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Home My WebLink About16960-z FORM NO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 16960 Z Permission is hereby granted to: ...~.....~...~...~..~..~...., .................. ....~...~..q..Z.~. ................................................... :... .... ....~.~~ ........... ~.~., ~l.~c.~ ~....~ County Tox Map No. 10OO Section ...... L.O...I~ ....... Block ...... ..~.....~ ........ Lot No.....~.~.:..~. ........ Building Inspector. Fee ,..~.~.:...~.. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined .. Approved ... Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 descript!on of layout of property must be drawn on the diagram which is part of this appli- cation. c. Tile 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 the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall have been granted by tile Building Inspector. APPLICATION IS ttEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tile Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regnlations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Tile 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) (Name and title of corporate officer) Builder's License No .......................... Phnnber's License No ......................... Electrician s License No ....................... - ' ....... lfifiiiifi~'fifififfi~' g?'fi3~ii~fifi£5 ....... State whether applicant is owuer, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' Name of owner of premises . ~.l~.~ .... '.~.~ ~ ........ , ............................... as on the tax roll or latest de~Pg0~[ If applicant is a corporation, signature of duly authorized officer. OmE: , "OTIFY BUILDING DEPARTMENT AT 2. ROUGH - FRAMING & PLUMBING ' ~. INSU~TION 4. FINAL CONSTRUCTION MUST 8E C~MPLETE FOR ~.O. Other Tradc's License Ho ...................... -* ALE' CONSTRUCT~N SHALL ME~ ~HE REQUIREME~S OF ~E N.Y. ]. Location o~ land on which proposed W, ork will be do~e ................ ST~. ~NSTR~N. & .ENERG~ ..... llouse Number Street County Tax Map No. 1000 Section ................ Block .. · · · ~ ~ '{P~:,..~{NN. OW. COfl~'~clIUCTION ERRORS ..... Hamlet .... ......... ......... Subdivision ......................... Filed Map No ............... Lot ............... (Name) 2. State existing nsc and occupancy of premises and intended use aud occupancy of proposed construction: 3 N f k ( ' fippl' bi ) N Additi Alt al.Lo ". ature owor checkwtuch , Ica e: ew Building .......... on .......... er n ..... ' ..... m litio ' Other W - Repair .............. Re oval .............. Demo , .............. ork ~7~:,~?-,,~...... 4. Estimated Cost .... .].}i.~.'?.¢~.i.5,:.D. .................. Fee .... '~P~3--, ced ii~.i..!.Deseripti°n) [to be paid on filing tiffs apphcation) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ If garage, number of cars i . 6 I ' ' ' specify nature and extent of each type of use . If bt slness, commercial or mixed occupancy, ................ 7 ' ' ~ ' Front Rear · D, nens~ons of ex~stmg strut, tm'es, ff any: ............................. Depth.. ............ l leight ............... Number of Stories ........................................... Dimensions of same structure with alterations or addmons:' ' Front Rear ' ........... Depth ' ; Height Number of Stories 8 ' ~ ' ' Rear Depth · D,~ ~enstons ofenhre new constmetmn: Front ......................................... Height ............... Nuinber of Stories ..................................................... 9 Size of lot: Front 7 ! : ' Rear ". Depth 10. Date of Pnrchase .......... ! ................... Name of Fenner Owner 1 1. Zone or use district in which premises are situated ............................... , .................... 1 2. Does proposed construction violate ariy zoning law. ordinance or regulation: .............................. 13. Will lot be regraded ..... '~_,~;u:~.:~..,,-~,_;. ·., ......Will excess. ,fiJ~lle,l:emoved frQm premises: Yes No 14. Name o'f Owner of premisesEA:Lft~g4.. ~/4./~ .... Address[)~ ./,y.'-:-..l?~.=. 72~.../~.z4d~'~. Phone No ......... Name of Arctutect ......... i .............. Address-. ........ ph,,.,,, NmneofContractor-["kqlOt.~'~ell~g ~..,~t~q~.. Addres~,,'0,~0j('6tqZ [b'[fl'~/i~b~'.' .... '.;"" b"c;~'2'~ ......... ; _ . . ....... '~ ......... ':'rhone l~o~:(a...,. ~.~... 15. ...... xs enxs property -oeateul wittainl.o0 feet of a t±dal wetland? ayes ..~.. No · If yes, Southold Town Tr,~ustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl interior or corner lot. number or description according to deed, and show street names and indicate whether STATE OF NE.W}~ORK'7, COUNT~YqOF~ ,q .a .&:e.'~, ~:,~.. UO~t''~'S g ' "' ' '~,' '.:. ~. :..~(~-h ~ ':~,,:,;l~a~ 9,t,~" ~,,,~;iRdr q_~fi.-m-~19 ~" · '. .... ~$}g~i~g~'~ '~6 ................. ontract ) . being duly sworn, deposes and says that he is the applicant flO~ .... ~,~a~",'~ ~ ,a~oL* ~Contractor, agent, corporate officer, etc.) of said;*¢w~eg ~rfi¢~?~fl: 1~ ~hofized to perform or have perfomed the said work and to m~e and file this applicotion; that all statements contained ~ ,this application are true to the best of his knowledge and belief; and that the work will be performed in the m~nbr set forth in the application filed therewith. Sworn to before me this /q .............. ...... ......... , Nota~ Public ....... ~ ..... Couut ' ....... N~A~N0, 4707878,PUBLIC' Suff01kState 0fCoUn~New York ~ (Signature of applicant) Term Expires Mamh 30, 1~ '