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Home My WebLink About15821-z FO]~M ~qO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15821 Z Permission is hereby grarLt~ed to: ~ ,~ ..... .~~.~ ................................................ ...... ........................................... .~.....:..~ ..................... ~ ........................................................ ~t premis~ I~'~t~'~"ot ..~.~..~. ...... ...~.,...~.~..~.:........~,~ ................. County Tox Mop No. lO00 Section ...... ~...?..2 ....... Block ...... ..Q~...3 ........ Lot No.....~....(~. .............. purSuont to opplicotton doted ...... .....~.~..~...'a'~...~. .............. , 19.~...~.., Building Inspector. and approved by the Building Inspector Rev. 6/30/80 Examined...~ .i~..~., 19~..~. Approved ·..~..~...~..~.., 19~..~-· Permit No.}..~.-?...~.l..~.. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ...~.~.IK[:.. ¢ ECK SEPTIC I~ORM ............. : CALL ................ MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 reg?lations, and to admit authorized inspectors on premises and in building for necessary i~pections. .~ ~ / ...... (Signature O~'~tpplicant, or name, if a corporatio, B) ........... f,.',' .............. (Mailing address of applicant) //~ 2--.. State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ...... ........../.:. ...... ..: ......................................... (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 HUST BE SUFFOLK COUNTY LICENSED Builder's License N67 ~. :~~ :. · · .. ~ · .~ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done; ................................................. ............ House Number Street Hamlet County Tax Map No. 1000 Section ./.0.7 ............ Block...f ............. Lot...f ............... 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...~L-O,-....~. ~'~...") :~~ ..................... : ...... . b. Intended use and occupancy ...,,~_,d~.: ..... .~-,/...~.-r~ . .~.... ..................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition · · · ! ...... Alteration,~ }: .~ ~ ... Repair ........ .~... Removal .............. Demolition ............ i. Other Work.. ~;.. ~ ~0~ ' i &rDescripti°n) 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, commercml or m~xed 15ccupancy, specify nature and extent of each typeiof 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 S~ories 8 i f ' pth · Dimens OhS o entire new construction: Front .......... . ..... Rear ......... ; ..... De . .............. Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... Diepth ...................... 10. Date of Purchase ............................. Name of Former Owner ..; ................... ~ ....... ! 1. Zone or use district in which premises are situated .......................... i .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... [ .......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..................... Address ................... i. · PhoneNo ................ Name of Architect Address ' Phone No Name of Contractor .................... ...... Address .... : ........... ~.. Phone No ................ [5. Is this property located within 300 feet of a tidal wetland? *Yes'. .... No ..... · If yes, Southold Town Trustees Permit maz be required. PLOT DIAGRAM : Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show ~treet names and indicate whether nterior or corner lot. '7~-6~1~2 [~,~t~t rO ~. ~1~ ~OR THE FOR ,POU~D RO[JGH ~RAMING & pLgh~ING INSULAI'IO~ ALI CONSl'~UCYtO~ g~[t_ ~FT ~ATE cONSTRUC~tr~ ~ ENERGY ~ NoT ~E~N OR lCGNST~JC130h~ iTATE OF NEW YORK, ?~)UNTY OF ............. S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. te is the .......................................................................................... (Contractor, agent, corporate officer, etc.) : ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements "qontalned in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this HELEN K. DE ~£ ~'-~ ~' (Signature of applicant) NOTARY PUBLIC, State of New Yodt . No, 4707878, Suffolk Cotlnty~ m~m Expires March 30,19. o j