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Home My WebLink About15207-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING P ER~'ilT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE. WORK AUTHORIZED) 15207 Z Dote ~...~....~.....a....~ .............. , ~.~..~ County Tax Map No 1000 Section . 0 ,~.~ . Block ..... ..~..~, ....... Lot No .... .'~,~..,. J .... pursuant to opphcot,on doted . ~/(W-~'. ]J ...... , 19.~. ~x, and approved by the Bu~Iding Inspector Building Inspector Rev 6/30/80 Examlned~ App rove dk.,../Ot.~ Disapproved a/c 'FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ,19 t* Pe lt No l b' eO (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19. Date . , 19. INSTRUCTIONS a Tins apphcahon must be completely filled m by Wpewnter or in ink and submitted to the Building Inspector, wltl- 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 pubhc stre~ or areas, and givmg a detmIed description of layout of property must be drawn on the diagram which is part of this ap!- cation. c The work covered by tins application may not be commenced before ~ssuance of Building Permit d. Upon approval of tins application, the Building Inspector wdI ~ssued a Bmldmg Permit to the apphcant Such peru shall be kept on the premises available for inspection throughout the work e. No budding shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Buddmg Department for the issuance of a Bmlding Permit pursuant to t Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buddings, additions or alterations, or for removal or demohhon, as herem describe The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises and m bufldmg for necessary inspections (Signature of applicant, or name, if a corporation) (Mailing address of applicant) / ~ ¢ ~': State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or bmlde Name of owner of premises ~ ~.. L~<L(~,//gt"/d:5 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and ntle of corporate officer) Budder's License No .3'-0 0~. Plumber's License No Electrician's License No Other Trade's License No 1 Location of land on wtuch proposed work will be done House Number Street Hamlet County Tax Map No 1000 Section '~ "~.. Block ~ ..... Lot .~ ~, ] Sub&vision Fried Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Ex,stlng use and occupancy .I /-~at ff)t~.~o.~//,,~ ~ ...... b Intended use and occupancy / ~/5-~-t'~*, /~")e.*Je/ff.,t~ z.o/ .~,'~c-~.. 3. Nature of work (check which applicable) New Bufldlng . . Addlbon ....... Alteration .. Repair .... Removal ........ DemohUon ..... Other Work F~'.~f-e.. . (Description) 4 Estimated Cost .... ~. ~ ............. Fee ... ' (to be prod on fihng this apphcatlon) 5. If dwelhng, number of dwelhng umts .............. Number of dwelhng umts on each floor If garage, number of cam 6 If bus~ness, commercial or m~xed occup~cy, specify nature and extent of each type of use .. 7. D~ensmns of ex~st~ng structures, ~f any Front .......... Rear ....... Depth ......... Height .. Number of Stones ......................... D~ens~ons of same structure w~th alterations or add~tmns' Front ......... Rear . .. 9 10 11. 12. 13. 14. Depth .. . Hmght .. Dunensions of entire new construcbon Front Height ...... Number of Stones S~ze of lot Front ..... Date of Purchase ........... ·. . Number of Stones ............ ......... Rear ........... Depth Rear ......... Depth · Name of Former Owner .................... Zone or use dtstnct tn whmh premises are situated ..... Does proposed constructmn wolate any zoning law, ordinance or regulabon ~ 9 ............... Will lot be regraded .... ~.'~' ~.. ..... , .... -:~ · Wall excess fill be removed from premises: Yes /N~, Name of Owner of premtses V . ~.5.a Ir e/.(a~. ,?'~. ~- . Ad dr e ss ~-~...Atq ('~, ~ ./. 5 .... Phone No. ~? 2 .-.~. ~. !~.--. Name of Architect ....... Aaaress ............ Phone No ........ NameofContractor-Fa,~:*0~.~-.. ~.-r'~.C~( .... Address .P¢.~3q/.¥'}~-. ..... PhoneNo.~.~ $. ?'?.7~... PLOT DIAGRAM Locate clearly and disbnctly all buddings, whether ex~stmg or proposed, and mdmate all set-back dunensmns from property hnes G~ve street and block number or descnptmn according to deed, and show street names and ~ndmate whether ~ntenor or corner lot. STATE OF NEW YORK, COUNTY OF . . APPROVED AS NOTED ~OTiFY~UILDtNG DEPARTMfiNT ',~5~1802 9 AM TO = ~ ~R FOLLOWING INSPEC~ON~' FOUNDATION ~0 n~QUIRED ~OUGH ~RAMINC- ~ pC~MBING S·S ·. . ~.t ,'~.¢ ~' '~..~'r~ .c~.r. 2~ ........ being duly sworn, deposes ~d says that he is the apphcant (Name of indiwdual s~ing contract) above named He ~s the ......... ~ .............................. (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d ~s duly authomed to perfom or have peffo~ed the smd work and to m~e ~d file ~s apphcaBon; that all statements cont~ed ~ thru apphcat~on am true to the best of h~s ~owledge and behef, and that the work will be perfomed m the m~ner set for~ m the apphcaaon filed ~erew~th Sworn to before me th~s Not~ Pubhc, . .. ·. . /'7 (S~gnature of applicant)