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Home My WebLink About23486-Z FORM NO. $ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. r---}-•-ice `-�-` -'---`_Li _ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1V23486 Z Date ..................� ....��........................., 19.. .. Permission is herebyranted to: V 9 _ ............. .................... &c1z*?c f......:! /l�Z.l............ to ........��......... 11....:. ::.....r . :.. ... ....� :- . ....................................................... �.L S............................................................................. at premises located at .... ..v..f1.-- .1/�:....,� J,/.G'.Yl/. ............. .......................................................................:� V�. j............................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ...LOP............ Block ...LVIF......... Lot No. .... .. e4 pursuant to application dated ...... 7......1, ........................... 19..7?.., and approved by the Building Inspector. FeeDLO...... ... ...... ..:g- . ............................�dinInspector I Rev. 6/30/80 BOARD OF HEALTH FORM NO. 1 3 SETS .OF PL,1:1S . TOWN OF SOU SURVEY . . . . . . FMAY13l996 p � THOLD • • - • . . . . . . . . . . . . . . BUILDING DEPARTMENT CtlliCl: . . . . . . _ . _ . . . . . • . _ . TOWN HALL SEPTIC FOR.I BLDG.DEPT. SOUTHOLD, N.Y. 11971 - • - d TN OF SOUTHOLD _ _OW -,.-.•. TEL.. 765-1802 z:aT I F f 19 CALL . I . . . . � Examined . . (Q�= S:�� . . . . . . j. ' . . ., M A I L TO : . . . Approved . . . . . . . . .�/4 . ., 19�. Permit No. � � . . . . . . _ . . . . . . . . . . . . Disapproved,a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . / (Bui di In pector) APPLICATION FOR BUILDING PERMIT Date �Ct;e /v . . . . ., . 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 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 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 necess�inspections. (Signa t ure 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 . . . . /. . . ... . . . ;. . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) . If appli ant is a corporation, signature of duly u orized officer.' CL- (Name and title of corporate officer) Builder's License No. :� IG(•�, , , . Plumber's License No. , , , • • , Electrician's License No. . . . , . . Other Trade's License No. 1. Location of land on which proposed work will be done. 1Iausc Number Street Hamlet County Tax Map No. 1000 Section . . : . , . . , ,. , , . Block . . '� . . . . . . . . . . . Lot_ Subdivision . .': rL' ! (-:(. .' �`1Oi2 . . . . . . . . . . . . . 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 ., , • , , , . . • . . . . . . . . . . . . . • • • . • . • • . . b. Intended use and occupancy . . . . �-�-(�Ci � - . • . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . : . . Addition Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . Alteration Demolition , , , , . • • • , , , , Other Work .L,06LJ . , , , , 4. Estimated Cost . . . . d (Description) . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . ....... . ... . . . . . . . . . . . (to be paid on:filing;thiswapplication) S. If dwelling _ - b,number of dwelling units . .. . � -----` If garage, number ' ' ' ' ' ' • • • • • . Number of dwelling units on each floor . . . . . . . of cars . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occu anc. • • . . . . . . . c " p ' " " " " " " • • • • • • • • - p y, specify nature and extent of•each type of use . . . . . 7. Dimensions of existing structures,if any: Front . ' ' . ' ' ' . Height . . . . . . . . . Rear . . ... . . . . . . . . . . Depth.. . . . . . . . . .. . . . . . Number of Stories Dimensions of same structure with alterations or additions: Front • • • • • ' ' ' ' ' ' ' ' Depth . • . . . . . Height . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . • • ' ' ' ' Number of Stories . . . . . . . . . • , , , , • • • • Height . . . Rear . ... . . ... . . . . . . . . Depth . • . . . . . Number of Stories 9. Size of lot:.Front . . . . . . . . . . . . . . .: Rear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase • � " " " " • • • ; • • • • • • • • Depth . . . . . . . . . . . 11. Zone or use district in which premises are•situated , ' ' Name of Former Owner . . . : . . . . . . . . . . . . . . . • - • , , , , , .12. Does proposed construction violate any zoning law, ordinance or.regulation:• . • • • • . . . • . . . • . . . .13. Will lot be regraded , n ��,, . • • n. ... . . • • • • •. • • • • . . . . . • . . . 14. Name of Owner ... '.' ' • ' • • • • Will excess fill be removed from p�e ;o-7(1h Yes 0 of premises .�:-� 47Cii;s, , . Address . (r�4s� ��L' rt• o Name of Architect o�bi d- �• • � •t �..: C '� o + sz;� ? !fir :t's�Sc7.� � C:�. . .Address lJq , Cr✓,,ff; (�f�i�� on �3 Name of Contractor A01�n. ,/ • o. . 15. ' Is this property • • • • • • Addresst�lJfrt��one No. .?iUJ:lJy',• ,P P y within 300 feet of a tidal wetland? *yes. . . . . . . . 3'*If yes,' Southold Town Trustees Permit may. .be required. No. . . . ... . . • 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. \ STATE OF NEKYQRK :OUNTY OF .Ji,?I�c , • .s.s r . . . . . . . . .. . beingduly deposes(Name of individual signing contract) • • sworn, p and says that he is the applicant hove named. . � � • le is the . . . . . . . . . . . . . . . . . . . . .C-v�1o�(-cs- c (Contractor, agent, corporate officer, etc.) . • • • • • . • . . • • • . ' ' ' ' f said owner or owners, and is duly authorized to perform or have performed the said work and 'to inake and file • • )plication;.that all statements contained in this application are true to the best of his knowledge and belief;and that he ork will be performed in the manner set forth in the application filed therewith. Morn to before me this . . . L .S�k:, . . . . . .day of. . . . 19 otary Public, . :. . ! . . . . . . . . . . .\. . . . . . County LINDA J.CC0PI:EB . . . . . . . . . •�/ Notary Public,State of New York- No (Signature of applicant) • • • .4822563,Suf$blk County b Term Expires-Decawber St.19 I ,