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Home My WebLink About20996-z · 0~ 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~N? ~0996Z Permission is hereby granted to: · .C..~.~.~.......~.~.../..~.~ .......... . ......... · om e ....................... *~ .......................................... *': ............. ;~ .............. .~c ................................. at pr's s located at ........ .~...~...~...~j. ....... ~..~ ...... Z~/~ .................................. ........................................................ ~....~z..4:? ....... ~.....~...... .................................... County Tax Mop No. lO00 Section ../..~.... .... Bilk ....~ ............ Lot No ...... ~....L ........... pursuont to application dated ........... ..~...~ ....... .~ .......... , ,9.~...~and approved by the Building Inspector. .................. Building msflector Rev. 6/30/80 FORt'vl NO. 1 TOWN OF SOUTHOLD .,. \., BUILDING DEPARTMENT '" ' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1802 / : .,amined ....... \pprovcd ........... 19 . ermit No. . )ixapproved a/c ..................................... _ .,. . (Building Inspc~tm APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLA~t~ .......... SURVEY CIIECK .................... SEPTIC FORH a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ts 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- ~tion. c. The work covered by this application may noi 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 :all be'kept on the premises available for inspection throughout the w6rk. c. No building shall be occupied or. used in whole or in part for any purpose whatever until a Certificate of Occupancy all 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 ailding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or -'gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to imit authorized inspectors on premises and in building for necessary~ /It") -- ' : qgnature of applicant, or name, if a corporation) ' 'it ( '' g pplicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.. am r o p emi s 0- .'E.~/&~.~..~...-'. . ( ~O,,khe tax roll or latest deed) applicant is a corporation, signature of duly auth~orized officer. Builder's License No PIumbar's License No Electrician's License Nb ...................... . Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. lIouse Number Street Hamlet County Tax Map No. 1000 Section l .~'~. · · Block ~.... ?. / Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premlses and intended usc and occupancy of proposed construction: a. Existing use and occupancy ....~..~ ................ · nten e use an occupancy .......... -, 3. Nature of work (check which a, pplicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition ......... Other Work .................. Fee . · i (to be paid on filing this application) 5. If dwelling, number 6f dwellin~ units ............... ~ ' ' floor ............... Number of dwelling units on each · Ifgara. ge numberofcars . .. ................ 6 If business commercial or mixed occupancy specify .......... ~ · ' , nature and extent of each type of use 7 Dimensions of existing structures if any: Front .......... · Height ................ Rear .............. Depth .............. ............... Number of Stories Dimensions of same structiur¢ with alterations or additions: Front Depth "i H~ight "' iN' ............ Rear ................. ................... ; ......................... umber of Stories . 8 D ..... Front ............ ""' ' · mmnslons of entire new conslruchon: Rear Height Nur~ber of Stories ............................................ · Depth Size of lot: Front ..... l ............ I0 DateofPurchase ~, ~/~' 7~__Z> ~ear ...................... Depth ...................... ' ' Name of Former Owner · one or use d:strlct in wh:cl{rl~em:ses are mtuated .................................................. !2. Does proposed construction v ate any zoning law, ordinance or regulation ............................. 13. ',Vi 1 lot be regraded . , .' ................. ~l t' Will ex ss fill be remove om premises: Yeswner o~ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor ........ i .... 15. Is this property within i300 f'e~'t' ;'f''" .... Address ................... PhorLe. No ................ a tidal wetland? *Yes ........ No...)~ .... *If yes, Southold ~own Trustees Permit may be required. PLOT DIAG RAM Locate clearly and distinctly ali' buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl mumber or description according to deed, and show street names and indicate whether ln~enor or comer lot. . (Name of individual signing contract) ,bore named· ' (Contractor agent corporate officer et~ ~ ............ ~f ~ald owner or owners, ~d is duly[authorlzed to perform or have performed tlie said work 'and to m~e and file this Pphcatm~; ~ha~ all s~atcments conta~hcd ' ' ' ~ this a~plication are true to the best oChis knowledge and belief; and that the' ,'ork will be pcrfo~ed in the manner ~ct forth in the application filed therewith. ;worn to before me this ,?