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Home My WebLink About20556-z leO~v,e NO. ~ TOWN OF $OUT~O£D BUILDING DEPARTMZrNT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHOPdTED) N°N,o 20555Z Permission is hereby granted to: ..~.o...~....l..~.~.q. ............................................ .... at premises located et .~..~-~.-'~.........~....~.~-~.~,....~.: ....... ~~.t~ ............... Coun~ Tox Map No. ~0o0 Se~,o~ ..... I.~.~ ......... 8~ock .... J..~ .......... Lot No..J..~.:..f ........... pursuant to application dated .... .~ ....... ~....~ .................. , 19.~...~%.., and approved by the Building Inspector. Fee $ ............. ; .......... Rev. 6/30/80 FOLLOWING INSPECTIONS. . ROUGH ~ . tN}~Ut. AT'ION I SCALE. 50'= I" &~LL= I.I3 /kC2ES FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765- 1802 '\pproved .' .~ I ~ ' . ~ ....... lPg~. eomit NoCO.~ ~ .... . ............ ..... ........ . . (Building Inspector) ~PPLIGATION FOR BUILDING PERMIT INSTRUCTIONS BOAKD OF HEALTII ......... 3 SETS OF ?LAXS .......... SURVEY ................... CIICCK .................... SEFTIC I:'0 ~ :1 .............. CALL ......... HAIL TO: , 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 ,~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. ¢. The work covered by this apphcatlon 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 applicant. Such permit hall 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 hall have been granted by the Building lfispector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ;uilding Zone Ordinance of the Town of Southold, Suffolk Count~,, New York, and other applicable Laws, Ordinances or Legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with ali applicable laws, ordinances, building Code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. (Mailing address of applicant) ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber Or builder2 lame of owner of premises ..0~.. . (as on the t.ax roll or latest deed) 7 applicant is a corporation, signature of duly authorized officer. ~a~e' ~nd titie of co;t~or'a}i officer) Builder's License No ...... .d~.~ .......... Plumber's License No... ~ ..................... Electrician's License No Other Trade's License No ...................... · Location of land orl which l~roposed work will be done. .~. Ilouse Nmnber Street Hamlet u ' ' ' Cotmty Tax Map No. {000 Section ............. Block ............... Lot .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and inicndcd use and occupancy of proposed construclion: a. Existing use and occupancy ~.. ...... / b. Intended use and occupanc~ ........ . ' ' :f.7ork (check wh,ch apPlica'ble): New Building .......... Addition ..~.. .... ,Uteration .. Repa/r ........... Removal 'i ............. Demolition .......... i... Other Work .... .~. ......... 4 Estim d Co ~- ~ ese .5. If dwelling, number of dwelling unitsl ............... Number (to be paid on filing this application) If garage number of cars . ~ of dwelling units on each floor ................ 6 ' Ifbusine'ss ......... ! ....................... ' · , commercial or mlx,-.,t - i ........................................ · ,.u uccupancy specify nature and extent of each type of use 7 Dimensions or'existing stractures ifalny: FrOnt Rear ~ Depth Height Num b'er o? Stories ........ ' ' ' ' ~ ................ Dimensions of same structure with a terations t~/ ....... ' ............................................... additions: Front Depth " ght ................. Rear .......... 8 ........................................... Number of Stories · Dimensions of entire new constmctiofl: Front ............. ~i: · . ............... · Rear ............... Depth ..... ~ .......... 9. "'" ~' - · ..... NumberofStones . ... ......... I0. Date of Purchase ..~,,/~' i ............... Dep.th .~,., ............. I 1. Zone or use district in which premisesiare situated ......... . ocs proposed construction violate any zoning law, ordinance or regulation: ....................... 13. Will lot 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 ...... [5. Is this property within 300 f6et of a tidal wetland? ..... ' ...... , ~Yes ........ No ......... · If yes, Sourhold Town Trustees Permit may be required. Locate Clearly and distinctly all buildihgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptio~ according to deed, and show street names and indicate whether interior or comer lot. (Name ofindividu~l'signing c~tr~ct) · · duly sworn, deposes and says that he is the applicant ore named. : said owner or owners, and ~s duly autl On,ed to perfo~ or have performed the said work and to m~e ~d file this flication; that all statements contained in tl~is application are true to the best of his knowledge and belief; and that the rk wil! be perfomed in the manner set forth i ~ the application filed therewith. om to before me this , uommms~on E~pi[fis,,De~emb~8~19~ ,,., ,'.