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Home My WebLink About16958-z POR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16958 z Permission is hereby granted to: --' ....1~,, ..... ~....~.... .....~.....-..~..~.~.~ ...................................................... ....~~.....~.:.~.....:.:..~.~..~ ........... ...... ........................................ at premises located at .............................................................. ~ ........ [~..- ................................ ........ ~~_~:' ............................ : ..................................... ~ ~ .J~' ............................................ ............. ~'"'J ............. u :~: .................................... Coun~ Tax Mop, No. lO00 Section ...... ~.?..~.. ....... Block ....... .(~...1~-~ ..... Lot No....~-~1 .............. ~ursuont to o,~,cot,on dot~ ...~ ........ ~.~ .................. , 1,.~.~..., and o~pro~ by Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-180:3 Examined .q. Approved ..... '~..~..I.I.., 19,~.g. Pennit No. Disapproved a/c ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink ~nd submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to scliedule. 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 Inspecfor will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout thc work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall liave been granted by tlie Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tlie Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for tile 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) State wbether,apgl&c¢~n~, oi~p~tl~lessee, agent, arcbitect, engineer general contractor electrician, p umber or builder. Name o ow e~is~i~ :~ m)~ ;'~ ~ ~'~ ~,~A ~ ~I,~ (as on the tax roll or latest deed) If applicant is a ~,9~,gr~tibn,~ ~y autnorizea officer. ...... 4~;,~{ ~ ~' ~' ~m~, ~. ,~ ........... Bu~er s Lme~l~l~.~.~ ............. mm~er c e · .......... ........... Ot ~er 'lraa¢ s License No .................... -.. Location of land on whicli proposed work. will be done .................................................. ..... ........ ....... ...... llouse Number ' Street Hamlet .................. Couuty Tax Map No. 1000 Section .... .'~7'..(? ..........Block...~;...5). ............ Lot...~./ ............. Subdivision ' Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. F.×isling ,sc ami occupancy .......... . ......................................................... b. lntm~dcd u~ mid occupancy ... ~' ................................................................ '~3. Nature of work (check which.applicable): New Buildine . Addition AlteraQon .......... ' · ...... ' i ............ Repair ....... RemovaI .............. I t o~ .............. Other Work· ~...~.. ~[.~t~ ..... Estimated Cost ' '~' '~ ~/~i O"x9 O c3 8 ( fDescription) 4 ........................................Fee ....... , (to be paid on filing this application) 5 If dwelling number of dwel ir~g units Number of dwelling units on each · ' ............... floor If garage number of cars ................ 6 If busine'ss ' ' ' ................................................ ~ ........ · , commercial or mixed occupancy, specify nature and extent of each type of use ........ 7. DimensionsofexistingstructUres, ifany: Front .... , .' ..... Rear ............ ... ?epth,.... tleight ............... NUmber of Stories ........... ' . . ' ........ .' Di nenmons of same structure Flth alterations or addlnons: Front ................. Rear ................. Depth .................. [... Hei.ght .................... Number of Stories .......... 8. Dimensions of entire new construction. Front ............... Rear ............. Depth .... ' .......... Height ............... Nulmber of Stories .................................... ' .......... 9 Sizeoflot: Front Z-.'ZZZi i · · Rear " ' Depth 10' DateofPurchase ' ": .............................. .... ~ ................... Name of Fenner Owner ................ I1 ' ' ' ~ ' · Zone or use district m whmh premises are situated ; 12 Does proposed construction violate any zoning law ........................................... · ordinance or regulation: ........ 13..W. ill lot .b~regrade.d ..... ~.lL'~xe~__x~6...t.~.. ..........Will ex. co~s~ QJ! be removed from prem sea' Yes ~ No Name of Architect ; .... ii ........ '~'~'-~-' ........ ~-.,~.~t~e~'~rPhone No.47).7.. k~.5.'~.~. .... ! 5. ~Nam.~. o.f Contraetor-/?/N.t~et~ ~..~d(ff~. ......... Address ~0, t~.OS.~.b... ~.?N .~h;~ ~'4¢~/.~.¢'~' '' xa cn~.a property xocated within1.00 feet of a tidal wetland? ~ Ye~ ..... ~'o .~...' ..... ~ If yes, Southold Town Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly all buildin,,s w"~- ...... :~--'~- . o, ,,~-,~, ~l~ung or proposea, ano. lndlcate I - ' · i treet a 1o¢ umber or d enption ording to deed, and show stree STATE OF NEW YORK, COUNTY OF ................. S.S ............................. ~ .................... being duly (Name .... above n'amed of individual s gn~ng contract) ., APPROVED AS NOTED ' .... 3 n~ BUI~G- OE~RTMENT A~ ~1~ ~ AM ~ 4 PM FOR THE F~NG iNSPECTIONS; 1. ~~ . ~ REQUmEO ~ ~ ~NCR~E ~ ~ - ~MING & '~UMBING 4. ~ CON~UCT~N MUST ~ ~TE FOR C.O. ~ ~~ ~ALL ~ ~~ ~ m~ N.Y. ~A~' ~ & ENEROY sw°~~~g~p, licant tlc is the ' (Contractor agent corporate officer, etc ) ' ' ' of said owner or owners, and is dui9 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 ; ......... /..f:.. ..... dayofL... ~ ........ , ".,. .... ., .