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Home My WebLink About15410-Z · O~'~' NO. lB TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15410 Z Permission is hereby granted to: ...~~....~....~% ................... .... ~~,~,......'9. ..:~...:....I.L.~..~.~,~.... , ~,~ .... ........ .............................................................. ................ Coun~ Tax Map No. 000 S.c'o ..... i' ....... i ........ 8,~k ........ a .......... Lot No ........................ pursuant to application dated .... .~.....~...~.....~..~. .............. , 19..~....~., and approved by the Building Inspector. Fee $..J ......... : ........... Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1803 xarnined ..~. ~-...o-~....J .~ -, 19 ?.~. pproved .C~...0~..~../.'?-, 19~.. Permit No..J..~.~ ~/.O..~. Hece±ved ........... ,19... isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. Ttfis application must be cmnpletely filled in by typewriter or iu ink and submitted to the Building Inspector, with 3 Is 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 areas, and giving a detailed description of layout of property lnust be drawn on the diagram which is part of this appli- tion. 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 all be kept on the premises available for inspection throughout the work. e. No buildh~g shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egufations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to hnit authorized inspectors on premises and in building for necessary inspections. (mailing addres3 o'f ap)licant)ff' tale whether applicant is owner, lessee, agent, architect, engineer, g¢~le~r~l~cont.~or, electrician, plumber or buikler 'applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Phunber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ......... Ix)cation of land on which proposed work will be done. ltouse Number Street Hamlet County Tax Map No. 1000 Section ..... ./..c/../. .......Block ....... ~ ........ Lot.....~. J~. ............ Subdivision .................. : .................. Eiled Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .J~. t2 ~_~. 7 ...... /~57~.,~..~'. F./"/A .'7g. .... ? ................................ b. lntended use and occupanc,, .~.0~)? .......... h .~..~.. fi). L/. ~..~..."7.. ,~/~. ~'7,.~ .~...~..o..B-..,-~..(~.~'. Nature of work (check which applicable): New Building_~ , ........... Addition .......... Alteration .......... 3. Repair .............. Removal .............. ~emolitio_gg) .............. Other Work ............... (Description) 4. Estimated Cost .. 9t'/~ .~.dg.~. Fee ......... ~tg~.... .. ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ ......... Number of dwelling units on each floor...'77 ............ If garage, number of cars ....................................................... ; ....... ~,~ ....... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ~/~]o~..~... (~1/7¥./9... 7. Dimensions of existing structures, if any: Front ..... ~..~' ....... Rear ...-~. ........ Dep ............... Height ..... ~/: ........ Number of Stones . .. J. ................................................... Dimensions of same structure with alterations or additions: Front ..... X..-7 ....... Rear ..... ~ ........... Depth ......... .~7.: .......... Height ........ .'~.: ........... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 0. Date of Purchase ............................. Name of Former Owner ............................. 1. Zone or use district in which premises are situated ..................................................... 2. Does proposed construction viola~ any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded .......... ~ ~ .............. Will excess fill be removed from premises: Yes No. 4. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No. 5. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No'~ ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. I'ATE OF NEW YORK, S.S OUNTY OF ................. ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) 3ore nanled. is the ......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. worn to before me this ....................... day of ..................... ,19... otary Public, . ................................ County (Signature of applicant)