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Home My WebLink About15867-z FOBM NO. ft TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15867 Z Permission Is hereby granted to: .. ...~~..,..a...~,...././....~.~..7. ...... ............................................... at premises located at .~.,~.,,,~.'. ...... .~..~.....~~.; ........ ~~ ........ County Tax Map No. 1000 Section ...... [..?,..,~. ....... Block ..... ,(~..,,~, ....... Lot No....,.~.,..,:~,. ........... pursuant to application dated ..... ~......;~L.. ...................... , 19~..~..., and approved by the Building Inspector. Fee $. ~e~..~.. ............... Building Inspector Rev. 6/30/80 L~TTLE CREEK U. >0 t-- 0 U BLDG. DEPT TOWN OF SOUTHO', 0 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved 19~. ?. Permit No. [.~.'fl..~.?..~. Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~...o~. ....... 19 .g.~. 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 Southokd, 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 desctibed. The 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. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) //'~3'~f State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or lates~e~ If applicant is a corporation, signature of duly authorized officer. ~ ~TE: ~ .............................................. FEE (Name and title of co,orate officer) - NOT~FY ALL CORTRACTOR'S ~UST BE SU~OUNTY LICENSED ']f~B-4~ Builder's License No .... f~ .............. Plumber's License No ......................... ~0¢ Electrician's License No ....................... 3, ~'~t~ Other Trade s License No ...................... ALt C:t¢ 1. Location of land on which proposed work will be done ................. ~[:.(,Oi,~.%-,t;t, . House Number Street ~ Hamlet County Tax Map No. 1000 Section ..... /.~..z/. ........ Block . . .~.,'~. ............ Lot...~./~,, ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. ~...c~_....~.~.?~. ............................................~. , . , b. lntended use and occupancy .. e~n-v'r~.......i'.~'i ............ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteratmn ~..~. ~ . t~ ' (Description) 4. Estimated Cost ..................... Fee ........................ ; ............. ~ ' (to be paid on filing,this ~pplication) 5. If dwelling, number of dwellin~ units. ~ ~ g ........ Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixOd occupancy, specify nature and extent of each type of us~ ..................... 7 Di ' of ex' ' gstm tui 'fany Fr t R D pth . menslons lstln c es~ 1 : on ............... ear .............. e ............... Height ............... Number of Stories ........................................................ D~ens~ons of same structure w~th alterations or additions: Front ................. Rear ., ................ Depth HeiSt 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 Fo~er Owner 11. Zone or use district in which p{emises are situated ..................................................... 12 Does proposed construction vi61ate any zoning law ordinance or regulation: 13. Will lot be regraded ........ ~ .................... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises . .~ .................. Address ................... Phone No ................ Nmne of Architect ........................... Address ................... Phone No ................ N~e of Contractor ........ [ .................. Address .... : .............. Phone No ................ 15. Is thls property ~ocated~thln 300 feet: of a t~dal wetland~ ~Yes ..... *If yes~ Southold To~ Trustees Permit maybe required. , PLOT DIAG~M Locate clearly ~d distinctly ~.'1 hurtings, whether existing or proposed, and. indicate ~1 set-back d~ensions from property ~nes. Give street and bloc~ number or description accord~g to deed, and show street names and indicate whether ~tefior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. · .~Q~ ~I ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in 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 ...................... day elf ............... ,19 . Notaw Public, . ..... ' .......... County 4~U~i.iC. ~ ~f ~ y~ (Signature of applicant) · 01678 SaflOk