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Home My WebLink About15438-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) Z Permission is hereby granted to: .... .... ......'~.~.~....~.~.~'.. .......................................... ~:ot prem,ses ...... :'""':'"""':,ocarea a, ........ ,..~.....~.......~ii~iiiiii...~~~' ..................................... ~1 ...................................... ;ii." . ............. ........... County Tax Map No. 1000 Section ..... 0..~:~'~..,,~. ..... BJock .... .,(~.,.,']. .......... Lot No...~.~... .... pursuant ~o application dat~ ..... ~.~~......~.~ .......... , 19.~.~., and approv~ by the Building Inspector. Building I~tor Rev, 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. ~:~ ..~..~..~., 19 ~.~. Approved .O.~...°'~. · . . .~.~., 19 .~. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. T~s 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 auth°rized inspect°rs °n premises and in building f°r necessary~s~ti°ns' ;7 ' (signal. ~li~a%"~, if a corp ration) ...................... ............. State whether applicant is o_w.n, er lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises..~.~;x-- · t.~..d.~.."'4 .~..~ .... ~ · .~.~.q'~..~. · .~'~. ~ ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... of land on which proposed worlt wiil be done....~.~ .~..~'¢..,~..~ .~ ~ c.~...'"] .~...~. ~. Location ... ..... ....................... House Number Street Hamlet County Tax Map No. 1000 Section .~...~-w.. ........... Block. '7 .............. Lot. Z 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 ..................................................................... b. inte9ded use and occupancy . ~ ...................................................... 3. Nature of work (check which applicable): New Building .......... Addition .~ ......... Alteration ........... Repair ........ ...... Removal .............. Demolition .~. ..... ~ .... Other Work ............... i (Description) 4 Estimated Cost Fee (to he 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 ..................... Di g st if ' pth 7. mensions ofexistin ructures, any: Front ............... Rear ..... , ......... De ............... Height ............... Number of Stories .......................... ! .............................. Dimensions of same structure with alterations or additions: Front .......... i ....... Rear .................. Depth Height Number bf Stories 8 Dimensions of entire new construction: Front Rear ' Depth Height ............... Number 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: ..~ .............................. 13. Will lot be regraded ......... ~ ................. Will excess ~1 be retained from premises: Yes . No 14. Name of Owner of premises ~ .~{ ~..~..~.~-~...'~-).. Address ~. '. '.~ .~.~O. · .~r ;2.q.4,~ ~one No..~ .;1 ~ .~. ~.o.~.~ Name of Architect Address ' Phone No Name of Contractor Address ' Phone No 15. Is this property located within 11120 feet of a tidal wetland? ]~ Yes ..... No ..... m If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly' and distinctly all buildings, whether existing or proposed, and.l indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and aow street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signing contract) above named. ....... being duly sworn, deposes and says that he is the applicant He is the .......................................................... i ............................... (Contractor, agent, corporate officer, ~tc.) of said owner or owners, and is duly authorized to perform or have performed ~he said work and to make and file this application; that all statements contained in this application am true to the best df 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 ............ ?..~. ....... day of ....~.~ .......... , 19(. Notary Public ....... ~g-r+~.... ~... ~. ~. ~..~t~-~....'~ County HI1E8 K, ~£ rOE .,------ ..... ~ .... .' .....