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Home My WebLink About16014-z lrO~.~ NO, ~ TOWN 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) No_ 16014 Z County Tax Map No. 1000 Section . ..O. ?....~ ..... Block ....... .~....kJ.. ....... Lot No. (~' Building Inspector. ..... , 19~...~.., end approved by the Building Inspector Rev 6/30/80 Examined ^pproved .. D~sapproved a/c FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SE?TIC TOWN HALL N0?IF¥ $OUTHOLD, N Y 11971 TEL.. 765-18051 CALL MAIL ,1987 , 19f7 Permit No I & ( Bu~xgfn~ Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ............. : Date ........... 19... INSTRUCTIONS a. Tlus apphcat]on must be completely filled m by typewriter or in ~nk and submitted to the Bufldmg Inspector, wlth 3 sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showmg location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc street- or areas, and giving a detmled descnptmn of layout of property must be drawn on the diagram which is part of this apph cation. c. The work covered by tlus application may not be commenced before issuance of Buddmg Permit d. Upon approval of this application, the Building Inspector will ~ssued a Building Permit to the applicant Such permt~ shall be kept on the premises available for mspectmn throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Cemficate of Occupanc3 shall have been granted by the Bufldmg Inspector. APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Btaldmg Permit pursuant to th~ Build, ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of bufldmgs, addmons or alterations, or for removal or demolmon, as hereto described The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized mspectors on premises and m bmldmg for necessary inspections. (S~gnature of apphcant, or name, ~f a corporation) (Mailing address of apphcant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .. '2 -. ......... .......... N~e of owner of premises ~ ~' ~~/~C~m~ ~a~ ~ ' ' · w~_ ~ ~. ~,~. ~ ~as on the tax roll or latest de~d~ ~' ~ If apphcant ts a co~oranon, s~gnature o~ duly authorized officer. ~ ~TE' ~/~[~7 B.P · (~o/q (Name and t~tle of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Bmlder's License No ............... Plumber's License No Electrician's L~cense No ..... Other Trade's L~cense No ............ 1. Location of land on whmh prgposed work will be done .. .... , .. Ho%se Number ' ' Street County Tax Map No 1000 Section /~ ~ . Block ~.. NOTIFY BUILD!NG t-)EP,~RTMr_,NT AT 766-1802 9 A~ TO ' ~ ~R THE FOLLOWING INS~C~O~q. ~NDATION ~O ~;~Q~D FOR ~URED CONCP~ ~, RObGH FRAMiN[- ~ ~L~MSING 3. iNSULATION BE COMP, ~ ~t~F C ~ Hamlet Subdivision Fried Map No ........ Lot . '(iXlame) State ex~shng use and occupancy of premises and ~ntended use and occupancy of proposed construchon a. Ex,stmguse and occupancy .. b. lntended use and occupancy . / 3 Nature of work (check which applicable) New Budding . . Repatr .... Removal ...... Demolition 4. EstlmatedCost.....//~/.~'..'7t/..~-~. ~r/TY't~... .... ... Fee Addition Alteration ...... Other Work ....... (Description) (to be paid on fihng this application) 5. If dwelling, number of dwelling units .......... Number of dwelling units on each floor .......... If garage, number of cars ........................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................. 7 D~rnenslons of existing structures, if any Front . Rear ........ Depth ...... Height ...... Number of Stones ........................ D~rnensions of same structure with alterations or additions Front ....... Rear ........... Depth ............ Height ......... Number of Stones ............... 8 Dnnenslons of entire new construction Front ..... Rear .............. Depth .......... Height .......... Number of Stones ........................................ 9 Size of lot Front .............. Rear ............. Depth ............. 10 Date of Purchase ................... Name of Fenner Owner ....................... 1 1 Zone or use district in which premises are situated.. , ~ ./. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation' .r~ .or~. ~7~. .................... 13. Will lot be regraded ..../.~.~ ......... Will excess fill be removed from premises Ye~s_ ~ 14. Name of Owner of premises .~[~tT/~,f'~/. ..... Address ........... Phone No ~ ~.~.gS~ .~. Name of Architect ...... ~ dT-~.<~... Address ........ Phone No ............ Name of Contractor ..... .~_~/. O..~.~ .~ .... Address . .. ~°n~?~' 15, Is this property located w~thin 300 feet of a tidal wetl~d;';~;~'~'...Ph°n .............. . *If yes, Southold Town Trustees Permit maybe required. PLO~f DIAGRAM Locate clearly and distinctly all buddings, whether exlstmg or proposed, and indicate all set-back dn~nenslons from vroperty hnes. Give street and block number or description according to deed, and show street names and indicate whether ntenor or corner lot. STATE OF NEW Y~QRK,, ~ ~I~ *"'[' I ~lltL~ S S ~OUNTY OF... ~% ' , ........ ~~: . .~[ ~.~. ~ .... being duly sworn, deposes and says that he ~s the apphcant (Name of ~nd~v~dual s~gmng~ontract) above named ..... ....................... (Contractor, agent, corporate officer, etc.) )f smd owner or ownem, md ~s duly authomed to perfom or have peffo~ed the smd work and to m~e and file t~s ~pphcatmn, that all statements contmed m ~m apphcatlon are true to the best of hm ~owledge and behef; and that the york will be perfo~ed m the m~ner set forth m the apphcatmn filed therewith. 3worn to before me th~s ......... .. q'otary Public, . ............. . ..-~...... Iqotar~ Ptlbh¢[$tate of New ~ork No 4787~6 Q*lrLf~I in Suffolk County County