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Home My WebLink About15139-z FOB, M NO, 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDiHG PEP, MIT (TH~S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Counl¥ Tax Map No, 1000 Section .... ~./...~... ......... Block ..... ..~...'-J. ....... Lot No ..... ...(~.....aj. .......... .......... ~..~..-.~ ~.. ............. , 19~..~.., and approved by the pursuont to application dated Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined · · .~.,~..~.~'., 19~.~. Approved.~ .... .~.~.., 19 ~?~'. Permit No../..~-./..~ $.~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date .... .r72 .~...~ .~..' .... , 19~.(,~ INSTRUCTIONS a. Tiffs 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 applk 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. N~ bui~ding shai~ be ~ccupied ~r used in wh~~e ~r in part f~r any purp~se whatever u~til a Certi~cate ~f ~ccupancy 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 inspec, tions. .~..~..~??~..~ .~..~ ~.~ .......... (Signatu-rdof applicant, or na~ttte, if a corporation) (Mailing address of applicant) (Name and title of corporate officer) . Builder's License No ..... .~.~.~ ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. G ~-~. ~ ~ .0, L .e o.,~ ~-. ,:~. .~ ~.~ .(? ............................................................. Name of owner of premises - . .~.~ .o..~ .~.,~ ............................................ (as on the tax roll or latest de~;~l;l~Vl~t~ ~8 ~TED If applicant isa corporation, signature of duly authorized officer. ~'~ ~! ~ ~.~ ~ ]_~./,~ ~ · '~ BY' ', 2 ROUG~ ¢~AMiNG & PLUMBING 4. ~INAL CoNgTRUCTIO~ MUST ~E COMPETE FOR ALL CONSTRUCTION ~ ME~ 1. Location of land on which proposed work will be done .................. T~.~EQUJ~E~E~[~ ~ ~.N,Y.. fi". 3.~ .......... ~ ~.~.~.c ~,..C~, . ~,~ co,s~o, · ~ . House Number Street Subdivision ..................................... Filed Map No ............... Lot . ~ ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,. ~x~,,~,g,,~ an~ o~.,,,~, ~.e.~- ~....h~ ~.~. ~.. ~. g.. ,... ~ .............................. b. Intended us~ and occupancy ...C. }~ D.~.. 3.~.. ~% ¢.~.. ~.r ~...~. q~. ~. ~.D~ ..... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition'. ......... Altera if~n I ......... : Repair .............. Removal .............. Demolition ......... j .... Other Work .I .~?-.-.r~C.~ ~ ..... ~ ~ ~. (Description) 4. Estimated Cost ..... ~'. ~.~- ~ ...................... Fee ... ! ,.(~. ~ ..................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling ttnits on each floor ................ If garage, number of cars ......................................... ~ .............................. 6. If business, commercial or mixed occupancy, specffy nature and extent of eachltype of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .... i ......... Depth ............... Height ............... Number of Stories ......................... i .............................. Dimensions'of same structure with alterations or additions: Front ......... i ....... Rear .................. Depth ...................... Height ...................... Numbe~ of Stories ...................... Dimensions of entire new construction: Front .......... ' ..... Rear ..... } ......... Depth ............... Height ............... Number of Stories ......................... [ .............................. 9. Sizeoflot: Front ...................... Rear .................... '.. Depth ...................... 10. Date of Purchase ............................. Name of Former Owne~ .................. ........... 11. Zone or use district in which premises are situated ...................... ! .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: 'i .............................. 13. Will lot be regraded ...... ,~ ....., .......... ..... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises I.~ r'~, .at ~ ~ .......... Addressq,~ ~ .~.~l't~.~.r~ .C7, Phone No~q ~ ~.~ ~ .~.. Name of Contractor~¢.~..C~.~,.~ ~b-q~ddress~ ~'P~/~'~.~.-C~one No. r~.G~ r.l.~?l ..~. 15. Is this property located-~fithin 300~feet of a tidal wetland? ~Yes ..... No ..... *If yes, Southold Towl~ Trustees Permit maybe required. .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an~ indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and ~how street names and indicate whether interior or corner lot. ~,~ ~ r¢~, ' STATE C COUNTY ~NE1 YORK, S.S OF .! ............... (Name of individual signing contract) above named. being duly sworn, Ideposes and says that he is the applicant He is the ......................................................... i ............................... (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed application; that all statements contained in this application are true to the best. work will be performed in the manner set forth in the application filed therewith. Sworn to before me this davo¢ ~ ~0'~ ~ ,, ...... ~ Notary Public ..... 2~..~.'..~'.~../~... County etc.) :he said work and to make and file this >f his knowledge and belief; and that the ...... ..... (~igna~ure of ;pplican"t)