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Home My WebLink About16293-zNO. ~ TOW'N 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) 1629 Z County Tax Map No. 1000 Section ..... ./...~ ........Block .....~t..~ ........ Lot No......~...:...~ ......... pursuant to application dated ........ ...~....~...~P~.~. ................. , 19.~.."]., and approved by the Building Inspector. Fee $..L .................... Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEFTTC TOWN HALL NOTIFY gOUTHOLD, N,Y. 11971 TEL.: 765-1803 CALL MAIL Examined' ~.~. ~J!7, 19~?. Approved 19 .~7. Permit No. }.0..~.~..~..~. Disapproved a/c ................... .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT sS rRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ........ FORM ............. : T0: JUL 3 01981 f7 Date .... (f · .... 1 a. This 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 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 w!ll issued a Building Perrnit 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY M~DE 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 o~ 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, anc~egulations, and to admit authorized inspectors on premises and m building for necessary i~spgdtions. /? (Mailing address of apphcant) State whether applicant is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed)ia If applicant is a corporation, signature of duly authorized officer. ,'~OT~¥ ~.~J,tDtr!?; '-0igA~T~'~~T AT (Name and title of co~orate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY Builder's License No..6.~?.rd~4 .................. LICENSED Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~)~,!!~ ~'~ I. Location of land on which proposed workwill be done. ~ ~O ~X~;"~G'.~} House Number Street Hamlet 000X .e ........... ............. 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 ....... ~;,.Z~.~.,: !.~.'.,~. ........................................ 3. Nature of work (check wh~able): New Building ..... ' ..... Addition .......... Alteration .......... Repair ............. ~~ .............. Demolition ........... ' Other Work ............... (Descrip~tion) 4. Estimated Cost./~-..Z?~...D~.. [ .......................... Fee ...................................... ~ " (to be paid on filing this application) 5. If dwelling, number of dwelhngi umts ............... Number of dwelling units on each floor ................ If garage, number of cars .... , ..................................................................... 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use .. / .................. 7. Dimensions of existing structures, if any: Front ................ Rear .............. Depth' . ............. Hexght ...... , ...... .,.. Number of Stones ........................................................ Danensmns of s~/~e ~{rhctj~ w~th alteratxons or additions: Front ................. Rear .................. Depth ................... !... Height ...................... Number of Stories ...................... '- 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .............. .~-'Number of Stories ........ Z,~) .............. Depth .,~7.~.. 9. Size of lot: Front .... /.~.O.i ......... ,.. Rear .............................. / .............. 10. Date of Purchase .......... , .................... Name of Former Owner ............................. 11. Zoneorusedistrictinwhichp~emisesaresituated.,~7~.~/g~'/~,~/~f ~.<(ff/~ ~.~/./.~.~. ....... 12. Does proposed constructi.on violate any zoning law, ordinanc;'or'r'e~iation': ~.~i' i'.' "i "'..' .' ',L~ 'iii.. 13. Will lot be regraded .. ~. ~,~.... ! ............... ,..;.. Will exc~si fi, Il beremoved from premises: {"Y~, No 14, Name of Owner of premises .f~t.'~..P~/..e~,.~.~.?~ .-~.~P~¢kddress ~ r'- '~X .~[ Phone No ~..~....,~..~74':4 Name of Architect ' .......... ; ............. Address ................... Phone No. Name of Contractor . ~ ....... : .................. Address .... : .............. Phone No ................ 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... ~ ..... *If yes, Southold Town TrOstees Permit maybe required. PLOW DIAGRAM 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 corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. · ~. · · being duly sworn, deposes and says that he is the applicant (Name of individual ' ' ' mgmng contract) above named. He is the ......................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day df ...................... 19... Notary Public, ................................ County-- (Signature of applicant) /50. PO The existence of r~ght of' ways and or easements of record, if any, not shown are not' guaranteed·