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Home My WebLink About15109-zTOWN 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) N? 15109 Z Permission is hereby gronted to: .... ................... ..~.~.~...~...~¥....~......~.,....t.~..s..%..~.. ~ . . ot premises Iocoted o' ..~-~...'~...~....~...........~....~.~..~....i.)..~.V~., ...... ~... County Tox Mop No. 1000 Section ...... ..~....~..] .....Block ...... .~...~.. ....... Lot No ...... .~..~. ........... pursuont to opplicotion doted ........ ...~...~....L.~.. ................. , 19..~...~,.., ond opproved by the Building Inspector. Fee $.,a~..:.~... Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N.Y. 11971 TEL.: 765-1803 Exa,nined...~.~..t..~ .... ,19 .~.~ Approved.. 7/~. 1.~ .... , 19~.9. Permit No./..~.~'/..o..~..~. Disapproved a/c ..................................... Received ........... ~19... (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 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 Inspedior 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 inspections. ....... 7.~. :,.~....~?~x... ,¥¥~cf.. f.o... .......... (Signature of applicant, or name, if a corporation) ....... .& Y.;.¢. ..................... (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No. Plumber's License No ......................... Electrician's License No ....................... Name of owner of premises . . ./f.~.. ? .... .?':f..'?.¢'. .... ..F/ff.: .c.tff!~' ..... ./~..~.T.~.. ? .~.~. ......................... (as on the tax roll or latestk~byE~ tk8 If applicant is a corporation, signature of duly authorized officer. '7/~ O~X~:-~mP · /~1o9_ 'G5.1802 9 A~ TO 4 ~ ~R THE ~:OLLOW~NG iN~C~ONS: ~ FOUi~OATION ~0 REQUIRED cOR ~OUREO CON~ETE ~, ~N~ CONSTRUCTION MUST Other Trade s Lic~ ~se No ...................... ' ~' co~PL~E ~OR MEET AL~ CONSYRUCTION ~L 1. Location of land on which proposed work will be done ................ '[H[.aE~Uffi~MENY~ ~. ~ ~ ~ , ..... ~ ~ ~ t gT~Tt CONST¢IUC~ON $ ENER~ ...... Co.nt * 000 S ction .... ?f2 mo k P }... Lot O ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..........0 ,'7 ~ ...... 'f~ '*'....~/.7 .... /..3. ~.<e. (/.~.~,.. ~...~:~ ~,lk¢~,~'~l~ .................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem?vol .............. Demolition .............. Other Work..~...~'71¢.~. ...... 4. Estimated Cost... ~>~ 7~'d~ ~'~.D~ ~ (Description) (to be paid on filing this application) 5, If dwelling number ofdwellinglunits If garage number of cars [ . · .............. Number of dwelling units on each floor ................ If business commercial or mixeB occupancy specify nature and extent of each type of use 7 Dimensions of existing structures if any: Front Rear 'l~}pt'h' ............... Height ............... Number of Stories .................................................. Dimensions of same structure with alterations or additions: Front Rear Depth ' Height .................................. ............................................ Number of Stories 8 Dimensions of entire new construction: Front ...................... ' Rear Depth Height .......... .L ....Number of Stories. .................. . ...................... 9. Size oflot: Front .............. · ........ ~Rear ', .............. ...................... Depth 10. DateofPurchase ! .................. ........... ~ .................. Name of Former Owner 11. Zone or use district in which pr6mises are situated ................... ' ............................ 12. Does proposed construction viollate any zoning law ordinance or regulation.. 13. Will lot be regraded . .. · ...... · ................. ......................... wut excess mi be removed from vremises. Ye 14. Nameo'fOwnerofpremises .~r~ ~. ~4u~be~,~ Arlrlw ~ .... , l~/ -- · S No Name of Architect ^ a~ ....... ...... · ......... ~.uuress · · Phone Nmne 9fC°ntract°r · '~"/.~(. !.~°. rt~..~'~,c'' .Address .F.O..~.~qT,t~ ..~?.~.....Phone No, 15. Is this property located ~±thinl.00 feet of a t±dal wetland? * Yes ..... No .~.~] .... ~ If yes, Sou~hold Town Trustees Permit may be required. PLOT DIAGRAM Locate Clearly and distinctly all Ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. application; that all statements contaified in this application are true to the best work will be performed in the manner s'et forth in the application filed therewith. Sworn to before me this ............... '~ · yo ~ ' · ......... 19.~. Notary Public .... :~ 4' '~' '~... County ~ STATE OF NE /O- , ~ ' ..... , s S COUNTY OF'. · ..... ... / /¢ /o · ' '(~a~; ;'f]~i'vi~it]~l'sij~i~g'c'o;i;a'c~i .......... being duly sworn, deposes and says that he is the applicant above named.' He is the ........... ~.~'r~'7~ ~ [ ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly huthorized to perform or have performed the said work and to make and file this of his knowledge and belief; and that the (Signature' of applicant)