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Home My WebLink About15205-z I~O~M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P EPJAIT (THIS PERMIT MUST RE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15205 Z Permission is hereby granted to' ...(;.~.~.,.~.....~L~..~...~;......u...~.a~..... ~.~...~.~ .~~,' .. ~' ...~~..~ ................. ' . premises I~o,~ ~, ..~.~.~.....~.~~.~.~: ...... ~~ ................. County Tax Map No 1000 Sect,on . (~"),'~.. .... Block ......(~.,.'~, ........ Lot No ...... ).\ ............. pursuant to apphcatlon dated ~.~.4~.~...~L[ .., 19 ~(4~., and approved by the Building Inspector. Rev 6/30/80 FORM NO I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL P, OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approve~_~.,c~W .~x$ , 19 '~.{9. ,19~{~. Permit No. ).~.~. ~ APPLICATION FOR BUILDING I Date ............ , 19 INSTRUCTIONS a. This apphcat~on must be completely filled m by typewriter or ~n mk and submitted to the Budding Inspector, w~ sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of bmldmgs on premises, relatmnsh~p to adjoining premises or public str or areas, and g~vmg a detmled descnptmn of layout of property must be drawn on the diagram which ~s part of this a! catnon. c. The work covered by tlus apphcation may not be commenced before ~ssuance of Bmldmg Permit. d. Upon approval of thru apphcat~on, the Bmld~ng Inspector w~ll ~ssued a Budding Permit to the apphcant. Such shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used ~n whole or ~n part for any purpose whatever until a Cerhficate of Occups shall have been granted by the Bmldmg Inspector. APPLICATION IS HEREBY MADE to the Bmldmg Department for the ~ssuance of a Braiding Permit pursuant to Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcabte Laws, Ordinance Regulahons, for the constructmn of buddings, additions or alterations, or for removal or demohbon, as hereto descril The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulatmns, an, admit authorized inspectors on premises and m bmldmg for necessary ~nsgect~ons. , (S~gnature[~3"t2C~of a;p~h a~t~;porat;o'~) -~.. r.. ~ .-,-4-- .... '- . ,">'..- ;, ,, '~ ~ _ , (Mi~fl~ng address of appI.mant )OOou4~ [~, ', 1.55 UO~"~.OJ_r- _-~" State whether apphcant ~s_owner, lessee, agent, architect, en~neer,~, general contractor, electncmn, plumber or~bml h Name of owner of premises ~..{5k.f~'~...O_~. ~ '~4,~._.~C~ ~ A~ (as on the tax ro~l~o~.atest deed)' B.P ~ / If apphcant ss a corporahon, mgnature ofduly attthonzed officer f:El~' _'D(. ~' BY' Y', ~' .... ,OTt[:Y"-~"'"'801t-DtNG DEPARTMENT Ar (Name and t~tle of corporate officer) ~05 1802 .q ~ TO ¢ PM [cOR THE ? 0~-, 0w~NG IN%PFCTION?., Budder's L~cense No. .. / ~-,.,x--~0_.~. .... =OO,~BA'q(m, ,'WO ~,.qlUIRED Plumber's L~cense No ....... 3 lt'~$Ut. Electrician's License No a- COMe,. e'~: ~uB C.O AL ~ 'Oe~8 ~ ~taC I 01'4 ~ht.L MEET Other Trade's L~cense No ............ TN[: l~kOk-qprio~N I ~ OF Tl'~ N ¥ ~r~ NOT H~s~NSIBL~ ~R I Locahon of land on which proposed work will be done .... ~w~. [ '~S~T~ON ER~OR~ House Number Street Hamlet County Tax Map No 1000 Section , ~ ~ . Block ~ .... Lot I ~ ..... Subd~vtston Fded Map No Lot .... (Name) State exlstmg use and occupancy of premmes and intended use and occupancy of proposed constructton a Emstmg use and occupancy hO t,'va~,., .... ~ ~,. ~,,. b Intended use and occupancy .--,%a2T~*~q ~ (..~ ,l-p.q.. - \ .~5~..e.e__... . ~'~.%, . .' ....... o 4 5. Nature of work (check which apphcable). New Budding ......... Adflltlon ..... Alterat{gn , . Repair ....... Removal ......... Demolition ...... Other Work . .-X~,e.~. Estxmated Cost .... '0.0.0 oo.... If dwellmg, number of dwelhng umts ... If garage, number of cars .......... (Descnptmn) · (to be paid on fihng th~s apphcat~on) .... Number of dwelhng umts on each floor ............ 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ............. 7. D~menmons of exastmg structures, if any. Front ........ Rear ......... Depth .... Height ....... Number of Stones ..................................... D~menmons of same structure w~th alterations or additions Front .......... Rear .......... Depth ..................... Hmght .................... Number of Stones ................. 8. Dwaenslons of entire new constructm~ Front ........ Rear ............. Depth .......... Height ......... Number of Stones ................................ ,9. Size of lot Fr0/~t ............. Rear ......... Depth ............... 10 Date of Purcl~ase .... ~ ; ........ Name of Former Owner .................. '11 Zone or use ctistnctJn'which.~prem~es are situated ................................... 12. Does proposed ~onstructtOn vxolkte any zomng law, ordinance or regulation . rkO.. 13 Will lot be regraded ........... Wall 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 ........... Phone No ........... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permzt may be required. PLOW DIAGRAM Locate clearly and dlstmctly all bmldmgs, whether exlstmg or proposed, and indicate all set-back dwnenmons frm~ property hnes. G~ve street and block number or description accordmg to deed, and show street names and indicate whethe mtenor or corner Iot. .-Pr~m~ w- moa[ STATE OF NEW YORK, S S COUNTY OF ............... ... ~ ~ .~ .~ ... belng duly sworn, deposes and says that he is the apphcant above named(Name of lfid~v~dual mgnmg contract)~t- He ~s the .... L ~ ................ (Contractor, agent, corporate officer, otc ) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file tins apphcatmn, that all statements contained in this application are true to the best of his knowledge and belief, and that the work wdl be performed in the manner set forth m the apphcatlon filed therewith. Sworn to before me th~s ...... .~..~.. . .day of ,...~..~..,~...... le,m Fx~i~s March 38, 19L...~/ County