The URL can be used to link to this page

Home My WebLink About17573-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) No- L)175-/3 Z Dote. /~,/ Permission is hereby granted to:~. '~ .~ ...~..~ ......... ~.......~z.~ ..... .......... ~'./....,,~.,..~..~........./~z~ ~ County Tax Map No. 1000 Section .... /Z~ ..... Bilk ........ ~ ...... Lot No .......... ~.~:.Z. pursuant to application doted~..~.~, ...... , .......................... , 19~ and approv~ by the Building Inspecter. ~' /~ ~ .... ....... Rev. 6/30/80 Examined ......... , 19 FORM 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 ................ Disapproved a/c ...... y .............................. ..............." ;'/' .......................... ...Y.:' '". % (Budd~g Insp~or) APPLICATION FOR BUILDING PERMIT NOTIFY CALL .......... MAlL Date ........... INSTRUCTIONS a. Tlfis application must be c0mpletety filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 l&yout of property must be drawn on the diagram which is part of th/s appli- cation. ¢. The work covered by ti'ds 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, ad~ditions or alterations, or for ~:emoval or demolition, as hereLn described. The applicant agrees tc~[l~[~licable taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on p!emises and in.~j~ing for necessary' insn4ctions · ~'--~ ~~ ~t~!lf):tql~t~ ' ~'~Oi~W~4 .! (Mailing address of applicant) whether a~~e?~,~rtft~arShitect, engineer, general contractor, electrician, plumber or builder. State ~7~ ~ ~ l~l'~JSt~)~ ~': "~" (as on the tax roll or latest deed) if applicant is a ~l~n ,~j)~ytr~l}; a ,~t h oriz e d o f fic e r. ~/~l ~31~¥g~O~.- ~, .......,.. (Name and title of co~orate officer) / Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work ,viii be done.. Iff..~.~'~.~.. ~-.~.-~..~....~..~.~....~...,.{..~. .............. ......................................................... .~....~...~?.-..~., .~..~. .... ~.%: ...... }louse Number Street\ ~ · Hamlet County Tax Map No. 1000 Section /./.4 ....... " ....... m?c~ .... /3 ........... Lot...~./.&l... Subdivision ..................................... (Name) Eiled¥ Map No ............... Lot ...... . ........ S~ate existing use and occupancy of premises and in tended use and occupancy of proposed construction: b. Intended use and occupancy .'-~...~....~....~.~ '~ · ~ : New Building ..... ' ..... ' ' ~ ': /"~ 3. Nature of work (check whic applicable) Addition ........ Altera ion '...~ ....... Repa/r .............. Removal .............. Demolition . '' Other ~¥6rk ' ~...~-.,~'~ .c..~. ' ....... ~ ~ ~-- ~ Des~ption) 4. Estimated Cost ....[ .........................Fee ...................................... If d ' i (to be paid on fi]ing this application) 5. welhng, number ordwelling?nits .... ? ......... 7.umber of dwelling units on each floor../d . ' If garage, num her of cars ... ~ ~ .............. ,x x; ......... ~fi~s~:~ ~d ...... 6. ss, Commercial or mix occupancy, specify natt re and extent or each type of use ................. 7. ' 'OhS of existing structures, if any: Front ............... Rear ............... De ...... ' ' ' ' Height ............... Number of Stohes ....... pth ........ ' ' ..... ............................... D~menslons of same structure alterations or additions: Fro .... Depth , ............. Rear . ................... '... Ilei~t ...... ' ............. ' ~ ................ Num bet of Stohes ..... 8. Dimensions of entire new cons ruction: Front ......... Rear ............... Depth ...... j j . .. Nulnber of Sto~es Height ............. . ....~. ~. 9. Size of lot: Front ........ . , . o, · ., ............ ....... 2 ............................. ..... , ...... ;' "' ..... , ................... Name o ~dr'Owne ( ....... 1 1. Zone or use district in which p~emises are situated ..................................... 1 2. Does proposed construction vi~late any zoning law ordinance or reou ation' ~ ............... 13. Will lot be regraded ...~R..: ..... o "' r .............................. ' ' ~' ','~ .... ,, · · ~. ..... wm excess fill be removed from r . Yes 14. Nme of Owner of premises~J./~(~ ~6~ ......... p cruises. ........... · ~. ~maress .... ¢~C~ ........ Phone No. Nme of Architect .~ ....... ~ ................. Address , . Nme of Contractor ~ g.~ ~d~ r~ ., , · ................ Phone No ............... 1 5. ' ' ' ~ · · -,..~..~ .... aaaress ................... Phone No ..... ~ .... j.. Is th~s property located ~ithin~O0 feet of a tidal wetlandt *Y~S ...... · If yes, Southold Iow~ trustees Permit may be required. ... ~ PLOT DIAG~M Locate cle~ly ~d dist~ctly ~I~ build~gs, whether existing or proposed ~d, indica - ~ropeny ~nes. Gwe street ~d block!number or descfi-*; ....... ~: ..... , , , te ~1 set back d~ensmns from mte~or or COmer lot ~ v,.~,, a~u~umg [o aeea, ~a snow street nines and ~dicate whether STATE OF NEW YORK, COUNTY OF ......... SiS 3, INSULATION 4. FINAL BE CONgTRUCllON COMI~LEr~ FOIl ALL ..... ~ ............... being duly sxvorn, deposes and says that he is the applicant (Name ofiodividual signin contract) above named. , (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly imthorized to perform or have performed tile said work and to make and file this ~pplication; that all statements containled in this application are true to the best of his knowledge and belief; and that the .york will be performed in the manner sbt forth in tile application filed therewith ;worn to before me this I · ................. day of..]. ~..e--r~7.. ~'otary Public, ~e County HELEN K. DEVOE j NOTARY PUBLIC, State of New Ye~k No. 4707878, Suffelk C~uflty~ Term Expires Nl&rch (Signature of applicant)