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Home My WebLink About15011-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PE~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: ~'~'""¢ ...... '~~'";'~'"¥~'"'~~, ~o_,, ~.. .............................. ~..~.~' ............................... ,,,r,~,,,, ,=,ed,,-.U..~-.~......~.~-~....~.~ ....... ............... County Tax Map No. 1000 Section ..... ]...~ ........ Block ........ ..O....J ....... Lot No ...... ..'~,....~ .......... pursuant to application dated .....~.....~....~,~ ..................... , 19.~...~.,"~' and / Building Inspector. approved by the Building Inspector Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .~4'~ .~-..~.., 19~. (o. Permit No.}. ~.'~.O.. !!..-~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOUTHOU) Received ........... ,19... Date...6. 7..1.~. -- ., 19g'oz~. . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspecto"r, 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 ~ertificate 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 pfi. rsuant 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 her~jn 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 ins~ ~ .~.~. (Signature of.~applicant, or name, if a corporation) .... (mailing address of a~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ...................... 1. ' Location of land on which proposed work will be done ..... .~..~. ..................... ?. .5 . 3 .... ........... ).4 i.;..¢. ..... .......... q-4 ......................... House Number Street HanSlet County Tax Map No. 100~ Section ....... C~ ....... Block ..... [ ............ Lot. ,~... · .~. ......... Subdivision....~..~-~. O,x.~.°x~..'.~Z;~.~.~.~3 ......... Filed Map No...~.~.~. ..... Lot....'.~.. · .~. ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~'-..~.S' ! O~..&-.. ~q~ ..... b. Intended use and occupancy .... .t:5. ~ ..... ~:~ ~:?,~.;~,,i~: '.~.~;' ;~ .':;.q,¢~ ................... 3. Nature of work (check which applicable): New Building .......... 'Addition .......... Alteratio.~n .......... . Repair ........... .... Removal .............. Demolition .......... - ~ Other Work. fir..e,?.a. ~ .... 4,~,.'.Estimated Cost ..... .' ..... ; ...... :~,~Ifdwelhng, number of dwelling units. (Description) ................. Fee .... (to be paid on filing this application) ........... Number of dwelling units on each floor ................ If garage, number of cars ... i ...................................... , ..... ~..~- ..... . ................. 6. If business, commercial or mixled occupancy, specify nature and extent of each type of use ....... , .............. 7. Dimensions of existing structures, if any: Front ..... ~ ....;, ¢. *.. Rear ...,..; ......... Depth ............... Height ............... NRmber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. ;... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .......... Nulmber or,, 8~o.ries ............... ~.~ .... . ....................................... 9. Sizeoflot: Front ......... i ............ 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 ...... .fr.O.: ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .i .................. Address ................... PhoneNo...:~?.~.:~?.?.~/... Name of Architect ........ i .................. Address ................... Phone No ................ Name of Contractor ....... ~ .................. Address ................... Phone No. ...'- ...... 15. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No'~.: · If yes, Southold Town T~ustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ~ buHdhlgs, whether existing or proposed, and, indicate .M1 set-back dimensions from property Hnes. Give street and block number or desc~ption according to deed, and show street names and indicate whether interior or corner lot. ~ STATE OF NEW YORK, S.S COUNTY OF ................. ,.. .......... (Name of individual signing contract) above named. ; .: .... being duly sworn, deposes and says that he is the applicant He is 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 and file this application; that all statements co6tained 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 .... /.~...~. ............ day bf .... . ..~..C~..t?..~:~. ......... 19..~.~o Notary Public, ....~..~.'...h.f-r...~..tg~-..... Count~. .... ~.~. (Signature of applicant)