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Home My WebLink About16358-z FOR]f NO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to/~ ........................................... at premises located at ..~'~.,~..~ County Tax Map No. 1000 Section ....... .~...~.~. .... Block ....... (~..~. ....... Lot No.....~..~ ............. pursuant to application dated ....~..~..~........]...~.(~- ......... , 19.~...I.,~-/ Building Inspector. and approved by the Building Inspector Rev. 6/30/80 BOARD OF HEALTH ..... 3 SETS OF PLANS ....... *FORM NO. I SURVEY ......... TOWN OF SOUTHOLD CHECK ~ .L~,.'-;[ .... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1803 CALL ...................... MAIL Examined .~ .~...W..~.*-.., 19 .s. ? Approve~ .1:~..W :ZZ., 19~. 7. Pe~it No. [.~ g.~ ~ Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19. INSTRUCTIONS a. This applicatiou must be completely filled in by typewriter or in ink and submRted to the Building Inspector, witli 3 sets of plans, accurate plot plan to scale. Fcc .;ording to schedule. b. Plot plan sliowing 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 co~nmenced before issuance of Building Permit. d. Upon approval of tliis application, the Building Inspector will issued a Building Permit to the applicant. Such permit sliall be kept on tile premises available for inspection throughout the work. e. No building shall be occupied or used in wliole 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 Bullring Department for thc issuance of a Building Permit pursuant to the Building Z0n0 Ordinance of the Town of 8outhold, Suffolk County, Now York, and other applioabl0 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whet~p_pli~cant?~_~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................ ~('on th~tax~'~(as roll or late;[ &~dd) ......................... if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . Builder's License No ...................... ~.~.. Plmnber's License No ..................... ..... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be d~e .................................................. ..... ..... ............ ' Hous~ Number Street co.,.~ Ta~ ~,~ ~. ~000 S~.~io~, ..... ~2 ......... ~ ..... ~ ........... ~l... ~ .............. Subdivision ..................................... Filed ~p ~ ............... ~ ............... (Name) 2. State existiug .se and occupancy of premises and intended use and occupancy of proposed construction: a. anS ...........: ................................. b. Intended use and occupancy . .~~ ........................................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work..~. · zz. ~.-~.~..'.. Descrip, ion) 4. Estimated Cost ............ ~..' ...................... Fee ... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 structures, if any: Front ............... Rear .............. Depth ........ : ...... Height Number of Stories ' Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... HeiSt ...................... Number of Stories ...................... '- 8. Dimensions of entire new construction: Front .......... ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Foyer Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ .v ................... Will excess fill be removed from premises: Yes No Nme of Contractor ~.[~ ~0~. ~e~ ...... Address .... :.. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 Phone N~g~ ~ .... 15. Is chis propergy located wtrhtn 300 feet of a tidal wetland? ayes ..... No ~... ~If yes, 8outhold Tom Trustee8 Permit maybe required. PLOT DIAG~M Locate clearly ~d distinctly ~1 bulldogs, whether existing or proposed, and. mdt~l~s~¢%~ ~ns from property ~nes. Give street and block number or description accord~g to deed, m~d sh~ street,~mes gnd indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........................ ' ............................................................... (Contractor~corporate officer, etc.) of said owner or owners, and is duly authorized to perfo~ or have perfoxaned 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 therewith. Sworn to before me this ............ /..7. ......... day of ...... ~ ......... , HOTAIIY ~lC, ~e ~ ~w ~ . ~. 4707878, ~olk ~ (Signature of applicant)