The URL can be used to link to this page

Home My WebLink About15932-z lrO~.M NO. Il TOWN 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) N9 15932 Z Date ' -~' ~ 19,.~,,.7 . Permission is hereby granted to: -..' , ....~... ,o..~.~.~..u.:.~.....~...~........~.... ....... ~...~~.._~ ................... ~ ~,~ ~,~ ~.'..~.~...~..~2~ ......... .G..~ ..................... County Tax Map No 1000 Sect,o):x~.....(~.~....~ .... Block ..... ..C~....~. ........ Lot No....~...~ ......... ~ur,ua., ,o o,~,,~o,,o,, da,~ ...~.....m'' '~ ................ , ,,~..7, a.d a,,~ove, ~ the Building Inspector. Fee $..~....~...; ............ Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORMNO. 1 SURVEY ......... · TOWN OF SOUTHOLD CHECK .......... BUILDINGDEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y 11971 TEL: 765-180;3 Examined .~,~. ~.~. Approved .i,~.'~..., 19'~"~. Permit No. Disapproved a/c .... NOTIFY CALL ................ MAIL TO: (Budding Inspector) APPLICATION FOR BUILDING PERI,lIT Date .............. , 19 INSTRUCTIONS a. Tins apphcatlon must be completely filled m by Wpewnter or in ink and submitted to the Building Inspector, wit sets of plans, accurate plot plan to scale. Fee according to schedule. b. Hot plan showing locanon of lot and of bulldmgs on premises, relationship to adjoining premises or pubhc str. or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this ap cation. c. The work covered by tins apphcat,on may not be commenced before issuance of Bmldmg Permit. d. Upon approval of this apphcatlon, the Building Inspector will issued a Budding Permit to the apphcant. Such pet shall be kept on the prein,ses avadable for inspection throughout the work. e. No braiding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Braiding Department for the msuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulatlons, for the construction of buddings, additions or alterations, or for removal or deraoht,on, as herein descnb The applicant agrees to coinpI× w,th all apphcable laws, ordinances, budding code, housing code, and regulations, and admtt authorized inspectors on ~rem~ses and in bmldmg for necessary tnsl~nctions.~ , . ...... (Slgnature~'~-- -of applicant, or name, ,f a corporation) (Marling address of applicant) State whether applicant ,s owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or build. Name of owner of premises .~-~ ~-[ ~ If applicant is a corporation, signature of duly authorized officer (Name and tide of corporate officer) ALL CONTRACTOR'S MUST BE.SUFFOLK COUNTY LICENSED Builder's License No . . ~.~ ~ ~.2. . . Pluinber's L,cense No ..... Electrician's L~cense No Other Trade's License No ....... Location of land on which proposed work wdi be done ttouse Number Street County Tax blap No 1000 S~ction z~-~ -!~ Subdi~ ~slon , (Name) ,'~ , , ~ ~ ~,,!'*l~b S~::*LL MEET Hamlet Block 4 Fded Map No Lot ..... Lot 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy b Intended use and occupancy -ti; : t ............ Nature of work (check which, applicable) New Bufldmg ..... Addition Repmr .. Re'moval Demohtion 4. EshmatedCost ~ iC)~'~ ...... If dwelling, number of dwelling units ..... If garage, number of cars ! ....... ... Alteration ·. Other Work (Description) Fee c) 57 .. " (to be paid on filing this application) Number of dwelling units on each floor ....... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. 7 Dimensions of existing structures, if any Front ....... Rear ........ Depth .... Height .. Number of Stones .................. Dtmenmons of same structure with alteratmns or additions Front ....... Rear Depth ............ Height ............. Number of Stones .............. Dimensions of entire new constructmn. Front ............ Rear ............. Depth ........... Height .......... Number of Stones ........................................ 9. Size of lot Front ...... Rear ........... Depth ............... I0. Date of Purchase ........... Name of Former Owner ................. 11 Zone or use dmtnct in which' preml;~s'a're'mt'uated .......................... 12 Does proposed construction violate any zoning law, ordinance or regulatmn' . .............. 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 ........... Name of Contractor ................ Address ................ Phone No ....... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees PermitpMa¥ heLOT required. DIAGRAM Locate clearly and distinctly' all bufldmgs, whether existing or proposed, and indicate all set-back dtmenmons froi property hnes Give street and block number or descnphon accordmg to deed, and show street names and indicate whethc mtenor or corner lot. STATE OF NEWJZORK. ~1~' S S ..... '.~) e.~ ~ ~ C~'2 ~¢¢~ . .. being duly sworn, deposes and says that he is the applica (Name of individual signing contract) above named He m the ~ ................ (Contractor, agent, corporate officer, etc.) of smd owner or ownem, ~d m duly auto. ed to perfo~ or have perfonned the smd work and to m~e and file apphcatmn, that all statements 'contmned m thru apphcat~on are true to the best ofh~s ~owledge and behef, and that work will be perfo~ed m the mmner set forth ~n the apphcat~on filed therewith. Sworn to before me th~s Nota~ Pubhc,~ . ~ .......... County ~ 8~ ~ ~ / ~S~ature ofapplic~