The URL can be used to link to this page

Home My WebLink About15319-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. 6UILDII4G FEKM~T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15319 Z Permission is hereby grante,e~to: ~.~ ,~ ...... ..... ..~..~...~...~.~.~,~ ....... ~ ..................... ...a~....~~.....~.:..~..:. ................. ~ to..~.....~....~..~'.L~.~......~....d~.L.~.~ ....... ****,~.. ........... et premises ,ocoted at ...~.~...?........~....-~..~~...~ .......... '"~'"'"'~"'.'" ............................................ County Tax Mop No. 1000 Section ....... I..!..g ........ B,o~k ..... .O..t~ ........ Lot No....~ ............... approved by the Building Inspector Rev. 6/30/80 ~' GRAVEL ~ M. D, KELLY NOTE* ELEVATION~AREONANASSUMEO~A'FUM. - ................. W~T~R ~tlt~ YE Y FOR /~t FFt~'t.7,~Ic L' VINCENT a RO~l~ ~4RT/N AT NEW SUFFOLK FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approv~,~ .~...21 .~., 19~.~. Permit No./.~...~./.~..~'. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. Tins 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 regulafi~s, and to admit authorized inspectors on premises and in building for necessary inspections. // ' ~Z ·~/7 ............. ....... (Signature of applicant, or nam% if a corporation) ... 31. .4.4. . ................ .~..oy~..~. · ~. , ~'$,~, . (.'; ...'w/e ...... .- ....... / (mailing/address of ~rpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrici~4i, plumber or builder. APPIlOYED AS NOTED ............................... ......... 6' . ._ Nine of owner of premises ........................ ('a~ 'o'n' ;~e' ~a'x' ;o'li ;; ii~4;~';;~N' 'G'~D~E[ 'p& R~/'( '2~'d'T/QA;~'' If applicant is a corporation, signature of duly authorized officer. 76B-1802 ~ .AM TO ~$ ~I FOR THE FOLLOWING IN[SPECTIONS: FOUNDATION TWO ~QU1RED (Name and title of corporate officer) FOR POURED CONCRETE 2 ROUGH FRAIVtIN(~ & PLOMBING Builder's License No .......................... ~, INSULATION 4. FINAL CONSTRtIC'TION MUST Plumber's License No. BE COMPLETE VOR CO ........................ ALL CONSTRUCTION S~,&-LL MEET THE ~IEQU~RE~ENTS O~ THE Electrician's License No ....................... STATE CONSTRUCTION & ENERGY CODE$. NOT ~E~POfl$It~ILE FOR Other Trade's License No ...................... .. r~gSlGN OR C.~ISTftU. CT,ON ~RORS. 1. Location of land on which proposed workwill be done....~.'~.O...~.'4:~/~...tY.~...~;]~t '~...A.~//'/ .............. ................................................. ...... House Number Street County Tax Map No. 1000 Section ..... //.'.~. ........ Block ... (~ ............. Lot .... .~...-~.'} .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing 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 which applicable): New Building .......... Addition.. Repair .............. Removal .............. Demolition ........... ........ Alteration .......... ·.. Other Work ............... ~ (Description) 4. Estimated Cost ...................................... Fee .......... ........................... :. (to be ~ald on filing this application) 5. If dwelling, number of dwelling units ............... Number o f dwelling uniis on each floor ................ If garage, number of cars .................................. .......... i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each tybe of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... ~ ....... Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ............ ..... Rear .................. Depth ...................... Height ...................... Number ofiStories 8 Dimensions of entire new construction: Front ' ..................... · Rear . :. Depth Height ............... Number of Stories ~) pth " 9. Size of lot: Front ...................... Rear ...................... e ............ 10. Date of Purchase ........................ Name of Former Owner ~ ........ 1 1. Zone or use district in which premises are situated ............ ' .......... ; .......... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: .... ................. 1 3. 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 I .. Phone No. Name of Contractor ................................ .......................... Address ............... J ·.. Phone No ................ 15. Is this property located withinl,00 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, ind'icate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho~ street names and indicate whether interior or corner lot. r^X E OF NEW OUNTY OF ............ S.S (Name of individual signing contract), ~ove named· being duly sworn, depose~ and say'that he is the applicant e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) · said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ,plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner set forth in the application filed therewith. yom to before me this m. 4~078~8, S~" ...... ' . . ' ' . .... r~--, (Si nature ola 1' · ~ £~ ~ a~,l~'"'~,/ i g pp ~c~t)