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Home My WebLink About16514-z FORM NO. ~1 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) [I .~.....~.:.~.,...!..!..t.?.l. ....... ,o~ ........ :.~....~~ ...... ~.....~~..~ .................................. ot premises located at ..~..*.'~.....~....~..~: ......... ~~~ ....... --. ......... County Tax Map No. 1000 Sectio ........ ~ .......... B oc ....................................... pursuant to application dated .... ~).~....~, .................... , 19'~..~...., and approved by the Building Inspector. Fee $..~.:.../ ....... Building Inspector Re~ ~/30/80 'FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ..... CHECK ~- ]~]~. - SEPTIC FORM ............. : NOTIFY CALL /d ~'~'~ MAIL : Examined .O ............... Approved .o..~.~.,¢ .Q: ,..,+..~ .~..., 19~.~. Permit No..[.(e..~-.I..~..~. D~sapproved a/c .......... J ........... fi') , TOWN OF SOUTHOLO · 1. ~.*,Y~*~..1~..~-~. · · ·~. ?-'. ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... ! .~. - .~. ....... 19~.~ INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. %'.~.. ~. ~., .e..~x..~..~.,..~-~... ~. ~.~-~ .~ ........... (Signat~f applicant, or na-?ne, if a corpqration) .~ ~ .~...~.~.~-:...~.o ~-~ ~ o.[ ~. ~,~. ~/.' .O.q..O. 1. (Mailing add~es~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... i..'.'.'.'..i ................................................. Name of owner of premises ............................... H '~ 'm?f ~'~' .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .... .~.~ ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done~ ................................................. House Number Street Hamlet Q County Tax Map No. 1000 Section ...C} .~...~..'. ...... Block .... 0..~ ......... Lot .... ).~>.,. 3..~. ..... Subdivision ................................... .. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alterari~j.q[1 .......... Repair .............. Removal .............. Demolition .............. Other Work 4. Estimated Cost ...... .~. .0. ~ .O .t:D. ................ Fee .... ~. , .O..O. ..................... 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage~ number of cars 6. Ifbus~ness, commerc,~01 o~'ojS~l~c~ ~pancy. specify nature and extent of each type of use 7, D~mensmnsofexJsnn structums~ any Front .... Rear Depth Height ........~,~ ~ ei ~~ ....... Nurnbe? 6f Stories ........................ ' ................................ Dimensions'of saf~lg~t~J~tul~ith hlterations or additions: Front Rear Depth ' Height Number of Stories '-,8. Dimensions of entire new construction: Front .......... , ..... Rear Depth Height ............... Nmpber of Stories ........................................................ 9. Size of lot: Front .......... ; .......... ,.. Rear ......... .' ............ Depth ...................... 10. Date of Purchase ........ ~ · ,. ~ ................... Name of Former Owner .......................... 11. Zone or use district in which premises are situated ................................................... ~,. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ]5}..~.: ........................ 13. Will lot be regraded ............ c, ............... Will excess fill be removegl from premises: Yes I~,~o 14. Name of Owner of premises . . .... I:{~e r~.~.~ ...... Addressq:~'.O .~.*l~t..q~-r.~hone No..~ ~.~."~.~.(a .q' Name of Architect ......... ~. · ,,~. ............ Address ..... ¢'. 77..? .k.°.%.~...~-~'.. Phone No ................ 15. Is this property locatedi~:'thin 300 f~et: of a t±dal wetland? ~Yes ..~... No j,~ ... · If yes, Southold Town Trostees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ............................ i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application', that all statements cont:ained 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 i Notary Public ............. N~A~ ~BLIC, ~te d New Y~ ..... ~. 4707~78, S~olk Term Ex,res March 30,19 (Signature of applicant),