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Home My WebLink About20600-zTOWN 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) NgN? 20500Z Permission is hereby gra~ . C//;5//.;.i-~--. , .... !.¢~ .............. ................. .......................... ..... ~~._.~..,..~......,...z/..z~... , at premises Iocoted~at _.~..~?~.....~~..~ ....................................................................... County Tax Mop No. 1000 Section ..... ./...~.....~.. ...... Block ...... ../....~... ........ Lot No ......... .~..~...~. pursuant to application dated .....~/.~..~.. ..................................... , 19~..t~ and approved by the Building Inspector. Fee $. Insl:~:tor Rev. 6/30/80 YOUNG .,v~..~Ao, .~, .o.K Examincd ................ , I . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~./../ ......... 19 .~'.~'. Permit No..,,~....~,..O.~ ~ Disapproved a/c ..................................... · . (Bu, i~ing I~ctor) APPLICATION FOR BUILDING PEHMIT INSTRUCTIONS BOAgD OF ;'{EALTII ......... 3 $£T$ OF PLA;IS .......... SURVr-Y ................... CIIECK .................... SEPTIC FO lI:l .............. / HAI~ a. 'This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ct, s 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 tile diagram which is part of this appLi- ation. ¢. The work covered by this application may not be c~)mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a BuLiding 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 Inspector. 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 County, New York, and other applicable Laws, Ordinances or ',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with ail applicable laws, ordinances, building code, hg~sing code, and regulations, and to for necessary in e rio . . ' elm it authorized inspectors on premises and in building ~.~~ ..... (Mailing address of applicant) ;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder} lame or owner of premises . .Oq ~q.~..~..~..~q..fL...~. (as on the t~ roll or latest deed) ~'applicant is a corporation, signature of duly authorized officer. ....... '(~'a~e ;nd title of co'orate offi;er) Builder's License No...C~a*..).r'),.CJ~.. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. IIouse Nu,nbcr Street Hamlet ~~. County Tax MapNo. i000Section ...[4~ ........... Block .... I.~ ........... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and in tended use and'occupancy of proposed construction: a. Existing use and occupancy ........O~r ~lJ~...~{Cr~ ........................... ...... ... .. b Intended use and occupancy ' .3. Nature of work (check which applicable): New Building .......... Addition .......... kl[eraug~n ......... Repair .............. Removal .............. Demolition .............. Other Work ," "-'. ,' (Descmptlon) ~ ),~ o ' . ........... ~. 07,. ~.,~. . ........................ 4. Estimated Cost ...... ].j ..... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each Iloor ................ · If garage, number of cars ....................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front. d4.,,~.4 .'f ........ F, ear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure, with alterations or additions: Front ................. Rear Depth ...................... Height ...................... Numbcr of Stories .............. ': ....... 8. Dimensions of entire nexv construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ....................................................... Size of lot: Front ...................... Rear ...................... Depth ............ ; ........ Date of Purchase ............................. Name of Former Owner ........................... Zone or usc district in which premises are situated ................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ............................. Will excess fill be removed from prom scs Yes Name of Owne of prem~ses~g Address de..'O. ~./-';,'. 'r ,~, ~ ~ ........... Phone No. ,. ' ' ~' Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ I~ this property within 300 feet of a tidal wetland? *Yes ........ ~ *If yes, Southold Town Trustees Permit may be required· PLOT DIAG lb'tM 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 comer lot. o 10. 11. 12. 13. 14. 1.5. .~ 8E COMPLETE FOR C.O. ~[.L CONSTRUCTIO~ SHALL ThE REQUIREMENTS OF THE N.Y STATE CONSTRU~ON & CODES. N~ RES~N81~ FOR DESIGN OR ~NS~U~ON ERRORS .'A'r~ OF N~¥O~:L~ (~ s s )UNTY OF..~.qs-F. ~-.~./. ?.U.. :'..-- ' .. ....... .,'-. ,..,,.. 7....L_.., .............. lieing du,y sworn, dc ,oses and s:,,'s tliat hc is the ap,,licant (Name of individual signing contract) we named. is the ' ~,. 6{)~ /~ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly anthorized to perform or have performed thc said work and to make and file this lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the k w/Il be performed in the manner set forth in the application filed therewith. ~m to before me this ......... ~..~ ....... dayor .... , ...... , ....... I~ ... ~ { ," , ~~ - .. (. ,..~....~.., 5~.. ................. ~1~ S~eofN~ -' ~ b,' ' (Signature of applicant)