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Home My WebLink About20606-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? 2050~Z Permission is hereby granted to,: ~..~, , ...~..~....~...~.....~ ..... ot premise'~ located at .................... ~ .................................. ~!, ...:~.. Block ..C~.....~.. Lot No. O County Tox Mop No. 1000 Section ,.~, pursuant to application dated ....... .~t~.....~ .................... , 19~...~..., and approved by the Building Inspector. Bu~1"ding Inspector Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examiaed .... .~..c~.~..., 19 ¢J .~. ^pp o ed . .... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTIi ......... 3 SETS oF' PLANS .......... SURV£Y ................... CIIECK .................... SEPTIC FORH .............. HAIL TO: Date ..... .7/~...F-; ....... 19 ~..9-~ INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se~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 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 work. e. No buliding 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, a~nd regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary insp(!:~r;L~.d .d y, . .v . z.L¢ .// ?:.z_ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ZZ y;. e_, ............................................................................... Name of owner of premises ...... ~.'T'.".'D ~ ~'... l~..F'..~./~. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ~ Plumbcr's License No ............ --7. ............ Electrician's License No. -- ....... Other Trade's License No ~- 1. Location of land on which proposed work will be' done....~,..~.... C~..~..~..c..~.c?-. afr~ .~..FSi. .......... ~. .......... ~ 5 House Number Street Hamlet County Tax Map No. 1000 Section .~ ........... Block ...~ ............. Lot /~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy_ of proposed construction: b. Intended use and occupancy 3. Nature of work (check which applilcable): New Building .......... Addition .......... Alteration .......... 4. Estimated Cost ........ ' · .'fY .................. Fee [ o filing this application) 5. Ifdv~elling, number of dwelllng units, ............ . Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed o!cupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, i~f any: Front ............... Rear ...... ·; ...... 'Depth ............. Height ............... Numbei- of Stories ........................................................ Dimensions of same structure with!alterations or additions: Front ................. Rear .................. Depth ...................... iHeight ...................... Number of Stories ............... . ....... 8. Dimensions of entire new construction Front ............... Rear ............... Depth ............... Height ............... Numbe~- of Stories ..................................................... : Rear J... pth '" 9. Size of lot: Front ............. I ........ De ........... 10 Date of Purchase . ...............: ....... ' ......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violateiany zoning law, ordinance or regulation: 13. Willlot be regraded ~ ........................... ........... r ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..... i .............. Address ................... Phone No ................ 15. Name of Architect ............ ! .............. Address ................... Phone No ................ Name of Contractor ........... i .............. Address ................... Phone No ................ Is this property within 300! feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Towh Trustees Permit may be required. ... I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property Hnes. Give street and block number or description according to deed, and show street names and indicate whether ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing c6ntract) bove named. ' re is the . ~i (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained lin this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the m/apner set forth in the application filed therewith. worn to before me this ............... otaryPublic, .L~.v/,~.~.~~ ' r,,,. interior or corner lot.