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Home My WebLink About22230-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT SOU';HOLD, N.Y N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE,~PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .................................................. 22230 Z Coun,,,TaxMap,,,o. ~000 Seo,,o,-, ........ .~ ........ B,oc,~ ....... ~ ............ ,.ot,,,o. ~.~ ................. pursuant to appllcation dated '"~Z~' ........~.i~., 19..?.../~,.. and approved bythe Building Inspector. Fee,...~..~ ...... Rev. 6/30/80 I! 111 .... II BUILDINGDEPARTMENT , ltl IJI994 Iii TOWNHALL Examined .~., 19 .~ Disapproved a/c ..................................... ................ A~P~ICATION FOIl BUIkDI~G BOARD OF HEALTH ......... '1 SETS OF PLAN/~ .......... SURVEY C ~ ~CK ' MAIL 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. 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- cition. 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, Ordinahces or Regulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to' comply ~'ith ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized ins~?~_c~o, rs on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) i~'~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State whether applicant ~Nami~ of owner.~ of premises . .~t~.~.~ .(.:.~.~..~....~..~..~..' G' 'O~' ' "Tk(as on th~'t'a~'~ollO ~ .~...~. [~. ~.o; latest deed) ........................... If app.!~cant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electncmn s L~cense No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. 5 ...... ..... t[q-/t ...................... House Number Street Hamlet County Tax Map No. 1000 Section ....~.C~. ........... Block ..... .l~ ........... Lot... 5.9 ......... Subdivision ..................................... Filed Map No ....... ........ Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ..~ .., ..,.' · ~ "." '~ b. Intended use and occupancy ........... ,,~, ~..? ',,~ ............... 10. Il. .12. 't3. 14. 15. Nature of work (cheek which plicable): New Building .......... Addition .......... Al{e ; · i [ .... Repair .............. Removal ............ Demolition ......... Other W~rkl~'~{-~-~-,~..... t:~'~' 2~~'''~..~..~.. ."~..~--i ~ (Description) Estimated Cos . · . .............. Fee ..................... ! (to be paid on f~ling t~i}~!pplication) If dwelling, number of dwelling units ............... Number o f dwelling units on each' ~qt~ ~:~i,~'(, ~ ',., ....... · If garage, number of cars .... i ................................................ :. iL :i.. i ........... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height . .~. Number of Stories .. ~ .................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i' · · Height ...................... Number of StoIies ~ Dimensions of entire new construction: Front ............ Rear ............... Depth ...... ......... Height ............... NmBber of Stories .... ,. ....................................... :-. .......... Size of lot: Front .......... i ............ Rear ...... ................ Depth ...................... Date of Purchase ..................... . ......... Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... D.oes proposed construction violate any zoning law, ordinance or regulation' . .t~l 0. .................... '. Will lot be regraded .... tD, C}.. ~ ................... Will excess fill be removed from premises: Yes ' '1~ Name of Owner of premises .. Name of Architect ......... Name of Contractor ........ Is this property within *If yes, Southold Locate clearly and distinctly ali property lines. Give street and block interior or corner lot. .................. Address ................... Phone No ................ ................. Address ................... Phone No ................ ................. Address ................... Phone No ................ 300 feet of a tidal wetland? *Yes ........ No..~... ~ town Trustees Permit may be required. PLOT DIAGRAM buildings, whether existing or proposed, and~ indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether APPJ~OYED AS NOTED ~ _/ NC~IF¥ BUILDING D~P~ ~:180~ 9 AM m 4 ~ FOR THE POLLOWI~G INSPECTIONS: ,' ,, ~'aG ~ PLI,JM~ING STATE OF NEW~rO~ /L ~ S COUNTY, OF ...-~,~Z/.~.[..~ i' ' "" ....... (Name of individual signing contract) abow named. .... being duly sworn, deposes and says that he is the applicant He is the i' ' (Contractor, agent , corporate officer, etc.) of said owner or owners, and is dulyiauthorized to perform or have performed tile said work and to make and file this application; that all statements contaified in this application are true to the be, st of his knowledge and belief; and that the work will be performed in tile manner set fo¢,.h itl the application filed therewithI. Sworn to before me'thi~ ' Qualified In Suffolk Count2Y - Commission E,~ires Deaembsr ~, 19,,~ ' (Signature of applicant)