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Home My WebLink About15898-zTOWN 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 15898 Z County Tax Map No. '1000 Section ..... ,~...0,..~ ......... Block ...... ..~....,~ ........ Lot No ...... .~,.~. ........... pursuant to application dated ..... .~.......~. .................... , 19.?....'1., and approved by the Budding Inspector. Fee $..~..:...~.... ..... Building Inspector Rev. 6/30/80 TOW' ,' t ~ "~ i Examined .~.. k ~-. Approved ~ ~" Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180;~ , 19,%q. , 19,3~ Permit No. I~'-. g~g~. B~ARD OF HEALTH 3 SETS OF PLANS SURVEY .......... CHECK .......... SEPTIC FORM NOTIFY CALL .... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . ./~/ 7. BLDG t)EffT TOWN, ,,OF,, SOUTHOLD .......... 19q.) INSTRUCTIONS a. Tins apphcatlon must be completely filled m by typewnter or in ink and submitted to the Budding Inspector, with 2 sets of plans, accurate plot plan to scale Fee accor&ng to schedule b. Plot plan showmg location of lot and of buddings on premises, relahonsinp to adjoining premises or pubhc street- or areas, and g~vmg a detaded descnphon of layout of property must be drawn on the diagram wtuch is part of this apph cation. c. The work covered by tins apphcat~on may not be commenced before issuance of Buddmg Permit d Upon approval of this application, the Building Inspector will issued a Budding Permit to the applicant Such perml~ shaH be kept on the premises available for mspectmn throughout the work e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc3 shall have been granted by the Bmld~ng Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buddings, addatlons or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and t, admit authorized inspectors on premises and in budding for necessary mspectmns. (Signature of applicant, or name, Ifa corporation) (Mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... Name of owner of premises . £.y. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corpprate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ...... Plumber's License No Electrician's License No Other Trade's License No ...... Location of land on winch proposed work will be done ..................................... House Number Street Hamlet County Tax Map No 1000Secnon IoI,.-/." l] mock ........ Lot ............ Sub&wmon .. Filed Map No .... Lot ...... , (Na~e) State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy ' O (~ ~ l ~-./'~ ....................... I b. Intended use and occupancy .. ---~ ~ fk.O C/ ~ ~ L4-:C, ."~.v~7. f~.J~..~,~, .. 3. Nature of work (check whxch apphcable) New Buddtng .. . Add}B/on ...... Alteratmn Repmr ..... Removal .... Demohnon . .//5, . . Oth~r,}¥?!~ ....... ~kl.~---~,e, --,, ,.-,'~ ' ~ '~ ~ ~ (Description) 4 EstlmatedCost . ....... Fee ..... .~.~72/~.~.~.....'Ou.:.~.~. ...... ~ ' (to be prod on filing thru apphcahon) 5. If dwelhng, number of dwelhng units. ] Number of dwelhng umts on each floor If garage, number of cars ........................................... 6 If business, commercml or m~x~d occupancy, specify nature and extent of each type of use .......... 7. Danenmo~ qfemstmg structu/es, xfany Front .... ~, 2.-... Rear .~..~D_.~ ...... Depth ......... He~gl~t ~. ...... Number of Stones ........................... Dwaenmons of same structure w~th alteratmns or add~tmns Front ......... Rear ............... 10. I1. 12. 13 [4 Depth .......... ,. Height . Dm~ensmns of enhre new constructmn Front Height .......... Number of Stones S~ze of lot Front ; ...... Date of Purchase ..... ~ ..... · .. Number of Stones ......... ...... Rear ........... Depth ......... Rear .......... Depth ................ ..... Name of Former Owner ................. Zone or use district in which premises are situated ......................................... Does proposed construction wolate any zomng law, ordinance or regulat~on' . ........................ Wall lot be regraded . .. I ............. ~. Wall excess~fill be removed from premmes Yes flq~ NameofOwnerofprem~ses /~/k37 ~.~{X.~'~CS~/1JAddress ..~.~/~4~r .... PhoneNo .-7.5.c/ Name of Architect ........... Address ............. Phone No ........... Name of Contractor .... , ............... Address ............. Phone No .............. LS. Is th~s property located wzthzn 300 feet of a tidal wetland? *Yes .... No .~ . *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and d~stmctly all buildings, whether exmtmg or proposed, and mdxcate all set-back drrnens~ons from ~roperty hnes G~¥e street and bloc~number or desc_np~on according to deed, and show street names and ~ndmate whether ntenororcornerlot ~ ~ -- /~&~t-k'~ ~ ;TATE OF NEW YORK, ~'OUNTY OF. S S (Name of ~ndlwdual mgmng contract) bove named · being duly sworn, deposes and says that he ~s the apphcant {em the ...... (Contractor, agent, corporate officer, otc ) ~f said owner or ownem, and m duly authorized to perform or have performed the smd work and to make and file ttus pphcahon, that all statements contamed in thru apphcatmn are true to the best ofh~s knowledge and behef, and that the york will be perfonned m the manner set forth in the apphcatmn filed therewith. ;worn to before me th~s ........ ,*otaryPubhc, ..~ '~., ~..V