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Home My WebLink About16371-z FOB~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6 3 71 Z Date ~~..~...........'~......;~... ......... , Permission is hereby granted to: 'i"~l'": ................ :~ ............. .~:~ .............. z> ...... .......~.-.n_ ,. ~- '~'"~¢.~"~ ................. .~~.~.::~...~..,.....c/...¢~.~... ...... , County Tox Mop No. 1000 Secti~..C~..~. ~ '" ...................... ....... Bilk ....... ..O...~. ....... Lot No.. O pursuant to application doted ...~.~';1..~........~....~ ....... , 103.3., and approved by the Building Inspector. Fee $...~t'...{.,:~ ~ding Inspector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1803 Exami . ~,¢¢.~...~..~., 19 $.2 Appro r JC¢? ?err. it No./..6..g. ?/. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC ~0RM ............. : NOTIFY CALL ..... MAIL TO: Date ....~..~.¢. fi.[ ...... , 19~..~ 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 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 necessary inspections. <. .................... ' (Sign~ure of applicant/dr name, if a corporation) · (Mailing address of applicant9 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~._~..o: .~.~.o~~~:~;,~i~,i~ii}; .~;.,~j~j~~ ....... If applicant is a corporation, signature of duly authorized officer. ,0~ .............................................. ,.. d". ~ (Name and title of corporate officer) - FEE:~¢'~ ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED b~OTtF¥ -.. .... ' ' Builder's License No .......................... ?66,df~O? !~:, -~¢~ Plumber's License No. FOU,>:(;i'.'; (O¢., Electrician's License No ....................... ,~ [ , -, Other Trade's License No ....................... ;~ 1. Location of land on which proposed work will be done .... [ .~. ~ ..... 5-~ .,.;,.,~....: ...... '. ,':'. ,."7 .~'~ .~ ....... Coun, 000 ...... ......... ............ .............. Subdivision .................................... . Filed Map No ............... Lot ............... (Name) 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 ......... 3. Nature ofwork (check which applicable): New Building ..... ' ..... Addition .......... Alteraticu .......... Repair .............. Removal .............. Demolition ............ ' Other Work. f.-4./~.( .-~-... ~v~ 07) .~ (Description) 4. Estimated Cost Fee ............... ~! ' (to be paid on filing this application) 5. If dwelling, number o f dwelling! units ............... Number of dwelling units on each floor ............... If garage number of cars ' 6. If business, commercial or mix4d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Number of Stories ...... Height ................................ Dimenmons of same structure With alterations or additions: Front ................. Rear .................. Depth ! Height Number of Stories 8 Dimensions of entire new construction: Front Rear Depth Height ............... Number. of Stories ...... . .................................................. 9. Size of lot: Front .......... i ............ Rear. ..................... Depth ...................... 10 Date of Purchase . Name of Former Owner 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed constructmn wolate any zoning law, ordinance or regulation: ............................... 13. W/Il lot be regraded ........ .'. ................... Will excess fill be removed from premises: Yes NO' 14. Name of Owner of premises . i . Address . Phone No ................ Name of Contractor ' ............... ........ . ................ Address .... ; .............. Phone No. 15. Is this property locatediwithin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. ~ PLOT DIAGRAM Locate. clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ............................ ,.; ................... being duty sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ..................... ~ ....... , ............................................................ ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is. ?ly authorized to perform or have performed the said work and to make and file this application; that ali statements contained in this application are true to the best 6fhis knowledge and belief; and that the work will be performed in'the mannbr set forth in the application filed therewith. Sworn to before me this i "' Notary Public, ......... County ~IE~ ~{ ~ V0~ ' ' //(Signature of OTARY PUBLIC, ~'t~te Of New Ym'k .. No. 4707878, Suffolk Ceunty