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HomeMy WebLinkAbout19306-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE woRK AUTHORIZED) N~ 'i930~ Z Permission is hereby granted to: ...~.~...-....~ ......... .~.~.~~ .......... .... i ................ ; ...... "~ .............................. ~'" ~ . ~.~....~.:.~ .... ~. .~ . ~ .......... -- ........ County Tax Map No. lO00 Secti~-~.~...~...~.. ....... Block ....... ~:~.~;~. ...... Lot No .......~.....[ ............ pursuant to application dated ...~'~.M~....~..........'~... ......... , IO.~...<~.., and approved by the Building Inspector. .... ;'"'"Builclt~ Insl:~ctor Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS .......... SURVEY . . ~ ................ SEPTIC ........ ' .. · NOTIFY~ 763 CALL - MAIL TO: Disapproved a/c .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This 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-cole. 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 l&yout of property must be drawn on the diagram which is part of this appli- c3tion .... 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 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 S~'uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, ad~d tions or alteration~J"or for removal or demolition as herein desc The applicant agrees to comply with all annlicable aws ~-": ....... ~-~']' ...... ' ribed. _ . .~ , ~uma.~, o~u~ng cooe4~oumng code, and regulations, and to · .' · ~,.- . . · . .-,~-~-.,,. .~.jx~ . · (Szgnature ot apphcant, or name, if a corporanoni''!~ . .... (Mailing address of applicant) ~,. x~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · \...... _. ... · amc o~ owner olprem:ses .t-'.N .-X~D..c>..--:x.~..%~h....~..'..N,~X~.x,.~_.%.QN.% .~~. ~,. ..... ~...-~ .~x,.'~7'..'%~. ' (as on the tax roll or latest deed) ' ' hr applicant is a corporation, signature of duly authorized officer. ra officer) Builder's License No ................ Plumber's License No ............ ~.~ Electrician's License No ; O/her Trade's License No ...................... Location of land on which proposed work will be done, tlouse Number Street, ' xx Hamlet ' ' ' " County Tax Map No 1000 S~ction .~...~ Block .~ . Lot .~. ' Subdivision ..................................... Fdled Map No. . ................. (Name) Lot ........... State existing use and occupancy of premises and intended nsc and occupancy o£proposed construction: A. Existing use and occupancy ...... .~..'~...~ .......... ¢~5~¥.~¢~ ... ~ B. Intended use and occupancy ...... .~ ............................... 3. Nature'ofwork (check which applicable): New Building ......... Addition .......... Alteration ........... Repair .............. Rbmoval! ............ :. Demolition .............. 8wlraralng pool. ............. Tennis Cour2 ..... ^e? ory Building ....... .22Z_20ther Work ............ 4. Estimated Cost . .~ ....... ~ ...................... Fee .~,~..~ .............................. · , (to be paid on filing this application} 5 If dwelling number of dwelling uniis 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 .................... 7 Dimensions of existing structures il'any: Front · Rear · 'Depth'. Hmght ............... Numbe~ of Stories .................................................. ... Dimensions of aame.stru~tute with ¢lterations or add tions: Front ............... Rear ..... i i Depth . ,~..., ..... ............ J-Ieight ...................... Number of Stories ................... Dimension~ of entire g~w q~r!stmction: Front Rear Depth ~ j Height" - ~ ~"'~ .~'~'~m~of Stones ~ ' ' 't;; F, ront Rear Depth 9. Size ofl0 ............. ;., ......................................... ~:,~ (; !; Name of Former Owner ' ' ' 0 Date of Pu~rchas~ ';- ~- . I Zone or use di~ri~'t in::whicl~'iSremi~es are situated ' Does proposed construction violatel~any zoning law ordinance or regulation: 3. Will lot be regraded ........... ~ ................ Will excess fill be removed from premises: Yes .... No. 4 Name of Owner of premises i ' Address Phone No . . Name of Architect ............ ~ .............. Address ........ · Phone No Name of Contractor i ' Address Phone No ' 15.Is this property loeqlte'd within 300 feet of a tidal wetland? s~YES .... NO .... ~If yes, Southold Town '~rustees Permit may be required. ; PLOT DIAGRAM Locate clearly and distillctly.all b~ildlngs, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and b!0ck number or description according to deed, and show street names and indicate whether nterior or corner lot. ;TATE OF NEW YORK ~ ~'OUNTY OF ' ............................... ~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) lbovc named. is the ~ ] (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly :iuthorized to pe,rform or have performed the said work and to make and file this ~pplication: that all statements containt~d in this application are true to the best of his knowledge and belief; and that the .~'ork will be performed in the manner s6t forth in the application qled therewith. ;worn to before me this ........................ day of. ~otary Public ................... .............. County (Signature of applicant) Z..