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Home My WebLink About19206-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~lT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 9 Z Date ........................................... , i 9..?..~. Permission is hereby g, ron~ted to; , . / <-~ ~~..~....~.~.~~.....~.~ ~ . ..~...~...~..,,T,.,~.~........~..~....~..< .................. . ...~......~<.....~.~.......~..~..:..~?./~/ ,o ~/..~~. .......... ..~.:~...~.....~~~ ............................ et °rem,se, ~o~oted ot ......... ~..~ ........... ~ .................................... ............................................ ~~~ .............................................................................. ~o,,~ To~ ~op No. ~000 S,~,o~ .... ~ ..... m~k ............. ~ Lot No ............. ~. ...... Building Inspector, Rev. 6/30/80 'IZYL~ ....... 3 SETS OF PLANS ......... ''' ...................... II1~1~ ' ~ ~ ~1 ] BUILDING DEPARTMENT SEPTIC DORM ......... ~ ..... , DE~T "' , ~' HOLD, N Y 11971 NOTIFY ~1/~1 ........... ~ ~ ~_ ~'''~ .......... Exaznin~d . ~//.4/, ........ 19 .~ ~" _ AIL TO: Dis=pproved a/c ............................. / APPLICATIO~ FOR BUILDING PERMIT INSTRUCTIONS a. Tlfls application must be completely filled in by typewriter orin ink and submitted to the Building lhspector, with sets of plans, accurate plot plan t0e~seale. Fee according to schedui¢. · 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 o£ l~yout of property must be drawn on the diagram which is par~ of this appli- cation. ~ o. The work covered by thi's application may not be commenced before issuance of Building Permit. d. Upon approval of this application, ths 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 Sbuthold, Suffolk County, New York, and other applicable Laws. Ordinances or Reeulations, for the construction of buildings, ad~ditions or alterations, or for removal or de n, as h ' described. Th~ applicant agrees to comply with all applicable laws, ordinances, buildkm--eod'e~hous' and reg~/ae~inons, and to admit authorized inspectors on premises and in building for · /-,.-., · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ame of owner . · '": ~ (as on the tax roll or latest deed) If applicaht is a cc lighature of. duly authorize~t officer. (Name :t~d,":t ~orate 6fficer) Builder's ~ Plumber's Lic~s~ Electrician's Ll~e~ls~No; .,.. ....... Other Trade's License No ................... Location of land on which proposed work will be done; · ....... .... Ilouse Number ' Street ' · ........ ~/~ff _ Hm?let Subdivision... ......... ~.~N'a~) ................ Eitcd Map No ...... ~ ...... Lot ............. State existing use and occupancy of premises and intended use and Occupancy of proposed construction: A. Existing use and occunancv ~¢~'~ ~ . .~'/~'/~'~/' ~ /"~- B. Intended use and occupancy ' ' ' ' 3. Nature'ofwork (check which apphqabie): New Bud ng .., Add tion ......, ,.. ;'.~ ) arizonan- ,,~!.... Rep;ar .............. Rgmoval, . .... , ........ Demolition .,,,.,-,..,.-,-,~ ..... wzmmno pool ',;.a ·., 'i" ', .... ennls Court ......... Acqess~or~ Building ........ ~. Fence y ..... ._,Othmc~rk~. ~.. $. ~'~t~mated Cost .... .~..~,f,,2'/.4'..~.. ................. Fee ...... .~.~-~..~ .......... ; ...... .; .,;: . . i ,' (to bE paid on filing.d3is~a~pJl~(~ti'c/n) $, If dwelling, number of dwelling units ............... Number of dwelling units on each floor I~ garage, number of cars ....... ; ....................... : ..................................... 6. Ii~bus ness commerc al or mixed o~cupancy, specify nature and extent of each type of use ....... 7. D, lmenslons of existing structures, if any: Front ............... Rear ............... Depth ............ H'eieht .............. NumbetofStories......................................t .............. · ' ' Front Rear D~mens oas of same structure with ~lteratmns or additions' D,~pth ...................... }leight ...................... Number of Stet/es ................. 8. Dimensions, of entire new constructlion: Front ............... Rear ............... Depth .......... Height Number of Stories 9. Size of lot: ~ront ...................... Rear .................... Depth ......... 0 Date of Purchase Name of Former Owner Z~on di i ti hi I '~ it d I. e or use str c n w c 1 premises are s uate .., .......... . ........................... 2. Does proposed constructmn wolatel any zoning law, ordinance or regulation ............................ 3. Will lot be regraded ........... i ............... Will excess fill be removed from premises: Yes .. No.. ~ Name of Owner of premises : Address Phone No Name of Architect ............ ; ........... ___ Address ................... Phone No ................ ............ Address ................... Phone No .... ~; .... 15.Ils this property lo~4~teld within300 feet of a tidal wetland? ~YES..~.NO..~. · ~f yes, Southold Town ~rustees Permit may be required. ! i PLOT DIAGRAM Lo;cate clearly and distinctly,all bqildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether' aterio'r or comer lot. / ..... ' ............... be the applicant . ~ . (Marne of individual signing,,contmct) ~bove ~amed. . ~ is (he , ~' : (Contractor, agent, corporate officer, etc.) ) ' . [ , f sa~fi owner or owners ~d s duly ut ~onzed to perform or have performed the said work and to m~e and file this ;Pphcat on: that all statements contra ~d ~n flus npphcatio ~ are trt e to the best of his knowledge and belief; and that the YOrk Will be perforated in the m~ner s~t forth in the application filed therewith. )wom[ to belore me this ,; · · ......... or..' ........... , ~ota~ Public ....................... County ~ ~ ~ · t ~lmsDe~T~r 01, 1