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Home My WebLink About15475-z FOR,~ NO. J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P ER/',A.I T CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~'I'ION OF' THE WORK AUTHORIZED) N9 15475 Z Permission ,s hereby granted to' .'.m ~.~_...~..,~ .~ ..... c~..~~....%..!./...'r.'u. ........... Lso ~ c~. ....... .~..~.¢ ............... .~._. ..... ~ ......................................................... at prem,ses located at ....3..)..~..~......~...~.........~'~.:..~.~ ............................ County Tax Map No 1000 Sect,on C)")..O.. Block . C).i ......... Lot No...~ ~ ....... pursuont to apphcation dated . ...~....~ ..~l~...~.g ........ , 19~(~, and approved by the Budding Inspector ~ee,.~'..~. Building Inspector ,Rev ,5/3O/BO Exam,ned ~'~OAtt~. ~. , 19~.~ Approved Dtsapproved a/c ........ 'FORM NO. 1 TO~'~'N/~[~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL . 765-1802 , 19~' Permit No).~. ¢7~.~;. APPLICATION FOR BUILDING PERMIT Received ........... Date .... 19. INSTRUCTIONS a Tius apphcat,on must be completely filled in by typewriter or in mk and submitted to the Building Inspector, wltl 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 stre. · or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this ap~ · cation. c The work covered by tins application may not be commenced before issuance of Build,ng Perm,t. d Upon approval of tlus apphcahon, the Braiding Inspector wJll issued a Budding Permit to the apphcant Such peru shall be kept on the premises avatlable for inspection throughout the work. e. No buddmg shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan, ' shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the tssuance of a Bmldmg Permit pursuant to tl Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of bmldmgs, addibons or alterations, or for removal or demohtion, as hereto describe, The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and ~ - aflm~t authorized inspectors on premises and m bmldmg for necessary inspections 7,,: . ........ (S~gnatdre of a~hcant, or name, if a corporation) (Marling address of applicant) State whether applicant is owner, lessee, agent, arch,tect, en~neer, general contractor, electrician, plumber or bmldm · Nmne of owner ofpremmes ............ (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's License No .. Plumber's License No Electrician s License No ......... Location of land on which proposed work w/Il be done ..... / . Ho~ Street Hamlet '" County Tax Map No 1000 Section ?.O .. Block . .~ ....... Lot. '? ....... Subd~vm~on .. Filed Map No . Lot (Name) State emstmg use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy ~ ........... . .: . b. Intended use and occupancy ................... 3. Nature of work (check wluch applicable) New Building .. . Addition ........ Alteratzon ...... Repa~ ~.~ &~/~, ~ ~ (Des~pt~on) .... ' ..... ,d Removal ........ ~emohtmn .............. Other Work . . 4. Est~atedCost .~ ............................ Fee &~" (to be prod on filing this apphcation) 5. If dwelhng, number of dwe~ng umts ........ Number of dwelhng umts on each floor ........ If garage, number of c~s ........ 6. If bus~ness, commercial or m~ed occupancy, specify nature ~d extent of each type of use ................ 7. D~ensmns of ex~stmg structures, if any. Front ............. Re~ ....... Depth Height ....... Number of Stones... D~ensmns of s~e structure with alterahons or ad&tmns Front .......... Rear .............. Dep~ .............. He~t ............... Number of Stones .................. 8. D~ensmns of entire new construction Front .......... Rear ............ Depth ........... ~ht Number of gtn~e~ S~ze of lot Front .......... Re~ ................... Depth .................. Date of Purchase .................... N~e of Foyer Owner ................ Zone or use &strict ~n which premises are situated ........................... Does proposed const~ctmn v~olate any zomng law, or&nance or regulation' . .......... W~I lot be regraded ...................... W~ excess fill be removed from premises Yes [ N~e of Owner of premises .......... Address ................. Phone No ............ N~e of ~ch~tect ........... Address ................. Phone No .......... N~e of Contractor ................. Address ................. Phone No ............ 10 11 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether existing or proposed, and. indicate all set-back danenslons property hnes. Give street and block number or descnphon according to deed, and show street names and indicate whetl interior or comer lot. COUNTY OF ........... S.S ............ . . ._~.~v.'- . .-v-~.~.~uly sworn, dey that he IS the applic (Name ofind~wd~g contract) ~ above named.~ ~ "~ He zs the .......................... .'~ ......... -"x, · - - (Contractor~porate officer, etc.) of smd owner or owners, and ~s duly authorized to ~rformed the smd work"~ to make and flight apphcatmn, that all statements contained m this application are true to the best of h~s knowledge a~lxbelief, and that work will be performed In the manner set forth m the application filed therewith. Sworn to before me this .... ~.. . dayof.....~'~.. ...... ,19~--~.. ..................· . NOTARY PUt~LIG, State of NOw York ....... No 4707818, Suffolk County,p?? (Siin~-tureN~ f apphce I~n~ E~tes [~h 30, 19 o. r