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Home My WebLink About23281-zFORM NO.$ TOWN OF $OUTHOLD B UILDITNoG DWNE Pi4AU.~ MENT $OUTHOLD, N,Y. (THIS PERMIT MUST BE KEPI ~'~IISE$ UN~.I~:ULL 23281 Z o~~=.~..~..~ ....... Permission Is hereby granted to: ..... ~..~..,~.9~.~....~ ....................... ...... ~.~..~,~...~(../.,,~,....~.//.z~£ ....... ~..~...~~..~~~.~..~ ....... .......... ......... ...................................... ...................................... LLL2L.;~...........................5~...............~~..~~.~~.....~....~....~.... ......................... ~'~ ... .~ ................ Building Inspector. Rev. 6/30/80 dJng Ins~ I"[l'~l.l) IIl~lll,~t:,~l()tt iU~i)()Wi· II.()UCII I;'Iq^HIC & PI.IIi~IIT ( 14C II'l~;lll.^'t'lOi/ I'F. It Ii. Y. COI)I~, Ir I' I1^ I, II II SCALE ¥-.-60' Exanfined ........... Disapproved a/c .......... FORM NO. 1 ' ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TELJ 765-1803 ., 19g~J?e,',r, tt No.C~3~..d~~- 3 SETS OF PLANS .......... Cil~CK .................... SEPTIC FORH .............. HAIL 'TO~ ?/PLICATION FOR BUILDING PERMIT INSTP, UCTIONS sets of plans, accurate plot plan to scale. Fee.according to schedule. b. Plot plan showing location of lot aud of btdldings on premises, relattonsh or areas, and giving a detailed descripfion of layout of property must be drawn cation. c. The work covered by fifl{; appBcatinn may riot be commeuced before is d. Upon approval of this application, the Building Inspector will shall be kept on the premises available For luspectiou throughout the work, e. No building !;ltall be occupied or used in whole or in part for auy shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department Building Zone Ordinauce of the Town of Southold, Regulations, for the construction of buildings, additinns or alteral The applicaut agrees to comply with all applicable laws, ordinan admit authorized inspectors on premises and in buildh~g for neces This application must be completely filled in by typewriter or in iuk and submt to the Building Inspector, with 3 adjolnlug premises or public streets the diagram which is part of this applt- of Building Permit, P~nnlt to the appllcaut. Such permit )ose whatever until a Certificate of Occupancy issuance of a Building Permit pursuant to tire York, and other applicable Laws, Ordinances or or for removal or demofitlou, as herein described. building code, housing code, and regulations, and to (Siguatu or name, if a corporation) (Mailing address of applicant) State whether appbca It is owner, lessee, agent, ami ~/~ame of owner of pre,uises . ~0.C3'.'-5. ~. If applicant is fl corporation, sJguature of dui englueer, geueral coutractor, electrician, plumber or builder. (as on the tax roll or latest deed) officer. (Name and title of corporate Builder's License No. Phtmber's Liceuse No.. Electrician's Llceuse No. BLDG. DEPT __TOWN OF SOUTHOLr) .,~j Other Trade's .... , .............. 1. Location of land ol proposed work will be done ........................................ Ilouse Num bet Street Hanflet . County Tax MM} No. 1000 Secflou ......... ,00 Block ....... ~.~,,,~ Lot:,.. t. Subdivision . o I u~ Filed Map Ho. ., .... Lot '. (Name) 2. State exisling use and occupancy of p~emises aud intended use and occupancy of propgsed constructinu: a. Existing rise and occupancy ............................................. , .............. b hi d d d I ~)/0~ ~ . 3. Nature of wot check which s cab e): blo ullding ...... ^dditlon ......... ^Iteration ........ Repair Removal Demolition ................. , ...... , · . ...... Other Work ............. 4. Estimated Cost , 5. If dwelling, nnmber of dwellln~ u~lts ,. ,0~ O) (to bo paid on flung mis application) . lfgarnflo, number of cars ,,,. ~ .'~S~'~ Nnmberofdwelltng nnitson each floor.,~, .(~3 ...... 6. Ir bnslnoss~ commercial or mixed 0coupancy, specify natnre and extent of each type of nsc ............... 7 Dimensions of existing stmotnres,llf ~ny: Front Rear lleight Nnmb~r of Stories ............................. Deplh ......... Dimensions of same stm~lnre wlfl~ alterations or additions: lhont .... ' Rear D~plh ~ Height Nnmber of Stories .... 8, D nenslons' of ~ntlr~ now ~onstru~tlon: Front ..... ~ ....... Rear .. ~t. Depth .. ~.~ 7 .... "' ' 9, Size orlot: Front ....... ~ ....' ..... R~r ..... ~.$~ ............. Deplh.., IO, DaloofPurohaso 1 .......... ~ ....... ' ......... NAmoofFormorOwn~r ~ ..... L- ~c,~eo ~" , ~ ~ ' I 1, Zone or nsc dis/riot n which prem~is~a are situated ..... ~O .............. ' ................. 12, Does proposed eonstrnotlqn violat~ any zoning law, ordinance or regn at on , ~.Q ......... 't · ~ , · , ........ ,, ..... Will OXOeSS fill bo removed from pre n sos: Yes 14. NamoofOwnerofp'cnlses d.~P~oo~ Address ~ O~u~ ~ Nam~ of Contractor .... : ............... Address ~ 7. .........'.~n~ N 30~ f °'l .............. 15. '' ''''* s ~hls proparty within eet of a tidal wetland? ~Yea ...... ~If ye.s, Southold Town Trust~es P~rmit may be required. '' ~'' .... PLOT DIA~RA~ Locat~ ~loarly and distlnotl~ all b~l dings, wh~fll~r existing or proposod, and, indloalo all sobb~ok dlmonslons from property Iln~s. GDo street ~nd blook nu ~bor or dosorlption ~ooordlng to dood, and show s~r~e~ namos ~nd lndlo~to whoth~r Jnlel'JOF or em'net Jot. n"^ m or NmV voRi<, S.S . OUN'rV OF ................ .............. ; ..... ~.~, , . . ,C%.. .................... being duly sworn, deposes m'~d says that he Is the applii:ant (Name ! nd vidnalsigntngcontragt) .bore Ilallled. le is Ille ........................ ~ .......... , co 'porat , otc,) )f said owner or ownel'Sl and Is duly at'lthor zed -t-6-p~rform or have performed lite saki work and to make and file this pplieation; that all statements contained In this application are true to tile beat of his knowledge and belief; and that the york wil be performed ill tho manner so{forth tn {lie application filed therewith. ~w0rn to before me this