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Home My WebLink About15248-z I~O]e,M NO, · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING P E PJAIT (THIS PERMtT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) H9 1524~ Z Perm~ssmn ~s hereby granted to' ............. ..~.~..~......~.:.~.... J..t ~.~ ...... County Tax Map No 1000 Sect,on/,-~ / e~./. Block ...... ~..~ ...... Lot No ...0...'~..~' .... to apphcat,on doted[ -]~/-~,'~--' 'w~t~) ..... , 1c)..~.(l~ and approved by the pursuant Building Inspector Building Inspector Rev 6/30/80 xammed~. ~ .. , 19~9. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971. TEL,: 765-1803 )mai)proved alc ................................. Received ........... ~19. (Braiding Inspector) APPLICATION FOR BUILDING PERiVIlT INSTRUCTIONS Date ..... f.//oe... a. Tins appheation must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ts of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan slmwmg Iocatmn of lot and of bmldmgs on premises, relationship to adjoining promises or public stree areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this app tion. c. The work covered by tlus apphcatron may not be commenced before issuance of Building Permit. d. Upon approval of tbls application, the Building Inspector wdl issued a Braiding Permit to the applicant. Such perm all be kept on die p'rendses available for inspechon throughout the work. e. No building'shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant all have been granted by the Braiding Inspector. APPLICATION i$ HEREBY MADE to the Bmld~ng Department for the issuance of a Building Permit pursuant to th hiding Zone Ordinance of the Town of .Southold, Suffolk County, New York, anst~ther applicable Laws, Ordinances c · gulahons, for the constructfon of buddings, additions or alterations, or for reja'f'oval~ or demolition, as hereto describer te applicant agrees to comply with all applicable laws, ordinances, bullsl, mg~e'6de, h~usin~, code, and regulahons, and t m,t authorized respecters on premmes and m bmldmg for neeessa~ c (S~gna~ure of apphcant, or name, if a corporation) (Maihng address of applicant) ate whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder .... ........................................................................... tree of owner of premises .... C,.P.'J.,~i'.~ ...5'22g./~.//zT~ ~ . ~Z/d-~/:J....~)eq.~.~il~,._~ .................... (as on the tax roll or latest deed) apphcant m a corporation, signature of duly authorized officer. Builder's License No ..... ~ ......... Plumber's License No ................. Electrician's License No ....................... Other Trade's License No ................... Location of land on which proposed work will be done .... .~. (..5 .o...-.5. etd. add~...~.gesT .... 'T..c,. O,~M~ .... .oE. tq ............. ....... Itouse Number Street Hamlet County Tax Map No I000 Section ... I.~..! ......... Block ...... ~).~. ........ Lot .... 15l O-~. ........ Subdivision .......... ,~J~ ................ Filed Map No .... ~ ........ Lot .... .'~ ....... (Namet State existing use and occupancy of prem,ses and intended use and occupancy of proposed construction a Exist,ag use and occupancy . . . f?~.t'.~. ~Tt~".. ]-/O,r?~. ............ ., ..... ~ ~ .~.. .................. b. Intended use and occupan, ~tga. Viq~W". .~.oro~.. .(~/i'7"t'/ P~i~.~'. . .~.,~.. .~[OM?. . ~ .b. .~.o~-. 3 Nature of work (cheek which applicable). New Budding ..... tmn .......... Alteratior~ ...... Repa/r ........ Removal .......... Demohtion ...... Other Work. (Description) 4. Estimated Cost ..... .~O.O., .O.O ................. Fee ................................... ' (to be paid on filing this apphcatlon) 5. If dwelhng, namber of dwelling umts .... ./. ......... Number of dwelhng umts on each floor .... [ ........ If garage, number of cnrs ...'~ ............ 6 If bumness, commercial or mzxed occupancy, specify nature and extent of each typic of use . ..-w. ........... 7 Dlmens OhS of emstmg structures, if any Front...,.~c>q ..... Rear ...--~.<:) ........ Depth ... ~.1 t N ~nber of Stones ,~. t ~.~.'?.~. Height ....... u .................................................. D~menmons of same structure w)th alterations or additions' Fron ............. Rear ............ D2tehn .................. !telght ................... Number of Stones .................. g. D mons of entire new constructmn' Front ~.~..~. ........ Rear ............... Depth tle~ght ............. Number of Storms .... ,===~ ~ I D,z~.~ ............ -. ~. &ze of lot Front ..... allmll~! ./.~.~..~... Rear ..... amm~, .... ?.z .... Depth .,~.~ ............... Date of I'urchase ../".//~.~/.~..,.~' ............ Name of Former, Owner o'I,'/~U~',, r..,~.Z, ff~.~'.... Zone or use d~str~ct In which premises are sztuatcd ~.Er,xl~ ~,.'x~.~..,'~.~.t,/;/~'~qr,~P~. ............. Does proposed construction violate any zomng l.tw, ordinance or regulation .g:o ............... ~ ..... Wdl lot be regraded . .~.o ................ Wdl excess fill be removed from prcmises:,~°~.~ ,,3(.Ss Name of Owner of premmes E44/~b:ra~O~ .~.4,..0"~. Address6~/~.q &od.~.is.~J~.~'~hone No. ~. ? ~ ~.-~..~ .-~ Name of Architect -- Address Phone No Name of Contractor -- Address Phone No ~o .~... 9 I 0 12 14 t5. Is this property located within 300 feet of a tidal wetland? *Yes ..... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back d~mensmns fro property lines G~ve street and block number or description according to deed, and show street names and re&cate wheth ntcnor or corner lot. APPROVED_~ AS NOT~~'~ 'tOTIf¥ ~OILDING DEP~RTM~NT A' 't 51802 9 AM TO 4 ~ ~R TH ~0~ P(IURE~ CONCRFfE ; ROtJG~ ~AMiNG ~ PL,JMBING ' ~ ~t,~l~, C{~fl~TRUCTIO~ MUST THE RED'JI~ME~I$ ~ THE N Y STA~ CONSTRUCTION S ENER~ COD~, NOT ~~E FOR r~ESIGN OR C.r -!STRUCT1ON ERROR~ ~TATE OF NEW YORK, S " 'OU~Y OF ............. - ~ _~. ~-_ ~-~- 1 ,, .................... ::' '~ ' '" ' I ' ' ' uci.s uuly"awot~6ses and says that he ~s thc apph (Name of mdmvi~al m~nmg con~ct) / m the~ .............................................. /* ....... ~ ........ ~ractor, agent, corporate officer, etc.) smd owner or ownem, ~d is duly authorized to perform or have perfonned the smd work and to m~e and file ~pptication, that all statements contained M this apphcation are true to the best of Ins knowledge and belief; and that ~ork will be perfo~ed m the m~ner set forth m the application filed therewith. ~wom to before me thru ........... .....