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Home My WebLink About15077-z FO~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. i5077 Z Permission is hereby granted to: . - ...... ....... ................... C~~f~......~......ff..:..!.~ ~.~.~..~.. ...... ,o~...~. ........¢~.~~....~~ ....... o~. .............. ~ ~...o.. ................ ~ ..................... ~. ~ .: ....... County Tax Map No. 1000 Section...... ~m ~J'~.... Block ...... ..~....'~. ....... lot No......'~...:..J ............ ....... ...~..~...~. ........................ 19..~..~0, and approved by the pursuant to application doted Building Inspector. Fee $, .~......:.~ Building Inspector Rev. 6/30/80 (Building Inspector? APPLICATION FOR BUILDING PEFIMIT INSTRUCTIONS a. Tlds application must be completely filled in by typewriter or i~ ink and submitted to the Building Inspector 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 drown 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 att applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~ns. (ma±l:[ng add~'~'6f ap~.c~nt) ....... State wbethe? applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pmmber or builde[. Name of owner of premises F~ , 'r~ ~ ' (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. ..................... ill be do 1. Location of land on which proposed work w ne...... ........... , · .,, ~, ........ · , .................... House Number Street . .- ' Hamlet Map No. 1000 Section .... Block .. , , , , ...... Lot, · · ('ounty Tax ' · ·, · ' ......... 2. State ex~stmg use and occupancy of premzses and intended use ~nd,o~u~g;Ofpr~po~d constmctmn. b. ]ntended use and occupancy .................................. ', .'; .................... Nature of work (cheek Which applieabie): New Build'hag' Repair 'Removal. 4. Estimated Cost ...... '~ ,, ~ ~,k,:~ ' ', ...... i ........ Alteration ........ n ~ ./Other Work ..... ~i (Description) ,, , (to be paid on filing this application) .6. If dwelling, Number of dW~liing unit~ on each floor ...... ".'...- ...... If garage number, of cars .,~,, ,:~.ia¢i ~ ~ ~ ~ ~ .-;..~,;,. !, .c,;.. ;.. ,,.,/., ~ ,,..; .... , .............. , ........ ' ' If business, comme~ial or mired oc~pm~, ~ecffy ~a~m ~d extent of each type of u~ ....... · '~ 't? ....... . Dimensi~s or,sister stint,res, if any: Front ~ 7~;,..,., .... Rear .~ ~: ...... : Depth .. ~../D f ...... ' -'~ r f ' / , . HeiSt ~.~ ~ ......... Numbe o Stones ..,,,,.,[. ........... . ................................. D~ension- s of same structure dth alterations or addttiofis: Front , ...... ~. ~, ~ ..... Rear .................. Depth ............. ~ :,,, ,.Hei~t .. ,..'...~...~ .... .... Numberof'Stofies...~ ................. i 8. D~ensions of entlr6 new'construction. Front..~. ,' ~'~, ~. i Rea{ ~,' ,~ Depth ...... ~ ........ .' HeiSt ...'.....:,~.,;..Number0fStories ....... ...~., ..... , ..... .,,...,~. ..... ~ ....... ~ ......... ~ .... . 9. S~eoflotFront...,..t~i~ ,;,,., .... Re~;,.~.,:.,~.~;~,', ....... ~ep~h ~ff'~c~V, ~.¢~ ~ . 11. Zoneoru~.districttn~i~hpremisesar~s~tuat6a i~ ' ~Ciff~.~.c.~.'~<}~!e/ . /.,.' ........ ' 12,' Does propo~d ~onst~chon violate any z0ffing law, o~il ~ce or re~iation: ~... ~. ~,~.., ~ ................ ,. 13, Will lot be reg~ded . .~,, ~,~, ~ ........ ;... ~... Will excess fill be r~moved fwm premises:' Yes _ ~ ,, ' 14.. ,N~e of O~er of premiss ~$~ ~ .¢~ ~.4~.',~ ~ress ~ l./~! C (q ;~;. ~E~hone No. ~7~.~.. Phone No ,' Name'of Architect ..... ~ ', ~.,, .; :,,.,, .', ',,, ', A~ ' Name0fContractor ' ,'". : '"" ',' ' 'A~ 15. Is this property locat~a,~ilihin:l;00,, feat',of If yes~ S~thold To~ T~ste~s P~i~ ma~' be Locate cle~t~ ~d dist~ctly ~1~ burden; whe~er ekis pwpe~ ~nes. Give street and block number or description ac ~teflor or comer lot. dreSS :~,..,,;. ,,.. ?.,. r, · · Phone No .............. t; tidal ,wetland? * Yes, ..... No . .~. ,,r~_qutr ed'. :mg~ or proposed~ and, indicate all. set-back dimensions from ,ordmg,to deed, and sho~ street names and indicate whether , ~. /O ,- 'STATEOF NEW YORK;": "~ ~ '1. ~ ''~'~ · ........... ,,,; ...... i,,..;~.,.:,i ,~¢ingduIyswom, depo~ es and says that he is the applicant ~ ':' ' ., (Nam~ Ofindividflal signing contract} : above named. ,~ ,.' , , ' ' "~ :' ' ,. :;., ' ' , ,' , ' ' (Contractbr;a~entdcorporate officer etc.) , ' ' of,said owner or oWne~ ~d ,is, duly authored to p~have perforated the sad work- and to m~e and file this m,.that ~t statements cogtamed m this-apphcatwn ale tree to'the bestof,hts knowledge and behef; and that the , i be:,peiiO~ed' ln.th~ m~her s~,t'forth ~ I ~ ' Ti'led therewith: ': ', . , '. : , ' ,' . ," , ~-,,