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Home My WebLink About15527-z FO~ NO. ~ 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) 15527, Z at premises located at ....~.,...~....~....~...,.~..........~.~...,...~,... ....... ,..(~.~ .................................... County Tax Map No. 1000 Section ..... ....... Block ........ ~.......:~.. .... Lot No...~.~ .......... pursuant to application dated ..... ~,~~..,~ ........... 19~.~., ond approv~ by the Building Inspector. Fee $.~...~..~..~.~ Building Inspector Rev. 6/30/80 TOWN OF $OUTHQJ~D BUILDING DEPARTMENT TOw~ HALL SOUTHOLD, N.Y. 11971,, TEL.: 765.1802 qsapptoved a/c ..................................... (Btlildilig Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be Comp!?teJy filled in by typewriter or in ink and submitted to the Buiiding lnspectoi', with 3 ts of p .,ins, accurate plot plan to scale Fee according to sc ledu e '.. b. Plot plan showing location of lot and of buildings 6n premises, relationship tO adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on tile diagram which is part of this applL- tion.. c. Tile work covered by this application may not be cominenced before issuance of Bnilding Permit. d. Upon approval of tiffs application, the Building InspectOr will issued a Building Permit to the applicant. Such permit all be kept on the?remises available for inspection t~roughotit the work. e. NO building shall be occupied or used in Whole oi- in part for any purpose whatever until a Certificate of Occupancy all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to th~ Building Department for tile issuance of a Building Permit pursuant to the hiding Zone Ordinance of tile Town .o.f Southold, Suffolk County, New York, and ~[har applicable Laws, Ordinances or ~gulations, for the eonstructi0n of buildings, addi~i0ns or alterations, or for removal or demolition, as herein described. m applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and {o mit authorized inspectors on premises and in buihling for necessary inspections. (Signatur~f applicant, or h/fine, if a corporation) (Mailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 3nJc of ow~Jer o remises ..................... , ............................ (as on the ta~ roll or latest deed) applicant is a corporation, s~gnatt're of duly authorized officer. (Name and title of corporate officer) · Builder's License No .................... i~lumber's License No ......................... Electrician's License No ....................... Otiler Trade's License No ...................... Location oi' land on which proposed work will be done .................................................. ... D,. ~.75..g. ~ ............... e,.., ..... . ................ ~.:~ .Z ................. House Number Street Hamlet Co.nty*ax No. 000 Scc.on ..... }..,Z. ........ B ock .... .&. ........... t. ot ...... $ ......... Subdivision ..................................... Filed Map No ............... Lot ............. (Name) State existing use and occupancy of premises find intefided usc and occupancy of proposed construction: a. Existing use and occupancy .. ...~.. ~ .%Y'x... v'o .I. ............... ,, ....................... b. lntended use and occupa~icy . . ~-vc, ""~'~t ' .O ,~,, ......................... 3. Nature. of work (check. which a plicable): New Building ......... .dti. on .......... Alt0r t~n ,,, · .... Repair .............. Rem ~val ........... Demolition ............ Other Work f.~r-~--~g~-,. ~ ~ ~ ~*~ (Description) ' ~ ~. ...~ Fee - ~ 4 Estimated Cost . . ' (to be paid on filing this application) 5 If dwelling number of dwelling :units " Number of dwelling units on each floor If garage, nmnber of cars ..... ........ i .......... ............................................ 6. If business, commercial or m xe( occupancy, specify nature find extent of each type of use ............ 7 Dimensions of existing structures if any: Front Rear Depth Beight Number of Stories * 'additions:' Front Rear Dimensions of same structure with alterations or .............................. Depth ...................... Height ...................... Number of Stories ................. 8 Dimensions of entire new construction Front ' Rear Depth tteight ............... Number of Stories ................................................... 9 Size of lot: Front ' Rear Depth I0 I)ate of Purchase ' . Name of Formm' Owuer I I. Zone or use d~strlct m winch premises are s t~ atet ................................................ 12. Does prol)osed constructmn we!ate any zoning htw, ordinance or regulatmn: ........................... 13. Will lot be regraded ........ ,~ .................. Will excess fill be removqd from premises: Yes N. 14. Name of Owner of premises .. ~[ ~. ~ ~ ........ Address D~.,~.~. ~.q ~.~ i. Phone No. ~.~ ~ ~ Name of Architect ........ .. ~ ................. Address ........... ~ ...... Phone No ............... N~e of Contracto~.~ p.~.,.v~. ~,~~ddress ~.~~ ~l~je No. ~.~Z { ~ · ~5. Is thts property located~ch~n 300~ea~ of a t~dal wetland. ~es ..... ~o ..... · If yes, 8outhold Tom Trustees Permit maybe required, PLOT DIAGRAM Locate clearly and distinctly ~1 buildings, whether existing or proposed, and. indicate ~1 set-back dimensions fro property lines. Give street and block~ nmnber or description .a~cording to deed, and show street names and indicate wheth~ :ntefior or corner lot. APPROVED NOTED 76fi~1~2 9 A~ TO 4 ~ ~R THE FOLLOWING IN~PEC~ONg: , F~NDATION TWO ~Q~RED FOR POU~eD ROUGH F~tAMING & PLUMBING & INSULA FIO~ · . ~INAL ~ CONSTRUCTION MU~T BE COMPLETE FOR A~ CONSTRUCTION SHALL MEET THE REQUI~MENTS ~ THE N.Y STATE CONSTRUCI'I~ & ENERGY CO~S. ~NOT ~S~NSI~E h~N OR CG~STRUCTtOF ~RROR~. 4TATE OF NEW YORK, S.S '~OUNTY OF ' beiug duly sworn deposes and says that he is the applies (Name of individual sighing contract) ~[)ove llanled. te is tile ..................... i. ~ ....................................... ; .......... . .............. (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th ,pplication; that all statements eoniained in this application are true to tile best of his knowledge and belief; and that ti york will be performed in the manner set forth in the application filed therewith. ~worn to before me this ................ c~ .... day f ................ 19 . -" " ,totary Public, . · ........ County t~ hp~s U,~ch a0, (Signature of appliv: n