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Home My WebLink About15899-z ~3,]B,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15 8 9 9 Z Date ....... .~'~.......J.....~:.. .................. County Tax Map No. 1000 Section ..... ~ '~....~., ......... Block ...... ,9...~ ........ Lot No ......~....,~ ........... pursuant to application dated ............................ , 107...~.., Budding Inspector. and approved by the Building Inspector Rev. 6/30/80 Exanuned · .~..[.'37..., 19~/7. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved(~3e~?.../. Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Tiffs application must be completely filled in by typewriter or ~n tnk and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing locatmn of lot and of buddings on premises, relationship to adjo~mng premises or public street or areas, and glvmg a detailed descript?n of layout of property must be drawn on the diagram which is part of this apph cation. c. The work covered by th~s apphcahon may not be commenced before ~ssuance of Budding Permit. d Upon approval of this applicat~on, the Braiding Inspector w~ll issued a Building Pemat to the apphcant. Such pe~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bud&ng Dep~tment for the issuance of a Building Permit pursuant to th Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulahons, for the construction of bulldogs, additions or alterations, or for removal or demohtion, as here~n described The apphcant agrees to rumply with ail apphcable laws, or&nances, buil&ng code, housing code, and regulations, and t( admit authorized ~nspectom on premmes and ~ bmldmg for necessa~ inspections .. ...... ~gn~ure of applicant, or name, ff a corporatmn) , . .... ......... ...... · State whether apphcant ~s owner, lessee, agent, architect, en~neer, general contractor, electricmn, plumber or builder: Name or owner or premises (as on the tax roll or latest deed) l~hcant ~s a corporation, s~gna~ure of duly authorized officer (Name and title of corporate officer) Builder's L~cense No ............. Plumber's License No .................. Electrician's License No .................. Other Trade's License No Location of land on which proposed work will be done ..................... l louse Numb~,'~ Street ' ' 'Haml'~ .................... County Tax Map No 1000 Section .... ! ~" .... Block ............... Lot ................ 2 ................ Filed Map No ............. Lot Subdlvmmn ' ' (Name) State existing use and occupancy. ~Jtt~ .L~.°f premises and~ ./,/]mtended use and/~cupancy of pr;posed construction a Exmtmg use and occupancy 1[~ .?, ,'( ~' .,.~.. q_~,t-~./~--r~-~...4~.-4;',· ................... b. lutended use and occupancy ...... ~/QI"V~ ............................... t ~'3. Nature of work (check wh,ch applicable) New Building ......... Addition ........ Alteratst~fi~ . ..... Repair .......... Removal ........... Demohtion ..........." - Other Work ..~..'-f~.~l~-~. ~...~..,. ~ _.~.~.$, ' ~-- (Descriptio~ $ , 4. Estimat~dC t x ............................. Fee ........................... (to be paid on filing this application) 5. If dwelling, number of dwelhng units .............. Number of dwelling units on each floor ............ If garage, number of cars .................................................................. 6. If business, commercml or. mixed occupancy, specify nature and extent of each type of use .................. 7 D~mensions of existing structures, if any. Front ............. Rear .............. Depth ............ tfe~ght ............. Number of Stones ................................................... Dnnensions of same structure with alteratmns or additions' Front ............... Rear ............. Depth .................... Height ..................... Number of Stories ................... 8. Dm~ensions of entire new construction. Front ............. Rear ............... Depth ............ ' Number of Stones Height ................................................................. 9. Size of lot: Front . .7 ......... : ....... Rear ". · Depth ....... ' 10. Date of Purchase ......................... Name of Former Owner ......................... 11. Zone or use district m which premises are situated ................................................... 12. Does proposed construction violate any zomng law, ordinance or regulahon: ............................. 13. Wdl lot be regraded .......................... Will excess fill be removed from premises: Yes i 14 Name of Owner of premmes~. .................. Address ................... Phone No .............. Name of Arctutect .......................... Address ................... Phone No ..... . ........ Name of Contractor ........................ Address .................. Phone No ............ 15. Is this property located wlthinl00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town'Trustees Permit may be required. , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dtmensmns fro property hnes. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lot. ' .~ STATE OF NEW YORK, S S COUNTY OF ............ ................... ' ................. being duly sworn, deposes and says that he is the applican (Name of individual signing contract) _ above named " He is the ....................... , ..................................................... .(Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi apphcatmn; that all statements contained in tins application are true to the best of his knowledge and behef;and that th. work will be performed in the manner set forth m the application filed therewith. Sworn to before me this ................... da ............. ,19 . Notary Ptlbhc, ·. .. County ~ll'hIW 1~lBI. l~ ~ot l~w Yo~k (Signature of apphcan~