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Home My WebLink About16438-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Mop No. 1000 Section .... ~)..~...~. ..... Block ..... .~.~. ......... Lot No...~...O. ..... ~,~,o,, ,o o~,,co,io. ~o,~ .....~.~..~....~. ........... , ,,~.].., ~ ~,o~ ~ ,he Budding Jnsp~tor. Rev 6/30/80 N~AP OF LANC) C) ?OWN OF SOuTHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL,, 765-1803 Examined D~sapproved a/c ................ (Bmldmg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............ NOTIFY CALL ................ MAIL TO: a Ttus application must be completely filled m by typewriter or mmk and submitted to the Bmld~ng Inspector, sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showmg locaUon of lot and of bmldmgs on premises, relatmnshzp to adjommg premises or pubhc or areas, and gzvmg a detmled descnphon of layout of property must be drawn on the dmgram whzch is part of thzs canon. c. The work covered by ttus apphcatlon may not be commenced before issuance of Budding Permit d. Upon approval of th~s apphcahon, the Bmldmg Inspector will issued a Bmldmg Permit to the apphcant. Such shall be kept on the premises avadable for inspection throughout the work e. No budding shall be occupmd or used ~n whole or m part for any purpose whatever until a Certfficate of Occu shall have been granted by the Braiding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmld~ng Permit pursuant Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordman Regulations, for the construchon of buddings, addmons or alterations, or for removal or demolmon, as hereto desc The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulations, a admit authorized inspectors an premises a~d m bmldmg for necessary (S~gnature of apphcant, or name, ~f a corporation (Mmhng address of apphcant) State whether apphcant ~s owner, lessee, agent, architect, en~neer, general contractor, elecmcmn, plumber or bu ¢.7-. ..................... Name of ownerofprem~ses ~-,-.Ok/':~O! .~,.~k~-.~--~-'-C2~'" .~'~'T... [~%.~xx[C~. ........ (as on the tax roll or latest deed) If apphcant ~s a corporatmn, szgnature of duly authorized officer (Name and title of corporatelofficer) ALL CON, TRACTOR'S MUST Blg~SUFFOBK CO,IJ_NTY LICENSED Broider s Lmense No .... .,~.\.~. ~ .~. ~ .~e.~v,~e~,% Plumber's L~cense No .... Electrician's License No Other Trade s Ltcense No ............. 1 Locahon of [and on whtch proposed work will be done House Number Street Coun yT pNo I000s t,on . Bloc q. Subdtv,slon _~-~l~x/~. ~flC,k. .~")¢x.A"VX, Fded Map No (Name) Hamlet .... Lot. State ex~stmg use and occupancy of premtses and intended use and occupancy of proposed constructmn a. Ex,shng use and occupancy AQ%3..~.~. ~-. %,~.~ ............. 3. Nature of work (check whmh apphcable) New Bmldlng ....... Add,tie[. {.f ,~ .... Al~texa~_~J~rl~ Repair . ..,. . Remov~ , ..... Demohtmn ..... ~} ~ ~.. Other Work - ' (to be prod on fihng t~c~ion) 5. If dwelling, number of dwelhng umts ......... Number of dwelhng units on each floor : .'% ...... If garage, number of c~s ................................ 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ...... 7 D~ensmns of ex~stmg st~ctures, ff any Front ........... Rear .......... Depth ........ HeOt . .. Number of Stones ................ D~ensmns of same structure w~th alterations or additions Front ............ Rear .......... Depth .............. He,~t ...... ~..~j[.. Number of Stories ....... 8. Dlmensmns of entire newconstmctmn: Front~ ~q'.~ear ............... Depth ... ~..~ .. Height ........ Number of Stones ................................................ 9. Size of lot Front ........ Rear ................ Depth ............... 10. Date of Purchase ................. Name of Fo~er Owner ...................... 1 !. Zone or use d,stnct in wb,,l~ premises are slttmted 12. Does proposed construction molate any zoning law, ordinance or regulation' . ............... 13. W~I lot be regraded ................. ~ ...... W~ll exce~q fill betremave~ from premises Yes 14. Nme of Owner ofpremmes ~qOk.~.~( Address~X~ ~%[... Phone No ~.~7.~Oq. N~e of Architect ................... Address ............. Phone No ........ N~e of Contractor ................ Address .... Phone No ........... 15, Is this properey ioeated w~tkzn 300 fee~ of a t~dal wetland~ *Yes ..... No ..... *If yes, Southold Tom Trustees PermSt maybe required. PLOT DIAG~M Locate cle~ly md distinctly fll buildings, whether ex~stmg or proposed, and md~cate ~I set-back d~enslons fro property hnes. G~ve street ~d block number or description accordNg to deed, ~d show street nines and mdmate wheth. interior or comer lot. (Name of mdlwdual signing contract) above named being duly sworn, deposes and says that he ts the applicant He ss 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 mid file this apphcatmn, that all statements contained m this apphcatmn are true to the best of h~s knowledge and belief; and that the work will be performed in the manner set forth m the apphcatmn filed therewath. Sworn to before me thru ..... day .. (Signature of applicant)