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Home My WebLink About23076-zFORM TOWN OF SOUTHOLD BUILDING DEPAgTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT ~THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] N-~ 23O76 Z CounlyTax Map No. 1000 Section .......... ,~...,~.,,,, Block ............ ~ ....... Lot No. ~.,.~,,,:...,,~,., ........ Building Inspector. Rev. 6/30/80 I fill 1995 , BLDG, DE 'tOWN OF ~O~ rr~Of ~ I5407'. ~J BL9 :.; I;, FORM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT,. TOWN HALL SOUTHOLD, N,Y. 1197i 'TEL': 765'1.802 Disapproved a/c ................................... ;. GOARD OF HgALTII ...... SURVEY ............... CALL .......... HAIL TO: FOR BUILDING'PERMIT Date . INSTRUdTIONS a. This apl~Iication must be completely filled in by typewriter orin ink and submitted to the Building Inspector, wit tots of plans, accurate plot plan to scale. Fee according to sc'hedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public st~'e ,or areas, and giving a detailed descriptioh of layout of property muit be drawn on the diagram which is part of this ap 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 wiI1 issued a Building Permit to the applicant. Such pert shall be kept on the premises available for inspection throughout the work. e. No building si.ali be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted ~,y the Building Inspector. . .. APPLICATION IS HEREBY MADE to the Building Departmer~t for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of SouthdId, .Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions'or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with ail appiicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary insp~tions. -- (S~gnature of applicant, or name, State whether applicant is ~owner, lessee, 'agent, architect, engineer, generai ·contractor, electrician, plumber or builde ':: "~ :~, ~'- '¢ .' , (as on'the tax roll or latest deed) If applicant is a co[,po=a~on,'¢ig~'tlture oF'duly author~ed officer. (Namehlidi~tifle o~c'0,r~orate 6fficer) ', ', ' Builder's License:;N9 % ¢ :r · .... I. Location of land on which proposed work will be'done..~! ..... ;., ..... lfouse Number Street Hamlet Subdivision ............. ..... ,' ......... '. Filed Map No ............. Lot ............... (Name) Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Emst o use and occupancy .. ......................................... b. Intended use and occupancy ........ / .... ~ ~'... ....................... ' .................... · 3. Nature of work (check which applicable): New Building .......... Addition ....... ~h' 'r Alteration ... Reprdr .............. ' Removal .............. Demolition ; ... O e Work..~ .... .... ~ V'VV~ (Desert 4. Estimated Cost : ..... Fee ............................... (to be paid on filing this applicati, $. If dwelling, number of dwelling units'. ............... Number of dwelling units on each floor ......... · If garage, number of cars ................................................................. 6, Ir business, commercial or mt.xed occupancy, specify nature and extent of.each type of use ............... 7. Dimensions of existing structures, if any: Front ....... : ....... Rear .............. Depth ......... Height ............... Number of Stories .................................................. Dimensions of sbme 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 ' 10. Date of Purchase .......'.}.--' . ........ .. Name of Former Owner ,~"~.'D..~75. ':~. ·~'. , · 11. Zone or use district in which premises are situated ................................................ .12. Does proposed constructipp violate any zoning law, ordinance or regulation: ........ ' ......... ~ ......... 13. Will 16t be regraded ,.. p./-.O... ....... ......... i.. Will excess fill be ~em0ved from premises: Yes Name of Architect ..... . ...... .....,.... ,; ....... Address ............ Phone No. 15.' I.s this property within 300 fee~ of a tidal wetland? *Yes ........ No..~ · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly a_nd distinctly ail buildings, Whether existing or proposed, and, indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and indicate wh, interior or corner lot. STATE OF NEW YORK, CO U NT.,Y._O F~././:; {. ...... : ..... .7.Sc ...... .......... . ......... bein. swo,n, de ose ays that he i.,. the.app,, (Name c~ndividual signing contract) ' ' % is the . ,.,... .... rector, agent, cor'porate officer, etc.) >f said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e and file ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that · york wgl be perfonned in the m~ner set forth in the application filed therewith. ;worn to before me this .... .IX . . ,, ........... day of ..... .~- ' ' ,. ' . ; .,RUDO~H,B ............. -- Commission ~ires March 30,