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Home My WebLink About16538-z ~OR~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTJ~ENT TOWN HALL SOUTHOLD, H. Y. BUILDING PEIU~IT (THIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: , .................................................... ........... . vt premises located at ..L.~e..~IL~...~..,.*~......~....~,--.~.~...~.~....~..(~..~..'...~.G~ County Tox Map No. 1000 Section ....(~...°1..~. ......... Block ...... ..~...~ ......... Lot No ..... J...~ ............... pursuant to application doted ....~-~....~..,.J..~. ..................... , 19.~..~.., and approved by the Building Inspector. Fee $.~:.~ ..... Building Inspector Rev. 6/30/80 Examined Approved: lit No. I ~ .~.~...~..'~.. BOARD OF HEALTH ...... " ' 3 gETS OF PLANS ....... 'FOnMNO. I SURVEY ......... TOWN OF SOUTHOLD ClIF, GK .... , . . . · . BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1803 CALL ................ MAIL TO: '-~'~;t Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................. 1 INSTRUCTIONS ,, a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witli 2 sets of plans, accurate plot plan to scale. Fee according to scliedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli catiofi. c. Tile work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tliis application, the Building Inspector will issued a Building Permit to the applicant. Such perlni shall be kept on tl~e premises available for inspection throughout the work. e. No buildiflg shall be occupied or used in whole or in part for any purpose wliatever until ~ Certificate of Occupanc] shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to tile Building Department for the issuance of a Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings., additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t( admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE,$.UFFOLK COUNTY LICENSED Builder's License No ...... h~.(~ ................~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether plicant is owner, lessee, agent, arcliitect, engineer, general contractor, electrician, plumber or builder, ,' Nan,e of owner of t, rcmises ........ ~g2:~.."..~,~r~.,.I.O .aR..#.J.l.,.K..~.3..~.~. (as on the tax roll or la.test aced}' V. ~ . If applicant is a corporation, signature of duly authorized officer.~OT~ Location of land on which proposed.~ork will be done .... 0 ........... ............. llouse Number Street Hamlet .... County Tax Map No. 1000 Section .... ~ .......... Block ...... ]. ........... Lot ................. Subdivisiou ..................................... Filed Map No ............... Lot ............... (Name) ~. State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occnpancy ~/~ ~. .,, ann ..... ................................................... ,~ ..,, -' ~ .~. 3. Natme of work (cl~eck which applicable): New Building ..... ' ..... Addition .......... Alteratio_~ ...t~.~. .... /,,//J R6pair ............. Re uoval .... i ...... Demolition .............. Other Work .ffff~ 4. Estimated Cost ............... Fee ' (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 structures, if any: Front Rear Depth Height Nmnber of Stories ' Dhnensions'of same structure with alterations or additions: Front Rear Depth ...................... Height ...................... Number of Stories ...................... ~ 8. Dimensions of entire new construction: Front Rear Depth tteight ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Fomer Owner ............................. I 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction giolate any zoning law, ordifiance or regulation: ................................ 13. Will lot be regraded ................. ~.., ....... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ....... /[~ddre~/~~.~. Phone No ~'~ Name of Architect ........................... Address ................... Phone No ................ Nmne of Contractor .......................... Address .... : ..... ~ .~ ...... Phone No. ~ ........... 15. Is this property located within 300 feet of a tidal wetland. Yes ..... No .~.~ *If yes, Southold To~ Trustees Permit maybe required. PLOT DIAG~M Locate clearly ~d distinctly ~1 bulldogs, whether existing or proposed, and. indicate ~1 sbt-back d~ensions from property liues. Give street and block number or desc~ption according to deed, ~d show street names and indicate whether interior or corner lot. ~.TATE OF cou w oF...b ..... s.s ....~.~'.~ - ~B~ ........................... being duly sworn, deposes and says that he is the applicant (Name of individual si~aing contract) abov~ nanled, (Contractor, a~ent, corporate officer, etc.) o~ said owner or owners, ~ld is duly authorized to perform or hare peffonn~d the said work and to m~e ~d file this ~pplication; that all statementJ contained k this application are tru~ to the best of his kowl,dg, and Belief; and that the work will be peffom~d in the m~ner set forth in the ~pplicatio~ filed th,r~with. 8worn to before me this ....... t* a,ror.. .... ,19r Xota. P.~lic, . · ~t. Co. ~A~ PUSUC, ~le ~ ~w Y~ · · , ........... ier~ [~0ir0~ ~reh ~0,19~ ~ (Signature of applicant)