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Home My WebLink About15525-z FOF,.~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N] i5525, Z Permission is hereby granted to/'~/~) o~ pre~,~es ,ocoted at./....O...t.~....~r..~ ........ ~ ....................... County Tax Map No. lO00 Section ...... L~....~. ......... Block ........ .C)...~.. ....... Lot No ...... '~,.~ ........... pursuent to application dated ...... ~..~~.....,'~,.~. ............ , 19.,~..,~.., and approved by the Building Inspector, Fee $...~.;..../ ............. Building Inspector Rev. 6/30/80 ORCHA RD STREET ELAINE ROMAGNOLi SURVEY FOR AMJAD ASSOCIATES AT NEW' SUFFOLK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. I000 - 117 07 30 SCALE' I"= 20' dAN. 2:5, 1986 CERTIFIED TO: FIRST AMERICAN TITLE .,~.~%~ INSURANCE COMPANY OF NEW YORK / //'¥~' % AMJAD ASSOCIATES '~ECO~~EYORS a ENGINEERS ~ R C . t~e ~t.~L~ and approved and adopted (51~) 7~5 ' ~020 for ~ ~ by T~ ~w Yo~ StYe Land PO. BOX 909 Tide MAiN ROAD SOUTHOLD, N. Y. 11971 86 - 114 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 xa,nined .~.~.*,~., 19:~¢. 4, proved .~.~...9:.~. ., ]9~. Pe~it No. ! ~q ~ ~q~ Received .......... ,19... lisapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .ts 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 public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. c. The work covered by this application may not be commenced before issuance of Building Pernfit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit mil be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until g Certificate of Occupancy mil have been granted by the Building Inspector.~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable LawL Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary inspections. , ~-~ ......... .................. (Signature of applicant, or na-qlYe, if a corporation) .. d'./. ¢. . ./. . ,. /r'Z¢.. /. . : , ...... (ma±lSng addre~Js or app.±cane) .tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ¢&'.~. (3 .......................................................................... la,ne of owner of premises .... ~..Z-....~..~. ~?.4~...7..~..,~...g-.~..~... ~..~]~.¢~./.~..~...~'~. ..................... (as on the tax roll or latest deed) ? applicant is 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 will be done../..~.,O.. ,,~..~.~.~....~..'.~.,~: (--4~.~ ................. .... /.o..,qO. .................... ,./.-~.,~.5 .z':.. 4'. z',,¢~,5 .~. ............ ,ffX.?x./.... 5'. ~, .,:'./:7,v.xAn'. ........ ltouse Number Street Hamlet County Tax Map No. 1000 Section ...... //..~ ........ Block ....... ~,~. ....... Lot .... ~.~.d? ............ Subdivision .................. : .................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constructiou: a. Existifig use and occupancy ...... ~../.riff. ~.~C~ .... ,fi'~./~,d'..,~'.... ~..~.~../.,d¢~.,~/~'~ ..................... b. Intended use and occupancy . .~g'~'/-/~.t~,~.....,Z~-ff./c~d?..,~..../'~-..~?~.E' .~L~. ... 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration ........... Repair: ...... Removal ...... Demolition .......... .... Other Work../~. ~'}f.~. ..~ ~.~.~r' ~.~9 .~?. i (Description) 4. Estimated Cost ..... : ......................... Fee (to be paid on filing this application) 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 existing structures, if any: Front ............... Rear ...... ' ........ Depth ...... , ......... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ........... ...... Rear .................. Depth ...................... Height .......... Number off Stories 8. Dimensions of entire new construction: Front i i i~,~; '~-'i ................ ; ...... ........ Rear ...~..i ........ Depth ...,~/. ....... Height ............... Number of Stories .... ~ ............................. :0. Date of Purchase ..... ,~.~.~' .................. mame of Former Owner '.~..t~.~.~...,~.~?V~?~..l~.t)..~. .... 1. Zone or use district in which premises are situated ...................... ' ; .................... ~2. Does proposed construction violate any zoning law, ordinance or regulation: ...~. ......................... 3. Will lot be regraded ............................ Will ex%ess fill be removed from premises: Yes No 4. Na,ne of Owner of premises .. ~Z,.. ~t~.. .... Address ,~.~...~q~....~t-~hone No.. ~).~. Name of Architect ........................... Address . .~./.~.~..~.~.~.. f .... Phone No ............ Nmne of Contractor .......................... Address ................... Phone No ................ 5. Is this property located withinl.00 feet of a t±dal wetland? * Yes .~ No ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ ifidicate all ~et-back dimensions from ,roperty lines. Give street and block number or description according to deed, and show street n~mes and indicate whether 4terior or corner lot. 4t'' 7t'15f/ 'HI&It XPT?Cd reof applicant) rATE OF NEW YORK, OUNTY OF .......... S.S : ................................................ being duly sworn, deppses and ts that he is the applicant (Name of individual signing contract) ,)eve named. e is the .............. ; ............................................. ~ ........ , .................... (Contractor, agent, corporate officer, etc;) ~' said owner or owners, and is duly authorized to perform or have performed the Said work and to make and file this >plication; that all statements contained in this application are true to the best of his knowled e and belief; and that the ork will be performed in the manner set forth in the application filed therewith. ~orn to before me this otary Publicl... . .... County