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Home My WebLink About20583-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N_°N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) '.% 205S~Z Do,. .... .~ ......... ~ .................... , ,~..~....~ Permission is hereby granted to: at prem,ses' ,~ated at ................. , ~o~ ~.~....~.~....~ ...... ....................................................................~ .......................... ¢: ........................ ~ .................. pumu~nt to application dot~ ..~...~. Building Inspector ~./ Rev. 6/30/80 APR 2 3 Exn Apt FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTII ......... '--3 SETS OF PLA~IS .......... ~SURVEY ...... SEPTIC F 0 RI'! .............. t, Or zPY , CALL ................... HAIL TO: a. 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. J b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the wbrk. 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or na~e, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~'4~ ........................................................... ~ ~~ ~..~ ~.~ ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth?rized officer. (Name and title of corporate officer) Builder's License No .... .(? P~.. t~.~./~ ............. Plumber's License No ......................... Electri?'an s License No ....................... Other Trade's License No ...................... · Location of land on which proposed work will be done ............................................ House Number Street Hamlet County Tax Map No. 1000 Section . .~. ~' Block ~ c/ Lot · .~. ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................... ~- t~,~ . ~: ........................ b. Intended use and occupancy " ' ~ ' ' 3. Nature ofwm-k (check which appflcable): New Building .......... Addition ..... Repair .............. Remo?l .............. Demolition ........... ' .... Alteration . ;~..' .... ,//[~/~,~,~a~ ~~~,~. - -~ Other W°rk · · ·/~/~ · '~' 'Cf'~' ,4 Estimated Cost ~.~} , ~,~ (Description) .[ (to be paid on filing this application) $. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................ If garage number of cars 6 If business commercial or mixed· occupancy .................................... · , , specify nature and extent of each type of use 7 HeightDimensi°nl,.,,. ~°f e. xisting structuresoy!if any: Front ~ .......'. Rear · ~..y~.~jZ.~. Numd~rofStories ... . ."7~...-7.~ ..... D~pth'.;...v. Dunensions o1~ same structure with alterations or additions: Front ..... Rear .................. Depth ~ .................. I' r~elg~tt ...................... Number of Stories ............... ~ ....... 8. Dimensions of entire new construction: Front ................ Rear ............... Depth ............... Height Number of Stories 9 Size of lot: Front ............. ~ .......... Rear ...................... Depth ...................... I0 Date of Purqhase ,.' ' Name of Former Owner 11. Zone or.use district in which premises are situated ..................................................... 12. Does proposed construction viola!e any zoning law ordinance or regulation: 13. Will lot be regraded..........,............, . .... Will excess fill be removed from premises: Yes No 14 Nam fO fp : Add . e o wner o remises .... r ............... ress ................... Phone No ................ Name of Architect ..... ~ Add ~ Ph No ..................... ress .................. one ................ 15 Name of Contractor .... ....... i ............... Address ................... Phone No ................ · Is this property within 300 feet of a tidal wetland? *Yes .~.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all b~ildings, whether existing or proposed, and. indicate all set-back dhnensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. DEPARTMENT AT FO['~802 9 A~ TO 4 PM FOR THE iNSPECTIONs: . 3N . TWO REQUIRED POURED CONCRETE ~ FRAMING & PLUMBING .................... r" CONSTRUcUON MUST 1'3[: COMpt,£TE: FOR C,O ALL CONSTRJCTION SHALL MEET ~TATEOFNE ~0~ .... j ~ ~/~.~ CONSTRUCTION & ENERGy , ........ .~.x~.~, ~..~, .~5( ' ~ ~.W. ............ being duly sworn, deposes"'° an~a~m " ' [~¢l~the applicant (Name of individual signing~ contract) bove named. e is the i (Contractor, agent, corporate officer, etc.) f said owner or owners, ~d is duly a~thofized to perform or have perfo~ed the said work and to m~e and file this ~plication; that all statements containgd ~ this application are true to the be~t of his knowledge and belief; and that the ork will be performed in the manner s~t forth in the application filed therewith. *om to before me this ~ Ota~ Public ..... . County