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Home My WebLink About15870-zTOWN OF $OUTtlOLD 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~ 15870 Z Permission Is hereby granted~., to: ~ ~ , ..~ ........ ~..~'~.~. ....... ~....~.~.. .......... ..~.~.~':.....~~~: ......................... .... ~~~.......~...~.:.:..~..:..,...~.~ ......... . ,o ........... County Tax Mop No. 1000 Section .... ...(~)...9...'] ...... Block ...... ..~...~ ........ Lot No ....... J...~. ............. pursuant to application dated ........... ~ ..... ~ .................. , 19..~...~.., ond oppro¥od by the Building Inspector. Building Inspector Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : I TOWN HALL NOTIFY SOU/HOLD, N.Y. 11971 CALL ................ TEL.: 765-1B02 MAIL TO: Approved ...... , 19... Permit No.)..~.-..~.7.0..~. 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 approvai 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 regulations, and to. admit authorized inspectors on premises and in building for necessary in~ections. ... ............... (Signature of applicant, or name, if a corporation) ./z..Y. .... (Mailing address of applicant) (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..... ~..~.t..~. .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~. ¢.~. -.r.~.~....~...-~q...¢].."'~..t.~q .~.~q..S'...o2~.. ~.. ~~. ~,.~ ....... (as on the tax roll or late~W~ ~[~' ~ '~0~ ......... If applicant is a corporation, signature of duly authorized officer, a ~Y[: q/~ 2 [LP 1. Location of land on which proposed work will be done ............... ~&Tk COJ~h V4'-.'-..' ;~2":' .~ .:'2q~J~)qY ....... House Number Street Hamlet County Tax Map No. 1000 Section ~7, O O Block ~% ~ Lot..~A~y. 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 ..... ~,*...~.~7 ff~ .............................................. b. Intended use and occupancy ..... ~.~ o.~::~ .... ~./..~....&.~ ....................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ........ .~:~J~ration .......... Repair .............. Removal, .............. Demolition .............. (~r Wo~..~'~oA' .~ .r.c,t './.~.c~ ~ ~' (D fipti esc on) 4. Estimated Cost ........... ! .......................... Fee ...................................... I ~ (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 commercial or mixed occupancy specify nature and extent of each type of use ..... 7. Dimensions of existing stmctuies, if any: Front ............... Rear .............. Depth ............... Hmght ............. Number of Stories ........................................................ D~e~o~s~stmcture w~th alterations or add~tmns: Front ............... Rear .................. Depth ~ HeiSt Number of Stories ~.8. Dimensions of entire new cons.~mction: Front .......... ~ ..... Rear Depth Height ............... Number of Stories ........................................................ 9 Size of lot: Front ~ Rear Depth 10. Date of Purchase .......... i ................... Name of Fomer Owner ............................. 11. Zone or use district in which p~emises are situated ..................................................... 12 Does proposed construction viglate any zoning law ordinance or regulation: 13. Will lot be regraded ........ ~ ....... ~. ~.~ ........ Will excess fill be removed from premises: Yes _No Nme of Architect ......... '. ................. Address ................... Phone No ................ Nme of Contractor ........ ~ .................. Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~.. *If yes, Southold Town T~ustees Permit maybe required. PLOT DIAG~M Locate clearly ~d distinctly ~I bufld~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions from property ~nes. Give street and block number or descfiOtion accord~g to deed, and show street nines and indicate whether interior or corner lot. oF vo r. . COUNTY OF.. S.S that i. ~ame of individual sig ~ing contract) above named. He is the ............. ~.~-~ ................................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly autho~zed to perform or have perfomed the said work and to m~e ~d file this application; that all statements con}ained ~ this application are true to the best of his knowledge and belief', and that the work will be perfo~ed in the m~n~r set forth in the application filed therewith. Sworn to before me this ~lun~ ~lo/}n[ ~ P*tllI~ ~ (Signature of applicant)