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Home My WebLink About14770-z I~OEM NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1~? 14770 Z Permission is hereb/granted to: ..... ~..~..~.~.....~....~. ............... ..~.~.~....~.:~.,....~.~.~.~..._..:... ~ot premises located at ~.~.......~.....~... ........ ~.~ ...... ,.~...., ............ .....................................~.,,..~-- ........... ,./,,/~ ................................................................................. County Tax Map No. 1000 Section ...l,.~.....~. .......... Block ...... .,O,...~'~,. ...... Lot No....~.~ ........... pursuont to application doted ........ (~ ~" o~j~,~...-~..I ................. , 19.~.~,~/ Building Inspector. and approved by the Building Inspector Rev. 6130/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-'I803 Approved ........ Disapproved a/c ..................................... (Buildin~ Inspector) APP L lC AT I(~J'~*~:~6"R- BuiLDINg1 ~ERM/T Received ........... ,19... INSTRUCTIONS a. This 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 appro~,ai 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· ~ t ~. ~. ......... ............ (Sign'.~.J~r'~o~ J~plicant, or nam e, ifa corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Name of owner of premises (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 License No ......................... Electrician's License No ....................... Other Trade's License No ............ ' .......... Location of land on which proposed wor~k will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section */.~i~/??'. .-. :%...:~.. · · Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupanc,y of proposed construction: a. ~stin~ asc and occupancy ........ ~. ............. b. Intended use and occupancy ppi" bl ) Additi Alt ti 3. Nature of work (check which a fca e New Building .......... on......' .... era on ...... . . . Repair .............. Remora ...... Demolition .......... :.. Other Work ............... ' (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. Number of dwelling unit! on each floor ................ If garage; number of cars 6. If business, commercial or mixed occupancy, specify natutre and extent of each typ~ of use ............ /: ....... 7. Dimensions of existing structures, if any Front... ~.'.~. ........ Rear ...l~?..~i ...... Depth../.~. .......... Height Number of Stories :'~./~. 0 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 Number of Stories , 9. Size of lot: Front ......................... Rear ...................... ,-Depth ........ t ...... ~ ..... 11. ZoneorusedistrictinwhichpremiseSaresituated~/~-/?/7 /~ .~.,{'F~..~ ]~_~. ~ I L~. ..~..~,a,'A 12. Does proposed construction wolate any zomng law, ordinance or regulation: ..... i ........................... 13. Will lot be regraded ............... Will excess fill be rem. ovedl from premises: Yes No Name of Architect ......................... Address ................ ~... Phone No ................ Name of Contractor ........................ Address ................ i. · · Phone No .......... 15. Is this property located with±hi.00 feet of a t±dal wetland? * Yes ..... No :~'.~..' · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM : Locate clearly and distinctly all buildings, whether existing or proposed, and, ind!icate all set-back dimenmons from property lines. Give street and block numb.er or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .... S.S :: ...... ~ ./~.~..~t..0.. ~..!~/..t/..~../~...~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........................................................... I ..... (Contractor, agent, corporate officer, etc.) i 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 contained 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 .............. g( ........ day of;...~ ......... , 19 .~. , N°tary Public' ' ' ' ' ~' ~'~' ~'4~'~' '~' ' 'd-~' ' ' ' ' C°unty ~~,, ~~ ......... ,' "i~ignatu~e ;f ;pplia,~n'ti