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Home My WebLink About15339-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15339 Z Permission is hereby gronted to: ..~....~.~.~....~...~..U~ ....... ~. , Ii ~.,.~ ,o .... ot ~, ~ ,, ..m~....~.~~.~ .................................................................... County Tax Map No. 1000 Section ..... J...~...~ ......... Block ..... ..~....~ ........ Lot No ..... ..~..~ ............. pursuon, to application dotecJ ...~.?::?~....~. ~.. .......... , 19...~...I'R., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 765-180:3 Approved~ ........... , ... Permit No. Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received 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 ...... insp~.~ ~.,.- ~.~ ~ ~ ?~/"~~_'f~' · '~' · '~/'/~J.- . .~ /k_ ...... (Signat~are-of.~p~can ,~jSf name,)f a corporation) .... (mailing address of app i State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, phimber or builder. (as on the tax roll or lates~.0~0¥[iD Ag ~OTED If applicant is a corporation, signature of duly authorized officer. D~TE:~\'<~.~_ B.P ~ ~ (Name and title of corporate officer) F~' -~ ..... ~Y' r~OT}t:Y BtJ~LD~NG O~PA~[~'M{iNT ~T ~. '~t~,5 1802. 9 A~ TO ~t PM fOR THE Builder's License No ............... l~OLt Ol~O~*i, INSPECTION,: FOL~qDA ?ION TWO Plumber's License No ......................... FOit POU~I~.~ COMCR~ ¢6 Electrician's License No ....................... 3, 4, ~NAL. (:ONSTRUL'TtON Other Tradc's License No. ,~ ............. B~ COMPLETE ALL CO~S'rROCT}ON SHALL MEET I. Locatmn~nd on which proposed work will be done .... THE ~EQUIREMENT~$ OF THE N. Street House Number , ~amJet 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 ..................................................................... .W.C b. Intended use and occupancy ....................................................... 3. Nature of work (check which applicable): New Building .......... Addition..' ........ Alteration .......... Repair .............. Removal .............. Demolition ........... i... Other Work ............... f.c~..~7~//~.°.~. c..~,. (Description) 4. Estimated Cost. · .". ....................... Fee ...................................... (to be ipaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unRs on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... i ....... Depth ............... Height Number of Stories Dimensions of same structure with alterations or additions: Front ............ 1 ..... Rear .................. Depth ...................... Height ...................... Number ox Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear .i .... Depth Height ............... Number of Stories........ .... · ............... .i....~ ........................ 9. Size of lot: Front ...................... Rear ...................... iDepth ...................... 10. Date of Purchase ..................... Name of Former Owner 11. Zone or use district in which premises are situated ......................... ~ ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ............... : ....Phone No ................ Name of Architect ........................... Address ............... i ....Phone No ............ ~ .... Name of Contractor .......................... Address ............... !... Phone No.c~.~.~.'~.7~ 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, indicate 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. 2,D". o Notary Public, .............. ~ i i County ._._ ...... Term Expires ~ 85, l~J-,,u STATE OF NEW YORK, S.S COUNTY OF,. ............. .. ~./~..- (fo] ~ .4....~.'... ~-.~/. ' .~...~..~_ ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.i of said owner or owners, and is duly authorized to perform or have performed the shid work and to make and file this application; that all statements contained in this application are true to the best of hiJ 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