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Home My WebLink About15129-z FO~M NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15129 Z Permission is hereby grante~l to: .... .6..m.......%......~.~.....~..,.-v'' ................... · ...... ........... _, o' premises Iocoted of .~....~...O...~..~......~.~.,.~ .......... ..(~. ~ .................. County Tax Map No. 1000 Section .... ,C~.....~.....~.. ...... Block ...... ..~}.....(~. ....... Lot No ....... I ................. pursuant to application doted .............. ...~~ ...'~....~.. ................, 19.~)..(~._., and approved by the Building Inspector. Fee $.~:.~ ..... Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . ...'~ .~.~..., 19 ~.~ Approved..~. ~ .~.., 19~..~. Permit No. ~/.,~.J..~..°l..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Tow~LoF SOUTHoLDDG, DEPT, Received ........... ,19... 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 Departmen~t for ~the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~z York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, 6r for removal or demoli~on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, J~i!ding code, housing coja~/and regulations, and to a~mitauth°rizedinspect°rs°npremisesan~inbui~dingf°r~e~ess~./J)~p~-~cti~.~[.s~//~ X~ ~ ~2//,z~,~r,~..~.~.,. ~. ~...,~....~.. ........ 'w(Signatur.~e of applicant/, or n~ei/ff a corporation) . ........ ~,o (M~liling ad, tress of apFlicant) _ ~ State whether applicant is~owner, lessee, agent, architect, en~ne~r, generm~onrracror, electr)c~an, plumber or builder. Name of owner of premises ~4~. ~-~/~./~ .... ".~.. :.....~. ~...~..~.. ................. .......... (as on the tax roll or lalt~~ i~'[~[O'1~ If applicant is a corporation, signature of duly authorized officer, l)~,l~: ~]~.$],'?t, . B.I~ ~ 4.~I ~'~ ~ (Name and title of corporate officer) . Builder's License No....~/~...~- ................. Plumber's License No ......................... Electrician's LicenseNo ....................... Other Trade's License No ...................... NOTIFY BUILDING OEPARTMBNT AT 765-1802 9 A~ ro 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNOATION TWO REQUIRED FOR ~OUI;fED CONC. RI~T~ ~ ROUGm FRAMING & PLUMBING 3. tNSULATIO~J 4. FINAl. CONSTROCTION MUST ~ COMPLETE FOR AL[ GONSTblUCTION SM/I, LL MEET rile iaEQUIREMENT$ OF I'HE N.¥ Street County Tax,ap No. 1000 Section ..... ~.~'.~ .... Block .... --~:)' ........... Lot...~ .............. ~-~ .... ,~-- .... ~'f-~-, ............ ~ ........... /(..~.~- ...~.~. ...... Subdivision ~..t...~. ~ Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~..~. 57. ~ .~..'~-'~. r..'~... ......................................... b. Intended use and occupancy ................ k .............. ~,~e~ );, ............. I. Loca~Lon of land on which proposed work will be done' CONe ~,,-.~..,. ,,,,~ ..... · : ........... S~r.~ C~ti-~STI~k,~,.,~,,~. ~.~,,~n~ .... 7 .... .. lie'R I{~LE , ,. &-,. ,Z'.. ..... House Number Hamlet // v 3: ~qatur~e of work (~heck Which applicable) New Building . '. ddition .......... Alteration .. ~.. 'i... · Repmr ........... < ... Removal .............. Demolition ....... Other Wori~.e,~O- ~, .~ C, ~, ~ ~" ~ ~ ~d~<,vo (Description) 4. Estimated2C6stq,~... ,,,~t,4. ~ Fee ...................................... ~ ~ ~ (to be paid on filing this application) 5. If dwelling, number ~f dwelling units ............... Number of dwelling units on each floor ........... If garage, number of tars .... ' .................................................................... 6. If business, commercial or mixgd 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 additions: Front Rear ............. Depth Height Num bet of Stories '-,8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Fr~t .......... ~ ..~ ....... Rear ...................... Depth ...................... 10. Date of Purchase ..... ~ ....~;.~r ................ Name of Former Owner //t~.q ~ .,~..% .d~.~. ~...tq~ .,,~..~. Il. I~oes Proposed construction violate any zoning law ...................................................... 12. one or use d~stnct m which pr~mises are situated ordinance or regulation: 13. Will lot be regraded ..... ~.~ ................... Will excess fill be removed from premises: Yes No 14 N fp Add . amc of Owner o remises .................... ress ................... Phone No ................ Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor .......................... Address .... ; .............. Phone No ................ 15. Is this property located ,within 300 feet of a tidal wetland? *Yes ..... No ..... *Iff 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 lines. Give street and block :number or description according to deed, and show street names and indicate whether interior or corner lot. STATE; OF NEW YORK, COUNTY OF .......... $.S ............................. ~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............ ... i ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements conta ned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... i Nota. ublic ....... ount applicant'"tt[8 ' ' ' of )