The URL can be used to link to this page

Home My WebLink About16980-z FOB~ NO. 0 TOWN 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_ 16980 z Permission is hereb~granted to: __ ~ __ ~ ~ ~~.~,........~....~ ............ ...................... ...~/.~. ~.......~ ............... ~- ..... County Tax Map No. 1000 Section .......... C..~... .... Block ........... Z .......Lot No ............ .~..../ ..... pursuant to application dated ....................................................... ~.~ , 19..~.~.., and approved by the Building Inspector. Fee $....~...~.. Rev. 6/30/80 FOFINI NO. 1 SURVEY .......... TOWN OF SOUTHOLD OllECK .......... BUILDING DEPARTMENT SEP?IC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N,Y. 11971 CALL · ............... Disapproved a/c ..................................... A~T~) APPLIOATION FOR BUILDING PERMIT DATE: B.P. # ~,~ Date .................. , 19... FEE' '~'-''~r'~-~ N~I~ ~ILDI~G DEPAm~NT AT INSTRUCTIONS 708-I~2 a. F~3~~ completely filled in by ~pewriter or in ink and submitted to the Building Inspector, with 3 sets o~ p~~qt~ ~*ee according to schedule. b.2~~~¢.~_[}ot and of buildings on premises, relationship to adjoining premises or pubic streets or..ar~s,~~e~s, ~ of layout of property :must be drawn on the diagram which is pa~ of this appli- c:'~~~~on may not be commenced before issu~ce of Bu~d~g Permit. d.A~~~h~ic~J~-ut the Building Inspector wU1 issued a Bufld~g Pe~it to the applicant. Such pemit shM1 ~:~e~i~~~ ~spection throughout the work. e.;~~~~used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy shall ~pn~t~~spector. A~~~ ~o the Building Dep~tment for the issuance of a B~lding Pemit pursuant to the Building. Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of bulldogs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appScable laws, ordinances, bu~d~g code, hous~g code, and regulations, and to admitauthofizedinspecto~onpremisesand~build~gforneces~.iyy~. ~ ...... ~~ ............... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~. ~ff./.~..J-'.."~..~.//~/~7~ · ./~.-....-/~../.'Q~Q ?. .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ... ................... .La: ................... .............. House Number Street Hamlet County Tax Map No. 1000 Section .... ~.~ ............ Block ...~ ' Lot...~.[ ............... Subdivision .... .~.0. [ 4~J~J.QQ~.~. ................... 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 ..... b. Intended use and occupancy . .[...J(. ~J~...I.l.~ Nature ~f work (check which applicable): New Building ' Addition . ......... Alteration .......... Repair .............. Removal ........ Demolition .......... :... Other Work ...~.2~.. J,.... ~ (Descrip,tion) .4 I.¢.Q,a o ' 4. Estimated Cost ............................ Fee i (to beI paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling un!ts on each floor ................ If garage number of cars 6, If business, commercial or mixed occupancy specify nature and extent of each type of use . .T',].O~-/ .............. 7. Dimensions of existing structures, if any: Front.. ~..,~.,. ,i~ ...... Rear . ,~.-,~ .' .~. ....... Depth ~.~. -..~'. ......... Height ........ ....... Number of Stories .I .................. ..... ' Dimensions'of same structure with alterations or additions: Front ~ ~ I Rear ... Depth ...................... Height ....... ~ .............. Number of Stories ...................... ~ 8. D~mensmns of entire new constructmn: Front . .¢% ~ ~ .' ..... Rear ....... i ....... Depth ............... Height . Number of Stories ................ 9. Size of lot: Front .... ].~5..: ............ 10. Date of Purchase ........ t.c] .~. ~ ............... Name of Fgrfn~er,Owner ~. ~./~0"/...~ t~ .-.~ ........ 11. Zone or use district in which premises are situated (~.&.~ ~.~tq ~Vi ..~ . . 2 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.f~.O ....................... .. 13. Will lot be regraded .~9~... k ..................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises (,~.l$...~.13g ~ ....... Address ~.%O ]'~c&,{4x0.~l%.l.4&.~. Phone No.."] ~.~{.'. Name Architect ........................... Address ........... ' .vgf3...°~hone No .............. :.. Name of Contractor ........... ............... Address .... : .......... u -! .... Phone No. ,w ........... · · 15. Is this property located within 300 feet of a tidal wetland? *Y~s ..... No .77'... · If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctIy ali buildings, whether existing Or proposed, and. in property lines. Give street and block-,number or description according to deed, and she, interior or corner iicate all set-back dimensions frdm street names and indicate v~he~e~', ; .............................. !. .................. being duly sworn, deposes and says that he is the applicafit (Name of individual signing contract) ~bove named. ~e is the .................................................... ' .. .... . (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the shid work and to make ~d file this lpplication; that ali statements contained in this application are true to the best of his knowledge and belief;and that the ~ork will be performed in the manner set forth in the application filed therewith. ~worn to before me this qotary Public .... ~d. i~.f-..~). ... Coun ~lebEN K,, DE VOEPUBLiC, State of New Yolk ...... (,./[.,/V/~4/~./~ ~.. , , Ne. 4707878, Suffolk C~untyp'~ /; (Signature of applicant) Term Expires March 30,19,.--~