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Home My WebLink About22514-zFORM TOV/N OF $OUTHO~,D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHO/,.R~D) 22514 Z ........................................................ . ~(_d~~ .¢~...../~z. ~. ....................... CountyTaxMap,o. 1000 Section ..~...~ Block ..... t ..... Lot No .~.~.z ~.. pursuclnt to clpplloatlo, dated ................. /~,..~...~...., ] g....~......~.., and approved bythe Bulldl~_~ inspector, Rev. 6/30/80 Building Insp~ proposea construction violate any zonin~ law ~- .12. Does e regraded ....... .. .................. ~i-'" ................... ' ...... ' ' 13. Will 16t b ~ , ,,-,~mance or regulation: . ' .................. · 14. Name of Owner of premises ........... ~ ........ Ad~V~essx. ............................. Na_m~ il ecess fill be removed from premises: Yes Nc of Architect ........... ) .................. Phone No ......... .. Name of Contractor ......... ' ..... Address .......... Phone No ......... ................. Address ... · ..... : ..... Phone No ...... "':' ' 15.· I.s this property within 300 feet of a tidal wetland?'''.~es..' ' .......... · If yes, Southold Town Trustees Permit may. be required. ' .... No ......... .--. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .... .,a. l /. . .jC. . . .op. .ed [r. .. n,;edr. -'me of individual sigJ ng co ntract> ...... being duly SWorn, deposep and says that he is the applicant ' (C r, agent corporate office ~ ' ontracto ........................... r ~:~ ............. , r, etc. ~ ............................. ii TOWN OF SOUTHOLD 'kh'~V 2 5 199~1 BUILDING DEPARTMENT ~ ~ TOWN HALL "--~'[~"'G.~,b-~ .....~ ' SOUTHOLD, N.Y. 11971 TOWN OF ~T~OI..D , TEL.; 765-1802 BOARD OF HEALTH ........ 3 SETS OF PLANs SURVEY ClIECK Disapproved. a/c ..................................... . . . Ins · R BUILDING'PERMIT ' · //- Date ............. ~-..., INSTRUCTIONS ~ a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 st?eet~ i'~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 tkis application may not be commenced before issuance of Building Permit. . d. Upoh 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 paxt 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 Build3ng 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 describbd. 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 f~)r necessary inse~ctions. ~ ,, ,~ .~ . _ .... . (Si~,nature of applicant, or name, if a corporation) · ', p State whether applicant is owner, lessee, age't, architect, engineer, ' ' .~ generaJ contractor, electrician, plumber or builder. Nm-ne of owner of premises ... ' ' ?';' .................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature 6f duly authoriied officer. (Name and title of corporatb! officer) Builder's License No .......... ~ ..... Plumber's License No ..... lectncmn s Lmense No... 6~ : - Other Trade's License No. ,.--4---~--T~- ' ' 1. Location of land on which proposed V/Ork will be done., ..................................... .... ......... .?.7.:c'..'. i ..... ltouse Number .......... · ...... County Tax Map No. 1000 Section ...:.9.~.' ......... Block :./--~. .......... ;... Lot./.~..'.~..~. ....... i .... "(Name) Filed Map No ............... Lot ............... State existing use and occupancy of premi~os -' - ........ occupancy of proposed construction: a. Existing use and occupancy ...... b. Intended use and occupancy ...................... · 3. Nature of work (cheek whic applicable). New Buildin . ~.... ~'~ .... ' Repair .............. Re- ' ' .... ,~,omuon .......... Alteration .... I mOval .............. · Demolition .;...: .......... Other. Work..~.~ ~ .(?. ~ ' (Description) 4 Estimated Cost ~ ~. ' ' Fee 5 If d eli' number old elli' (to be paid on filing this pplicatio ) · w mS, w ~ngunits ' N 'be a n Ifga g numb of cars .......... i"'" um rOfdwellingunitsone.4chfloor 6 Ifb i 7 Di ' f i -, ,,,-,ecu occupancy, specify nature and extent of.each type of use ............... , .... · H menmons o ex sting struct)res, if any: Front .... : · ·; ....... R e .. 'gl N~ fSt ..... ear .... ........... ~ D pth D~l at ............... unber o ories ..... · ........... . I ith It ti dditi ........................................ mensions o s me structure w a era ons or a ons: Front ................ ear ....... D pth i ' · R e ............ , .... . Height ................ . .......... 8 Di i f new coifs ' · · · .'. Number of Stories ............ · mens OhS o entire truction: Front ......... Hight N~ b fStorie .............. : Rear ............ Depth 9 Si ofl F -- . ze or; ront ......... it, ............ ear .... . De I0. Date of Purchase . · ................ pth ......... l ........... * ......... Name of Former Owner ....... 11. Zone or use district in which premises are situated .............. ~ ........ 12. D°es pr°p°sed c°nstruct~on v olate any zoning law, ordinance or regulation: ............ 13. Willl0t be regraded i ..................... f P ....................... ~ i ' ' Will excess fill be~removed from premises: Yes No 14. Name of Owner o remises . i ............... Address ..: ...... . .......... Phone No .......... .- Nam~ of Architect ........ ; ............... Address ...... Name of Contractor ....... i "' . .......... ' ........ Phone No ............ j.,.. ! .................. Address ...; ........ : ...... Phone No... ............. 15.' I~ this property within 300 feet of a tidal wetland? *Yes ........ No ......... ' · If yes, SoutholdiTown Trustees Permit may..be required. ' ! ' PLOT DIAGRAM " ocate, clearly and d~stmctly ~1 buildings, whether existing or proposed and. indic . ' · property lines. Give street and block number or d~o"Hntion ~,~ ...... , . . ate all set back d~raenmons from ' ri r or corner lot '-o~- ,- ~ummg *o ueect aha snow street names and indicate whether rote o . i ......... ' ' ' ' ' ~ ~ . 'ALL ONSTRUC'rlbN SHALl. MEET STATEO~NEW~RC¢_ //~ < O /~ ~ . . cou oF.. .... a.~5~.l/ '~ ~/a~ being duly sworn, ~eposes ~d sa sth--' ..... /--' (Name of inaivla ;:l'si;fli~g cqntract~" ........ . . Y ac ne is me applicant above named. [ (Contractor agent corporate officer etc ) ............. ff s. aid owner or owners, ~d is duly [authorized t0 perfom or have perfomed the said work and to m~e ~d file this ppfication; that all statements contaiged ~ tills'application are true to the best of his knowledge and belief; and that the york w~l be perfo~ed in the m~ner ~et forth ~ the application filed therewith. ;worn to before me this '