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Home My WebLink About15660-z ~'o~ NO. o TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 15660 Z Date .... ~~....~ .......... , Permission is hereby g~nted to: 0 /~ //~ ,~ , ' ~ ~v. , ~/~.~.__ ~_ ~.~ .............. ..V. .............. ~....; %_ ........ ....... ............ W ................................................................. ;.... -...;~ ........... ; ..... ~--~...~.;.....~....~ ............... f .... Ot premi,es located ot ..~.. ~.~...~..~........~.../.~.......~......~....~....~.~.......~'..~....e:~... .... ond approved by the pursuant to application dated ......~.(:~t~t~......~......~. c[~ ~ ......... , 19.?.....~,<~1 Budding Inspector. Fee $../....~....:...~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.. 765-1803 Approved ~-~'~ , i9~. Permit No ! ~'.~ D~sapproved a/c ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. Date INSTRUCTIONS a. Tlus appbcatlon must be .completely filled in by typewriter or in mk and submitted to the Building Inspector, wxtl sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buildings on premises, relat~onstup to adjoining premises or pubhc stm. or areas, and g~vmg a detmled descnptmn of layout of property must be drawn on the d~agram whtch ~s part of this ap! cation. c. The work covered by tki~ application may not be commenced before ~ssuance of Bufldmg Permit d. Upon approval of th~s application, the Building Inspector will ~ssued a Building Permit to the apphcant Such perr shall be kept on the premises available for mspectmn throughout the work e. No building shall be occfip~ed or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBYi MADE to the Building Dep~rtment for the ~ssuance of a Bmld~ng Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmances Regulahons, for the construction of buildings, add~hons or alterations, or for removal or demohtmn, as herem describ. The apphcant agrees to complylwlth all applicable laws, ordinances, bufldmg code, housing code, and regulabons, and admit authorized ~nspectors on premises and in bmldmg for necessary mspecbons (Signature of apphg~nt, or no. me, ~f a corporation) State whether applicant ~s owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or build~ If applicant is a corporanon, signature of duly authorized officer deed) 2 (Name and title of corporate officer) Budder's, License No .~Xq,X . Plumbers ~lcense No XX,X. Electnclan s,L~cense No xX,,X Other Trade s klcense No XX. Location of land on Winch proposed work wdl be done ftouse Number Street County Tax Map No 1000 Section (~'~ ~ Subdlv~smn .... (Name) Hamlet Bloc Lot q 0, Filed Map No Lot State ex~shng use and occupancy of premises and ~ntended use and occupancy of proposed constructton a Existing use and occupancy ~~ ..... b Intended use and occupancy ' ~~ k,~ ............ 3 Nature of work (check which applicable). New Budding Addition ........ Alteration .. Repmr .,~.~. ~.. . Removal ..... Demohtlon ........... Other Work ............ I (Description) 4. EstnnatedCost .. ! ....................... Fee .................................. , (to be prod on f'fling 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 type of use ............. 7. Dnnenslons of ex~sting structures, if any. Front ...... Rear ......... Depth ........... Height ............ Number of Stones .......................................... Dimensions of same structure with alterations or additions Front ........ Rear Depth ......... Height .............. Number of Stones ............ g Dimensions of entire new ~onstructmn' Front ..... Rear ........... Depth ............. Height .......... ~ Number of Stones 9. Size of lot Front Rear ............. Depth ................. 10 Date of Purchase ............... Name of Former Owner .................... 11. Zone or use district in whlqh premises are situated ........ 12. Does proposed construction violate any zoning law, ordinance or regulation' . ................ 13. Will lot be regraded .. I ............... Will excess Fill be removed from premises' Yes ~ 14 Name of Owner of premlse~ ........ Address ............. Phone No ...... Name of Architect ............ Address ........... Phone No ........ Name of Contractor .............. Address ............. Phone No .......... 15. Is thzs property located wzthznl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be requmred. PLOT DIAGRA~ Locate clearly and d~stmctly all bmldmgs, whettler existing or proposed, and indicate all set-back dnnenslons fr, property lines Give street and (lock number or descnptmn according to deed, and show street names and indicate whetl intenor or corner lot. &S NOTED ~N~PECT~ONS. ~qAMINC- & ~UMBING SHALL ME~ JOh'STRuc~I~ & ENER~ C(,,~STRuC~ON ~RRORS STATE OF NEW YORK .... COUNTY OF~....~ .,~ . t9 l-'}' a a ~ · ~ above named. ~ ~ ~ He Is the ..... ~ ~m~h~J~ -/ (Contractor, agent, corporate officer, etc ) of sa~d owne~ o~ owners, ~d ~s dui7 anthonz~d to perform or have peffo~d the sa~d work and to m~e and file t apphcatmn, that ~1 statements cont~ed m th~ apphcat~on are true to the best efh~s ~owledge and behef, and that 1 work wdl be perfo~ed In the m~ner set forth ~n the apphcat~on filed therewith Sworn to before ~e th~s Nota~ Pubhc ........... County (Signature of applica