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Home My WebLink About19915-z · OR~dK BO. 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N. ¥. BUILDING PERA4IT (THIS PERAAIT AAUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 19915 Z Date ....~. ..................................... , 19...~/ Permission Is hereby granted to: /~ .~ / /'~ ; -~ ...... ~_~ .... ~ ........ ~ ~ pursuant to application doted ........ .,~-../.....~..~.. ............................. , 19...~./., and approved by the Building Inspector. Fee $...~ Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined ., 19 ~./ Approved ., 19 .~/Permit No..~. ~...~..~.~..~. ~ Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. APPLICATION FOR BUILDING PERMIT 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 c~mmenced 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 shail 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 applicarn,t, or n~me, if a corporation) ¢ (Mailing address of applicant) //~?ff~.~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............i¢i ........................... Name of owner of premises (as on tl~e taxx 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 ......................... Electrician'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) State existing use and occupancy/~'~ .//~°f premises and intended use and occupanc~ of proposed, construc tion:~,, ,, b Intended use and occupancy ~,¥ ' ~ , Locate clearly and distinctly all property lines. Give street and block interior or corner lot. 3. Nature of work (check which aplplicable): New Building .......... Addition. .......... Altera~n .......... Repair .............. Removal .............. Demolition ............. Other Work..~t~f. TaZ~ ....... ' .~..~. 5 (Description) 4. Estimated Cost ........ ~'.~..~.'f-) ~ ............ Fee .................................. j (to be paid on filing this application) 5. If dwelling, number of dwelling ~tnits ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixec occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~ if any: Front Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth . .,... '~,'t~.'~ ....... i' ' Height ...................... Number of Stories ...................... 8. Dimensions bf~n~lre new constrUction: Front . .. ............ Rear ............... Depth ............... Height ............... Numl0er of Stories ........................................................ 9 Size of lot: Front ' Rear ............ ~ ................... Depth 10. Date of Purchase ........... ~ ......... . ......... Name of Former Owner ............................. I 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. , ......~.., ....... 13. Will lot be regraded .... ....................~ .... Will excess fill be removed from premises: Yes No fp 14. Name of Owner o remises ...; ................ Address ................... Phone No ................ Name of Architect .......... i ................ Address ................... Phone No ................ Nanae of Contractor ~ Address ......... ~ ................................... Phone No ................ 15. Is this property within 3100 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Tiown Trustees Permit may be required. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from .umber or descriptioh according to deed, and show street names and indicate whether STATE OF NEg/~/-ORg~:::~ · ,~,f~.~...~_~, ~c. .......... being duly sworn, deposes and says that he is the applicant (Name of individual sigffing contract) above named. He is the .................................................................................... (Contractor, agent, corporate officer, etc.) vf said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 'lpplication; that all statements contalnled in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. ~worn to before me this