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Home My WebLink About16998-z TOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No' 1~998 z County Tox Map No. 1000 Section .... ~.,~., ............. Block .... ,./..,,~,., ......... Lot No ........... ~,. ......... pursuont to opplicotion doted ......... ~./~;....~ ................... , 19~....~.., ond opproved by the Building Inspector. Rev, 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORMNO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ........ , Ig.'ff Approved ~ ......... 19~t~. Permit No.Z~.....~?..~/ Disapproved a/c ................ ; :" .................. APPROVED Ag NOTED ' PLICATION DATE ~B.R. ~ FOR BUILDING PER~IT NOTIFY CALL ............... MAIL TO: ff);~4~ Date . .~..~..Y.. & ......... 19 oc~.. 765-1802 9 AM TO 4 PM FOR THE INSTRUCTIONS FO OWING INSPECTION · ~zo~3 ely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of l[~l~ilffi[tl~llll~ll~to s~ale. Fee according to schedule. ~. ~.. ~.~~' and of~uild~gs on premiss relatio~hip to adjoining premises .... or pubic streets or a~a~ a detmled descnptaon of lay?t of property must be drawn on the diagram which as pa~ of thru apph- cati~. FIN~ - ~N~N MUST c. ~~~s application may not be commenced before issuhnce of Bufld~g Permit. ~~t~[i~, the Building Inspector will issued a Bulldog Pe~it to the app~c~t. Such pemit sh~l~~~]~ inspection throughout the work. ~ ~ ~c~ used in whole or in part for any purpose whatever until a Certificate of Occup~cy shall~e~t~i~spector. 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 here~ described. The applicant agrees to comply with all app~cab~e laws, ordinances, bulldog code, housing code, and regulations, and to admit authorized inspectom on premises and ~ bu~d~g for necessa~ inspections. ~ ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~(~.~.~... 5.. ~.. ~.:..~).~.~ ~ .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) , ALL CONTRACTOR'S MUST Bg SUFFOLK COUNTY LICENSED Builder's License No. , .,r~..0-~¥.. ~ ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... 7.~. ....... Block.../..~. .......... Lot.....~/. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,~ .~-~. r tg~w~e &-- 3. Nature of work (check which applicable): New Building ..... ~ ..... Addition . ! ........ Alteration .......... Repair ............. Removal .............. Demolition .......... i... Other Work. t'i/57'/;~-t~. ..... ~-r~t~,^~'- ~--t.~ee-- ~>' /,,~ 4~&-~--r- n,, ~,~-~/-__ y,,b~r~ (Description) 4 Estimated Cost F. /~.6 Fee .' ' (to beI 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. If business, commercial or mixed occupancy, specify nature and extent of each tY_EPe of use ..................... 7. Dimensions of existing structures, if any Front ~°7, ~ ~ Rear . ¢~, ~ .. ' Depth ~..~7/. Height Number of Stories ,¢.."< ¢77. ,' Dimensions'of same structure with alterations or additions: Front ........... , ..... Rear ................ Depth ...................... Height ...................... Number of Stories .................... '--8. Dimensions of entire new construction: Front. ....... .. . ..... Rear ..... ..~' ....... Depth ............. Height Number of Stories ' 9. Size of lot: Front ..... /..~.o.: ......... ~.. Rear .... /.~..o./. ............. iDepth . ./.fi.o/ .............. 10. DateofPurchase ...d?.ct~.q.r-...<~...7 ........... Name of Former Owner i.p~c,t-~c.,~ c~.(cf<_. . 11. Zone or use district in which premises are situated ......................... : .......................... 12 Does proposed construction violate any zoning law ordinance or regulation: ' 13. Will lot be regraded ............................ Will excess fill be removeld from premises: Yes No 14. Name of Owner of premises 7'..~.~.47 e.' Q.'R¢..~..'~.~k°d~r~s~..7.J~.~?:.oo~. ~[ ... Phone No..'7.a.~...-.~.?.~77. .... Name of Architect ........................... Address ...... ' . Phone No. Name of Contractor .~..4, :~¢~4¢~.~e'. ............... Address .,U..'o..~F...rYt. c.t.2--, . .~.~.... Phone No ................ I5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *~f yes, Southold Town Trustees Permit maybe reouired. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and red,cate whether interior or corner lot. · '" ' -: po~t) 6 ' 5'7~ct'<L ,~O~~- STATE OF NE~ YoRK,.~ .., COU~Y DF . . ~ V.W~.&d~ . . . ...... .................. (Nmne of individual signing contract above named. being duly sworn, dep?es and says that he is the applicant He is the o .~...~.~..-?~ (Contractor, agent corporate officer, etc of said owner or owners, and is duly authorized to perform or have performed the s~td 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 ................. , ..... day of .......... Notary Public, .... ~--,-~-~*~,...~. '..D./r..~...dd~.... County _ HELEN IL D£ VOE NOTNA~RY PUBLIC, State of New Yerk ' . o._4707878, Suffolk Countyl~ ,~ ierm I:xpiros M~rch 30, 19-..~ !