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Home My WebLink About15253-z FO~ NO. · TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Perrmsslon Is Hereby granted to. .....~..o..~.....~...~'7.9.. .................... .~.~.m....~.,.~,. ,.: ~ ~.~ .......... ,o..~~.......~f.-..~ '-~"~I' '~' ........................ of premises Io~ated {at ................... County Tax Map No 1000 Sech(q% O"J...~ ,.. pursuant to apphcatlon dated Budding Inspector. ::~" .... , 19.~, and approved by the Building Inspector Rev 6/'30/80 Approved i~~. Disapproved a/c .... FORM riO. 1 TOWN OF S~UTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.. 765-1802 , , 19~{~. Permit No (Building Inspector) APPLICATION FOR BUILDING PERM IT INSTRUCTIONS BLDG. DEPT, ~..,.J,.OWN OF SOUTHOLI~I Received ........... ,19... a. Ttus application must be completely filled In by typewriter orln mk and submitted to the Building Inspector, with - sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjo~mng premises or pubhc street or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this appl~ catlon. c The work covered by this application may not be commenced before issuance of Budding Permit d. Upon approval of th~s appl~cahon, the Bmldmg Inspector will issued a Building Permit to the applicant Such permt shall be kept on the premises available for inspection throughout the work. e. No bmldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm,t pursuant to th Build,rig Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulat,ons, for the construction of buildings, additions or alterations, or for removal or demol,tion, as herren descnbec The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and t, admit authorized inspectors on premises and in bufldmg for necessary inspections ~ (SlgnatuYe of applicant, or name, if a corporation) .... (Mailing address of applicant) ,.//~ ~? State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofprem,ses .~..ff..~4~.-~.~ ~- ~.~..~ ............... (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer. (Name and title of corporate 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 wall be done...~. 2 .~..~.. ~"~..~ ................ Cou.t axMapNo ,000Sectio. .'70 . B,ock..37 ...... Lot..5.3 ...... Subd,vmlon ...... .... ... . Fried Map No .......... Lot ............... (Name) State ex~stmg use and occupancy of premises aud intended use and occupancy of proposed construction. a Existing use and occupancy ~/%//~. b. Intended use and occupancy .. 5~'2::o-r-s.~ .... /.t.p....~ -~ ............................... 3. Natureofwork(checkwhichapphcable) NewBufldmg .... Add,tm ...... Alter~tmn~,.. /.. Repair . . . Removal ....... Demolit~on ........ Other Work/./-~.. ~ (Descmptmn) 4 Estimated Cost .'-'~,D"~'~ ........................... Fee ................................... ' (to be paid on filing this application) 5. If dwelhng, number of dwelhng units ............. Number of dwelhng units on each floor ............. If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of exlstmg struq,tures, if any Front ......... Rear .......... Depth ............. Height ao.2~.. Number of Stories ................................................ Dnmensmns of sa' - me structure with alterations or additions' Front ................ Rear ........ Depth ............... Height .................... Number of Stories .................. 8. D~mens~ons 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 .................... Wdl excess fill be removed from premises: Yes ~' 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 ..... No ~-,~... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether existing or proposed, and. indicate all set-back dtmens~ons fro property hnes. Give street and block number or descnphon according to deed, and show street names and indicate wheth interior or corner lot. APPROVED A8 NOTED NOTIFY BUILDING .DEPARTMENT AT 765-1802 9 AM T~ ~ C~ ~R THE ~LOWlNG IN~PFC~Oh~ FOUNDA~IO~' ~ ' ~U1RED FOR POURF~ '~'~ 3. INSULA rlO~ 4 FtNAt, C(/~STRUCTtON 'MUST TH~ ~EQUI~Fh(FN1S O[ rile N,Y ~ CONSTRUCTION & COD~ ~OT ~S~NS~ n~fGN OR CC ~S~UCTtON ~RO~ STATE OF NEW YORK, COUNTY OF SS (Name of ~ndivldual signing contract) above named ...... being duly sworn, deposes and says that he ~s the apphca He is the ...... (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl apphcatmn; that all statements contained m this apphcat~on are true to the best of his knowledge and belief; and that t work will be performed m the manner set forth ~n the application filed therewith. Sworn to before me this .......... $..67. ........ day of , NotaryPubhc ..... ~,~,-?c~...~."~..7~.~.-.~ '~23~ty "' ~tlC. St~ ~ ~r~ ~ (Signature of appbca~ lerm Exmres March :~6. 1~ , t7