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Home My WebLink About19913-z ]FOR,Bi HO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/rUSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- 1991~ Z Permission is hereby granted to: . __ ~.~,~..~.~.~ .......................... ..... ~.~....~..~...~ ..................................... ..... /'~'~'~,a"."'~'~'""~-; ...... ~..,-./~,- ........ ,.,-. - . o~r.m,,., ,o~; ~¥~....~~......~.../.....~-C.Z ....................................... County Tax Map No. 1000 Section ...... ;.. ,/, .. ~......~.. Block ........... ~. ....... Lot No ....... ../'....,,~.. ......... pursuant to application dated .......... :~f....T;../... ............................... , 19./../..., and approved by m~ Building Inspector. Fee $.,~...~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ., 19 .~. Permit No. J~' Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORH .............. CALL . · -~ .... AIL TO: Date ......... , .......... 19... 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 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 cbmmenced 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 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 infi~p~ections. - (Signature of ttpplicant, or name, if a corporation) i ..... ........ (Mailing[address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~. ~..~..~.: .~. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location ofland on which proposed work will be done ~.~..~[~ ~. ~f )'~ )~4__~ ~/+' ~ ~ .... · n~.~..'~. ~* ............ ~.~.- i~.i ~.~i'.).2'~Ii'.¢.'). 5 1 iiiii ii iii iii i iiii i iiiii 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 occupanc~ of proposed construction: a Existing use and occupancy ~ ~k) .~. II' .1~.~ b Intended use and occu anc . ~ ~.. I)X . . .~ ,~ property lines. Give street and block fiumber or descriptioh interior or corner lot. 3. Nature of work (check which applicable): New Building .......... Addition Alteratigo Repair ............. - Removal ...... . ....... Demolition .............. Other Work..~ .~C-¢71.0-.~. .... I ,/ esc on 4. Estimated Cost ...... ~ ...................... Fee ................................. .[ (to be paid on filing this application) 5. If dwelling, number of dwellin units ............... Number of dwelling units on each floor ........ · If garage, number of cars ..... I ..................... 6 If business commercial ormixed .............................................. · , occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any' Front ............ R ... ear .............. Depth ........... Height ............... NuMber of Stories ........................................................ Dimensions of same structu[~? th alterations or additions: Front ............. Rear ............... mensxons oz entire new construction: Front ............... Rear ............... Depth ............ Height ............... Num~ber of Stories ........................................................ 9. Size of lot: Front ..... : ...... I ........... Rear ...................... Depth ...................... 10 Date of Purchase ' ............ 1 .................. Name of Former Owner ............................. 1 1.' Zone or use district in which premises are situated 1 2. Does proposed construction violhte, any·zoning law, ordinance or regulation: ............... 1 3. Will lot be regraded ......... .' ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ... I. ~ ................ Address ................... Phone No ................. Naxne of Architect .......... , ................. Address ................... Phone No ................ Name of Contractor ......... ! ..... . Address .................... Phone No ................ 15. Is this property within 3.00 feet of a tidal wetland? *Yes ........ No..~ .... *If yes, Southold Town Trustees Permit may be required. -.. PLOT DIAGRAM Locate clearly and distinctly all !buildings, whether existing or proposed, end. indicate all set-back dimensions from according to deed, and show street names and indicate whether STATE OFN~~ ,I - SiS COUNTY OF ...... x~--~. [.~"~. :~ ~.. ........ (Name of i*Rlividual signin~ cent;ac'ti .......... above named. being duly sworn, deposes and says that he is the applicant He is the i (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly huthorized to perform or have performed the said work and to make and file this application; that all statements contain!ed in this application are true to the best of his knowledge and belief; and that the ~vork will be performed in the manner s~t forth in the application filed therewith. ~wom to before me thi~.~ ........... '~'/~,' - ..... -day ofF:i~ . . . . ... '~ .... , 19°~. ?. ~'°tary Public,('-~..~. ~..~. i ~ounty Clullifled in Suffolk