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Home My WebLink About18485-z lrORB~ NO. · TOWN OF $OUTNOLD 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°- 18485 Z County Tax Map No. 1000 Section ........ ~.../.. ....... Block .............. ./,..... Lot No .......... ~...~.. ..... pursuant to application dated ........ ~./.~./.: ................................. , 19..~, and approved by the Building Inspector. Fee $. ~...~ Rev. 6/30/80 FORM NO. TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,; 765-1802 ,,pproved ........I, Pe=it No. Disapproved a/c ..................................... glu[ldi~g'Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH .......... 3 SETS OF PLANS .......... SURVEY ....... ~ .......... CHECK SEPTIC FORM ............... ~ OF ~OUTHOL ..... Date .................. 19~. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wit; 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 sire or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this cation. o. 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 pen 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 a~y purpose whatever until a Certificate of Occupm~ shall have been granted by ~e Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New Yorls, and other applicable Laws, Ordinances Re=ulations, for the construction of buildings, ad. ditions or alterations, or for removal or demolition, as herein reset/b, Th~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspections. ~ : fSignature et applicant, of name, if~ Corpgff~non) · e ..... ~r'~k~ :::'~ ", ' ~,1~51 (Mailing address of applicant) 77 ~1 T State wl~ether applican~ is owner, lessee,-~.~nt, architect, engineer, general contractor, electrician, plumber or hullo ..... ...................................................... Name of owner',o~!'premises ~.~.-,/~',4°..~: .?~."JS....-~..~...~., .~.~..''. -.'~..:. -~- -~. -~...~- .~-~- ..................... ~ e ' ~ (as on the tax rgtf'or latest deed) If applicant is a ~r~p. ora, tiOn,, ~ig~ature o f,~ltl~'Y authorized officer. (Nam~afld ti~te~ 6t' corporate ' ' i"' / /'/' Bmlder s L cense No ........... ."3 ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ....... ' ......... : ............................... llouse N umber Street. Hamlet Subdivision ..................................... Eitud Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ../..: ...... ."5x'-' ' b. Intended use and occupancy .................. ~'¢,~i;::~',~.',.2 ',',~ ....... 3. Nature of work (check ~vhich applicable): New Building ..... ' ..... Addition .......... Alteration ......, Repair ............. ROmoval ........... Demolition ............ Other Work ~. ~. G..~. (Dcscriptir 4. Estimat6d Cost . . .i~../....~...O.....-7~-.. ................... Fee .................................. (to be paid on filing this application) $. If dwelling, number of dwelling units ............... Nnmber of dwelling units on each floor ............ If garage, num her of cars .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................. 7. Dimensions of existing structures, if any: Front ............... Rear ............... Depth ........... Height ............... Number of Stories .................................................... Dimen~icms of same structure with atterations or additions: Front ................. Rear .............. Depth ].o. ................... Height ...................... Number of StoNes .................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ........... Height ............... Number 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 14. Name of Owner o£pmmises .................... Address ................... Phone No ............. Name of Architect ........................... Address ................... Phone No ............. Name of Contractor ................. i ........ Address ................... Phone No ............. : IS.Is this property located within qO0 feet of a tidal wetland.* ~YES .... NO .... *If yes, $outhold Town Trustees Permit may he required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions f, property lines. Give street and block number or description according to deed, and show street names and indicate whel interior or comer lot. FO~'NG 'NSP~ ~R ~ 1. ~NDATJON . ~ REOI~n F~ ~URED CONCR~ --' -' 2. R~H. FRAMING & ~UMStNG 3. IN~TION 4 FI~ CONSTRUC~N M~I ~E ~P~l~ FOR C.O. ALL C~STRUcTION SHA~ ME~ THE R~tR~E~ OF ~ N.~ S~E ~STRU~oN & ~E~Y CODEs. NOT RESPON81~ ~ ~SIGN ~ ~NSTRU~oN ERRS8 STATE OF L E",~L YOR. K~... ~ ~/-- ° S COUNTY _OF ~ &. .%'C,'%?. /. .f",-..,-_ ':" /, ,/~/, ,/~",~/~ . . . .~. · f'~./f.~./~..~'///..~. · ~'id: . -'~..G'7.."~4! .< .~./~. · .~f'.~' .... being duly sworn, deposes and says that he is the appIic (Name of individual signing contract) above named. He is the ...................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file application; that all statements contained in this application are true to the best of his knowledge and belief; anti that Work will be performed in the m~ner set forth in the application filed therewith. Sworn to before me this ............% ,...q.: ..... d=y or, .cc, qp.4 . r ........ Nota~ Public ...............:5..( ~. County . ' (Signature of applicr