The URL can be used to link to this page

Home My WebLink About16408-z ~0~ NO. 0 TOWN OF SOUTHOLD 8~JILDIHG DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- J (~408 Z Permission is hereby granted to: , /~ /' /'~ / ~....+..~.~....~.~....~.:..~... ......-~.~,.~..~. .................................................. ..~.~.....~..;.~.......l.L.~..~-.~ ..... ,o ............................................... at premtses located at .(R. ....................~ ~ ...~. ...... .~~.....~...~ ..................................................................... .:. ............ County Tax Mop No. 1OO0 Section ...... (~)..~..I ......... Block ..... ...~;...[ .......... Lot No ..... .~ ............ p, rs,ont to opp,,cotion dated .... .CL~.r......~ ............ , l~..~.--t.., and appro~ b~ t~e Building Inspector. Fee $....~'...~..:. ............. Rev. 6/30/80 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL F, OUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH 3 SETS OF PLANS SURVEY ......... CHECK ,'l~'.J2.(,,.~' .... SEPTIC FORM NOTIFY CALL Examined Approved .0~ 44~....I~.~.., 19~77. Pe~it No. I ~ q.q~ 1987 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... o.0.O0/q INSTRUCTIONS ' a. Tiffs application must be completely filled in by Wpewriter 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. Tile 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 shail be kept on th.~ 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 shail 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. Tile 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. (Signatore of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plu. inber or builder. ............. Name of owner of premises ...~. '~)..t'.O..ge~ ('~.~....~.0..~./. {.~. .... .~-~! ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) , ALL CONTRACTOR'S MUST BE~$UFFOLK COUNTY Builder's License No ..... ~.~. ~'. ............. Plumber's License No ......................... LICENSED Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. .0 ............ : .s. r. .o ^/... ...... d .... House Number Street Hamlet ] Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended ose and occupancy of proposed construction: a. Existing use and occupancy ..................................................... b. Intended use and occupancy ......... 3. Nature of work (check which applicable): .New Building ..... ' ..... Addition .......... ALterationc..~r~t;?t~ ......... P, epair .............. Removal ..... ......... Demolition ............ '' Other Work .F..4~. (¥.* ~...... ~ ./~. fd~ O~ (Descriplion) 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, com~nercial 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 ...................... Height ................... .... 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 Former 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 ...................... ~: .... Will excess fill be removed from_prejnises: Yes No 14. Name of Owner of premises ~?~b~,Ogb..0~./.~..~../~.,Address~,~ .tO..'g~../~/~,TO~.~ q~.. fi~.~o~b No..~. ~.~.~ ./~. ~.~.. Nmne of Architect ........................... Address ................... Phone No ................. 15. Is this property located within 300 feet of a t±dal wetland? ~Yes ..... No.~.... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clea~ly and distinctly all buildings, whether existing or proposed, an& indicate all s~t-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. CO~INTY OF ' ' ' ~~ . .~ [~'( ¢/1 J:t .~:-. :se/-~.,~. ~-¢ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above nanled. Ite is the.. ~ ................... ' ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfonned the said work and to m~e and file this application; that all statements contained ~ 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 ~ ..... ~ ~ ~ /*'/ (Signature of a plicant) ~l~ In 8u~k Coun~ ~'~ ~. P