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Home My WebLink About15290-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~4.1T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~? 152~0 Z Perm,sslon is hereby granted to' .................. 'i;iiZ"ii.'i'i.f;....~.: ~. ~.~ ...... ................................. at p~m,,~$ ,ocated a* ...~..~.~Z......')rrJ.~,......~.. ......... ~~__... i"~.iii~;;Zi i~;~Zi iii'i.'ii ......................................................................... County Tax Mop No 1000 Section Budding Inspector ....... , 19~. ~., and approved by the Rev 6/30/80 Ex amln ed ~.~,~,,, App roved .~.~.~ [t~ D~sapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.. 765-1802 ,19 ~[o (Building Inspector) APPLICATION FOR' BUILDING PERM IT Received ........... ,19... INSTRUCTIONS a. Ttus application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, with 2 ~ets 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 street- or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thas appl!. cation. c. The work covered by flus application may not be commenced before issuance of Buddmg Permit d. Upon approval of this apphcatIon, the Building Inspector wall issued a Bufldmg Permit to the apphcant. Such permll shall be kept on the premises available for mspechon throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldmg Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances m Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, budding code, housmg code, and regulations, and tc admit authorized mspectors on premises and m bmldmg for necessary inspections. (Signature of~m_lHmant, or name, if aJ:orporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electnman, plumber or builder. ...... I . N~eofownerofprem~ses GC~ ..... PaOWn Tm. (as on the tax roll or latest dee~) DATE: If apphcant is a co~orahon, s~gnature of duly authorized officer 7054802 (Name and title of corporate officer) Builder's License No . ;~.~ {.Ct Plumber's License No Electnman's License No Other Trade's License No ...... Location of land on which proposed work will be done House Number Street County Tax biap No 1000 Section I .e~ ~ Block . FOLLOWING IN~,PECTION,q F, OuNOA'rfON TWO ~"' CIU1R[D r-'OR ~,QLhqE ti ALL CO~ST~UCTIO~ THE REOUt[~ MFNTS ~ rH~ N v ~A~ CON~UC~ON ~ ENF~GY * '~0~' NOT . . Hamlet .... ..... Subd~vision Filed Map No .... Lot (Name) State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction a Exlstmg use and occupancy ~")~:¥~ ),..~.~ . c.$,Vr>,,.z,r~. ~ ,, ., Q~ ........... 3 Nature of work (check which apphcable) New Budding .... Additmn ......... Alterat~ · · Repmr Removal ...... Demolition ....... Other Work. ~.<L¥~ ~.~,_..~. (Description) 4. Estimated Cost ~' ~. 'D .~>..~>., cO O ......... Fee . .~ '~ '.~.~ (to be prod on fihng this apphcat~on) 5. Ifdwelhng, numberofdwelhngumts. .. Number ofdwelhng umts on each floor ............. If garage, number of cars ......... 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ............. 7. D~menmons of exmt~ng structures, if any Front ......... Rear .......... Depth Height ..... Number of Stones .............................. Dtmenmons of same structure with alterations or additions Front ........... Rear ....... Depth ...... Height ........ Number of Stones ................. - 8. Dlmenmons 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 dmtnct ~n which premises are mtuated .................................. 12. Does proposed construction violate any zomng law, ordinance or regulation . .~,5.t?~ ................. 13. Will lot be regraded .................. Will excess fiI1 be removed from premmes Yes N 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 Permitp_ma5' heLOT DIAGRAMrequired' Locate clearly and distinctly all buddings, whether exmt~ng or proposed, and md~cate all set-back dtmenmons fro property hnes. G~ve street and block number or descnphon according to deed, and show street names and andmate wheth mtenor or corner lot. STATE OF NEW YORK, COUNTY OF .... SS ....................... being duly sworn, deposes and says that he is the apphca (Name of ~ndlwdual mgnmg contract) above named He m the ... (Contractor, agent, corporate officer, otc ) of said owner or owners, and as duly authorized to perform or have performed the sa~d work and to make and file t apphcatmn, that all statements contained m this application are true to the best of his knowledge and belief, and that t work wdI be perfonned in the manner set forth m the apphcatlon filed therewith. Sworn to before me this ....... ~r... da~.f ~ .. ,19z~ ~ & I~ ~1~ (S~gnature of apphca ~ 4~ ~1~ ~9