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Home My WebLink About16338-z FORM NO. ,s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT COMPLETION OF THE WORK AUTHORIZED) ~ote ...~~W.~.....!....7. .......... . ,~.~..). Permission is hereby granted to: ~.~.~.~..~.,.q~ ......................... ~ ..................... ...~.~........~..... ...... .c~..~...%~.~ ............. ~ ..... ....... ......................... County Tox Map No. 1000 Section ~.....~..?.....~. ...... Block ...... ?....~.. ........ Lot No ..... !..( ................ pursuo,t to o,p,co,on dot~ ..... ~~.~.../..~ .......... , 19~.~.., ond °,prove by the Building inspector. Fee $.~.~.:..~... Building Inspector Rev, 6/30/80 ' , ' 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine~.,~.~../..~., 19 .~.7 ApproveX~~.~. t.-/, 19~.~. Permit No./..~..~..~.?..~ Disapproved a/c ..................................... ................................ .... 0'/~. ~[.2/q.q \'~ (Building Inspector) ~\qT\TM APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF P~ANS ....... SURVEY ~21]~2 2~ CHECK SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: Date .................. , 19... INSTRUCTIONS a. Ttfis 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 will issued a Building Permit to the applicant. Such permit shall be Rept 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatiqns, and to admit auth°rized inspect°rs °n premises and in building f°r necess~.~:~.~Z~/__~_.~.. .............. (3'~nature of applicant, or name ifa corporation) · (Mailing addre~'s of applicant) State whether applicant i~essee, agent, architect, engmeer, general contractor, electrician, plumber or builder. Name of owner of premises . YY~tJ'/V~'~../ti,..~.~..d4t~%~' ..................... ~%j~,[~,.a~ ~7~ ....... (as on the tax roi1 or latest deed)~ I __ If applicant is a corporation, signature of duly authorized officer. ~: NOTIFY ~fL[)~tG DEpA~TM~T AT 765,-1~2 9 ~,~ T~) ~ ~ ~R THE ~. Location o[ l~nd on which proposed work will be done .................. ~. ~0~' t~SWJ~t~,~'~ ...... .................................. L'~NF~./rvg..~.. .... :~:.~.~.z~o ~ ............... House Number Street Ha~lbt ,000 ........ ,,oc .......... ZZ .......... Subdivision ..................................... Filed Map,No. ~ ....... Lot ............... (Name) State existing use and occnpancy of premises and intended use and oc,~upancy o,i proposed construction: a. Existing use and occupancy . ~. ...... ~f~ ~. ·/~ ~. ~Z ~i :~¢~ ....................... b. Intended use and occupancy .~ ....... ~.: ....................... (Name and title of corporate officer) - ALL CONTRACTOR*$ lq[IISI BI~ SUFFOLK COUNTY LICENSt*..D Builder's License No...'..~.~:~.."7.c~.q~..-./Tt~. .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. -' ~ 4. Estimated Cost. Fee .................. ] '~ (to be paid on filing this application) 5; If dwelling, number of dwellinglunits ............... 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 strucrurCs, if any: Front ............... Rear ................ Depth ............... ight mb f St ' ' ' ' ..... ' He ............... Nu er o ones ........................................................ Dimensions'of same structure wlith alterations or additions: Front ................. Rear .................. Depth ...... . ............. i · ' Height ...................... Number of Stories ...................... -.8. Dimensionst~ffert~4r~ new construction Front ~/,~:~ Rear Devth ,/~,~...J.'7. . Height . ~ ........... Number of Stones ........................................................ 10. Date of Purchase 1 .' Zone oz use d~str':ct in which prc.h~ds¢:s~ arz ait:;aLc, d (,7.-.--,~ . .~..,A?/i~'f . 12. Does proposed construction vioiate any zoning law, 0rdinance or regulation: 13. Will lot be regraded ..... fl/~ ................... Will exceskfill,be,,r~mov, e.~ l:rl~m prem~e~l, ..- Yes ('NO Name of Architect 15. Is this property located ]within 300 feet of a tidal wetland? *Y~.g.~.. No .~,.. · If yes, Southold Town TrUstees Permit maybe required. ~ PLOT DIAGRAM Locate clearly and distinctly all~ buildings, whether existing or proposed, and. indicate all sst-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, ..... -~~,- ~ ................... being duly sworn, deposes and says that he is the applicant //'' ' "'~ ' ' '(Name of individual signing contracO above flamed. . ~Heis the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 therewitt:. Sworn to before me this ...................... day of ......... '., 196~