The URL can be used to link to this page

Home My WebLink About15434-Z FO~M NO. ~J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15434 Z Permission is hereby granted to: ................ · ...~;,,,,,~.....~ ...... ~ ....................... ......... ?., ' ~ et premises located at ....~....~......~.~ .......... ~......~.. ....... ~..~d,~.~.. ........... County Tax Map No. 1000 Section ...... J...~..~. ........ Block ..... .q)..~"~. ........ Lot No....;~cj~..~.l~. ..... pursuant to application doted .... .~....~...~........~...~ ................. , 19.~...(q.., 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 xa,nined .q>..~Y~'~'~......~.~.., 19~..~. lq)roved .O..~....?~'q?....~.~., 19~1~. Permit No..I..~.q.~. 5..~. 8e. ce±ved ........... ,19... fisapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be co]npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 rs 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 must 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 building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy al! 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 filding Zone Ordinance of the Town of Southold, Suffolk County, New York, and/~er applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for re~lofi~al/br demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building c~, ~ousing code, and regulations, and to !mit authorized inspectors on premises and in building for necessary in~'~j~o~///~/~. ...... .¢W4z-7.~,~.~~ ............... (Si~n/gture/6f/,/x°,qzapplicaut' or na~e, if a corporation) · ~.~_-~-~ .,~x,.": ..... ate whether applicant is owner, lessee, agent, architect, engine, er, general contractor, electrician, plumber or builder. a,,,c of owner of premises ..... >Z.5 .~. ~ .'. ~e~..'~..... ~ .6: V~ +*./..~....C' ~...."~...~.... (as on thc tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (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 5j~done ................................................... .....¢.~. ~.~.~+.~. ~.~...,q. ~¢.~.. ¢~? .............. ~.~ ~ ~:~.~ ~.~ ........... I louse N umbcr Street I lam let ('ounty 'Fax Map No. 1000 Section /.~/..../~.. ~ ~ '/ ¢/2~ 0 ........... Block .... '~ ............. Lot ...... ~ ........... ~quhHivi~in -7" /St/~ ((/;~--~ 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 ......... · .~.-~.. ??..~.~.~....'~J~/..J-A~.. :~ ......................... u~e .... Z'./d/f-,~C ,~d: b. Intended and occupancy ..~.g ............................ ~ ........................... 3. Nature of work (check which applicable): New Builq,iffg...... ' '..\ACai~tl~t .......... Alteration .......... Repair .............. Removal ............ t ~. ,. x/xl. ' Demolition ~ ..... I ..... Other Work ............... k /~ ' / (Description) 4. Estimated Cost .......... ..?X~?...O.O. ........... ~ Fee ..... ,4. ............................... (to be paid on filing this application) 5. If dwelling, numbef' of dwelling units / Number of dwelling units on each floor If garage, 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ........... ,<-. ~. ...... /:.. Rear ...................... Depth ...................... Date of Purchase ........... ~.:/.-.C'..~.. ........ Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ ..~ ....... , .......... Will excess fill be removed from premises: Yes No Name of Owner of premises . ?.~../~..-: ~..~...~...~.. Address (.('d_?.~4~.,~...,~..cf..,~./(.7). Phone No.. ~ .-4 .~..i/~.. Name of Architect ........................... Address .~.~ .X/.&//'?. ,~../.~. Phone No...~. · .~.~. ~.y/..~'~.. Name of Contractor .......................... Address ........ /./. ~.-'~.~ :... Phone No ................ · Yes ..... No ..... 0. 1. 2. 3. 4. 5. Is this property located withinl.00 feet of a tidal wetland? * 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 hnes. Give street and block number or description according to deed, and show street names and indicate whether ~terior or coruer lot. ! q FATE OF NEW. YORK, ~ ~ · .'~..~-/~.h...~..'...~..['/.~'~.. ]'~4.~. ................. being duly sworn, deposes and says that he is the applicant (Name of individual si~ing contract) (Contractor, agent, corporate officer, etc.) ' said owner or owne~, ~d is duly authored to perfo~ or have performed the said work and to m~e and file this )plication; that ~I statements contained ~ this application are true to the best of his knowledge and belief; and that the ork will be perfomed in the m~ner set forth in the application filed therewith. yom to before me this Commissioa Expkes ~,~L 30, 19~