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Home My WebLink About15063-z l~Oll,~ NO, ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL. SOUTHOLD, Iq. Y. N°. BUILDiHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) i5063 Z Dote .......... ~. .................................... Permission is hereby granted toL~. /~ .- , ........ J~.~ ..../..-..~..~.~..~.~ .~...~..~ ...... ........ ...'~x ....... ~..~ ............................................ ..... ..,.~...~. -~c~.~.~.~,.~....~. ........ m]..~.e> ,o ........ ~ ~.. F...cz'c .....~...~ L~.¢..~..., ............................................................................................. County Tax Map No. 1000 Section ....~..,.~[... Block ....~...,~, ...... Lot No..~[.[ ............ Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ltli~E~....1~...., 19 .~..~ Approved .~'{Jl.,~....~.. .... 19~..~errnit No. { .~ .~...~ Disapproved a/c ......... ~'~ ....~ ........ ~,~ ............ · (Building Inspector) APPLICATION FOR BUILDING PERMIT ____TOWN OF $OUTHO ,, ,,, 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, Ordh~ances or Regulations, for the construction of buildings, additions or alteratior[s, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, yuilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~spections. (~ I ~ ~(S~nat~of applicant, or name,~ if a corporation)· ....... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .~.~'... ~~" ~-7. · ¢:. U[ ~-~.'..~ .(<'. {-~J. ............. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title o~eporate officer) . uilder s~License No ...... ~. ....... Plumber's License No ........... /. ............. Electrician's License No ....................... Other Trade's License No .... : ................. 1. Location of land on which proposed work will be done. ~.-.'. .................................... County Tax Map No. I000 Section .. ~..~.~ ........... Block ....~ ............. Lot .... !1 ............. Subdivision 'x/ .. ......... Lot ..... ).~' ........ (Name) <? 2. State existing use and occupancy of premises and intended.use and occupancy of proposed construction: . b Intended use and occupancy ........ ~, ~i~'' :' ~.~?~. 3. Nature of, work (c~a~eck whtch,~l~p!icable): New Building ..... ' .... Addition .......... Alteratior~_~..: ...... Repair .' i ...... :"i' ;:!.. RemiSvM. ............. Demolition .............. Other Work... i ~},oi ~ ~ ~..~ ,~ ~-~ .~, c~, (Description) 4. Estin~t.e.d;Colr.": .~:.: (~29~ .................... Fee ...6~ ~. ~ .......................... ~ ~ ........ i' i: " (to be paid on filing this application) 5. If d~~r:~)f ~twelliffg u~(ts ............... Number of dwelling units on each floor '... ....... If garage number of cars ' 6. If business, commercial or mixed 0ccupancy, specify nature and extent of each type of use ..................... 7. Dm~enslons of existing structures if any: Front .............. '. Rear ......... ..... Depth... 2 ........... Heig ~t Number of Stories ... Dimenmons of same structure witt~ alterations or additions: Front ................. Rear .............. Depth ' Height Number of Stories 8. Dimensions of entire new construction Front .......... . ..... Rear .. .............. Depth ............... Height . .............. Number of Stories ......................................................... Size of lot: Front ..,.........i Rear ......... . Depth ................. .... . Date of Purchase ............. i ................ Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........ ............ ............ Will lot be regraded ........... i ....... . .......... Will excess fill be removed from premises: Yes No Name of Owner of premises" Address Phone No Name of Architect ............ ~ ............... Address ................... Phone No ................ Name of Contractor ' '. · · Address Phone No 1~. Is this property located w~thin 300 feet of a tidal wetland? *Yes *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ;TATE OF NEW YORK, 2OUNTY OF ................. ............................... : .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) .bove named. te is the ........................ i ................................................................. I (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly ~uthorized to perform or have performed the said work and~ to make and file this pplieation; that all statements contained in this application are true to the best,of his knowledge and belief; and that the ~ork will be perfonned in the manner s{t forth in the application filed therewith. .worn to before me this 707878, Seffolkd nl~ ! Term Expires March 30, ~9,,~_~ ? (Signature of applicant) 0