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Home My WebLink About23576-z II~O~M NO. · TCFW'N OF $OUTHOLD IUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. RUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / N.° 23576 Z Date ~./. ....... ./.~ .................................... , ,~.f.~. Permission is he~y~i~~~,,,,,~.~ ~eby g~ ted . . · ' ~-~' ..~.~..,47....~.....?;/.~...., ................................... ..........~~>:..:.:,.,..~:..~:- ..... ,/.~-~- . ,o~/~~. .... ~ ....... ~~,~....?~..~...~~.~ ,~ . ....ff~._~~~ ................................................. ~un~ Tax Map No. 1000 Section ..... ~ ..... Dl~k ~ Lot No. ~/ pumuant to application dat~ .... ~ .................................... 19.~, and app~ by ~e / Building Insp~tor. ~. s..~~.. Rev. 6130180 ~.[ yes, $oq,chol~! To~n ir ~lee~ Perml~ may i~e req~tLred.d¥" ~(~ ;?.'~',]~'~ ~d..,' · " PLOT DIAGRAM .~,,~ ~'~L ,.~*~.* ~U~' ' t" ].~.~le clen~ly m~] distinctly nil 'lmilding~, whefl~er existing or proposed, ~nd. indlc~te all set-back dimensions from prnlmrfy line~. (,'ge slrccl ~ml him k mlnll)et oz descliplioll according to deed. ami SJlOW stgeet nanles and indicate whether x ................................................ bein§ dtfly sworn, deposes m~d says thltt lie is the applicant (N~me of mdivtd~ ~1 sJgnJlJlJ Collll~cl) , ' (Contraclor. agent, cor'porat~ officer, lie,) ' ' ' ~ · .f ~ald owner Ot ow~e~s, ami Je duly authorized to petfomt or ITave performed the,said work attd t~ ma~e and file Iq~llcaliml; thal all statements con/~ined J~l lhls applicalim~ a~e lrtle to the ~est ofbts knowledge an~ belief; and tirol Ihe ,,ink ~ill bb'~e~nfled In lite manner s~t fo[lb Itt Ibc application flied therewith. ,woril to I)erore Ille IJlJs · ' .d~y of ................ ~ ,., lc),,, hll:Jlg I'uhlic, , ................................ (!Ollllly (Signalure of applicanl) FORM NO. I .. "': ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT .......... TOWN HALL ............. SOUTttOLD, N.Y. 11971 Examiued .......... 19 /', Approved i.y,t'~. ......... 1~... 'e;mit No..,~:.~.~-'~. l)isap ,roved a/c APPLICATION FOB BUILDING PERMIT BOARD OF IIEALTII 3 SETS OF PLANS CIIECK ......... ~ ....... SEPTIC FORtl CALL t ......... FLAIL TO; Date ..~] .~.~.f ........... 19: INSTRUCTIONS a. This application must be completely filled in by typewriter or ii1 ink and submitted to the Building Inspector, wit sets of plans, accurate plot plan to scale. Fee according to s~hedule. 6. Plot plan showing location of lot and of buildhlgs on premisgs, relationship to adjoining premises or public sti-~ or areas, and giving a detailed description of layout of property must be drawn on tile diagram which is part of this ap cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tile Building Inspector will issued a Building Permit to tile applicant. Such per shall be kept on the premises available for inspection througllout tile work. . ' e. No building shall be occupied or used itt whole or iu part for any purpose whatever.until a Certificate' of Occupai stxalt bare been granted by tile l~uilding Inspector. APPLICATION IS IIEP, EBY MADE to tile Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of tbe Town of Soutb01d, Suffolk County, New York, and other applicable Laws, Ordinance: P, egulations, for tile construction of buildiugs, additions or alteratious, or for removal or demolition, as herein describ The applicant a~rees to comply with all applicable laws, ordinances, buil~lg code, housing code, and regulations, and admit autl,orized inspectors on premises aud in buildiug for necessary ins~'tious. /r [ ! . - ('gignature of apiglica/it, or name, if a corporation) . (Mailing address of a~-plicant) State .