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Home My WebLink About21412-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ ~ , , ,,~ .................................................. ~....~.~ ................ ~....~. ........................................... Coun~ Tax Mop No. 1000 Section .../~ .......... Bilk ...... ~ ............ Lot No..~%.~ ......... Building Inspector. Fee $ ........................ / 8'uildl~g In~ector Rev. 6/30/80 OUI__~DATIO__.~ --- (~st) OU~DATIO:! OUGH FRAHE & ~ -PLUMBING (2nd) .'::SULATIO~; PER N. STATE E}IERGY CODE I FI:IAL ADDITIO~IA'L COMME[ITS: ~6611 I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971, TEL.: 765-1802 Approved ?.~?..~.' .... 19,~.~.. permit No...~./..~.~...~. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT B~ARD OF HEALTH ......... 3 SETS OF PLANS SURVEY CIIECK ,.. . . Date ................... 19... INSTRUCTIONS , a. This apl~lication 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 locatio'n of lot and of buildings on premises, relationship to adjoining premises or public streets br 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 i~sued 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections.\ / ~ ~] /,/. . · ..... ....... .... ....... -- . . , (Signature of applica, nt, or name, if a c,~'r~r~ration) ,;me ofowne of premises .... ' .... (as on the tax roll or latest deed) If applic~nt~is a cor~ation,~signature of duly authorized officer. ' . (Name and title of~orporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No. Location of land on which proposed work will be done. [.~-o~..~. ................. : ............... i...' ............................. ..'. House Number Street Hamlet County Tax Map No. I000 Section ...: .... [~..~).. .... Block ..... ~... ' Lot...tt.~..'.c~ .......... Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of~emises and intended use and occupancy of proposed Construction: a. Emstmg use and occupancy .... . ............... ~ .~ ~'. ' ' ~: ~ · 3.~ Nature of work (check which aCplicable): New Building .......... Addition .......... Alteration .... ,. 2'. · · Repair .............. RemOval .............. Demolition .... : ........ Other Work· .~.~.~ ' .~.~.~? i '"" ' (D iptio ) . . escr 4.. Estimated Cost. ~: ................. Fee ........................ t i (to be paid on filing this application) 5. I dwell,ng, number of dwelhngiumts ............... Number of dwelling units on each floor ............... If garag mb rot · e, nu e cars ............................ 6 Ifb i i Iormi ~oc pan y sp ifynat eand ........ f .................................. · us ness, commerc a .xe cu c , ec ur extent o .each type of use ............ , .... 7 Di insofe isti gst cturq ifany:F Re .... · mens o x n ru s, ront ............... ar .............. Depth .............. Height Number of Stories ' ' Dimensions ot's~me structure with alterations or additions: Front ...... Rear ....... Depth . ' . H~k, ht ' ,, , ': 2 .............. ~,. . ' ........... } .... ~- ........... ~ ......... ;.. J'iumoer or Stories ........... ~.., ....... 8. o:mensmns of entire new construction: Front ...... ; Rear . . . Depth .... Height ............... Number of Stories ..... j :; . ' ...... - .......... 9. Size of tot Front .... R~-~ ......... ' ....~. ......................... I0. Date of Purchase "'. i ...... . ..... x,_'- ~-;.. .... ..~ ..... ~aeprn ..................... ........... . ............... t~ame o[ vormer owner .......... . ................. 11. Zone or use district in which promises are situated ............................................. ~ ....... 12. Does proposed construction viol te any zoning law, ordinar~ce or regulation: ................................ 13. ,W, fillotfbe._regrade.d '''.'''~:Ft'Cb:/d';..'..';,': .... Will exc~ess fiK be renloved from premises: Y s No 14.dame o owner mpramises d~t-t..~v~VL~F/e~t~q.. Address/~...67..ff.g~4/~.g~..tS0[.7-Y~'hone No ....... ~ .... :... Name of Architect ......... i'lL.' ~.' i~.' ..... ' ....Address ................ ~0/V~.' Name of Contracto~c~."~.'. ,. ...~---4~4.c-,... Address l~.~. ,~tark/.)~. ~)f'/.. ~tp~i~o.' ~/~ .~'.~..~.:~. il 15.' I.s th±s property within }00 feet of a t±dal wetland? *Yes ........ No ......... · If yes, 8outhold To.wn Trustees Permit may be requ±red. PLOT DIAGRAM Locate clearly and distinctly ~11 ibuildings, '~heth~r existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. above named· being duly sworn, depose~ and says that he is the applicant He is the ~ agent ' , corporate officer, etc.) of said owner or owners, and is duly lauthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work w/l/be performed in the manner ~et forth in the application filed therewith. Sworn to before~ . : ''. .......... I~" · 'day °~ ~/~'~.' ..... ,19q.~ . N°tary Public' ' ~~'~' ~' C°unty ~.~ ~ ' CLAIREI. GLEW ¥ x ., {... · Notary Public, Stete of NewYork NO. 4879601~ " ~ .' ....... · . · . Qualified in Suffolk County ~:Tt/~/. ..................... Commission Explrea Dace, ,mbar 8~ 19,~ f applicant)