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Home My WebLink About19217-z ~ ~0o ~ BUILDII~IG DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUI~DJNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premis~s Iocatod ,t ............................................................................................................................ ......................................... &zz~ ....... ~... ~.....~.~.~~. pursuant ,o application dated ...... ~ .......... .~.. ......... , ,9..~...~., ond approved by the Building Inspector. Rev. 6/30/80 Examined ................ , 19... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765.1802 Disapproved a/c ff ................................. BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ............. NOTIFY~ MAIL (Building inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building lhspector, 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 layout of property must be drawn on the diagram which is part of tiffs appli- cation. 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' S6uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, ad~ditions or alterations, or for x;emoval or demolition, as herein described. The applicant agrees to comply with all applicable taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature o? &pplicant, or name, if a corporanon) (Mailing address of appilctmt) .State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of fP ........ , .................. ~ . .~z-w-.. ............... ownero remises ...//,'/-~ "~, ~ ~,c,,//;,~,> ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ........... .tie or cgh;/;ate elkS/6 (Name and .................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ................. :. Location of land on which proposed work will be done; Il b ................. oust Num er Street, Hmnlet County Tax Map No. I000 Section / .~ · · · Block . .d/d ............ · ............... Lot.. .... ." Subdivision . ./y~.f~',~.q~ .......................... Eilcd Map No. ....... Lot../.e. .......... · State existing use and occupancy of premises and intended usc and Occupancy of proposed construction: A. Existing use and occupancy ....... ~. ....... ""f'~"~/'4~q~'/c.~. · .gm~vri.~{.i~ ~,~.,:; ,:-~%r~¥~¢.~.~{ .... B. Intended use and occupancy. . ,/3'F;z-"~V n'~"'.-~/~'-4zc e--- .-/-~5~ ~-,d,~v~F~ ,,~dw;O 3. N~ature'ofwork (check which applicable): New Building ......... Addition .......... Alteration ........... Repair .............. Rbmoval[ .............. Demolition ........ j.~....Swiraraing pool ............ Tennis Court ......... Aceessory Buildlng .......... ¥ohce~,__~ ..... Other Work ....... itima e Cost ............. ......... (to be paid on filing this application} ' nii / N b fd Iii its h fl $, It]dwelling. numberofdwellingu s.............., um ero we ngun oneac oor. .......... . . It]garage, number of cars ....... ~ ........................................................... Itl ' ' 6. business· commercial or mixed o~cupancy, specify nature and extent of each type of use .................. HiHght Num bc~ of Stories ' ' 'imensions of same with 0. Iterations or additions: Front Rear D structure ......................... D,epth ...................... Height ...................... Number of Stories ................... 8 ...... Rear Depth · D3menmons of entire new constrncpon: Front .................................. H~eight ............... ,Numbe~ of Stories .... ,~ ......... ; ..................................... 9. Slzeoflot: Front ............. ; ........ Rea ..................... Depth ................ 0. D,ate of Purchase ........ Name of Former Owner ,¢~, //~2e-w'~ I. Zbne, or use district in which premiies are situated .................................................... 2. DPes proposed construction violate]any zoning law, ordinance or regulation: ................................ 3. W~ill lot be regraded ........... i ................ Will excess fill be removed from premises: ~e.~s .,~.. No. 4. Name of Owner of premises ..... ! .......... ' .... Address ................... Phone No. ,~..,~..r~... Name of Architect ~ Address Phone No Name of Contractor ... ~ ' .. Address ........ Phone No... ' . l$.I!z this property ........ loeqtte,ld '~t~i'~'~0 feet o~ ~' ti4'a't '~e~:l'~nd? ~f yes, Southold Town Trustees Permit may be required. ' ' PLOT DIAGRAM Lo,cate clearly and distLnctly,all buLldmgs, whether existing or proposed, and. indicate all set-back dimensions from ~rope~ty lines. Give street and block number or description according to deed, and show street names and indicate whether ateriOr or corner lot. ,TATE OF NE~g&YO{R-4~t> ~ I~ S q :ou r¥ tm,.. .... ~ .... %-h., x ~O'.k~,6-: ......... i .................. being duly . [ (Name of individual signin~ contract) sxvorn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) )f saiO owner or owners, and is duly :uthorized to pe,rform or have performed the said work and to make and file this ~pplic~tion: that all statements contained in this applimltio ~ are true.to the best of his knowledge and belief; and that the fork trill be perfom~ed in the manner sot forth in the application filed: therewith. ~Wom! to before me this ' ,. ' ..... ', ........ ;daVe ...... ~'otar~ Public, . ~e e e ~ e e e · · · , ......