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Home My WebLink About15808-z FORI~ NO. I~ TOWN OF SOUTHOLD BUlL,DING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 15808 Z Permission is hereby granted to: , __ ~ __ ~ .~.:.., ...-l.!..~ ] I O.~,~"[r-.~_¢- ,-/- ~ ,, ,~ ~ ~0 ~ ...~... ro ................................................................................ ] ....... O'~ ................ ~ ......... -/ ~_~ ~ ~ ~ ~ ~. at premises I~ated Ot ~ ~....~. .................... ~ ......... ~. ...................... ~ ................. ................................................................................................ Co~ ,~ ~p uo. moo s,~,o~ ....... ~_~.~.... ~k ...... ~..~ ......... to~ ~o ..... ~.b..~ ........ tO opplicotion dated .~.~.~...s~...~. ............. , 19.~...'7., pursuant / Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180~3 Approved /~. V , 19~.?. Permit No..I.~...~.?.~. .~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewgiter 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 unt~ 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nece~ary inspections. , - ~q~..~ r.~.x~x....~.~'r ~ ~.-¢-~..~.~,~¢~.S ...... (Signatuye4f applicant, or name,~if~a corporation) · ..................... :: .... · (mailing' a pp ' ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .C~.~.~-~,. [..Co. ~-~.~r.~.C ............. , ................................................ Name of owner of premises ..................... Z~' .... L.' .<& ......... · .~.pp~q~¥1~D. &$ .~t~D ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. NOT~:¥ ~ali ?'lqG ~3~.iPAgTM~T AT (Name and title of corporate officer) '7~'-~3 i80;? v ~'~ -' 'r('~ * P!~ ~OR THE Builder's License No. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No. ......................... ~, ~ ';,~. FHE ~.Y ~, Location of land on which pzoposed work will be don~ ........................ ,, ~ .... '~ ~ ,~(~k.~, ~fi- .... ....... House Number Street Ha le ,000 <tio: . .q.4 ........... J :ot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which appliqable): New Building .......... Addition .. I ....... Alteration .. ~ .... i... Repair .............. Removal ............ Demolition ........... i.. Other Work...?.~r~,~-~. .... Ja : (Description) 4. Estimated Cost ..... C~ ..C~..~ ................... Fee .... ~1[-'~7.,.~. 'O. ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling umts on each floor ................ If garage, number of cars ............................................ i ........................... 6. If business, commercial or mixed occupancy, specify nature and extent of each typ~ of use ..................... 7. Dimensions of existing structures, if any: Fiont ............... Rear .. ...... ~ ...... Depth ........ ' ....... Height ............... Number of Stories ............................ i ........................... Dimensions of same structure with alterations or additions: Front ............ i .... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ........ ~ ...... Depth ............... Height ............... Number of Stories ............................ i ........................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner . J ........................... 11. Zone or use district in which premises are situated ......................... i ........................... 12. Does proposed constructinn violate any zoning law, ordinance or regulation: ....~.,~ ........................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises,. ................... Address ............... i... Phone No ................ Name of Architect ....... ~ ................... Address ............ ' .... ...Phone No ................ 15. Is this property locateh'~withinl,0~ feet of a tidal wetland? * Yes ..... No .~f... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ............ S.S ................................................. being duly sworn, depos.es and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................................................... (Contractor, agent, corporate officer, etc.) ' of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~otary Public .......... . - t£n ~ OE ¥0£ ( I U (Signature of applicant) NOTARY PIJBLIC, §t'~te of New York . No, 4707878, Suffo k lerm Expires March 30, 19 : [