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Home My WebLink About16000-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) County Tax Map No 1000 Section...(~..~.~ . Block ........ ..~...J. ....... Lot No .... ..~....~. ......... purSuant to application dated ..................... .~~ !.l ....... , 19..~.7.., and approved by the Building Inspector. Fee Building Inspector Rev 6/30/80 Disapproved a/c .. ,19~? , 19~ 7 Permit No ] FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL $OUTHOLD, N.Y 11971 TEL. 765-1802~%, MAILCALL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. : .%3: O.qP. ...... TO: (Bmldlng Inspector) APPLICATION FOR BUILDING PERMIT Date . .:~'~ IN ST RUCTION S a. Tlus application must be completely filled m by typewriter or in ~nk and submitted to the Budding Inspector, w~tl sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showmg location of lot and of buddings on premises, relatlonsinp to adjoining premises or public sire or areas, and giving a detmled description of layout of property must be drawn on the diagram winch Is part of this ap cation. c The work covered by ttus application may not be commenced before issuance of Building Permit d. Upon approval of this apphcatlon, the Building Inspector will Issued a Budding Permit to the apphcant Such pen shall be kept on the premmes available for inspection throughout the work e. No budding 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 Binld~ng Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Permit pursuant to Building Zone Or&nance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buddings, additions or alterations, or for removal or demohtlon, as hereto descnb The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and re~ulatlons, and admit authorized inspectors on premises and In building for necessary inspections ...... (Slgnature'~f-~apphcant, or nart~l ff a corporation) (Mailing address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build G~-.~-,e-~- q&l .~.,~r,nv~2.~T-c~ ~ .................... Name of owner ofpremmes :c,:~-.r )',~.c~ . . . th ~p ~ If apphcant ts a corporanon, mgnature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST._~_E SUFFOLK COUNTY LICENSED Builder's L~cense No .... ~ h' (-~ .. . Plumber's License No Electncmn's L~cense No .. Other Trade's License No Locatmn of land on wtnch proposed work will be done llouse Number Street County Tax Map No 1000 Sechon q %J Block Lot 3 Subd~vtsmn .... Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construchon a Existlng use and occupancy (~[O~c~ ~C::>c:r-W~ ~.e~q~.~..<~.-~. ~'xO~p,5~v~ ........... b Intended useandoccupancy ~-'Io~.~-- ~r-, ~O~T'~ ~'-t ~ .I~-Zl.'~.~'X ~C-~-~' ........ 3 Nature of work (check which applicable) New Budding Addition ...... Alteratlk~B . Repair ......... Removal ...... Demohtlon .. Other Work (Description) 4 EstlmatedCost ..;~:B'~<2D , c~ .r::? .. Fee. . .~.~V,~:D ~ .......... ' (to be paid on filing this application) 5. If dwelhng, number of dwelling umts ...... Number of dwelling units on each floor .... If garage, number of cars ................................ 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ..... 7. Dimensions of exmttng structures, If any Front . . . Rear ....... Depth ...... Hmght . . Number of Storms ................. Dnuens~ons of same structure with alterations or addmons Front ....... Rear ....... Depth ...... Height .. 8. D~menslons of entire new constructmn Front Height ...... Number of Stones ...... 9 10 11 12 ·. Number of Stones ............ .. Rear ..... Depth .... S~ze of lot Front .... Rear .......... Depth ............. Date of Purchase .............. Name of Former Owner ............... Zone or use d~stnct m which premises are situated ......................... Does proposed construction wolate any zomng law, ordinance or regulation' . . .I~. '~ ................ 13 ..............Will lot be regraded Will excess fill be removed from premises' Yes No 14. Name of Owner of premises . . ~m' . . Address'~/(~ ]--qq~l~q-. ~ .. Phone No ~)3¢. Name of Architect ........"J Address . . .C~..°D~..° %.~ .~. Phone No ........... Name of Contractor~.e~,~-,-~ wx.~.q~v, e-,-~.~'v~-~ddressl~r~.:S'~g'~--. _~o'r~,~[e[ Phone No t~.'-.~7~.Oc? (~ 15. Is thzs property located-w~thzn 300 {-&et of a tidal wetland? *Yes ..... No ~... *If yes, Southold Town Trustees Permmt maybe required. PLOT DIAGKA~ Locate clearly and dmtmctly nil buddings, whether ex~st~ng or proposed, and md~cate all set-back dnnenslons from )roperty hnes G~ve street and block number or description according to deed, and show street names and ~ndmate whether ntenor or corner lot ¢TATE OF NEW YORK, S S 7OUNTY OF .............. being duly sworn, deposes and says that he is the apphcant (Name of lndlwdual s~gmng contract) ,bore named te is the .... (Contractor, agent, corporate officer, etc ) ~f smd owner or owners, and m duly authorized to perform or have performed the said work and to make and file ti'as pphcatlon; that all statements contmned m th~s apphcatmn are true to the best of his knowledge and behef, and that the york will be performed m the manner set forth m the apphcatmn filed therewith. ,worn to before me this ..... ((.. , aay of ..... ....... 4otaryPubhc, . .... ~ .~, ~.~--.~.~/~ County~ ~. , ] t ' ~..t~ ~1t~ ~ (S~gnature of apphcant)