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Home My WebLink About22007-zFOI~M NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEIlON OF THE WORK AUTHORIZEDI 2~-007 Z Date ....... ~ .....................................19....? .~.~ Permission Is hereby granted t.o: .~...~.~./~.z.. ......... ~.~.~ ................................ .~.....~.z-~ ....... ..,/Z..~: ....................... -g~,'~ ~..~....~......./.../.~.~ .................... ,o ......... ....... at promises located at ............. .,,~,,,,~,,~ ....... ~,~.,.~-,J~.,,,'~..,'~.,...~.,, ....... ~: ...................................... ...................... ~~ ....... ~.,....,..,z~.zzz Cou~lyTax Map No. 1000 Section.,,.,,.~..,..~',. ........... Block ........ ..~....~'.. .......... Lot No. ...../-,"~.., ................. pursuanf to appllcaflorl daf ed ...... .~..~,...,~....~,, .......... ~ .................... 19....?...~......, and approved by the Building Inspector. Fee*..~ ...... Building Inspector Rev. 6/30/80 l~i/ ~;~- ~ 'f-j~u, ] ~ BUILDING DEPARTMENT .J~"*~ . ~nn,~ '.' i TO N OF SOUTHOLD Jl~I "' ~ ~ TOWN HALL ~~, n ~ SOUTHOLD, N.Y. 11971 ~ ~~ TEL.: 765-1802 Disapproved a/c ......... ~ ........................... .............................. · ..... . (Build~ ~spector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTIt ~ .... ¢~... 3 SETS OF ?LA;tS ......... SURVEY CI1ECK ................... SEPTIC FORtl ............. HAIL TO: INSTRUCTIONS Date . .~/~.. 7 19 ?..~ a. Tlfis 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 ~r 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 ~pplicant. Such permit shall be kept on thc premises availab/a 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections· (Signature of applicant, or flame, if a corporation) (Mailing address of applicant) State whether applicant is owner,~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpbrate officer) BIder s Ltcense No ................ , .......... Plumber's'License No ......................... Electrician's License No ......................... Other Trade's License No ...................... Location ofland'on which proposed work will be done House Number , Street Hamlet County Tax Map No. 1000 Section ...... . ..... Block ................ Lot ..... ~. Snbdivision ...... .... Filed Map No. · Lot (Name) ............................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: /: -~ Re ar ....... ~ g .......... ddxhon '~. ...... ~ ............. ~emontmn ........... O t h e r W'g~'~f Ce~.C. ~' ...... 4 Estimated Cost ~ ,~v~ If dwelhng, number o f dwellih~ uni,~ J2JJ~ (to be paid ~apOlication) ' .,' ...... j ....... Number of dwelling units on e~'d~*fid~¢/J i if garage, number of cars .... ~: ....... . -~_,. · .. .......... 6. If business, commercial or m 8 ........................................... ed occupancy, specify nature and extent of eaoh ~ ..... ~- ' ' ' 7. Dimensions el existing structures, if any: Front .... ~ / ~- -~w ~, ~se ................... ' ......... Depth ~ O / ........ 'ght N~ He~ ............... tuber of Stories ..... ~..; ......... Dimensions of same structure with a terations or additions: Front ................ .. Rear.. . Depth .. ;./...; ........... He ........ ........... Number of Stofies ..... ' ...... 8. Dimensions of entire new con~tmetion. a.. ~oes proposed construction violate any zon~no law ~.~/' ~ ...... / ' / ................................. ; · ]4 ~o~. ~ ....... ~ . ~ ...... , ........... ~m excess nn ue removed from premises: : Yes · ...~,,~ u*vwn~r uipremlses . ~ ............. ; .... Address ................... Phone No.... ......... .. ~ Nme of Architect ..... i' '' · · · . ~lf'r~ erty within{300 feet of a tidal wetland?. *Yes... ~ . 1~. this p p ....... ... ~ ~ ~ :~ )~'.,,.'~,. es, Southo own Trustees Permit may be required. ,'~ Locate clearly ~d distinctly ~1 buildings, whether existin ......... '-. -. ;'. ~' ' ~'"~ "/" . prope~y Enes. Give street ~d bloc~ number or desc~ption accord~g to deed, and show street nines and ~dicate whether .. ~tefior or corner lot. :,/,..~ ,~.,,~ -,,,~:, . . :'. ,., ~ m vropusea, ~n, mmcate ~I set-back d~ensions from STATE O F NE K, ' COUNTy OF. ~,~h;'~(~2 ' ' ~ ......... ' .............. ~ .................. being duly sworn, deposes ~d says'that he iS the applicant (Na&e ofindividu~fsignin contract) above named. , , :i,,,;, :. , . -.,' He~s the .......... .,... ....... " ' {' (Contractor, ageht, corporate officer, etc.) .' ...... .~ · ' O~aid owner or owners ~d is duly uthofized tn ~e~ ~ have'perfo~ed the said work and to m~e and file this a · · statements containe ' . - matron, that all d m thru application are true to the best of his knowledge and belief; and that the Work w~l be perfo~ed in the m~ner s~t forth in, the application filed therewith. Sworn to before me this, ....... .day .... ., .',, 19 .~ ~'Ota~.Public, . < ,~ ~ ' ..