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Home My WebLink About15131-z 1~0~ NO. ~ TOWN OF SOUTHOLD BIJILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~41T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 15131 Z Permission is hereby granted to: ........ ...~.,o..~..~ ................................................ ~~...~...~.,.../..~.~.~. ...... Building Inspector. Fee $ ..~.:'..~ Rev. 6/30/80 NO. TOWN oF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and givh~g a detailed description of layout of property must be drawn on the diagram which is part of this appl[r cation. c. The work covered by tins application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for r. cm~val or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildin$,dode,/housing code,rand regulations, and to admit authorized inspectors on premises and in building for necessary inspe~ C~.~~. ~''' i~i~at~lr-~'~'~P~tida'n~' 0~ name';~ c ~.,, ~.(~ai g~ 3 )/.adc~e.s~ ~ ~pplc f;~)a'~)'~ .... · ' " '--'lin- a--'i-ant) ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .................................................................. Nane of owner of premises ' ' .~~. [ .~ ...... .~.. (.a; o.~n. t h~.e~a.x~, r o~1/~,~e~'~6~. '~ ...... If applicant is a corporation, signature of duly authorized officer. O~T'E: ~]'Dg ~-J.~L B.P # ~ (Name and title of corporate officer) . Builder's License No...~..~..~. .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be donel ......... ~ .~!Fr,j~,It,~N~. ~tS;;liN.F, .~;Ly~...,~..~,~,a~-.~ ~ ---~ -- ~--~--- .... CODEr~, NOT RESi~Ol~tt*" ' House Number Street . Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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.....~.l.~.~.r~. ..... .~.~. t~) .~--'~. · .~ ........................... b. Intended use and occupancy ./~/..O~.~..~'~ .... ~j~..~.dj~...t~ ........................... 3. Nature of work (check which applicable): ' · ' '~ .... . New Building ..... . . Addition Alteration Repair .............. Removal ........... .... Demolition ..... / .... .... Other Work..~-4~..C.q--. ....... ~'/~ t~' / ~ ~--~ ~.,"t~' ~ ~l, -, (Description) 4. Estimated Cost ..... '~'a.~q~'~ ..... : ............... '. Fee ./.{..~..'.[~...~. ~ ..................... ,," '/tto bb paid on filing this application) ~. ' If dwelling, number of dwelLing units . ......... ' ..... Number of dwelling uxiits on each floor ................ If garage, number of cars ........................................... . ............................. ~ 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..~..e~ ......... Height ............... Number of Stories . ! ...................................................... Dimensinns of same structure with alterations or additions: Front ................. R Depth ...................... Height ..................... Number Of Stories...' .................. '-,,8~ Dimensions of entire new construction: Front .......... ' ..... Rear ....... ........ Depth ............... Height , NulI~ber of Stories ............ 9. ' ........ i'fi;" .... ............. Size of lot: Front ..... ~...O~..... Rear . . .~/.~. . ii ~., .~Z~ii i i i i i i i ] i i i 10. Date of Purchase .,,~/..~..~ ..... iiiiiiii ..... i. Na~e of~'o'r~e'r'6~v~'e;'j....Pl.. 11. Zone or use district in'which premises are situated ....................... i ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: i~.'~ ..................... 13. Will lot be regraded ....... ~t.~ .............. Will excess fill be removed from premises: Yes (No~) 14. Name of Owner of premises .~. · t~'-'-~ ¢~. ~I~I~ ss .............. : .....Phone No..]~b~'.d.. Name of Architect ........................... Address .............. ~ .....Phone No ................ Name of Contractor Address : Phone No 15. Is this property located within 300 feet of a tidal wetland? *~es ..Y~.. No · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM : Locate clearly and distinctly all buildings, whether existing or proposed, and. {ndicate all set-back dimensions from property Lines. Give street and block number or description according to deed, and show street names and indicate whet, hbr interior or corner lot. STATE OF NEW YORK, S.S COU .N~ OF ................. .... (Name of individual signing contract) above named. ...... being duly sworn, dePoses and says that he is the applicant He is the ...... , ................................ :. .q .O. ~4,; .... (Contractor, agent, corporate officer, etq.) of said owner or owners, and is duly authorized to perform or have performed thel said work anff,toi~ta0dJ¢le this application; that all statements contained in this application are true to the best of his knowledge and hell, fl rna,that the work will be performed in the manner set forth in the application filed therewith. Sworn to before °<9'~ '-'"- d/ay o~. ~ ., 19~. Notary Pubhc, ~....~. ...... County sid~lg in Suffolk County -(3~ature of applicant) · ' No. 52.4822133 My Commissiofl Expires