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Home My WebLink About15934-z FOBM NO. ~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT N_O (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLET ON OF THE WORK AUTHORIZED) 15934 Z ~t, ............. ~...~. ............. , ~9.~..7. County Tax Map No. tO00 Section .I......C~...~...~.. ....... Block ....... ,.~...~ ....... Lot No ..... I .~..:...J ....... approved by the pursuant ,o application dated ... ~ ....... i....j .............. , 19.~[.J.., and Budding Inspector. Building Inspector Rev. 6/30/80 iNDIAN NECK ROAD ' O0 "~ LOT 28 160.98' LOT 50 LOT 32 MAP OF t70.00 ?~ ' ~ LOT~4 "-' CO~ft~V~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..~...~..~..., 19 .'~... Permit No.l.~..$-~..~.. Disapproved a/c ..................................... .............................. ' APPLICATION FOR BUILDING PERMIT Date ................... 19.. ' ~ INSTRUCTIONS a, Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street or areas, and giving a detailed descript!on of layout of property must be drawn on the diagram which is part of th~s apph 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 Inspec{or will issued a Building Permit to the applicant. SUCh permi 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 Occupancl 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 tt admit authorized inspectors on premises and in building for necessary inspections. ii'WIN FORK FENCE COMPANY ~vwa m~, I'ENCE COMPANY (Signatt~r~,af am;dicaat, or name, if a corporation) P0 Box 476 . N~h Paa I ......... P0. B~x.4Z6 ... ~ ~a~ .............. Mathtuck, NY ' ', ' ~atbtuck, NY 11952 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the t~ roll or latest deedS' .~ If applicant is a~orporat~on, signature of duly authorized officer. (Name and tit eot co.orate officer) NOTI~ 765 1~2 Builder's License No ....... ~ ......... OW'N6 ~O~ oou~r:L Plumber's License No ROuG~ 3 INSOL~TtOr ' Electrician's License No ....................... 4 g~&b[ C¢ ,-,a~i~C~ ~. ~ N4UST Other Trade's License No ...................... '* · ~C CCr 1. Locahon of land o~ winch proposed work will be done ............ ~T~ ' ' '~ .... ~U~ 'iO~'~e'~ ~ ~R. lIouse Number ' Street Hamlet County Tax Map No. 1000 Section..0~, .0.~..,.... Block .~,. ~ ......... Lot Subdwision ..................................... Filed Map No ............... Lot ........... '(Name) 2 Slate existing use and occupancy of premises and intended rise and occupancy of proposed construction: b. Intended us~ and occupancy ..... ~ ~ ................................................ '"3 Nature of work (check which applicable): New Budding .......... Addition .......... Alteration ........ Repmr ........... Removal .............. Demolition ............. Other Work..-~E'.'.2.(-~ .... 4d~;~ ~'/00 .'.'.~.~. ',~ ~).0. (Description) 4 Estimated Cost ..................................... Fee .................................. ~¢_.~ ~1 ~ ~ (to be paid on filing 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. Dimensions of existing structures, If any. Front .............. Rear .............. Depth,. ............ tleight ............... Number of Stones .................................................... Dnnenmons of same structure with alterations or additions Front ................ Rear ............... Depth ..................... Height ..................... Number of Stones .................... 8. Dmmnsions of entire new construction: Front ............. Rear ............... Depth ........... lleight ............. Number of Stones ..................................................... 9. Size of lot: Front . .7 ........ ;.: ........ Rear ..... ': ................ Depth .................. '.. 10. Date of Purchase ............................. Name of Former Owner .......................... 11. Zone or use district in whmh premises are situated .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................... ~.. 13. Will lot be regraded ....... ,: ................... kT..L.^ Will excess fill be removed from premises: Yes i 14. Name of Owner of premises to'rcCtI&.~/.~ .... Address qo..,7 ~/~'./J'.,~40(~.¢.. Phone No. Name of Architect .~......~ .................. Address .... ~..~.(~,p/./,-~Phone No Name of Contractor /6t?7.rl'/'O(/.d.~.,~Et.~ff...~O. .... Address .~9, ~.0~, .~.'O..A~, .Phone No.~.~.q~.. ~..T~'... ...... * Yes ..... No ..... 15. Is this property located withinl00 feet of a tidal wetland? * If yes, Southold Town Trustees Permitmay be required. PLOT DIAG1L~.M Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fr, property lines. Give street and block number or descnption according to deed, and show street names and indicate whetl interior or corner lot. ~ .. STATE OF NEW YORK, S S COUNTY ~F . .- ¢ .................. ......~. ................... being duly sworn, deposes and says that tie is the apphc (Name of ln&vldual signing contract) above named. lie ,s the .......... .......................................................... _(Contractor, agent, corporate officer, etc.) of said owner or owners, and m duly authorized to perform or have performed the said work and to make and file apphcahon; that all statements contained in tins application are true to the best of lm knowledge and belief; and that work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .~, ,~,z'~ Notary Pul>hc,_ . .......... ~.~. ........... 19 ..... Cotmty UNDA d COOPER Notary Public, State of New Yo T~Ym°c48,22563, Suffolk Count__ ~o ,~ o~=e.,~,.~ 3, tg}~- (S~gnature of apphc;