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Home My WebLink About15920-z TOV~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15920 Z Date .......... L.'] .................... 19.~..7. Permission is hereby granted to: t p c:X: t ............................................................. · ............................................ pursuant ,o application dated .......... : ..~... ..........., 19~..]., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6130/80 . FORM NO. 1 TOWN OF SOUTHOLD J BUILDING DEPARTMENT TOWN HALL \\~.,. ..... SOUTHOLO, N,Y. 11(371 TEL.: 765-1803 ...... Exam,ned'(~" .(~.- ]. I.~.., 19~.']. Received ........... ,19.,. Al, proved l.~.., 19~ ~. re~it No../.~.~. ~ Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. ,19... ~ INSTRU~IONS a. This application must be completely filled in by ~pewnter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee acceding to schedule. b. Plot plan showing location of lot and of bmld~gs on promises, relationship to adjoining prdmises or public street- or areas, and giv~g a detailed des~ript{on of layout of property must be d~wn on the diagram whmh ~s pa~ of this appli cotton. c. The work covered by this application may not be commenced before issuance of BulldOg Permit. d. Upon approval of this application, the Braiding Inspecfor wdl ~ued a Building Pe~it to the applicant. Such permi~ shall be kept on the premises avadable for inspection throughout the work. e. No butld~g shall be o~upied or u~d in whole or in part for any purpo~ whatever until a Certificate of Occupanc~ shall have been granted by thc Building Inspector. APPLICATION IS HEREBY MADE to ~e Braiding Dep~tment for the issu~ce of a Building Pe~it pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, O~d~ances Regulations, for the construction of bulldogs, additions or alterahons, or for removM or demohtion, as herein described The apphcant agrees to ~mply with all apphcable laws, ordinances, budding code, housing code, and regulations, and tc admit authorized ~nspectom on premises ~d m bufld~g for necesa~ inspections. (Signature of applicant, or name, if a corporatton) ~ Box 476 · North Roa~ ............ ..., NaA~[~c~, ~ .~a~ ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or I . Name of owner of premises Mrs. ~lores Lyons (as on the tax mil or latest deed) p AOV, O NOT if ap,~ ~~sa corporatign,.(~signatUre, of auly authorized officer. .,T~, " ....... tName .... an'' itil; ;;ggr;[i ......... __e - Budder's License No. 508 %OXt~y ~iLD~tl;3 r)cpA~{T~eNT AT ~htmbe~'s License No ......................... FOU{~ATI~I~ ~'~ff) ~,'O~ I~RED : FOR P(IUR~ [~ Electriman'sL~censeNo. ................,..... ~O~JG~" Other Trade's ~cense No ...................... ~ ~ ' ~¢'' 1. Locahon of land on which proposed work will be done. 'r~n; · ' 1160 To~ Harbor ~e ~ *~ld .... ' ~O~ ~'~; · ~": ' >': .... ~' ' · · Ilouse Number Street ~Aml~ County Tax Map No. 1000 Section .............. Block ............... Lot ................ Subdiv~smn ..................................... Filed Map No ............... Lot ............... j(Name) 2. State existing use and occnpan? of premises and intended nsc and occupancy of proposed construction: S2~Ie F~kly ~eIlzng a, ]:xtStlllg rise and 0cctlpaaey .............................................................. b. Intended use and occupancy ] ........................................................... '"3. Nature of work (check which applicable): New Bmldxng ......... Addition ........ Alteration ...... Repair .............. Removal ............. Demohtion ......... Other Work Fence ~, [ ~.172.00 $25.00 (Description 4. Estmlated Cost ..................................... Fee ................................... ; (to be paid on filing this application) 5. I f dwelhng, number of dwelhng umts ............... Number of dwelhng unlts on each floor If garage, number of cars ..................................................................... 6. If business, commercial or mixed occupancy, spemfy nature and extent of each type of use .................. 7. Dimenslonsofexist~ngstructures, lfany: Front ............... Rear .............. Depth,. ........... lteight ............... Number of Stones .................................................... Dimensions of same structure with alterations or additions. Front ................ Rear ........... Depth ..................... Height ...................... Number of Stories ................... 8. Dunenslons of entire new construction. Front ............. Rear ............... Depth ............ lle~ght ............... Number of Stones ..................................................... 9 Size of lot: Front ~ · ' Rear " Depth ' 10. Date of Purchase ............................. Name of Fenner Owner ........................ I 1. Zone or use district In which premises are situated 12 Does proposed construction violate any zomng law, ordinance or regulation' . ............................ 13. Will lot be regraded ............................ Wall excessfill 14 Name of Owner ofpremises'.D9..19.r.e.8. ,L~.o.n$ .... Address .B?x497-., ................. ruone rio ............. Name of Arclntect ........................... Address . Phone No ..... Name of Contractor Twin york .Fence ..... Address .t~?'476i 15. Is this property located withinl00 feet of a tidal wetland~ a Yea ..... No ..... ~ If yes, Southold Town Trustees Permit may be required. PDOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunensions fro property lines Give street and block number or description according to deed, and show street names and mdmate wbetl~ interior or corner lot STATE OF NEW YORK, S S COUNTY OF ................. ~ob~n E. Car~ being duly sworn, deposes and says that he is the apphca (Name of mdiwdual s~gmng contract) ., above named. tie ~s the ....................... ~ .................................................... ~Contractor, agent, co.orate officer, etc.) of said owner or owne~, ~d is duly authorized to perform or have peffo~ed th~ sa~d work and to m~e and appbcaBon; that all statements contained m tlns apphcatmn are true to thc best of Ins knowledge and beh~f, and that work will be performed m the m~ner set forth m the apphcatmn filed therewith. Swo.~ to before me this ...................... day of ..................... 19... (Signature of apphca