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Home My WebLink About15809-z l~OB3~ NO. ~ TOWN 01: $OUTHOI.D BUILDING DEPARTMENT TOWH HAIL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 15809 Z Permission is hereby granted to: , ~ ~ . ~,...~. ~-~ ...;~.~...~.~ ............ .q ................... ...~....o..~..~>..~..- -- ~. ................................................. ~~ ...... ~:.~.:...L~Y...~ ........ ~ ~-~ ,o ..~.~.~.~...~.~......~.....~~....~ ........... ............ : ................................. ~ ......................................................................... ~. ...... ;..~.~ County Tox Mop No. 1000 Section ..... .(~.~. ...... Block ..... ..~ ............. Lot No ........................ pursuant to application dated ..... ...~.~.....~..~. .............. 19.~...~..., and approved by the Building Inspector. Fee $ ..................... Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 \ TEL.: 765-1802 Examined. ,.~.~,,M~. ~ ~.., 19 ~. Approved . .~.O~ .~.~., 19~. .~. Permit No. ~ .~.-.~. ~.~...~. Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary~ inspec~tions~ ~.~.~-.'cd.m .¢.n o.c ~...~.~.~'~3 ........... (Signatur,~of applicant, or agllne, if a corporation) ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'~,'~x- ~ I... C0'..~.1 .r..~r=.~. o ..~. ........................................................... Name of owner of premises (as on the tax roll o~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . 7~fi-1~2 ~ ~ ~'~ 1t¢ a ¢~ ~)B THE ALL CONTRACTOR'S NUST BE SUFFOLK COUNTY LICENSED Builder's License N6 .... ] ~ ~...~7 .... ~ ] · .~ FO~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location~of land on which proposed work will be done ................ ~;~4 F~'t,' tlI~;~T~C;~:~t~'' q~O~ .... .q0 ....................................... ~ a=~. ~-~ ~ :~ ........... House NumbeY ~ ...... Street Hamlet County Tax Map No. 1000 Section .... ~.~ ........ Block ....~ ............ Lot. J. [. j ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .O. ~-.o..~ c. ~r~..~., ~ ~ ~ g...~ .~.o..). ....................... b. n en ed and occupancy 3. Nature of work (check which applicable): New Building ..... ' ..... Addition...: ....... Altera~ ... ....... Repair .............. Removal: ............. Demolition ......... .- ,.. Other Work. (Description) 4. Estimated Cost ...... ~).~.'~.t,_~. O. ...................... Fee ....... .~..~'~.: .C~.. ~ .................... ~ (to be p~id on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units 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: Front ............... Rear ........ i ...... Depth ............... Height ............... Number of Stories ............................. i ........................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...... ' ................ Number of Stories .... . .................. $. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ............................. ! ........................... 9. Size of lot: Front ...................... Rear ...................... Depth ........... 10. Date of Purchase Name of Former Owner . ,. 1 1. Zone or use district in which premises are situated .......................... i .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..['Q.q~ ......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. NmneName of°f ArchitectOwner of premises ....... ~ .{D.~ ~-$.~.% I 1. AddressAddress .......... ~]? ?- .m.~. ~. ~.~.'Pttonei'..Phone. No..~) .q .Q.x .0.~/~. No ~ ....... . .................. ...... 'd;~' ................ Nmne of Contractor~2~,:,~;,¥ .~,~r~,-~.~t~; Address ~>~:~.,,~ .~: ~.~..o.~T~.*.Jl~one No. ")~ o~..: 15. Is this property located~within 30~feet of a tidal wetland? *Yes'. .... No~... *If yes, Southold Town Trustees Permit mag be required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. ind{cate all set-back dimensions from )roperty lines. Give street and block number or description according to deed, and show 'street names and indicate whether nterior or corner lot. iTATE OF NEW YORK, ~OUNTY OF.. S.S ................................................. being duly sworn, deposes and says that (Name of individual signing contract) tbove named. he is the applicant te is the .............................................................. ~ ............ ... ............... (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this .pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. ;worn to before me this ............. ~ ~.. ....... day of ........ ~/~. · · .~....., 19 ,rotary Public, ~ . .~.'..~.'~'.~..~.. .............. County ~t[~ ~ 0£ ¥o~ (Signature of applicant) NOTARy PUfLIC, ~tate of ~low York No, 4707878, Suffolk ~oonty~.- Term Expires March 30, 19__.~.~