FOR BUILDING PERMIT 1981 Received ........... ,19... Date ................... 19... I. Location of land on which proposed work will be done ....................................... .......... ~ .............. Cc~ / O/?x~. . . House Nmnber Street Hamlet Couuty Tax Map No. 1000 Section ...... O.?..~-'. ...... Block ...... O.~. ...... Lot.../.qJ .I. .......... Subdivision ................. ' Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occopancy of proposed construction: a. Existing use and occupancy ..................................................................... b. lnteoded use and occopancy ................... ; ..................... ~'-~','~'~ ~] ~, . . ' 765 ~:5 ,::~ !~ :~ FOR THE FOLLO'; 't' ' ('; 2. ROUGH FRz~ ,, ': & PLUMglNG 3. 4, FINAL -~-~ -~ ~CI'tON MUST BE COMPLL ' :~'~ C O ALL CONRTRUcI-~ON SHALL THE 8[QUI~EMENT$ OF THE STA~ CONsTRUCTiON & ENERGY CO~ ~ RE~ONSlBLE FOR D~I~ ~ ~TRUCTION ERRORS Other Trade's License No ...................... *, If applicant is a corporation, sig.noture of duly authorized officer. ..... (Name and title of corporate officer) Builder's License No .... ~ ~5> ' Phnnber's License No ......................... Electrician's License No ....................... INSTI~UCT1ONS 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 descript!on 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 Insped~or'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 ~ Certificate of Occupancy sliall 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. (Signature of applicant, or name, if a corporation) /fo . . ........ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . [7.~ ~ .... ~ ..................................................... ; ......... ........... Nalne of owner of premises ~ O ~ ~ cD , .................................... ~EE ..... ~ ...... ~ · ·ff'--~--~; ............ (as on t xe tax roll or ~t~d)~;y;> r:~--~ -"73. ' ~ ' Nature of work (check which applicable): New Building ..... : .... Addition .......... Alteration .......... Repair ...~. ,t ~, ~ 5~' :'1 Removal .............. Demolition .............. Other Work ~5~, (Description) 4, Estimated Cost .... .C.'5..~..~.:,,~? ........................ Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars, ' ' 6 lfb ine cil ' ~d 'fy d tel htyp of · us ss, commer a or mix occupancy, specl nature an exten cae e use .................... 7 Dimensions .... Rear Depth,. · of existing struc, tur~s, ff any: Front .......................................... Height Number of Stories · Dimensions of same stnl~ure ' .... Front Rear with alterations or additions: ................................ Depth ' Height Number of Stories 8. Dimensions of entire new constrUction:, Front ............... Rear ............... Depth ............ Height ............... Nmgber of Stories ..................................................... 9 Size of lot: Front ~. ' Rear ': Depth 10. Date of Purchase .......... : ................... Name of Fenner Owner .......................... 1 1. Zone or use district in which pr~mises are situated ........................ . .......................... 12. Does proposed construction violate any zoning law. ordinance or regulation: .............................. 13. 5dl lot,ob~regrad~d .......,,27~.~ .... b~' .......... Will excess fill be rem,eyed from premises: Yes No 1 4. t~ame et owner oI premmes;/o... 0~...'a.~?.m..~.... Address ~,~.ac4,~. ~.~.~. ~.ff. ....... Phone No. ?..~'.37-..L ~'..~..... Name of Architect ......... i ................. Address ..... ~ ............. Phone No .... ./ ........... Name of Contractor .~.~ :'(...~.o,4~/5. ~v~..~.~- ........ Address~.0 .~..ff. 2~, /q/~.~.4zo..(4Phone No..~,~, ...~ ~Yff...7., 15. :ts this property locatedlwithinl,00 feet of a tidal wetland? ~ *,~e~ ''.~" ,No~..~'. '' ~ If yes, Southold Town TrUstees Permit may~be required. ... ;~ PLOT DIAGRAM ' ~ ' ' Locate clearly and distinctly ali buildings, whether existing 'or proposed, and, indicate all set-back dimensions from property lines. Give street and bloeklnumber or description according to deed, and show street names and indicate whether interior or corner lot. of said owner or owners, and is dui i application; that all statements conti ' work will be performed in the manne: 'Sworn to before me this (Signature of applicant) ...... ~ Clc~ ............ day of ~ .............. ~ ...... County Notary Public No~w P~l~ ~te ~ N~ ~ No. ~5~, Suff~ ~ ~ Term ~pires~r ~1, 1=' ~ u STATE i~.F NEWXORK, COUNTY OF .......,~o~%Namo.of~ ? ........... mdiv~du~j.~ff'l .n.~o~)tract)" '; [' ' TM <'' ' '*[ ................. being duly sworn, deposes and says that he is the applicant above n'a~g0d. He is the ~Contractor, agent, corporate officer, etc.) authorized to perform or have perfo~ed the said work and to m~e and file this ined ~ this application are true to the best of his knowledge and belief; and that the ' set forth in the application filed therewith. '