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Home My WebLink About15551-z lrOF,,~ NO. 2 TO~N O~ $OUT~OLD TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15551, Z Permission is hereby granted to: ~ ~ .~..~...~ ~ · ~,. ......-'.~.~..~.~ ............................................... .~~. ..... .~.:~.....~.~.~ ..... , , ,. ,o ...~.~.....~..:.'...m....~.....?. ........ ..o._~.........~ ................ at premises located at ...~.. :..~..:...u~..m..C.)~..~..~...~)......~.I...~X~,~'~..-~..:........-~...~... County Tax Map No. 1000 Section ...... ~.!..~. ........ Block ...... .~.......'~... ..... Lot No ....... J..:.,~.. .......... pursuant to application doted~J~.~....~.: ........... , 19..~...~., and approved by the Building Inspector. Fee $..~ .................. Rev. 6/30/80 Exa,,,ined Ai, proved .. . FOnM.O. , TOW. O SOU'r,oLD ?. BUILDING DEPARTMENT ,o..,^,, e.¢: ?¢ SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19,.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~: . · b. Plot plan showing location of lot and of buildinga on premises, relationship to adjoining premises or public streets or areas, a ~d giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ' ' c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspedt'or'will issued a Building Permit to the applicant. Such permit shall 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 .a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build, ings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Nameofownerofpremises..../~.r?.../'-/r5 Ac:','b,~/' ~1/~,'4~,-',-- ~ .1~}~_/'2{, (as on the tax roll or latest de~dL. ~.~ If aPl)licant is a corporation, signature of duly authorized officer. NOTIFY gOf{,DiNO ~3EPAST~EqiT AT .............................................. FOLLOWING iNSPECTiONS: (Name and title of corporate officer) F~NBWdO~ Builder's License No ......................... ROOGN F~AM~NG Plumber's Licens~ No ......................... 4. ~'-:i., Cr>,~STRUCi~Oa MUST Electrician's License No ....................... A~& CC~¢~¢I'FIUCT~ON SHALL Other Trade License No ' ~OOES NOT I'~5~Yi~BL~5 1. Location of land on which proposed W, ork will be done .............................. ' ......... House Number Street , ' Hamlet County Tax Map No. I000 Section ............ Block ............ Lot .. r... Subdivision Filed Map No ' Lot (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing nsc and occupancy t ~ Nature °f work (check whle~ applicable): New Building Repair ............... Removal ........ .' ,' ... ~ ..... : .... Addition ....... ... Alteration ......... emqlition ............ Other Work. ~/~.e'.~.¢.~q .... !~ dwelhng, number of dwell: "~.: ~to bo paid on filing this application) $' ing units ............. '.' Num ir garage, number of cars... I ............... ~ ...... J bet of dwelling units on each floor, . ............. 6 If business commercial orm~xed ' occupancy spe0lfy ........................ 7. Dimensions .of existing street_Utes, if any: Front ...... tleight ............ ;. Number of Stories ...... Dimensions of same structurg with alterations or addi Depth ............. : Hight 8 ,D, n. ons of ntire ........ ;tio~: Front · i mnsi e new constru r~l. gl ' '. ........ 2 Number of St ri .... 9 el it .... o es., .... · ~ze of lot. Front ......... : ....: ........ Roar It of each type of use .................... Rear ' Depth ' ~ ' '. Front .............................. Rear ' ........ Number of Stories ..................... Rear Depth '.' ,' .' .' .' .'..'... property lines, lve street and block number or interior or corner lot. ·., ,, · DateofPurch.ase. . . ..... ~ ................... "'.,.,... Depth ,.. ................... I I. Zone or use district in which .premises are situated er Owner 12 Does pop d .................... ......... onst uction violate any zoning law .... 13 Will lot be regraded or regulation. ' .............. 14. Nmne of Owner of premises,, ~a~-~ . l excess fill be removed from premises: Yes No Name of Architect ....... ]. 9 . . 15. Is this nro-~-~- a~_ ~ ~ :'l'''~ ......... Adc nr.?:c.V. 4~. ~/zb~LLx,_ ' ~ r---~ ~a~e9 w/thin 1.00 feet of a '' ~' ~ ~,,,v,~s~u....,, .... :. * If yes, Southold To~ Trustees Permit ~ ~ .,,,, ,nw ..... Locate clearly and distinctly ~1 buildMgs~ whether . or proposed, and. indicate fll set-back d~onsions from d0scfipti0n to, de,d, and show street names and indicate whether ":'~' (gignature of applicant) NOTARY ~ll~LEN K. DE VOE ~ 47 UBL~, ~ of New Y~k ' . .. 07878, Suffolk Coun~ I~m Expires Ma~h 30, STATE OF NEW YORK, COUNTY OF S S ~.[/~C~.q :..~".(. i' ' bt gd ly " ;i'i[; ....... t~ .......... in u 'w°rn, dopos~s and says, that h~ ts th, applicant ,(Nam~ of individual s n contra¢ of said owner or ....... !~unt{a~tor~ agent, o. ~rporato offio~r, ~to.) ............... ' ' own~=, ~a ~a duly authorized to p~rform or law porfonn~d tho said work aha 'to m~'and, fil~' this application; that all statements contained M Ihia appliCation am. · work will b~ performed in tho m.--~.~, e~.., ...... .?~ to tlm b~at oflus ~owlodu~ and h~,.c, ~8wom to before me tins , ~ aPplmatmn ~,fl0d th0rowRh,. ~ ~P,~47~'~' ~o?H~W,:';;~