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Home My WebLink About15389-z FOBM NO. ~l TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDif4G PEP~AiT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15389 Z Permission is hereby granted to: (~ ~'~ ~.....~...~.~...d~.....~.:....~.~.,.. · ...~..~...2.Z..~. ................................................ ~.~....~.m....u...,...©~ ...... ~ ~_~ ,o ..~~...~~....~.~~.....~....¥~...~ ............... ot prem,se, ,~oted at ..~.~.2..q.......~...~...~ ...... , ................. County Tax Map No. 1000 Section ..J.....,~....~. ......... BI .................... Lot No ..... )....~. .............. pursuant to application dated ..... ~..~.....~.....~. ............... , lg?...(t~.., and approved by the Building Inspector. Fee $....~.. ................. Building Inspector Rev. 6/30/80 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work..~/~.~..~. c f. ...... (Description) 4. Estimated Cost .... &/. ?.? .......................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f.d~e~il~units on each floor .............. '.. If garage, number of cars .......................... i% ~..i~.. ~,~.,. n..,%i I I!~ a, .......................... 6. If business, commercial or mixed occupancy, specl~[~R~~t o f[~,~ use ..................... 7. Dimensions of existing structures, if any: Front. ~.~Ik~V.~'....~..t l[~t]l Pk~.~I ..~. ~: ,~'l[~epth ............... Height ............... Number of .................. Dimensions of same structure with alterations or a(~,5~ ~2~nt .,~ tear ............... Depth ...................... Height ....... .~.. ~,~[.~.~. I~q~e~ of, Stories ................... 8. Dimensions of entire new construction: Front .~BU _~.eitli~lk.~e,~[ Depth Height ............... Number of Stories ..... ?l?. ~... ~t~.~ ~. []~g.~.~. i[ i i i i i i ...... 9. Size of lot Front Rear ~ De th Date of Purchase ............................ .~me of Fm~er Owner -. ............................ 10. ' '~'~ ............ P ...................... 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Same of Owner of premises).r, t /Y, ~. F. .~.o/a. ~. :~.:. . Address ~.o. t-:/:~7~y.~, p ....... PhoneNo.~?O./....7..~.~:.~.?,~ Name of ArchiteCt · Address ... o.*o ¥~ .......... Phone No ................ Name of Contractor~..'/...f9?C~. ./. ~ ........... Address ~.fl..~.~.. ~.?.~...~?.z.C.. Phone No..~..~f..; .~2. ~. ?... ~ Yes ..... No .~.. 15. Is this property located withinl.00 feet of a tidal wetland? * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property 1/nes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. /--- //¢b ~ &z~, xLde:-/cC or ~, o being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ....... ?.' .z.-]..f?..q~. ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained .in this application are true to the best of his 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 3 .day of ~e"~ 19J;~ Nota. County FFdm · ~ ~ 7~.: ............. NOI%RY I~IBLIC, 8tm d N~ ' ' 810. 4707878~ Suffolkl;~m~,~ (Signature of applicant) Term Expires March ~0,1~-.,*~-/ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .O..~...e$~. ?l ·.., 19 ~.~. Approved ~..~...v~.....q ..... 19~.g.. Permit No./..~.".~ ~.~ .~. ~eceived ........... ,19... Disapproved a/c ..................................... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submlitted 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 4o 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 bf Building Permit. d. Upon approval of this application, the Bmldtng Inspector will ~ssued 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 {t Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc6 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 alterati6ns, 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 inspections. (Signature of applicant, or name, if a corporation) ......... (r~a±l±ngI address of'appl±eant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.4.?./7-{~..-¢. .... .~.'~..~.te./.C/q ~..O..t-:~.~.U/:e~/. .......................... (as on the tax roll or latest: deed) If applicant is a corporation, signature of duly authorized officer. ...... ¢..E... (Name and title of corporate officer) Builder's License No. '5~) O~ Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... . Location of land on which proposed work will be don'~...,., .... ;.~ ~ ......t.~d[ ............................. County Tax Map No. 1000 Sect,on ......... ~ ......... :., Blh.~¢>,¥.v ........ J ~ .... Lot.../¢ ............ Subdivision ..................................... Filed Map Notz',?¢.. ~ ......... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed const~ction: a. Existing use and occupancy . ./ ........ /~...~ ......................................... b. h]te~ded use a~d occupancy ...~ ~ .... ~ ¢¢ ~¢¢ .... ~.4~ ..... ~¢~.~-. ....................