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Home My WebLink About16165-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 16165 z Permission is hereby gra~,.c[~ ( .... ~c.~.~....~.:.....~.~.~ .............. ....... u..~.-..~ ...... ..~..~...~..: ............ at premises located ot ......................................... County Tax Map No. 1000 Section .../...?..~.. ............ Block ..... .0..~... ......... Lot No .......I/7./. .............. to application dated ....... ...~..~...~..~.. .................., 19.~.~..., and approved by the pursuant Building Inspector. Rev. 6/30/80 MAIL TO: ..... Approved Disapproved a/c (Building Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVBY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT S~FTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 '~"~'~"~" '~'~' "~"7 TEL.: 765'1802 CALL - · · APPLICATION FOR BUILDING PERMIT 1987 INSTRUCTIONS a. Tins 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 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 inspe~%j~f ~ / ~/657-/~? . ................ .... ......... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE~/~FFOLK COUNTY Builder's License No .................. ,~.. Plumber's License No ......................... LICENSED Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done[ House Number Street Hamlet County Tax Map No. 1000 Section ./.0..~..~ Block ~- Lot... C?g 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 ........................................... ~:,r~.~v~'~..,.,,~ ~' ~}'~,ry, ... .............. b. Intended use and occupancy ........... ,?):~: ~ .X'}~ .... ,,. .......... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteratiol~ ...... '. J.'. Repair .............. Return/al .............. Demolition ............. Other Work...~F. c., .Er. ..... F/I~_~" ~ ~: "~ (Descnp.tion) 4. Estimated Cost ......... ~/..~.~..fi ..................... Fee.. ~.Z/~,~.~/...~...' .................... I ' (to be paid on filing this application) 5. If dwelling, number of dwelling ut~its ............... Number of dwelling units on each floor If garage, number of cars ....... ................................................................. 6. If business, commercial or mixed ~c upancy, spemfy nature/and extent of each t. vp/e of use D~men~mns of exlshng ~t~c~ures if any: Front ..... ~.~ ....... Rear ...~'~. ........ Depth. ~ Y...' ........ Height ....... ' ' '..~.,Numt er of Stories ....... · ............... r ............................. Dimensions'of same structure wits, alterations or additions: Front .......... Rear ............. Depth .~.' ~; .' .:, ........... : Height ...................... of Stories ...................... 8. Dimensions of entire new constru :tion: Front .......... . ..... Rear ............... Depth ............... Height .............. '. Num e~r of Stories ........... 10. Date of Purchase ........... :! ................. Name of Former Owner ............................. l 1. Zone or use dmtnct ~n whmh premises are mtuated ..................................................... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: ....... .~..T ..................... t3. Will lot be regraded ......... ..i ................ Will excess fill be removed from premises: Yes No ~. N fO fp I Add N amc o wner o remises .... I., ............... reds ................... Phone o ................ Name of Architect ........... I" ............... Address ................... Phone No ................ Name of Contractor .......... I ................ Address .... : .............. Phone No ................. [5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .z~.... · If yes, Southold Town Trus~'ees Permit may be required. I PLOT DIAGRAM Cu Locate clearly and distinctly all tidings, whether existing or proposed, and. indicate all set-back dimensions from )roperty lines. Give street and block npmber or description according to deed, and show street names and indicate whether nterior or corner lot. ~TATE OF NEW~ORJ~/. (Name of individual signi~ tbove named. te is the ...................... )f said owner or ownem, ~d is duly tpplication; that all statements contai york will be perfo~ed in the m~ner ;worn to before me this g contract) being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this ~ed in this application are true to the best of his knowledge and belief; and that the set forth in the application filed therewith. ....(~'. ~......~....~ ........... (Signature of applicant)