The URL can be used to link to this page

Home My WebLink About21498-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPAgTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 21498 Z Permission Is hereby granted to: .../t.,. ~,d:/.,~._ ~.~.. ~ ............................................... pursuant to application dated ...... ~.....~.~..,. ...... ] 9.f...~ ..... and approved bythe Building Inspector. Building Inspector Rev. 6~30~80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;2 Examined ................ , 19... B~ARD OF HEALTH ] SETS OF FLANS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .~.~ .. 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 st?eets or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- cation. c. The work covered by this application ma5; 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 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 for necessary,ipspections. ......... ~.-(.:c.:~ ...... -- (Sign~tur~qof applicant, or name, if a corporation) (Mail~g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. .~..~. t~ £r7. ......... ' .................... ' ........ ..4q N~ne of.owner of premises..,r .o.r.7... ih .ac/O.e.d. .... (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 ............... . .......... Other Trade s hc~nse No ...................... I. Location ofland on w fich proposed work will be done ...... /~OZ{~.' .... .~..~./(~ ~.-~.'~E~...~.~f~." ' ' ' ' . ..' ...... oto' a ...... · Itouse Number Street Hamlet Couhty Tax Map No. l'00q Section .. 3: .~.O.~'~ .... Block ...0.~.~.~... i...?"'~bI-:?~&~2~*~ ..... St;bdivision.. S ... r ............... Filed MapNo '~(: .L~t:" ~ ... (N ) .... 2: State existing use and occupancy of premises and intended use and occupancy ofprop0sed ~on~trudti~: ~ a. Existing use and occupancy .... ' .... i ~. ~ " ...... ' ~ ' b. tntenoea use and occupancy ..................... · ........... c:.'i. . * f('-~,q~? MI k3;i ~t~,~S.~ ...... · 3.Nature of work (check which iapplicable): New Building . .... Addition ..... Alterati~- - ' . Repmr .............. Removal . . , ~ ....... De~,j,;_' ' · '_- · · ,~w,~ ..., ..... · , · · ua,on ..... : .......... Other Work .... 4. EstimatedCost:...~../~.,49.~. " .... ... :: Fee . : .~.~..~.,'~t~.~. ~~ I ' ' (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each If garage number of cars ! ' floor ................ 6 If business .......... . .................................... commercial or mixed occupancy specify nature and extent of ............. ' .... 7' ' , ,each type of use · Dimensions of existing structures if any: Front Rear ............ ' ..... Height Nu[n der of Stories ............................. Depth ............... Dim ensi;l~i ............ ' ...................................... ofshme structure with alterations or additions: Front ................. Depth ' Height .................. Rear .................. · Number of Stories 8 Dimensions of entire new consiruction: Front ............... ' ' ' ' .............. : Rear ............... Depth . .Height ............... er of Stories .................... l,,w. /¢.o'¢.4('"' .... b ....................... 9. Size of lot: Froht ...... .... :.. Re;ir. ' · · · 10. Date of Purchase .... ' ...... epth ..... ,~"..,5'~...-fir'.~-7-. ........ · . ' ', ..... ............... ' ........ . Name ofForme 0 .. 11. Zone or use dlstrmt in winch premises are situated .... ~,q,rt~v~nq~r;,, '[ ................ ,: ....... .12. ,D,,..o,,es,:p,r,o_posed c.on, s ' ' 'l~t~ ' '' '" .............. ~':'"~"' ..... : ........ . ........ ' ..... any zoning law, ordinance or regulation' ,' ~lu ~o~ ce re~raaea tructlon vl. oxt~ 0 ,, . ..... .~ ................... 13. , . ~ ~ - · · ch ~..'-' · ~-~1' .1' ' _# ...... Will excess fill be remove~'ronl, premises: Yes '.2'?".~.. 14. r~ame m Owner of premises (,r..rl¢.~pf~.. ! .~0qge.a~.. Address ~,.0~ ~c.~/.).g~'~/~'/¢q4ghone No. ~7.t¢ Name of Architect ......... : ................. Address ................... Phone No ................. Name of Contractor ........ : ............... Address ............. . ...... Phooe. No ........... ' 15.' I.s this property within 30~ fa'et of a tidal wetland? *Yes ........ No.~. ..... ' .... ~If yes, Southold Town Trustees Permit may be required· ' r PLOT DIAGRAM Locate clearly and distinctly all i buildings, Whether existing or proposed, and. indicate all set-back dimgnsions from property lines. Give street and block Oumber or description according to deed, and show street names and indigate whether interior or corner lot. . .4' STATE OF NE~ YO.R~,, ~ S ~ COUNTY OF .~..C-7 .... ., '! (N~me oTindividual signinglcontract) ...... being duly sworn, depose,s and says that he is the applicant above named. ' - te is the ' (Contractor, agent, cori~orate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements containeB in this'application are (rue to the best of his knowledge and belief; and that the ~ork will be performed in the manner sei forth in the application filed therewith. ' .worn to before me this ]