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Home My WebLink About15984-z FO~.~ NO. 2 TOWN 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) N~ 15984 Z Permission is hereby granted to: ....~...~.....~..~...! ................................................ at premises located at ../,...,~,,.~...,~.,.,~,,.......,,~., ,.~.. ,.~,.t ........ ~,~ ..~.,. .............. County Tc~x Mop No. 1000 Section ...... ,/..~....O.. ....... Block ....... .~..~1 ...... Lot No...,.'~.~. ......... pursuant to application dated ....... ~.....~ ................. , 19.~..7.., and approved by the Budding Inspector. Fee Rev. 6/30/80 Examined Approved Disapproved a/c BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORMNO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ~9~.. .[( ..,1987 ...~. II ,19'1~9 PermitNo (Building Inspector) APPLICATION FO~ NOTIFY CALL ................ MAIL TO: Date ~FZ'/ ~¢ , 19 INSTRUCTIONS a Tbas application must be completely filled m by typewriter or in ink and submitted to the Buddmg Inspector, wi; sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showmg location of lot and of bmldmgs on premises, relationship to adjmnmg premises or pubhc str or areas, and giving a detmled descnphon of layout of property must be drawn on the diagram wh,ch m part of this cation. c The work covered by ttus application may not be commenced before issuance of Budding Permit d. Upon approval of this apphcatlon, the Building Inspector will issued a Budding Permit to the apphcant Such pet shall be kept on the premises avaL!able for inspection throughout the work. e. No buddmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa shall have been granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btaldlng Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buddmgs, additions or alterations, or for removal or demolition, as hereto descnl The applicant agrees to comply with all apphcable laws, ordinances, buddmg code, housing code, and regulations, an, admit authorized mspectors on premises and m braiding for necessary. (Signature of apphc~(t, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or built . . ........ ................. Nme of owner of prem,ses ~b~ ~r~O~3 ' (as on the tax ;ol1 If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No. ~'~'~ [. ~-- . Plumber's License No Electrician's License No Other Trade's License No. Location of land on which proposed work will be done. llouse Number Street Hamlet ..... Lot . 2~5:>. Subdzv~sion Flied Map No Lot (Name) State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy b Intended use and occupancy Nature of work (check which applicable) New Budding .... Add~tlon Repmr .... Removal ....... Demolition . .. 4. Est,mated Cost 10. 11 I2. 13 14 If dwelling, number of dwelhng units If garage, number of cars ... · . Alteration · Other Work. ~-dJ31:SW_~ (Description) ........ Fee '~2-~.. OD (to be prod on filing this apphcation) ..... Number of dwelling umts on each floor .......... 6 If business, commercial or m,xed occupancy, spec,fy nature and extent of each type of use 7. D~mensmns of exlst,ng structures, if any Front Height .. Number of Stones Dnnensmns of same structure w,th alteratmns or add~tlons Front Depth ...... Height .... 8 Dwnens~ons of entire new construct,on Front ..... Height ..... Number of Stones ... S~zeoflot Front .. ~.~q-/ ..... Rear .. .~.~.. f Date of Purchase ..... Name of Former Owner Rear ........... Depth ..... ........ Rear .. · Number of Stones ............. Rear ......... Depth ......... 15. Is this property located wzthin 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLO~F DI AG RAM Zone or use dmtnct m wh~h premmes are situated .................................. Does proposed construct,on v~olate any zomng law, ordinance or regulation . ~.~ W~I1 lot be regraded Will excess fill be removed from premmes Yes No Nmme of Owner of pr;mlses' .~bler.~ i~.~.~. Address .~L)~O~v~07 ,q¢.'/'{..... Phone No .eq.~- .~'~./..t~... Name of Arclntect ........ Address .......... Phone No .......... Name of Contractor ........ Address ............ Phone No ......... No ..... Locate clearly and d,sttnctly all buddings, whether ex,sting or proposed, and ,ndicate all set-back dtmensmns from vroperty braes G,ve street and block number or descnptmn according to deed, and show street names and indicate whether tntenor or C~rner lot ~'~" / ~TATE OF NEW YORK, 2OUNTY OF SS (Name of,nd~wdual slgmng contract) ~bove named ? ,,%,%xg being duly sworn, deposes and says that he ~s the applicant {e is the (Contractor, agent, corporate officer, etc.) >f sa,d owner or owners, and is duly authorized to perform or have performed the said ~ a~a~to'make and file ttus ~pphcatmn; that all statements conta,ned tn thxs apphcation are true to the best of...h4s knowledge and be, her; and that the ~ork will be performed in the manner set forth tn the apphcat~on filed therewith./ ,worn to before me thru ......... ,~O..... dayof . ~ ....... 190Y.~ qotaryeubhc,. ~[~-~... ~' ..D~-~f..~.... County .#0~..~ ~*~ ..0I~.~ / (S,gnature of apphcant)