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Home My WebLink About16301-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) No_ 1 ~.~01 Z Dote Permission is hereby I'O at premises located at County Tax Mop No. 1000 pursuant to application dated Building Inspector. Fee $...~...~...~'....~ .J../...D.. ......... Block ..... ...O.....~.. ....... Lot No.....~.~ ............ ...~.....~'..~. ................... , 19..~.7.., and approved by the II Building Inspector Rev. 6/30/80 UNDATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADqlTIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY t~' ~''~, CHECK SEPTIC FORM ............. $OUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL ................ ~ MAIL TO: Disapprove /c ........... .............................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS 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 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 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 denjqlition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, b~ing code, housin, g/c~de.~an-d'fesulat~ons,~d to admit authorized inspectors on premises and in building for necessa~.n~ec~o,~. ,////11, (.-~ ,,~, C~,~(Signature ~f applicant, or name, if a corporation) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. r~/:¢..~/~.-~..c~....../ff..~, zff..'~., t/~ .~...(~. ..................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · ALL CONTRACTOR'S MUST, BE SUFFOLK COUNTY LICENSED Builder's License No...3ff....'.~ ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed wgrk will be done .................................................. ........................ / v ............................... I~n'lgt' '~'~ ................... House Number Street County Tax Map No. 1000 Section .... I I.Q .......... Block ...... ~..'~. ......... Lot...~..0 .............. Subdivision ..................................... Filed Map No ............... Lot ................ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /.~.,.~..~./.{7..~../.cf..(<..~. . ./.,q. ..... · ...................................... use and occupancy ..... · . .-~-.../-d'2~....~W..~.. F~-~ ......... b. Intended Nature of work (check which a~plicable): ..... ..... Addition .......... ......... Repair .............. Remloval .............. Demolition .............. Other Work ..... (Description) 4. Estimated Cost ........... i .......................... Fee ...................................... I *' (to be paid on filing this application) 5. If dwelling number of dwellin~ units / Number of dwelling units on each floor / Ifg mber of ca arage, nu rs .... i .................................... ,.. .............................. 6. If business, comlnercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimerisions of emstlng stmcturps, if any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions'of same s~ruqt~,re With alterations or additions: Front ................. Rear .................. Dept ................... I' ' · Height .............h ~ ~'~ ~ ~ ........ Number of Stories ...................... Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories .............. , .......................................... 9. Sizeoflot: Front .......... I ............ Rear ....... ~ ............... De~th ...................... 10. Date of Purchase ..... .~..~'..2',.4 ................. N~me,~f Former Owner ... ~'?¢'.~/~. ~'~ .... ../~./.~..~. ~... · 1 1. Zone or use district in which p~emises are situated .................................................... .~.. ~. / 12. Does proposed construction vi{late any zoning law, ordinance or regulation: .... ............................ 13. Will lot be regraded ........ i.~-/..O ............... Will excess fill be removed from premises: /Y~es 1 4. Name of Owner of premises .. i .................. Address ................... Phone No..~.~. ~2 ;7?..~. ~... Name of Architect ......... i .................. Address ................... Phone No ................ Name of Contractor ........ i .................. Address .... ; .............. Phone No ............. o I5. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... N ..... · If yes, Southold Town Trostees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, IS.S COUNTY OF ................. ............................ ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract above named. He is the .............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du;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 tkerewith. Sworn to before me this HELEN K. DE VOE .... NOTARY PUBLIC, State Pf New York No. 4707078, Suff0{[ C0er~'/~-~ (Signature of apphcant) Term Expires M~lch 30, LO ,,/