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Home My WebLink About15914-zTOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5954 Z Date ............................ , 19 .... Permission is hereby granted to: j~ . {'~ . pursuant to application dated ....... ..~ ..................... , 19.~... .., and approved by the Budding Inspector. Fee $.~.'.., .............. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ ,,oOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~. ).~. .... , 19~.~.. D d / .................... tsapprove a c ............. · · · (Buifiling Inspector) APPLICATION FOR BUILDING PERMIT Recexved ........... ,19... 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 buddings on premises, relationship to adjoining pr~mises or public streets or areas, and giving a detailed description of layout of property must be drawn on the d~agmm which is part of this apph- cation. c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this apphcation, the Building Inspedfor will issued a Budding Permit to the applicant. Such permtt shall he 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 Sou}hold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or at}erst}ohs, or for removal or demolition, as hereto described. The apphcant agrees to comply wxth all applicable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m building, for nece~spectlons.. '] ~']' '~''' '~' '~' '~' ·/~'~' ~' · "'~--~/~'-'~ ....'"'- r' ~)~'~' 'r~" .~' '~/ ~ (Sign_s}ute of applicant, or name, if a corporatiofi) ......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... 6' ';f ............... Nameofownerofpre 'e . . (asonthetaxrollorlatestde~ IG-lO? ~:,. ~ I ' If al!Rhc~3nt is a corporation, signathre of duly authorized officer. ....... ........... '~ (Name and title of corporate officer) Bu,lder'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 ............... . ':'~. ' ~' t ~ ' - ........ '":<"' ................... }louse Number ' ' Street Hamlet , County Tax Map No. 1000 Section .................. Block ........... Lot ............. Subdivls:on .................................... Filed Map No ............... Lot ............... . (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: 8, tlS~ ...................... ~ .................. . b lnlended use a~d occupancy '3. Nature of work (check which applicable): New Bufldang ........ Add,hen ......... Alteration . Repair ............. Removal .............. Demol,t,on .............. Other Work. 4. EstJmate~ ., ........................ Fee .................................. (to be paid on filing tiffs apphcatlon) 5. If dwelhng, number of dwelhng units ............... Number of dwelhng umts 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. Dimensmns of existing structures, fishy: Front ............... Rear .............. Depth,. .......... fleight ............... Number of Stones .................................................... Dm~ensions of same structure with alterahons or additions' Front ................ Rear .............. Depth ...................... Height ...................... Number of Storms ................... 8. Dm~enmons of entire new construction: Front .............. Rear ............... Depth ........... Ileight .............. Number of Stones .................................................... 9. S~ze of lot. Front . .7 ........ :.: ........ Rear ..... ': ................ Depth .................. 10. Date of Purchase ............................. Name of Fenner Owner ......................... 11. Zone or use district in which premises are situated ................................................. l 2. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes 14. Name oTOwner of premises,. .................. Address .................. Phone No Name of Architect ........................... Address ................... Phone No .... .. ........ Nmne of Contractor .......................... Address ................... Phone No.....~. ......... 15. Is this property located within 140 feet of a tidal wetland? * Yea ..... No~)~... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alt bmldh~gs, whether existing or proposed, and. indicate all set-back dimensions fm property hnes. Give street and block number or description according to deed, and show street names and mdmate whetl intenor or corner lot. ~ ,, STATE OF NEW YORK, S.S COUNTY OF ................. being duly sworn, deposes and says that tie is the applies: (Name of individual sigmng contract) above n~nled. tlc is 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 ti apphcat~on; that all statements contained in tlus apphcat~on are true to the best oflus knowledge and behef; and that ti work wdl be performed m the manner set forth m the application filed therewith. Sworn to before me this .............. f ...... day ....... ....... Notaryl'ul,hc, . t~'~...~:../:)...z~..~ .... County .......... ............... TamE~.M~a:lCt~19 ~--7 (Signature of npphcar