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Home My WebLink About17977-zTOWN 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) N9 017977 Z Permission ~s hereby gra,?ed, to; -- /, ( . ~/3 .~, ~t pre~,~o, ~ocotod ot ..... /...~...~.~. ..... ? .... County Tax Map No 1000 Sechon ....~747 ...... Block pursuant to apphcahon dated ...... .~/..~.~.. ........ Building Inspector. ......... ;Z. ......... Lot No... ...... , 19..~.., and approved by the Rev 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y, 11971 I ........ n~pector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ........... 3 SETS OF PLANS ........... SURVEY CHECK ..................... SEPTIC FORM NOTIFY CALL MAIL Date .................. 1.9.. INSTRUCTIONS a. This apphcahon must be completely filled in by Wpewnter or in tnk 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 braidings on premises, relationship to adjoining premises or public stree ,or areas, and giving a detmled descnptmn of layout of property must be drawn on the diagram which is parr of tins appl cat~on. c. The work covered by tins application may not be commenced before issuance of Bmlding Permit. d Upon approval of t ns app canon, the Braiding Inspector wdl msued a Bu,ldm~ Permit to the apphcant Such perm shall he kept on the premises available for mspectlon throughout t~,e~drkS. e. No bmldmg shall be occupied or used m whole or in part l~a~a .~tg-pos~wh~eve~unt~a,~,erhficate of Occupanc shall have been granted by the Budding Inspector. =, APPLICATION IS HEREBY MADE to the Building Departm~f~r~ih.g ~Astianceac~ ,:g~"~.tulth~ Permzt pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk Cou~"~j Reeulatlons, for the construction of bufldmgs, additions or alteranCTn~g or for remov"¢)~r'qle;m~ht} .c~,, .as lierem descnbm Th~ applicant agrees to comply with all apphcab]e laws, ordlnanc%s~b.i)ff~l~g'code, ~o" ~Smg'g[b;{t~'~,.qnd regulations, and t, admit authorized inspectors on premises and m bmldmg for necess~tryaIr~vt~ctlons... .... ~ ~a.~ .,._ . '~' .~ ....... '".~i ............... · (~lgrkattlre~ot apphc~,nt, or ~.a~e, ifa corporanon) ' ~ (Mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, p[umber or builder ....... .......................................................................... (as on the tax roll or latest deed) [f appttcant is a corporation, signature of duly autkonzed officer. (Name and title of corporate officer) Builder's License No. . . .~.. ~-"~ Plumber's LlcenseNo ....................... Electrician's Llcense No .................... Other Trade's License No ..................... I. Location of land on which proposed work wdI be done ............................................. House Number Street Hamlet 7 /? 7/9 County Tax Map No 1000 Sectlon .... ~ .,-. · ........ Block ............... Lot ............... Subdlv~mon ............................. Fded Map No ............ Lot .............. (Name) 2. State existing llse and occupancy of premlses and ~ntendcd usc and occupancy of proposed construction. a- ,,s,ng use and occupa,cy ...... f...r.*. X b. Intended use and occupancy .- --'~--'~ [/It ~.~.~' ...... 3. Nature of work (check ~hlch apphcabte) New Braiding ......... Addmon ........ AlteraUon -m vel . Dcm .... Rep:ur ........... P,~; o ............. olmon ........ Other Work .~q~.~.~. 4. Esumat~ Cost . .~ ...................... Fee ................................. ~ (to be pa~d on ~hng thru apphcat~on) S. If dwelling, number of d~velhng umts ............ Number of dxvelhng umts on each floor ............ If garage, number of cars ................................................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .................. 7. D~menstons of existing st~ctures, ff any. Front... ~ ........ Rear.. ............ Depth ........... Height ............... Number o[Stones ...~.~ ......................................... D~menslons of same structure with alterations or additions' Front ........ Rear Depth ...................... He~t ................... Number of Stones. 8. D~mens~ons of entire new const~ctton Front ............ Rear ............. Depth ............ Hmght .............. Number of Stones . 9. Sizeoflot Front ..................... Rear ................... Dc~rh ................. ~.. 10. Date orPurchase ~ ~t Name or ro~er Owner 1 1. Zone or use d~stnct m w~ci~ premises are s~tuated . .~ ...................................... 12. Does proposed construction v~olate any ~onmg law, ordinance or regulation: ~ ~ 13. Wdl lot be regraded ../~.O .... . ............... ;. ~. ~Y~ll excess fill~e removed fr~.¢~lmses: Yes t 4. N~e of Owner of prem,ses ~,~/~/a/~/q~.~ress I~V..~q~/(~. qq~e No. N~e of Architect .......................... Address ................... Phon~ No ............. N~e of Contractor ...~.~ ............. Address ................... Phone No ............. 15.Is th~s property located ~ithln$OO feet of a t~dal ~atland? ~Y~S ~If yes, Southold To~n Trustees Permit may be required. PLOT DIAG~M Locate cle~ly ~d &stmctly ~I buddings, whether ex,sting or proposed, ~d. ind~cate ~1 set-back d~ensmns ftc prope~y gnes. Gxve street ~d block number or description according to deed, ~d show street n~es and indicate wheth interior or STATE OF NEW YORK, S.$ COUNTY OF .............. .......................................... being duly sworn, deposes :md says that he is the apphca (Name of individual signing contract) above named lie 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 ti application, that all statements contained in this application are true to the best of lus knowledge and behef; and that t Work will be performed m the re:tuner set forth in tim application filed therewith Sworn to be/ore me this ............... ...... .......... Notaz3, Public NOTARY PUBLIC, State Term Exg~res M~fch ($~o~ature of applica~