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Home My WebLink About17108-Z IVOWM' NO. It 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) N9 017108 Z Permission is hereby granted to: ..... .. .~....~......~.. .,,,.,..,...,~.:.~, ...... U..~..T.~.... , at premises located at ..~..~.~...~......~..~..~... ........... ..~~o~ ................ County Tax Map No. 1000 Section ....... 1/..~, ......... Block ........ .~...I ......... Lot No ....../...~ ......... pursuant to application dated ...... ....~.~.....~ .................... , 19..~...~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 BLDG. DEPT. TOWN OF SOUTHOLD , J FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:;] . .~/,d, Or~C.t' ./..~., 19 ~.~Permit No./.~../..~. ~..~. Approved / Disappro3t~ ~'TO~,~A~. !~1~?~?~..~O~ ................. .... .......... D . ~,~ · ~-~, , . . .~ ~ ....... ~ ..... ~ ....... ~[ Ct~r~ ~ ~ C 1.:, (Building Inspector) 3' I~i;'~[*~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ........ ~ ............ SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: a. ~:~.~pp. lic~t/cn~must be completely filled ]n by typewriter or in ~nk and submitted to thc Building Inspector, with 3 ,sets of ~[d~,~a~tll'li~ 'filbt plan to scale. Fee according to schedule. b. Plo,t pl. lfil_sh~wing locaZion*of lot ahd Of buildings on premises, relationship to adjoining premises or public streets or area~dfl~ givin~ a detailed description 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 Inspector 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 a Certificate of 0ccupancy shall 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 ~r for removal or demolition; as herein described. Regulations, for the construction of buildings, additions or alterations,? The applicant agrees to comply with all applicable laws, ordinances, admit authorized inspectors on premises and in building for necessary ir~st: (Sig Iding code, housing code, and regulations, and to t~;e'o'f'a' ' :c~3t, or flame', if'a'co['i~orat,c~n') ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premise~~~' .')'~.' ~...)~ ~ ..~.'.'' ...... ..~i ................... If ap~plicant is a corporation~nature of_~_duly a~orized officer. (Name and title of co.orate officer) Builder's License No .......................... Plumber's License No ......................... Electncmn s L~cense No ....................... Other Trade's License No ...................... 1. Location .o f land on whic~h p&posed 5ork wil~ done ........ ~w.~ ................................ .... ....)..,m-..., ......... ........................ House Num her ' Street· IRgi~let County Tax Map No. 1000 Section .../.t-~. ........... Block ..... / ............. Lot... J.~.. ........... Subdivision ................ (~q'a~) ................ Filed Map No ............... Lot ............... 2. State existing use and occupanc~t of premises and intended use/and occupancy of proposed construction: b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Additi~. ......... Alteration ......... Repair Removal .............. Demolition ..... ~ ....... Other Work .............. .............. ~s (Description) -_ Fee .m.. ........................... 4. Estimate'd Cost ....................................... i't; 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 ............................................................ usmess commerc al or mixed occupancy, specify natgreland extent of each t~p~ of use ...... · · .~. ~ ¢ ........ 6. Ifb ' , - ~- '~r [ .'( Depth 7 ........ Dimensions of exis~ting structures if any: Front... ·..t.~x ...... r, ua .............. 7. Height /.O Number of Stories ....... t ................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. 8. Dimensions of entire new construct' : Front ............... Rear .............. Height ............... Number of StoNes ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase .... Name of Former Owner ............................. lo. 'si&¢ i .... emoved 13 ..... ..... 14. NNX;;[ P. .......................... Address · PhoneNo · Architect . Phone No ................ Name of Contractor .......................... Address .................. 15.Is this property located ~*ithin 100 feet of a tidal }tetlaud? *YES .... NO .... · If yes, $outhold To~n Trustees Permit may be required. PLOT DIAG R32Vl Locate clearly and distinctly all buildincs, whethe~g ~roposed, and. indicate all set-back dimension~ from property lines. Give street and block number or descrip~ accordii~I° deed, and sttow street names and indicate whether interior or comer lot. ~ .... ~ -_..~___.~__.A ~ ~IiOVED AS NOTED '/0&,1802 0 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS I. FOUNDATION TWO REQUIRED FOR POURED CONCRETE COUNtY~'~-~I~I~ '~N NlUgT ...... being duly sworn, deposes ~d says that he is the applicant above ~e~ ~ ~ ~.~ of said owner or owners, ~d is duly authorized to .perfom or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of bis knowledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application flied therewith, Sworn to before me this ~l~,, ~} ~ ' ~ (Signature orapplic~t)