The URL can be used to link to this page

Home My WebLink About15959-zTOWN 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) N~ 15959 Z Permtss~on is hereby granted to: ..... ~.~ ~-~. '°°~-~ ~-h ~~" ~t C o ....... ~ ~~ ~,r~ ,,~' .... ': .......... '~ ......... ; ...................... to pursuant to application doted .... [ ~' ~..X~.~.J¢~. ............................. ~ ~ , 19.~.."].., ond approved by the Building Inspector. Building Inspector Rev. 6/30/80 Examined Approved "~ ~. Dxsapproved a/c · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,, BLDG DEPT. or soumqm Rece3_ved ........... ,19. (BmlWlng Inspector) APPLICATION FOR BUILDING PERMIT Date . , 19 INSTRUCTIONS a Tins appllcatlon must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, wltl sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing locahon of lot and of buildings on premises, relahonship to adjoining premises or pubhc stre, or areas, and giving a detaled description of layout of property must be drawn on the diagram which is part of flus apl catlmf c The work covered by flus apphcahon may not be commenced before issuance of Building Permit d~ Upon approval of ttus application, the Building Inspector will issued a Building Permit to the applicant Such pern shall be kept on the premises available for inspection throughout the work e. No bmldmg shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupan shall have been granted by the Binldlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmlding Permit pursuant to t Budding Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constructton of buildings, additions or alterations, or for removal or demolition, as hereto descnb. The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectors on premises and m building for necessary inspections (Signature of applicant, or name, ~f a corporation) ma. s'-"1'5 State whether apphcant is owner, lessee, agent, architect, engoneer, general contractor, electrician, plumber or build, (as on the tax roll or latest deed) If apphcant is a corporatmn, s~gnature of duly authorized officer 2 (Name and t~tle of corporate officer) Builder's L~cense No Plumber's Lmense No Electrician's License No Other Trade's License No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Sectmn Subdtv]smn (Name) Block Fried Map No Hamlet . Lot tl'~ .. Lot State existing use and occupancy of premises and intended use and occupancy of proposed constructmn a Existing use and occupancy .... b Intended use and occupancy '~.'[~ '~. ~'~ ~...,~ ......... 3. Nature of work (check which applicable). New Bmldmg .......... Addition ....... STATE OF NEW YORK, COUNTY OF A1terat~oll.. ..... Repair . . ~ [ $ ~t[Removal ...... Demohtlon .......... Other Work.. ' ..~ ~ '-, </ ~ (Description) 4. Est~a~ed Cost.. ~ ' ~ ...................... Fee .~?./ ............................ (to be paid on filing thru apphcat~on) 5. If dwelling, number of dwe~ng umts ............ Number of dwelhng units on each floor ........ If garage, number of c~s .......................................................... 6 If buaness, commerc~ or m~xed occupancy, specify nature and extent of each type of use .............. 7. D~ens~ons of exishng structures, if any Front ..... Rear ............ Depth ........ Height ........... Number of Stones ........ D~ensmns of same structure w~th alterations or addatmns' Front ........... Rear ......... Dep~ ....... He~t ........... Number of Stones ......... 8 D~ensmns ofenhre new const~ctmn Front ......... Re~ ............ Depth ........ Height . Number of Stones ................................. 9 S~ze of lot Front Re~ ..................... Depth ........ 10 Date of Purchase ......... N~e of Foyer Owner .. 11 Zone or use d~stnc~ m w~ch prelmses are situated ........... 12 Does proposed construchon v~olate any zomng law, ordinance or re~labon ~O ......... 13. Will lot be regraded .. ~ .......... Wall exce~ fill be removed from premises. Yes 14 Nme of Owner of premises ........ Address .............. Phone No . Nme of ~ch~tect ....... Address ............ Phone No ........ Nme of Contractor ......... Address ............. Phone No ....... 15. Is th~s property located withinl00 feet of a tidal wetland* * Yes ..... No .~. · If yes, Southold To~ Trustees Permit may be requmred. PLOT DIAG~ Locate cle~ly ~d dis~nctly ~1 budding, whe~er ex~stmg or proposed, ~d ~ndmate ~1 set-back d~enslc~s fro prope~ hnes Give street ~d block number or descnptmn according to deed, ~d show street nines ~d red,cate whetb interior or corner lot , ~OVEO Ag NOT~ ~T~ CONSrRuc~ & ~ERGY ~ ~ SS (Name of lndlwdual signing contract) above named .... being duly sworn, deposes and says that he is the appbca He is the ....... (Contractor, agent, corporate officer, etc ) of smd owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file ti apphcanon, that all statements contained m th~s application are true to the best ofhm knowledge and belief, and that t work will be performed m the manner set forth ~n the apphcation filed therewith. Sworn to before me this ..... 4[ .. .dayof.. ~ ......... 19f,~ Notarymubhc, ~ ~...p~.f,j~.lI/ ..... County I~. 4707878, ~ ~ ~ (Signature of applica. Term Eqxtes l/~ch 30, l_ o/