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Home My WebLink About17909-Z lrOB~ NO. ~ TOWN 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 017909 Z Permission is hereby ....... ............ /~8~ ~..,....~.~~/.....~. ..... ....... ~,.:~.~ .... -- /:.,,? ..~?'...~.......~..:...~..~ .......... ./. ./. ~:~- ~. ...... ....... Counb/ Tax Map No. 1000 Section ....... ,~.,?:....~,. ..... Block ...... ~ ............ Lot No ..... ./...~.. ........... pursuant to ~pplic~tion doted .... .~ ...................................... , 19.~..., ond oppro¥c~l by the Building Inspector. Rev. 6/30/80 [~ Town OF'SOUl~OLO j Approved .~.~/..~..~. ........ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... ................................ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL ..................... MAIL TO: Date ......... INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter orin ink and submitted to thc 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 par~ of this appli- cation. e. The work covered by this 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 ~hall 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 Reo. ulations, for the £fll~l,~iv~i~ings, ad~ditions or alterations, or for removal or demolition, as herein described. Th~ applicant agreesq~n'~l~'~v~'all applicable laws ordinances building code housing code, and regulations, and to admit authorized mspecto~ll ~ll~-a~l i~ building for necessary xnspecUons. (S~gnature ot applicant,.,gr name, ~f a corporauon) ........... :. (MailiWg address of applicant) State whether'l~ll~[~li~ e,, .agenl, architect, engineer, general contractor, electrician, plumber or builder. .0 ~ ~()':~'Ji' 1' 'li'~ ................................................................ Name of o~vner~e~. ~M.~O/~ ...................................... ~ ~ ~ (as on the tax roll or latest deed) Ir applicant is a ~o~re ~auiy authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on wlffch proposed work will be done ....... ' ......... ~ ................................. ...... k~ c).o ..... ~z.' ~. ;-.~ :.a. .... ,5: 7:. ~ ~'¢.~. .................... zr.~.'F.T:.:. ~.< >A .................... House Number Street, Hamlet County Tax Map No. 1000 Section ....... /.~.~ ..... 2 Block ....... ~. O. ....... Lot' ..../.~;. ............ Subdivision ..................................... Filed 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 ........... · -~./2./-~-/-zLxt~ ff4.. ............................................. b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... ~n . [ ........ Alteration ......... Repair .............. Removal .............. Demolition ........ .~-~... Other Work .............. ~ ¥ ' (Description) 4. Estimated Cost .................... ~ ................................. (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 eac~ type o[ use .................... 7. Dimensions of existing st~ctures, if any: Front ..... .~.~ ....... Rear ...... ~ ~ ...... De~th .. ~ ~ ~ ....... Helg~t ...... .~] ...... Number of Stories ...... J ................................................ Dimensions ofzame st~cture with alterations or additions: Front ................. Rear ................. Depth ...................... HeiSt ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .............. : ......................................... 9. Size of lot: Front ...................... Rear ...................... De~th ...................... 10. Date of Purchase ............................. Name of Foyer Owner ............................. 1 1. Zone or use district in w~ich premises are situated ..................................................... 12. Does proposed constmclion v~olate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Ye~ 14. Nme of Owner of premises .................... Address ................... Phone No ................ Nme of Architect ........................... Address ................... Phone No ................ 15.Is this property located within$OO feet of a tidal wetland? ~YHS .... *If yes, Sou[hold Town Trustees Permit ~ay be required. PLOT DIAG~M Locate cle~ly ~d dist~ctly fll bu~d~gs, whether existing or proposed, ~d, indicate fll set-back d~ensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, ~d show street n~es and ~dicate whethe interior or comer lot. · 8. STATE OF NEW YORK, COUNTY OF .......... .... ... S.S ................................................. being duly sxvorn, 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 pc,florin or }}ave 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 knowledg~and belief; and that the Work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............ , j ., , dayo . .L ............ ..... County HtLEN ~ ~ ;~ (Signature of applic~t) No. 6707~'1~, Term Expi~