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Home My WebLink About15444-z 1~0~ NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15444 Z Permission is hereby granted to: ...%..~,..~....g....')..~ ........................ .~ ......................... ....... ,o ........ .~.....~ ........... .~..~........~... County Tax Map No, 1000 Section ..... ..¢~...'~...'~. ....... Block ...... ..~....~. ...... Lot No....~.~'..iJ~ ........... pursuant to appJication dated ..... (~.....~...~......~...~ ................. , 19..~...(~., 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 Exanfined .O..~..~. ~., 19 ~.(e. Approved .o.e,~O~-....~.~..., 19,~G Permit ! ~c,/c] ~ Disapproved a/c flor 2 4 1986 Received ........... ,1 9 · . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19.. 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 Not 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 descript!on 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 Inspedfor'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 tho 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 inspections. (Signature of applicant, or name, if a corporation) (ma±Z±ng address of appl±cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. mine of owner orpremises ..... :... y..n. e0 , (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~ ~ Plu nber s L cense No ~ Electrician's License No ....................... Otl er Trade s License No .................... -.. -* 1. Location of land on which proposed work will be done ................................. House Number Street . Hamlet County Tax Map No. 1000 Sec.tion ...... .~>.7. i ....... Block .... .~..... ' ........ Lot....O~....~. .......... 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 ./ /~/~m ~- ~ . ............ .z?..va~q...~. (...~ ............... ;'G ..,;* ..t":.q*.,. ................ b. Intended use and occupancy ./. ~./q .,'X. . . ~. ,/~/.*TC.C//.~.k . . ~ r'r-~ /7-~:a/c~ i "-'.:,' ~ ' i ew Building ........ ' -~3. Natnre of work (check which applicable): N · · Addition .......... Altera .......... Repair .............. Removal .............. Demolition .............. Other Work & .~q'O~'~': ...... 4. Estimated Cds~ ....... . ~ s on ~ (to be paid on filing this application) 5. If dwelling, number of dwolling units ............... Number of dwe n u o If garage, nomber of cars ...; ..... Iii g nits n each floor ............ 6. If business, commercial · ~ ........................................... 2 ...... ' ' ' ' or m~xed occupancy spec'fy nature and extent of each t~pe ofus~ 7 Dinensi nsofe itingst etudes ifany F ' ~ ......... . I o x s m . : rent .............. Rear ..................... ' ' ............. Depth ,. .......... Height ......... ~nu~oer et ~to~ ~ith ..... Dimensions of same structure alterations or additions: Front . · R Depth Height ~ ~ ear '. ............. Dimensions Num e of Stofi of entire new construction: Front.. · ........ ~gl ; . . ............ Rear .... pth He ~t . .. ............. Nu~be[ofStones ....... ' .......... De ....... 9. Sizeoflot Front - ' ................................. ' ....... ' ' ......... ~ ............ Rear.. ' ................. I0. Date of Purchase .... ~ ................ ,... Depth ..... .. .... h p~ .................. Name of Fo~er Owner ............. 1 I. Zone or use dmtnct m whm cruises are situated ....................... 2.. · .............. ti~n ' ' ' 12. D°es pr°p°sed c°nstruction violate any zoning law, ordinance or regula ........ : 13. Will lot be regraded ...... ; Will excess fill be re 14. Name o~ Owner of ~remises ,,~,~ ~ ~ ~m premises: Yes No ...... ~.. · ~ .... Address ~ aaa " Name of Architect ................... . .o. ~ ; Phone No "~ ... ~ ~ ~¢Wq ....... ress ................... Phone No ..... ~ ........ N~e of Contractor ~./ f.~ ..... Address ~0 ~ ~ ~, ....... ?/.772'" ......... Phone No . 15. Is this property locatedlwithinl.00 feet of a tidal wetland? ~ Yes ..... No ~... ' " ~ If yes, Southold Town TrUstees Permit may be required. ... , PLOT DIAGRAM Looat~ clearly and distina~ly Mil buildMgs, wh~thCr existing or proposed, and. mdmato ~1 sat-baok dimonsions from property lines. G' ' ' ' tw strait and block ;number or d~scfiption according to deed, and show street namos and indi~at~ whath~r int¢fior or corner lot. ~. FOuNOA rlO~ FOR POJ)~ED STATE OF NEW YORK, ~-~ ~a'r~ C;Ot~g ~ COUNTY OF ....... S,~'S C~DE~ NOr f~,~!,POm~qq; .......... . ............... above named(.Name of individual si[ning contract) · ·, being duly sworn, deposes and says that he is the applicant Itc is the ............. -- ...... :,. ................. ~ (Contractor, agent, corporate .................................... of said owner or owne~ and is duly }uthot~zed to er officer, etc.) application; that all statements contain¢ ~ [~2;; ~j~ perfo~ed the said work and to m~e and file this work will be performed in the intoner s d m .thru app ca to the best of his knowledge and belief; and that the Sworn to ~t forth in the application filed therewith. before me this ............. ....... ....... ,,9f0