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Home My WebLink About15395-z FO~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDiHG PERJv~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 1539§ Z Permission is hereby gronted to: ..... a~.7.....~..~..~..,. ........... ...~.~..~. ....... ~.:.~., ....................... , ~ ut premises Iocoted ot ..~.~..~..~..~.. ......... [~]L~......~... .............. ~.~ ................. County Tox Map No. lO00 Section ..... /....'~......2m/. ..... Block ..... ...~....~ ...... Lot No....l.!,..t/ ............. pursuon, to opplicotion doted .... 0....~....~.....OJ. ................. , ]9...~...~.., ond opproved by the Building Inspector. ~ee ,J.~.~.:.~.~... Building Inspector Rev. 6/30/80 , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. Of~-M.¥..~:..., 19 ~.~ Approved .(~.~ .~. · · · .~...., 19~.~.. Permit No..1.~,'7.~?..~. .~ Received ........... ~19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~..~..~.4 ........... 19.~.(O. 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 thc 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 re~a~pval 9r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildinxl~nS'o/~,j~isfi~g/fl/~,de, a~ regJ~fitions, and to admit authorized inspectors on premises and in building for necessary.~/~__. '~' ' '~ S~g'~~t ~ff/r~. m ~, i~/~ cor_p o ration) e ........... .... .......... ' (mailing ~ff~g~' ;~ ' ~iic~nt) ....... State whether applicant is Owner~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~...O.~..~?.YLn~-.. · · .~. · ~?.1~. ~.. ·..~. · .~. '. .............................. [J (ad'on the tax roll or latest deed) Builder's 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 .................................................... House NumSer Street County 'Fax Map No. 1000 Section ..... ]..27_...~. .......Block ....... .~..~ ....... Lot .... /.'. ~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ofwork (check which applicable): New Building .......... A~djlition . 'i ........ Alteration .......... Repair .............. Removal ............. Demolition ......... ,~. :... Other Work ...... (Description) 4. Estimated Cost .... .o../. ~...~..:..C,,' ./~. ............... Fee .......... i ............................ (to be ipaid on filing this application) 5. If dwelling, number of dwelling units ............ Number of dwelling uniis on each floor ................ If garage, number of cars ............................................ ~ ............................ 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 ....... i ....... Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ............ i ..... Rear .................. Depth ...................... Height ...................... Number o4 Stories ...................... 8. Dimensions of entire new construction: Front ·.. Rear I pth Height Number of Stories . 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: ,' 13. Will lot be regraded ............ , ........... Will excess fill be removed from premises: Ye~s.., / No 14. Name of Owner of premises,~e)/~e...~, i .~.~i.' Address . ~"2 .f~.e~.e~,!/~e~ Phone No...~. ?../..'..~../ .... Name of Architect ..... ·; ........... Address .... i Phone No . .. Name of Contractor ~r~O~! ~t~d~'~ ~'~...Pt~..~ Address,L~/.~.'~4'~ ..... ~525~'P"/ .... ............. .............. Phone No. ¢. ......... 15. Is this property locat&fl withinl,00 feet~of a tidal wetland? *iYes ..... 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 show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF --~ S.S ,~ / ........... · ............ being duty sworn, depoCes and says that he is the applicant (Name of individual s~g'ning~nti'act) above named. (C6ntractor, agent, corporate officer, e cji of said owner or owners, and is duly authorized to perform or have performed the s~id 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 Notary Public ..... 'County DOMINIC VISSICHELLI NOTARY PUBLIC, State of New york ~ ., .... - QualiNad in Nassau County ~ of applicant) Commission l[splres ~taroh 30f 19!,y