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Home My WebLink About15807-z FO~M ~0. 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~ 15807 Z Permission is hereby granted to: , .......~ ................ .~ ........................... .'...ra.?..~...~,-~,, .~. ................................................. ~~.....~..:~.,......!.L~.z~. ......... C ,o ....... o, prem,ses located at ........................ ~......~.,~..~ ...... ~.....c~........~.. County Tax Map No. 1000 Section ..... C)..~J ......... Block ...... .q~.~. ........ Lot No ...... L.~. .............. pursuant to application dated ..... ..~.~ ........................... , 19.J~.~..., and approved by the Building Inspector. Fee $...~...~...:..~ Building Inspector Rev. 6/30/80 Examined..~..(~q~. ~,.g..., 19 . Approved · .~...&..~.., 19 ~.~. Permit No./.~.'~..~..o..~ BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAlL TO: Disapproved a/c ..................................... 'i : .....................................,.: ........... '!' .. ~,,-~ ;,,., ,~,~%' ,~"' ..... ...... ,ii~~. i,,,· (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ... ~...~ ....... 19 g9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description 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 Building Permit to the applicant. Such permit 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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 c6de, h6using code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~,,,.o ,¢,-,. g-~,~,~-..~ ~,~.T.~:~.~ ~ .......... (Signatu'i~°of applicant, or na~he, if a corporation) i~. o.. rB.~ ~.. ~.~.~;..~ o.~.~. ;., .o .icj. L.~i ~.Y .~ ~ .q..~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .m.o_~ck .. ~D'r~c.c~c:.-r'o. C7 ................................................................. o l. 1 ................................. Name of owner of premises ...... } .....-' "'~' ' '('a~'' 'on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ........ :~--.~f-~ ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done'. ................................................. ........... 3..0.o ..... .... ....... House Number Street Hamlet County Tax Map No. 1000 Section ...... 3. J ........ Block .... ~-. ............ Lot..~ ~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing nse and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... O .~'O. ~-~ ~....~.__ .~ c~ .l..o¥ .~ ~o...-~ .............................. - b. Intended use and occupancy .... o.S. ~cs,~.~.~...[O.~_..~.~.r:~,,~..c,o.v't'Jr~. ~. · 3. Nature of work (check which applicable): New Building' ' Addition ~ ......... Alteration .......... liti ~ Oth ..~ Repair .............. Removal .......... Demo on .............. er Work ~c,a~-~ ...... ~ ~ ~,~ .~ (Description) 4. Estimated Cost ........ .~. ~ ~ ............ Fee ........ ~ .~ ........................ (to ~e paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling ugits on each floor ................ If garage, number of cars .......................................... ~ ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each fype of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ..... ~ ........ Depth ............... Height ............... Number of Stories .......................... ~ ............................. D~ensions'of same structure with alterations or additions: Front .......... ~ ...... Rear ........ .......... Depth ...................... HeiSt ...................... Number 0f Stories ...................... ~'-8. Dimensions of entire new construction: Front .......... . ..... Rear ...... [ ........ Depth ............... Height ............... Number of Sto~es .......................... , ............................. 9 Size of lot: Front Rear ' Depth 10 Date of Purchase Name of Fomer Owner~ 1 1. Zone or use district in which premises are situated ....................... ~ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.m ........................ 13. Will lot be regraded ............................ Wilt ex~ess fill be removed from premises: Yes No 14. Name of Owner of premises ..... ~r ~ l~ ....... Address ...O.l~.~q~ ~hone No. ~ ~.'. ~ ~ ~.~ Nme of Architect ........................... Address .................. ~hone No ................ N~e of Contractor~ ~ ~.~ .~*w.~.~ ~ddress ~~a~J.~Phone No.~.-.~O.~ .~.. 15. Is this property located~ithin 300 ~eet of a tidal wetland? *Yes ..... No ~... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAG~M Locate cle~ly and distinctly ~1 buildings, whether existing or proposed, and. indicate ~1 set-back d~ensions from prope~y Hnes. Give street and block number or description accord~g to deed, and sh~ow street n~es and indicate whether interior or corner lot. STATE OF NEW YORK, S.S ~'r[ CON.BrStlC'rRit¥ & ~NERGY COU~Y OF ................. (Name of individual signing contract) .,., . j above named. ., i He is the (Contractor, agent, corporate officer, etc;.) of said owner or owners, ~d is duly authorized to perform or have performed the~said work and to m~e and file this application; that all statements contained ~ this',application are true to the best of his knowledge and belief; and that the work will be performed in the m~ner set forth in the application filed therewith. Sworn to before me this ' ' .~ ........ day of .... Note, Public ........ ~.. ~% . ~.~ County ....... HELEN K. DE ~E (Signature of applicant) . No. 4707878 Su~lk ~un~c lerm Exp res Msrch 30, 19~