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Home My WebLink About15387-z i~Oll~ NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PEiO, AiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15387 Z Permission is hereby gronted to: ....~...~.~..~.~...&~. ................................................. ...~~.**.~.....~.:~.,.....!.~.~..~ ......... ; County Tax Map No. 1000 Section ........ L./....~.. ....... Block ......... L.I ......... Lot No ......]....2 ........... pursuant to application dated ....... ~..~...~....~.. ................ , 19..~..~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. i, TOWN OF SoUTHOLD BUILDING DEPARTMENT Town HALL $OUTHOLD, N.Y. 11971,. TEL.: 755-1802 ,pproved O~ / O., 19~(,, Permit No / ~.~"/"~ BLDG. DEFT. TOWN OF SOUTHOLD Received ........... ,19... ~isapproved a/c ..................................... (Bntldtng Ingpcctor) APPLICAT~QN FOB 8U~LplNG~PERMIT INSTRUCTIONS a. This application must be completely filled in by ~yp~wriler or in ink and submitted to tha Building Inspector, wi~h 3 ts of plans, accurate plot plan to scale. Fee according to sdledulc.- b. Plot plan showing location of lot and of baild~g~ 0n prem,ises, relationshiO t6 adjoining Otemises or public streets areas, and giving a detfiled description of layout of property must be drawn on the dtag~m which is pa~ of this appli: tion. c. The wdrk covered by this application m~y not be c~inmenced before issuance of BuildUp Permit. . Upo~ approval of this apphcatmn, the BUilding Inspector wdl xssued a Budding Pe~zt to the appheant. Such permit all be kept o~ the ~remises ava~abte for inspectmn t~foaghou~ tM work. e. No bnilding~sfia I be occupied or Used in whole or in pa~t for any purpose whatever hntii a Certificate of Occnpancy a~l have been granted by the Building lnspebtor. APPLICATION IS HEREBY MADE to the Building Dep~tment for the issuance of ~ BfildJng Pe~it pursuant to the dlding Zon~ Ordinance of the Town 0f Southold,Suffolk County, New York, and 0[her applicable Laws, Ordihances or ~gulatlons, for the construction of buildhags, additions or alterations, or for remo,al or demolition,as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, b~ilding code, hohsing code, and regulations, and to mit authorized inspecton on premises and in building for necessa~ inspections. (Signature of apptie~, or name, if a corporation) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) applicaut is a corporation, signature of duly anthorized officer. (Name and title of corporate officer) Builder% License No .......................... Plumber's License No ......................... Electrician's License No ' Other Trade's License No ..................... Location of land on which proposed work will be done: . b?. ~t...>. . ....-q o 1~o~.~<... . . . .1'~...~.L;., . ~ ~.~'. ltouse Number Street Namlet County Tax MapNo. 1000Section...{.(. . oek .......,.,..,.... Lot ........... Subdivision ................... ....... / .......... Filed Map No. (Name) State existing use and occupancy of premise~ and a. Existing use and occupancy ............. b. Intended use and occupancy ............ intended Use and occupancy of proposed construction: Repair .......... Removal ..... Est/mated Cost .............. I ..... If dwelling, number of dwelling un'its .... k (check which applicable): New Betiding ' Ada Alteration Nature ofwor ............................. ...... De~nolition ...Tx% ......... Other Work .............. -.~ (Description) , , ' (to be paid on filing this application) ........ Number of dwelling unit s on each floor ............. If garage number of cars q . · If business, commercial or mixed0ccupancy,' specify nature and extent of each type of use .................. iif any: Front Rear Depth Dimensions of existing structures,. . ............................... lteight ............... Number of Stories ....... : .............................................. structure with alterations o/-'addition,S: Front Rear Dimensions ofsame .................................. Depth .' ' Height :' Number of Stories construOtion: Front .'... Rear Depth 8 Dimensions of entire new tleight Nu nbgr of Stories ' 9 Size of lot: Front ....................... Rear ...................... Depth ................... Nanie of Former Owner of Purchase I0. Date ...................................................... I I. Zone or use district in which .pre~ roes are sitnated ...... .... ........................................... 12.Does proposed construction violate tiny zoning law, ordina,ce or regulation: ............................ 13. Will lot be'"'rcgraded· .......... I" ......... ;. ;., .'.. '. Will excess fill be removed from premises: Yes N: 14 Name of Owner of premises ' " Address Phone No Name of Architect ...................... ; .... Address ....... ~ ............ Phone No .............. Name of Contractor ~ Address ' Plione No 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No .~.. ~If yes, SouthoJd Town Trustees Permit maybe required. ' PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro. property lines. Give street and block '.nterior or corner lot. [umber or description according to deed, and show street names and indicate wheth, STATE OF. NEW YORK~ ~..,, :OUNTY OF ..... ~.~ >... [ S.S (Name of individual sigping contract) d)OV¢ nllnled, being duly sworn, deposes and says that he is the applica .. (Signatdgi~-~ applican te is the ....................................................... ' .............. , (Contractor, agent, corporate officer, etc.) ff saki owner or owners, and is rely authorized to perform or Ilave performed the said work and to make and fi!e ti q~plication; that all statements co, rained in this application are true to the best of his knowledge and belief; and tha.t ti york w~l be performed in the manner set forth In the application filed therewith. ;worn to before me this ........ day Of .... : ...... , ........ .... . ..