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Home My WebLink About22843-zFO~M NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Date ................... ~ .......................... N_ 22843 Z CounlyTax Map No. 1000 Section ....... /..~..~. ..... Block ........ .Z ............ LotNo. ~,.,?,. ................. pursuant to application dated .................. ..~.....~....¢~... ....... 19...¢~ and approved by the Building Inspector. Fee $..,,.,~.,,,~',,.,,.~. Rev. 6/30/80 l FORM NO. 1 JUN - 8 I~)o~ ,,, it TOWN OF SOUTHOI_D ~ ~ Bl lU DING DEPARTMENT - ',:-' ...... ,S ,OUT¼,~ ~j, I',1.~,. 11971 ~C~';'N O[ SOUTHOI.U ,~ TEL.: 765-1802 Examined..~~ ~19 ~ ' ' Disapproved a/c ................................ ~ .... ................. .. ~LICATION FOR BUILDING PERMIT BOARD OF HEALTH ........ 3 SETS OF PL~S ......... SURVEY .................. .............. SEPTIC NOTIPY~ CALL .................. HAIL TO~ 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. ~s b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eets ,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 b~ilding f°r necessary inspecti9 .~...~ ~ . (Mailing address of_applicant) State wl~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owne~ 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 ...................... 1. Location of land on which proposed work will be done. House Number Street Hamlet County Tax Map No. 1000 Section ...; ......... Block .... ' Lot ............... Subdivision ........ , .............................. Filed Map No ............... Lot ............... (Name) ' ~ - :: State existing use and occupancy of prcqfises and intended use and occupancy of proposed onstruction: E ' a. xisting Use and occupancy .... . .... R .......... Rer~oval .............. Demolition .... Othe~Work .~. ~.~ t Ot3 ......... .... 4. Estimated Ce*' ~ (Description) If d ' ~ (to be paid on filing this application) 5. welhng, number of dwellin units ........... Number ef dweliing units on each floor .......... · Il' garage, number of cars ............ ' ' ' ' '.. ....... · .... ~d p ify f~ ~ .............. 6. If business, commercial or mix occupancy, sec nature and extent of.eat 7 Dimensi h type o se ............. · OhS of existing structures, if any: Front... . · · · Rear ..... ight ' ' ~ ...... . pth He ............... Nuinber of Stories .............. De ........... . .... yith ............................................ Dimensions of same structure ~ alterations or additions: Front Depth ' Rear ~ Height .................................... 8 .................... ~' ' ' ' ................... ... Number of Stories · Dimensions of entire new construction: Front ..................... ............... Rear ............... Depth . . Hight 'N nb fSt 9 Sie ............. i' u ere ones ......................... 10' zee et: rent ......... ,~ ............ Rear .................... De ................. · · · pth Date of Purchase ....... : ................. me of Former Owner ................ I I. Zone or use district in which premises are situated Does proposed construction wolate an,, z^~:~, ...... ' :r~, ........................... 13, Will lot be reuraded AV~ · ! . g n..~. ........................ Name of Contractor ........ ~ ................. Address ......... Phone No. 15.' Is this property within 2,00 feet of a t±dal wet.l, andV ~ ..... ' .............. · If yes, Sout:hold Town Trustees Permit may be ...... i Fequ~d. No ......... ..... PLOT DIAGRAM ~... Locate clearly and distinctly alii buildings, whether existing or proposed, and. indicate tdl set-back d}rnensions from' property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or comer lot. ..... ~ ....... · ......... oemg amy sworn, aeposes mm says that he is the applicant (Name of individual signinq contract) )eve named. ~ is the . ~ ' . (Contractor agent corporate officer ere ) ' said owner or owners, ~d fs duly ~'uthorized to perfom or have perfo~ed the said work and to m~e and file this plicafion; that all statements containgd in this application are true to the best of his knowledge and belief; and that the ~rk ~fll be perfo~ed in the manner set forth in the application filed therewith. ' /om to before me this N/F MOL£1NEAUX N 58° CONe, RE~'AINING ~IALL---~ PROPOSEO '1 · IP , ~0,4 / ENO GAS SERVICE