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Home My WebLink About17612-Z FOB. M NO. Jl TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ bi?BI2 Z Permission is hereby granted to: ....... ~.~. .............. ,~.~.: ........ ,,.~..~, ................. ............ vt premises located at ....... ~..~ ...................... County Tax Mop No. 1000 Section~ .... ...(~....~....~.. ..... 8lock ....... ..~...~. ....... Lot No ...... !.! ................ pursuant to opplication dated ...... ~...~.~.....~.. ............. , 19..~, and apprOved by the Building Inspector. Fee $../. J~...'...~ Rev. 6/30/80 3. Nature of work (check which applicable): New Building ..... ' ..... Addit~ .......... Alteration ......... Repair .............. Removal . ~ ........ Demolition ... ~.. ........ Other Work ...... (Description) 4. Estimated Cost ...................................... Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling 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 ........................... , .............. 'i;5- ............. Dimensions of same structure with alterations or additions: Front ......... ]ff. ..... Rear .../ ............... Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: .......................... L&'"' ' ' Will lot be regraded ............................ Will excess fill be removed from premises: Yes No Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ..................... : ..... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No .......... t~ · - 15.Is this property located within 300 feet of a tidal wetland? ~YES .... NO .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM 10. 11. 12. 14. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, APPROVED AS [tOTED FEE: /~' ~ ,BY: ~' ~' ~' N~I~ BUILDING DEPARTMENT AT 785-1~2 9 AM ~ 4 PM FOR THE NS.EC ONS. CONCR T 2. R~H - ~MI~ & ~UMBING 4. FINAL ~N$~U~N MUST eE cokIPt.eie c.o. ALL COf~TIIIJCT~ IHALL MEET COUNTY OF ................. S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracty 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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. ......... day of... ............ 19 Notary Public ...... ~.'~-...~."....~.~. ~f .a~-~. .... County ~ 4707878, SuffolkCeaatyF~ (Signature of applicant)