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Home My WebLink About15289-z /OF, M NO. ~1 TOWN OF SOUTHOLD BUILDI~G DEPART/~ENT TOWN HALL SOUTHOLO, N. Y. BUILDING P EP.t,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 15289 Permission is hereby granted to' ...~.... ?~.~ ...................... .~~. ~..~.~.,....,.~.~.~ ~. ...... ~a .~, ~.. at premises located at ..~,~.~. ...... ~ ...... ..~....~~ ..... co,,w To× Mop No ,000 Se=,,on . C~ ~?- ~'ock ....~..~T~.... ~o, No... ~ ..... pu~uont to =pphcat,on dat~~ ~~-~ ~ ..... , 19~ ~, and appr~ by the Budding inspector Rev 6/30/80 SCALE /"- So' FOR ~L~ INSU~TIOr~ ~INAL CONSTRUC, ,~LL CONSTRUCTION T~ ~EQUI~MENTS Exammed %~.-~*~'~ ~.0. Approved~.~.lh~u~ ~ Disapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~eOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,19'~o , 19~ ~. Permit No } htr, ~ ~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Recezved ........... ,19. Date ~..~.~.//f ....... 19 a Tkis application must be completely filled m by typewriter or in ink and submltted to the Bmldmg Inspector, wlt sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing locatmn of lot and of buildings on premises, relationship to adjoining premises or pubhc str. or areas, and givmg a detailed description of layout of property must be drawn on the diagram winch is part of this ar- cation. c. The work covered by tins apphcation may not be commenced before issuance of Budding Permit. d Upon approval of th~s apphcation, the Bmldmg Inspector will ~ssued a Budding Permit to the apphcant. Such pet shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupa shall have been granted by the Budding Inspector APPLICATION IS HEREBY MA~DE to the Bufldmg Department for the issuance of a Bmldmg Permit pursuant to Bmkhng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinance Regulations, for the constructmn of buddings, additions or alterations, or for removal or demehtion, as herem descnl The apphcant agrees to comply w~th all apphcable laws, ordinances, bufld)ng code, housing code, and regulations, an~ admit authonzed inspectors on premlses and m budding for necessary ml~pictions. /? .~ ~, ..... (Signatut;e,of/apph'Lant, or no'me, if a corporation) State whether apphcant ~s owner, lessee, agent, architect, ;~;1; Name of owner of premises .~'~"?~4 ./4t/~'*"~,r'~- ... (as on the tax roll or latest deed) If apphcant ~s a corporation, s~gnature of duly authorized officer (Name and title of corporate officer) Builder's L~cense No ...... Plumber's L~cense No Electrician's License No Other Trade's License No .. 1. Location ofland on wtuch proposed work wlll be done /~,'~d~,q',,9./~.. P..~f .t4z.~-:~ ........... ,-.3 0 House Number ~,5~o~ Street Hamlet County Tax Map No 1000 Section '~.-9~z?~. '~ Block . .'-gi- .......... Lot. :.~.2~. ..... 2 Subdlv~smn (Nan~e) ' .. Fded Map No .... Lot ...... State exmting use and occupancy of premmes and ~ntended use and occupancy of proposed construction a. Ex/sting use and occupancy c~,~ /~-~ c ~-o~, ~s -f.. ~.a...C.~..~ ~.,_. ~i.' ; ' '/~'~' 'Xfer' '- ~'~"-:' ~?' ~' ?" ~" b Intended use and occupancy ...................................... 3. Nature of work (check which apphcable) New Budding ...... AddlBon ...... Alteration ..... Repair ........ Removal ........ Demolition ............ Other Work ......... ~ ~.. (Description) 4. Estimated Cost ZOoo Fee (to be paid on filing th~s application) 5. If dwelling, number of dwelling umts ......... Number of dwelling 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 ............... ?. DLmenmons of exmtmg structures, if any Front ........ Rear ......... Depth ........... Height ............ Number of Stones ............................... Dimensions of same structure with alterations or add~tmns Front ............. Rear ............ Depth .............. Height ........... Number of Stones ............... 8. Dnnenmons of entire new construction Front ........... Rear .......... Depth ........... Height ........ Number of Stones .......................................... Size of lot Front ........ Rear .............. Depth ................ Date of Purchase ............. Name of Former Owner .................... Zone or use district in which premises are mtuated Does proposed construction molate any zoning law, ordinance or regulation Will lot be regraded ................... Will excess ~l be removed from premises. Yes I Name of Owner of premises .......... Address ............. Phone No ....... Name of Architect ............. Address .............. Phone No .......... Name of Contractor ................ Address ............... Phone No .......... * Yes ..... Iqo ..... 10 11 12. 13. 14. 15. Is this property located withinl00 feet of a tzdal wetland? * If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and dmtmcfly all buddings, whether exmtmg or proposed, and, indicate all set-back danenmons fro property hnes. Give street and block number or descnptmn according to deed, and show street names and indicate wheth interior or comer lot. STATE OF NEW YORK, .. COUiqlCY OF ......... ... ~'~ -- -/-z- --- - ' '~ "~ ' '---/~fff'~..'J ~/~ff.'~'..~ ~ ........ being duly sworn, deposes ~d says that he 1, the apphcm ~/me of ffi&wdu~ mgmng c~tract) above nme~ He ~s the ................. (Con.actor, agent, corporate officer, etc ) of said owner or owners, and m duly authorized to perform or have perfonned the smd work and to m~e and ~e ~ apphcat~on; that all statements contmned m thru apphcahon are true to the best of hm ~owledge and behef, and that ti work will be perfomed ~n the m~ner set forth m the apphcatmn filed ~erewxth. Sworn to before me thru ........... ~ . dayof .... ~ ...... ,19~ Nota~ Pubhc, .~,....__ --'''~. ~.~ ...... County ~, ~~~~. ~, ~ ~ .......... r~ a~s ~¢n ~, 15 , - ~ ~/ ~ (Si~atu~ of apphca