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Home My WebLink About19180-Z lrOUM NO. · 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) N~_ i 91 BO Z Permission is hereby granted to: .................... .... ;~....~X..,..~.,...~ .... ~oun~ Tax Ma, No. ,000 >c,,on ........ % ............ ,,o~, ........... /. ......... Lo, No...~.....~.. ....... pursuant to application dated ..... ~ ........... ~.....~......., 19..~.~., and approved by the Building Inspector. Rev. 6130/80 Examined ................. 19... Disapproved ale .................. (Building Inspector) ' APPLICATION FOH BUILDING PERMIT BOARD OF H£ALTH ............ ~ SETS OF TOWta O~ SOUT~OLD C.~C~: .~... ~.~ ....... ' TOWN HALL ............ ~OUTHOLD.~.y. 11971 NOTIFYI TEL: 705-1802 CALL ;j; .................. INSTRUCTIONS Buildcr'sU=,~e No .... J. [.?..~. ....... :.: ...... :'lumber's Li=nse No.: ..:..'. :.'. ............... Electrician's license No ....................... Oilier Trade'~ License No ...................... 1. Location o£1and on which proposed work will be done; a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Buildir~ lmPector, with ~ 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 premi~.~_ or public streets or areas, and giving a detailed description of layout of property must be draxvn on the diagram which is part of tMs appl.:- cation. c. The work covered by tkis 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 throu?~hout the work. ¢. No building shall be occupied or used in whole or i-n part for a.ny purpose xvhatever until a Certificate of Occupancy shale"have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building De artment fo '. , ~uddmg Zone Ordinance of the Town of Southold Succ~,?c' .... r th,e, issuance of a Btulding Permit pursuant to the = w., ~' ~U~gs, aochtlons or alterations or for l:cmoval or demolition, az hcre'~dde.~c~;~e'~' Ti,e applicant ' " lica e laws. ordinances bu, '. .. · . adm:t authonze~{)~.x{i/}~0[re~.~e~d in buildin ........... ,,__ d~= code. housing code, and re~btions, and to \ . .~..~:; ~,,. .... . · (Signature ox apphcant, or name, ifa co~6r~o'n')' ' ' (Mailing addresl ~f a~piicant) '--r ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .... . ... (as on the tax roll or latest dged') ............... · °use Num r Street. Hamlet ......... COunty Tax Map No. 1000 Section ............. · BlOck . /; ,. ................. Lot. Subdivision ........ -.. '.. ............................. ' · Eilcd Map No ' (Name) Lot ' ' · Slate existing use and occupancy of premises and intended usc and occupancy of proposed construction: · -- a. ExiSting use ami occupancy ........... t ........ b Intended Use and .~. ?~..fti'.~ ' occupancy 3 Nature of ork (check hich applicable): Ne Buildin§ Additisn kltcratmn ' Repair' :~ ' R~moval Demolition Swimn. in,q poor Tennis Court:' : ....... Accessor Buildin ~eq/,a/a~ Fen · Y g Othe Work 4. Estimated Cost .. Z~'.~.~: .......................... · . Fee ..................... ... ... . · · (to be paid on filing this application) $. Ifdwelling. numberofdwcllingunits.. ...... . ---' ..- Numbcrofdwcllingunitsoncachfloor. If garage, number of cars ................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. Dimensions of exmting structures, if any: Front ............... Rear ............... Depth .... , ....... 10 Date of Purchase ''"' ................ Name of Former Owner 11. Zone or use district in whicLi premises are situated .... ; ................ '~ proposed Construction violate any zoning law. ord ........................ l_. Does inance or regulation: ............ ' . .. 13. Will lot be regraded .;. ,/~.~;~. .................... Will excess fill be removed from premises: Yes .... No.. I $ Name of Owner of premises ...' .... Address Phone No ' Name of Architect ......... . Address ................... Phone No ................. Name of Contractor ~?~'t'~. ~'~/~'~.~ ! )~/~_~ i i Address ~oj(.~..~.S~.% ..~...~. Phone...No.-5~'. ~.7.~--~.: ."~ IS.Is this property located ~ithin lO0 feet of a tidal wetland? ~zgs .... mir yes, Southold Town Trumtees 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. Height ..... ',',, ~ .~'~-4~-r_W, ixf~'n bcr of Stories ........................................... Dimensions of s~mc si~:ty~c~t~(x~tith alterations or additions: Front ' ' D, . ................... Rear .......... · . - .............. {gat ...................... Number of Stones .............. 8. D~mensmns of entire r~, construction- Front .. ~..~ . 'o~,,,. ~ ' 13. th z ~" ........... ,Number of Stones . / ...... ....; ............................... 9. Size of lot: Front ............... Rear ......... Depth . . STATE OF NEW[~a~,' COU~ITY OF .~..~.~..~..~..t~... ..... S.S a ...................... ....... · 't.. 3:...6t..%4 . (Name of individual signing contract) above named. being dnly sworn, deposes amd says that he is thc applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application: that all statetnents contained in this, application are true to the best of his knowledge and bclicf; and that the ~°vro~rn';flol bb¢Ct. Po~;l~?,tCh~.'~ ,'sm=~c~l, i~thc application filc~ therewith. ::. ..... .........' ..,: No~ ~u~{le 81.~* ot NeW t0r~ ,' (S = r o f apphc