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Home My WebLink About17858-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) N~ 017858 Z Permission is hereby g_ra~_nj~l to: .~ -- ...... ~..~z2......~.,,_-_~.......~.z~. ..................... -- ......~~~:~...-...~......,.~..~..-...~ ~, ,~ .... ~ ................................ ;.~..- ............................................ .~ ......... ., ................................... et premises located at ....,~.,..~.. .......... .~,.~,,~t~ ...... ~......~..,~. .................................. ...................................................... ...................................................... County Tax Map No. 1000 Section .././....~.... ......... Block ......... ?....-~... ..... Lot No ........ ./....~...'..../... pursuant to application dated ..... ~...~-./.. ................................. , 19.~..~.., and approved by the Building Inspector. Fe. $..../..~. Rev. 6/30/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ~ CHECK ...................... SEPTIC FORM ...; ............ TEL.: 765-1802 CALL ........ ~. .......... ....... Disa proved a/c ............. - "" " ........................ .............................. ........ ~ ~ '~ ~'/ · BLDG. DEPE INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter 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 layout of property must be drawn on the diagram which is part of tiffs appLi- cation. ¢. The work covered by tiffs 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 throug~hout 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 Btfilding 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 constructic~l~l~t~t~81Mllli~ons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply'Wi't~-arl~a~i~'a'T0re'Taws, ordinances, building code, housing code, a3nd regulations, and to admit authorized inspect~~M · · - ~'~ .. ..... State whether applican~ ~J~l~~engineer,- ~---- - general contractor, electrician, plumber or builder. ........................ ............. ................................ Name of owner Of prem~~'L''' on~ .~ . . . ?~,.' . .t~..the tax roll or latest deed) ....................... If applicant is a corporai (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No.. 2/D. ~...r.r.r.r.r.r.r.r.e~. · .5 ~~ I. Location ofland on which proposed work will be done ................ ~ ................................. ........ ./~,.,:.,:.....'~.<q:.>te.~.~...~.Yi~.~ ........ ~..~.:.r/r.<</.< ..................... ttouse Number Street, Hamlet County Tax Map No. 1000 Section ! I ~.. Block I ~ Lot [ol,, J Subdivision ..................................... Eiled 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 .......... ~ ~/~ ~ ........................... ...... .. b. Intended use and occupancy .................................................................... 3. Nature of work (check xvhich applicable): New Building ' Addition .......... Alteration Repair .............. Removal .............. Demolition ...'~ ......... Othcr Work .............. (Description) 4. Estimate'dCost ....... ...{ 5...~.'. .... ............... . .... 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 ,2._ z~ Height ............... Number of Stories ........................ l~;ir' i ' ' ~, ............ Dimensions of same structure with alterations or additions: Front . 2~ i ii Depth ...................... tleight .. .................... Number of Stories. ~ .................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Nme of Contractor .......................... Address ................... Phone No .......... . 15.15 this property located withinqO0 feet of a tidal wetland.* *YES .... NO .... *If yes Southold To}tn Trustees Permit may be required. · PLOT DIAGRAM 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. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (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 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 ............ 4./. ....... day of ............. 19 ~.~. ........ Coonty HELEN IL DE VDE NOTRR~ PUBL~ State 6~ Ne~q yet. No, 4707878. Suffolk County T~m f&pires M~lch ~0, 19--.~--/ (Signature of applic~t)