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Home My WebLink About15638-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) N~ 15638 Z Permission is hereby granted to: ..... .~.~....~ ......... ...... .~...?..~i. ...... i..:A....~....~,~..:. ................... .~~ .................. u.~.~. ....... ...................................... at premises located at ..,.~.....~....~...?....~.. ....... ...~......~. ~.....~. ........... ~~...;...~...:.~.:... County Tax Map No. 1000 Section ..... /...~......~.. ...... Block ....... ..~...I ........ Lot No ....../....~ ............ pursuant to application doted ...~. ~....~...c~.. ............ , 19.~..~.., and approved by the Building Inspector, Building Inspector Rev. 6/30/80 $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .'~.O,,~ ."%~, 19 ~..~ Approved.~ o.,~,~.~c~ ~, ~., 19't~ .7. Permit No..1 .~...'~...~?..~ Disapproved a/c ..................................... ................................ ..... (Building Inspector) BOARD OF HEALTH 3 SETS OF PLANS 'FORM NO. 1 SURVEY TOWN OF SOUTHOLD BUILDING D£PARTMENT SEPTIC FORM TOWN HALL MAIL TO: APPLICATION FOR BUILDING PERMIT 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 pint 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 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 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 building for necessar~ inspections...~.~ ~:......... . ~ .. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder. .... o.~)~.~. ~..- .............................................................................. Name of owner of premises . .~.S.?.~.~...~.~.~. ~...~0.{~Z~.. ' . ........... (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 ......................... Electncmn s L~cense No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done~ ................................................. · ..,2. ................... . 4/..: Y. ....... ............. House Number Street Hamlet County Tax Map No. 1000 Section .//P..~. .......... Block .... / ............. Lot.. X .~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~×ist~ng use and occupancy .~..,'~t~...r.....t~...~..0..~y...~.g!C.~//V~....Te...~(¢~.~4~..~..X~.~g;~.'... b. lntended use and occupancy ................................................................... ~ Nature o/work (check which applicable): New Building .......... Addition~,< ........ Alteration ....... acnai Removal ...... L<.~ ..... Demolition ..... ~ ...... Other Work ............ d~/ (Description. 4. Estimated Cost Fee . /..~. ................... ' (to be paid on filing this application) 5 It dwelling~ number of dwelling units ......... ! ..... Number of dwelling units on each floor..../ .......... If garage number of cars ........ . .-"~. :-. .................................................. 6 If bus/ness, commercial or mixed occupancy, specify nature and extent of each type of use ? Dimensions of existing structures, if any: Front..../.~. ........ Rear ..... .t'~.. ..... Height . .J. 5. [ ...... Number of Stories ... ( .............. ~.. :.... .............................. Dimensions of same structure with alterations or additions: Front . ~-e~5~:~ ~.~. ,~Re~. Depth .............. Height ...................... Number of Stories .................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............ Number of Stories ...................................................... 9. Size of lot: Front . .,~5~.t.~. .t ............ Rear...~570..r .............. Depttt ..r/' .,/~.. ,.r .......... 10 Date of Purchase . . .I.~./,,~.~./.~(a..: .............. Name of Former Owner . ,~_.y/....t/')~....: .............. I ! Zone or ase district in which premises are situated.. ~q~::~/O.~.'~', ./~...' .................................. ! 2 Does proposed construction violate any zoning law, ordinance or regulation: .. ~ ......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes N 14. Name of Owner of premises .................... Address ................... Phone No ............... Name of Architect .......................... Address ................... Phone No ............... Namc of Contractor .......................... Address ................... Phone No,: :., ........... 15. D this property located within 300 feet of a tidal wetland? *Yes ..... No ..~%.. *If yes Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorr property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner STATE OF NEW YORK. S.S COUNTY OF .................. being duly sworn, deposes and says that he is the applicant ~ Name ot individual signing contract) {Contractor, agent, corporate officer, etc.) ~,~f smd owne~ or owners, and is duly authorized to perform or have performed the said ~,~l~aake and file this application: thai all statements contained ~ this application are true to the best of his knowledge and b~lief; and that the work will Hc perle)treed in the m~ner set forth in the application filed therewith. Swam to before me this .day of. ,/.: ~ PUBLIC, ~ o ~_ (Signature of applicant)