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Home My WebLink About15985-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, H. Y. BUILDING FERMIT (THIS PEt~/dT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15985 Z Permission is hereby granted to: ('~ /~ {~ ~..~.....~..,..~.~..~.:..~:.. .....~....?..~..~.]..~ ............................................... ~o~ .................. .~ ........................................ Building Inspector, Fee $...~....:..:~.. Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN oF SOUT.OLD 270 -- 7 7'7 BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ][ .... 19~.1. .]2 ....19~.~.Permit No ) ~..9 J'~ ~ Approved . Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, with 3 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 deseript!on of layout of property must be drawn on the diagram which is part of this appli 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 Inspector will issued a Buildmg Permit to the applicant. Such permH 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 Occupancy 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 m 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 tc admit authorized inspeetora on premises and in building for necessary inspections. If applican.t i)L~corporation, signature of duly authorized officer. (Nam'~and tide of corporate officer) 508 Budder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... (Signature of applicant, or name, if a corporation) TWIN FORK yE.N.C.[ PO Box 476 - North Road ........... ~t~t¢~..N~ ~ ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or I . Agent Hayes Name of owner of premises ........................... ? ..... ~- .... .'~. ........... (as on the tax roll or latest deed) -, ':,TE ..... -- G,P __ _ - 76'5 1802 q h~ 1'(, *~ ':~'1 ,¢0~ THE. Olher Trade's ~cense No ...................... - TR~ ~QLtt[~?-~l~, 'b OF I ~IF N Y I. Location of land on winch proposed wprk will be done ................. ~. NtiS. ~1~')[%[ Y. [~ ..... 645 ~y H~ Road .~'~,,,ST~U.,,., llouse Number Street ', ', , Hamlet ...... ....... .... ......... . ......... Sub&v~sion ..................................... Fried Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: Single Family Dwelling a. Existing u~e a.d occupancy .................................................................... "3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratlcl~qe~-~..~.,.,~ . Repair ........... Removal .............. Demolition .............. Other Work ............ $639.50 $25.00 (Description 4. Estimated Cost ................................... Fee .................................. (to be paid on filing this application) 5. If dwelhng, number of dwelhng umts .............. Number of dwelhng units on each floor ............ If garage, numb~ ~ Viii ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............... 7. Dnnenmons of existing structures, lfany: Front .......... ... . Rear ......... ... . . Depth'. ....... .. .. Height ............... Number of Stones .................................................. Dunensions of same structure with alterations or additions. Front ................ Rear ................ Depth ...................... lteigbt ..................... Number of Stories .................... 8. Dimensions of entire new construction: Front .............. Rear .............. Depth ............ lleight ............... Number of Stories ...................................................... .... ;.: .... Rear... ': ........... Depth 9. Sizeoflot Front ..7 ............. 10. Date of Purchase ............................. Name of Former Owner ....................... 11. Zone or use district in which premises are situated ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation' . ............................ 13. ' Will lot be regraded ............................ Will excess fill be removedt, from premises: Yes 14. Name of Owner of prem,se~.~.C.FeI~.nYe~,s ......... Address .g~).5x. ~[.,.H~.~_.~k. Phone No. ~.~7 .~... Name of Arcluteet .'~!i.rl... :k, ................. Address ................... Phone No .... 7 ....... Name of Contractor ......................... Address ................... Phone No .............. 15. Is this property located withinl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dhnensions fr,_- property lines Give street and block number or description according to deed, and show street names and indicate whetl' interior or corner lot. (Name of individual signing contract) , above named. Agen~ tlc is tim ..................................................................................... (.Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file apphcat~on; that all statements contained in tins apphcatton are true to the best of Ins knowledge and belief, and that work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Sa a ..................... d yof .... ......... ,19 Notary I ttbhc ..... /-',---~--~ .' ~ · .......t.-: ......... County N~ 4707818, %a ,I, Loun~ q Tram ~O~t~ March 30, 19 ~,/ ., ~5,~r.2H,)t ££P.5 AVE - BI2ONX~.N.,Y. 1.0z~75 r",~: ?-JSZ4 t Sq.rr. , , DEE~. Ll~E~r~q'?.~ [;A~SESGi i!u '.,