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Home My WebLink About16320-Z I~OwM' 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) Ne_ 16~20 Z Permission is hereby granted to: ~.~....~.~~.~..:...~,~ ~ .......... ......~.!...: ...... ~.~.. ~~ ....... .:. ............. ~ ............. :.~ ................. ~. ..................... ~ ........... : .......... ~.. at premi.s I~at~ at ..~.~.~....~...~.~~...~..:.....~ County Tax Map No. 1000 Secti~)~.._.C)._..~....~ ..... Block ....... ..~..~ ...... Lot No....~....~. ........... pursuant to application dated ...~,~R.~.........~. ............... , 19.~.~...., and approved by the Building Inspector. Fee $.~.~..~ Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY . TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL l TO':;'* o' :~ ,' '".::, ~ $OUTHOLD, N.Y. 11971 e~ .l,~..~.. TEL.: 765-1802 Examin ..~..., 195 7 Approve~5~..~..~...~.., 19i il Permit No. ! 9..~..'~...~. (Building Inspector) APPLICATION FOR BUILDING PERMIT CALL ................ MAIL TO: Date . .A.u.g.u.s.t..3., ......... 19 .8.7. 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 description of layout of properW 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 Occupancy 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The 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. The Cove at Southold (Signature of applicant, or name, if a corporation) 5044 Expressway Drive South lto~tkozdmma.,. I'~. . 11.7.79 ......................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owns' of pre~..T.h.~. I licant c i ' ~i,*.TE: [ / 7 B.P , ~ licantts l cJ~f~tion.J,=nat reof d~t~y authonzed officer. & ., _ [ (~a~e and title of co,orate offi~e~ 76~1~2 9 AM rOI ~ ~R THE [g . CON,ACTOR'S ~UST BE SU~LK COUNTY LICg~SED [~[OWtNGINS~C~ONg: ( ;uilder's License No .............. Plumber's License No ......................... Electrician's License No ....................... ~, FiN~ *~ ~*iSVRUC¢*G** MUST Other Trade's License No. ALt, C:Oc- s. ~ ~: ~t:* ,r,~ SuAct MEET 1. Location ofland on which proposed work will be done~ S/S ~n House Number Street Hamlet County Tax Map No. I000 Section .087 05 .................. Block Lot 020 Subdivision ..................................... 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 Motel b. Intended use and occupancy . .~E~q~E~ .gff~qnqq ..... ~ ..... ~4 .~.~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... AlIe~:aI~a .......... Repair .............. Removal .............. Demolition ..... X ........ Other Work ............... ? ' ~crip.tion) 4. Estimated Cost 15,000 · (to be paid on filing this application) 5. If dwelling, number of dwelling units.. ..... 12........ 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 type of u'~e ..................... 7. Dimensions of existing structures, if any: Front ..... ' .......... Rear .............. Depth ............... Height ............... Number of Stories .... ' · .................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ...... ......... Rear ............... Depth ............... Height ............... Number of Stories ......................................................... Size of lot: Front ..................... '. Rear '. ............ . ......... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....N.o. .......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~.. · If yes, Southold Town Trustees Permit maybe required. PLO~r 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. Demolit~on: i1 - one story cottages 1 - two story, main building STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the President (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said 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 Notary Public,... ~-&t~C....~.-. ~]fl..~...0~.O. ..... County No 4~78~ ~ ~