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Home My WebLink About21388-z lVOll~ NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~T.° ~1388 Z Permission is hereby granted to: ...~..~...~.~~..~ .... .£~~.....~. z~..~77 .......... ,7"' ~'"~; ........ fO ..... ,~...~....~ _...~.~~~~~.~ ~..:., ,, :,'"~ ~ ..,, ,,~ ..... ~. at premises located at ......... ...~.~ ...... /...~.....~../../.~..../..~..~....L.. ............................. County Tax Map No. 1000 Section ... ~......~... .......... Block ....... ~ ........ Lot No ..... ..~.....,,~,. ...... Building inspector. euilding inspector Rev. 6/30/80 '3. Nature of work (check which applicable). New Buildin,, . ' ' · Repair .............. Removal · .'., 2 ...... ~De'~' ¥:' .... Addition .......... Alteration .~,a.. ~ 4. Estimated Cost escr on 5 Ifd ll' b old lling unit (to be paid on filing this application) · ifgWe rog, hum er we s ............... Number of dwelling units on each floor ·arage, number of cars ........... ' ......... 6 If bu i i 1 o i d ...... ' .... · ncy sp ify d f h typ of use ............. 7 s ness, commerc a r m xe occupa , ec nature an extent o .eac e .. Dim i of isti gst if any: F nt R .... · CBS OhS ex n ructures, ro ........... · ·. Hight N be fSt i ............... ear .... Depth e ...... um ro ores ....... ... ' ......... · ........... Di ionsofshm itl It ati ........................................ D mens e structure, w ~ a er ons or additions: Front .......... ear .. pth ' Hight ' " R · ' N b f St tie .... 8 Di i f ti " . ........ ... um ero o s ..... · mens OhS o en re new construction: Front ......... Re ' ' ' ' ...... Height ' N mba f St ries ...... ar ............ Depth .... · ze o or: o it ............ . ' Re .............. ' .......................... I0 Dar fP h ' . ......... ar ...... D pth ...... ' N me of Form Ow ............ 11 Zo edi i ti Ii h mi ............... a er ncr · ne or us strc nw~c pre ses are situated ............. · ............................. 12 Do opo d ti iol i gl ' '' '13' es pr se construe on v ate any zon n aw, or nance or regulation: · Will 10t be regraded ................................ ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ............... ~ .... Address .................. Phone No ............ ;%.. Name of Architect ........................... Address ................... Phone No ........... ..: .... Name of Contractor .......................... Address ............. . ...... Phone No ..... ' 15.· I.s this property within 300 feet of a tidal wetland? *Yes ........ No .... ' ........ · If yes, Southold Town Trustees Permit may be required. ' .... ... 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. OF N[W _ b 30UNTY OF .... ~'.'~kk... S.S -. . ......... "~9> ~>'~' ' ~ ~-~ · · - being duly sworn, deposes ~d says that he is the apphcant (Name of individual signing contrac}j" ......... bove named. isthe . ~.~ . ' (Contractor agent corporate officer etc ) '' said owner or owners, md is duly authorized to perfom or have perfo~ed the said work and to m~e and file this 9plication; that all statements contained ~ this application are true to the best of his knowledge and belief and that the 'ork w~l be perfomed in the manner set forth in the application filed therewith. ' worn to before me this ff ....... . ......... ...... ~a~ Public, ~~ '~~--..~[~' ' ' ..... ..... N~ 472508~I~ .~ ' . ' ' (Signature of FORM NO. 1 ~> TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 , TEL.: 765-1803 Examined ................ , 19[ ..... Approve .... , erm o. _ DisapProved· a/c ................... (Building Inspector) " APPLICATION FOR BUILDING'PERMIT INSTRUCTIONS B~ARD OF HEALTH 3 gETS OF PLANS SURVEY CIIECK ....... ¢ ........... :. HAIL TOi Dat~ .. (; 7.:; .......... ,1~. a. This apl~lication must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to s~ale. Fee according to schedule· 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 desc~ptmn of layout of property mu~t be drawn on the diagram which is part of this appli- cation. · ¢. ' The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this appliclation, 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 Build!ng 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,'ahd other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for rernovai or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing c'ode, and regulations, and to admit'authorized inspectors on pren: ises and in building for necessary ir~sp, ections. ..~ ~ . (Signa_tur~ of applicant~ or name, if a grlrporation) (Mailing address of applicant) State whether applicant is ~n~er, iessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder· Name of owner of premises ........ ' (as on the tax roll or latest deed) If applicant is a corporation, signatur'e of duly authori2ed officer.' ; (Name and title of corporate, officer) Builder's License No .... ~.... Plumber's License No ....... .i ....... . .......... Electrician's License No. Other Trade's License No ..... i ........... · . 1. Loc_ati.,on of land on whi~ proposed work w I1 be done . . ltouse Number ; .......... ! : Street Hamlet Cou'nty Tax Map No.1000 Sectio¢' l ...: .... ' Block .......... ' Lot ........ ' ..... Subdivision ............... ~ .................. '. Filed Map No. (l,~ame) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed ~onstruction: a. Existing use and occupancy .. i .'. · .~. · · · ·