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Home My WebLink About15006-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDinG PERMIT CYHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 'No. 15006 Z is hereby granted to: , ~) Permission ~.~....~.:..~.,.....u...~..~J. ......... tO.-~ ............ ~.~.......~.--. -~ u----- ...-~----- ..................................... ,~ p~,~i~es ~,t,~ ,t ........ .~.~.~.....~.~ ................................................................... County Tax Map No. 1000 Section ...... ..~...'~.....~.. ..... Block ...... ..~..-1. ....... Lot No ...... ..1~...~. .......... pursuant to application doted ..... ....~.....~....~.....'~.. ................., 19..~...~., and approved by the Building Inspector. Building I~spector, Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTNIENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~.4'~m~...~. O..., 19~..~. Approved . . .~..~....~..o..., 19~.. ¢. Permit No./.q~.'~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERIVIlT Received ........... ,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 buildings on premises, relationship to adjoining premises or public streets or areas, and 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 Inspector 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 buildings, 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 inspe~ctions. .~.&.~..~, T..,~. ~..~. ~ e,~ .~3~x,T:mv. e, rv~~ ............. (Signat'Ctl~of applicant, or'T?ame, if a corporation) · F.:..m. ..................... .SJ ¼ .o..I I · ' (raa±l±n~ a~dress of appl±can ~ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....C-Q~...~..~:c..~. !....~..~ .'xf,.oi~-~c.~ o. ............................................................... Name of owner of premises · ~..~. .~,~.:~.~.'.4~fl ...................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~.--.~ ~4~ ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l. Location of land on which proposed work will be done ............................... : ................... House Number Street Hamlet County TaxlVlap No. 1000 Section... :.~..O. ........ Block ..... .~.. Subdivision ................ (~q.a.~.m ~ ) ................ Filed Map No ..... ~ ....... Lot...~.. ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~. ¢~. 2. ~.,.~'~-~...~y.ch..~...c% .~. ~ .o,. .............................. b. Intended use and occupancy . ~ .~..<~...~.~.o~...~.. ~t.~, .~., .c?~~?~Jo..~.' ~ ~.O~.,.,O..Cx.' . .which ~pplicable): New Building .......... Addition .......... Altera '_~n .......... ·, 'd.: Removal .............. Demolition .............. Other Work .r.'.~.~ %~.. ! ..... '-.~'1]'~'{~ ~ ~., (Description) · ,.,, ;;.~,. .... ! .......................... Fee ~.~,~..' o ?.. ...... "' ' ' (to be paid on filing this application) '/iumber 6'Fff~velling 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 addmons: Front ................. Rear .................. Depth ................... ... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction; Front ............... Rear ............... Depth ............... Height ............ ... Number of Stories ........................................................ 9. Size of lot: Front .......... , ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Fenner Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does.proposed construction vi01ate any zoning law, ordinance or regulation: ................................ 13. Willl t beregraded ........ ' ...... : ............... Willexcess ,fillbe em°ved from premises: Y. 7. No 14. Name of Owner of premises . .!. ~.~.ct.l~ .... Address . .%~.~.~.~...~9.o.~?. [4. Phone No ............. Name of Architect ......... , .................. Address .................. ~ Phone No ................ Name of Contraotorff~->,:,~'%.'5,~ ~.*~.~. AddressP. o eSo~:.~-.~4k:-. ~ Phone No. 15. Is th±s propert:y Zocat:e~"'w±t:hJ-n :1..~' feet: of a t:±da:L wetXand? ~ Yes ..... No ..... * Tf yes) Sout:hokd Town Tlbuat:ee$ PeseTa±t: may be requ±red. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interioro~wAer~,lat.. - NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FORiTHE FOl..LOWING INgPECTIONS: l. FOUNDATION - TWO REQU:IRED FOR POURED CONCRETE ~. ROUGH ~ FRAMING & PLUMBING ~. INSULATION 4. FINAL - CON~TRIJCTION ~UST ~E C'~b^P) rTE FOR C.O. ALL CONSTR'JCTION SHALL MEET THE REOtqPk-MEhFTS OF THE lq. Y. STATE CONSTRUCTION & ENERGY NOT RESPONS!BLE ;FOP, CODES.DESIGN OR CONSTRUCTION ER~OR~'~O STATE OF NEW/OR,~, -- ~ S ..................... i ..................... being duly '~orn, deposes and says that he is the applicant '~' "~' '('biame of individual signing contract) above named. He is the .................................................. ' ........ ; ......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements coritained in this application are true to the best of his .knowledge .and belief; and that the' work will be performed in the manger set forth in the application filed therewith. Sworn to before me this , ............ :.//~ .~.~...da~/'&f ./9 .... ~ ...... , 19~.. ..... .... (Signature of applicant)