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Home My WebLink About15061-Z IPORM NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~,IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15061 Z Permission is hereby granted to: ..... .... ~..~.........~....~ ~.._..~....~.....~..:. .~.~ ............... ,..~ ................... ~ .......... at premises located at ....~.~...~...~...~... ....... ~&.....~.....~. ...... ~~.'.~.........J~..:..~, ................... County Tax Map No. 1000 Section ,...0....~.....~. ......... Block ...... ..~...~. ........ Lot No..,..~.,.~.....~. .......... pursuant to application dated ....... ....~..~...~ ..................... , 19...~....~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ;..., Approved . .'~-~/ ..... 19~.. Permit No. ).~.'~..~.l..~.. ~J Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19~ INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 coveted 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 pr~mises 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. Heidtmann & Son, Inc. (Signature of applicant, or name, if a corporation) Demolition .... .P...0.:. ~o..x.x..9.3..2.,..C..u.t.c.h. gg.u.e.,...N.,.y,..1.!9.35 " (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premises ...... .R.u.t..h. ~n. ¢.ej:.plTi~.e~ ................................................ (as on the tax roll or latest deed) If~orporatiojL signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... 1.Q .................... Plumber's License No. HcCarvill Plumbing Electrician's License No .... E,,E.. Ca .......... ~Lnci ii.ut s License i~o ...................... ~4 f-~ Location ofland on which proposed work will be donel Rt. 48, Peconic, N,Y. House Number Street Hamlet County Tax Map No. 1000 Section ....... .~..~. ....... Block ....... .~.. ........ Lot .... O.q...~. ........ 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 ..................................................................... b. Intended use and occupancy ./~.~.~¥~...~ ' ~:? 9 ~:~! .....................'~':o~ ~'~'~'~ '~', d'~ .~ · ................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition . :~;~./. ....... Other Work ............... ; ' ~ (Description) ,~,' - I1~3,.500.00 4. :,Zstima~2~st ...................................... Fee~./../'~.~ ~.~. ........................ ,& .... . (to be paid on filing this application) 5. If dwi, lling, number of ~welling units ............... Number of dwelling units on each floor ................ ~ t&gatage, number of cars ........................................................................ 6. If business commercial or mixed occupancy specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front .... .4.0. ........ Rear . .4.0. .... ...... Depth...2.4. .......... · 10 · one Height ............... Number of Stones ........................................................ Dimensions of same structure with alterations or additions: Front ..... .~.~.x. ~ .......Rear ..... ?$.l~.X. ~ ........ Depth ........ ~.~.x. ,. ......... Height .......... ~.i~..~.x.x. ...... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... 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 ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM No 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 comer lot. ]TATE OF NEW ~_K/,T..-Z~ :OUNT¥ O~ ..M~.~. ~./,4, · · S.S .......... (Name of individual signing contract) tbove named. ~;~'PROVED A~ NOTED ~UILD~NG OEPARTM~ AT ~O 4 ~ ~ THE ~*~TRiJCTiON MUST FOR C 0 ROGTION S~ALL M~ 4EQU~ME~TS OF ~E N,Y ~S~E ~R CqNS~N ~RORS. being duly sworn, deposes and says that he is the applicant te,sthe ......................__ ~ . -- -----,.-p--"~t"i~i~ent, corporate officer, etc.) said owner or owners, and is or have perf=ed the ,o pplication; that all statements contain~.~ th~ion are true to the best of his knowledge and belief; and that the 'tork will be perfomed in the m~ner set forth ~ the application filed therewith. ,worn to before me this .......... .7~ ...... dayof ....... .~1~ ..... ,19~ of