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Home My WebLink About15322-z i~ORM NO. O TO~YH 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) 15322 Z Permission is hereby granted to: .L J.~...~.~... ~'t..~.-. ~ ......................................... ...... County Tax Map No. 1000 Section ......0....~....(~.. ....... Block ..... )...~-~. ........ Lot No....'~ .......... pursuant to application dated ....'~?..~......~.~ .......... , 19...~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'xamined .~.~.a,.~..~...~L.q . ,pptoved~.....-°?~... 'FORM NO. 1 Town oF SoUTHOLD BUILDING DEPARTMENT IowN HALL 8OUTHOLD, N.y. 11971,. TEL.: 765-1802 ., 19~.~. Permit No.].~.~, .~,2-...~ Jisapproved a/c (Building inspector) APPLICATION FOR gUILDING PERMIT .Date ............ , ....... 19... INSTRUCTIONS a. This appllcati6n mdst be compietely filled in by typg,wrtter or in ink and submitted to the Building Inspector, with 3 ts of pla/is, accurate 'plot plan to scale. Fee according to scliedule.. b. Plot plah showing location of lot dfid of buildings on premises, relationship ~0 hdjoining premises or public streets areas, find givlng a det~led description of layout of property must be drawn on thb diagram which is pa~ of this tion. C. Tl~e work f0vered by t~s application may not be c0mm~ficed before issuance of Build~g Pe~mlt.. d. Upon approval of this application, the Building ~nspector will issued a Bulldog Pemit to the applicant. Such pemlt all be kept o~ the ~remises available for inspection throughout th~ work. ~ e. NO butlding's~all be occupied or used in whole Or in pa~ f6i any purpose Whate~er unffi a Certificat~ 0fOccupancy ail have beefi granted by the Building Inspector. : APPLICATION IS HEREBY MADE to the Bufldihg Dep~tment for the issuance Of a ;B~idtng Pemit pfftsu~nt to the dldingZo~O Ordinance of the Town'of Southold, Suffolk Cou~ty, New York, and o[het applicable Laws, Ordinances br ~guladons, for the construction of buildings, additiofis or alterations, or for removal ot demolition, as herein described· ~e applicant agtges to comply with all applicable laws, ordinances, building code, housing code, a~d regulations, and to mit authorized inspecto~ on premlses and in buildit~g for llecessa~ ilispectio~s. ........ (Signatur~ applicant, or nadir a corporation) (Mailing address of applicant) ate Whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~.~o.~ ............................................. ,me of owner of premises ........... .~ ~ 7C~z,.,~ ,(. ~ ............... ~}~q)~b 'B.P' *' '~~" . (as on the tax roil B~[~st d~ applicant is a corporation, signature of duly authorized officer. FEE' ~_'~ ~,~,~ NoTI~ ~U~LUu~ ~ ............................................ '76~A80~ 9 AM TO '~ ~ ~R THE (Name and title of co. orate officer) . FO[.LOW~NG ~NBPECTIONS: Builder's License No ................... ~0¢ ~OO~O CON~.PE ~ ~ Plumber's License No ......................... 3, ~NS Electrician's License No ...................... ALi tgONS"'~'~C rtO~ $~At.t MEET Oilier Trado's License No ..................... ST~ O0NST~UC't~ON ~ ~NE~GY ?;. CC qST~U~T~O~ Location of land on which proposed work will be done ................ O~8~G~:.Q .............. ' ... .... ........... ,, ........ E ................ ltouse Number Street Hamlet County Tax Map No. I000 Section ....... .~ ..... Block .... ~ ..... Lot ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Natne) State existing use ahd occupancy of premises and intended u~e and occupancy of proposeg construction: ~, Existi~ us~ ~,d ocou~ .... ~ ~...~.~ .... ~, ~ ~.~ ,.:.i. ,, ~ ~ ~. ~ ............... ~ ~' ...,., .~,~'~, .~' 3. Nature ofwork (check which ap.phcable). New Burl&ny.. ......... Additi, ....... Alterat old. ......... Repair .............. RemOval .... ~ ....... .Demolition ......... ..... Other Work. J-V.~r~o~.-~,. · · ~)~ : ~ j~ (D~scription) 4. Estimated Cost ........... ~ .............. ~,~, ....... Fee . · .~ ........................ ; . . ~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling hnits .............. .~: Numbe~ of dwelling units on each floor ............. nunlber of cars If garage 6. If business, commercial or mixeO occupancy, specify nature and extent of each type of use ................. 7 Dimensions of existing structure's if any: Front Rear. Depth Nuniber of Stories lteight ................. , ................................................. structure with alterations or ' ' ' Rear Dimensions of same ad&tlons: Front ............................... Depth ' Height Number of Stories 8 Dimehsions of entire new construction: Front ' ' Rear ' Depth Height ............... Number. of Stories ................................................... 9 Size of lot: Front ~ Rear Depth 10. n..~ ~e ~,..~ ..... . Na ne Of Former Owner ......... . I 1. Zone or use district In whmh prqmmes are smmted ................ . ................................. 12. Does pro rased construction violate' airy zoning law, ordinance 'or regulatmn: ...~. ~.: .................... 13. Will lot bo regraded ......... ~ .................. ,. Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~,.~'.~ 'i ........ Address l3.~ ~.~.~.~.~. phone No. ~.~ ~ .I ~q Name of Architect . . ........ ~ ................. Address .............. ~... ~hone No .............. Nm~e of Contractor~9 un* .n%~a~.~K~Address P~ ~¢~u~ll_~e No. ~ ~ ~,O 15. Is this properCy locate~ith.in 30~eet of a tidal wetland? *Yea .~ ~o ..... · lf yes, SouChold 'town TrUstees Permit may be reqntred. PLOT DIAGRAM Locate clearly ~d distinctly ~1 buildings, whether existing or proposed, and. indicate all set-back dimensions fro~ property hnes. Give street m~d blockinumber or description according to deed, and show street names and indicate wheth, :nterior or corner lot. ¢TATE OF NEW YORK, S.S 20 Ut~q'T'Yx OF ........... ~. ..... . .... ~x' },.~(Nm'de of individual sig0ing contract) d)ove .... nanl~d, being duty sworn, deposes and says that he is the applica (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to xnake and file ti ~pplieation; that all statements coniained in this application are true to the best of his knowledge and belief; and thaJ ti york will be performed in the manner set forth:in~ the application filed therewith. lworn to before me this Notary Public, ................. ~ ................. (Signature of applican