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Home My WebLink About18509-z FO~M NO, · TOWN OF SOUTHOLD 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~ 18509 Z Permission is hereby granted to: , C~ ~ · · '"~'"'~. ~...~...o.~~.. ..... .~.~...~.......~.:~...,.. J...~..~.2.t-- ....... pursuont to opplicotion doted ...... ."~.~,~,.....~.J. ....... 19..,<~.~., ond opp~ by the Building Inspector. ~ .................. ~~~;~.-. = ................ Rev. 6/30/80 FOSh~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ........... 3 SETS OF PLANS ........... SURVEY .................... CHECK ..................... SEPTIC FORM ............... NOTIFY CALL .................... MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date...%. I.) ........... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildLrtgs on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app 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 pcn~ 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 agy purpose whatever until a Certificate of Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of' buildings, additions or alterations, or for removal or demolition, as herein describe. The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and i admit authorized inspectors on premises and in building for necessary inspections. "P r'~.O~ ,2 v'r:. 1.%.'. ~ ~..>,,r.--.. ,~.,v>~ ~ ..... (Sionature-di applicant, or name)if a corporanon) (MaRing address of applicant) ~ I ~ ~ f State ~vhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ............. 3 .o.L ~ ..... .~..'~.~FT~o ~ ............................... (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~'~' ./~. y 1.~ iX~..1..~T Plumber's License No ......................... OtherTrade's License No. ~ · L~;' :~; - , ,-' ~. Locafion o~land on which proposed work will be done. ' , ......... Ilouse Number Street Hamlet Subdivision ..................................... Eilcd Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~e~'' '~'~ ~ .............................................. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... /dtcr~k°n ..... Repair ........ R.3movai ......... Demolitio'n ......... Other ~Vork r2~..? 4. EstimatddCost ~9~D.~,0 0 .... Fee (to be paid on filing this application) $. If dwelling, number of dweJ[ing units ............... 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, if any: Front ............... Rear . .. ............ Depth ........... Height ............... Number of Stories .................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .............. Depth ...................... HeiSt ...................... Number of Stohes .................. 8. Dimensions of entir~ new construction: Front ............... Rear ............... Depth ........... Height ............... Number of Stohes .............. ; ..................................... 9. Size of lot: Front ...................... Rear ...................... Depth .................. 10. Date of Purchase ............................. Name of Fo~er Owner ......................... I 1. Zone or use district in which premises are situated .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... N ~ ..................... 13. W~I lot be regraded ............................ Will excess fill be removed from premises: 14. N~e of Owner of premises 2.~[~ ~~... Address~.~ ~q~r~.~ Phone No,~ Nme of Architect ........................... Address ...... ~.~ [4... Phone No ............. N~e of Contractor ................. 2 ........ Address ................... Phone No ............ 15.Is this property located within~00 feet of a tidal wetland? ~YES .... NO~. *If yes, Sou?hold Town Trustees Permit may be required. PLOT DIAG ~M Locate clc~ly ~d dis~ctly ~I buHd~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions prope~y ~nes. Give street ~d block number or desc~ption accord~g to deed, ~d show street nmos and ~dicate whet in?char or corner lot. 2. ROgGU ' FRAMING ~ pLUM~ING c,e ..... ' · 'A~' ~U~')~ .~. ~. -N.Y .................. being duly swam, deposes ~d says that he is the applic: He is~ ~ ~." :'7.n ........................................................................ (Contractor, agent, corporate officer, ere.) of said owner or owners, md is duly authoriz~ to perform or have perfo~ed the said work and to m~e and file application; tha~ aH statements contained in this application are work w~l be performed in the m~ner set forth in the application filed therewith. Swam to before mc this ............. .......... ..... ......... ~A~ PU6tlC, ~te of Hew ~ (Signature of applic~ No, 4707878 Term ~p t~ ~rch ~0,