~mther applicant is owner, lessee, agent, architfi}ct, engineer,dgeneral contractor, electrician, p!umber or build .... ..... ,.., ....................... (as on the tax roll or latest deed) { lCpplicant~s ] corporatiou, signa~s.fe of duly authorized officer. k...~ame and title of corporate officer) Builder's License No .......................... Plmnber's License No ..... ' .................... Electrician's License No ....................... llouse Number . Street oD"),{:~'~ ;,.~,, ~ ,I ~ . llamlet ~omtty Tax Mai, No. 1000 Section .... t~:.Z..~ tBlock..' ....... .... i... Lot ..... /~ ....... Subdivision ........ .. ~ ...................... . ..... Filed Map No. . .' ............ Lot .............. ~, (Name) State existing use and occupancy of premises trod intended use and occupancy of proposed construCtion: ,. .............. 3. Nature of work (check which applicable): New Building . '. ....... ~ .4.dditlon .......... Alteratio~ _:_.-. Repair .............. Removal .............. Demolition ..... : .......... Other Work. (Descrit:ftlonl 4. Estimated Cost... : .'W' ..... Fee ........................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ............... Nurilber of dwelling units on each floor .............. · If garage, nmnber of cars .............................................. , ...................... .. 6. ir business, commercial or mixed occupancy, specify natnre and extent of,each, type of use ............... ~... 7 Di ~sions f isting tructa if F Rea D pth · mci o ex s res, any: ront ............... r ............... e ............. 1 leight ............... Nmn bet of Stories Dimensions of sim~e structure with alteratious or additions: Front ................. Rear ................ Depth lleigbt ' Number of Stories ' 8. Dimensions of entire new construction: Front .............. : Rear ............... Depth ............. ileight ............... Number of Stories ........................ ~ .............................. 9. Size of lot: Front .................. . Rear ...................... Depth .................... 10. Date of Purchase .................... . ....... .. Name of Former Owner .................... ~: ..... 11. Zone or use district in which premises are situated ............. , ..................................... 12. Does p~'oposed constmetion violfi}e...any zoning law, ordinance or regulation: ......................... 13. Will lot be regraded .............................. Will exl:ess fill be removed from premises: Yes N 14. Name of Owner of premises J.~.~?..~.~. Address ~.. ~ ~ Phone'No.~°.°.~.~ Name of Architect .......................... Address ................. ..., Phone No.. ~ ....... .~... 15. Is this property within 300 feet of a tidal 'wetland? *Yes..;~'.~ ~.... · *If yes, Southold Town Trustees Permit may be required.' ~ '" PLOT DIAG RA~g Locate clearly and distinctly all ~buildings, wtleth~r existing or proposed, and, indicate all set-back dimensions rrm property lines. Give street aud block number or description according to deed, and show street names and indicate whethe interior or corner lot. STATE OF NE'~O R~___., ~.]~. gs: CO~,P.ET'E FOR C O. COUNTY OF. ~:~' 1.7.0. S.S ,ML CONSTrUCTiON ~N . ~ 0~ I~l= ~ ~ '" (Name of individual signing contract) ,"~ , "=~,~ .. NOT ~ES~ONSICL~ FOR above warned. O~$~gN OR CONgTRUCTION ~RRORS lie is the ..... . ............ . ...~-~. - ' (Coutractc~, age~}, cor'porate officer, etc.) of said owner or owners, and is duly authorized to per~ or bare performed the,said work and to make and file tbi( application; that all statements contained in Ibis application, are true to the best of his knowledge and belief; and that the work will be perfomed in the manner set foTtb in the applicaiion filed therewith. Sworn to befor~ me t~_ ' ........ .... ' ...... /) .... co..,, . .