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Home My WebLink About18255-Z I~B,~ 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) N~ 18255 Z Building Insgector Rev. 6/30/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . .6. 7 .2 .7.'~ 8. .9 ......... 19... INSTRUCTIONS a. This 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 this appli- cation. c. 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 permil 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 uhtil a Certificate of Occupanc.x 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 m Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. appl±cant ±s attorney for owner Name of owner of premises ...... ~ ..... .M.a.r.g .r.e.t:..B.....S.e. J,..b 9.1.d. ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/A (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SU~NI~5{LK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No. N/A N/A Other Trade's License No .................... ?. ~dT~,_.~ 1. Location of land on which proposed work will be done2 .... ~9....(). ¥.o.u.n..ct.e.r.s...P.a.t.h. x..Sp.u.t..hg.l.d' ,.. ~.ey..Y..o~'k No.# / '- ounder Path So tho d House Number Street Hamlet County Tax Map No. 1000 Section ....0.6.4.: 99 ........ mock ... 9.4...0.9 ......... Lot ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Shed a. Existing use and occupancy ..................................................................... b. Intended use and occupancy Shed . .',' '~ ', ~,.~,,ai,~ ~ ;. Nature of work (check which applicable): New Building Addition ·. ~ · Alteration .......... Repair ................... Removal ,. ....... Demolition ~ ........ Other 9, or~.-~.'..~t.CC-~. ...... . (Description) I. Estimated Cost . ?.~Cto ............................... Fee~. ,.lt~.,.~..?. ...................... /tto be paid on filing this application) ;. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................ ; ............... i. If business, commercial or mixed occupancy, specify nature and eXtent of each type of use ..................... ~. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Iteight ...................... Number of Stories ...................... 1. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nmnber of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated.., a...r.e.s. ............................................ Does proposed construction violate any zoning law, ordinance or regulation: no ....................... Will lot be regraded .............. : ....d ........ Will excess fill be removed from premises: 1I"~ No Name of Owner of premises ...Pl....S.e..~.b.o.1. ....... Address. ?.qu..n.d.e.r.s...V.a.t.h... Phone No... 7.6.5.71..~i1.0.... Name of Architect ........................... Address ................... Phone No ................ Nmne of Contractor .......................... Address .... : .............. Phone No ................ ~. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether See attached Survey 'ATE OF NEWYORK,.! o ~ )u v s.s ~ ( .... .~..: /'f'2Wl~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ,'it;.) said owner or ownem, ~d is duly authored to perfo~ or have perfomed the said work and to m~e ~d file t~s plication; that all statements cont~ned ~ this application are true to the best of his knowledge and belief; and that the ~rk will be perfo~ed in the m~ner set forth in the application filed therewith.' /om to before me this tary. lc, . ....... ..~! L .......... County "-ZL[I!l~ll& ~ ~I~ / / (Signature of applican )