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Home My WebLink About19315-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 'i951S Z Permission is hereby granted to: ~-~ ot premises l~oted o, ..-Z.~~--~~...~ ..................................... ..................................................... ~.~~~ ................................................... County Tax Map No. 1000 Section ....... .~.....~... .... Block .............. .~..... Lot No ............ ./...,~..... pursuant to application dated ............ ...'~../~.. ................................ , 19~.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~/'~.: . ........ , 19 ~..~9 Approved/.~/.'? .., 19 ~D Permit No /~'-~/ ~.~' Disapproved a/c ..................................... BOARD OF HEALTH .... iii'ii: i ...... ' 3 SETS OFf. PLANS SURVEYWQ. ........... · SEPTIC FORM ................ NOTIFY: ?.2- CALL ...... . . . . MAIL TO: ~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLD(.. TOWN OF SO.I r { ~ ~, Date ...... g.. 7 ~ .......... i SP a. Tltis application must be completely filled in by Wpewfiter orin ink and submitted to the Building Ihspector, with 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 lhyout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 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 ~hall 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 iemoval 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 inspection¢.~ · . '' '(Si~;~at~/e'o't"~l~lich~t~ ~>; ~a'n~e;~'~o}t~o"r.~r~c;n')' ' ' · (Mmlin~ address of applicant) I State is ~iwn~, architect, engineer, general contractor, electrician, plumber or builder. _z o I¥ -r csc, .. . . . .......... ................. ............. ~n~ ~o~J,on, signature oS~h'iy~ut~rJzed officer. ?(~a~[~d:htle~o~,,ca¢orate 0~ce ) '~ ' ,: . . , - . ' . [~ Plumber's License No ' lcctnc an s L~cense No ....................... Other Trade's License No ...................... I. Location ofdand on which proposed work xvill be done; }louse Number Street Hamlet ty T I000 S S ~ ' I /~ Coun ax Map No. ~ction ....... Block ........ Lot ....... ,.,. Subdivision ..................................... Riled Map No. Lot (Name) ............................. 2. State existing use and occupancy of premises and intended use and ocCUpancy of proposed construction: A. Exisring use and occupancy. / B. Iq~ended use and occupancy ..... ~. · . ...................... 3. Nature of work (check xvhich applicable): New Building .......... Addition .......... Alteration ........ Repair ........ ~ ..... Rbmoval .............. Demolition .~ ..... S'Oiraraing pool ........... Tennis CourtA ......... ~- A~cessory Building ........ . ~r'~°ne°-~z ~ ...... Other Work; .......... 4. Estimated Cost~ ~ .~ P ..... ~ ....................... Fee ..................................... ] (to be paid on filing this application} 5 If dwelling number of dwelling u~its ............... Number of dwelling units on each floor ...... , ........... 6. If business, commercial or mixed 6ccupancy, specify nature and extent of each type of uso ...................... ~ Front Rear Depth 7. Dimensions of existing stmctures,]:f any .., .......................................... Height ............... Number of Stories ....................................................... D?th .. ........ . '"' "':'$'r' ' 'J' ~Ie,~t ...................... Number of Stories ................... 8. Damenmons of entxre new constm~tmn: eront ............... Rear ............... Depth ............ Hero xt ..... .,:; v~ -Number of Stones ................................ ~..- ~ 9. Size of lot: Front ...~..., .... I .......... · " · 10. Date of Purchase .... ~...~. ............ Name of Foyer Owner ........................ 11. Zone or use d:stnct xn which pre~:ses are mtuated .................................................. 12. Does proposed Construction viola..te any zoning law, ordinance, or regulation: ............................... 13. WIll lot be regraded .~ .......... Will excess fill be removed from premises: Yes .... A~aress ..... ~. ~ .'.~ N~e of Architect .......... ~ .................... ~. P~one No ................ ~e of Con~raetor ......... ' ................ Address .............. Phone No ................. PLOT DIAG~M Locate cle~ly ~d dist~ctl~ ~1 Ibu~dmgs, whether ex~sting or proposed, ~d. indicate ~1 set-baak d~ens~ona prope~y ~nes. Give street ~d block ~umber or desc~ption accord~g to deed, ~d show street n~es and ~di~ate STATE OF NE'N~YO.R~,~-~ ~ { q S · (Name of individual signing co~r~t) above named. I lace is the .......... ~ ....... being duly sworn, deposes and says that he is the applicant of said owner or owners, and is dt application; that all statements con work will be perfomled in the mann Sworn to before mc this ............. . .day ir.. .t,4, ...... 19... ... County . (Contractor, agent, corporate officer, etc.) ly authorized to perform or have performed the said work and to make and file this :ained in !his application are true to the best of his knowledge and belief; and that the :r set forfh in the application filed therewith.