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Home My WebLink About15215-z i~0]~[ NO. S TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERJ~AIT 15215 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) z Dote~....~....~.....~.~. ...... , ,, Perrmss~on Js hereby granted to ...~.~:~....~.~ ~,~.~~ / ..~.~..~.:~ ..... ~/.~.~..~ ~ ' ,o ..~...~........~..,:..o.. + ...L, .:.~ ...... .~....-... ot premises located at ...~. ......... .~.~ .......... pursuant to apphcahon dated~~-:<~.~' k ~., 19~...~:9, and approved by the Budding Inspector Building Inspector Rev 6/30/80 Exa,mned~ ./4,o.V'.. ,.l ~ Approve~.la,P?.. 4.~[ Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.. 765-1802 , 198(~ ,19~(~ Permit No / ,~a/, ~"' ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT LIL L Bt D.,G D~ - f Received ........... ,19... IN STRUCTION S a. This application must be completely filled m by typewriter or in ~nk and submitted to the Building Inspector, w~th 3 sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showmg location of lot and of buddmgs on premmes, relationship to adjoining premises or pubhc streets or areas, and g~vmg a detailed description of layout of property must be drawn on the dmgram winch is part of this appk. canon. c. The work covered by tins apphcation may not be commenced before Issuance of Budding Permtt d Upon approval of tins apphcation, the Bmldmg Inspector will ~ssued a Building Permit to the apphcant. Such permit , shall be kept on the premises available for mspection throughout the work. e. No buildmg shall be occupted or used m whole or m part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Bmld~ng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Bmldmg Permit pursuant to the Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o~ Regulatmns, for the construction of buildmgs, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and to admlt authorized inspectors on premlses and in bulldmg for necessary In.~ ~.. ~:/~e'~' at;ptldan~, or na~~)"' (Maihng address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or budder. If applicant ~s a corporation, signature of duly authorized officer (Name and t~tle of corporate officer) Builder's License No Plumber's Dcense No .. Electrician's Dcense No ........... Other Trade's License No ..... Location of land on which proposed work will be done"'x ... House Number Street County Tax Map No 1000 Section / ,3 ~ . Block .. Subdiwaon Filed Map No (i',lame) Hamlet Lot State existing use and occupancy of prerp)afies and intended use and occupancy of proposed construction a. Existing use and occupancy ~.__...__ . . ~. ........ b Intended use and occupancy ./(~57 ~ 3 Nature of work (check which applicable) New Building ........ Addition ........ Alterat.,,~n~ ~, ~, ~ .. 4. Estimated Cost.. /~../_/r.~.,~...: .................. Fee ................... ' (to be paid on filing thru apphcatlon) 5. Ifdwelhng, numberofdwelhngumts ....... -w. .... Numberofdwelhngumtsoneachfloor. ..-r .......... If garage, number of cars ~'- 6. If business, commercial or mixed occupancy, specify nature and extent of each tyge of use ...... % .... , .... 7. Dimensions of exmtmg structures, ff any Front .~_t_t_t_t_t_t_t_~ ~ '.. Rear .. '~..d' .....Bepth ~ ~ . Height ........... Number of Stones ..... D~nenmons of same structure w~th alterations or ad~t)ons Front., ............. Rear ............ Depth .......... Height .... ~' . ~ ~ . Number of Stones ................. 8 D~nensions 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 ................. 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. Yes N 14. Name of Owner ofpremmes ......... Address .............. Phone No ............ Name of Architect ................. Address ......... Phone No .......... Name of Contractor ................... Address .............. Phone No .............. Bio ..... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether exlstmg or proposed, and in&cate all set-back dimensions rrm property hnes. Give street and block number or description according to deed, and show street names and indicate whethc interior or corner lot. APPROVF. D AS NOTED m,'. V. L NO¥i~Y BUII'DIN~ DEPA~M~'I~T 765-1802 ~J AM TO ~, r%1 FOR I FOLLOWING INSPECTtONg' FOUMDA'rlON 'tWO ~CIU1RED FOR tmOURED 2 ROUGH ~RAMING e PL0h~RINL 4, F~NA~ L'O~J~TRIJC THE R~QUIP~MENTS ~ rile N Y ~D~ NOT ~B~N$1~ m~tGM OH CC STATE OF NEW yOR~, ~2 ,~ S S :. / (Name of individual s~gmng cofftract) above named ..... being duly sworn, deposes and says that he m the apphcar He m the .................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file th apphcat~on, tha~ all statements contained m this apphcatmn are true to the best of his knowledge and belief, and that tl~ work wdl be performed In the manner set forth m the application flied therew[th. Sworn to before me this