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Home My WebLink About15171-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PEPJ41T (THIS PEPJv~IT MUST BE KEPT ON THE PREMISES UHTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15171 Z Perrmsslon ~s hereby granted to' 'k , . .............. ,a ..~~...~.....~...%.~...~/...~..~..._h.~ ........ ot pr.m,~ ,=,~ ~, ....Z.~.~...~_¥_~ ....~...~~~ ....................................... County Tax Map No 1000 Section . J.~,~ ..~ Block .... ..~...~. ..... Lot No..1...~ .............. .(~.~t~' J ........ , 19~J(~, and approved by the pursuant to application dated Building Inspector Building Inspector Rev 6/30/B0 50f 'RIGHT OF' t00~00~ .~ WAY Ili APPROVED AS NOTED ~e NOTIFY I~UILD!NG OEPARTMENT AT O. '"!765-1802 9 AM TO 4 PM FOR THE ~ FOLLOWING INSPECTIONS: FOUNDAI'ION TWO REQUIRED FOR ~OUR~'D 2 ROUGH FRAMING & PLUMBING 3. INSULA I'10~'; zl. FINAL C(')NSTRUCTION MUST BE COMPtE'i'E ,FOR C O ALL CONSTRUCTION SHALL MEET THE REQUI[~EMENTS OF THE N.Y STATE CONSTRUCI'ION & ENERGY CODES NOT RESPON$1,BLE FOR m~SIGN OR CONSTR~CTION ERRORS~ =~coNIC BAY Examined .~~' {~. Approve~14-0~' ~ Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N Y 11971 TEL. 765-1802 , ,1996 Permit No ~. ~'~! "~.1 '~ Received ........... ,19. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ , 19 INSTRUCTIONS a. Tins application must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, w~tl sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc sire or areas, and giving a detailed description of layout of property must be drawn on the diagram winch is part of tins ap! cation. c. The work covered by tlus application may not be commenced before issuance of Bmldmg Permit d Upon approval of this application, the Building Inspector wall issued a Budding Permit to the apphcant. Such pen shall be kept on the premises available for inspection throughout the work e. No buildmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occuptm shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Bulldmg Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of bmldmgs, add~tsons or alterations, or for removal or demohtzon, as hereto descnb, The apphcant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises and in buildmg for necessary g~spections. ,~ ,-~ . (S~naturfe of applicant, or name, if a corporation) ................... ......... h Ic r e t tect [malzing addres~of applicant) State w ether appl ant is owne , lesse , agen , arcin , engineer, general contractor, electnclan, plumber or build, ................. Nameofownerofpremmes /t'~/t~J-.- ~/ r/~-. /~/,/Tt~.~ ...... .. 'i'.'. ...... (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's License No .tfO2~q~.... Plumber's License No, Electrician's License No ..... Other Trade's License No. Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section ~kt ~Y,,. /~ ~ Subdlvmion (Na~e) ' Hamlet Filed Map No Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy ........ ~ ;X. :,;;, .............. b Intended use and occupancy . ~ ......... : .............. 3 Nature of work (check winch apphcable). New Budding ........ Add~tmn ........ Alteration ..... Repmr .~-~ ~_~. Removal... ~ .f//~,~. ~L-~¢em~t~o~,/:./.. .¢--,...f~ ~/]. O2&er/_t,~/~_.. (Descnpt~on)W°rk ........... 4. Estnnated Cost ._..~. fedS. ~.....-~ ............... Fee ............................... (to be paid on fihng tins applicataon) 5. If dwelling, number of dwelhng umts ............ Number of dwelhng units on each floor .............. If garage, number of cars ................................................................ 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use .............. 7. Dmaensions of existing structures, if any Front ......... Rear ......... Depth ........... Height ........... Number of Stones ...................................... Dunens~ons of same structure with alterations or additions' Front ............. Rear ............... Depth ......... Height ..... Number of Stones .................. 8. Dunensmns of entire new construction Front. ............. Rear ............. Depth ......... Height ......... Number of Stones ............................................ 9. Size of lot Front ........ Rear ............ Depth ................. 10. Date of Purchase ..................... Name of Former Owner ...................... 1 1 Zone or use dtstrict in winch premmes are s~tuated .......... 12 Does proposed construction wolate any zomng law, ordinance or regulat~on' . .Ac. ~ ................ 13. Will lot be regraded ......... ; ............. Will excess fill be removed from premises _ Y~s ~ 14 Name of Owner ofpremmes//~, J~/g_.~/q~J~.~J~. AddressffP,~'~.~.~Phone $o~..~.; .~. ~Td~p. Name of Arcintect ................ Address ............. Phone No .......... Name of Contractor ................ Address ................. Phone No......~>~ .... 15. Is thzs property located wxthinl00 feet of a tidal wetland? * Yes ..... No ..~.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and dmtmctly all bu,ldmgs, whether ex~stlng or proposed, and, indmate all set-back dnnensaons fr, property Hnes. G~ve street and block number or descnpt~on according to deed, and show street names and indmate whetl interior or corner lot. STATE OF NEW YORK, S S COUNTY OF ................. (Name of ~nd~wdual s~gnmg contract) above named. ..... being duly sworn, deposes and says that he ~s the apphc He m the ............................... (Contractor, agent, corporate officer, etc.) of smd owner or owners, and ~s duly authorized to perform or have performed the saad work and to make and file apphcat~on, that ali statements contamed m tins apphcatton are true to the best of ins knowledge and belief, and that work will be performed ~n the manner set forth m the apphcatmn filed therewith Sworn to before me tins ......... I/. ..... day ..... ..... ,9 .. ' ' ' (Signature of applic~