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Home My WebLink About13167-zTOWN 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) County Tax Mop No. 1000 Section ...... ...~. ......... Block ................. Lot No .... ' pursuant to application dated ........ ....~...~....'~......~.. ..................... 19~....~,-- and approved by t~e 8,,ildln~ Inspector. Rev. 6/30/80 " F(bRM riO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ........ ~ ..... , l¢. ..Permit No.! Disapproved a/e ..................................... (Building Inspector) APPLICATION FOR BUILDING PfiRMIT Application No .................. May Date ...~...~a.~...2.~. ,..1.9.8.4..., 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot 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 covered by this application may not be commenced before issuance of Building Permit. · d. Upon approval of this application, the Building Inspector will issue 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 a Certificate of Occupahcy shall have t~een- granted by the Building Inspec~o,r '- APPLICATION IS HEREBY MADE to the' ~uiiding De~arfment f~¥ th~ {~suan~ ol~'a Building Perrfiif~puf~0-~fi£ 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 buildings for necessary insjzections. ' (Signature of applicant, or name, ifa corporation) Anne lit. Olsen (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder. owner .......... Nmne of owner of premises ..... AtlQe. YI... ID,I~ ri ...................................................... (as on the tax roll or latest deed) If 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 ...................... 1. Location of land on which proposed work will be done .......... .3/I.a.[.n. ~.l~.a.d. ,,..C.tl.t.o.h.o.~u. e., . ~, .~, ........... House Number Street Hamlet · C~hnty Tax Map No. 1000 Section .0.9.7. ....... Block .. ,5 ............... Lot. p/o. 4, .1 ........... Subdivision..M..i .ng.r.S..u.b.d.i.y.s.igB ,loB.ri 2M~[esne:c. .... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premis'e~s and intended use and ocbhpancy of proposed constru~tio~n~i a. Existing use and occupancy . .o.f£icet.buildi. ng ........... , ......................................... b. Intended use and occupancy .... ,q.~. ~e ........ ;.. ................................................ Installation of Sign 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Removal Demolition --~ Other Work ............... Repair ............... · ........................ ~- (Description) $800 00 Fee ~]' ~ " 4 Estimated Cost · (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling:units on each floor ............... If garage, number of cars ..... ~ .................................................................. 6. It' business, commercial or mixed occupancy specify nature and extent of each type of use ................... ~ if any: Font R Depth 7. Dimensions of existing structures, r ............... ear ........................... Height ............... Numlber of Stones ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .............. ~ Height Number of Stories Depth .................... i ............................................ 8. Dimensions of entire new construction:. Front ............... Rear ............... Depth ............. Height...............Number. of Stories ....................................................... 9. Size of lot: Front ........... I' ........... Rear ...................... Depth ..................... ' Name of Former Owner !0. Date of Purchase . .. ......... ~ .................. · ............................ 11. Zone or use"distriet-~n which pr~mises are situated ..................................................... 12. Does proposed construction vic!ate 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 ................ i Address Phone No Name of Architect '. .................................. ~ Address Phone No Name of Contractor ............................................................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and blockinurnber or description according to deed, and show street names and indicate whether interior or corner lot. [ ~pplicant seeks to construct a sign 4' X 4' . Said sign to be located 5' inside tk~ front yard hn~. Staid sign also to be 4' off of ground. NOTIFY BUIL. uIm 7654 802. 9 ,s,M TO 4 PM FOR FOLLOWING iNSPEcTIONS I. FouNDAT oN ~ TWO R£QUIRED POURED CONCRET , FOR -' LUMBING 2. ROUGH - FRAMING & P BE COMP~ ;?['F FO~ C O, , ALL CoNST2.L.rCT~OM SS~AI:L, MEET CODES, N~ RESpONsibLE COUNTY OF ..... Du~ffo.~k ...... , / work will be performed Sworn to before me thi4 nanper/set forth in the application filed therewith. ............... 19..84 ,. (Signature of applican& Anne H. Olsen being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named., r I owner He is the ~ .............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dhly authorized to perform or have performed the said work and to make and file this applicatiofi; thatk all statements co~tained in' this application are true to'the best of his knowledge and belief; and that the