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Home My WebLink About20861-z I~OB~ NO. B 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) · ~~~.,....~.../.,..~:,:...:.,, ,._...... ............ : ...... :..........:.. ....... :...~.q>....~:~ ........................... at premises iocat'ea at .................. ~. ........... ,~.....~......~..,, ................................. .................................................. ........................................... co,n~ Tex Map No. ,000 Se,t,on .... ~...~... ,,o,k ..... ,Z... .......... 'ot No.... :/.,...~. ....... pursuant to application dated .~ .......... ..~....~.. ...... , 19...,~.~..~L, and approved by the Building inspector. Building Inspector Re~ 6130/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 BOARD OF HEALTH SURV£Y ................... CIIECK .................... SEPTIC FORH .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... .~. / .7<~..., 19°J..qr' INSTRUCTIONS 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. 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- "~ation. 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 w6rk. 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 inspectom on premises and in building for necessary inspections. ~ I" ~ , ~ -- (Sig~re of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enginee contracto ectrician, plumber or builder. Name of owner of premises ........................................................ (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 ....... ' .............. Plumber's License No ......................... Electriqian's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ....................... .... , ............................................ House Number Street Hamlet County Tax Map No. 1000 Section ............. Block ....,,~ ............ Lot. ~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~{],~.. ............................. ......... b. Intended use and occupancy .... S ~..~.t)~.. ~:~.~}..L.,...' ~ t;. ,: J~ i~ ~.,,.r~ ........ 3. Nature of work (cheek which appheable): New Building ....... ; · · Addition .......... Alteration .......... Repair .............. Removal ......... Demolition ...... Other Work 4. Estimated Cos .. .i. ........ . ............ Fee .............. , (to be paid on filing this application) 5. If dwelling, number of dwelling On/ts ............... 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 ...... i.. structures, ]f any: " ' ' ~ ' ' '"" ......... 7. Dimensions of existing i . Front...:.. ,'. Rear ' ' Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth . (. Height ' Number of Stories 8 D' ' ' ~ ' Front Rear ....................... · ~menmons of entxre new construchon. Height Number of'Stories .............. · ............................... · ,~ Depth 9 Size of lot: Front ' ' ' Rear ........................................ Depth ...................... 10. Date of Purchase ........... ~ · · ·: .... ' ......... Name of Former Owner I 1. Zone or use dmtnct ~n whtc re ~ses are mtuated .................................................. '" 12. Does proposed construction rio e ny zoning law, ordinance or re ulation 13. WHI lot be regraded ....................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ... i ................ Address ................... Phone No ................ Name of Architect .......... i ................ Address ................... Phone No ................ Name of Contractor ......... i ................ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Tpwn 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 lines. Give street and block ~umbei' or description according to deed, and show interior or corner lot. street names and indicate whether . STATE OF NEW YO~RI~. cou ¥ OF .... S.S (Name of individual signing contract) lbove named. ra if said owner or owners, and is duly ~uthorize~"'to peYform or have perfo~ed the said work 'and to m~e and file'this :pp ication; that all statements cont~i~d ~ this apphcation are true to the best of his knowledge and belief; and that the york w~l be perfo~ed in the man~6~ ~t forth in the application ~led therewith. ;worn to before me this ........ ..... ...... , .... NOT Y BU d · · ............ .......... ~O. 4Z,~9.,U,O,I~' [ -.) ...... . (S,gnature of applicant)