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Home My WebLink About15291-z FORM NO. · TOWN OF SOUTHOLD BILJILDING D£PARTMENT TOWN HALL SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15291 Permission ~s Hereby granted to ~ /~ ....... .~.~.i ~..~..~.....~% .......... ...C~ ........ ~:..~,: ..... LL..~ ~..~ ...... ,o. ~~....~.-..~.. ~.. ~..~...~...~ ....................... at premises located at _~..~?1[....~. ....... .~..'~.......~... ~ ........ .~..~ ........................ County Tax Map No 1000 Sect,on (~ [ ~.. pursuant to appl,cot,on dated Budding Inspector Fee $.~..-%/' ...~ Building Inspector Rev 6/30/80 rom .o ~ ,."~TOWN OF SOUTHOLD '~l~l~ll L DING DEPARTMENT TOWN HALL °,0,OUTHOLD, N Y. 11971 TEL.' 765-1~]02 Examined c~.'~~. .~.o.., 19~(a. Approved~..~.... ,19g~. Pe~at No. I ~-3..q L ~ Disapproved a/c ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlus apphcatmn must be completely filled in by typewriter or in ink and submitted to the Bmlding Inspector, w~th sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing location of lot and of braidings on premises, relationship to adjmmng premises or pubhc street or areas, and g~vmg a detatled dcscnptmn of layout of property must be drawn on the diagram which is part of th~s appl[ cation. c The work covered by th~s apphcatxon may not be commenced before issuance of Building Permit. d. Upon approval of this apphcatlon, the Building Inspector will ~ssued a Bmldmg Pe~it to the apphcant. Such pe~ shall be kept on the premises available for inspection throu~out the work. e. No braiding shall be occupied or used in whole or m part for any purpose whateve~ until a Certificate of Occupy% shall have been granted by the Braiding Inspector. APPLICATION IS HEREBY MADE to fl~e Building Dep~tment for the Issuance of a Bmld[ng Pe~t pursuant to the Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable ~ws, Ordnances o~ Regulations, for the construction of buddings, addmons or alteratmns, or for removal or demolitmn, as hereto described The applicant agrees to comply w~th all app~cable laws, ordinances, bufld~g code, hous~g code, and regulatmns, and to admit authorized inspccto~ on pretmses and ~ building for necessa~ insp~. ~ ~ ~ ~ __ ................ t (S~gnature of apphcant, or name, if a corporation) .... .... ..... (Mafl,ng address of applicant) ~t Q~ 7 State wkether applxcant ~s owner, lessee, agent, architect, engineer, generfl cont~ctor, electrician, plumber or broider. ............................ (as on the tax roll or latest deed) If apphcant ~s a corporatmn, s~gnature of duly authorized officer. (Name and title of corporate officer) Budder's Lmense No .............. Plumber's License No ................ Electrician's L~cense No. .. Other Trade's License No .............. Location of land on which proposed work will be done .. House Number St reel County Tax Map NO 1000 Sechon . ..~. ......... .......... Hamlet Block .. ~ .......... Lot .... '--?.: ? ..... 2 Subd~vis~on ............. Filed Map No ........... Lot ......... (Name) State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction a Exlstmguse and occupancy ...... [~ ~.-~?. ......................................... b. Intended use and occupancy . .~'..v~ .(.,.J2.._..~ ............................................ 3. Nature of work (check whrch applicable) New Building ..... Addmt~c .. . Alteratmn .. · Repair Removal ........ Demolition . Other Work .~/.<1 ~' ~o~ d .~.2~- (]C~ (Description) 4 Estimated Cost' . ..... Q ................... Fee ...... ; ......................... (~o be paid on filing this apphcatlon) 5. If dwelling, number of dwelling units ......... 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 ............... 7. Dimensions of ex]sting structures, if any Front ........... Rear .............. Depth ............. Height ......... Number of Stones ............................................... Dimenmons of same structure with alterations or additions. Front ............... Rear .......... Depth ................ Height ................ Number of Stones ................ 8. Dimensions of entire new construction Front ............... Rear ............... Depth ........... Height ........... Number of Stones ............................................. 9. Size of lot Front ................. Rear .................... Depth .................. I0 Date of Purchase ................... Name of Former Owner ....................... I 1 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 ........................ Wilt excess fill be removed from premises: Yes t4. 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 ..... mIf yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and dishnctly all buHdmgs, whether existing or proposed, and. indicate ~lt set-back dtmenmons ftc property hnes. Give street and block number or description according to deed, and show street names and indicate wheth mtemor or corner lot. STATE OF NEW YORK, S S COUNTY OF ...... (Name of individual signing contract) above named ........ being APPROVED AS NOTED NOTI~ ~ILDING OEPARTM~NT AT 765.1802 9 A~ TO · ~ ~R THE FOLLOWING IN~PEC~ON~' ~uNDA~ION ~I0 ~Q~RED 3. INSULATIOr; ~ ~NA~ CO~S~RUCTtON MUST B~ COM°LET~ ¢()R C 0 ALL CONSTROCTION SHALL MEET THE REQUIreMeNTS ~ THE N,Y ~A~ CONSTRuC~ON & EN~GY ~D~. NOT ~s[~E ~R . Q~IGN O~ CCNS~ON ER~RS ~my sworn, oeposes ~d says that he ~s the apphc He is the .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authomzed to perform or have performed the said work and to make and file application; that all statements contained m this application am true to the best of his knowledge and belief; and that work wdl be performed in the manner set forth in the application filed therewith. Sworn to before me thru .day Notary Pubhc, ' ' ~ '~-kn)T~No 4,078t8,1t[t' It DE v0£ PUaUC, ~ate S~o'~' ~'' ~t4)'' 'd~'''' '°L~e'~°r[ couav~cZ~ 1' County. .... ~... _' e,t-~at ' t; r(~ l~m Ex~ms March 30,1~ t